Immunizations are an important aspect of preventive medicine in pediatrics. Diseases which had been common earlier in this century are now rare. Even the incidence of varicella (aka chicken pox) is declining with the advent of routine varicella vaccinations. Many new companies are engaged in the discovery of new vaccines and in the creation of new delivery systems for the older more established vaccines. Please use this discussion about immunization schedule and various vaccines as a source of reference and feel free to ask more specific questions to any of the Hyde Park Pediatrics providers.

Special circumstances in immunocompromised patients

Traveling abroad

Hyde Park Pediatrics recommended immunization schedule for children 

* please note that the above represents the Hyde Park Pediatrics ideal schedule, but there are multiple ways to catch children up on their immunizations if they have not rigidly adhered to the above schedule.

** for female patients only

Hepatitis B:
Hepatitis B virus causes liver problems which can be fatal. Although most infections are acquired through habits seen in teenagers and adults such as sexual contact, drug abuse, and blood handling, the use of the Hepatitis B vaccine is safe and therefore, is felt necessary at any age. Recently, children are begun on the Hepatitis B series upon discharge from the hospital. No matter when started the Hepatitis B series consists of three vaccinations given over the course of 6 months.

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Haemophilus Influenzae B vaccine (HiB):
This immunization has reduced the incidence of serious Haemophilus influenzae disease which had been seen in children in previous decades. This vaccination is not given if an individual has an allergy to thimersol or diptheria toxoid. Additionally, it is not given to individuals older than 6 years of age.

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Polio:
This immunization is available in an intramuscular killed version.  Effective January 1, 2000, only the intramuscular version of the vaccine will be used.

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DTaP (Diptheria, Tetanus, and acellular Pertussis), Td (Tetanus, diphtheria):
The DTaP immunization protects against three childhood diseases: diphtheria, tetanus, and pertussis (aka "whooping cough"). The recent version of this vaccination contains an acellular Pertussis component which has been proven to have decreased neurologic side effects. This immunization is not used in children older than age 7 years. A tetanus and diphtheria booster is given 10 years after the last DTaP vaccine, usually sometime during the teenage years.

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MMR (Mumps, Measles, and Rubella):
MMR protects against three childhood illnesses; mumps, a viral infection of some of the glands in the body, measles, a serious illness usually accompanied by a high fever, characteristic rash, conjunctivitis and cough, and rubella a mild measles-like illness that can cause birth defects if a women gets it during pregnancy. MMR immunization is a live virus vaccine and therefore should not be administered to individuals afflicted with live tuberculosis or certain blood disorders, pregnant females, or immunocompromised individuals with the exception of those afflicted with HIV. Individuals allergic to eggs or neomycin should not receive this vaccine. The vaccination should not be given with 6 weeks of a blood transfusion or immunoglobulin (IVIG) infusion. In recent studies, it was determined that 2 doses were necessary to maintain active immunity.

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Varicella (chicken pox) vaccine:
Children with chicken pox can have from mild to very severe illnesses. Complications from chicken pox include serious skin infections including necrotizing facitis (flesh eating bacteria), staph and strep skin infections, and pneumonia and encephalitis. The varicella vaccine is a live-attenuated version of the varicella zoster virus. Within one month of the vaccination, approximately 7-8% of susceptible immunized adults and children will develop a low-grade chicken pox infection. One dose of the vaccine is given to patients between age 12 months and 13 years with the preferred period being between age 12 and 18 months. If the status of varicella exposure is not known, blood can be drawn for assessment of varicella antibody titers. This vaccine cannot be used in individuals allergic to eggs or neomycin or with blood disorders, immunodeficiencies, or active tuberculosis. Pregnant individuals should not be given this vaccine either. The vaccine should not be given within 6 weeks of a blood transfusion or IVIG infusion.

Vaccination of household contacts of immunocompromised patients is prudent since the theoretical risk of exposure to such patients are outweighed by the potential benefits.

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Gardasil Vaccine:
GARDASIL is for girls and women ages 9 to 26. GARDASIL works when given before you have any contact with HPV Types 6, 11, 16, and 18. HPV stands for Human Papilloma Virus. This virus is the most common cause of genital warts. Cervical cancer is caused by certain types of HPV. When a female becomes infected with certain types of HPV and the virus doesn’t go away on its own, abnormal cells can develop in the lining of the cervix. If not discovered early and treated, these abnormal cells can become cervical precancers and then cancer. GARDASIL is the only vaccine that may help guard against diseases caused by HPV Types 16 and 18, which cause 70% of cervical cancer cases, and HPV Types 6 and 11, which cause 90% of genital warts cases.

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Influenza A vaccine:
The influenza A vaccine has been shown to be effective in increasing immunity to particular forms of Influenza virus. However, it is unable to protect against all strains of influenza since the virus is so quick at changing its appearance. Children less than 9 years receiving Influenza A vaccine for the first time need a second dose. Efficacy has not been established in children less than 6 months of age. The vaccine cannot be administered to individuals allergic to eggs or thimerosol.

The 1997 Red Book which is published by the American Academy of Pediatrics recommends Influenza immunization in the patients with the following risk factors:

**Please note that anyone can receive the flu shot if they so desire.

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Pneumococcal Congugate Vaccine (PCV7):
This vaccine reduces the risk of infections from the pneumococcal bacteria which can cause blood infections, meningitis, pneumonia and some ear infections. It's greatest effect is on the more serious infections such as blood infections, and meningitis. It decreases ear infections by about 7%. It reduces infection by 7 strains of the bacteria thus it is called PCV7. It will be given to all children under the age of 2 years and to certain children at high risk for the disease until the age of 5 years.

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Menigococcal Vaccine (MCV4):
This vaccine protects against bacterial meningitis  caused by the bacteria  N. menigitidis.  Although it is not a "recommended" vaccine, the advisory committee on immunization practices (ACIP) recently recommended that this vaccine be offered to college students, especially freshman living in college dormitories. This group of young people have a higher risk of contracting this disease. A single dose of the vaccine decreases the risk of developing the disease but does not offer 100% protection. Anyone exposed to a confirmed case of this disease should seek medical advise immediately, even if they have received the vaccine.

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Special circumstances in immunocompromised patients:
Children that have immunodeficiencies such as HIV or agammaglobulinemia require special considerations. It is important to realize that these guidelines apply to children who are undergoing chemotherapy and as a result are immunocompromised as well. Not only do such patients have special immunization criteria but so do any family members with whom they reside. Live vaccines such oral polio given to immunocompetent patients may be shed and affect immunocompromised individuals in contact with the immunized patients.

In general, immunocompromised patients can not be given weakened live vaccines such as MMR, varicella, and the oral polio virus vaccine. The exception to this rule is that patients with HIV may be given the MMR vaccination.

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Traveling abroad:
Traveling abroad can be a very enjoyable experience if planned for in advance. Each area of the world however presents medical challenges as there may outbreaks of various illnesses not regularly seen in the United States. Additionally access to good medical care and pharmaceutical agents may prove difficult. For instance, given the recent flooding in Central America there has been increased incidence of typhoid fever and cholera in that region.

The best source of recommended vaccinations for travel is the following CDC (Center for Disease Control) web site:

www.cdc.gov/travel/index.htm

If additional vaccinations are needed, please let our office know in advance since we may need to order them. Also, many vaccinations are given as multiple injections and therefore, as much as 6 months may be required to complete a given series.

References:

The 2000 Red Book, published by the American Academy of Pediatrics.

The American Academy of Pediatrics Web site.

The Center for Disease Control Web site.