Vaccines Indicated for Infants, Children, and Adolescents Based on Medical and Other Indications

Transcription

1 Vaccines Indicated for Infants, Children, and Adolescents Based on Medical and Other Indications Vaccine Prematurity 1 Altered Immunocompetence 2 (excluding human immunodefi ciency virus [HIV] infection) HIV infection 3 CD4+ T lymphocyte count Severe immunosuppression Non-severe immunosuppression Diabetes, heart disease, chronic lung disease, chronic alcoholism, cochlear implants Asplenia including elective splenectomy and persistent complement component deficiency Hematopoietic cell transplant recipients (HCT) 4 Kidney failure, end-stage renal disease, on hemodialysis Haemophilis Infl uenzae type b 5 Hepatitis A Hepatitis B 6 If indicated Human papillomavirus Inactivated poliovirus Influenza 7 Measles, mumps, Contraindicated Contraindicated If indicated rubella 8 Meningococcal conjugate 9 ages 2-10 years Meningococcal conjugate 9 ages years If indicated Pneumococcal conjugate 10 Pneumococcal If indicated polysaccharide 11 Rotavirus 12 If indicated Tetanus, diphtheria, pertussis Varicella 13 Contraindicated If indicated - Vaccine is recommended for all persons who meet the age requirements and who lack evidence of immunity (i.e., no documented vaccination or no evidence of prior infection, or no laboratory evidence of immunity). If Indicated - Vaccine is indicated based on specifi c risk factors or timing constraints. Contraindicated - Vaccine is contraindicated based on the medical condition of the person. No recommendation. 101

2 Vaccines Indicated for Infants, Children, and Adolescents Based on Medical and Other Indications Footnotes: 1. Prematurity Vaccinate premature infants, regardless of birth weight, at the same chronologic age and schedule as full-term infants, except for hepatitis B; see Hepatitis B footnote (#6). 2. Altered immunocompetence (excluding HIV) Includes congenital immunodefi ciency, leukemia, lymphoma, generalized malignancy, or therapy with alkylating agents, antimetabolites, radiation, or a high dose, prolonged course of corticosteroids. Inactivated vaccines generally are acceptable, e.g., pneumococcal, meningococcal, and inactivated infl uenza vaccine. However, the response and effi cacy may be reduced. Generally avoid live vaccines for persons with altered immunocompetence including defi ciencies or immunocompromising conditions. 3. HIV infection ACIP and AAP defi ne severe immunosuppression in HIV infected children as: CD4+ T-lymphocytes counts less than 750 for children younger than 12 months, less than 500 for children age 1 through 5 years, or less than 200 for persons age 6 years or older; Or CD4+ T-lymphocytes constituting: less than 15% of total lymphocytes for children younger than 13 years. 4. HCT recipients Begin revaccination at least 12 months after HCT. For live virus vaccines, MMR and varicella, begin revaccination at least 24 months after HCT; see MMR and varicella footnotes (#8 and #13). 5. Haemophilis Influenzae type b (Hib) Consider 1 dose for unvaccinated high-risk persons age 5 years and older with sickle cell disease, leukemia, or HIV infection, or who have had a splenectomy. 6. Hepatitis B (HepB) Give hepatitis B vaccine and at birth to premature infants born to HBsAgpostive mothers. Delay the fi rst dose of hepatitis B vaccine to premature infants born to HBsAg-negative mothers until the infant weighs at least 2000 grams. 7. Influenza Give HCT recipients infl uenza vaccine 6 months or more after HCT, and annually thereafter. Give annually to all children age 6 months and older regardless of medical and other indications. Give 2 doses separated by at least 4 weeks to children younger than age 9 years who are receiving infl uenza vaccine for the fi rst time or who were vaccinated for the fi rst time last season and only received 1 dose. 8. Measles, mumps, rubella (MMR) Evaluation and testing of asymptomatic persons to identify HIV infection is not necessary before deciding to administer MMR or other measlescontaining vaccine. Severely immunosuppressed HIV-infected patients who are exposed to measles should receive, regardless of prior vaccination status. Give 1 dose to HIV-infected children with non-severe immunosuppression (see #3) as soon as possible after their fi rst birthday. The immunologic response to both live and killed antigen vaccines may decrease as HIV disease progresses; vaccination early in the course of HIV infection may be more likely to induce an response. Consider giving the second dose of MMR vaccine as soon as 28 days after the fi rst dose rather than waiting until the child is ready to enter kindergarten or fi rst grade. Give 1 dose to HCT recipients 24 months after transplant and if the HCT recipient is presumed to be immunocompetent. Give 1 dose to all asymptomatic HIV-infected children without evidence of measles immunity. 9. Meningococcal conjugate (MCV) Give 2 doses 2 months apart to children age 2 years and older with persistent complement component defi ciency, anatomic or functional asplenia, or HIV infection and 1 dose every 5 years thereafter. Give 1 dose of MCV to children who remain at risk and are: Age 6 years and older who received MPSV or Got Your Shots? Providers Guide - SCREENING & ASSESSING Minnesota Department of Health, July 2011

3 MCV 3 or more years previously. Age 7 years and older who received MPSV or MCV 5 or more years previously. 10. Pneumococcal conjugate (PCV) Consider a single supplemental dose of PCV13 for children age 6 through 18 years with anatomic or functional asplenia including sickle cell disease and immunocompromising conditions including HIV infection, cochlear implant, or CSF leaks. Give a single supplemental dose of PCV13 following a completed PCV7 series for children with certain medical conditions through age 5 years. 11. Pneumococcal polysaccharide (PPSV) A single revaccination is recommended 5 years after initial dose for children age 2 years and older with anatomic or functional asplenia or altered immunocompetence. Give 1 dose to HCT recipients at 12 and 24 months after HCT. 12. Rotavirus (RV1, RV5) Contraindicated in children with severe combined immunodefi ciency. Assess children with altered immunocompetence to determine the risk of prolonged shedding versus the benefi t of protection against rotavirus disease. 13. Varicella (VAR) Give a 2-dose series 3 months apart to asymptomatic or mildly symptomatic HIVinfected children in CDC class N1 or A1 with age-specifi c CD4+ T-lymphocyte percentages of 25% or greater. Such children should receive 2 doses of vaccine with a 3-month interval between doses. Give 1 dose to HCT recipients 24 months after transplant and if the HCT recipient is presumed to be immunocompetent. Notes: For additional ACIP recommendations refer to Vaccines may be also be indicated during a community outbreak of a disease. Sources: CDC. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011:60 [No. RR-02]:1-60. American Academy of Pediatrics. Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics;

4 Summary of ACIP Recommendations on Use of Immune Globulin Immune Immune (IG) Not immunocompromised HIV-infected Severely immunocompromised 1 for infants and adults exposed to measles with a contraindication to measles vaccine for hepatitis A postexposure in persons less than age 1 year and persons over age 40 years for symptomatic patients exposed to measles regardless of immunization status for patients exposed to hepatitis A for patients who have not received hepatitis A vaccination and are traveling within 2 weeks to hepatitis A endemic areas for patients exposed to measles regardless of immunization status for patients exposed to hepatitis A for patients who have not received hepatitis A vaccination and are traveling within 2 weeks to hepatitis A endemic areas Varicella zoster 2 (VZIG) for newborns of mothers who develop chickenpox within 5 days before through 48 hours after delivery for exposed pre-term infants age 28 or more weeks gestation born to a susceptible mother for exposed preterm infants younger than age 28 weeks gestation or less than 1000 g regardless of mother's susceptibility May be used for exposed, susceptible adults, pregnant women, and infants less than 28 days old Strongly consider for exposed, susceptible pregnant women for susceptible infants and adults after signifi cant exposure to varicella zoster for susceptible infants and adults after signifi cant exposure to varicella zoster Tetanus (TIG) for those with serious wounds who have received fewer than 3 doses of tetanus toxoid vaccination in their lifetime Hepatitis B (HBIG) for prophylaxis of infants born to HBsAg+ mothers and susceptible persons with percutaneous, sexual, or mucosal exposure to hepatitis B virus Human rabies (HRIG) for post-exposure prophylaxis of persons not previously vaccinated against rabies Footnotes: 1. Severely immunocompromised includes primary or acquired immunodefi ciency, neoplastic diseases, and immunosuppression. 2. Varicella zoster (VZIG) - The most important use of VZIG is for passive immunization of persons at greater risk for complications (e.g., neonates and susceptible, severely immunocompromised persons) after signifi cant exposure to chickenpox or zoster. Varicella-susceptible pregnant women may be at higher risk for serious complications than are adults in general. VZIG protects pregnant women against severe complications but does not prevent viremia and fetal infection, congenital varicella syndrome, or neonatal varicella. Sources: CDC. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011:60 [No. RR-02]:1-60. CDC. Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006:55 [No. RR-07]: Got Your Shots? Providers Guide - SCREENING & ASSESSING Minnesota Department of Health, July 2011

5 Vaccines Indicated by Occupation Vaccine Health care personnel Child care, school personnel Laboratory personnel Essential community service worker (e.g., EMTs, paramedics, police, etc.) Sanitation or sewage worker Veterinarian, animal handler College student Anthrax 1 If indicated If indicated Hepatitis A 2 If indicated Hepatitis B 3 Inactivated If indicated If indicated poliovirus 4 Infl uenza 5 Japanese If indicated encephalitis 6 Measles, mumps, rubella 7 Meningococcal If indicated If indicated conjugate 8 Pre-exposure If indicated rabies 9 Tetanus, diphtheria, pertussis:tdap 10 /Td Give 1 dose of Tdap to all adults regardless of the interval since the last dose of Td Tdap Typhoid 11 If indicated Varicella 12 Yellow fever 13 If indicated - Vaccine is recommended specifi cally because of their occupation. If indicated - Vaccine is indicated based on specifi c occupational risk factor. Not indicated -Vaccine is not indicated or no evidence of occupational risk. 105

6 Vaccines Indicated by Occupation Footnotes: 1. Anthrax Give 5 doses and an annual booster dose to laboratory personnel who work: with high concentrations or pure cultures of B. anthracis spores, with environmental samples associated with anthrax investigations, or in spore-contaminated areas or other settings with exposure to aerosolized B. anthracis spores. Note: Consider giving anthrax vaccine to veterinarians and other persons at risk for anthrax if they handle potentially infected animals in research settings or in areas with a high incidence of anthrax cases. 2. Hepatitis A (HepA) Give 2 doses to persons who work with hepatitis A-infected primates or with the hepatitis A virus in a research laboratory setting. Note: Studies conducted among U.S. workers exposed to raw sewage do not indicate increased risk for hepatitis A infection. No other populations have been demonstrated to be at increased risk for hepatitis A infection because of occupational exposure. 3. Hepatitis B (HepB) Give 3 doses to all persons including health care personnel whose tasks involve exposure to blood or bodily fl uids. 4. Inactivated poliovirus (IPV) Give a booster dose to health care personnel who have close contact with patients who may be excreting polio virus. Give a booster dose to laboratory personnel who are routinely exposed to polio viruses. 5. Influenza Give annually to all health care personnel and persons whose occupation involves care or close contact with infants less than age 6 months. Note: Give to all persons regardless of occupation. 6. Japanese encephalitis (JE) Give 3 doses to laboratory personnel routinely exposed to Japanese encephalitis. Give a booster dose 12 to 24 months after third dose. 7. Measles, mumps, and rubella (MMR) Give 2 doses of MMR to students, health care personnel, laboratory personnel, and child care and school personnel unless they have evidence of immunity which includes: documentation of 2 MMR doses, or history of measles, mumps, and/or rubella disease verifi ed by a health care provider, or laboratory evidence of measles, mumps, and/ or rubella immunity. Note: Give at least 1 dose of MMR to all persons who lack evidence of immunity, regardless of occupation. 8. Meningococcal conjugate (MCV) Give 1 dose of MCV to previously unvaccinated college freshmen who live in dormitories or whose last dose was 5 or more years ago. Give 1 dose to laboratory personnel who are routinely exposed to isolates of N. meningiditis. Give a booster dose every 5 years. 9. Pre-exposure rabies (RAB) Give 4 doses to laboratory personnel directly involved with testing or isolating rabies virus. Check serum titers every 6 months and give a booster dose if titers fall below protective levels (i.e., complete neutralization at a 1:5 serum dilution by the RFFIT). Give 4 doses to veterinarians and animal handlers. Check serum titers every 2 years and give a booster dose if titers fall below protective levels (i.e., complete neutralization at a 1:5 serum dilution by the RFFIT). 10. Tetanus, diphtheria, pertussis (Tdap/Td) Give 1 dose of Tdap to adults age 64 years and younger in place of their next 10-year booster dose of Td. Give Tdap to adults having close contact with infants under age 1 year (e.g., parents, child care and health care personnel) regardless of when the last Td was given Note: Tdap is recommended for all adults. 11. Typhoid, oral and inactivated Inactivated: Give 1 dose to laboratory personnel routinely exposed to Salmonella typhi. Give a booster dose every 2 years. Oral: Give 1 capsule every other day for 4 days to laboratory personnel routinely exposed to Salmonella typhi. Give a booster dose every 5 years. 12. Varicella (VAR) Give 2 doses of varicella to health care personnel, laboratory personnel, and child care Got Your Shots? Providers Guide - SCREENING & ASSESSING Minnesota Department of Health, July 2011

7 and school personnel unless they have evidence of immunity, which includes: documentation of 2 doses of varicella vaccine at least 4 weeks apart, or U.S.-born before 1980, or history of varicella disease verifi ed by a health care provider, or history of herpes zoster disease based on health care provider diagnosis, or laboratory evidence of varicella immunity. Note: Give to all persons who lack evidence of immunity, regardless of occupation. 13. Yellow fever (YF) Give 1 dose to laboratory personnel routinely exposed to yellow fever virus. Give a booster dose every 10 years. Notes: For additional ACIP recommendations refer to Vaccines may also be indicated during a community outbreak of a disease. Sources: CDC. General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2011:60 [No. RR-02]:1-60. CDC. Human Rabies Prevention: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2008:57 [No. RR-03]:1-26,28. CDC. Immunization of Health-Care Workers: Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC). MMWR 1997:46 [No. RR-18]:1-42. CDC. Prevention of Hepatitis A Through Active or Passive Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2006:55 [No. RR-07]:1-23. American College Health Association (ACHA). Recommendations for Institutional Prematriculation Immunizations. Linthicum, MD. ACHA Vaccine Preventable Diseases Committee; January