IMMUNIZATIONS, IMMUNIZATIONS, PART IPART I

Janine Clark Adjo, M.D.Janine Clark Adjo, M.D.

2010 IMMUNIZATION SCHEDULE2010 IMMUNIZATION SCHEDULE

DTaP (IM)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

DTaPDTaP

• 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

DTaPDTaPINDICATIONSINDICATIONS

• 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

DTaPDTaPTrue ContraindicationsTrue Contraindications

• Anaphylaxis to vaccine or constituent of vaccine

• Encephalopathy within 7 days of receiving vaccine, then use DT for remaining doses

DTaPDTaPPRECAUTIONSPRECAUTIONS

• 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

DTaPDTaPSIDE EFFECTSSIDE EFFECTS

• Erythema, swelling, pain, fever, irritability

• Anaphylaxis

• Seizure

• Hyporesponsive/hypotonic episode

• Persistent crying

• Fever >105

DTaPDTaPDifferent FormulariesDifferent Formularies

• Daptacel- Sanofi Pasteur

• Tripedia- Sanofi Pasteur

• Infanrix- GlaxoSmithKline

• DT- Sanofi Pasteur

• Td- Decavac- Sanofi Pasteur

• Adacel/Boostrix- Tdap- Sanofi Pasteur/GSK

DTaPDTaPDifferent formulariesDifferent formularies

• TriHIBit- Sanofi Pasteur

• Pediarix- GSK

• Pentacel- Sanofi Pasteur

• Kinrix- GSK

Haemophilus Influenza Type BHaemophilus Influenza Type BHib (IM)Hib (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

HiBHiB

• 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

HiBHiBSide Effects/ContraindicationsSide Effects/Contraindications

• Local pain, erythema, swelling, fever, irritability

• Anaphylaxis

HiBHiBDifferent FormulariesDifferent 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)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 BHepatitis BSide Effects/ContraindicationsSide Effects/Contraindications

• Pain at site, fever

• Anaphylaxis to vaccine or Baker’s yeast

Hepatitis BHepatitis BDifferent FormulariesDifferent Formularies

• Hepatitis B, Recombivax, Merck

• Hepatitis B, Energix- B, GSK

• Hep B/Hib, Comvax, Merck

POLIO (SC or IM)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

POLIOPOLIOSide effects/ContraindicationsSide effects/Contraindications

• Pain, swelling and erythema at site

• Anaphylaxis to vaccine, polymyxin B, neomycin, or streptomycin

POLIOPOLIODifferent FormulariesDifferent Formularies

• IPV, IPOL, Sanofi Pasteur

• Pentacel, Sanofi Pasteur

• Pediarix, GSK

Pneumococcal Vaccine (IM)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

PrevnarPrevnarSide effects/ContraindicationsSide effects/Contraindications

• Pain, swelling, and erythema at site of injection

• Fever, irritability, decreased appetite

• Anaphylaxis to vaccine

PrevnarPrevnarDifferent FormulariesDifferent Formularies

• Prevnar, Wyeth

Pneumococcal vaacine Pneumococcal vaacine Different FormulariesDifferent Formularies

• Pneumovax (IM or SC)- pneumococcal polysaccharide vaccine, 23 valent, Merck

• Ages 2 and up

• Immunosuppressed patients