Vaccine

Hepatitis B
Give IM




















DTaP (Diphtheria, tetanus, acellular pertussis) Give IM




DT
Give



Td
Give IM




MMR (Measles, mumps, rubella) Give SC












Varicella (Var) (Chickenpox) Give SC
Ages usually given and other guidelines

• Vaccinate all children 0 through 18yrs of age.
• Vaccinate all newborns with monovalent vaccine prior to hospital discharge. Give dose #2 at 1– 4m and dose #3 at 6– 18m (the last dose in the infant series should not be given earlier than age 24wks). After the first dose, the series may be completed with single- antigen vaccine or up to 3 doses of Comvax (2m, 4m, 12– 15m of age) or Pediarix (2m, 4m, 6m of age). Although not the preferred schedule, dose #1 can be given as late as age 2m of age if the mother has written documentation of HBsAg- negative status at the time of child’s birth.
• If mother is HBsAg- positive: give the newborn HBIG + dose #1 within 12hrs of birth, #2 at 1– 2m, and #3 at 6m of age.
• If mother’s HBsAg status is unknown: give the newborn dose #1 within 12hrs of birth, #2 at 1– 2m, and #3 at 6m of age. If mother is subsequently found to be HBsAg positive, give infant HBIG within 7d of birth.
• May give with all other vaccines.

• Give at 2m, 4m, 6m, 15– 18m, 4– 6yrs of age. • May give dose #1 as early as 6wks of age.
• May give #4 as early as 12m of age if 6m have elapsed since #3 and the child is unlikely to return at age 15– 18m.
• Do not give DTaP to children >7yrs of age (give Td).
• May give with all other vaccines.
• It is preferable but not mandatory to use the same DTaP product for all doses 

• Give to children <7yrs of age if child had a serious reaction to “P” in DTaP/ DTP or if parents refuse the pertussis component.
• May give with all other vaccines 

• Use Td, not tetanus toxoid (TT), for persons >7yrs of age for all indications.
• A booster dose is recommended for children 11– 12yrs of age if 5yrs have elapsed since last dose. Then boost every 10yrs.
• May give with all other vaccines.

• Give #1 at 12– 15m of age. Give #2 at 4– 6yrs of age.
• Make sure that all children and teens over 4– 6yrs of age have received both doses of MMR. • If a dose was given before 12m of age, it doesn’t count as the first dose, so give #1 at 12– 15m of age with a minimum interval of 4wks between the invalid dose and dose #1.
• May give with all other vaccines.
• If MMR and Var (and/ or yellow fever vaccine) are not given on the same day, space them >28d apart.
• 2 doses of MMR are recommended for all children <18yrs of age.
• Do not withhold vaccine from children of pregnant women.


• Give at 12– 18m of age.
• Vaccinate all children >12m of age including all adolescents who have not had chickenpox.
• May use as postexposure prophylaxis if given within 3– 5d.
• May give with all other vaccines.
• If Var and MMR (and/ or yellow fever vaccine) are not given on the same day, space them >28d apart.
• Do not withhold vaccine from children of pregnant women.
If child falls behind

• Do not restart series, no matter how long since previous dose. • 3- dose series can be started at any age. • Minimum spacing for children and teens: 4wks between #1 & #2, and 8wks between #2 & #3. Overall there must be >16wks between #1 & #3 (e. g., 0-, 2-, 4m; 0-, 1-, 4m). 













• #2 & #3 may be given 4wks after previous dose. • #4 may be given 6m after #3. • If #4 is given before 4th birthday, wait at least 6m for #5 (4– 6yrs of age). • If #4 is given after 4th birthday, #5 is not needed.






• For unvaccinated patients: give dose #1 now, give 2nd dose 4wks later, give 3rd dose 6m after #2, then give booster every 10yrs.

• Dose should be given whenever it is noted that a child is behind. Exception: If MMR and Var (and/ or yellow fever vaccine) are not given on the same day, space them >28d apart. • Dose #2 can be given at any time if at least 28d have elapsed since dose #1 and both doses are admin- istered after 1yr of age.






• Do not give to children <12m of age. • Susceptible children <13yrs of age should receive 1 dose. • Susceptible persons >13yrs of age should receive 2 doses 4– 8wks apart.
     
Precautions & contraindications

Special Notes on Hepatitis B Vaccine Dosing of hepatitis B vaccines: Vaccine brands are interchangeable for 3- dose schedules. For persons 0 through 19yrs of age, give 0.5 mL of either Engerix- B or Recombivax HB. Alternative dosing schedule for unvaccinated adolescents age 11 through 15yrs: Give 2 doses Recombivax HB 1.0mL (adult formulation) spaced 4– 6m apart. (Engerix- B is not licensed for a 2- dose schedule.) For premature infants: Consult 2003 AAP Red Book (p. 66– 68) as hep B vaccination recom- mendations for premies may differ from routine infant schedule.








Contraindication for DTaP only: Previous encephalopathy within 7d after DTP/ DTaP.
Precautions for DTaP: The following are precautions, not contraindications. When these conditions are present, the individual child’s disease risk should be carefully assessed. In situations when the benefit outweighs the risk (e. g., community pertussis outbreak), vaccination should be considered. • Temperature >105° F (40.5° C) within 48hrs after previous dose. • Continuous crying lasting >3hrs within 48hrs after previous dose. • Previous convulsion within 3d after immunization. • Pale or limp episode or collapse within 48hrs after previous dose. • Unstable progressive neurologic problem (defer until stable).




• Pregnancy or possibility of pregnancy within 4 weeks. • If blood, plasma, and/ or immune globulin were given in past 11m, see ACIP statement General Recommendations on Immunization †regarding time to wait before vaccinating. • HIV is NOT a contraindication unless severely immunocompromised. • Immunocompromised persons (e. g., because of cancer, leukemia, lymphoma). Note: For patients on high- dose immunosuppressive therapy, consult ACIP recommendations †regarding delay time. Note: MMR is not contraindicated if a PPD test was recently applied. If PPD and MMR not given on same day, delay PPD for 4– 6wks after MMR.

• Pregnancy or possibility of pregnancy within 4 weeks.
• If blood, plasma, and/ or immune globulin (IG or VZIG) were given in past 11m, see ACIP statement General Recommendations on Immunization †regarding time to wait before vaccinating. • Persons immunocompromised because of high doses of systemic steroids, cancer, leukemia, lymphoma, or immunodeficiency. Note: For patients with humoral immunodeficiency, HIV infection, or leukemia, or for patients on high doses of systemic steroids, see ACIP recommendations.
• For children taking salicylates, see ACIP recommendations.
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Summery of Rules for childhood and Adolescent Immunization
(Continues)
Polio
Hib
Hepatitis A
Influenza
Pneumococcal
Meningococcal