Childhood Immunization Schedule

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Data provided by DHHS: CDC Recommended Immunization Schedule for Persons Aged 0 Through 6 Years—United States 2011; Fox, J. A., & Gilman, L. (2001). Pediatric nurse practitioner certification review. St. Louis: Mosby.

DTaP is contraindicated:

If an anaphylactic rx to a prior dose or to any vaccine component was observed; child suffers from mod. or severe illness (don't postpone for mild illness); prev encephalopathy (within 7d p DTP/DTaP); unstable progressive neuro problems; prev T >105.5 within 48h p dose; prev cont. crying >3hrs within 48h p dose; prev convulsion within 3d p immunization; prev pale or limp episode, or collapse within 48h p dose.

DTap should be given at what ages?

2mos; 4mos; 6mos; 15-18mos; and 4-6yrs. May give #1 as early as 6wks; may give #4 as early as 12mos if 6mos have elapsed since #3 and child is unlikely to return at age 15-18mos.

If a child falls behind schedule with DTaP, how soon can #2 and #3 doses be given?

4 wks after the previous dose.

How soon can the #4 dose of DTaP be given after the #3 dose?

As early as age 12mos, provided 6mos have elapsed since #3.

If the #4 dose of DTaP is given before age 4y, how long should you wait to give #5 dose?

at least 6 mos.

If the #4 dose of DTaP is given AFTER age 4y, is the #5 dose needed or not?

No, the #5 dose of DTaP is NOT needed if the #4 dose is given after the child is 4 years old.

How should DTaP be given?

IM

Should any of the immunization series EVER be "restarted?"

NO.

After what age should DTap/DTP "NOT" be given?

DTaP/DTP should not be given from the age of 7yrs on. Once a child reaches 7, give Td.

Can DTaP/DTP be given with other vaccines?

Yes, but must be given at a separate site.

Should the same DTaP product be given for all doses?

It is preferable, but NOT mandatory.

Why give DT instead of DTaP/DTP?

Give to children <7y/o if the child has had a serious rx to the pertussis in DTaP/DTP, or if the parents refuse to pertussis component.

What is the difference between DTaP and DTP?

DTaP contained "acellular pertussis" and DTP contains "whole-cell pertussis"

Ages DT are usually given

2mos; 4mos; 6mos; 15-18mos; and 4-6yrs. May give #1 as early as 6wks; may give #4 as early as 12mos if 6mos have elapsed since #3 and child is unlikely to return at age 15-18mos.

Can DT be given with other vaccines?

Yes, but must be given at a separate site.

What are the guidelines if a child falls behind in their DT immunizations?

Same as the guidelines for falling behind with the DTaP or DTP immunizations: #2 & #3 may be given @ 4wks p previous dose; #4 can be given as early as 12mos provided 6mos have elapsed since #3; if #4 is given before age 4y, wait at least 6mos for #5. If #4 if given p age 4y, #5 is not needed.

What are the contraindications to DT?

Anaphylactic rx to prior dose or to any vaccine component; moderate or severe acute illness (do not postpone for minor illness).

How is DT administered?

IM

Td should be given to patients of what age?

7 years or older.

When should a booster dose of Td be given?

Recommended for children 11-12y if 5yrs have elapsed since last dose; then boost Q10yrs.

What are the contraindications to Td?

Anaphylactic rx to prior dose or to any vaccine component; moderate or severe acute illness (do not postpone for minor illness).

What if a child falls behind with Td?

For those never vaccinated or behind or if the vaccination hx is unknown: give dose #1 now; dose #2 in 4wks; dose #3 - 6mos after dose #2; and then boost Q10yrs.

How is Td administered?

IM

IPV (inactivated poliovirus) should be given to patients of what age?

2mos; 4mos; 6-18mos; and 4-6yrs. Not routinely given to anyone 18 yrs or older (except for certain travelers).

How many doses of IPV must a patient receive?

4; children must receive all 4 doses, regardless of what age when first initiated. (Minimum age of first dose: 6 wks)

What are the dosing intervals of IPV?

#1, #2, and #3 should be separated by at least 4 weeks. A 6 month interval is preferred between dose #2 and #3 for the best response. If 4 or more doses are given before age 4, an addt'l dose should be given between 4-6yrs. The last dose should be given on or after the 4th birthday and at least 6 mos following the previous dose.

What are the contraindications to IPV?

Anaphylactic rx to prior dose or to any vaccine component; moderate or severe acute illness (do not postpone for minor illness).

How should IPV be administered?

SQ or IM

Varicella is recommended at what age?

Anytime AFTER a child's first birthday. Should also be given to children 12 yrs and older who have not had prior infection with chickenpox.

How many doses of Varicella must be given?

Two. 2nd dose may be given before age 4y, provided a min. of 3mo have elapsed since 1st dose. For children ages 12 mos-12yrs, the recommended min interval between doses is 3 mos. However, a min. of 4wks is acceptable.

How is Varicella administered?

SQ

What are the contraindications to Varicella

Anaphylactic rx to prior dose or to any vaccine component; moderate or severe acute illness (do not postpone for minor illness). Pregnancy or possibility of pregnancy within 1mo. If blood, plasma, or immune globulin (IG or VZIG) were given in past 5mo. Immunocompromised persons (because of high doses of systemic steroids, cancer, leukemia, lymphoma, immunodeficiency). Note: manufacturer recommends no salicylates for 6wks after this vaccine.

When should the first dose of MMR be given?

At 12-15 mos.

When should the 2nd dose of MMR be given?

At 4-6 yrs. *Ensure all children (and adolescents) >4-6 yrs have received both doses of MMR.

What should you do if a dose of MMR was given BEFORE 12 mos of age?

Continue to give the "official" 1st dose between ages 12-15 mos (making certain to ensure a minimum interval of 4wks between these doses).

What is the minimum interval between MMR #1 and MMR #2?

28 days.

What are the contraindications to MMR?

Anaphylactic rx to prior dose or to any vaccine component; moderate or severe acute illness (do not postpone for minor illness). Preg or poss preg within next 3 mos (use contraception). If blood, plasms, or immune globulin were given in past 11 mos. Immunocompromised persons (e.g., cancer, leukemia, lymphoma). MMR is not contraindicated if a PPD test was recently done, but PPD should be delayed if MMR was given 1-30 d before the PPD; HIV is not a contraindication.

How should MMR be administered?

SQ.

When should Hib be given?

HibTITER (HbOC) and ActHib (PRP-T): 2m; 4m; 6m; & 12-15m. PedvaxHiB (PRP-OMP): Give @ 2m, 4m, & 12-15m.

What happens if a child between 15m-5y never received a Hib vaccine?

That child requires only ONE dose of Hib.

What is the earliest age you can administer Hib dose #1

6 weeks.

Can any Hib vaccine be used as a booster dose?

Yes.

After what age is Hib no longer routinely given to children?

5 years and older.

How should Hib be administered?

Give IM

What is the vaccination schedule for Hep B?

Dose 1: Birth (administer "monovalent HepB" before hospital discharge); Dose 2: 1-2 mos; Dose 3: 6-18 mos; A 4th dose is ok to give as part of a combination vaccine after the birth dose. Infants who did not receive birth dose should get 3 doses on schedule of (0, 1, and 6 mos). The final (3rd or 4th dose) should be given no earlier than age 24 wks. (CDC, 2011).

What if the mother is hepatitis B surface antigen (HGsAg)-positive?

Give the infant HepB and 0.5 mL of Hepatitis B immune globulin (HBIG) within 12 hrs of birth.

What if the mother's HBsAg status is unknown?

Administer HepB within 12 hrs of birth. Determine the mother's HBsAg status ASAP and, if +, administer HGIB (no later than 1 wk old).

Are Hep B vaccines interchangeable?

Yes

What are the contraindications to Hep B?

Anaphylactic rx to prior dose or to any vaccine component; moderate or severe acute illness (do not postpone for minor illness).

How should Hep B be administered?

IM

When should the first dose of Rotavirus vaccine (RV) be administered?

Age 6 wks - 14 wks (minimum age 6 wks). Vaccination should NOT be initiated for infants older than 15 weeks, 0 days.

What is the maximum age for the final dose in the Rotavirus series?

8 months, 0 days.

What is the vaccination schedule for RV?

2 months; 4 months; 6 months* (if Rotarix is administered at 2 and 4 months, a dose at 6 months is not indicated).

What is the immunization schedule for Pneumoccoccal (PCV)?

2 mos; 4 mos; 6 mos; and 12-15 mos.

What is the minimum age to receive pneumococcal conjugate vaccine (PCV)?

6 weeks

What is the minimum age to receive pneumococcal polysaccharide vaccine (PPSV)?

2 years.

What is the minimum age to receive the trivalent inactivated influenza vaccine (TIV)?

6 months

What is the minimum age to receive the live, attenuated influenza vaccine (LAIV)?

2 years

How many doses of seasonal influenza vaccine should be given?

Give 2 doses (separated by at least 4 wks) to children aged 6 mos-8yrs receiving the vaccine for the first time or who were vaccinated for the first time during the previous flu season but only received one dose.

Can either TIV or LAIV be used?

For healthy children 2 and older (without underlying med conditions that predispose them to flu complications), either TIV or LAIV can be used - except LAIV should not be given to children ages 2-4 who have had wheezing in the past 12 months.

How far apart should Hep A vaccines be administered?

At least 6 months

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