The ultimate goal of immunization is eradication or elimination of disease; the immediate goal is prevention of disease in people or groups. To accomplish these goals, physicians must make timely immunization, including active and passive immunoprophylaxis, a high priority in the care of infants, children, adolescents, and adults. The global eradication of smallpox in 1977, elimination of poliomyelitis disease from the Americas in 1991, elimination of ongoing measles transmission in 2000, and elimination of rubella and congenital rubella syndrome in 2004 from the United States serve as models for fulfilling the promise of disease control through immunization. These accomplishments were achieved by combining a comprehensive immunization program providing consistent, high levels of vaccine coverage with intensive surveillance and effective public health disease Control Measures. Future success in the worldwide elimination of polio, measles, rubella, and hepatitis B is possible through implementation of similar prevention strategies.

High immunization rates have reduced dramatically the incidence of diphtheria, measles, mumps, polio, rubella (congenital and acquired), tetanus, and Haemophilus influenzae type b disease (see Table 1.1) in the United States. Declines in the incidence of varicella, invasive pneumococcal disease, and hepatitis A also have occurred. Yet, because organisms that cause these diseases persist in the United States and elsewhere around the world, continued immunization efforts must be maintained and strengthened. Discoveries in immunology, molecular biology, and medical genetics have resulted in burgeoning vaccine research. Licensing of new, improved, and safer vaccines; anticipated arrival of additional combination vaccines; establishment of an adolescent immunization platform; and application of novel vaccine delivery systems promise a new era of preventive medicine. The advent of population-based postlicensure studies of new vaccines facilitates detection of rare adverse events temporally associated with immunization that were undetected during prelicensure clinical trials. Studies of the rare occurrence of intussusception after administration of the first licensed oral rhesus rotavirus vaccine confirmed the value of such surveillance systems. Physicians must regularly update their knowledge about specific vaccines, including information about their recommended use, safety, and effectiveness.

Each edition of the Red Book provides recommendations for immunization of infants, children, and adolescents. These recommendations, which are harmonized among the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians, are based on careful analysis of disease Epidemiology, the benefits and risks of immunization, and the feasibility of implementation. Whereas immunization recommendations represent the best approach to disease prevention on a population basis, in rare circumstances, individual considerations may warrant a different approach.

Table 1-1

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