Those of us born before 1971 may have a distinctive scar on our arms or legs: the coin-sized result of a smallpox vaccination. Today's children no longer need this immunization, smallpox having been eradicated from the face of the earth by 1977. Polio is also nearing eradication; the last documented case of wild poliovirus in the United States occurred in 1979. Since then, reported cases have been either vaccine-associated or imported. By 1991, polio caused by wild-type viruses had been eliminated from the Western Hemisphere. Most physicians educated since 1985 have never seen a case of measles. In fact, in 1998 measles reached a record low number of 89 cases with no measles-associated deaths; all of these cases were imported from outside the United States. Such is the power of the child immunization program.

With this level of success, why continue vaccinating children, especially since there are risks involved? Simply put, stopping vaccination short of eradication would expose children to an unacceptably high risk of serious epidemics. Except for smallpox, all the other childhood diseases still exist in other parts of the world. In an increasingly peripatetic society, these organisms could easily be imported into the United States. Discontinuation of the immunization process would result over time in a group of vulnerable individuals. The result would be a return to the previous levels of disease. In addition, there are no cases where the risk of the vaccine outweighs the risk of actual disease (this, in fact, is one of the criteria the FDA imposes before licensing a vaccine). Finally, there is the concept of "herd immunity." There are a small number of individuals who cannot be immunized (allergic reactions to vaccines, for instance). Since they are vulnerable, elimination of the disease in those around them would protect them from transmission.

The following figure is the latest recommendation for childhood immunizations, taken from the CDC Web site. This is followed by a brief discussion of the diseases themselves.

A Recommended Childhood Immunization Schedule
United States, January - December 2000

Vaccines are listed under routinely recommended ages. Bars indicate range of recommended ages for immunization. Any dose not given at the recommended age should be given as a "catch-up." Immunization at any subsequent visit when indicated and feasible. Ovals indicate vaccines to be given if previously recommended doses were missed or given earlier than the recommended minimum age.

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