Combo 10 Immunizations for Patients Up to 24 Months Old | February 2022 | Clinical Corner

February 15, 2022

Combo 10 Immunizations for Patients Up to 24 Months Old

Historically, immunizations have been shown to be effective in reducing morbidity and mortality caused by the pathogens they are designed against. For example, the annual morbidity from smallpox in the 20th century was 29,000 deaths.  The annual morbidity in 2017 from smallpox was zero.  The annual morbidity from Rubella in the 20th century averaged about 47000.  In 2017, the annual morbidity fell to 7.  1,2,* Yet, the Michigan Department of Health and Human Services estimates that only 50% of patients are up to date on immunizations at 24 months old.3,*

The NCQA recommends the following immunizations before the age of 24 months4:

  • Measles, Mumps, and Rubella (MMR) – 1 dose
  • Chicken Pox (Varicella Zoster) – 1 dose
  • Polio (IPV) – at least 3 doses
  • Hepatitis B (HBV) – at least 3 doses
  • HiB (Haemophilus Influenzae type B) – at least 3 doses
  • Pneumococcal (Prevnar-13) – at least 4 doses
  • Hepatitis A (HAV) at least 2 doses
  • Rotavirus-at least 2 doses of 2-dose series, at least 3 doses of a 3-dose series, or at least 3 doses if a mixture is administered
  • Influenza – at least 2 doses

    To overcome immunization hesitancy:

  • Give a strong recommendation to administer immunizations as their provider
  • Personalizing the message is more effective than anecdotal information (e.g., My grandson got all these immunizations.)
  • Listen to families’ concerns and encourage questions
  • Make immunization administration routine


  1. JAMA 2007:(18): 2155-2163.
  2. CDC. National Notifiable Infectious Disease Surveillance System. 2017 Annual Tables of Infectious Disease Data.
  3. MDHHS internal data.
  4. NCQA website,

* Data presented by Terri Adams, RN, BSN, MM and Heidi Loynes, RN, BSN from MDHHS at PGIP Quarterly Meeting, September 17, 2021. 

A special thanks to Dr. Jim Brouillette, Pediatrician in Lansing, for his development of this document. For more information or questions please contact Dr. Brouillette at