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Types of immunizations

Immunization can occur in one of two forms.


Active immunization involves stimulating the
immune system to produce antibodies to
fight a disease. This is the form of
immunization used in creating vaccines.
Passive immunization involves providing an
antibody to the patient. It provides only
temporary protection against disease. For
example, a fetus receives antibodies
through the placenta that provide temporary
protection against certain illnesses during
the newborn’s initial months of life.
Standard childhood immunizations target 13
diseases. Some vaccines provide protection
throughout a person’s lifetime, whereas
others must be updated after a period of
time (such as every 10 years).
The vaccine used to immunize a patient
against a disease falls into one of four
categories:
• Attenuated live viruses. These are
weakened viruses.
• Killed viruses or bacteria. These are
dead viruses.
• Toxoid. These contain a toxin produced
by a bacterium.
• Biosynthetic. These contain synthetic
substances.
All of these vaccines are administered
through injections. In many cases, patients
will experience side effects. These are
typically mild and may include fever and
redness or soreness at the injection site,
including soreness of the muscle used for
the injection. A physician will typically
suggest a pain reliever and fever reducer
such as acetaminophen to treat such side
effects. It should be noted that certain types
of nonsteroidal anti-inflammatories
(NSAIDs), including aspirin and ibuprofen,
which are often used to relieve pain, fever
and/or inflammation may react with the
immune system in a way that reduces the
effectiveness of some types of
immunizations including flu shots, according
to recent findings. As a result, it is
recommended that patients avoid the use of
any NSAIDs when receiving any type of
vaccination.
Children who are sick (with the exception of
colds or other minor illnesses) should
usually wait before receiving a vaccine. In
addition, children who have serious allergic
reactions during or after an immunization
injection should not receive additional
doses. Parents are urged to talk to their
child’s pediatrician about these
circumstances.
Major childhood vaccines and their side
effects, if any, include:
• Hepatitis B vaccine (HepB). Protects
against hepatitis B, which infects the
liver and can lead to long-term problems
such as cirrhosis or cancer of the liver.
The vaccine is given in three separate
injections. The first injection should be
given to all newborns soon after birth
and before hospital discharge. Infants
born to mothers who have hepatitis B
should receive the first shot within 12
hours of birth. It is believed that a
complete series of hepatitis B
immunizations provides protection from
the disease over a person’s lifetime.
Adolescents and adults should receive
these vaccinations if they did not have
them as children.
• Rotavirus vaccine. Protects against
rotavirus, a virus that is the most
common cause of gastroenteritis in
children ages 3 months to 15 months,
and the leading cause of diarrhea in
children under age 5. Each year, 55,000
children in the United States are
hospitalized due to rotavirus infection,
according to the Centers for Disease
Control and Prevention (CDC). A
vaccine for rotavirus (RotaTeq) was
approved last year for use in infants
under 8 months of age. It is
administered orally in three doses,
usually at ages 2 months, 4 months and
6 months. Vaccination should not be
initiated on babies over 12 weeks old,
and the entire series must be completed
before the child is 32 weeks (8 months)
old. The vaccine is not approved for use
in older children. It should be noted that
this new vaccine is not associated with
Rotashield, the first rotavirus vaccine
that was pulled from the market in 1999
because it was linked to intussusception
(bowel obstruction caused by the
intestine folding into itself). The oral
rotavirus vaccine prevents severe
rotavirus infection in 98 percent of
babies who are immunized, and
prevents milder forms in 74 percent of
immunized infants.
• Diphtheria, tetanus and pertussis
vaccine (DTaP). Protects against
diphtheria (serious throat infection),
tetanus (severe nerve disease) and
pertussis (respiratory illness sometimes
known as “whooping cough”). DTaP is
provided in a series of five injections
from ages 2 months to 6 years. To
protect adolescents against these
diseases, a new Tdap (tetanus,
diphtheria and pertussis) booster
vaccine is recommended at age 11 to 12
years, and for those aged 13 to 18 years
who missed the earlier Tdap booster
dose. Once the final dosage has been
administered, tetanus and diphtheria
(Td) booster shots are urged every 10
years. Diphtheria has been eradicated
and tetanus has been nearly eradicated
in the United States thanks to this
vaccine. The vaccine is up to 80 percent
effective in preventing pertussis
infections.

Mild side effects are common with DTaP


immunization, and include mild
crankiness, fatigue and temporary loss
of appetite. Severe complications are
rare, but may include seizure brought on
by high fever. Children who are sick
(with the exception of colds or other
minor illnesses) should delay having this
vaccine, and children who have an
uncontrolled seizure disorder or
neurologic disease may be given a
different form that excludes the pertussis
part of the vaccine. Children who have
certain reactions following
administration of the vaccine may not
receive subsequent injections. Such
reactions include seizures, allergic
reaction, breathing difficulties, high
fever, shock or collapse, or uncontrolled
crying.
• Hib vaccine. Immunizes patients against
haemophilus influenzae type b bacteria,
the leading cause of meningitis in
children prior to the development of this
vaccine. It is given in three doses and a
booster from 2 months to 15 months.
More than 90 percent of infants who
receive at least three doses of the
vaccine are protected against
meningitis, pneumonia, inflammation of
the membrane covering the heart
(pericarditis), and certain infections of
the blood, bones and joints.
• Inactivated polio vaccine (IPV). Prevents
polio, a virus that can cause permanent
paralysis. The vaccine is typically
administered four times between ages 2
months and 6 years. More than 95
percent of children who are immunized
will be protected against polio, which
has been eradicated in the United
States thanks to this vaccine.
Previously, children often received this
vaccine in oral form. Today, it is given
almost exclusively by injection, which
eliminates the small risk of developing
polio that was associated with the live
oral vaccine. Older children and
teenagers should receive these
vaccinations if they did not previously
have them.

Children with severe allergies to certain


antibiotics including neomycin,
streptomycin and polymyxin should not
receive this vaccine.
• Pneumococcal conjugate vaccine
(PCV7). Protects against pneumococcal
infections, which can lead to
pneumonia, blood infections and
bacterial meningitis. This infection is
spread through direct contact with
another person and is most dangerous
to children under 2 years of age.
Immunizations are given through four
injections between ages 2 months and
15 months, and they provide three years
of protection. PCV is also given to
children who have sickle cell anemia, a
damaged spleen, HIV/AIDS and other
chronic diseases (e.g., diabetes, cancer)
as well as those who are on medications
that affect the immune system, including
steroids and chemotherapy. Children
with these health conditions may also
receive the pneumococcal
polysaccharide vaccine (PPV) after the
age of 2 years.

• Measles, mumps and rubella (MMR)


vaccine. Protects against measles,
mumps and rubella (also known as
German measles). The vaccine is given
in two doses between the ages of 12
months and 6 years. More than 95
percent of children who receive the
vaccine will be protected from these
diseases. Older children, teenagers and
young adults should receive these
vaccinations if they did not previously
have them.

Side effects include rash, swollen


cheeks, febrile seizures (associated with
high fever) and mild joint pain. Children
may not be good candidates for this
vaccine if they have allergies to eggs,
gelatin or the antibiotic neomycin; have
received gamma globulin; have immune
system problems related to cancer,
leukemia or lymphoma; are taking
corticosteroids or immunosuppressive
drugs; or are undergoing chemotherapy
or radiation therapy.
• Chickenpox (varicella) vaccine. Protects
against chickenpox, a common
childhood illness. The vaccine is now
given in two dosages with the first dose
administered between 12 months and
15 months of age, and the second one
at age 4 to 6. Older children and
adolescents who have already received
one dose of the vaccine should be given
another. Unvaccinated teenagers and
young adults may require two doses
given one month apart. The vaccine
prevents severe forms of chickenpox in
95 percent of those who are immunized,
and prevents milder forms in 85 percent
of those who are immunized.

Side effects include fatigue and the


potential for a rash up to one month
after injection. Children may not be good
candidates for this vaccine if they have
allergies to gelatin or the antibiotic
neomycin; have received gamma
globulin; have immune system problems
related to cancer, leukemia or
lymphoma; are taking corticosteroids or
immunosuppressive drugs; or are
undergoing chemotherapy or radiation
therapy.

• Hepatitis A vaccine (HepA). Protects


against hepatitis A, a viral liver infection.
The vaccine is nearly 100 percent
effective in protecting children from
hepatitis A. It is now universally
recommended for all children at age 1
year. The HepA immunization is
administered in two doses given six
months apart. Children not vaccinated at
1 to 2 years of age should be vaccinated
during the preschool years. It also is
typically recommended for individuals
who live in communities with high rates
of hepatitis A.

• Meningitis (MCV4) vaccine. Protects


against meningococcal disease, a
bacterial infection that can lead to
bacterial meningitis. This potentially life-
threatening disease involves an
inflammation of the membrane that
covers the brain and spinal cord. It is
highly contagious. The vaccine is given
to children at age 11 or 12 as well as to
unvaccinated adolescents upon high
school entry (age 15), and is especially
recommended for youths who will soon
enter college and live in a dormitory. The
vaccine offers protection for 10 years.

Side effects include headache, fatigue


and rash. Children who have a history of
allergic reaction to latex should not be
given this vaccine.
• Human papillomavirus (HPV) vaccine. In
2006, the Food and Drug Administration
(FDA) approved a vaccine (Gardasil) to
protect against several strains of HPV, a
common sexually transmitted infection
that may cause genital warts in men and
women and can infect the cervix in
women. Left untreated, HPV in women
may lead to cervical cancer. The vaccine
is most effective when given before the
onset of sexual activity, when a person
has not been exposed to HPV. The CDC
recommends that the HPV vaccine be
routinely given to 11- and 12-year-old
girls. However, it can be given to girls as
early as age 9 at the discretion of the
physician or healthcare provider. It is
given in a series of three shots over a
six-month period. Although females who
have not been exposed to HPV gain full
benefits of the vaccine, it offers
protective benefits to young girls who
have been sexually active and may
have been exposed to HPV. For that
reason, the CDC recommends that
unvaccinated teen girls between 13 and
18 years of age receive the vaccine.
In addition to these standard vaccines, the
CDC recommends that children younger
than 6 months of age who have conditions
that can cause breathing and swallowing
difficulties, such as spinal cord injuries,
seizure disorders or other neuromuscular
disorders receive the influenza (flu) vaccine
each year. The CDC and other health
organizations such as the American
Academy of Pediatrics also recommend that
children between the ages of 6 months and
5 years receive the flu vaccine each year.
Children with chronic medical conditions
(e.g., asthma, cystic fibrosis, diabetes) and
children on long-term aspirin therapy should
also receive the influenza vaccine each
year. The vaccine can reduce the chances
of getting the flu by up to 80 percent during
flu season.

Immunization
Age
Type
Hepatitis B (HepB) First dose: Birth
Second dose: 1-2
months
Third dose: 6-18
months
19 months to 18 years
(if necessary)
Rotavirus First dose: 2 months
Second dose: 4
months
Third dose: 6 months
Diphtheria, First dose: 2 months
tetanus, pertussis Second dose: 4
(DTaP) months
Third dose: 6 months
Fourth dose: 12-15
months
Fifth dose: 4-6 years
Booster shot: 11-18
years (tetanus,
diphtheria and
pertussis [Tdap])
Haemophilus First dose: 2 months
influenza type b Second dose: 4
(Hib) months
Third dose: 6 months
(not needed if Merck’s
Hib vaccines were
previously used)
Fourth dose: 12-15
months
Pneumococcal First dose: 2 months
(PCV7) Second dose: 4
months
Third dose: 6 months
Booster shot: 12-15
months
Inactivated polio First dose: 2 months
(IPV) Second dose: 4
months
Third dose: 6-18
months
Fourth dose: 4-6 years
7-18 years (if
necessary)
Influenza Yearly: 6 months to 5
years
measles, mumps, First dose: 12-15
rubella (MMR) months
Second dose: 4-6
years
7-18 years (if
necessary)
Chickenpox First dose: 12-15
(varicella) months
Second dose: 4-6
years
7-18 years (if
necessary)
Hepatitis A (HepA) First dose: 12 months
Second dose: 18-24
months (at least 6
months after first
dose)
Human First dose: 11-12 years
papillomavirus Second dose: 2
(HPV)* months after first dose
Third dose: 6 months
after first dose
13-18 years (if
necessary)
Meningococcal First dose: 11-12 years
(MCV4) 15 years (if necessary)

The BCG (Bacille Calmette-Guerin) vaccine is


given in an effort to prevent tuberculosis (TB).
As I have discussed in this column in the past,
what most people think of when they talk about
TB is a chronic lung infection, the most common
form of active (symptomatic) TB. The BCG
vaccine is a strain of Mycobacterium bovis, a
bacterium very similar to Mycobacterium
tuberculosis, the bacterium that causes TB. The
BCG vaccine is, perhaps, up to 50 percent
effective in preventing active TB. Its greatest
benefit, however, is in preventing serious forms
of TB in children, such as tuberculous
meningitis (infection of the membranes covering
the brain and spinal cord) and disseminated
tuberculosis (widespread infection). Some
studies found the BCG vaccine more than 80
percent effective in preventing these forms of
TB in children, which are significant causes of
death in many countries.