Vaccine Requirements
2010/2011
In preparation for “Back to School”, one of the most important items on the list of every parent is immunizations. The current requirements for school entry are:
DTP (diphtheria, tetanus, pertussis)
There are six doses at 2, 4, 6 and 15-18 months, 4-6 years and a booster dose (Tdap) at 11-12 years. Thereafter, a booster dose is required every 10 years. Diptheria is spread from person to person via the respiratory route and causes a thick coating to the back of the throat which can lead to difficulty breathing, paralysis, heart failure or death. Tetanus infection is contracted through an open cut or wound and causes the muscles of the body to tighten which can lock the jaw resulting in the inability to open the mouth or swallow. Pertussis is spread via the respiratory route and results in a whooping cough. Pertussis can lead to severe coughing spells making it difficult to breathe and can result in pneumonia, seizures or death.
IPV (inactivated polio vaccine)
There are four doses at 2, 4, 6-18 months and 4-6 years. Polio is caused by a virus which enters through the mouth and can result in paralysis of the body or death by interfering with the ability to breathe.
MMR (measles, mumps, rubella)
There are two doses at 12-15 months and 4-6 years. The measles virus is spread person to person via the respiratory route. It causes a rash which may be accompanied by cold symptoms, conjunctivitis and fever. Mumps is also spread via the respiratory route and can cause swollen glands, fever, meningitis or swelling of the ovaries and testicles. Rubella causes a rash, fever and arthritis but if contracted by a pregnant woman, it could result in miscarriage or birth defects.
Varicella (chicken pox)
There are two doses at 12-15 months and 4-6 years old. Children who have not had chicken pox by the age of 13 will also need two doses separated by 4 weeks. The chicken pox virus is spread via the respiratory route and also via contact with fluid from blisters. The severity of chicken pox can range from being mild with rash and fever to very serious causing pneumonia, skin infection or death. If a child gets chicken pox after the vaccine, it is usually milder with fewer blisters, fever and not as many days missed from school.
Hib (haemophilus influenzae type b)
There are three or four doses at 2, 4, 6, and 12 – 15 months. The dose given at 6 months may not be necessary, depending on the brand of vaccine. Haemophilus influenzae is a bacterium which is spread from person to person. This bacterium can cause meningitis, deafness, pneumonia, swelling of the throat to the point of not being able to breathe or death.
Hepatitis A
Hepatitis A is required for all children born after (1/1/2006) or who live in or are about to travel to a high risk area. Two doses are given 6 months apart. The hepatitis A virus can be found in the stool of infected persons and can be transmitted by eating food or drinking water contaminated with this virus. Hepatitis A can cause jaundice (yellow) of the skin and eyes, stomach ache, diarrhea and a flu-like illness. This virus is easily transmitted in settings such as daycare, cafeterias and households. Hepatitis A virus can cause severe liver disease.
Hepatitis B
This is a three dose series with the first dose given at birth, the second dose is given at 1-2 months and the third dose is given at 6-18 months. Four doses of Hepatitis B may be given if combination vaccines are used after the birth dose. For adolescents who did not receive the primary series or are catching up should receive the first dose, the second dose at least one month later followed by the third dose at least two months after the second and at least four months after the first. Infants must be at least six months when they receive the third dose. The hepatitis B virus can affect the liver causing cirrhosis, liver cancer or death and occurs more often in those who contract the virus as infants or children. This virus is also characterized by jaundice (yellow) of eyes and skin, diarrhea, vomiting and loss of appetite with these symptoms being seen more when infected as an adult. It is spread by person to person contact through blood or other bodily fluids. It can also be sexually transmitted or spread to an infant upon contact with an infected mother’s blood or bodily fluids.
HPV/Gardasil (Human Papilloma Virus)
This vaccine is recommended to be given to females and males at 11-12 years old but may be given as early as 9 years. Three shots are given within a 6 month period. The human papilloma vaccine can prevent genital wart infections and cervical cancer. This vaccine is active against four types of HPV which includes two types responsible for 70% of cervical cancer and two types responsible for 90% of genital warts. The human papilloma virus is sexually transmitted and affects greater than 50% of sexually active men and women. A major implication of this vaccine is that again it protects against strains of this virus responsible for 70% of cervical cancer which is the second leading cause of cancer deaths among women.
Menactra (meningococcal vaccine)
It is recommended for those 11-12 years old, entering high school or college and for military recruits. Meningococcal infection is one of the leading causes of bacterial meningitis in children 2-18 years of age. One out of ten who become infected with this bacteria die despite treatment with antibiotics. Of those who survive, up to 20% lose their arms or legs, suffer from deafness or seizures or become mentally deficient. This vaccine protects 90% of those vaccinated.
Prevnar (pneumococcal conjugate vaccine)PCV 13
The PCV 13 has replaced the PCV 7 vaccine which has been in use since 2000. The updated vaccine covers six more pneumococcal types than the old vaccine. This vaccine is given at 2, 4, 6 and 12-15 months. Children who have completed the four dose series with PCV 7 and who are less than five years old should receive one booster dose of PCV 13.The pneumococcal vaccine protects against the Streptococcus pneumoniae bacteria which is the leading cause of bacterial meningitis in the United States. This bacterium can also cause serious blood infections, ear infections and pneumonia. It is also spread from person to person contact.
Rotavirus
It is recommended for children at 2, 4 and 6 months of age or 2 and 4 months depending on the brand of vaccine. The first dose can be given as early as 6 weeks or as late as 14 weeks and 6 days. All doses should be completed by 8 months. Rotavirus most commonly affects infants and children and results in severe diarrhea, dehydration or death. This vaccine is oral and decreases the severity of infection if affected.
For more information, please visit the Decatur Pediatric Group or www.cdc.gov.
Regina A. Hardin, MD, FAAP
Seasonal Influenza
2010-2011
Seasonal Influenza (flu) is a contagious viral respiratory infection. It is transmitted by coming into contact with respiratory droplets from sneezing, coughing, or contact with the virus on persons or surfaces. The severity of infection ranges from mild to severe and can result in death. There are three types of flu viruses. The most important are Influenza A and B. The seasonal flu usually peaks in February but can be very unpredictable. In 2009, a subtype of Influenza A known as H1N1 (Swine FLU) emerged much earlier during the late spring and summer season. The symptoms of both types are similar but the most important difference is that the younger population and pregnant women have been found to be more affected by H1N1. Those with H1N1 may also experience more vomiting and diarrhea.
Signs and Symptoms of Seasonal Influenza and H1N1 are:
- Fever (can be high but not always present)
- Cough and congestion
- Headaches
- Chills
- Muscle and Body Aches
- Excessive tiredness
- Sorethroat
- Vomiting/Diarrhea
The best way to protect ourselves from contracting the flu is by vaccination every year. Because Influenza viruses change from year to year, the World Health Organization makes recommendations on which strains should be included in the current vaccine based on which strains were most prominent during the previous year. Thus the 2010-2011 vaccine will include last year’s influenza A/H1N1, influenza A/H3N2 and influenza B. Those with the flu virus can infect others as early as one day before symptoms develop and up to one week after becoming sick. The two types of vaccines for influenza are the flu shot and the nasal spray. The flu shot is an inactivated or killed virus that is given as an injection. The nasal spray is a weakened live virus recommended now for those who are 2-49 years of age, without chronic illnesses such as Asthma and not pregnant. Well persons who care for those with a severely weakened immune system and require a protected environment should not receive the nasal spray but instead should receive the injection. The new recommendation for receiving the flu vaccine has been changed to reflect that all people 6 months of age and older should be vaccinated. Those who received the 2009 H1N1 vaccine or who had H1N1 flu should still get the 2010-2011 seasonal influenza vaccine. Specific recommendations are as follows:
- Children 6 months to 8 years who are receiving flu vaccine for the first time should receive 2 doses
- Children who received 1 dose of seasonal influenza vaccine in the first season they received vaccination should get 2 doses in the following flu season
- Children 6 months to 8 years who did not get at least 1 dose of the 2009 H1N1 or whose vaccination history can’t be determined should receive 2 doses of the 2010-2011 vaccine, regardless of previous vaccination history
Unfortunately, the flu vaccine is not for everyone. It is not recommended for:
- Those with a severe allergy to chicken eggs
- History of a severe reaction to the influenza shot including the development of Guillian-Barre Syndrome within six months of getting the flu shot
- Children younger than six months of age
- Sick persons with a fever
In addition to receiving the vaccine, there are other ways to help protect yourself and others from getting the flu which include coughing into the bend of the arm instead of into the hand, avoiding touching your eyes, nose or mouth, staying at home if you are sick, wearing a mask and washing your hands frequently or using an alcohol based hand sanitizer.
Most healthy people should be able to fight off the flu virus without having to be treated with an antiviral medication. However, there are certain groups of people who are at an increased risk for complications and should be treated promptly such as:
- Suspected or confirmed H1N1
- Children younger than two years old
- Adults older than 65
- Pregnant women and those up to 2 weeks post-partum
- Asthma
- Heart Disease
- Diabetes
- Sickle Cell Disease
- Cystic Fibrosis
- Weakened Immune System/HIV
- Illness requiring hospitalization
- Progressive or severe illness even if not included in one of the above categories
Currently, the treatment of choice is Tamiflu for patients at least one year of age. Relenza is also an option for those older than seven years of age. Your pediatrician can decide the best method of treatment for your child.
Regina A. Hardin, MD, FAAP
For more information, please see www.cdc.gov/flu
Regina A. Hardin, MD, FAAP
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