With the different vaccines there are different schedules. In general, you give a primary series of either two or three doses of H. flu type B vaccine and then you give a booster dose at 12-15 months. Now the thing that makes this a little more complicated is that one of these vaccines, the Merck product, you only give two doses for the primary series and you don’t need to give the third dose at six months of age. So these vaccines are interchangeable, however if you do interchange these vaccines you should err on the side of getting more vaccine doses rather than less. For example, if you give the first dose of PedvaxHIB at two months of age and then you switch over to HibTITER for the second dose, then you need to also give the third dose of HibTITER and then another dose at 12-15 months of age. Otherwise these vaccines are interchangeable.
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In terms of catch-up immunization with HIB vaccines, it’s important to know that the older one is, the less doses one needs of HIB vaccine. So that after 15 months of age you only need to give one dose at time zero and you don’t need to give a whole primary series, just the one dose.
Then you need to be aware of combination vaccines. HIB may occur not just alone as a single antigen, but may occur in combination with whole cell DTP vaccine, and this may result in a decreased number of immunizations at 2,4,6 and 12-18 months of age. However, remember, DTP vaccine, whole cell DTP vaccine, is not routinely recommended anymore. What’s preferred is the acellular pertussis component vaccine.
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Well, let’s move on and talk about the DTaP-HIB combination vaccine. Great idea, and unfortunately this is only approved for use at the fourth dose of a vaccine series only; 12-18 months of age. Do not give this vaccine at 2, 4 and 6 months of age. Do not give the combination vaccine. That’s wrong, it’s contraindicated, it’s not approved for use. There is a decreased immune response to the vaccine components when it is given at 2, 4, 6 months of age. And then there is the HIB and hepatitis B vaccine combination, and this can be useful to decrease the number of injections at 2 months, 4 months and 12 months of age. But in terms of knowing all the different vaccines and combinations that exist, it’s important to know that you do have choices and it’s important to know when these choices may be possible and when they shouldn’t be given.
Now I am going to move on and talk about hepatitis B vaccine and the strategy behind recommending universal immunization against hepatitis B. The rationale behind that is that hepatitis B does occur in this country. What we are most familiar with, though, is acute hepatitis B infection. Symptomatic infection which may result in death due to fulminant hepatitis; about 400 per year as shown on this slide from the CDC. Now what may also occur is asymptomatic infection with hepatitis B and whether it’s asymptomatic or symptomatic, chronic carrier carriage may occur following infection with hepatitis B. And this is where the main problem exists in terms of public health importance. Is that chronic carriers can get chronic disease, either death due to cirrhosis or death due to liver cancer, and if you add these up you can see that the chronic disease, death due to chronic liver disease, due to chronic carriers is ten times more important as a public health issue compared to death from acute symptomatic hepatitis B. That’s why it’s important to prevent chronic carriage. Where that enters into pediatrics is shown on this graph by the CDC, which is the inverse correlation between age and risk of having chronic carriage; that is, the younger the age, those who acquire hepatitis B at birth have a 90% risk of becoming chronic carriers and those who get hepatitis B at a year of age, 50% risk, and older children and adults only 5-10% risk of becoming a chronic carrier. Viagra Jelly online without prescription. So really, preventing hepatitis B at the youngest age can really have a major impact on preventing chronic carriage of hepatitis B and that’s where the main number of deaths occur. A lot of times it is said that, “Well, the kids that I’m treating, my population, aren’t at risk. They don’t have the classic risk factors for hepatitis B” and this slide from the CDC shows intensely investigated cases of acute hepatitis B. The usual risk factors that we are familiar with; IV drug use, high risk heterosexual or homosexual activity or needle stick. But you can see that 35-40% of cases of acute hepatitis B don’t have these classic risk factors and so everybody is at risk for hepatitis B whether they have the classic risk factor or not. Children especially are at risk of becoming chronic carriers. So because of this we do recommend universal immunization with hepatitis B vaccine.
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