Vaccinations

I am not trying to convince or deter anyone from getting your children vaccinations. I am just giving you some information about what vaccines do what. If you want to know side effects, please research each vaccine to see it's pros and cons. Some people choose not to vaccinate, and some choose to vaccinate. It is ALWAYS important to do research the pro's and con's before you make any decisions. Google: "evidence based research vaccines". Always research Evidence Based Information when looking for information. There are quite a lot of evidence based information about most things you may have questions about. The best time to do this research is before birth and find out when they do the vaccinations. This is very important!

First off, there is a lot of controversy on vaccinations and the possible risks if given vaccinations. I hope that this will help you make your decision. Please do your research and decide if the rumored risks outweigh the benefits of vaccinations. This handout covers vaccinations for different times of your child’s life. A good website to look at is the CDC.

VACCINATIONS

Hepatitis B (HepB) vaccine. (Minimum age: birth)

Key facts

• Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease.

• The virus is transmitted through contact with the blood or other body fluids of an infected person.

• An estimated 240 million people are chronically infected with hepatitis B (defined as hepatitis B surface antigen positive for at least 6 months).

• More than 686 000 people die every year due to complications of hepatitis B, including cirrhosis and liver cancer 1.

• Hepatitis B is an important occupational hazard for health workers.

• However, it can be prevented by currently available safe and effective vaccine.

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus. It is a major global health problem. It can cause chronic infection and puts people at high risk of death from cirrhosis and liver cancer.

A vaccine against hepatitis B has been available since 1982. The vaccine is 95% effective in preventing infection and the development of chronic disease and liver cancer due to hepatitis B.

Routine vaccination: At birth

• Administer monovalent HepB vaccine to all newborns within 24 hours of birth.

• For infants born to hepatitis B surface antigen (HBsAg)–positive mothers, administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. These infants should be tested for HBsAg and antibody to HBsAg (anti–HBs) at age 9 through 12 months (preferably at the next well–child visit) or 1 to 2 months after completion of the HepB series if the series was delayed.

• If mother’s HBsAg status is unknown, within 12 hours of birth, administer HepB vaccine regardless of birth weight. For infants weighing less than 2,000 grams, administer HBIG in addition to HepB vaccine within 12 hours of birth. Determine mother’s HBsAg status as soon as possible and, if mother is HBsAg–positive, also administer HBIG to infants weighing 2,000 grams or more as soon as possible, but no later than age 7 days.

Doses following the birth dose

• The second dose should be administered at age 1 or 2 months. Monovalent HepB vaccine should be used for doses administered before age 6 weeks.

• Infants who did not receive a birth dose should receive 3 doses of a HepB–containing vaccine on a schedule of 0, 1 to 2 months, and 6 months, starting as soon as feasible. See Catch–up Schedule.

• Administer the second dose 1 to 2 months after the first dose (minimum interval of 4 weeks); administer the third dose at least 8 weeks after the second dose AND at least 16 weeks after the first dose. The final (third or fourth) dose in the HepB vaccine series should be administered no earlier than age 24 weeks.

• Administration of a total of 4 doses of HepB vaccine is permitted when a combination vaccine containing HepB is administered after the birth dose.

Catch–up vaccination:

• Unvaccinated persons should complete a 3–dose series.

• A 2–dose series (doses separated by at least 4 months) of adult formulation Recombivax HB is licensed for use in children aged 11 through 15 years.

Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV1 [Rotarix] and RV5 [RotaTeq]) Rotavirus disease is most common in infants and young children. However, older children and adults also can get sick from rotavirus. Once a person has been exposed to rotavirus, it takes about 2 days for the symptoms to appear.

Children who get infected may have severe watery diarrhea, often with vomiting, fever, and abdominal pain. Vomiting and watery diarrhea can last from 3 to 8 days. Additional symptoms may include loss of appetite and dehydration (loss of body fluids), which can be especially dangerous for infants and young children.

Symptoms of dehydration include

• decrease in urination,

• dry mouth and throat and

• feeling dizzy when standing up.

A dehydrated child may also

• cry with few or no tears and

• be unusually sleepy or fussy.

Adults who get rotavirus disease tend to have milder symptoms.

Children, even those that are vaccinated, may get sick from rotavirus more than once. That is because neither natural infection with rotavirus nor rotavirus vaccination provides full protection from future infections. Usually a person’s first time getting rotavirus causes the most severe symptoms. However, vaccinated children are much less likely to get sick from rotavirus, and if they do get sick, their symptoms are usually less severe than unvaccinated children.

Routine vaccination:

• Administer a series of RV vaccine to all infants as follows:

1. If Rotarix is used, administer a 2–dose series at ages 2 and 4 months.

2. If RotaTeq is used, administer a 3–dose series at ages 2, 4, and 6 months.

3. If any dose in the series was RotaTeq or vaccine product is unknown for any dose in the series, a total of 3 doses of RV vaccine should be administered.

Catch–up vaccination:

• The maximum age for the first dose in the series is 14 weeks, 6 days; vaccination should not be initiated for infants aged 15 weeks, 0 days, or older.

• The maximum age for the final dose in the series is 8 months, 0 days.

Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine. (Minimum age: 6 weeks. Exception: DTaP–IPV [Kinrix, Quadracel]: 4 years) Diphtheria:

Diphtheria is an infection caused by the Corynebacterium diphtheriae bacterium. Complications from diphtheria may include:

• Blocking of the airway

• Damage to the heart muscle (myocarditis)

• Nerve damage (polyneuropathy)

• Loss of the ability to move (paralysis)

• Lung infection (respiratory failure or pneumonia)

For some people, diphtheria can lead to death. Even with treatment, about 1 out of 10 diphtheria patients die. Without treatment, as many as 1 out of 2 patients can die from the disease.

Tetanus Toxoids

Tetanus, commonly called lockjaw, is caused by a bacterium that is mostly present in soil, manure, and in the digestive tracts of humans and animals. Tetanus bacteria enter the body through a wound - sometimes as small as a pinprick or deep scratch but most often through a deep puncture wound or laceration such as those made by rusty nails or dirty knives. Such wounds are difficult to clean adequately and, if tetanus bacteria were present on the nail or knife, the bacteria can remain deep in the wound where they can grow and produce several toxins that attack the body's red and white blood cells and central nervous system. Tetanus bacteria do not grow well in the presence of oxygen, which is why deep puncture wounds are a perfect environment for them to grow in.

The incubation period for symptoms of tetanus to begin can range from one to three weeks. The first symptoms are likely to be headache, irritability, fever, chills, and muscular stiffness of the jaw and neck. As the poison increases and spreads, the body becomes rigid and locked in spasm with head drawn back, legs and feet extended, arms stiff, hands clenched and the jaw unable to open with difficulty in swallowing. The stomach muscles also become rigid and convulsions may occur.

Immediate hospitalization and the use of tetanus antitoxin and powerful tranquilizers and anti-spasmodic drugs are used to treat the disease. The symptoms last for several weeks. Complications of tetanus include pneumonia, bone fractures from violent muscle spasms and death.

In 1948 there were 601 cases of tetanus reported in the U.S., the highest number of cases reported in one year. In 2002 there were 25 cases of tetanus and 3 deaths reported in the U.S. Tetanus is a much more serious problem in underdeveloped countries, especially among newborn babies born in unsanitary conditions whose umbilical cords can become infected with tetanus.

Acellular Pertussis

Pertussis (whooping cough) Pertussis (whooping cough) can cause serious illness in babies, children, teens, and adults. Symptoms of pertussis usually develop within 5 to 10 days after being exposed, but sometimes not for as long as 3 weeks.

Early Symptoms

The disease usually starts with cold-like symptoms and maybe a mild cough or fever. In babies, the cough can be minimal or not even there. Babies may have a symptom known as "apnea." Apnea is a pause in the child's breathing pattern. Pertussis is most dangerous for babies. About half of babies younger than 1 year who get the disease need care in the hospital. Learn more about pertussis complications.

Early symptoms can last for 1 to 2 weeks and usually include:

• Runny nose

• Low-grade fever (generally minimal throughout the course of the disease)

• Mild, occasional cough

• Apnea – a pause in breathing (in babies)

Because pertussis in its early stages appears to be nothing more than the common cold, it is often not suspected or diagnosed until the more severe symptoms appear.

Later-stage Symptoms

After 1 to 2 weeks and as the disease progresses, the traditional symptoms of pertussis may appear and include:

• Paroxysms (fits) of many, rapid coughs followed by a high-pitched "whoop"

• Vomiting (throwing up) during or after coughing fits

• Exhaustion (very tired) after coughing fits

Pertussis can cause violent and rapid coughing, over and over, until the air is gone from the lungs and you are forced to inhale with a loud "whooping" sound. This extreme coughing can cause you to throw up and be very tired. Although you are often exhausted after a coughing fit, you usually appear fairly well in-between. Coughing fits generally become more common and bad as the illness continues, and can occur more often at night. The coughing fits can go on for up to 10 weeks or more. In China, pertussis is known as the "100 day cough." However, the "whoop" is often not there for people who have milder (less serious) disease. The infection is generally milder in teens and adults, especially those who have been vaccinated.

Routine vaccination:

• Administer a 5–dose series of DTaP vaccine at ages 2, 4, 6, 15 through 18 months, and 4 through 6 years. The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.

• Inadvertent administration of fourth DTaP dose early: If the fourth dose of DTaP was administered at least 4 months after the third dose of DTaP and the child was 12 months of age or older, it does not need to be repeated.

Catch–up vaccination:

• The fifth dose of DTaP vaccine is not necessary if the fourth dose was administered at age 4 years or older.

Haemophilus influenza type b (Hib) conjugate vaccine. (Minimum age: 6 weeks for PRP–T [ActHIB, DTaP–IPV/Hib (Pentacel), Hiberix, and Hib–MenCY (MenHibrix)], PRP–OMP [PedvaxHIB])

Haemophilus influenzae type b (Hib) disease is a serious disease caused by bacteria. It usually affects children under 5 years old. It can also affect adults with certain medical conditions.

Your child can get Hib disease by being around other children or adults who may have the bacteria and not know it. The germs spread from person to person. If the germs stay in the child’s nose and throat, the child probably will not get sick. But sometimes the germs spread into the lungs or the bloodstream, and then Hib can cause serious problems. This is called invasive Hib disease.

Before Hib vaccine, Hib disease was the leading cause of bacterial meningitis among children under 5 years old in the United States. Meningitis is an infection of the lining of the brain and spinal cord. It can lead to brain damage and deafness. Hib disease can also cause:

• pneumonia

• severe swelling in the throat, making it hard to breathe

• infections of the blood, joints, bones, and covering of the heart

• death

Before Hib vaccine, about 20,000 children in the United States under 5 years old got Hib disease each year, and about 3% - 6% of them died.

Hib vaccine can prevent Hib disease. Since use of Hib vaccine began, the number of cases of invasive Hib disease has decreased by more than 99%. Many more children would get Hib disease if we stopped vaccinating.

Routine vaccination:

• Administer a 2– or 3–dose Hib vaccine primary series and a booster dose (dose 3 or 4, depending on vaccine used in primary series) at age 12 through 15 months to complete a full Hib vaccine series.

• The primary series with ActHIB, MenHibrix, Hiberix, or Pentacel consists of 3 doses and should be administered at ages 2, 4, and 6 months. The primary series with PedvaxHIB consists of 2 doses and should be administered at ages 2 and 4 months; a dose at age 6 months is not indicated.

• One booster dose (dose 3 or 4, depending on vaccine used in primary series) of any Hib vaccine should be administered at age 12 through 15 months.

Catch–up vaccination:

• If dose 1 was administered at ages 12 through 14 months, administer a second (final) dose at least 8 weeks after dose 1, regardless of Hib vaccine used in the primary series.

• If both doses were PRP–OMP (PedvaxHIB or COMVAX) and were administered before the first birthday, the third (and final) dose should be administered at age 12 through 59 months and at least 8 weeks after the second dose.

• If the first dose was administered at age 7 through 11 months, administer the second dose at least 4 weeks later and a third (and final) dose at age 12 through 15 months or 8 weeks after second dose, whichever is later.

• If first dose is administered before the first birthday and second dose administered at younger than 15 months, a third (and final) dose should be administered 8 weeks later.

• For unvaccinated children aged 15–59 months, administer only 1 dose.

Vaccination of persons with high–risk conditions:

• Children aged 12 through 59 months who are at increased risk for Hib disease, including chemotherapy recipients and those with anatomic or functional asplenia (including sickle cell disease), human immunodeficiency virus (HIV) infection, immunoglobulin deficiency, or early component complement deficiency, who have received either no doses or only 1 dose of Hib vaccine before 12 months of age, should receive 2 additional doses of Hib vaccine, 8 weeks apart; children who received 2 or more doses of Hib vaccine before age 12 months should receive 1 additional dose.

• For patients younger than age 5 years undergoing chemotherapy or radiation treatment who received a Hib vaccine dose(s) within 14 days of starting therapy or during therapy, repeat the dose(s) at least 3 months following therapy completion.

• Recipients of hematopoietic stem cell transplant (HSCT) should be revaccinated with a 3–dose regimen of Hib vaccine starting 6 to 12 months after successful transplant, regardless of vaccination history; doses should be administered at least 4 weeks apart.

• A single dose of any Hib–containing vaccine should be administered to unimmunized* children and adolescents age 15 months and older undergoing an elective splenectomy; if possible, vaccine should be administered at least 14 days before procedure.

• Hib vaccine is not routinely recommended for patients 5 years or older. However, 1 dose of Hib vaccine should be administered to unimmunized* persons aged 5 years or older who have anatomic or functional asplenia (including sickle cell disease) and unimmunized* persons age 5 through 18 years with HIV infection.

* Patients who have not received a primary series and booster dose or at least 1 dose of Hib vaccine after 14 months of age are considered unimmunized.

Pneumococcal vaccines. (Minimum age: 6 weeks for PCV13, 2 years for PPSV23) Pneumococcal disease is an infection caused by the Streptococcus pneumoniae (S. pneumoniae) bacterium, also known as pneumococcus. Infection can result in pneumonia, infection of the blood (bacteremia/sepsis), middle-ear infection (otitis media), or bacterial meningitis. The World Health Organization (WHO) says that pneumococcal disease is the world’s number 1 vaccine-preventable cause of death among infants and children younger than 5 years of age.

There are two main types of pneumococcal diseases:

1) Non-invasive pneumococcal diseases

These may be less serious than invasive pneumococcal disease and occur outside the major organs or the blood. S. pneumoniae can spread from the nasopharynx (nose and throat) to the upper and lower respiratory tract and can cause:

• Otitis media - middle ear infection. Inflammation of the middle ear, typically with accumulation of fluid in the middle ear, swelling of the eardrum, earache. If the eardrum is perforated drainage of pus into the ear canal.

• Non-bacteremic pneumonia - infection of the lower respiratory tract without detectable spread of organisms to the blood stream

2) Invasive pneumococcal diseases (IPD)

Streptococcus pneumoniae bacteria, or pneumococcus, can cause many types of illnesses. Some of these illnesses can be life-threatening.

Pneumococcus is the most common cause of bloodstream infections, pneumonia, meningitis, and middle ear infections in young children.

You have probably heard of pneumonia, which is an infection of the lungs. Pneumonia can be caused by many different bacteria, viruses, and even fungi. Pneumococcus is one of the most common causes of severe pneumonia.

Besides pneumonia, pneumococcus can cause other types of infections too, such as:

• Ear infections

• Sinus infections

• Meningitis (infection of the covering around the brain and spinal cord)

• Bacteremia (blood stream infection)

Some of these infections are considered “invasive.” Invasive disease means that germs invade parts of the body that are normally free from germs. For example, pneumococcal bacteria can invade the bloodstream, causing bacteremia, and the tissues and fluids surrounding the brain and spinal cord, causing meningitis. When this happens, disease is usually very severe, requiring treatment in a hospital and even causing death in some cases.

Routine vaccination with PCV13:

• Administer a 4–dose series of PCV13 at ages 2, 4, and 6 months and at age 12 through 15 months.

Catch–up vaccination with PCV13:

• Administer 1 dose of PCV13 to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.

Vaccination of persons with high–risk conditions with PCV13 and PPSV23:

• All recommended PCV13 doses should be administered prior to PPSV23 vaccination if possible.

• For children aged 2 through 5 years with any of the following conditions: chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure); chronic lung disease (including asthma if treated with high–dose oral corticosteroid therapy); diabetes mellitus; cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; solid organ transplantation; or congenital immunodeficiency:

1. Administer 1 dose of PCV13 if any incomplete schedule of 3 doses of PCV13 was received previously.

2. Administer 2 doses of PCV13 at least 8 weeks apart if unvaccinated or any incomplete schedule of fewer than 3 doses of PCV13 was received previously.

3. The minimum interval between doses of PCV13 is 8 weeks.

4. For children with no history of PPSV23 vaccination, administer PPSV23 at least 8 weeks after the most recent dose of PCV13.

• For children aged 6 through 18 years who have cerebrospinal fluid leak; cochlear implant; sickle cell disease and other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiencies; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma:

1. If neither PCV13 nor PPSV23 has been received previously, administer 1 dose of PCV13 now and 1 dose of PPSV23 at least 8 weeks later.

2. If PCV13 has been received previously but PPSV23 has not, administer 1 dose of PPSV23 at least 8 weeks after the most recent dose of PCV13.

3. If PPSV23 has been received but PCV13 has not, administer 1 dose of PCV13 at least 8 weeks after the most recent dose of PPSV23.

• For children aged 6 through 18 years with chronic heart disease (particularly cyanotic congenital heart disease and cardiac failure), chronic lung disease (including asthma if treated with high–dose oral corticosteroid therapy), diabetes mellitus, alcoholism, or chronic liver disease, who have not received PPSV23, administer 1 dose of PPSV23. If PCV13 has been received previously, then PPSV23 should be administered at least 8 weeks after any prior PCV13 dose.

• A single revaccination with PPSV23 should be administered 5 years after the first dose to children with sickle cell disease or other hemoglobinopathies; anatomic or functional asplenia; congenital or acquired immunodeficiency’s; HIV infection; chronic renal failure; nephrotic syndrome; diseases associated with treatment with immunosuppressive drugs or radiation therapy, including malignant neoplasms, leukemias, lymphomas, and Hodgkin disease; generalized malignancy; solid organ transplantation; or multiple myeloma.

Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks) Polio, or poliomyelitis, is a crippling and potentially deadly infectious disease. It is caused by the poliovirus. The virus spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis (can’t move parts of the body).

Routine vaccination:

• Administer a 4–dose series of IPV at ages 2, 4, 6 through 18 months, and 4 through 6 years. The final dose in the series should be administered on or after the fourth birthday and at least 6 months after the previous dose. Catch–up vaccination:

• In the first 6 months of life, minimum age and minimum intervals are only recommended if the person is at risk for imminent exposure to circulating poliovirus (i.e., travel to a polio–endemic region or during an outbreak).

• If 4 or more doses are administered before age 4 years, an additional dose should be administered at age 4 through 6 years and at least 6 months after the previous dose.

• A fourth dose is not necessary if the third dose was administered at age 4 years or older and at least 6 months after the previous dose.

• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age. If only OPV was administered, and all doses were given prior to age 4 years, 1 dose of IPV should be given at 4 years or older, at least 4 weeks after the last OPV dose.

• IPV is not routinely recommended for U.S. residents aged 18 years or older.

Influenza vaccines. (Minimum age: 6 months for inactivated influenza vaccine [IIV], 18 years for recombinant influenza vaccine [RIV]) What is Influenza (also called Flu)?

The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year.

Signs and Symptoms of Flu

People who have the flu often feel some or all of these signs and symptoms:

• Fever* or feeling feverish/chills

• Cough

• Sore throat

• Runny or stuffy nose

• Muscle or body aches

• Headaches

• Fatigue (very tired)

• Some people may have vomiting and diarrhea, though this is more common in children than adults.

*It’s important to note that not everyone with flu will have a fever.

How Flu Spreads

Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or possibly their nose.

Period of Contagiousness

You may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 to 7 days after becoming sick. Some people, especially young children and people with weakened immune systems, might be able to infect others for an even longer time.

Onset of Symptoms

The time from when a person is exposed to flu virus to when symptoms begin is about 1 to 4 days, with an average of about 2 days.

Complications of Flu

Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

People at High Risk from Flu

Anyone can get the flu (even healthy people), and serious problems related to the flu can happen at any age, but some people are at high risk of developing serious flu-related complications if they get sick. This includes people 65 years and older, people of any age with certain chronic medical conditions (such as asthma, diabetes, or heart disease), pregnant women, and young children.

Preventing Flu

The first and most important step in preventing flu is to get a flu vaccination each year. CDC also recommends everyday preventive actions (like staying away from people who are sick, covering coughs and sneezes and frequent handwashing) to help slow the spread of germs that cause respiratory (nose, throat, and lungs) illnesses, like flu.

Diagnosing Flu

It is very difficult to distinguish the flu from other viral or bacterial causes of respiratory illnesses on the basis of symptoms alone. There are tests available to diagnose flu.

1. Routine vaccination:

• Administer influenza vaccine annually to all children beginning at age 6 months. For the 2016–17 season, use of live attenuated influenza vaccine (LAIV) is not recommended.

For children aged 6 months through 8 years:

• For the 2016–17 season, administer 2 doses (separated by at least 4 weeks) to children who are receiving influenza vaccine for the first time or who have not previously received ≥2 doses of trivalent or quadrivalent influenza vaccine before July 1, 2016. For additional guidance, follow dosing guidelines in the 2016–17

• For the 2017–18 season, follow dosing guidelines in the 2017–18 ACIP influenza vaccine recommendations.

For persons aged 9 years and older:

• Administer 1 dose.

Measles, mumps, and rubella (MMR) vaccine. (Minimum age: 12 months for routine vaccination)

Measles

Measles virus is an enveloped, ribonucleic acid virus of the genus Morbillivirus. Although at least 20 different genotypes have been isolated in various parts of the world, there is only one serotype. Measles is highly contagious, and an infected person will often transmit the virus to over 90% of unprotected close contacts.

Following inhalation of virus-containing droplets, measles virus replicates in the cells of the nose and throat, and 5-7 days after exposure infection is spread through the blood to the skin, the eye, and the respiratory tract. Patients develop high fever, cold-like symptoms, and conjunctivitis. A typical rash appears after another 3-4 days, spreading from the face and neck to the trunk and extremities. While most persons recover from measles without lasting effects, severe forms of the disease with bleeding from skin and mucosa may occur. Among children less than 5 years of age measles complications frequently include otitis media and pneumonia. Persons with malnutrition, especially vitamin A deficiency, or with severe immunological disorders such as advanced HIV infection are at increased risk of developing severe or even fatal measles.

Measles signs and symptoms appear 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:

• Fever

• Dry cough

• Runny nose

• Sore throat

• Inflamed eyes (conjunctivitis)

• Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots

• A skin rash made up of large, flat blotches that often flow into one another

The infection occurs in sequential stages over a period of two to three weeks.

• Infection and incubation. For the first 10 to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.

• Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.

• Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first, particularly behind the ears and along the hairline.

Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.

• Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.

Mumps

• Complications from mumps are rare, but they can be serious if left untreated. Mumps mostly affects the parotid glands. However, it can also cause inflammation in other areas of the body, including the brain and reproductive organs.

• Orchitis is an inflammation of the testicles that may be due to mumps. You can manage orchitis pain by placing cold packs on the testicles several times a day. Your doctor may recommend prescription-strength painkillers if necessary. In rare cases, orchitis can cause sterility in males.

• Females infected with mumps may experience swelling of the ovaries. The inflammation can be painful but doesn’t harm a woman’s eggs. However, if a woman contracts mumps during pregnancy, she has a higher-than-normal risk of suffering a miscarriage.

• Mumps may lead to meningitis or encephalitis, two potentially fatal conditions if left untreated. Meningitis is swelling of the membranes around your spinal cord and brain. Encephalitis is inflammation of the brain itself. Contact your doctor if you experience seizures, loss of consciousness, or severe headaches while you have mumps.

• Pancreatitis is inflammation of the pancreas, an organ in the abdominal cavity. Mumps-induced pancreatitis is a temporary condition. Symptoms include abdominal pain, nausea, and vomiting.

• The mumps virus also leads to permanent hearing loss in about 5 out of every 10,000 cases. The virus damages the cochlea, one of the structures in your inner ear that facilitates hearing.

Signs and Symptoms:

• Swollen, painful salivary glands on one or both sides of your face (parotitis)

• Fever

• Headache

• Muscle aches

• Weakness and fatigue

• Loss of appetite

• Pain while chewing or swallowing

The primary — and best known — sign of mumps is swollen salivary glands that cause the cheeks to puff out. In fact, the term "mumps" is an old expression for lumps or bumps within the cheeks.

When to see a doctor

If you suspect that you or your child has mumps, see your doctor. Let your doctor's office know before you go in that you suspect mumps so that you won't have to wait so long in the waiting room, possibly infecting others. Mumps has become an uncommon illness, so it's possible that the signs and symptoms are caused by another condition. Swollen salivary glands and a fever could be an indication of inflamed tonsils (tonsillitis) or a blocked salivary gland.

Other viruses can infect the parotid glands, causing a mumps-like illness.

Rubella

• Rubella is a contagious, generally mild viral infection that occurs most often in children and young adults.

• Rubella infection in pregnant women may cause fetal death or congenital defects known as congenital rubella syndrome (CRS).

• Worldwide, over 100 000 babies are born with CRS every year.

• There is no specific treatment for rubella but the disease is preventable by vaccination.

Rubella is an acute, contagious viral infection. While the illness is generally mild in children, it has serious consequences in pregnant women causing fetal death or congenital defects known as congenital rubella syndrome (CRS).

The rubella virus is transmitted by airborne droplets when infected people sneeze or cough. Humans are the only known host.

Symptoms

In children, the disease is usually mild, with symptoms including a rash, low fever (<39°C), nausea and mild conjunctivitis. The rash, which occurs in 50–80% of cases, usually starts on the face and neck before progressing down the body, and lasts 1–3 days. Swollen lymph glands behind the ears and in the neck are the most characteristic clinical feature. Infected adults, more commonly women, may develop arthritis and painful joints that usually last from 3–10 days.

Once a person is infected, the virus spreads throughout the body in about 5-7 days. Symptoms usually appear 2 to 3 weeks after exposure. The most infectious period is usually 1–5 days after the appearance of the rash.

When a woman is infected with the rubella virus early in pregnancy, she has a 90% chance of passing the virus on to her fetus. This can cause miscarriage, stillbirth or severe birth defects known as CRS. Infants with CRS may excrete the virus for a year or more.

Congenital rubella syndrome

Children with CRS can suffer hearing impairments, eye and heart defects and other lifelong disabilities, including autism, diabetes mellitus and thyroid dysfunction – many of which require costly therapy, surgeries and other expensive care.

The highest risk of CRS is in countries where women of childbearing age do not have immunity to the disease (either through vaccination or from having had rubella). Before the introduction of the vaccine, up to 4 babies in every 1000 live births were born with CRS.

Large-scale rubella vaccination during the past decade has practically eliminated rubella and CRS in many developed and in some developing countries. In April 2015, the WHO Region of the Americas became the first in the world to be declared free of endemic transmission of rubella.

CRS rates are highest in the WHO African and South-East Asian regions where vaccine coverage is lowest.

Routine vaccination:

• Administer a 2–dose series of MMR vaccine at ages 12 through 15 months and 4 through 6 years. The second dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose.

• Administer 1 dose of MMR vaccine to infants aged 6 through 11 months before departure from the United States for international travel. These children should be revaccinated with 2 doses of MMR vaccine, the first at age 12 through 15 months (12 months if the child remains in an area where disease risk is high), and the second dose at least 4 weeks later.

• Administer 2 doses of MMR vaccine to children aged 12 months and older before departure from the United States for international travel. The first dose should be administered on or after age 12 months and the second dose at least 4 weeks later.

Catch–up vaccination:

• Ensure that all school–aged children and adolescents have had 2 doses of MMR vaccine; the minimum interval between the 2 doses is 4 weeks.

Varicella (VAR) vaccine. (Minimum age: 12 months)

Varicella, also commonly referred to as “chickenpox”, is an acute and highly contagious disease. It is caused by primary infection with the varicella-zoster virus (VZV). Varicella occurs worldwide and in the absence of a vaccination program, affects nearly every person by mid-adulthood. The epidemiology of the disease differs between temperate and tropical climates. The reasons for the differences are poorly understood and may relate to properties of VZV (known to be sensitive to heat), climate, population density and risk of exposure (e.g., attendance at childcare facility or school or the number of siblings in the household).

VZV is highly transmissible via respiratory droplets or direct contact with characteristic skin lesions of the infected person. The first symptoms of clinical varicella generally appear after a 10-21 day incubation period and include fever, malaise and the characteristic itchy rash. Varicella is generally self-limited and vesicles gradually develop crusts, which disappear over a period of 7-10 days. Individuals remain contagious until all lesions have crusted over. The disease is typically mild, but severe complications may arise, including bacterial infections (e.g. cellulitis, pneumonia) and neurological complications (e.g. encephalitis), and these can be fatal. Disease is associated with higher morbidity and mortality in infants and in individuals with an impaired immune system.

Routine vaccination:

• Administer a 2–dose series of VAR vaccine at ages 12 through 15 months and 4 through 6 years. The second dose may be administered before age 4 years, provided at least 3 months have elapsed since the first dose. If the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.

Catch–up vaccination:

• Ensure that all persons aged 7 through 18 years without evidence of immunity,have 2 doses of varicella vaccine. For children aged 7 through 12 years, the recommended minimum interval between doses is 3 months (if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid); for persons aged 13 years and older, the minimum interval between doses is 4 weeks.

Hepatitis A (HepA) vaccine. (Minimum age: 12 months)

Key facts

• Hepatitis A is a viral liver disease that can cause mild to severe illness.

• The hepatitis A virus (HAV) is transmitted through ingestion of contaminated food and water or through direct contact with an infectious person.

• Almost everyone recovers fully from hepatitis A with a lifelong immunity. However, a very small proportion of people infected with hepatitis A could die from fulminant hepatitis.

• The risk of hepatitis A infection is associated with a lack of safe water, and poor sanitation and hygiene (such as dirty hands).

• Epidemics can be explosive and cause substantial economic loss.

• A safe and effective vaccine is available to prevent hepatitis A.

• Safe water supply, food safety, improved sanitation, hand washing and the hepatitis A vaccine are the most effective ways to combat the disease.

Hepatitis A is a liver disease caused by the hepatitis A virus. The virus is primarily spread when an uninfected (and unvaccinated) person ingests food or water that is contaminated with the feces of an infected person. The disease is closely associated with unsafe water or food, inadequate sanitation and poor personal hygiene.

Unlike hepatitis B and C, hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is often fatal.

Hepatitis A occurs sporadically and in epidemics worldwide, with a tendency for cyclic recurrences. The hepatitis A virus is one of the most frequent causes of food borne infection. Epidemics related to contaminated food or water can erupt explosively, such as the epidemic in Shanghai in 1988 that affected about 300 000 people1. Hepatitis A viruses persist in the environment and can withstand food-production processes routinely used to inactivate and/or control bacterial pathogens.

The disease can lead to significant economic and social consequences in communities. It can take weeks or months for people recovering from the illness to return to work, school, or daily life. The impact on food establishments identified with the virus, and local productivity in general, can be substantial.

Routine vaccination:

• Initiate the 2–dose HepA vaccine series at ages 12 through 23 months; separate the 2 doses by 6 to 18 months.

• Children who have received 1 dose of HepA vaccine before age 24 months should receive a second dose 6 to 18 months after the first dose.

• For any person aged 2 years and older who has not already received the HepA vaccine series, 2 doses of HepA vaccine separated by 6 to 18 months may be administered if immunity against hepatitis A virus infection is desired.

Catch–up vaccination:

• The minimum interval between the 2 doses is 6 months.

Special populations:

• Administer 2 doses of HepA vaccine at least 6 months apart to previously unvaccinated persons who live in areas where vaccination programs target older children, or who are at increased risk for infection. This includes persons traveling to or working in countries that have high or intermediate endemicity of infection; men having sex with men; users of injection and non–injection illicit drugs; persons who work with HAV–infected primates or with HAV in a research laboratory; persons with clotting–factor disorders; persons with chronic liver disease; and persons who anticipate close, personal contact (e.g., household or regular babysitting) with an international adoptee during the first 60 days after arrival in the United States from a country with high or intermediate endemicity. The first dose should be administered as soon as the adoption is planned, ideally, 2 or more weeks before the arrival of the adoptee.

Meningococcal vaccines. (Minimum age: 6 weeks for Hib–MenCY [MenHibrix], 2 months for MenACWY–CRM [Menveo], 9 months for MenACWY–D [Menactra], 10 years for serogroup B meningococcal [MenB] vaccines: MenB–4C [Bexsero] and MenB–FHbp [Trumenba])

Meningococci are a type of bacteria that cause serious infections. The most common infection is meningitis, which is an inflammation of the thin tissue that surrounds the brain and spinal cord. Meningococci can also cause other problems, including a serious bloodstream infection called sepsis.

Meningococcal infections can spread from person to person. Risk factors include

• Age - it is more common in infants, teens, and young adults

• Living in close quarters, such as in college dorms or military settings

• Certain medical conditions, such as not having a spleen

• Travel to areas where meningococcal disease is common

In its early stages, you may have flu-like symptoms and a stiff neck. But the disease can progress quickly and can be fatal. Early diagnosis and treatment are extremely important. Lab tests on your blood and cerebrospinal fluid can tell if you have it. Treatment is with antibiotics. Since the infection spreads from person to person, family members may also need to be treated. A vaccine can prevent meningococcal infections.

Routine vaccination:

• Administer a single dose of Menactra or Menveo vaccine at age 11 through 12 years, with a booster dose at age 16 years.

• For children aged 2 months through 18 years with high–risk conditions, see “Meningococcal conjugate ACWY vaccination of persons with high–risk conditions and other persons at increased risk” and “Meningococcal B vaccination of persons with high–risk conditions and other persons at increased risk of disease” see below.

Catch–up vaccination:

• Administer Menactra or Menveo vaccine at age 13 through 18 years if not previously vaccinated.

• If the first dose is administered at age 13 through 15 years, a booster dose should be administered at age 16 through 18 years, with a minimum interval of at least 8 weeks between doses.

• If the first dose is administered at age 16 years or older, a booster dose is not needed.

• For other catch–up guidance, see Catch–up Schedule.

Clinical discretion:

• Young adults aged 16 through 23 years (preferred age range is 16 through 18 years) who are not at increased risk for meningococcal disease may be vaccinated with a 2–dose series of either Bexsero (0, ≥1 month) or Trumenba (0, 6 months) vaccine to provide short–term protection against most strains of serogroup B meningococcal disease. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses.

• If the second dose of Trumenba is given at an interval of <6 months, a third dose should be given at least 6 months after the first dose; the minimum interval between the second and third doses is 4 weeks.

Meningococcal conjugate ACWY vaccination of persons with high–risk conditions and other persons at increased risk:

Children with anatomic or functional asplenia (including sickle cell disease), children with HIV infection, or children with persistent complement component deficiency (includes persons with inherited or chronic deficiencies in C3, C5–9, properdin, factor D, factor H, or taking eculizumab [Soliris]):

• Menveo

• Children who initiate vaccination at 8 weeks. Administer doses at ages 2, 4, 6, and 12 months.

• Unvaccinated children who initiate vaccination at 7 through 23 months. Administer 2 primary doses, with the second dose at least 12 weeks after the first dose AND after the first birthday.

• Children 24 months and older who have not received a complete series. Administer 2 primary doses at least 8 weeks apart.

• Children who initiate vaccination at 6 weeks. Administer doses at ages 2, 4, 6, and 12 through 15 months.

• If the first dose of MenHibrix is given at or after age 12 months, a total of 2 doses should be given at least 8 weeks apart to ensure protection against serogroups C and Y meningococcal disease.

• Children with anatomic or functional asplenia or HIV infection

• Children 24 months and older who have not received a complete series. Administer 2 primary doses at least 8 weeks apart. If Menactra is administered to a child with asplenia (including sickle cell disease) or HIV infection, do not administer Menactra until age 2 years and at least 4 weeks after the completion of all PCV13 doses.

• Children with persistent complement component deficiency

• Children 9 through 23 months. Administer 2 primary doses at least 12 weeks apart.

• Children 24 months and older who have not received a complete series. Administer 2 primary doses at least 8 weeks apart.

• All high–risk children

• If Menactra is to be administered to a child at high risk for meningococcal disease, it is recommended that Menactra be given either before or at the same time as DTaP.

Meningococcal B vaccination of persons with high–risk conditions and other persons at increased risk of disease:

Children with anatomic or functional asplenia (including sickle cell disease) or children with persistent complement component deficiency (includes persons with inherited or chronic deficiencies in C3, C5–9, properdin, factor D, factor H, or taking eculizumab [Soliris]):

Bexsero or Trumenba

• Persons 10 years or older who have not received a complete series. Administer a 2–dose series of Bexsero, with doses at least 1 month apart, or a 3–dose series of Trumenba, with the second dose at least 1–2 months after the first and the third dose at least 6 months after the first. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses.

For children who travel to or reside in countries in which meningococcal disease is hyperendemic or epidemic, including countries in the African meningitis belt or the Hajj:

Administer an age–appropriate formulation and series of Menactra or Menveo for protection against serogroups A and W meningococcal disease. Prior receipt of MenHibrix is not sufficient for children traveling to the meningitis belt or the Hajj because it does not contain serogroups A or W.

For children at risk during an outbreak attributable to a vaccine serogroup:

For serogroup A, C, W, or Y: Administer or complete an age– and formulation–appropriate series of MenHibrix, Menactra, or Menveo.

For serogroup B: Administer a 2–dose series of Bexsero, with doses at least 1 month apart, or a 3–dose series of Trumenba, with the second dose at least 1–2 months after the first and the third dose at least 6 months after the first. The two MenB vaccines are not interchangeable; the same vaccine product must be used for all doses.

For MenACWY booster doses among persons with high–risk conditions, refer to MMWR 2013;62(RR02):1–22[32 pages], MMWR June 20, 2014;63(24):527–530[16 pages], and MMWR November 4, 2016; 65(43):1189–1194[6 pages].

For other catch–up recommendations for these persons and complete information on use of meningococcal vaccines, including guidance related to vaccination of persons at increased risk of infection, see meningococcal MMWR publications.

Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine. (Minimum age: 10 years for both Boostrix and Adacel)

See page 3 for definitions

Routine vaccination:

Administer 1 dose of Tdap vaccine to all adolescents aged 11 through 12 years.

Tdap may be administered regardless of the interval since the last tetanus and diphtheria toxoid–containing vaccine.

Administer 1 dose of Tdap vaccine to pregnant adolescents during each pregnancy (preferably during the early part of gestational weeks 27 through 36), regardless of time since prior Td or Tdap vaccination.

Catch–up vaccination:

Persons aged 7 years and older who are not fully immunized with DTaP vaccine should receive Tdap vaccine as 1 dose (preferably the first) in the catch–up series; if additional doses are needed, use Td vaccine. For children 7 through 10 years who receive a dose of Tdap as part of the catch–up series, an adolescent Tdap vaccine dose at age 11 through 12 years may be administered.

Persons aged 11 through 18 years who have not received Tdap vaccine should receive a dose, followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter.

Inadvertent doses of DTaP vaccine:

• If administered inadvertently to a child aged 7 through 10 years, the dose may count as part of the catch–up series. This dose may count as the adolescent Tdap dose, or the child may receive a Tdap booster dose at age 11 through 12 years.

• If administered inadvertently to an adolescent aged 11 through 18 years, the dose should be counted as the adolescent Tdap booster.

For other catch–up guidance, see Catch–up Schedule.

Human papillomavirus (HPV) vaccines. (Minimum age: 9 years for 4vHPV [Gardasil] and 9vHPV [Gardasil 9])

HPV is short for human papillomavirus.HPV is a group of more than 150 related viruses. Each HPV virus in this large group is given a number which is called its HPV type. HPV is named for the warts (papillomas) some HPV types can cause. Some other HPV types can lead to cancer. Men and women can get cancer of mouth/ throat, and anus/rectum caused by HPV infections. Men can also get penile HPV cancer. In women, HPV infection can also cause cervical, vaginal, and vulvar HPV cancers. But there are vaccines that can prevent infection with the types of HPV that most commonly cause cancer.

How do people get HPV?

HPV is transmitted through intimate skin-to-skin contact. You can get HPV by having vaginal, anal, or oral sex with someone who has the virus. It is most commonly spread during vaginal or anal sex. HPV is so common that nearly all men and women get it at some point in their lives. HPV can be passed even when an infected person has no signs or symptoms. You can develop symptoms years after being infected, making it hard to know when you first became infected.

In most cases, HPV goes away on its own and does not cause any health problems. But when HPV does not go away, it can cause health problems like genital warts and cancer.

Genital warts usually appear as a small bump or groups of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. A healthcare provider can usually diagnose warts by looking at the genital area.

HPV cancers include cancer of the cervix, vulva, vagina, penis, or anus. HPV infection can also cause cancer in the back of the throat, including the base of the tongue and tonsils.

Routine and catch–up vaccination:

Administer a 2–dose series of HPV vaccine on a schedule of 0, 6–12 months to all adolescents aged 11 or 12 years. The vaccination series can start at age 9 years.

Administer HPV vaccine to all adolescents through age 18 years who were not previously adequately vaccinated. The number of recommended doses is based on age at administration of the first dose.

For persons initiating vaccination before age 15, the recommended immunization schedule is 2 doses of HPV vaccine at 0, 6–12 months.

For persons initiating vaccination at age 15 years or older, the recommended immunization schedule is 3 doses of HPV vaccine at 0, 1–2, 6 months.

A vaccine dose administered at a shorter interval should be readministered at the recommended interval.

• In a 2–dose schedule of HPV vaccine, the minimum interval is 5 months between the first and second dose. If the second dose is administered at a shorter interval, a third dose should be administered a minimum of 12 weeks after the second dose and a minimum of 5 months after the first dose.

• In a 3–dose schedule of HPV vaccine, the minimum intervals are 4 weeks between the first and second dose, 12 weeks between the second and third dose, and 5 months between the first and third dose. If a vaccine dose is administered at a shorter interval, it should be readministered after another minimum interval has been met since the most recent dose.

Special populations:

For children with history of sexual abuse or assault, administer HPV vaccine beginning at age 9 years.

Immunocompromised persons*, including those with human immunodeficiency virus (HIV) infection, should receive a 3–dose series at 0, 1–2, and 6 months, regardless of age at vaccine initiation.

Note: HPV vaccination is not recommended during pregnancy, although there is no evidence that the vaccine poses harm. If a woman is found to be pregnant after initiating the vaccination series, no intervention is needed; the remaining vaccine doses should be delayed until after the pregnancy. Pregnancy testing is not needed before HPV vaccination.

Content source:National Center for Immunization and Respiratory Diseases Provided by: Centers for Disease Control and Prevention (CDC) World Health Organization Hepatitis B

World Health Organization Rotovirus CDC Diphtheria and tetanus toxoids and acellular pertussis, haemophilus Influenzae Type b (Hib)VIS

• Mumps Symptoms - Mayo Clinic

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