• Precautions
  1. See Immunization regarding risks of undervaccination
  2. Take every opportunity to catch up Vaccinations
  • Technique
  • Decreased adverse reaction associated factors
  1. Greater depth of injection with longer needle (2.5 cm or 1 inch)
    1. Fewer injection site reactions
  2. Use 23 gauge, 25 mm needle
  • Adverse Effects
  • Safety
  • Contraindications
  1. Hepatitis B Vaccine (HepB Vaccine)
    1. Dose 1: Birth to age 2 months
    2. Dose 2: Age 1 to 4 months (>1 month after dose 1)
    3. Dose 3: Age 6 to 18 months (>2 months after dose 2)
  2. Hepatitis A Vaccine
    1. Dose 1: Age 12 months
    2. Dose 2: Age 18 months
  3. Diphtheria Tetanus acellular Pertusis (DTaP Vaccine)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months
    4. Dose 4: Age 12 to 18 months (>6 months after dose 3)
    5. Dose 5: Age 4 to 6 years
    6. Tdap Booster: Age 11 to 12 years
  4. Haemophilus Influenzae type B (Hib Vaccine)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months
    4. Dose 4: Age 12 to 15 months
  5. Inactivated Polio Vaccine (EIPV)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 to 18 months
    4. Dose 4: Age 4 to 6 years (Dose 4 not needed if third dose given after age 4 years)
  6. Pneumococcal Conjugate Vaccine (PCV, Prevnar)
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months
    4. Dose 4: Age 12 to 15 months
  7. Measles Mumps Rubella Vaccine (MMR)
    1. Dose 1: Age 12 to 15 months
    2. Dose 2: Age 4 to 6 years (by age 12 years)
  8. Varicella Vaccine
    1. Dose 1: Age 12 to 18 months
    2. Dose 2: Age 4 to 6 years
  9. Rotavirus Vaccine
    1. Dose 1: Age 2 months
    2. Dose 2: Age 4 months
    3. Dose 3: Age 6 months (not required if Rotarix was used for Dose 1 and 2)
  10. Influenza Vaccine
    1. First year of Vaccine (age <8 years): two doses at 4 weeks apart
    2. Annually starting at age 6 months
  11. Meningococcal Conjugate Vaccine (MCV4)
    1. Dose 1: Age 11-12 years
    2. Dose 2: Age 16 years
  12. Human Papillomavirus Vaccine
    1. Age 9 to 14 years (2 dose series)
      1. Dose 1: Age 11-12 years in boys and girls (as early as age 9 years)
      2. Dose 2: Give 6-12 months after first dose
    2. Age 15 years old or older (3 dose series)
      1. Dose 1
      2. Dose 2: Give 1-2 months after dose 1
      3. Dose 3: Give 6 months after dose 2
  • Protocol
  • Special Circumstances
  1. Prematurity: Immunize if over >1000 grams or >27 weeks
    1. Low Incidence of Hepatitis B and Hib reactions
  2. Children with HIV Infection
    1. Inactivated Polio Vaccine (EIPV) in Primary Series (avoid Oral Polio Vaccine)
    2. Influenza Vaccine
    3. PneumococcusVaccine at 24 months
    4. Measles-Mumps-RubellaVaccine