II. Technique: Decreased adverse reaction associated factors

  1. Greater depth of injection with longer needle
  2. Use 23 gauge, 25 mm needle

III. Adverse Effects: Safety

  1. Vaccines are safe
    1. Serious Allergic Reaction occur in less than 4 in one million with DTaP Vaccine, MMR Vaccine, Varicella Vaccine
    2. Most pediatric Vaccines do not contain thimerosol (and thimerosol)
    3. Of the 6000 daily antigen exposures daily, a full Primary Series only exposes children to a total of 150 antigens
  2. Vaccines prevent life threatening illness
    1. Tetanus will kill one child in 10 who contract the infection
    2. Measles will kill one child in 1000 who contract the infection
    3. Varicella will kill one older child in 100,000 who contract the infection
  3. Undervaccination puts community health at risk
    1. Undervaccination has been associated with resurgence of Measles
      1. Gahr (2014) Pediatrics 134(1): e220-8 +PMID:24913790 [PubMed]
  4. Vaccine refusal
    1. Listen to concerns without minimizing concerns
    2. Explain risks and benefits
    3. Consider asking parents to sign a "Refusal to Vaccinate"
    4. Consider applying appropriate billing codes
      1. V64.05 Vaccine refusal by caregiver
      2. V64.07 Vaccine refusal for religious reasons
  5. References
    1. (2015) Presc Lett 22(3): 13

IV. Contraindications: Vaccination

  1. True contraindications to vaccination
    1. Anaphylaxis to Vaccine or Vaccine constituent
    2. Current moderate to severe illness
  2. Conditions that do not contraindicate Vaccine
    1. Moderate inflammation at prior Immunization site
    2. Moderate fever following prior vaccination
    3. Current antibiotic usage
    4. Recovering from illness or recent exposure to illness
    5. Prematurity (no change in dosage)
    6. Unvaccinated household contact
    7. Pregnancy of household contact

V. Protocol: Vaccinations

  1. Hepatitis B Vaccine (HepB Vaccine)
    1. Dose 1: Birth to age 2 months
    2. Dose 2: Age 1 to 4 months (>1 month after dose 1)
    3. Dose 3: Age 6 to 18 months (>2 months after dose 2)
  2. Hepatitis A Vaccine
    1. Dose 1: Age 12 months
    2. Dose 2: Age 18 months
  3. Diphtheria Tetanus acellular Pertusis (DTaP Vaccine)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months
    4. Dose 4: Age 12 to 18 months (>6 months after dose 3)
    5. Dose 5: Age 4 to 6 years
    6. Tdap Booster: Age 11 to 12 years
  4. Haemophilus Influenzae type B (Hib Vaccine)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months
    4. Dose 4: Age 12 to 15 months
  5. Inactivated Polio Vaccine (EIPV)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 to 18 months
    4. Dose 4: Age 4 to 6 years (Dose 4 not needed if third dose given after age 4 years)
  6. Pneumococcal Conjugate Vaccine (PCV, Prevnar)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months
    4. Dose 4: Age 12 to 15 months
  7. Measles Mumps Rubella Vaccine (MMR)
    1. Dose 1: Age 12 to 15 months
    2. Dose 2: Age 4 to 6 years (by age 12 years)
  8. Varicella Vaccine
    1. Dose 1: Age 12 to 18 months
    2. Dose 2: Age 5 years
  9. Rotavirus Vaccine
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months (not required if Rotarix was used for Dose 1 and 2)
  10. Influenza Vaccine
    1. Annually between age 6 months and 5 years
  11. Meningococcal Conjugate Vaccine (MCV4)
    1. Administer at 11-12 years or
    2. Before age 18 years
  12. Human Papillomavirus Vaccine
    1. Dose 1: Age 11-12 years in boys and girls
    2. Dose 2: 2 months after first dose
    3. Dose 3: 6 months after first dose

VII. Protocol: Special Circumstances

  1. Prematurity: Immunize if over >1000 grams or >27 weeks
    1. Low Incidence of Hepatitis B and Hib reactions
  2. Children with HIV Infection
    1. Inactivated Polio Vaccine (EIPV) in Primary Series (avoid Oral Polio Vaccine)
    2. Influenza Vaccine
    3. Pneumococcus Vaccine at 24 months
    4. Measles-Mumps-RubellaVaccine

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