immunization

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height="220">  </B></div> <bR> <div> <A HREF="id18.htm" TARGET="_top" TITLE="PEARLS 1"><U><B>PEARLS 1</B></U></A></div> <div> <A HREF="id27.htm" TARGET="_top" TITLE="pearls2"><U><B>pearls2</B></U></A></div> <div> <A HREF="id30.htm" TARGET="_top" TITLE="Phenylketonuria (PKU)"><U><B>Phenylketonuria (PKU)</B></U></A></div> <div> <A HREF="id31.htm" TARGET="_top" TITLE="food poisoning"><U><B>food poisoning</B></U></A></div> <div> <A HREF="id32.htm" TARGET="_top" TITLE="acute otitis"><U><B>acute otitis</B></U></A></div> <div> <B>immunization</B></div> <div> <A HREF="id34.htm" TARGET="_top" TITLE="craniofacial anomaly"><U><B>craniofacial anomaly</B></U></A></div> <div> <A HREF="id35.htm" TARGET="_top" TITLE="chiari malformation"><U><B>chiari malformation</B></U></A></div> <div> <A HREF="id36.htm" TARGET="_top" TITLE="PEDIATRIC RESPIRATORY DISORDERS"><U><B>PEDIATRIC RESPIRATORY DISORDERS</B></U></A></div> <div> <A HREF="id37.htm" TARGET="_top" TITLE="Cephalhematoma "><U><B>Cephalhematoma </B></U></A></div> <div> <A HREF="id38.htm" TARGET="_top" TITLE="Subgaleal Hematoma"><U><B>Subgaleal Hematoma</B></U></A></div> <div> <A HREF="id39.htm" TARGET="_top" TITLE="BIRTH INJURY "><U><B>BIRTH INJURY </B></U></A></div> <div> <A HREF="id40.htm" TARGET="_top" TITLE="infectious in a new born"><U><B>infectious in a new born</B></U></A></div> <div> <A HREF="id41.htm" TARGET="_top" TITLE="jaundice"><U><B>jaundice</B></U></A></div> <div> <A HREF="id42.htm" TARGET="_top" TITLE="INFANT OF DIABETIC MOTHER (IDM) "><U><B>INFANT OF DIABETIC MOTHER (IDM) </B></U></A></div> <div> <A HREF="id43.htm" TARGET="_top" TITLE="FETAL GROWTH "><U><B>FETAL GROWTH </B></U></A></div> <div> <A HREF="id44.htm" TARGET="_top" TITLE="Moebius Syndrome"><U><B>Moebius Syndrome</B></U></A></div> <div> <A HREF="id45.htm" TARGET="_top" TITLE="SHORT STATURE"><U><B>SHORT STATURE</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="MICROCEPHALIA"><U><B>MICROCEPHALIA</B></U></A></div> <div> <A HREF="id47.htm" TARGET="_top" TITLE="PIERRE ROBIN SYNDROME "><U><B>PIERRE ROBIN SYNDROME </B></U></A></div> <div> <A HREF="id19.htm" TARGET="_top" TITLE="Prenatal Diagnosis"><U><B>Prenatal Diagnosis</B></U></A></div> <div> <A HREF="id28.htm" TARGET="_top" TITLE="Febrile Seizures "><U><B>Febrile Seizures </B></U></A></div> <div> <A HREF="id20.htm" TARGET="_top" TITLE="dvlp bis"><U><B>dvlp bis</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="DEVELOPMENTAL NEUROLOGIC DISEASES"><U><B>DEVELOPMENTAL NEUROLOGIC DISEASES</B></U></A></div> <div> <A HREF="id22.htm" TARGET="_top" TITLE="GENETIC DISEASES "><U><B>GENETIC DISEASES </B></U></A></div> <div> <A HREF="id26.htm" TARGET="_top" TITLE="angelman syndrome"><U><B>angelman syndrome</B></U></A></div> <div> <A HREF="id23.htm" TARGET="_top" TITLE="TAYSACHS DISEASE"><U><B>TAY-SACHS DISEASE</B></U></A></div> <div> <A HREF="id24.htm" TARGET="_top" TITLE="krabbes disease"><U><B>krabbe's disease</B></U></A></div> <div> <A HREF="id25.htm" TARGET="_top" TITLE="Refsums Disease"><U><B>Refsum's Disease</B></U></A></div> <div> <A HREF="id29.htm" TARGET="_top" TITLE="meningitis"><U><B>meningitis</B></U></A></div> <div> <A HREF="id17.htm" TARGET="_top" TITLE="Contact Me"><U><B>Contact Me</B></U></A></div> </td> <td valign="top" height=355 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> immunization</div> <div> <IMG SRC="09819c50.gif" border=0 width="537" height="453" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="0990d880.gif" border=0 width="525" height="392" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <div> <IMG SRC="09afcd50.gif" border=0 width="508" height="213" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="09bdbdb0.gif" border=0 width="475" height="219" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="09c13a90.gif" border=0 width="531" height="425" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div> <IMG SRC="1094e580.gif" border=0 width="590" height="344" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"><IMG SRC="10a403b0.gif" border=0 width="576" height="827" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <div>  <A NAME="1"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>STANDARD CHILDHOOD IMMUNIZATIONS — Immunization against hepatitis A and B, diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, Hib, pneumococcus, and varicella-zoster virus (VZV) is considered the standard for the United States </div> <div> . The <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pneumococcal conjugate vaccine</U></FONT> (Prevnar) was added to the vaccination schedule in 2000. Vaccine requirements for school entry vary from state to state.</div> <bR> <div>  <A NAME="2"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Hepatitis B vaccine — Nearly 250,000 people in the United States contract acute hepatitis B virus (HBV) infection each year]. More than one million individuals in this country have chronic liver disease and hepatocellular carcinoma. Although acute HBV infection can occur at any age, the number of cases increases during adolescence. Acquisition of HBV at a younger age is associated with an increased probability of developing chronic HBV infection, cirrhosis, or hepatocellular carcinoma. HBV is transmitted from exposure to contaminated blood, sexual intercourse, and vertically from mother to infant at the time of delivery.</div> <bR> <bR> <div> Guidelines are also available for administering HbCV to patients with immunologic impairment including:</div> <bR> <div> • HIV infection</div> <div> • IgG2 subclass deficiency</div> <div> • Sickle cell disease</div> <div> • Those receiving chemotherapy for malignancies</div> <div> • Bone marrow transplant recipients</div> <div> • Splenectomized patients.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">For patients in any of these categories who are 12 to 60 months of age and have received either one or no previous HbCV injections, two doses of any of the preparations should be given two months apart. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">For patients with sickle cell disease or asplenia who are older than 59 months and have had no previous HbCV, a single dose should be given, and for those with HIV infection, IgG2 subclass deficiency, bone marrow transplant, or malignancy, two doses separated by one to two months are suggested </div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Patients with invasive Hib disease who are younger than two years of age, regardless of previous history of having received HbCV, should be given HbCV during convalescence according to the age appropriate schedule for unvaccinated children.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> Patients whose disease occurred at age 24 months or later do not need immunization.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">To reduce the number of injections, a combination vaccine, HbCV-DTaP is available. It has been approved for use only as the fourth dose of DTaP in children 15 months or older.</div> <bR> <div>  <A NAME="13"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A><B>Measles-mumps-rubella vaccine</B> — Measles, mumps, and rubella live-virus vaccines, although available for separate single-antigen administration, are preferably given subcutaneously as a combination MMR vaccine. Previous guidelines recommended a first dose of MMR at 12 to 15 months of age and a second dose at either four to six or 11 to 12 years of age. Current guidelines recommend that the second dose be administered routinely at school entry (age four to six years) . To rapidly complete a two-dose MMR series, a minimum interval of one month is required.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">For patients who are older than 12 years, who were born after 1956, or who do not have adequate history or documentation of having received either dose of MMR, one or two doses should be given. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">This guideline is particularly true for healthcare workers, for people involved in post-high school education, and during epidemics  MMR should not be administered to women who are pregnant or are contemplating pregnancy in the next three months, particularly because of the rubella component of the vaccine.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0"> However, data in pregnant patients who have inadvertently received this vaccine from the Centers for Disease Control and Prevention (CDC) have revealed no case of adverse fetal outcome.</div> <bR> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Parenterally administered immune globulin can blunt or block the host response to certain live-virus vaccines. </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.gif" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Suggested guidelines from the Committee on Infectious Diseases of the AAP regarding length of interval between administration of various immune globulin preparations and MMR or monovalent <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>measles vaccine</U></FONT> should be consulted</div> <bR> <div>  <A NAME="14"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Contraindications — True contraindications to administration of MMR vaccine include pregnancy, known altered immunodeficiency states such as congenital immunodeficiencies, long-term immunosuppressive therapy, and hematologic or solid tumors. Immunization should be withheld temporarily from patients with moderate or severe febrile illnesses until the acute phase has subsided. Patients experiencing thrombocytopenia within six weeks of having had MMR vaccine probably should not receive a subsequent dose.</div> <bR> <div>  <A NAME="15"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Immunocompromised patients — MMR should be administered to all asymptomatic HIV-infected persons and to HIV-infected persons who are not severely immunocompromised and who have no evidence of measles immunity. Routine immunization of the severely immunocompromised HIV-infected individual remains controversial. Should a person in this latter group be at risk for measles exposure during an outbreak, the choice between measles vaccination and immune globulin prophylaxis should be considered.</div> <bR> <div>  <A NAME="16"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Adverse reactions — Reports suggest that anaphylactic reactions to measles-containing vaccines are associated not with hypersensitivity to egg antigens but with some other component of the vaccines Because MMR and its component vaccines contain hydrolyzed gelatin, as a stabilizer, and trace amounts of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>neomycin</U></FONT>, extreme caution should be used before the vaccine is given to individuals with a history of anaphylaxis to these additives.</div> <bR> <div>  <A NAME="17"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Varicella vaccine — VZV vaccine (Varivax) was added to the list of standard childhood vaccines in 1995. Before its recommended use, an estimated 3.7 million cases of chickenpox occurred in the United States annually, resulting in nearly 9000 hospitalizations and approximately 100 deaths . A cost-effectiveness study of vaccination in 1994 estimated savings of nearly $400 million in the costs of medical care and time lost from work for parents </div> <bR> <div> VZV vaccine is recommended for routine administration to all immunocompetent children at 12 to 18 months of age. However, anyone one year or older without a history of having had chickenpox can be immunized. For individuals between ages 1 and 13 years, a single subcutaneous injection is required; after age 13, two injections given four to eight weeks apart are needed </div> <bR> <div> VZV vaccine appears to confer a high rate of protection against severe disease. Seroconversion rates for children one to 12 years of age are >95 percent, and for those older than 12 years, 94 percent. Ongoing studies from the United States and Japan indicate that antibodies to VZV are present 10 years after immunization in more than 95 percent of recipients.</div> <bR> <div>  <A NAME="18"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Contraindications — Contraindications to giving VZV vaccine include primary or acquired immunocompromised states, pregnancy, moderate or severe illnesses, and a previous anaphylactoid reaction to <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>neomycin</U></FONT>. As a precaution, salicylates should not be administered for at least six weeks after the vaccine has been given because of an association between salicylates, acute VZV infection, and the development of Reye syndrome </div> <bR> <div>  <A NAME="19"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Adverse reactions — Approximately three to five percent of all patients develop either a localized rash or a generalized varicella-like rash consisting of two to five lesions within one month of immunization. Most of the varicella-form rashes that occur within the first two weeks after varicella immunization are caused by wild-type VZV. Approximately one-fifth of children and up to one-third of adolescents and adults complain of pain, tenderness, or redness at the injection site. Temperature higher than 102 ºF, occurring up to 1.5 months after varicella immunization, has been noted in 15 percent of patients, but because of similar febrile response in placebo recipients, the reaction is not considered significant </div> <bR> <div> The FDA in association with the CDC have published the results of more than three years of reports to the United States Vaccine Adverse Event Reporting System (VAERS) postlicensure of the <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>varicella vaccine</U></FONT>; 6574 reports were received for a rate of 67.5 per 100,000 doses sold  Four percent of these reports were of serious adverse events, none of which could be confirmed to have resulted from varicella vaccination although some were caused by wild-type VZV and several remain under investigation. The authors conclude that most reactions to varicella vaccination are mild.</div> <bR> <div> VZV has been recovered from skin lesions of healthy vaccine recipients, yet no clinical case of varicella has occurred in contacts of those vaccinees. Subclinical or extremely mild cases of varicella have been reported in contacts of vaccinees with leukemia. Children with acute lymphocytic leukemia in remission for at least one year and with platelet counts >100,000/mm3 and lymphocyte counts higher than 700/mm3 twenty-four hours before immunization should be considered potential recipients </div> <bR> <div>  <A NAME="20"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Risk of herpes zoster — Although herpes zoster has been noted in both immunocompetent and immunosuppressed recipients of <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>varicella vaccine</U></FONT>, data from postlicensure surveillance indicate that the age-specific risk for this condition is less in immunocompetent hosts who received the vaccine than in those who acquired the natural disease. However, care must be taken in interpreting these data because the rates obtained for those having had natural disease are based upon patient populations monitored actively for longer periods of time when compared to the shorter time of passive surveillance following immunization. Wild-type VZV also has been identified in persons with herpes zoster after immunization, indicating that herpes zoster in immunized persons also may result from antecedent natural varicella infection </div> <bR> <div>  <A NAME="21"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Pneumococcal vaccine — Streptococcus pneumoniae is the leading cause of bacterial pneumonia worldwide and a principal cause of sepsis and meningitis , particularly in infants and children younger than two years of age. The <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pneumococcal conjugate vaccine</U></FONT> was added to the recommended childhood immunization schedule in 2001</div> <bR> <div>  <A NAME="22"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Pneumococcal polysaccharide vaccine — The 23-valent <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pneumococcal polysaccharide vaccine</U></FONT> (Pneumovax 23), which has been available for many years, has not been considered effective in children younger than two years old because of their minimal antibody response to most polysaccharide antigens. In immunocompetent hosts older than two years of age, the polysaccharide vaccine is considered to be 55 to 60 percent effective in preventing invasive pneumococcal disease </div> <bR> <div>  <A NAME="23"><IMG BORDER="0" SRC="1x1.gif" HEIGHT="1" ALIGN="bottom" WIDTH="1" HSPACE="0" VSPACE="0" ></A>Pneumococcal conjugate vaccine — Approximately 80 percent of invasive disease in children is caused by seven serotypes: 4, 6B, 9V, 14, 18C, 19F, 23F ]; among these, the serotypes that are most frequently penicillin-resistant are: 6B, 9V, 14, 19F, 23F . A seven-serotype <FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><U>pneumococcal conjugate vaccine</U></FONT> (Prevnar [PCV-7]) was recently added to the recommended immunization schedule for children. (</div> <div> . The vaccine consists of seven capsular serotypes of Streptococcus pneumoniae conjugated to CRM197 (a nontoxic mutant of diphtheria toxin). Like Haemophilus influenzae conjugate vaccine, this vaccine enhances immunogenicity by eliciting T-cell-dependent responses.</div> <bR> <div> The AAP, the ACIP, and the AAFP have recommended that all children up to two years of age receive the number of vaccine doses appropriate for their ages as follows </div> <bR> <div> • A total of four 0.5 mL IM injections should be administered. The first three doses should be at two, four, and six months of age. The first dose can be given as early as six weeks of age. A minimum of four weeks between the three doses is acceptable. The fourth dose should be given at 12 to 15 months of age but at least two months after the third dose.</div> <bR> <div> • For older infants and children not immunized before six months of age, the number of recommended doses decreases depending upon the age at the time of first vaccination. Children seven to 11 months of age need only three doses, with the first two doses at least four weeks apart. The third dose should be administered when the child is older than one year of age and at least two months after the second dose. For patients 12 to 23 months of age, only two doses are needed. They should be given at least two months apart. Children who are at least 24 months of age and up to 10 years of age need only a single dose.</div> <bR> <div> The vaccine also should be given to those children two to five years old considered to be at high risk for invasive pneumococcal disease, including those with sickle cell disease, other types of functional or anatomic asplenia, HIV infection, or primary immune deficiency and those receiving immunosuppressive therapy</div> <div> . The recommended immunization schedule for these high-risk children again depends upon the age of the child</div> <bR> <div> Other children between the ages of two and five years with a moderate risk of pneumococcal infection can be considered for receipt of the PCV-7, but no data exist upon which to base a firm recommendation. </div> <bR> <div> These children include </div> <bR> <div> • All children 24 to 35 months of age.</div> <bR> <div> • Children 36 to 59 months of age who attend out-of-home care (at least four hours per week with at least two unrelated children).</div> <bR> <div> • Children 36 to 59 months of age who are of African American, American Indian, or Alaskan Native descent.</div> <bR> <div> • Children 24 to 59 months of age who are socially or economically disadvantaged, are living in crowded or substandard housing, are homeless, have persistent or recurrent exposure to tobacco smoke, or have a history of severe or recurrent otitis media within the year prior to immunization or prior placement of a tympanostomy tube.</div> <bR> <bR> </td> </tr></table></body>