Vaccine Education Center

History of Vaccine Schedule

Every year since 1995 the Centers for Disease Control and Prevention (CDC), American Academy of Pediatrics (AAP), and American Academy of Family Physicians (AAFP) has endorsed an annual childhood immunization schedule. Prior to 1995, these groups updated the immunization schedule every few years as needed. 

The first vaccines: Smallpox, diphtheria, tetanus, and pertussis

Edward Jenner invented a method to protect against smallpox in 1796. The method involved taking material from a blister of someone infected with cowpox and inoculating it into another person’s skin; this was called arm-to-arm inoculation. However by the late 1940s, scientific knowledge had developed enough, so that large-scale vaccine production was possible and disease control efforts could begin in earnest.

The next routinely recommended vaccines were developed early in the 20th century. These included vaccines that protect against pertussis (1914), diphtheria (1926), and tetanus (1938). These three vaccines were combined in 1948 and given as the DTP vaccine.

Time Frame Recommended Vaccines

By Late 1940s

Smallpox Diphtheria*
Tetanus* Pertussis*

* Given in combination as DTP

The vaccine everyone was waiting for: Polio vaccine

Parents were scared of the polio epidemics that occurred each summer; they kept their children away from swimming pools, sent them to stay with relatives in the country, and clamored for an understanding of the spread of polio. They waited for a vaccine, closely following vaccine trials and sending dimes to the White House to help the cause. When the polio vaccine was licensed in 1955, the country celebrated and Jonas Salk, its inventor, was an overnight hero.

Time Frame Recommended Vaccines

By Late 1950s

Smallpox Diphtheria*
Tetanus* Pertussis*
Polio (IPV)

* Given in combination as DTP

More vaccines followed during the 1960s: Measles, mumps, and rubella

In 1963 the measles vaccine was developed, and by the late 1960s, vaccines were also available to protect against mumps (1967) and rubella (1969). These three vaccines were combined into the MMR vaccine in 1971.

Time Frame Recommended Vaccines

By Late 1960s

Smallpox Diphtheria*
Tetanus* Pertussis*
Polio (OPV) Measles
Mumps Rubella

* Given in combination as DTP 

The 1970s: Vaccine success

During the 1970s, one less vaccine was used than during the previous decade. Because of successful eradication efforts, the smallpox vaccine was no longer recommended for use after 1971. While vaccine research continued, new vaccines were not introduced during the 1970s.

Time Frame Recommended Vaccines

By Late 1970s

Diphtheria*
Tetanus* Pertussis*
Polio (OPV) Measles**
Mumps** Rubella**

* Given in combination as DTP
** Given in combination as MMR

Vaccine Development in the 1980s: Hepatitis B and Haemophilus influenzae type b

The vaccine for Haemophilus influenzae type b was licensed in 1985 and was recommended on the schedule published in 1989. When the schedule was published again in 1994, the hepatitis B vaccine had been added. The hepatitis B vaccine was not new, as it had been licensed in 1981; however, between its licensure and 1990, the vaccine was recommended only for high-risk sub-groups of the population, such as infants of hepatitis B surface antigen-positive mothers, healthcare workers, intravenous drug users, homosexual men and people with multiple sexual partners. However, immunization of high-risk groups didn't effectively stop transmission of the hepatitis B virus. That’s because about one-third of patients with acute disease were not in identifiable risk groups. The change of recommendation to immunize all infants was the result of these failed attempts to control hepatitis B by only immunizing high-risk groups and to prevent the cases that occurred in individuals not identified as high risk (which accounted for about one-third of all cases).

Time Frame Recommended Vaccines

1985 - 1994

Diphtheria* Measles**
Tetanus* Mumps**
Pertussis* Rubella**
Polio (OPV) Hib
1994 - 1995 Diphtheria* Measles**
Tetanus* Mumps**
Pertussis* Rubella**
Polio (OPV) Hib
Hepatitis B

* Given in combination as DTP
** Given in combination as MMR

Annual Updates to the Immunization Schedule: 1995 to Present

As more vaccines became available, an annual update to the schedule was important because of changes that providers needed to know, such as detailed information about who should receive each vaccine, age(s) of receipt, number of doses, time between doses, or use of combination vaccines. New vaccines were also added. 

Important changes to the schedule since 1995 included: 

Time Frame Recommended Vaccines

2000

Diphtheria* Measles**
Tetanus* Mumps**
Pertussis* Rubella**
Polio (IPV) Hib
Hepatitis B Varicella
Hepatitis A
2005 Diphtheria* Measles**
Tetanus* Mumps**
Pertussis* Rubella**
Polio (IPV) Hib
Hepatitis B Varicella
Hepatitis A Pneumococcal
Influenza
2010 Diphtheria* Measles**
Tetanus* Mumps**
Pertussis* Rubella**
Polio (IPV) Hib
Hepatitis B Varicella
Hepatitis A Pneumococcal
Influenza Rotavirus

* Given in combination as DTaP
** Given in combination as MMR

Combination Vaccines

In the early 1950s, there were four vaccines: diphtheria, tetanus, pertussis and smallpox. Because three of these vaccines were combined into a single shot (DTP), children received five shots by the time they were 2 years old and not more than one shot at a single visit.

By the mid-1980s, there were seven vaccines: diphtheria, tetanus, pertussis, measles, mumps, rubella and polio. Because six of these vaccines were combined into two shots (DTP and MMR), and one, the polio vaccine, was given by mouth, children still received five shots by the time they were 2 years old and not more than one shot at a single visit.

Since the mid-1980s, many vaccines have been added to the schedule. Now, children could receive as many as 24 shots by 2 years of age and five shots in a single visit. The result is that the vaccine schedule has become much more complicated than it once was, and children are receiving far more shots than before (see Vaccine Safety for answers to the questions, Do vaccines weaken the immune system? and Do vaccines overwhelm the immune system?). However, help is on the way. Vaccines are again in the process of being combined in the same way that the DTaP and MMR vaccines are already combined. The following combinations of vaccines are now available:

Vaccines for Adolescents: A new generation of vaccines

Adolescents, like adults, were recommended to get tetanus boosters every 10 years; most requiring their first booster dose around age 11. Other than this, however, most adolescents did not require additional vaccines unless they missed one in childhood. By 2005, vaccines specifically recommended for adolescents were only recommended for sub-groups based on where they lived or medical conditions that they had. However, a new group of vaccines became available in the latter part of the decade. Vaccines for meningococcus and human papillomavirus (HPV) as well as expanded recommendations for influenza and pertussis now provide opportunities for adolescents to be protected as they enter their teenage years.

Time Frame Recommended Vaccines Catch-up Sub-groups

2000

Td

MMR
Hepatitis B
Varicella

Hepatitis A

2005

Td

MMR
Hepatitis B
Varicella

Hepatitis A
Pneumococcus
Influenza

2010

Tdap
HPV
Meningococcus
Influenza

MMR
Hepatitis B
Varicella
Polio

Hepatitis A
Pneumococcus

Vaccines for Adults: Increasing opportunities for health

Historically, vaccines were deemed to be “only for children.” However, vaccines for adults are becoming increasingly common and necessary. Most adults think only of the tetanus booster recommended every 10 years and even then, many adults only get the vaccine if they injure themselves. In 2006, the Tdap vaccine was licensed as an improved version of the typical tetanus booster, Td. The newer version also contains a component to protect against pertussis (whooping cough). All adults, especially those who are going to be around young infants, should get the Tdap vaccine. Adults often unwittingly pass pertussis to young infants for whom the disease can be fatal.

Influenza vaccines, available since the 1940s, are now recommended for most adults. Vaccines like MMR and chickenpox are recommended for adults who have not had the diseases, and vaccines including hepatitis A, hepatitis B, pneumococcus, and meningococcus are recommended for sub-groups of the adult population. The HPV vaccine became available in 2006 and a shingles vaccine was licensed in 2008. Both of these vaccines are specifically recommended for certain age groups within the population.

Unlike childhood vaccines, which are often required for entrance to schools, adult vaccines are not mandated. No requirements and a lack of preventive healthcare by most adults have led to low levels of vaccine use by adults.

The first formalized adult immunization schedule was published in 2002 and is updated annually.

Learn more about the vaccine schedule for adults»

Reviewed by: Paul A. Offit, MD
Date: April 2013

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.

 

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