Review – Child Health Promotion / Vaccinations

•  Measles, mumps, rubella (MMR)

•  Offers protection against these three diseases

•  In times of measles epidemics, it is possible to give measles protection at 6 months and repeat the MMR at 15 months.

•  Measles vaccine is contraindicated for persons with history of anaphylactic reaction to neomycin or eggs, those with known altered immunodeficiency, and pregnant women. It may be given to those with human immunodeficiency virus (HIV) and to breastfeeding women.

•  Administer subcutaneously at separate sites.

•  Child may have a light, transient rash 2 weeks after administration of vaccine.

• DTaP: History of reactions, seizures, neurologic symptoms after previous vaccine, or systematic allergic reactions

• MMR: History of anaphylactic reaction to eggs or neomycin

•  Offers protection against these diseases

•  Booster doses given at 15 to 18 months and at 4 to 6 years.

•  Administer intramuscularly (separate site from other vaccine).

•  Not given to children past the seventh birthday; they receive Td, which contains full-strength protection against tetanus and lesser strength diphtheria protection.

•  When pertussis vaccine is contraindicated, give DT, full-strength diphtheria and tetanus without pertussis vaccine, until seventh birthday.

•  Contraindications to pertussis vaccine include:

→ Encephalopathy within 7 days of previous dose of DTaP

→ History of seizures

→ Neurologic symptoms after receiving the vaccine

→ Systemic allergic reactions to the vaccine

•  Systemic allergic reactions to the vaccine.

•  Parents should be instructed to begin acetaminophen (Tylenol) administration after the immunization (normal dosage is 10 to 15 mg/kg).

•  Instruct parents to report immediately any side effects of the immunization to the primary caregiver.

•  Administer at 2 months of age and again at 4 months of age. Boosters are given at 6 to 18 months and at 4 to 6 years.

•  Administer IPV subcutaneously or IM at separate site.

•  IPV is contraindicated for those with history of anaphylactic reaction to neomycin or streptomycin.

•  May give with all other vaccines

•  Vaccines have different series administration schedules; the schedules cover children through 5 years of age.

•  Children at high risk who were not immunized previously should be immunized after the age of 5.

•  Administer intramuscularly.

•  There are no contraindications.

•  May be given to newborns prior to hospital discharge

•    All children up to 18 years of age should be vaccinated.

•  See note at bottom of Recommended Childhood Immunization Schedule, Figure 5-2.

•  Is a school entry requirement almost all states

•  Is safe for children with asymptomatic HIV infection

•  Give MMR and varicella on same day or >30 days apart (separate site).

•  See note at bottom of Recommended Childhood Immunization Schedule, Figure 5-2.

→ Mantoux test with PPD (tuberculin purified protein derivative) injected intradermally on the forearm; standard method for identifying infection with Mycobacterium tuberculosis

→ Tine test (OT, old tuberculin), which consists of four prongs pressed into the forearm. These multiple puncture tests are unreliable and should not be used to determine the presence of a TB infection.

•  A positive reaction represents exposure to M. tuberculosis.

•  Screening can be initiated at 12 months.

• Irritability, fever (<102° F), redness, and soreness at injection site for 2 to 3 days are normal side effects of DTaP and IPV administration.

• Call health care provider if seizures, high fever, or high-pitched crying occurs.

• A warm washcloth on the thigh injection site and “bicycling” the legs with each diaper change decreases soreness.

• Acetaminophen (Tylenol) is administered orally every 4 to 6 hours (10 to 15 mg/kg).