Severe immunosuppression resulting from congenital immunodeficiency, human immunodeficiency virus (HIV) infection, leukemia, lymphoma, cancer therapy, or a prolonged course of high-dose corticosteroids (>2 mg/kg/day for >2 weeks) predisposes to complications and is a contraindication for live virus vaccines. For HIV-infected children who do not have evidence of severe immunosuppression, MMR vaccination is recommended at 12 months of age with a second dose 1 month later rather than waiting until 4 to 6 years of age. Varicella vaccine is contraindicated for persons with cellular immunodeficiency but is recommended for persons with impaired humoral immunity (hypogammaglobulinemia or dysgammaglobulinemia) and at 12 months of age for HIV-infected children without evidence of severe immunosuppression, given as two doses 3 months apart.
The National Childhood Vaccine Injury Act requires that clinically significant adverse events after vaccination be reported to the Vaccine Adverse Event Reporting System (VAERS) ( http://www.vaers.hhs.gov or (800) 822-7967). Suspected cases of vaccine-preventable diseases should be reported to state or local health departments. The act also established the National Vaccine Injury Compensation Program, a no-fault system in which persons thought to have suffered an injury or death as a result of administration of a covered vaccine can seek compensation.
Prophylaxis may include antibiotics, immunoglobulin or monoclonal antibody, vaccine, alone or in combination; they may be used postexposure, for perinatal exposure, and preexposure for persons at increased risk for infection. Primary prophylaxis is used to prevent infection before a first occurrence. Secondary prophylaxis is used to prevent recurrence after a first episode.
Primary prophylaxis to all contacts of index cases of N. meningitidis infection should be administered as soon as possible (see Chapter 100). Prophylaxis is recommended for all household contacts, especially young children; child care or nursery school contacts in the previous 7 days; for direct exposure to the index patient’s secretions through kissing or sharing of toothbrushes or eating utensils; and for mouth-to-mouth resuscitation or unprotected contact during endotracheal intubation within 7 days before onset of illness. Prophylaxis is also recommended for contacts who frequently sleep or eat in the same dwelling as the index patient or passengers seated directly next to the index case during airline flights lasting longer than 8 hours. Chemoprophylaxis is not recommended for casual contacts with no history of direct exposure to the patient’s oral secretions (school or work mate), indirect
Recommended immunization schedule for persons aged 0 through 18 years – 2013. (FOR THOSE WHO FALL BEHIND OR START LATE, SEE THE CATCH-UP SCHEDULE [FIGURE 94-2]).
These recommendations must be read with the footnotes that follow. For those who fall behind or start late, provide catch-up vaccination at the earliest opportunity as indicated by the green bars in Figure 94-1. To determine minimum intervals between doses, see the catch-up schedule (Fig. 94-2). School entry and adolescent vaccine age groups are in bold.