Medscape article on immunizations

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I'm happy to say that I am sooooooooo glad my boys are older. I still do

not believe any infant/child can handle all these immunizations.....thermarisol

or not!!!

Immunization Schedule for Children and Teens Updated CME/CE

News Author: Laurie Barclay, MD

CME Author: Penny Murata, MD

January 8, 2008 — The American Academy of Pediatrics has issued an updated

immunization schedule for children and adolescents aged 0 to 18 years, as well

as a catch-up immunization schedule for those aged 4 months to 18 years who

start late or who are more than 1 month behind. The new recommendations appear

in the January issue of Pediatrics.

The schedule indicates the recommended ages for routine administration of

currently licensed childhood vaccines, as of December 1, 2007, for children aged

0 through 6 years, and for those aged 7 through 18 years. It also notes that

additional vaccines may be licensed and recommended during the year.

" Any dose not administered at the recommended age should be administered at

any subsequent visit, when indicated and feasible, " the authors from the

Committee on Infectious Diseases write. " Licensed combination vaccines may be

used whenever any components of the combination are indicated and other

components of the vaccine are not contraindicated and if approved by the Food

and

Drug Administration for that dose of the series. Providers should consult the

respective Advisory Committee on Immunization Practices statement for detailed

recommendations, including for high risk conditions. "

If there are any clinically significant adverse events after immunization,

these should be reported to the Vaccine Adverse Event Reporting System.

For children aged 0 through 6 years, recommended ages for routine

administration of currently licensed childhood vaccines are as follows:

* Hepatitis B vaccine: At birth, give monovalent hepatitis B vaccine

to all newborns before hospital discharge. If the mother is positive for

hepatitis surface antigen (HBsAg), hepatitis B vaccine and 0.5 mL of hepatitis

B

immune globulin should be given within 12 hours of birth.

* After the birth dose, the hepatitis B vaccine series should be

completed with either monovalent hepatitis B vaccine or a combination vaccine

containing hepatitis B vaccine, with the second dose given at age 1 to 2 months

and the final dose no earlier than age 24 weeks.

* After completion of at least 3 doses of a licensed hepatitis B

vaccine series, at ages 9 to 18 months (typically at the next well-child

visit),

infants born to mothers who are positive for HBsAg should be tested for HBsAg

and antibody to HBsAg. When combination vaccines are given after the birth

dose, 4 doses of hepatitis B vaccine may be given. The 4-month dose is not

needed if monovalent hepatitis B vaccine is used for doses after the birth

dose.

* Rotavirus vaccine: The first dose should be given at ages 6 to 12

weeks, and the final dose in the series by age 32 weeks, because data on safety

and efficacy outside of these age ranges are insufficient.

* Diphtheria and tetanus toxoids and acellular pertussis vaccine

(DTaP): Minimum age for administration is 6 weeks, and the fourth dose may be

given as early as age 12 months, but not sooner than 6 months since the third

dose. The final dose in the series is given at ages 4 to 6 years.

* Haemophilus influenzae type b conjugate vaccine: Minimum age for

administration is 6 weeks. A dose at age 6 months is not needed if H influenzae

type b Neisseria meningitidis outer-membrane complex protein conjugate

(PedvaxHIB or ComVax; Merck) is given at ages 2 and 4 months. In children aged

12

months or older, DTaP/H influenzae type b conjugate (TriHIBit; Sanofi Pasteur)

combination products should not be used for primary immunization but can be

used as boosters after any H influenzae type b conjugate vaccine.

* Pneumococcal vaccine: Minimum age for administration is 6 weeks for

pneumococcal conjugate vaccine and 2 years for pneumococcal polysaccharide

vaccine. All healthy children aged 24 to 59 months having any incomplete

schedule should receive 1 dose of pneumococcal conjugate vaccine. Children aged

2

years or older with underlying medical conditions should receive pneumococcal

polysaccharide vaccine.

* Influenza vaccine: Minimum age for administration is 6 months for

trivalent inactivated influenza vaccine and 2 years for live, attenuated

influenza vaccine. Children aged 6 to 59 months and all close contacts of

children

ages 0 to 59 months should be vaccinated every year, as should children aged

5 years or older with certain risk factors, individuals in close contact with

persons in groups at higher risk, and any child whose parents request

vaccination.

* Either live, attenuated or trivalent inactivated influenza vaccine

may be administered to healthy, nonpregnant persons, ages 2 to 49 years,

without underlying medical conditions that predispose them to influenza

complications. Children receiving trivalent inactivated influenza vaccine

should

receive 0.25 mL if they are 6 to 35 months old or 0.5 mL if they are 3 years or

older.

* Two doses, separated by 4 weeks or longer, should be given to

children younger than 9 years who are receiving influenza vaccine for the first

time

or who were vaccinated for the first time last season, but only received 1

dose.

* Measles, mumps, and rubella vaccine: Minimum age for administration

is 12 months. The second dose of this vaccine should be given at ages 4 to 6

years, but it may be given sooner, provided 4 weeks or longer have elapsed

since the first dose and both doses are administered at age 12 months or older.

* Varicella vaccine: Minimum age for administration is 12 months. The

second dose should be given at ages 4 to 6 years, but it may be administered 3

months or longer after the first dose. The second dose should not be

repeated if administered 28 days or more after the first dose.

* Hepatitis A vaccine: Hepatitis A vaccine is recommended for all

children aged 12 to 23 months, with 12 months being the minimum age for

administration. The 2 doses in the series should be given at least 6 months

apart.

Children who are not fully vaccinated by age 2 years can be vaccinated at

subsequent visits. Hepatitis A vaccine is recommended for certain other groups

of

children, such as in areas where vaccination programs target older children.

* Meningococcal vaccine: Minimum age for administration is 2 years for

quadrivalent meningococcal conjugate vaccine and for quadrivalent

meningococcal polysaccharide vaccine. Although quadrivalent meningococcal

conjugate

vaccine is recommended for high-risk groups including children ages 2 to 10

years with terminal complement deficiencies or anatomic or functional asplenia,

the quadrivalent meningococcal polysaccharide conjugate vaccine may also be

used. Individuals who received quadrivalent meningococcal polysaccharide

vaccine 3 years or more previously and who are still at increased risk for

meningococcal disease should be vaccinated with the quadrivalent meningococcal

conjugate vaccine.

The schedule also gives specific recommendations for vaccinating persons 7 to

18 years of age with tetanus and diphtheria toxoids and acellular pertussis

vaccine (TdaP); human papillomavirus vaccine; meningococcal vaccine;

pneumococcal polysaccharide vaccine; influenza vaccine; hepatitis A and B

vaccines;

inactivated poliovirus vaccine; measles, mumps, and rubella vaccine; and

varicella vaccines.

A separate catch-up immunization schedule is also provided for those aged 4

months to 18 years who start late or who are more than 1 month behind. A

vaccine series does not need to be restarted, regardless of the time that has

elapsed between doses, the Committee on Infectious Diseases concludes.

Pediatrics. 2008;121:219-220.

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