Recommended Immunization Schedules for Children and Adolescents,

2007CRISBERT I. CUALTEROS, CRISBERT I. CUALTEROS,

M.D.M.D.http://http://

crisbertcualteros.page.tlcrisbertcualteros.page.tl

2007 Schedule Major Changes

• The addition of oral live rotavirus vaccine for routine administration to all infants at ages 2, 4, and 6 months of age.

• Routine administration of a second dose of varicella vaccine at 4 to 6 years of age.

2007 Schedule Major Changes

• The addition of human papillomavirus vaccine for girls 11-12 years of age, with catch-up immunization of girls 13-18 years of age. This vaccine, administered intramuscularly in a 3-dose series at 0,2, and 6 months is expected to prevent most cases of cervical cancer and genital warts.

2007 Schedule Major Changes

• The age range for annual administration of influenza vaccine has been expanded to children 6 to 59 months old. Vaccine is also recommended for close contacts of children 0 to 59 months old.

Recommended Immunization Schedule for

Ages 0-6 years

Hepatitis B vaccine (HepB)

• 1st Dose: At birthALL NEWBORNS prior to discharge.Monovalent hepB

• 2nd dose: 1-2 months old• Final Dose: age ≥ 24 weeks• Permissible to administer 4 doses

of Hepa B when combination vaccines are given after the birth dose.

• >90% efficacy; probably 5 years or longer immunity

Inactivated Polio Vaccine (IPV)

• Minimum age: 6 weeks• Schedule: age 2,4,6 months

with booster at 4-6 years• Dose: 0.5ml SQ• >95% efficacy

Inactivated Polio Vaccine (IPV)

• Indications:• Persons with immunocompromised

immunity who are unimmunized or partially immunized

• Household contacts of an immunodeficient individual

• Unimmunized adults at future risk of exposure to poliomyelitis who have been partially immunized with OPV or IPV

• Adults at future risks of exposure to poliomyelitis who have had a primary series of IPV

• Individuals refusing OPV immunization

Rotavirus vaccine

• Minimum age: 6 weeks• 1st dose: between 6-12 weeks of

age• Do not start the series later than age 12

weeks!

• Schedule: 2,4,6 months• Final Dose: by 32 weeks of age

• No more than age 32 weeks.

• Insufficient data on safety and efficacy

Diphtheria & Tetanus toxoids and Acellular

Pertussis vaccine (DTaP)• Minimum age: 6 weeks• Schedule: 2,4,6 months with

booster as early as age 12 months, provided that 6 months have elapsed since the 3rd dose.

• Dose: 0.5 ml IM• Administer the final dose in the

series at age 4-6 years• 100% efficacy/length of immunity

for 10 years except pertussis component

Diphtheria & Tetanus toxoids and Acellular

Pertussis vaccine (DTaP)• Pertussis component- not recommended

after the age of 6 years because of the increased risk for neuroparalytic reactions.

• Subsequent doses are not recommended if the previous dose was followed by reactions such as:

• Collapse• Shock-like state• Persistent screaming • Fever >40.5 C• Convulsions• Alterations in level of consciousness or other

neurologic sx

Haemophilus influenzae type B (HiB)

• Minimum age: 6 weeks• Schedule: 2,4,6 months with

booster at 12-15 months old• Dose: 0.5ml IM• Possible reaction: pain, redness

and/or swelling at injection site in 25%; rarely fever and irritability

• 90-100% effective

Pneumococcal vaccine

• Minimum age: • 6 weeks for PCV (Pneumococcal

conjugate vaccine)• 2 years for PPV (Pneumococcal

polysaccharide vaccine)

• Administer PCV at ages 24-59 months in certain high-risk groups

• Administer PPV to certain high-risk groups aged ≥ 2 years

Influenza vaccine

• Minimum age: • 6 months for trivalent influenza vaccine

(TIV)• 5 years for live attenuated influenza

vaccine (LAIV)

• All children aged 6-59 months and close contacts of all children aged 0-59 months

• Recommended annually for children aged ≥ 59 months with certain risk factors.

• For healthy persons aged 5-49 years, LAIV may be used as an alternative to TIV

Measles, mumps and rubella vaccine (MMR)

• Minimum age: 12 months• Schedule: 12-15 months with booster

at 4-6 years old.• MMR may be given prior to age 4-6

years, provided that ≥ 4 weeks have elapsed since the first dose and both doses are administered at age ≥ 12 months.

• Dose: 0.5 mL SQ• >95% efficacy and long-lasting

immunity

Varicella vaccine• Minimum age: 12 months• Schedule: 12-15 months with second

dose at 4-6 years old.• The second dose may be administered

prior to age 4-6 years, provided that ≥ 3 months have elapsed since the 1st dose and both doses are administered at age ≥ 12 months.

• Dose: 0.5 ml SC• Possible reaction: Fever,

papulovesicular eruptions in 3%• Close to 100% efficacy

Hepatitis A vaccine (HepA)

• Minimum age: 12 months• All children at 1 year of age

(i.e. 12-23 months)• 2 doses should be administered

at least 6 months apart.• Children not fully vaccinated by

age 2 years can be vaccinated at subsequent visits.

Meningococcal polysaccharide vaccine (MPSV4)

• Minimum age: 2 years• Administer to children aged 2-

10 years with terminal complement deficiencies ot anatomic or functional asplenia and certain other high risk groups

Recommended Immunization Schedule for Persons Aged 7-18 years

Tetanus and Diphtheria toxoids and acellular

pertussis vaccine (Tdap)• Administer at age 11-12 years for those

who have completed the recommended childhood DPT/DTaP series and have not received a tetanus & diphteria toxoids vaccine (Td) booster dose

• Adolescents aged 13-18 years who missed the 11-12 year Td/Tdap booster dose should receive a single dose of Tdap if they have completed the recommended childhood DTP/DTaP vaccination series.

Human Papillomavirus vaccine(HPV)

• Minimum age: 9 years• 1st dose: females at 11-12 years• 2nd dose: 2 months after the 1st

dose• 3rd dose: 6 months after the 2nd

dose• Administer the HPV vaccine series

to females at age 13-18 years if not previously vaccinated.

Meningococcal vaccine

• Minimum age: 11 years for MCV4; 2 years for MPSV4)

• Administer MCV4 at age 11-12 years and to previously unvaccinated adolescents at high school entry

• Administer MCV4 to previously unvaccinated college freshmen living in dormitories; MPSV4 is an acceptable alternative.

Pneumococcal polysaccharide vaccine (PPV)

• Minimum age: 2 years• Administer or certain high risk

groups

Influenza vaccine

• Children aged <9 years who are receiving influenza vaccine for the 1st time should receive 2 doses

• Separated by ≥ 4 weeks for TIV• By ≥ 6 weeks by LAIV

Hepatitis A vaccine

• 2 doses should be given at least 6 months apart

Hepatitis B vaccine (HepB)

• Administer the 3-dose series to those who are not previously vaccinated.

• A 2-dose series of Recombivax HB® is licensed for children aged 11-15 years

Inactivated Polio Vaccine (IPV)

• For children who received an all-IPV or all-OPV series, a fourth dose is not necessary if the third dose was administered ≥ 4 years.

• If both IPV and OPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.

Measles, Mumps, and Rubella

vaccine (MMR)• If not previously vaccinated,

administer 2 doses of MMR during any visit, with ≥ 4 weeks between the doses.

Varicella vaccine

• 2 doses:– Persons without evidence of

immunity– Persons aged <13 years at least

3 months apart– Persons aged ≥ 13 years at least

4 weeks apart

addendum

Bacillus-Calmette Guerin vaccine(BCG)

• Given anytime after birth• 1 dose: 0.05 mL ID over deltoid area• Booster: school entrants (0.1 mL)• If given at the earliest possible age

protects against the possibility of infection from other family members

• 50% efficacy• Possible reaction: Keloid scar,

suppurative regional adenitis; disseminated BCG infection & osteomyelitis in immunocompromised

Oral Polio Vaccine (OPV)

• Given at 2,4,6 months • Minimum age: 6 weeks• 1st booster: 1 year after the primary dose• 2nd booster: 4-6 years• Dose: 0.5 ml orally for single dose

preparation or 2 drops for multiple dose preparation

• Lifelong immunity with >90% efficacy• Possible reaction: paralytic polio -

extremely rare• Advantage over IPV: ease of

administration and better intestinal immunity conferment

Measles Vaccine

• Live attenuated virus• Given at 9 months or later; maybe

given as early as 6 months• 1 dose SQ• Booster: 2nd dose given at 15mos. If 1st

dose given below 1 year• 3rd dose given at 5-12 years as part of

MMR• 95% efficacy with at least 12 years of

immunity• Possible reaction: fever and rash 5-10

days after dose

Expanded Program of Immunization for Infants

(EPI)Vaccine Minimum

age at 1st dose

Number of Doses

Minimum Interval

Between Doses

1) BCG Birth or anytime after birth

1

2) DPT 6 weeks 3 4 weeks

3) OPV 6 weeks 3 4 weeks

4) Hepa B vaccine

At birth 3 4 weeks

5) Measles vaccine

9 months 1