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Immunization is widely recognized as one of the greatest public health achievements of modern times. Largely due to immunization, the annual incidences of diphtheria, paralytic poliomyelitis, measles, mumps, rubella, and Haemophilus influenzae type b (Hib) in the United States have fallen by more than 99% compared with the average annual incidences of these diseases in the 20th century. Invasive pneumococcal disease in children younger than 5 years has declined steeply since routine pneumococcal vaccination began in 2000. Similarly, rotavirus vaccination is associated with substantial declines in hospitalizations and emergency department visits for diarrheal illnesses in young children. Childhood immunization has also led, through herd immunity, to significant decreases in several infectious illnesses in adults, including pneumococcal, rotavirus, and varicella disease. The coronavirus 2019 (COVID-19) pandemic disrupted health care delivery and was associated with declines in routine vaccination coverage among infants, children, and adolescents; efforts to regain these coverage losses are paramount.

Every year, approximately 3.6 million children are born in the United States, and successful immunization of each birth cohort requires the concerted effort of parents, health care providers, public health officials, and vaccine manufacturers. Public perceptions about immunization, particularly routine childhood immunization, are generally positive. However, parent concerns about the safety of vaccines have risen in recent years, in part fueled by unfounded speculation about an association between various vaccines or vaccine components and autism. Modern vaccines have a high degree of safety, serious adverse events following vaccination are rare, and vaccination benefits strongly outweigh these rare risks. Nonetheless, health care providers need to be prepared to discuss the benefits and risks of vaccination with uncertain parents, providing factual information in a clear, empathic, and nonjudgmental manner.

This chapter starts with general principles regarding immunization and the recommended pediatric and adolescent vaccination schedules, followed by a discussion of vaccine safety. Each recommended vaccine is then discussed. Vaccines only given in special circumstances are discussed in the final section. Several acronyms commonly used in this and other vaccine-related publications are summarized in Table 10–1.

Table 10–1.Vaccine-related acronyms.

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