Types Of Immunizations

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:

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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:

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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.

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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. •

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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 lifethreatening 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 Type

Age

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 influenza type b (Hib)

First dose: 2 months Second dose: 4 months

Third dose: 6 months (not needed if Merck’s Hib vaccines were previously used) Fourth dose: 12-15 months Pneumococcal (PCV7)

First dose: 2 months Second dose: 4 months Third dose: 6 months Booster shot: 12-15 months

Inactivated polio (IPV)

First dose: 2 months 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 (varicella)

First dose: 12-15 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 papillomavirus (HPV)*

First dose: 11-12 years Second dose: 2 months after first dose Third dose: 6 months after first dose 13-18 years (if necessary)

Meningococcal (MCV4)

First dose: 11-12 years 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.