RecommendedChildhoodImmunizationSchedule—UnitedStates,2001

Each year, CDC's Advisory Committee on Immunization Practices (ACIP) reviews the recommended childhood immunization schedule to ensure that it remains current with changes in manufacturers' vaccine formulations, revisions in recommendations for the use of licensed vaccines, and recommendations for newly licensed vaccines. This report presents the recommended childhood immunization schedule for 2001 (Figure 1) and documents the changes that have occurred since the January 2000 publication.

EACH YEAR, CDC'S ADVISORY COMMITtee on Immunization Practices (ACIP) reviews the recommended childhood immunization schedule to ensure that it remains current with changes in manufacturers' vaccine formulations, revisions in recommendations for the use of licensed vaccines, and recommendations for newly licensed vaccines. This report presents the recommended childhood immunization schedule for 2001 and documents the changes that have occurred since the January 2000 publication. 4 For 2001, ACIP, the American Academy of Family Physicians, and the American Academy of Pediatrics have added pneumococcal conjugate vaccine to the schedule 2 and have extended the recommendation for the use of hepatitis A vaccine to include persons through age 18 years in selected geographic areas and in certain highrisk groups. 3 Detailed recommendations for using vaccines are available from the manufacturers' package inserts, ACIP statements on specific vaccines, and the 2000 Red Book. 5 ACIP statements for each recommended childhood vaccine can be viewed, downloaded, and printed from CDC's National Immunization Program World-Wide Web site, http://www.cdc .gov/nip/publications/ACIP-list.htm.

Pneumococcal Conjugate Vaccine
In February 2000, the Food and Drug Administration licensed a heptavalent pneumococcal polysaccharide-protein conjugate vaccine (PCV) (Prevnar™, * Wyeth Lederle Vaccines and Pediatrics, Philadelphia, Pennsylvania) for use among infants and young children. All children aged 2-23 months should receive four doses of PCV intramuscularly at ages 2, 4, 6, and 12-15 months. ACIP also recommends the vaccine for children aged 24-59 months who are at increased risk for pneumococcal disease (e.g., children with sickle cell hemoglobinopathies, human immunodeficiency virus infection, and other immunocompromising or chronic medical conditions). For these children, ACIP recommends two doses of PCV administered 2 months apart followed by one dose of a 23-valent pneumococcal polysaccharide vaccine (PPV 23) administered two or more months after the second dose of PCV. ACIP also recommends that PCV be considered for all other children aged 24-59 months, with priority given to children aged 24-35 months, American Indian/Alaska Native and black children, and children who attend child-care centers. ACIP recommends one dose of PCV for children in these groups. Additional information on the use of PCV can be found in the ACIP statement. 2

Hepatitis A Vaccination Recommendation
ACIP continues to recommend hepatitis A vaccine (Hep A) for routine use in some states and regions. For 2001, the recommendation has been extended to include adolescents through age 18 years and for persons in certain high-risk groups (i.e., persons traveling to countries where hepatitis A is moderately or highly endemic, men who have sex with men, users of injectable and noninjectable drugs, persons who have clotting-factor disorders, persons working with nonhuman primates, and persons with chronic liver disease). The hepatitis A vaccine label is shaded on the 2001 Immunization Schedule to indicate its use in selected states and regions, and for certain highrisk groups. Providers can contact their local public health authority for the current recommendations for hepatitis A vaccination in their community. Additional information on the use of Hep A can be found in the ACIP statement. 3

Vaccine Information Statements
The National Childhood Vaccine Injury Act requires that all health-care providers give to parents or patients copies of Vaccine  2 Infants born to hepatitis B surface antigen (HBsAg)-negative mothers should receive the first dose of hepatitis B vaccine (Hep B) by age 2 months. The second dose should be administered at least 1 month after the first dose. The third dose should be administered at least 4 months after the first dose and at least 2 months after the second dose, but not before age 6 months. Infants born to HBsAg-positive mothers should receive Hep B and 0.5 mL hepatitis B immune globulin (HBIG) within 12 hours of birth at separate sites. The second dose is recommended at age 1-2 months and the third dose at age 6 months. Infants born to mothers whose HBsAg status is unknown should receive Hep B within 12 hours of birth. Maternal blood should be drawn at delivery to determine the mother's HBsAg status; if the HBsAg test is positive, the infant should receive HBIG as soon as possible (no later than age 1 week). All children and adolescents (through age 18 years) who have not been immunized against hepatitis B should begin the series during any visit. Providers should make special efforts to immunize children who were born in or whose parents were born in areas of the world where hepatitis B virus infection is moderately or highly endemic. This report summarizes the findings of the review, which indicated that during July 23-August 20, 1999, 50% of suspected case-patients had undiagnosed dengue infection. Recognition of the diagnosis of dengue can be improved through heightened surveillance, professional and public education, and prompt reporting of cases by the health-care providers to local or state health departments. Medical records were reviewed for all patients who presented to one of the five facilities with fever, arthralgias, myalgias, rash, or headache during July 23-August 20. A case of dengue was suspected in a person aged Ն5 years with a temperature of Ն101°F (Ն38.3°C) and rash of any duration or fever for Ն3 days without cough or diarrhea. During August 20-October 31, blood was drawn from suspected dengue case-patients and serum samples were tested for antidengue IgG and dengue IgM antibodies at the TDH laboratory. A confirmed case of recent dengue was defined as a positive IgM test or a fourfold or greater increase in the IgG antibody titer between acuteand convalescent-phase serum samples.

Underdiagnosis of
Forty-nine suspected dengue case-patientswereidentifiedfrom494records; 24 (49%) were located and interviewed. Of these, 22 (92%) agreed to provide a serum sample. Eleven case-patients had serologic evidence of recent dengue infection; 10 (91%) of the 11 tested positive for both IgM and IgG antibodies. One case-patient was negative for IgM antibodies but had a fourfold increase in IgG antibody titers over a 3-month period. Symptoms reported by the 11 confirmed case-patients included fever (100%), arthralgias (73%), headache (64%), malaise (64%), and rash (45%). Discharge diagnoses of "viral syndrome" or "viral fever" were given to nine (82%) and "flulikeillness"weregiventotwo(18%).Nine case-patients reported a history of travel to Mexico within 2 weeks of illness onset; two had not been outside Texas.

CDC Editorial Note:
Dengue is an arboviral illness of tropical and subtropical areas commonly transmitted by Aedes aegypti mosquitoes. 2,3 Approximately 2.5 billion persons live in regions where dengue is endemic and 50-100 million infections occur annually. 2,4 Although infection may result in lifelong homotypic immunity, cross-protective immunity does not occur among the four dengue virus serotypes. Infection with any dengue serotype can be asymptomatic or can cause dengue, dengue hemorrhagic fever (DHF), or dengue shock syndrome (DSS). DHF and DSS are life-threatening conditions. 5 Since the 1970s, outbreaks of dengue, DHF, and DSS have increased in frequency and severity in the Americas and the Caribbean. 2,6 Dengue may present as an undifferentiated febrile illness and unless physicians retain a high level of suspicion, a dengue diagnosis may be missed easily in areas where the virus is not endemic. Laboratory testing is necessary for diagnostic confirmation. Acuteand convalescent-phase serum samples should be obtained for diagnosis and sent for confirmation to state or territorial health department laboratories. Serum samples should be accompanied by a summary of clinical and epidemiologic information, including onset date, sample collection date, and a travel history for the 3 weeks before illness onset.
An estimated two million crossings occur each month between Laredo and Nuevo Laredo, and Ae. aegypti is found in both cities. Movement of infected persons can introduce the virus into denguefreeareas.Travelerstoregionswheredengue is endemic should avoid exposure to mosquito bites by using repellents and protective clothing and by staying in wellscreenedorair-conditionedquarters.Residents of areas where dengue is endemic andMexico-U.S.bordercommunitiescan reduce the Ae. aegypti population in and around homes by changing water in bird baths or flower vases daily, tightly covering stored water receptacles, and eliminatingoldtires,containers,treeholes,and other potential mosquito breeding sites.
Following identification of dengue cases, the Laredo Health Department implemented mosquito reduction activities (e.g., aggressive refuse and tire disposal campaigns and insecticide fogging). Dengue alerts were sent to health-care providers, and mosquito reduction and personal protection information was distributed through health fairs and schools. Information exchange increased substantially between health officials from Laredo and Nuevo Laredo. Although no suspected cases were reported before the alerts were issued, 161 suspected dengue cases were reported during mid-August-December 1999; 18 cases tested positive for dengue. No positive cases were reported from Laredo in 2000.
When a case of dengue is confirmed in a community, the public health response should include education of health-care providers and the public, intensified surveillance, and enhanced vector-control activities. Additional information about dengue is available on the World-Wide Web, http://www.cdc.gov /ncidod/dvbid/dengue.htm.

Health-Related Quality of Life Among Persons
With Epilepsy-Texas, 1998 MMWR. 2000;50:24-35 EPILEPSY IS A CENTRAL NERVOUS SYSTEM disorder characterized by unprovoked, recurrent seizures that may affect physical, mental, or behavioral functioning. 1 In 1995, approximately 2.3 million persons residing in the United States had epilepsy. Approximately 181,000 new cases of epilepsy are diagnosed each year, with annual estimated costs of $12.5 billion in medical care and lost productivity. 2,3 Because epilepsy has a substantial impact on health (e.g., physical and psychosocial difficulties, side effects of anticonvulsant therapy, lifestyle restrictions, and perceived stigmatization), 1,4-6 self-reported physical and mental healthrelated quality of life (HRQOL) measures are useful in gauging the impact of epilepsy on persons with the disorder. Persons with chronic health disorders are at risk for impaired HRQOL. 7 Few studies have examined the HRQOL of persons with epilepsy, 5,6 and none has used a representative sample of adults residing in the United States. This report examines data from the 1998 Texas Behavioral Risk Factor Surveillance System (BRFSS) that included a question about epilepsy; findings indicate that persons with epilepsy reported substantially worse HRQOL than persons without epilepsy. Community-based interventions such as the Sepulveda Epilepsy Education Program that address medication self-management, psychosocial self-management, and other education interventions can improve the quality of life for persons with epilepsy. 8 BRFSS is an ongoing, state-based, random-digit-dialed telephone survey of the civilian, noninstitutionalized population aged Ն18 years that tracks the prevalence of key health and safetyrelated behaviors and characteristics. 9 BRFSS data are weighted to reflect the age, sex, and racial/ethnic distribution of the state's estimated population during the survey year. The standard survey used in all states includes four selfrated questions: general health status, number of days during the 30 preceding the survey when physical health was not good, number of days during the preceding 30 when mental health was not good, and number of days during the preceding 30 when activity was limited as a result of poor physical or mental health. Unhealthy days are the total number of days when physical and mental health were not good, with the total not to exceed 30 days. In 1998, Texas added an optional quality of life module to its healthy days' measures that asked respondents about the nature of their activity limitations and the number of days of pain, depression, anxiety, insufficient sleep or rest, and overall vitality during the preceding 30 days. One question was added about epilepsy.
In Texas in 1998, 52 (1.8%) (95% con-fidenceinterval=1.4-2.1)of3355respondents reported having epilepsy. These respondents did not differ in age and sex from those without epilepsy. Those with epilepsy reported substantially worse HRQOL than those without epilepsy; 18 (45.9%) respondents with epilepsy reported fair or poor health compared with 570 (18.5%) of 3290 respondents without epilepsy. * Compared with those without epilepsy, respondents with epilepsy reported 4.4 more physically unhealthy days, 5.2 more mentally unhealthy days, 6.4moreoverallunhealthydays,4.0more recent activity limitation days, 6.8 more days of pain, 5.6 more days of depression, 5.2 more days of anxiety, 3.5 more days of insufficient sleep or rest, and 3.3 fewer days of vitality in the 30 days presurvey.

CDC Editorial Note:
On the basis of HRQOL responses to the 1998 Texas BRFSS questionnaire, respondents with epilepsy had substantially worse HRQOL than respondents without epilepsy based on valid HRQOL measures. 10 These findings are comparable with the number of unhealthy days among BRFSS respondents from eight other states with ar-thritis, heart problems, diabetes, and cancer. 7 Additional study is needed to determine whether the high number of reported days with pain in persons with epilepsy is associated with seizure severity, injuries from seizures, unintended effects of anticonvulsant medications, or other factors. The high number of days with depression and anxiety suggests that this population has high levels of anxiety and low levels of life fulfillment. 1,5,6 The findings in this report are subject to at least four limitations. First, BRFSS excludes persons without telephones, in institutions (e.g., nursing homes and the military), and persons aged Ͻ18 years. Second, BRFSS may underrepresent the severely impaired because time and functional capacity are required to participate in BRFSS. Third, it is unclear whether lower levels of HRQOL in persons with epilepsy in this study are a result of the disorder or factors unrelated to epilepsy. Finally, because the sample size of respondents with epilepsy was small, comparisons by sex and racial/ ethnic subgroup were limited.
To improve the HRQOL of persons with epilepsy, the International Commission on Outcome Measurement in Epilepsy has recommended further research into the HRQOL among persons with epilepsy. 6 In addition, BRFSS and other surveillance systems can provide data on the health status, behaviors, and HRQOL of persons with epilepsy. State andlocalhealthdepartmentscancollaboratewithhealth-careproviderstodevelop and promote comprehensive and continual care among minorities, children, the elderly, and other underserved populations. Schools, worksites, and places of worship can educate the public to destigmatize epilepsy, and interventions such as the Sepulveda Epilepsy Education Program can improve medication self-management and psychosocial selfmanagement of epilepsy. 8