For infants

Vaccines are used in either the general population of children or adults or for special groups. Recommendations for vaccine usage are made by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control. The Committee on Infectious Diseases of the American Academy of Pediatrics (Redbook Committee) also makes recommendations for infants through adolescents, and the American Academy of Family Physicians makes recommendations for adults. An excellent review of vaccine history, development, usage, and related regulatory issues is available (2). 

Hepatitis B. Although Hepatitis B (Hep B) is not an infant disease, it is recommended for infant immunization to better control spread, because compliance with vaccine immunization programs is easier to achieve Hi an infant population. Infants receive immunizations at bHth, 1—2 months. 

Influenza. Although current influenza vaccine (subunit spHt vaccine) has been in use yearly for the elderly, it is not recommended for the general population or infants. Improvements to increase or prolong the immunogenicity, reduce the side-effects (due to egg production procedure), and provide mass protection are stiU being pursued. One approach is to use a five, attenuated vims though cold adaptation. A vaccine has been used in Russia and demonstrated to be safe and efficacious for infants (82). Clinical trials for a similar vaccine are being carried out in the United States (83). 

Pantothenic acid is widely distributed in food and because of the lack of conclusive evidence regarding quantitative needs, a recommended dietary allowance (RDA) for pantothenic acid has not been estabUshed. In 1989, the Food and Nutrition Board of the United States National Research Council suggested a safe intake of 4—7 mg/d for adults. The provisional allowance for infants is 2—3 mg daily (90). 

In all fermented foods, microbes contribute as preservatives, ie, by lowering the pH and producing ethanol, or by making the food more palatable. The dehberate use of yeasts as food in themselves is less common. Small beer, the sediment from beer, has been traditionally used as a vitamin supplement for infants. Beginning in 1910, dried, spent brewers yeast was developed as a food, and Candida utilis was used as a food supplement in Germany during World War II. 

Zinc is also an essential food element in the human diet. Too Httle zinc in the diet can lead to poor health, reproductive problems and a lowered abHity to resist disease. Taking too much zinc into the body through food, water or dietary supplements can also affect health. The levels of zinc that produce adverse effects are higher than the Recommended DaHy AHowances, which are 15 mg/day for men, 12 mg/day for women, 10 mg/day for children and 5 mg/day for infants. 

No more than 5.0% samples total coliform-positive in a month, (For water systems that collect fewer than 40 routine samples per month, no more than one sample can be total coliform-positive). Every sample that has total coliforms must be analyzed for fecal coliforms. There may not be any fecal coliforms or E. coli. Fecal coliform and E. coli are bacteria whose presence indicates that the water may be contaminated with human or animal wastes. Disease-causing microbes (pathogens) in these wastes can cause diarrhea, cramps, nausea, headaches, or other symptoms. These pathogens may pose a special health risk for infants, young children, and people with severely compromised immune systems. 

The sites for IM administration are the deltoid muscle (upper arm), the ventrogluteal or dorso-gluteal sites (hip), and the vastus lateralis (thigh Pig. 2-7). The vastus lateralis site is frequently used for infants and small children because it is more developed than the gluteal or deltoid sites, hi children who have been ambulating for more than 2 years the ventrogluteal site may be used. 

Immunization against pneumococcal pneumonia and bacteremia caused by the types of pneumococci included in the vaccine Active immunization against Streptococcus pneumoniae for infants and toddlers... 

Haemophilus influenzae type b (Hib) conjugate vaccine. Three Hib conjugate vaccines are licensed for infant use. If PRP-OMP (PedvaxHIB or ComVax) is administered at ages 2 and 4 months, a dose at age 6 months is not required. DTaP/Hib combination products should not be used for primary immunization in infants at ages 2, 4 or 6 months, but can be used as boosters following any Hib vaccine. 

Appendix E contains two body surface area nomograms—one for infants and young children and one for older children and adults. 

Lutter C, Iyengar V, Barnes R, et al. 1998. Breast milk contamination in Kazakhstan implications for infant feeding. Chemosphere 37(9-12) 1761-1772. 

Although epinephrine autoinjectors are widely dispensed for first-aid treatment of anaphylaxis in some countries, they are neither available nor affordable in many others [33]. In these situations, physicians sometimes equip patients at risk for anaphylaxis in the community with an epinephrine ampule and a disposable 1-ml syringe. Some physicians also recommend this approach for infants, for whom, as noted previously, no appropriate epinephrine dose is available in an autoinjector formulation. 

In recent years, new legislation (Council Directive 99/39/EC) has placed severe restrictions on the use of pesticides in the production of food for infants and young children. 

Approximately 99.8% of all bananas available in theUSA are imported. The highest consumption level for any population sub-group is 0.96% of the diet for infants. Based on information given in the Import Tolerance Guidelines, a minimum of 12 trials would be required. 

There are very few studies on asthma therapy for infants. 

Oral pseudoephedrine should not be used in children under 1 year of age due to safety concerns. Intranasal ipratropium can be used as intermittent therapy for mild rhinitis or as add-on therapy in more severe cases. AIT is recommended for persistent rhinitis, particularly severe disease, because studies have shown that children respond better than adults. Montelukast is indicated for children 2 years of age and older with SAR and for infants 6 months of age and older with PAR. Studies evaluating leukotriene receptor antagonists as monotherapy or in combination with antihistamines have contradictory results.33... 

Management algorithm for adults with suspected bacterial meningitis.3 Management algorithm is similar for infants and children with suspected bacterial meningitis. 

Differences in receptor sensitivity have been offered to explain the spectrum of unexpected drug responses observed in children. Neonates and young children are at increased risk to experience paradoxical CNS stimulation following antihistamine administration. Symptoms observed in pediatric cases of acute overdose include hallucinations, excitation, and seizures. A physiological explanation for this reaction has not been identified. Antihistamines should not be included in over-the-counter (OTC) cough and cold products recommended for infants and young children. 

Achievements in Public Health 1900 1999 Control of Infectious Diseases. Atlanta, GA Centers for Disease Control. 48, no. 29 (July 30, 1999) 621-629. Source for infant mortality rates. 

Schumann, K., The toxicological estimation of the heavy metal content (Cd, Hg, Pb) in food for infants and small children, Z. Emahrungswiss, 29, 54-73, 1990. 

The indicator for infant mortality in children up to one year of age in Armenia turned out to be significantly higher in those regions that actively used pesticides than in those where pesticides were less actively employed [A99]. 

In 1985, Berteau and Mengle (1985) of the California Department of Health Services and Maddy of the Department of Food and Agriculture conducted a preliminary review of pesticides used indoors. They noted several cases (six) from the Pesticide Illness Surveillance system in which illness was reported after structural pest control. Hypothetical exposure estimates for infants, children, and adults following label use for propoxur, DDVP, and chlorpyrifos were sometimes greater than toxic levels. In 1987, Berteau et al. (1989) reiterated the concern about the potential magnitude of indoor exposures, particularly for children. 

A worktable that can be used to calculate a cumulative exposure estimate on a site-specific basis is provided in Table 2. To use the table, environmental levels for outdoor air, indoor air, food, water, soil, and dust are needed. In the absence of such data (as may be encountered during health assessment activities), default values can be used. In most situations, default values will be background levels unless data are available to indicate otherwise. Based on the U.S. Food and Drug Administration s (FDA s) Total Diet Study data, lead intake from food for infants and toddlers is about 5 pg/day (Bolger et al. 1991). In some cases, a missing value can be estimated from a known value. For example, EPA (1986) has suggested that indoor air can be considered 0.03 x the level of outdoor air. Suggested default values are listed in Table 3. 

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