Hepatitis B vaccine
Series of 3 (0 to 6 months)
All newborns: 1st dose prior discharge from hospital
Second dose: 1-2 mo, monovalent or a combination vaccine containing HepB
Final dose should be given at 6 months of age or later
Hepatitis B vaccination: infant born to HBV + mother (HBsAg +)
Administer HBV vaccine and 0.5 mL hepatitis B immune globulin within 12 hours of birth
Hepatitis B vaccination: mother’s HBsAg status unknown
- Determine/ check status immediately after birth
- Administer HepB vaccine within 12 hours of birth
- If mother tests +, HBIG (immune globulin) should be given no later than 1 week of age
Rotavirus vaccine (Rota)
Series of 3 (6 - 32 weeks)
- Administer first dose 6 to 14 weeks, and each subsequent dose at 4 weeks intervals
- Must complete series before 32 weeks
- Do not administer a dose after the age of 32 weeks (8 months)
Diphtheria/ Tetanus/ Pertussis Vaccine (DTaP)
Series of 3 primary (2-4-6 months) and 2 boosters ( 15 months & 6 years)
- DTaP is not indicated for children 7 years of age or older
Tetanus, Diphtheria, Acellular Pertussis Vaccines (Tdap)
Series of 1 (11-12 years)
- Subsequent Td boosters are recommended every 10 years
Hib Conjugate Vaccine (Hib)
Series of 3 primary (2-4-6 months) and 1 booster (12 months
- First dose of Hib can be given as early as 6 weeks of age, not recommended for children 5 years of age or older
Pneumococcal Vaccine (PCV13 or PS23)
PCV13 (Prevnar):
- Series of 3 primary (2-4-6 months) and 1 booster (12 months)
PS23 (Pneumovax):
- Children aged 24 - 59 months who completed PCV 13 series and are immune compromised should receive an additional one dose of PS23 at 24 months of age
- Immune compromised: hemoglobinopathies, aslplenia, splenic dysfunction, HIV infection, congenital immunodeficiencies, renal failure, nephrotic syndrome, chronic cardiac disease, chronic pulmonary disease, diabetes, consider if this age group if of Native American, African Americn, or Alaska descent, or attending day care
Polio Vaccine (IPV)
Series of 4 (2, 4, 6 months and 6 years)
- Inactivated polio vaccine (IPV) for all four vaccines scheduled above
- Oral polio vaccine (OPV) is discouraged and only possible for dose number 3 and 4 or epidemics
0 IPV is contraindicated in those with history of anaphylaxis to streptomycin
Influenza vaccine (annual)
- Beginning at 6 months
- In children 6 - 35 months, the dose = 0.25 mL IM, for children 3 & older: 0.5 mL IM
- Live attenuated inactive virus (LAIV), known as FluMist, may be used as an alternative to trivalent inactivated virus (TIV) in health persons aged 2-49 years
- Children younger than 9 yo receive two doses 1 month apart
- May be contraindicated in those with an egg allergy
Measles, Mumps, Rubella (MMR)
- Series of 2 (1 year and by 12 years)
- If exposed to measles or traveling to endemic area, can give MMR as early as 6 months of age, but the patient will need to continue primary series at appropriate time
- May be given simultaneously with TB testing with purified protein derivative (PPD), but prefer to postpone PPD for 4-6 weeks to avoid possible suppressive response to PPD
- Should not be given to those who are pregnant or immunosuppressed
Varicella
- Series of 2 (between 12 months and 12 years, minimum 3 months apart)
- Give two doses after the age of 12 months when no reliable history of chicken pox and no evidence of immunity is available)
- Prefer to separate by 1 month from MMR vaccine
- Contraindicated in pregnant women and immunocompromised persons; and in those with streptomycin allergy
Hepatitis A vaccine
- Series of 2 (1 - 2 years, 6 months apart)
Meningococcal vaccine
- Series of 2 (ages 11-12 years and a booster at the age of 16 years)
- There is an increased rate of meningococcal disease btw 16 and 21 years
- Meningococcal conjugate vaccine (MCV4 [Menactra, Menveo]
- Adolescents receiving first dose at or after 16 years: no booster necessary
Human Papillomavirus Vaccine (HPV)
- Series of 3 (11 or 12 years; second dose given 1 month after 1st dose, then third dose is given 6 months after the initial dose)
- Most common sexually transmitted disease
- Males and females
- Two preparations are commercially available; both cover the oncologic strains of HPV (types 16 & 18) for cancerous lesions of cervix, genital warts, anus, penis, oropharyngeal, recurrent papillomatosis
- Human papilloma virus quadrivalent also covers types 6 & 11 (genital warts), as well as above cancerous lesions (16,18) (Gardasi, 9 - 26 yo)
- Human papilloma virus biivalent vaccine (Cervarix; 10 -25 yo)
- It is recommended that adolescents sit for at least 15 minutes after receiving the vaccine due to risk of labile syncope, postural hypotension, and vasovagal responses
Immunization catch-up pearls
If there is a break in immunizations from the recommended schedule, resume immunizations according to the child’s current age regardless of the vaccines previously missed
Johnny, 5 yo, is in your clinic for his initial well check. You note he has not received any immunizations. Which of the following is not necessary at this age?
a. MMR
b. DTaP
c. Hib
d. Varicella
c. Hib
As the NP, you are assessing an 8 mo infant in an immunization clinic. You know that by 8 months the child should have had which of the following immunizations?
a. Hep B (1st/ 2nd), all primary DTaP series, two doses of polio
b. All DTaP, polio series, MMR
c. DTaP (1st/ 2nd), MMR (1st), all hep B series
d. Varicella, DTaP (1st), Hep B (1st)
a. Hep B (1st/ 2nd), all primary DTaP series, two doses of polio
Mom informs you that she and her 6 mo infant are traveling to a place where measles is endemic. Your best response is:
a. She should not take her baby with her
b. Reassure her that her baby has passive immunity
c. Give baby a MMR or monovalent measles injection
d. Give baby gamma globulin prior to the trip
c. Give baby a MMR or monovalent measles injection
Tommy is in for his 4 month well check. He was born preterm with a birth weight of 2 kg. The appropriate immunizations to give him today would be:
a. DTaP, Hib, IPV, Hep B - 3
b. DTaP, Hib, IPV, PCV 13
c. DTP, Hib, Hep B-3, PCV 13
d. Hold off on immunizations until he reaches his term due date
b. DTaP, Hib, IPV, PCV 13
In considering client situations, which one requires the use of an inactivated (not live) vaccine?
a. History of nonspecified allergies
b. Immunocompromised patient
c. Concurrent antimicrobial therapy
d. Mild acute illness
b. Immunocompromised patient
