Vaccines for special groups include meningococcal, typhoid and rabies.
The meningococcal disease is caused by Neisseria meningitidis, or meningococcus which is a gram-negative, biscuit-shaped diplococcus bacteria found only in man. Transmission is from person to person through respiratory droplets. It is not as contagious as the common cold but is transmitted through saliva, and occasionally, prolonged contact with an infected person. The incubation period is from 1 to 10 days. The clinical manifestations include upper respiratory infection with or without bacteremia; bacteremia without sepsis; meningococcemic sepsis without meningitis; meningitis with or without sepsis, meningoencephalitis and focal organ infections. This type of meningitis is the only form of bacterial meningitis known to cause epidemics. It is a serious condition. The more severe disease called meningococcemia is a widespread blood infection with a high rate of mortality. A patient afflicted with this disease can deteriorate within hours. Although a small number of patients die, those who survive incur long term sequelae like deafness and brain damage.
Typhoid or typhoid fever is caused by Salmonella typhi. It is acquired through ingestion of food or water contaminated by fecal material from an infected person. It is characterized by a sustained high fever, profuse sweating, and diarrhea. Occasionally, a rash with flat rose-colored spots may appear. If untreated, typhoid fever can lead to serious complications like intestinal bleeding and perforation, encephalitis, and abscesses and inflammation in other organs including the gallbladder, bones and the heart. Sanitation and good hygiene are critical preventive measures for typhoid.
Rabies is a highly fatal viral encephalomyelitis which is transmitted to man by the bite of a rabid animal. The rabies virus is a bullet-shaped rhabdovirus of the Lyssa group. It can be transmitted in either 2 ways: (1) bite exposure(injection of infectious saliva into abreak in the skin caused by animal's teeth) or (2) non-bite exposure by licking of mucous membranes or scratches, open/healing wounds,abrasions; aerosol; or human to human. The incubation period in man varies from as short as 4 days to as long as 19 years, but is usually between 20-90 days. Ninety five percent of cases develop symptoms within a year from the time of the bite. It tends to be shorter in multiple severe bites or bites on the head and neck areas. The clinical manifestations may range from a prodromal phase characterized by nonspecific constitutional symptoms such as fever, malaise, and body weakness followed by pain or paresthesia at the site of the bite then enters into an acute neurological phase with the characteristic feature of violent and painful spasm of the pharyngeal and laryngeal muscles and eventually death due to a respiratory paralysis.
With the existence of the above disease entities, the use of vaccines for each has been an option in certain areas or conditions.
The meningococcal vaccine is not recommended for routine use. It is recommended only in areas where there is an outbreak as declared by health authorities and for children and adolescents known to be at risk for the disease.
The typhoid vaccine is an active immunization against typhoid fever for adults and children older than 2 years of age. A single dose is recommended for both children and adults. Subjects who remain at risk of typhoid fever should be revaccinated using a single dose of vaccine every 3 - 5 years. This vaccine is also recommended for travelers to areas with a risk of exposure to salmonella typhi or persons infected with Salmonella typhi. There are two vaccines for typhoid - an oral live attenuated and an injectible.
Based on the Anti-rabies Act 2007, pre-exposure prophylaxis for children aged 5 years and above is recommended where there is a high incidence of rabies (>2.5 human rabies/million population). The regions with a high incidence of rabies reported in 2006 are Regions 1,2,3,5,7,8,12 and CAR. Booster is not mandatory but may be given every 3 years depending on continuing risk of exposure. Any exposure regardless of severity after completion of the Primary series should be given rabies vaccines as follows: interval from last dose of 0-6 months needs one booster dose, >6 months - 3 years, needs 2 booster doses(given on days 0, 3) and > 3 years require a full dose of vaccine (days 0,3,7,14,28) without Rabies immunoglobulin.
Thursday, January 14, 2010
Tuesday, January 12, 2010
Childhood and Adolescent Immunization Schedules Approved for 2010
by Laurie Barclay, MD
The 2010 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians, according to a report posted online January 4 and to be published in the January 2010 issue of Pediatrics.
There are 3 revised schedules describing current guidelines for use of US Food and Drug Administration (FDA)–licensed vaccines: one for children from birth through age 6 years, one for children and adolescents aged 7 through 18 years, and a catch-up immunization schedule for children and adolescents who start late or fall behind with scheduled vaccinations.
Noteworthy changes in the 2010 schedule are a new recommendation for influenza A (H1N1) 2009 monovalent vaccine, a recommendation to revaccinate children who remain at increased risk for meningococcal disease with meningococcal conjugate vaccine (MCV4), recommendations on combination vaccines, and recommendations for the recently licensed bivalent human papillomavirus (HPV) vaccine in girls and the quadrivalent HPV vaccine in boys.
Specific changes from last year's recommendations for vaccination with FDA-approved vaccines include the following:
• A footnote refers to ACIP recommendations regarding use of influenza A (H1N1) 2009 monovalent vaccine.
• Only children 6 months or older should receive trivalent inactivated influenza vaccine (TIV), and only those 2 years or older should receive the live attenuated influenza vaccine (LAIV). Healthy children aged 2 to 6 years may receive either TIV or LAIV. However, children aged 2 to 4 years who have a history of wheezing in the preceding 12 months should not receive LAIV.
• The dose of TIV is 0.25 mL for children aged 6 to 35 months and 0.5 mL for those at least 3 years old. For children younger than 9 years given the influenza vaccine for the first time, 2 doses should be given 4 weeks apart. Children who received a single dose of influenza vaccine the previous season should be given 2 doses, separated by 4 weeks or more.
• Children who remain at increased risk for meningococcal disease because of persistent complement deficiency, asplenia, or other conditions should be revaccinated with MCV4. Children who received the initial MCV4 dose at ages 2 through 6 years should receive a dose of MCV4 after 3 years. If the first dose was given at age 7 years or older, children should be revaccinated after 5 years. These children should then be revaccinated with MCV4 every 5 years.
• Children not previously vaccinated with MCV4 should be given this vaccine at age 11 or 12 years or between ages 13 and 18 years. College freshmen living in a dormitory who have not previously received MCV4 should be given this vaccine.
• Combination vaccines are usually preferred to separate injections of the equivalent component vaccines. Updated recommendations regarding the inactivated poliovirus vaccine series are that the final dose should be given on or after the fourth birthday and at least 6 months after the previous dose. Children receiving 4 doses before age 4 years should receive an additional (fifth) dose at ages 4 through 6 years.
• Updated recommendations describe use of the recently licensed bivalent HPV vaccine in girls and the quadrivalent HPV vaccine in boys. Girls not previously vaccinated against HPV should receive the bivalent HPV series at ages 13 through 18 years. For catch-up, the second and third HPV dose should be given at 1 to 2 months and at 6 months after the first dose. The minimal interval for vaccination is 4 weeks between the first and second doses, 12 weeks between the second and third doses, and 24 weeks or more between the first dose and third dose.
The 2010 recommended childhood and adolescent immunization schedules have been approved by the American Academy of Pediatrics (AAP), the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention, and the American Academy of Family Physicians, according to a report posted online January 4 and to be published in the January 2010 issue of Pediatrics.
There are 3 revised schedules describing current guidelines for use of US Food and Drug Administration (FDA)–licensed vaccines: one for children from birth through age 6 years, one for children and adolescents aged 7 through 18 years, and a catch-up immunization schedule for children and adolescents who start late or fall behind with scheduled vaccinations.
Noteworthy changes in the 2010 schedule are a new recommendation for influenza A (H1N1) 2009 monovalent vaccine, a recommendation to revaccinate children who remain at increased risk for meningococcal disease with meningococcal conjugate vaccine (MCV4), recommendations on combination vaccines, and recommendations for the recently licensed bivalent human papillomavirus (HPV) vaccine in girls and the quadrivalent HPV vaccine in boys.
Specific changes from last year's recommendations for vaccination with FDA-approved vaccines include the following:
• A footnote refers to ACIP recommendations regarding use of influenza A (H1N1) 2009 monovalent vaccine.
• Only children 6 months or older should receive trivalent inactivated influenza vaccine (TIV), and only those 2 years or older should receive the live attenuated influenza vaccine (LAIV). Healthy children aged 2 to 6 years may receive either TIV or LAIV. However, children aged 2 to 4 years who have a history of wheezing in the preceding 12 months should not receive LAIV.
• The dose of TIV is 0.25 mL for children aged 6 to 35 months and 0.5 mL for those at least 3 years old. For children younger than 9 years given the influenza vaccine for the first time, 2 doses should be given 4 weeks apart. Children who received a single dose of influenza vaccine the previous season should be given 2 doses, separated by 4 weeks or more.
• Children who remain at increased risk for meningococcal disease because of persistent complement deficiency, asplenia, or other conditions should be revaccinated with MCV4. Children who received the initial MCV4 dose at ages 2 through 6 years should receive a dose of MCV4 after 3 years. If the first dose was given at age 7 years or older, children should be revaccinated after 5 years. These children should then be revaccinated with MCV4 every 5 years.
• Children not previously vaccinated with MCV4 should be given this vaccine at age 11 or 12 years or between ages 13 and 18 years. College freshmen living in a dormitory who have not previously received MCV4 should be given this vaccine.
• Combination vaccines are usually preferred to separate injections of the equivalent component vaccines. Updated recommendations regarding the inactivated poliovirus vaccine series are that the final dose should be given on or after the fourth birthday and at least 6 months after the previous dose. Children receiving 4 doses before age 4 years should receive an additional (fifth) dose at ages 4 through 6 years.
• Updated recommendations describe use of the recently licensed bivalent HPV vaccine in girls and the quadrivalent HPV vaccine in boys. Girls not previously vaccinated against HPV should receive the bivalent HPV series at ages 13 through 18 years. For catch-up, the second and third HPV dose should be given at 1 to 2 months and at 6 months after the first dose. The minimal interval for vaccination is 4 weeks between the first and second doses, 12 weeks between the second and third doses, and 24 weeks or more between the first dose and third dose.
Saturday, January 2, 2010
Recommended Visits and Schedule of Immunization
The Expanded Program of Immunization (EPI) being administered in local health centers througout the country still covers the primary series consisting of 1 dose of BCG anytime from birth onwards, 3 doses of hepatitis B vaccine at 0,1,6 months and 3 doses each of whole cell DPT and OPV at 6, 10 and 14 weeks and 1 dose of measles at 9 months. This is the routine vaccines given at 0-12 months recommended by the Department of Health or DOH.
The BCG (Bacillus Calmette-Guerin (BCG) vaccine is ideally given at birth . If given beyond 12 months, do PPD (Protein Purified Derivative) or a Tuberculin skin test. If PPD is negative, give BCG. It is immunization against extrapulmonary Tuberculosis and is given as a single dose.
The first dose of Hepatitis B vaccine is ideally given within the 12th hour of life. This may be used as the first dose in a 3-dose primary series at least 4 weeks apart. A fourth dose is needed in the following instances, namely: the third dose is given at less than 6 months of age; no birth dose was given using the EPI schedule of 6, 10, 14 weeks amd for preterm infants less than 2 kgs., due to poor immunogenicity of the vaccine for these infants. For the third condition, the initial dose should not be counted in a 3-dose immunization schedule to complete the series. In infants born to a mother positive for hepatitis B via screening for HBS antigen, hepatitis B Immunoglobulin is ideally given within the first 12 hours of life together with the Hepatitis B vaccine at different injection sites or on alternate thighs intramuscularly.
For the Diptheria, Pertussis, Tetanus (DPT) vaccine, a first booster dose is given at 12-24 months or at least 1 year after the third dose. A second booster shot is administered between 4-6 years of age. For those who did not receive or complete the DPT three series by age 7-16 years, DT (Diptheria & Tetanus) vaccine is recommended at least 4 weeks apart. Booster shots are to be given every 5-10 years after completing the three series.
For the Oral Polio Virus (OPV)vaccine, the first booster is given at 12-24 months or 1 year after the third dose. While the second booster is given at 4-6 years of age.
In case of epidemics, the measles vaccine can be given as early as 6 months of age as a single dose instead of the EPI recommended schedule at 9-11 months.
The other recommended vaccines are Hib, IPV, MMR, Varicella, Hepatitis A, Pneumococcal, Rotavirus, Influenza and HPV.
The Haemophilus type b conjugate vaccine or Hib is indicated in infants from 2 months, for the prevention of invasive diseases such as meningitis, septicemia, epiglottitis caused by H. influenzae type b. In infants less than 6 months, it is given for 3 doses at intervals of 1 or 2 months followed by a booster injection one year after the third injecton. Between 6 and 12 months, 2 doses at an interval 1-2 months is given followed by a booster at 15-18 months of age. For children from 1 to 5 years, a single doses is given if no shot has been received earlier.
Another preparation of the polio vaccine is IPV which is an inactivated poliomyelitis virus vaccine. It is usually given with the other vaccines like Acellular DPT and Hib as combination vaccines so the interval between doses can be at least 1 or 2 months.
MMR (Measles, Mumps, Rubella) vaccine is given as early as 1 year of age with a booster shot between ages 5 - 12 years old. Although some authors recommend that the first dose be given at 15 months.
The first dose of Varicella vaccine is recommended at 12-15 months whereas the second dose may be given at 4-6 years but may be administered earlier provided the interval between the first and second is 3 months. The second dose is recommended for children, adolescents, and adults who received only 1 dose. All indiviuals aged 13 years and up, without previous evidence of immunity should receive 2 doses of varicella at least 4 weeks apart.
Hepatitis A vaccine can be given as early as 1 y/o with a second dose to be given within 6 - 24 months after the first dose or at 0, 1, 6 months schedule depending on the type of hepatitis A vaccine to be administered.
The pneumococcal vaccine or IPD can be given as early as 1 & 1/2 months or 6 weeks with a minimum interval of 4 weeks apart for 3 doses. The pneumococcal polysaccharide vaccine (PPV) is recommended for certain high risk groups in addition to PCV at 2-19 years of age. For healthy children, no additional doses needed if PCV series is completed.
The rotavirus vaccine (RV) is available in two preparations. One is a monovalent human Rotavirus vaccine which would require 2 doses: first dose at 6-14 weeks of age, and the second dose between 14-24 weeks of age. The interval should not be less than 4 weeks and the second dose should be given by age 24 weeks. Whereas the pentavalent human-bovine reassortant Rotavirus vaccine would need a 3 dose series: first dose between 6-12 weeks of age, subsequent doses should be administered at 4-10 weeks intervals and the final dose should not be given later than 32 weeks of age. The RV may be given with OPV or given 2 weeks apart. if give, concommitantly with OPV, 2 doses of monovalent human RV or 3 doses of pentavalent RV should be completed to overcome interference of OPV with RV immune response. This should be given at least 2 weeks apart from OPV.
Influenza vaccine is recommended in children 6 months to five years and those with high risk like congenital heart disease, vascular disease, chronic lung disease like asthma, chronic metabolic disorders, renal disorders and hemoglobinopathies and those children on long term (Aspirin) ASA therapy. Children aged 6 month to 8 years receiving influenza vaccine for the first time need 2 doses given at least 4 weeks apart. Those who received only 1 dose in the first year should receive 2 doses the following year. Children recommended for vaccination who are in their 3rd or more year of being vaccinated and who received only 1 dose in each of the first 2 years of being vaccinated should continue receiving a singlke annual dose. Vaccination should be given once a year preferably between February to June to cover the expected increase in influenza activity from June to October. Healthy children more than 5 years of age who wants to be protected against influenza can also be given the vaccine. Contraindications to vaccine administration are hypersensitivity to any constituent, acute febrile illness,prebious history of Guillen barresyndrome within the last 6 weeks.
Human papilloma virus (HPV) vaccine is available as a bivalent HPV vaccine and a quadrivalent HPV vaccine. The bivalent vaccine (cervarix) is recommended for ages 10-55 years at 0,1,6 months schedule. The second dose may be given 1 - 2.5 months after the first dose if flexibility is needed. Whereas the quadrivalent type (gardasil) is recommended for ages 10-26 years at 0,2,6 months schedule. If flexibility is needed, the second dose should be given at least 1 month after the first dose and the third dose at least 3 months after the second dose.
Other immunization schedule is recommended for the combination vaccine like 6-in-1 combinations (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Polio virus, H. influenzae type B, hepatitis B virus); 5-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus, H. influenzae type b) or 4-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus or H. influenzae type b virus). The age of administration may vary between brands but the first dose is usually given at least 2 months of age and the 3-dose series is completed at interval of 1-2 months.
The BCG (Bacillus Calmette-Guerin (BCG) vaccine is ideally given at birth . If given beyond 12 months, do PPD (Protein Purified Derivative) or a Tuberculin skin test. If PPD is negative, give BCG. It is immunization against extrapulmonary Tuberculosis and is given as a single dose.
The first dose of Hepatitis B vaccine is ideally given within the 12th hour of life. This may be used as the first dose in a 3-dose primary series at least 4 weeks apart. A fourth dose is needed in the following instances, namely: the third dose is given at less than 6 months of age; no birth dose was given using the EPI schedule of 6, 10, 14 weeks amd for preterm infants less than 2 kgs., due to poor immunogenicity of the vaccine for these infants. For the third condition, the initial dose should not be counted in a 3-dose immunization schedule to complete the series. In infants born to a mother positive for hepatitis B via screening for HBS antigen, hepatitis B Immunoglobulin is ideally given within the first 12 hours of life together with the Hepatitis B vaccine at different injection sites or on alternate thighs intramuscularly.
For the Diptheria, Pertussis, Tetanus (DPT) vaccine, a first booster dose is given at 12-24 months or at least 1 year after the third dose. A second booster shot is administered between 4-6 years of age. For those who did not receive or complete the DPT three series by age 7-16 years, DT (Diptheria & Tetanus) vaccine is recommended at least 4 weeks apart. Booster shots are to be given every 5-10 years after completing the three series.
For the Oral Polio Virus (OPV)vaccine, the first booster is given at 12-24 months or 1 year after the third dose. While the second booster is given at 4-6 years of age.
In case of epidemics, the measles vaccine can be given as early as 6 months of age as a single dose instead of the EPI recommended schedule at 9-11 months.
The other recommended vaccines are Hib, IPV, MMR, Varicella, Hepatitis A, Pneumococcal, Rotavirus, Influenza and HPV.
The Haemophilus type b conjugate vaccine or Hib is indicated in infants from 2 months, for the prevention of invasive diseases such as meningitis, septicemia, epiglottitis caused by H. influenzae type b. In infants less than 6 months, it is given for 3 doses at intervals of 1 or 2 months followed by a booster injection one year after the third injecton. Between 6 and 12 months, 2 doses at an interval 1-2 months is given followed by a booster at 15-18 months of age. For children from 1 to 5 years, a single doses is given if no shot has been received earlier.
Another preparation of the polio vaccine is IPV which is an inactivated poliomyelitis virus vaccine. It is usually given with the other vaccines like Acellular DPT and Hib as combination vaccines so the interval between doses can be at least 1 or 2 months.
MMR (Measles, Mumps, Rubella) vaccine is given as early as 1 year of age with a booster shot between ages 5 - 12 years old. Although some authors recommend that the first dose be given at 15 months.
The first dose of Varicella vaccine is recommended at 12-15 months whereas the second dose may be given at 4-6 years but may be administered earlier provided the interval between the first and second is 3 months. The second dose is recommended for children, adolescents, and adults who received only 1 dose. All indiviuals aged 13 years and up, without previous evidence of immunity should receive 2 doses of varicella at least 4 weeks apart.
Hepatitis A vaccine can be given as early as 1 y/o with a second dose to be given within 6 - 24 months after the first dose or at 0, 1, 6 months schedule depending on the type of hepatitis A vaccine to be administered.
The pneumococcal vaccine or IPD can be given as early as 1 & 1/2 months or 6 weeks with a minimum interval of 4 weeks apart for 3 doses. The pneumococcal polysaccharide vaccine (PPV) is recommended for certain high risk groups in addition to PCV at 2-19 years of age. For healthy children, no additional doses needed if PCV series is completed.
The rotavirus vaccine (RV) is available in two preparations. One is a monovalent human Rotavirus vaccine which would require 2 doses: first dose at 6-14 weeks of age, and the second dose between 14-24 weeks of age. The interval should not be less than 4 weeks and the second dose should be given by age 24 weeks. Whereas the pentavalent human-bovine reassortant Rotavirus vaccine would need a 3 dose series: first dose between 6-12 weeks of age, subsequent doses should be administered at 4-10 weeks intervals and the final dose should not be given later than 32 weeks of age. The RV may be given with OPV or given 2 weeks apart. if give, concommitantly with OPV, 2 doses of monovalent human RV or 3 doses of pentavalent RV should be completed to overcome interference of OPV with RV immune response. This should be given at least 2 weeks apart from OPV.
Influenza vaccine is recommended in children 6 months to five years and those with high risk like congenital heart disease, vascular disease, chronic lung disease like asthma, chronic metabolic disorders, renal disorders and hemoglobinopathies and those children on long term (Aspirin) ASA therapy. Children aged 6 month to 8 years receiving influenza vaccine for the first time need 2 doses given at least 4 weeks apart. Those who received only 1 dose in the first year should receive 2 doses the following year. Children recommended for vaccination who are in their 3rd or more year of being vaccinated and who received only 1 dose in each of the first 2 years of being vaccinated should continue receiving a singlke annual dose. Vaccination should be given once a year preferably between February to June to cover the expected increase in influenza activity from June to October. Healthy children more than 5 years of age who wants to be protected against influenza can also be given the vaccine. Contraindications to vaccine administration are hypersensitivity to any constituent, acute febrile illness,prebious history of Guillen barresyndrome within the last 6 weeks.
Human papilloma virus (HPV) vaccine is available as a bivalent HPV vaccine and a quadrivalent HPV vaccine. The bivalent vaccine (cervarix) is recommended for ages 10-55 years at 0,1,6 months schedule. The second dose may be given 1 - 2.5 months after the first dose if flexibility is needed. Whereas the quadrivalent type (gardasil) is recommended for ages 10-26 years at 0,2,6 months schedule. If flexibility is needed, the second dose should be given at least 1 month after the first dose and the third dose at least 3 months after the second dose.
Other immunization schedule is recommended for the combination vaccine like 6-in-1 combinations (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Polio virus, H. influenzae type B, hepatitis B virus); 5-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus, H. influenzae type b) or 4-in-1 Immunization (Diptheria toxoid, Tetanus toxoid, Pertussis toxoid, Poliomyelitis virus or H. influenzae type b virus). The age of administration may vary between brands but the first dose is usually given at least 2 months of age and the 3-dose series is completed at interval of 1-2 months.
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