IMMUNIZATION SCHEDULE             

A.        IMMUNIZATION SCHEDULE                                                                       

                         Age of Child                             Immunization                                                               

                        Birth                                         Hepatitis B

                        1 month                                    Hepatitis B

                        2 months                                  DTaP, IPV, Hib, RotaTeq

                        3 months                                  Prevnar

                        4 months                                  DTaP, IPV, Hib, RotaTeq

                        5 months                                  Prevnar

                        6 months                                  DTaP, Hib, RotaTeq

                        8 months                                  Hepatitis B, Prevnar

                        12 months                                Varivax, Prevnar, Hepatitis A

                        15 months                                MMR, Hib

                        18 months                                DTaP, IPV, Hepatitis A

                        5 years                                     DTaP, IPV, MMR, Varivax*****

                        11-12                                       Tdap, Menactra, Gardasil****

                        13-15 years                              Tdap, Menactra***

                        College                                    Menactra ***                                           

            Explanation of abbreviations:

            DTaP   =          diphtheria, tetanus, acellular pertussis (whooping cough)

            Tdap   =          adult tetanus, diphtheria, acellular pertussis***

            MMR   =          measles, mumps, rubella

            Hib       =          Hemophilus influenzae type b

            Hepatitis B=     Hepatitis B *

            Varivax=          Varicella (chickenpox)

            IPV      =          inactivated polio vaccine

            Prevnar=          pneumococcal vaccine**

            Menactra=       meningococcal  (meningitis) vaccine***

            Gardasil=        human papilloma virus vaccine****

            RotaTeq=        rotavirus vaccine

            *Hepatitis B should be done at any age if not done in infancy.

            ** Prevnar should be done at any age 2 or under if not done in infancy.

            *** Tdap should be done at age 13-15 if not done at 11-12, Menactra should be done at age 14-15 if not done at

                11-12 or if not done by college should be done then.

            **** Gardasil is given to girls ages 11-26

            *****Varivax booster is now recommended for anyone older than 4-6 who has had one prior Varivax

  B.      MEASLES, MUMPS AND GERMAN MEASLES (RUBELLA)

           Measles

         Measles is a serious communicable disease that produces a high fever, cough and rash that lasts for one to two weeks.  Measles outbreaks have occured in the United States and, in particular, in New Jersey and New York.  One out of every ten children who contract measles will have an ear infection or pneumonia, and measles can cause encephalitis in some children producing seizures, spasms, twitching, jerking or staring spells, hearing loss and mental retardation.  This happens to about one out of every thousand children reported to have the disease and in the United States one child out of five hundred to ten thousand who gets measles dies.  Babies and adults who contract measles are more often sicker and more likely to suffer longer or die than an elementary school child or teenager with the measles.       

          Mumps

         Mumps causes fever, headache and swollen and painful glands under the jaw.  Mumps can be a very serious disease that lasts for several days.  It is passed from person to person and can cause inflammation of the brain such as meningitis in about one out of every ten people that get it.  Before there was a mumps vaccine, many children had hearing loss by mumps and one out of every four teenage adult males with mumps had painful swelling of the testicles for several days called orchitis.           

          Rubella or German Measles

         Rubella is a mild disease that lasts for a short time.  However, when a pregnant woman contracts the disease, it could be very dangerous for her unborn baby.  Up to half of the women who contract rubella when they are pregnant will lose their babies or have babies born with heart disease, blind, deaf or mentally retarded.  People who contract rubella usually have fever, swollen glands and a rash that lasts up to three days and sometimes soreness in the joints and swelling.           

         MMR is the combination vaccine used to prevent the above diseases.  Reactions to the mumps component are rare, but appear as a little swelling of the glands in the cheeks under the jaw.  It lasts for a few days. Reactions to the rubella component (German Measles) are also rare, but are known to be lymph gland swelling in the neck or a rash for one to two days, occurring one to two weeks after the immunization is given.  A transient arthritis or stiff joints may occur one to three weeks after the immunization, but is more common in adults. The measles vaccine can result in a fever and rash about 7 to 10 days after the injection.  The symptoms need no treatment.

 C.       POLIO

         Polio is a disease caused by a virus.  Some children who get this disease become paralyzed.  This means they are unable to move their body parts and they may even die from the disease.  The serious cases of polio cause severe muscle pain and make a person unable to move arms, legs or have difficulty breathing without the help of a machine.  Mild cases of polio may only last a few days and may cause the person to have a fever, sore throat, stomachache and headache.  There are no drugs to cure people with polio.  How sick people get with the disease and how much they recover is different from person to person.  Most people who are afflicted by polio will have some weakness in the arm or leg for the rest of their lives or be paralyzed.  Many will be seriously disabled.      

         IPV is the vaccine given for all polio vaccine doses.  The IPV is injectable as opposed to oral.  Since it is not a live virus vaccine, there is not the risk of contracting polio from the vaccine.  Patients who will be living in third world countries may still benefit from having the oral vaccine.

 D.       DIPHTHERIA, TETANUS AND PERTUSSIS (WHOOPING COUGH)

             Diphtheria is a very serious disease.  It can make a person unable to breathe, cause paralysis and heart failure; about one out of every ten people that gets diphtheria dies. 

          Tetanus (sometimes called lockjaw) is a very serious disease that can occur after a cut or a wound lets the germ into the body.  Tetanus makes a person unable to open his or her mouth or swallow and causes muscle spasms.  In the United States tetanus kills three out of every ten people who get the disease.

          Pertussis (commonly called whooping cough) may be a mild or serious disease.  It's passed from one person to another.  Pertussis can cause spells of coughing or choking that make it hard to eat, drink or breathe.  The coughing can last for several weeks.  Pertussis is most dangerous to children less than one year old.  Even with modern medical care, complications occur.  Most children are so sick they have to be hospitalized.  As many as sixteen out of one hundred babies will get pneumonia.  As many as two out of one hundred will have convulsions.  About one out of two hundred will have brain problems lasting the rest of their life.  About one in two hundred babies will die.  Serious illness is less likely in older children and adults.

The pertussis vaccine we use currently is an acellular pertussis vaccine.  It is combined with diphtheria and tetanus and is called DTaP or TDaP(for ages 11 and up).  This vaccine has been shown to have fewer reactions than the DTP vaccine and is just as effective.

E.         PERTUSSIS VACCINE CONCERNS 

          The pertussis vaccine scare has made some parents postpone their child's immunizations.  Keep in mind that pertussis is a very dangerous disease.  The chance (1:3000) of getting whooping cough without the vaccine is much greater than the risk (1:300,000) of having a neurological reaction to the vaccine.  The American Academy of Pediatrics has stated clearly that "the risk of suffering and death caused by whooping cough is far greater than the possible side effects of the vaccine."  The pertussis vaccine should be withheld initially only in children with seizures or serious neurologic disease

F.         VACCINE AGAINST HEMOPHILUS INFLUENZAE TYPE b (HIB)

          Hemophilus influenzae b is a bacteria that causes several life-threatening diseases (e.g., meningitis, epiglottitis, and pneumonia) in young children.  This vaccine (HIB), first released in mid-1985, gave over 90% protection against these diseases.  New "conjugate" vaccines licensed in 1988 have provided 98% protection and can be administered at an earlier age.           

          All side effects have been minor.  Pain or swelling at the injection site occurs in 1.5% of children and mild fevers occur in 7%.           

          If your child is over 15 months of age, the vaccine can still be helpful if given through age 5 (American Academy of Pediatrics, Committee on Infectious Diseases, 1988).

  G.        VARIVAX (VARICELLA, I.E. CHICKENPOX VACCINE) 

Although varicella is a fairly benign disease in most healthy children, there are potential complications.  Also, the disease can be much more severe in adolescents and adults.  There is also a high cost to families in terms of lost work and school time.

 Varivax, the vaccine for chickenpox is approved to give to children over 1 year of age, who have not yet had chickenpox.  The American Academy of Pediatrics is recommending the use of this vaccine.  The vaccine is a live attenuated vaccine, as is the MMR vaccine.  It is required by law in New Jersey for all children in day care 19 months of age or older and school age children born after January 1, 1998.  There is also now a booster recommended.

         The recommendations are for children 12 months-12 years to receive 2 doses of the vaccine at least 3 months apart. All children routinely should receive the first dose at 12-15 months of age and a 2^nd dose at age 4-6.  From age 13 and up, they should receive 2 doses spaced 1-2 months apart (if they have not already had chickenpox or a previous dose of varivax).  Anyone 13 and older who has had one varivax need only have one booster.

           Immunodeficient children should not receive the vaccine, but family members may.  Children on high dose steroids should not receive the vaccine unless they have been off steroids for a period of time.  There is no evidence showing that the vaccine will prevent the disease if received after exposure.

          The reactions to the vaccine may be rash(7-8%), local pain or redness at the injection site(20-30%), fever(15%) and occasionally headache, fatigue and upper respiratory infection symptoms.

H.        HEPATITIS B IMMUNIZATION 

          The American Academy of Pediatrics has recommended universal immunization of infants, children and adolescents against Hepatitis B.  Hepatitis B is a virus for which there is no cure.  It is one of the many types of Hepatitis, but is usually the one that causes the most illness. 

          It may lead to a chronic infection of the liver and a serious disease.  It may not show signs of infection until years later when the patient develops liver failure and/or liver cancer. 

          Hepatitis B virus is transmitted in several ways: (1) from mother to infant at the time of birth, (2) children living in the same household with a Hepatitis B  carrier, (3) through sexual intercourse or through sexual contact with infected blood, (4) drug use, (5) swimming in water contaminated by raw sewage and (6) blood and blood products. 

          The Hepatitis B vaccination is a recombinant vaccination and is genetically engineered.  It contains no serum or blood products as the old vaccination did.  No serious reactions have been associated with this vaccine and most children have no side effects.  Occasionally there may be fussiness and soreness, swelling or redness where the shot was given.  These symptoms can occur within 24-48 hours after the shot. 

         The American Academy of Pediatrics has recommended the use of this safe vaccination to eradicate Hepatitis B from this generation of young people.  More than 95% of the children who receive all the recommended doses of Hepatitis B vaccination are protected against the illness by the Hepatitis B virus.  It is a series of three immunizations.  The first injection is given, followed by the second injection one to two months later and a third injection at six to eighteen months later. 

          It is now New Jersey law that all school children born after January 1, 1996 have the Hepatitis B vaccine. 

I.       PREVNAR (PNEUMOCOCCAL VACCINE) 

Each year in the U.S. invasive pneumococcal disease is responsible for approximately 40,000 deaths, 3000 cases of meningitis, 50,000 cases of bacteremia (bacteria in the bloodstream) and 7,000,000 cases of otitis media (ear infections). 

The pneumococcal vaccine (Prevnar) is now available to protect infants and children from the invasive diseases this bacteria (streptococcus pneumoniae) can cause (meningitis, pneumonia and some ear infections). 

This is a safe and effective vaccine.  The most common side effects (if any) are: fever, local reaction at the injection site and irritability. 

The vaccine is recommended routinely for 2 month to 2 year olds and for those 2-5 year olds who are at increased risk. 

J.       MENACTRA (MENINGOCOCCAL VACCINE) 

Meningitis is an infection of the spinal fluid, usually caused by a virus or one of several types of bacteria.  Viral meningitis is less severe and resolves without specific treatment. There are three types of bacterial meningitis, for which we have vaccines and antibiotic treatment.  Younger children receive vaccines for Hemophilus influenzae type b (HIB) and pneumococcal (Prevnar) meningitis.  Meningococcal meningitis is the third type of bacterial meningitis, which is often fatal because of its rapid progression and its high level of contagiousness.  Symptoms of meningitis are high fever, headache, stiff neck and also may include nausea, vomiting, extreme light sensitivity, confusion and sleepiness.  A rash may also occur with meningococcal meningitis. 

Although meningococcal meningitis may occur at any age, certain lifestyle factors may increase the risk of contracting and spreading the disease.  These are direct contact with an infected individual, especially through saliva, crowded living conditions and active or passive smoking.  Until this year, the vaccine that was available to protect against this disease (Menomune) was given primarily to those adolescents/young adults going off to college, because of the above risk factors.  That vaccine had been shown to last for approximately 3-4 years. The American Academy of Pediatrics now recommends the new meningococcal vaccine (Menactra), which lasts longer and may be boosted if it turns out to be necessary as future studies are done.  The recommended ages for the vaccine are:

·        11-12 year olds

·        adolescents at age 14-15 or high school entry, whichever comes first

·        college freshman living in dormitories (many colleges,  including all New Jersey colleges,

     require this vaccine.

·        other groups at high risk (those with underlying medical conditions or those traveling to areas with a high    incidence of meningococcal disease). 

Once the supply of the vaccine is adequate, in 1-3 years, the vaccine will be recommended for all adolescents, 11 and up.  The vaccine may also be approved for 2-10 year olds in the future. 

We will be vaccinating those children in the above groups at their physicals.  If your child falls into any of these groups and has already had his/her physical this year and you wish them to have the vaccine, please call our office for an appointment.

K.    GARDASIL

Gardasil is a new vaccine that helps protect against the following diseases caused by certain Human             Papillomavirus (HPV) Types:  cervical cancer (cancer of the lower end of the uterus or womb), abnormal and        precancerous cervical, vaginal and vulvar lesions and genital warts. Gardasil helps prevent these diseases – but it will not treat them. 

HPV is a common virus. In 2005, the Centers for Disease Control and Prevention (CDC) estimated that 20 million people in the United States had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people the virus goes away on its own. When the virus does not go away it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type.

In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk. Many people who have HPV may not show any signs or symptoms. This means that they can transmit the virus to others and not know it.

Cancer of the cervix is a serious disease that can be life-threatening. This disease is caused by certain HPV types that can cause the cells in the lining of the cervix to change from normal to precancerous lesions. If these are not treated, they can turn cancerous.

 Genital warts are caused by certain types of HPV. They often appear as skin-colored growths. They are found on the inside or outside of the genitals. They can hurt, itch, bleed, and cause discomfort. These lesions are usually not precancerous. Sometimes, it takes multiple treatments to eliminate these lesions.

 Vaccination does not substitute for routine cervical cancer screening. Females who receive Gardasil should continue cervical cancer screening.

 As with all vaccines, Gardasil may not fully protect everyone who gets the vaccine. Gardasil will not protect against diseases due to non-vaccine HPV types. There are more than 100 HPV types; Gardasil helps protect against 4 types (6, 11, 16, and 18). These 4 types have been selected for Gardasil because they cause approximately 70% of cervical cancers and 90% of genital warts. This vaccine will not protect you against HPV types to which you may have already been exposed.  Gardasil works best when given before any contact with these types of HPV. Gardasil is approved for girls and women 9 through 26 years of age, but is currently recommended for ages 11-26.

It is given as a series of 3 injections; the second is 2 months after the first and the 3^rd is 6 months after the first.  The side effects, if any are pain, swelling, itching and redness at the injection site and fever.

If you are interested in having your daughter receive this vaccine, please contact our office so that we may order it for you.

L.    ROTATEQ 

Rotavirus is a virus that causes severe diarrhea, often with vomiting and fever, mostly in babies and young children.  It occurs mainly between November and May.  It can cause severe dehydration, leading to hospitalization and occasionally death.  It is very contagious and although good handwashing and hygiene may help to prevent spread of the disease, it has not been effective enough.  

There is now a vaccine (Rotateq) which can protect children from rotavirus disease.  It is given orally, not by injection.  The vaccine is only given to babies and the series should be completed by 32 weeks of age.  It is a series of 3 doses, at 2 months, 4 months and 6 months of age.

There are no significant side effects to the vaccine.  Children are slightly (1-3%) more likely to have mild, temporary diarrhea or vomiting within 7 days of getting the rotavirus vaccine than children who have not gotten the vaccine.

 If your child or a household member is immunocompromised, your child may not be able to receive this vaccine as it is a live vaccine.

M.        HEPATITIS A

 Hepatitis A is a liver disease caused by the Hepatitis A virus. The virus is spread by close personal contact and sometimes by eating food or drinking water contaminated by the virus.  It is found in the stool of people with the disease.  It can cause    “flu-like” symptoms, jaundice (yellow skin or eyes), abdominal pain and diarrhea. It is quite contagious within households.

 There is a vaccine for this virus, which has been given to people traveling to certain countries. There are now some new recommendations for this vaccine.  It is now recommended that the following people should routinely receive the vaccine:

·        Children age 12 months- 23 months

·        People 1 year and up traveling to high risk countries (see the CDC website at www.cdc.gov/travel)

·        Children and adolescents in states where it is law to have the vaccine because of higher incidence of disease or if there is an outbreak of Hepatitis A.

The vaccine is given as 2 doses at least 6 months apart.

N.  PEOPLE WHO SHOULD NOT RECEIVE SOME VACCINATIONS 

            -           People who have progressive or undiagnosed neurologic diseases such as convulsions or are on steroid medication, or any other illness that the physicians would indicate other than a minor illness or a common cold.           

            -           People allergic to an antibiotic called neomycin or who have cancer, AIDS or other immunosuppressive diseases.           

            -           People receiving gamma globulin within the last three months or a person who thinks they are pregnant should not receive immunizations without consulting the physician. 

If you feel your child has in any way been harmed by an immunization, please feel free to discuss the immunization with the physicians in the practice who will then refer you to the National Vaccine Injury Act information form. 

We believe that immunizations have had a positive impact on the public health, therefore this office accepts only patients who will be immunized.  Medical exemptions must be documented by your previous pediatrician.  We are prepared to discuss any questions you may have.

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