Figure 66.1 Immunization schedule for children 2 months to 18 years
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Childhood immunizations
There are many decisions parents and carers have to make about their infants and children, and immunizations are often an area that parents worry about, particularly with media hype and the misguided research on the adverse affects of immunizations on some children.
The benefits of immunizations outweigh the risks to the infant or child. Sharing information and reassuring parents and carers by health care professionals is paramount if we are to continue to ensure that some diseases do not return.
Smallpox was officially declared wiped out in 1980, and polio is heading towards eradication. Immunizations have saved more lives and prevented more serious diseases than any advance in recent medical history. There will be more potentially life-saving immunizations in the coming years as there are more than 150 new immunizations currently being tested.
Immunizations given at 2, 3 and 4 months
By about 2 months of age, the baby’s natural immunity gained from his/her mother begins to diminish and so that is why the program starts at aged 2 months.
A 5-in-1 vaccine (DTaP/IPV/Hib) protects the infant against diphtheria, tetanus, pertussis, polio and haemophilus influenza type B.
The infant is also given PCV (pneumococcal) at 2 months and 4 months and meningitis C at 3 months and 4 months.
Immunizations given at 12–13 months
A booster of meningitis C and haemophilus influenza type B is given and a third dose of PCV (pneumococcal) along with MMR (measles, mumps and rubella).
Immunizations given at 3 years 4 months or soon after
A booster of MMR is given, along with a pre-school booster for diphtheria, tetanus, pertussis and polio (DTaP/IPV).
Immunizations given to girls at 12–13 years
Human papillomavirus immunization was commenced in 2008 to try to reduce the numbers of cervical cancer. The immunization program is given via three single injections over a period of a year. The girl will have protection for 6 years after the last dose, but it is still unknown how long protection will last.
Immunizations given to teenagers aged 13–18 years
A booster of diphtheria, tetanus and polio is given before the child leaves senior school.
Other immunzations available
Immunosuppressed children may be offered varicella immunization between the ages of 1 and 12 in one single dose. A child over 13 years will be given two doses given 4–8 weeks apart.
Tuberculosis immunization is given to infants and children who have a high chance of coming into contact with the disease and is given from birth to 16 years of age.
Influenza immunization is offered to children who have certain medical conditions or who are immunosuppressed once a year from 6 months of age.
Common problems
The 5-in-1 injection may cause redness and swelling at the site for a few days, and mild fever may last up to 10 days after the immunization.
The pneumococcal immunization causes redness and inflammation in 1 in 7 infants. Mild symptoms of irritability, raised temperature and digestive disturbances can occur.
The meningitis C vaccine can cause swelling and redness to the site. In toddlers, disturbed sleep and mild fever can occur, whereas older children may complain of headaches.
MMR can cause cold symptoms, fever, swollen salivary glands, for a few days up to 3 weeks after the immunization. Rash and loss of appetite can also occur.
Treatment
All the common problems are manageable and minor. Paracetamol for pain and discomfort according to prescription advice is recommended along with frequent fluids and rest.
When not to immunize
Immunization should be postponed if a child has a pyrexia (above 38°C).
If a child has had a bad reaction to a previous immunization, they may require assessment first, and future doses may be given in a hospital setting.
Only children who have had a confirmed anaphylactic reaction to an immunization will be advised not to have further doses.
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