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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues
E. Anticipatory Guidance
F. Screening Tests
G. Immunizations
--Screening Tests and
Immunization Schedule
--Influenza - Dx and Prevention
--Varicella Vaccine – 2002 |
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Pneumococcal Vaccine: 2002
Introduction: Prevnar is given to children 2mo, 4mo, 6mo,
and 12-15 months of age. It is a seven-valent vaccine (pneumococcal
serotypes 4, 6B, 9V, 14, 18C, 19F and 23F) conjugated covalently with CRM
197 protein. These seven strains cause about 85% of the pneumococcal
disease in the US.
Side Effects of Vaccine: deemed safe; Fever, soreness most
common.
Ages at which vaccine should be administered: High Priority
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Age at which start |
Ages at which given |
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2 month old |
2, 4, 6, 12-15 months |
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7-11 months of age |
Two doses 2 months apart; third dose at 12-15 months |
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12-23 months of age |
Two doses 2 months apart |
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24-59 months of age |
Sickle cell disease: 900-5720:100,000
HIV: 5500-9900:100,000,
Others: chemotherapy induced immunosuppression , organ donation, Alaska
natives or American Indians:
Two doses 2 months apart if older than 24 months of age |
Ages at Which Vaccine Should Be Administered: Moderate Priority:
Healthy children 24-35 months: invasive disease rates of
pneumococcal infection: 64.7/100,000.
Ages at Which Vaccine Should Be Administered: Low Priority:
Healthy children aged 36-59 months of age: the proportion of strains
covered by the vaccine comprises only 63% of those causing invasive disease
in 4 year olds and 58% of 5 year olds. This could occur at the 4-6 year
visit. However, it should be noted that some physicians in our community
are now giving a second dose after 2 years of age if the first dose had been
delayed.
Anticipated Effects of Giving the Conjugate Pneumococcal Vaccine:
- Otitis Media. Prospective study in Finland of 1662
children. Found the vaccine was more reactogenic than the Hep B vaccine,
but less than DTP/Hib combination. Found that in these children, 357
episodes of otitis, 107 in the conjugate group, 250 in controls.
Implication: many fewer tubes needed.
The prediction is that since pneumococcal infections are responsible for
more than 30% of cases of bacterial otitis media, there will be a marked
decrease in the number of cases of otitis as a result of this vaccine.
The question remains whether other organisms will then become more
prevalent. This decrease may not be noticed by the primary care
physician, but more on a population base.
- Pneumonia. Three year study of 38,000 children at
Kaiser found that consolidated pneumonias decreased by 73%, others by 33%;
11% fewer doctor visits for pneumonia.
- Bacteremia and Meningitis. Vaccine 97% effective
against these infections.
Role of Polysaccharide Vaccine (23 valent): High risk
only: sickle cell, asplenia, HIV, others:
Give 1 dose at 24 mos at least 6-8 wks after PCV 7; repeat 3-5 years
later.
If no Prevnar previously given to these children: 2 doses PCV 7 6-8 wks
apart then followed by PS vaccine 6-8 weeks and 3-5 years later.
Updated 10/01
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