Vaccines for children

There are two pneumococcal vaccines, a 7-valent conjugated vaccine for children younger than 6 years of age and a 23-purified-capsular polysaccharide antigen vaccine for adults. The 23 capsular types in the vaccine represent at least 85% to 90% of the serotypes that cause invasive pneumococcal infections among children and adults in the United States.41 After vaccination, an antigen-specific antibody response, indicated by a twofold or greater rise in serotype-specific antibody, develops within 2 to 3 weeks in 80% or more of healthy young adults.42... 

Vaccines are a cost-effective means for disease prevention. It is estimated that for every dollar spent on routine childhood vaccines there will be a savings of 0.90 to 24.00 in direct medical expense. The rates of vaccination for children are well over 90%. This has been attributed to the requirements for proof of vaccination by states for enrollment into day care centers and school. Additionally, children (less than or equal to 18 years of age) may receive routine vaccinations free of charge through state health departments or other assistance programs, such as the national Vaccines for Children program. 

Gosse, M.E., Manocchia, M., and Nelson, T.F., Overview of US Pharmaceutical Development, 1980-1994, Tufts University Center for the Study of Drug Development, May, 1996. Grabowski, H.G. and Vernon, J., The search for new vaccines the errors of the vaccines for children program, American Enterprise Institute, Washington, 1994. 

Chang CC, Chang AB. Influenza vaccine for children and adults with bronchiectasis. Cochrane Database Syst Rev 2006. 

An improved tick-bome encephalitis vaccine for children, produced by Baxter, has been licensed and is being used without safety concerns in many countries. 

Currently, no data are available regarding the association between anthrax vaccine and chronic disease, snch as infertility or cancer. In addition, no data are available regarding the safety of anthrax vaccine for children under 18 or people over 65 years, nor are there stndies regarding the safety of anthrax vaccine during pregnancy. A recent stndy of the association between anthrax vaccine and congenital anomalies was inconclnsive dne to the limitations in computerized records used in the study (16). 

Table 1 Vaccines covered by Vaccines for Children program...

Key AAP, American Academy of Pediatrics ACIP, Advisory Committee on Immunization Practices CDC, Centers for Disease Control and Prevention FDA, Food and Drug Administration MMWR, Morbidity and Mortality Weekly Report VFC, Vaccines For Children. 

The Center for Disease Control (CDC) recommends a schedule for vaccination for children Web site (http //www.cdc.gov/mmwr/preview/mmwrhtml/ mm5351 -Immunizational. htm). 

Currently, there is no anthrax vaccine for children. The anthrax vaccine used for adults has never been studied in children, and it is not recommended for people younger than 18 years old. It is currently available only for people in the military service, although public health officials are now considering its use for people in other high-risk professions. 

The measles vaccine is considered an immunization. Immunization is a form of artificial active immunity and an important metiiod of controlling some of the infectious diseases tiiat are capable of causing serious and sometimes fatal consequences. The immunization schedule for children is given in Figure 54-2. Currentiy, many infectious diseases may be prevented by vaccine... 

On occasion, it may be necessary to postpone the regular immunization schedule, particularly for children. This is of special concern to parents. The decision to delay immunization because of illness or for other reasons must be discussed with the primary health care provider. However, the decision to administer or delay vaccination because of febrile illness (illness causing an elevated temperature) depends on the severity of the symptoms and the specific disorder. In general, all vaccines can be administered to those with minor illness, such as a cold virus and to those with a low-grade fever. However, moderate or severe febrile illness is a contraindication. hi instances of moderate or severe febrile illness, vaccination is done as soon as the acute phase of... 

Influenza vaccine. Influenza vaccine is recommended annually for children age > 6 months with certain risk factors (including but not limited to asthma, cardiac disease, sickle cell disease, HIV, diabetes see MMWR. 2001 50(RR-4) 1-44), and can be administered to all others wishing to obtain immunity. Children aged <12 years should receive vaccine in a dosage appropriate for their age (0.25 mL if age 6-35 months or 0.5 mL if age >3 years). Children aged <8 years who are receiving influenza vaccine for the first time should receive two doses separated by at least 4 weeks. 

Children with SCD should receive the required immunizations as recommended by the American Academy of Pediatrics and the Advisory Committee on Immunization Practices.15 Additionally, influenza vaccine should be administered yearly to SCD patients 6 months of age and older, including adult patients. Any SCD patient who is scheduled for splenectomy should receive the vaccine for meningococcal disease if over 2 years of age.16... 

Centers for Disease Control and Prevention. Direct and indirect effects of routine vaccination of children with 7-valent pneumococcal conjugate vaccine on incidence of invasive pneumococcal disease—United States, 1998-2003. Morbidity and Mortality Weekly Report (MMWR) 2005 54(36) 893-897. 

Herd immunity refers to high levels of immunization in one population resulting in protection of another unvaccinated population. For example, concentrated vaccination of children with the 7-valent pneumococcal conjugate vaccine resulted in decreased invasive Streptococcus pneumoniae infection not only in the vaccinated children, but also in elderly persons within the same community. 

A number of mineral-based substances display an adjuvant effect. Although calcium phosphate, calcium chloride and salts of various metals (e.g. zinc sulfate and cerium nitrate) display some effect, aluminium-based substances are by far the most potent. Most commonly employed are aluminium hydroxide and aluminium phosphate (Table 13.13). Their adjuvanticity, coupled to their proven safety, render them particularly valuable in the preparation of vaccines for young children. They have been incorporated into millions of doses of such vaccine products so far. 

Two doses administered at least 1 month apart are recommended for children ages 6 months to less than 9 years who are receiving influenza vaccine for the first time. 

Pneumococcal conjugate vaccine is recommended for children ages 2 months to 2 years and Al in those with high-risk conditions and older than age 2. 

This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1,2006, for children aged 0-6 years. Additional information is available at http //www.cdc.gov/nip/recs/child-schedule.htm. Any dose not administered at the recommended age should be administered at any subsequent visit, when indicated and feasible. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and other components of the vaodne are... 

TriHiBit (DTaP/Hib) combination products should not be used for primary immunization but can be used as boosters following any Hib vaccine in children aged >12 months. 

Influenza vaccine is recommended annually for children aged >59 months with certain risk factors, health-care workers, and other persons (including household members) in dose contact with persons in groups at high risk. SeeMW/ 2006 55(No. RR-10) 1-41. 

The table below provides catch-up schedules and minimum intervals between doses for children whose vaccinations have been delayed. A vaccine series does not need to be restarted, regardless of the time that has elapsed between doses. Use the section appropriate for the child s age. 

Vaccine is not generally recommended for children aged >5 years. 

Two strengths of diphtheria toxoid are available (pediatric [D] and adult, which contains less antigen). Primary immunization with D is indicated for children younger than 6 weeks of age. Generally, D is given along with acellular pertussis and tetanus vaccines (DTaP) at 2, 4, and 6 months of age, and then at 15 to 18 months and 4 to 6 years of age. 

Two types of trivalent poliovirus vaccines are currently licensed for distribution in the United States an enhanced inactivated vaccine (IPV) and a live attenuated, oral vaccine (OPV). IPV is the recommended vaccine for the primary series and booster dose for children in the United States, whereas OPV is recommended in areas of the world that have circulating poliovirus. 

Typhoid vaccine contains not more than one million organisms per milliliter based on a potency of 8 units per milliliter. For children less than 10 years old, two injections of 0.25 milliliter are given four weeks apart for vaccination. How many units are given in this vaccination dose of two injections ... 

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