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Image: “Child receives MenAfriVac™ shot in Burkina Faso” by PATH global health. License: CC BY 2.0

Kids are most vulnerable to potentially life-threatening conditions. Vaccines are a safe way to protect against potentially life-threatening diseases. The previously speculated connection between autism and vaccination has been disproved.

The Impact of Vaccines on Public Health

The incidence, morbidity, and mortality of communicable diseases have decreased in the western world largely due to the progress of national immunization strategies aimed at infants and children. The vaccines lead to lower carrier rates and development of herd immunity.

The current schedule by the ACIP for vaccines and immunizations in the United States for children and adolescents up to 18 years include:

Hepatitis B vaccine

  • 1st dose – birth
  • 2nd dose 1 – 2 months
  • 3rd dose 6 – 18 months

Side effects

Hepatitis B vaccination does not have any serious side effects. Minor problems like soreness at the site of injection and fever of 37.7° C or higher are seen. These problems last for about 1 or 2 days after the vaccination. 

Rotavirus vaccine

  • 1st dose – 2 months
  • 2nd dose – 4 months
  • 3rd dose – 6 months

Side effects

Mild problems following the rotavirus vaccine are irritability, vomiting, and diarrhea. These are temporary issues.

Serious problems include Intussusception that is seen within a week of 1st or 2nd dose of rotavirus vaccination. The prevalence of this issue is 1 in 20,000 to 1 in 100,000 infants.

DTaP vaccine

The acellular pertussis vaccine replaced the earlier toxic whole-cell vaccine. It is protective against pertussis (whooping cough) a common condition in infants younger than 6 months.

  • 1st dose – 2 months
  • 2nd dose – 4 months
  • 3rd dose – 6 months
  • 4th does – 15–18 months
  • 5th dose – 4–6 years
  • Booster dose after 7 years of age

Side effects

Mild Problems

  • 1 out of 4 children gets swelling and redness in the region where the shot was given.
  • 1 out of 30,000 cases gets low platelet count temporarily.
  • 1 in 4 children has a fever.
  • 1 in 4 children develops soreness at the site of the shot.
  • Vomiting, fuzziness, and tiredness 1-3 days after the shot.

Uncommon Problems

  • Seizure, jerking and/or staring is seen in about 1 out of 14,000 children.
  • 1 in 1000 children may experience non-stop crying for 3 days.
  • 1 in 16,000 children gets a high-grade fever.

Hemophilus influenza type B (HiB) vaccine

Before its inclusion to the schedule, all the diseases caused by this bacterium affected children younger than 5 years old and two-thirds of those below 15 months of age.

The vaccine is scheduled at 2 or 3 doses and a booster dose (could be third or fourth dose depending on the vaccine) during month 12–15 of life.

  • 1st dose – 2 months
  • 2nd dose – 4 months
  • 3rd dose – 6 months

In children older than 5 years who were not vaccinated in infancy, the vaccine is not needed if they are asymptomatic; the vaccine is recommended in asplenia and immunosuppression.

Side effects

There are only mild problems associated with the HiB vaccine. Swelling and redness at the site of vaccination and fever are common. The problems usually resolve in 2 to 3 days after the shot.

Pneumococcal PCV 13 vaccine

Protective against streptococcus pneumonia that causes meningitis, pneumonia, otitis and sinusitis, among other diseases.

The PCV13 is administered as a series of four doses as shown:

  • 1st dose – 2 months
  • 2nd dose – 4 months
  • 3rd dose – 6 months
  • 4th dose – 12–15 months

Side effects

There are only mild problems associated with PPCV vaccine. Pain and redness at the site of vaccination are seen. The problems usually resolve within 2 days of the shot. 1 percent of the cases present with myalgia, fever and other local reactions.

Inactivated Polio Vaccine (IPV)

  • 1st dose – 2 months
  • 2nd dose – 4 months
  • 3rd dose – 6–18 months
  • 4th dose – 4–6 years

Side effects

Other than a sore spot at the site of vaccination, the IPV vaccine has not shown any serious problems.

Mumps, Measles, Rubella (MMR)

These are common viral diseases associated with:

  • Mumps: swelling of the cheeks and jaw, orchitis, meningitis, and salivary gland inflammation.
  • Measles: rash, encephalitis, and pneumonia.
  • Rubella: congenital abnormalities and mental retardation in babies born of infected mothers.

The vaccine administration is done in two doses:

  • 1st dose – 12–15 months
  • 2nd dose – 4–6 years

For ease of administration and follow-up, the recommendation is that the vaccines be done at an interval of 4 weeks. Also recommended for those traveling outside the U.S and during outbreaks.

Side effects

Mild problems:

  • 1 out of 75 people has gland swelling in the neck or cheeks.
  • 1 out of 30,000 cases gets low platelet count temporarily.
  • 1 in 6 people has a fever.
  • 1 in 29 individuals develops a rash.
  • Fever causes seizures, jerking or staring in 1 out of 3000 cases.

Varicella vaccine

  • 1st dose – 12–15 months
  • 2nd dose – 4–6 years

Side effects

Problems following the Varicella vaccine are as follows:

  • 1 out of 5 children has soreness in the region of the shot.
  • 1 out of 3 people has swelling or redness.
  • 1 in 10 people has a fever.
  • 1 in 25 individuals develops a rash after one month of vaccination.
  • Seizure, jerking or staring is very rarely caused by fever.

Hepatitis A vaccine

  • 12–23 months
  • Typically, two vaccines are given 6–18 months apart.

Side effects

Minor problems like a low-grade fever, tiredness, soreness at the site of injection and headache are seen after hepatitis A vaccine.

Human Papilloma Virus vaccine

HPV is the most common sexually transmitted infection in the United States. It leads to the development of cervical and vaginal cancer in female preteens as well as anal and oropharyngeal carcinoma in both sexes.

The available vaccines in the U.S include :

  1. The quadrivalent vaccine (Gardasil) protective against HPV subtypes 6, 11, 16 and 18.
  2. The bivalent vaccine (cervarix) protective against HPV subtypes 16 and 18.
  3. Nine valent vaccine (Gardasil 9) protective against HPV subtypes 6, 11, 16, 18, 31, 33, 45, 52 and 58.

Any of the above vaccinations can be administered as a 3-dose series at 0, 1 and 6 months beginning at 11–12 years.

  • 3-dose series at 11–12 years.
  • Given as 3 doses at 0, 1 and 6 months.
  • Prevents cervical and penile cancer.

Side effects

Problems following Human Papilloma Virus vaccine:

  • 9 out of 10 people have soreness in the region of the shot.
  • 1 out of 3 people has swelling or redness.
  • 1 in 10 people has a mild fever (100° F).
  • 1 in 65 people experience moderate fever (102° F).
  • 1 in 3 individuals develops a headache.

Meningococcal vaccine

The epidemiology of meningitis and the safety of the available vaccines guides the administration of a meningococcal vaccine. Epidemiologically, invasive meningococcal disease has two age groups at risk:

  • Infants less than 6 months of age who are too young to receive the two or three doses of the protective vaccine.
  • Adolescents aged 13–21 years.

Based on the above findings, the ACIP recommends administration of the vaccine only in:

  1. Infants at higher risk of the disease, in cases of:
    1. Complement deficiency patients.
    2. Community outbreaks.
    3. Asplenia.
    4. Travel to endemic areas.
  2. Adolescents aged 11–12 years and a booster dose is given at 16–18 years of age.
  • It prevents meningococcal meningitis.
  • Typically given in 16–18-year-old individuals.
  • Optional vaccine.

Side effects

Mild problems like redness and soreness at the site of vaccination are seen in almost half of the individuals. This soreness usually settles in around 2 days. These problems are more commonly seen with MenACWY as compared to MPSV4.

A small percentage of vaccinated individuals experience fever. 

Combined Vaccines 

Combination vaccines make it possible to inject more than one vaccine with one shot. It is a safe and effective way of maximizing adherence, reducing the burden of visits and hence the cost of healthcare. The following are a few examples:

  • Kinrix is a combination of IPV and DTaP.
  • Comvax is a combination of Hep B and HiB.
  • Pentacel is a combination of IPV, DTaP, and HiB.
  • Pediarix is a combination of Hep B, DTaP, and IPV.
  • ProQuad is a combination of varicella and MMR.
  • Twinrix is a combination of Hep B and Hep A.
  • The 5-in-1 vaccine is a combination of diphtheria, whooping cough, tetanus, polio and HiB (Haemophilus Influenzae Type B). It is given at 8, 12 and 16 weeks of age.

Contraindications to vaccines

If a child is moderately or severely ill, administering the following vaccines is contraindicated. 

  • MMR
  • Varicella
  • Pneumococcal conjugate vaccine
  • Influenza
  • Rotavirus
  • Meningococcus

People who have allergies or intolerance to the following should not be given specific vaccines:

  • Gelatin and neomycin allergy – MMR vaccine
  • Egg and chicken allergy – IM Influenza vaccine
  • Latex allergy – Some DTaP and Rotavirus vaccines
  • Yeast allergy – Hepatitis B vaccine
  • Gentamycin, gelatin, arginine – live attenuated nasal influenza vaccine

A person who was allergic to the previous vaccine should not be given the 2nd dose of the same vaccine.

MMR, Varicella, Rotavirus and influenza vaccine (nasal spray) are live attenuated vaccines. These vaccines should not be given to pregnant women and immunodeficient children.

Adverse reactions to vaccines

Vaccine Reaction
All Local pain, swelling, redness, low-grade fever, fussiness, febrile seizure
Hepatitis A Headache
DTaP Limb swelling, high fever, hypotonic/hyporesponsive episode
MMR Joint pain, rash
Menigococcus, Influenza GBS
Rotavirus Mild diarrhea

Precautions against using vaccines

Vaccine Reaction
Pertussis Change in neurologic status or Guillain-Barre after previous dose
Diphtheria, tetanus, influenza Guillain-Barre after previous dose
MMR Thrombocytopenia after previous dose
All live attenuated vaccines Close contact with someone with immunodeficiency
Varicella Administration of high dose steroids or IVIG
Influenza IM High-dose steroid or chemotherapy
Rotavirus GI illness, history of intussusception

Contraindications to vaccines

Allergy or intolerance Which vaccine
Allergy to previous use of vaccine All
Yeast Hepatitis B
Latex Some DTaP and rotavirus
Gelatin, neomycin allergy MMR
Egg, chicken IM influenza
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