IMMUNIZATIONS, PART I Janine Clark Adjo, M.D.
2010 IMMUNIZATION SCHEDULE
DTaP (IM) • Diptheria and Tetanus components are bacterial toxoids (modified bacterial toxin that has been made nontoxic but retains ability to stimulate antibody production) • Acellular pertusis- inactivated acellular bacterial components
DTaP • DTaP- for use in children <7 • DT- for use in children <7, in whom pertussis vaccine is contraindicated • Dt- Tetanus toxoid, with 1/3- 1/6 the dose of diptheria toxoid, for use >7 • DTP- whole cell pertussis no longer marketed in US
DTaPINDICATIONS • Routine schedule- 2 mths, 4mths, 6mth, 15-18 mths, followed by Tdap at 11/12 years and then every 10 years • Unimmunized pregnant women • Tetanus prophylaxis, wound management
DTaPTrue Contraindications • Anaphylaxis to vaccine or constituent of vaccine • Encephalopathy within 7 days of receiving vaccine, then use DT for remaining doses
DTaPPRECAUTIONS • Moderate or severe illness regardless of fever • Seizure within 3 days of administration • Persistent crying within 48 hours of prior dose • Collapse or hypotonic/hyporesponsive episode within 48 hours of prior dose • Neurologic disorders
DTaPSIDE EFFECTS • Erythema, swelling, pain, fever, irritability • Anaphylaxis • Seizure • Hyporesponsive/hypotonic episode • Persistent crying • Fever >105
DTaPDifferent Formularies • Daptacel- Sanofi Pasteur • Tripedia- Sanofi Pasteur • Infanrix- GlaxoSmithKline • DT- Sanofi Pasteur • Td- Decavac- Sanofi Pasteur • Adacel/Boostrix- Tdap- Sanofi Pasteur/GSK
DTaPDifferent formularies • TriHIBit- Sanofi Pasteur • Pediarix- GSK • Pentacel- Sanofi Pasteur • Kinrix- GSK
Haemophilus Influenza Type BHib (IM) • Conjugate vaccine of Hib capsular polysaccharide antigen and a carrier protein to enhance immunogenicity • Two types 1) PRP+CRM- given at 2,4,6, and 12-15 months 2) PRP+OMP- given at 2, 4 , 12-15 months
HiB • Routine vaccination has led to a 99% decrease in invasive Hib disease • Schedule for unimmunized children 1)7-11 months: 3 doses, 2 months apart 2)12-14 months: 2 doses 2 months apart 3)15-59 months: 1 dose 4) >5 does not require immunization
HiBSide Effects/Contraindications • Local pain, erythema, swelling, fever, irritability • Anaphylaxis
HiBDifferent Formularies • HiB, HbOC, conjugate, 4 dose- Hib titer, Wyeth • HiB, PRP-OMP, conjugate, 3 dose- pedvaxHiB, Merck • HiB, PRPT, conjugate, 4 dose, ActHiB, Sanofi Pasteur • DTaP-HiB, TriHiBit, Sanofi Pasteur • Hep B/Hib- Comvax, Merck
Hepatitis B (IM) • Inactivated viral antigen • Required for middle school entry in 1998 • Routine schedule 0-2 months, 1-4 months, 6-18 months • Dose 3 cannot be given prior to 6 months
Hepatitis BSide Effects/Contraindications • Pain at site, fever • Anaphylaxis to vaccine or Baker’s yeast
Hepatitis BDifferent Formularies • Hepatitis B, Recombivax, Merck • Hepatitis B, Energix- B, GSK • Hep B/Hib, Comvax, Merck
POLIO (SC or IM) • IPV- trivalent vaccine of inactivated polio virus types 1, 2, and 3, grown in human diploid cells • Routine schedule- 2 mths, 4 mths, 6 mths, 4-6 years
POLIOSide effects/Contraindications • Pain, swelling and erythema at site • Anaphylaxis to vaccine, polymyxin B, neomycin, or streptomycin
POLIODifferent Formularies • IPV, IPOL, Sanofi Pasteur • Pentacel, Sanofi Pasteur • Pediarix, GSK
Pneumococcal Vaccine (IM) • Prevnar 13- Pneumococcal Conjugate vaccine comprised of 13 capsular polysaccharides of Streptococcus pneumoniae • Routine schedule 2mths, 4 mths, 6mths, 12-15 mths
PrevnarSide effects/Contraindications • Pain, swelling, and erythema at site of injection • Fever, irritability, decreased appetite • Anaphylaxis to vaccine
PrevnarDifferent Formularies • Prevnar, Wyeth
Pneumococcal vaacine Different Formularies • Pneumovax (IM or SC)- pneumococcal polysaccharide vaccine, 23 valent, Merck • Ages 2 and up • Immunosuppressed patients
