1. IMMUNIZATIONS, PART I Janine Clark Adjo, M.D.

2. 2010 IMMUNIZATION SCHEDULE

3. DTaP (IM) Diptheria and Tetanus components are bacterial toxoids (modified bacterial toxin that has been made nontoxic but retains ability to stimulate antibody production) Acellular pertusis- inactivated acellular bacterial components

4. DTaP DTaP- for use in children <7 DT- for use in children <7, in whom pertussis vaccine is contraindicated Dt- Tetanus toxoid, with 1/3- 1/6 the dose of diptheria toxoid, for use >7 DTP- whole cell pertussis no longer marketed in US

5. DTaP INDICATIONS Routine schedule- 2 mths, 4mths, 6mth, 15-18 mths, followed by Tdap at 11/12 years and then every 10 years Unimmunized pregnant women Tetanus prophylaxis, wound management

6. DTaP True Contraindications Anaphylaxis to vaccine or constituent of vaccine Encephalopathy within 7 days of receiving vaccine, then use DT for remaining doses

7. DTaP PRECAUTIONS Moderate or severe illness regardless of fever Seizure within 3 days of administration Persistent crying within 48 hours of prior dose Collapse or hypotonic/hyporesponsive episode within 48 hours of prior dose Neurologic disorders

8. DTaP SIDE EFFECTS Erythema, swelling, pain, fever, irritability Anaphylaxis Seizure Hyporesponsive/hypotonic episode Persistent crying Fever >105

9. DTaP Different Formularies Daptacel- Sanofi Pasteur Tripedia- Sanofi Pasteur Infanrix- GlaxoSmithKline DT- Sanofi Pasteur Td- Decavac- Sanofi Pasteur Adacel/Boostrix- Tdap- Sanofi Pasteur/GSK

10. DTaP Different formularies TriHIBit- Sanofi Pasteur Pediarix- GSK Pentacel- Sanofi Pasteur Kinrix- GSK

11. Haemophilus Influenza Type B Hib (IM) Conjugate vaccine of Hib capsular polysaccharide antigen and a carrier protein to enhance immunogenicity Two types 1) PRP+CRM- given at 2,4,6, and 12-15 months 2) PRP+OMP- given at 2, 4, 12-15 months

12. HiB Routine vaccination has led to a 99% decrease in invasive Hib disease Schedule for unimmunized children 1)7-11 months: 3 doses, 2 months apart 2)12-14 months: 2 doses 2 months apart 3)15-59 months: 1 dose 4) >5 does not require immunization

13. HiB Side Effects/Contraindications Local pain, erythema, swelling, fever, irritability Anaphylaxis

14. HiB Different Formularies HiB, HbOC, conjugate, 4 dose- Hib titer, Wyeth HiB, PRP-OMP, conjugate, 3 dose- pedvaxHiB, Merck HiB, PRPT, conjugate, 4 dose, ActHiB, Sanofi Pasteur DTaP-HiB, TriHiBit, Sanofi Pasteur Hep B/Hib- Comvax, Merck

15. Hepatitis B (IM) Inactivated viral antigen Required for middle school entry in 1998 Routine schedule 0-2 months, 1-4 months, 6-18 months Dose 3 cannot be given prior to 6 months

16. Hepatitis B Side Effects/Contraindications Pain at site, fever Anaphylaxis to vaccine or Baker’s yeast

17. Hepatitis B Different Formularies Hepatitis B, Recombivax, Merck Hepatitis B, Energix- B, GSK Hep B/Hib, Comvax, Merck

18. POLIO (SC or IM) IPV- trivalent vaccine of inactivated polio virus types 1, 2, and 3, grown in human diploid cells Routine schedule- 2 mths, 4 mths, 6 mths, 4-6 years

19. POLIO Side effects/Contraindications Pain, swelling and erythema at site Anaphylaxis to vaccine, polymyxin B, neomycin, or streptomycin

20. POLIO Different Formularies IPV, IPOL, Sanofi Pasteur Pentacel, Sanofi Pasteur Pediarix, GSK

21. Pneumococcal Vaccine (IM) Prevnar 13- Pneumococcal Conjugate vaccine comprised of 13 capsular polysaccharides of Streptococcus pneumoniae Routine schedule 2mths, 4 mths, 6mths, 12-15 mths

22. Prevnar Side effects/Contraindications Pain, swelling, and erythema at site of injection Fever, irritability, decreased appetite Anaphylaxis to vaccine

23. Prevnar Different Formularies Prevnar, Wyeth

24. Pneumococcal vaacine Different Formularies Pneumovax (IM or SC)- pneumococcal polysaccharide vaccine, 23 valent, Merck Ages 2 and up Immunosuppressed patients