Recommended Immunization Schedules for Children and Adolescents, 2007 CRISBERT I. CUALTEROS, M.D. http://crisbertcualteros.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.

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.

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.

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 birth ALL 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

1st Dose : At birth

ALL 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

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

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 1 st 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

Minimum age: 6 weeks

1 st 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 3 rd 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

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 3 rd 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

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

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

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.

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

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

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 1 st 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

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 1 st 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.

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

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.

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 1 st dose : females at 11-12 years 2 nd dose : 2 months after the 1 st dose 3 rd dose : 6 months after the 2 nd dose Administer the HPV vaccine series to females at age 13-18 years if not previously vaccinated.

Minimum age: 9 years

1 st dose : females at 11-12 years

2 nd dose : 2 months after the 1 st dose

3 rd dose : 6 months after the 2 nd 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.

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

Minimum age: 2 years

Administer or certain high risk groups

Influenza vaccine Children aged <9 years who are receiving influenza vaccine for the 1 st time should receive 2 doses Separated by ≥ 4 weeks for TIV By ≥ 6 weeks by LAIV

Children aged <9 years who are receiving influenza vaccine for the 1 st 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

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

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.

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.

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

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

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 1 st booster: 1 year after the primary dose 2 nd 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

Given at 2,4,6 months

Minimum age: 6 weeks

1 st booster: 1 year after the primary dose

2 nd 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 : 2 nd dose given at 15mos. If 1 st dose given below 1 year 3 rd 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

Live attenuated virus

Given at 9 months or later ; maybe given as early as 6 months

1 dose SQ

Booster : 2 nd dose given at 15mos. If 1 st dose given below 1 year

3 rd 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) 1 9 months 5) Measles vaccine 4 weeks 3 At birth 4) Hepa B vaccine 4 weeks 3 6 weeks 3) OPV 4 weeks 3 6 weeks 2) DPT 1 Birth or anytime after birth 1) BCG Minimum Interval Between Doses Number of Doses Minimum age at 1 st dose Vaccine

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