KEYWORDS:
DTaP-HepB-IPV, DTaP-Hib-IPV, combination, vaccines, immunizations, schedules

BACKGROUND:
Currently, children routinely receive vaccines that protect them from 11 diseases via as many as 20 separate injections within the first two years of life. Combination vaccines protecting against 5 diseases may soon receive Food and Drug Administration licensure. Although combination vaccines are eagerly awaited because they will decrease the number of injections and simplify administration, their use will require knowledge on issues of: implementation (schedules), interchangeability, extra doses, safety, recordkeeping, supply, and finances.

OBJECTIVE:
To utilize combination vaccines, it is necessary to understand recommendations and data on interchangeability addressing efficacy and safety. Then, schedules reducing numbers of injections, simplifying office procedures, and optimizing financial management can be adopted.

METHOD:
The recommendations of the ACIP, AAP, and AAFP will be explained. Studies on vaccine interchangeability demonstrating equivalent immunogenicity and safety will be reviewed. Schedules for incorporating combination vaccines into the plan for infants who've already begun their immunizations, and for newborns, will be presented. Suggestions that streamline recordkeeping, inventory, and financial issues will be provided.

RESULT:
Combination vaccines that are and may soon be available (e.g., DTaP-HepB-IPV, DTaP-Hib-IPV) can be incorporated into the Recommended Childhood Immunization Schedule in ways that retain the efficacy and safety of previously approved individual components, significantly reducing the number of injections for full protection, and simplifying inventory, recordkeeping, registry entry, NSI's, and--perhaps--the financial management of immunizations.

CONCLUSION:
Healthcare providers responsible for planning and delivering childhood immunizations have new tools--combination vaccines--that result in progress and improvement in reducing morbidity and mortality from vaccine-preventable diseases.

LEARNING OBJECTIVES:
The audience will gain knowledge of current and future combination vaccines, and how to incoporporate them into the recommended schedule and implement their use in a beneficisal manner.