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PEDIATRICS

COMMON CHILDHOOD DISEASES

 

Introduction

Because this section deals with nearly 30 diseases, the information about each disease is necessarily limited. The intent of this section is to provide those working with children in groups with a quick reference to help them identify common, communicable diseases, and take appropriate measures to make sure these diseases are not spread to others.

For this purpose, each disease in this booklet is described according to:

  • Symptoms (how to identify that particular disease);
  • Method of Spread (how the disease is passed from one child to the next);
  • Incubation (how long it takes from when the child is first infected to when the first symptoms appear);
  • Communicable Period (how long an infected child is able to spread the disease to others);
  • Control (how to stop the spread of the illness to others); plus suggested treatments and preventive measures.

 

The spread of communicable disease can be reduced or prevented by observing some simple precautions:

  1. Practice good personal hygiene, including washing hands carefully after toileting, sneezing and coughing, after touching pets and animals, and before food preparation. Cover mouth and nose when sneezing and coughing. Dispose of articles soiled with discharge from nose and/or mouth.
  2. When antibiotics are prescribed by a physician, take the complete prescription. This will decrease the chance of bacteria becoming resistant to antibiotics. Antibiotics are ineffective against viral infections.
  3. If you are taking your child to the emergency department or doctor’s office, call first to inform them if you suspect your child has chicken pox, pertussis, influenza or measles. This will reduce the transmission of a potentially highly contagious or airborne communicable disease.
  4. Practice good hygiene when preparing, storing and disposing of food. Wash hands before any preparation. Clean surfaces before and after preparing food. Cover food and store at recommended temperatures for recommended times.

 

Diseases Spread by person-to-person Contact

Chickenpox (varicella-zoster virus)

Symptoms Sudden onset with slight fever. Blister-type rash occurs in successive crops. Scabs form after the blister stage. Spots or blisters usually appear first on the body, face and scalp, then later spread to the limbs.

Method of Spread Spread by sneezing and coughing. Direct contact with secretions from nose, throat and mouth of infected people.

Incubation Usually 14 - 21 days from date of contact.

Communicable period From 2 days before spots appear to 5 days after the first crop of blisters.

Control Exclude from school when spots first appear until 5 days after onset.

Suggested Treatment Control fever with acetaminophen. Do not use ASA or Aspirin. Cut fingernails short to prevent scratching. Calamine lotion, baking soda paste or tepid baths with oatmeal or baking soda may help to relieve itching. Antihistamines may also reduce itching.

Prevention A vaccine is now available. Prevent contact with pregnant women or people whose immunity may be reduced due to disease or drug/ radiation therapy. Those with reduced immune response who are exposed should contact their physician immediately.Contact your local Health Unit for information.

 

Fifth Disease (Human Parvovirus)

Symptoms Raised, red, warm rash, first appearing on cheeks (slapped cheek appearance). After 1 - 4 days, a lace-like rash spreads to the rest of the body. Rash fades but may recur for 1 - 3 weeks on exposure to sunlight.

Method of Spread Contact with infected respiratory secretions; also from mother to fetus.

Incubation 4 - 20 days from date of contact.

Communicable period Greatest before onset of the rash and probably not after the rash.

Control In school outbreaks, alert pregnant staff. Careful handwashing and disposal of articles soiled with nose and throat secretions.

 

Hand / Foot / Mouth Disease (Coxsackie virus)

Symptoms Sudden onset. Fever, sore throat, small greyish blisters in mouth lasting 4 - 6 days. Blisters may also appear on palms, fingers and soles for 7 - 10 days.

Method of Spread Spread by coughing and sneezing. Direct contact with nose and throat secre- tions and feces of infected persons.

Incubation 3 - 5 days from date of contact.

Communicable period While sick and sometimes longer.

Control Avoid close contact. Careful disposal of articles soiled with discharge. Careful hand-wash- ing, especially after toileting. Isolation of case and children with fever, pending diagnosis. Suggested Treatment Control fever with acetaminophen.

Prevention Promote hand-washing and hygiene measures in home and particularly in daycares.

 

Herpes “cold sores” (virus)

Symptoms Superficial clear vesicles (blisters) with red base, usually on face or lips, which crust and heal within days.

Method of Spread Direct contact with secretions from throat and mouth of infected people.

Incubation 2 - 12 days from date of contact.

Communicable period Up to 7 weeks after onset.

Control Avoid direct contact with secretions or infectious materials.

Suggested Treatment For severe cases, see physician.

Prevention Education to minimize transmission of infectious material, avoid contact with children with eczema or burns and the immunocompromised.

 

Impetigo (may be staphylococcal or streptococcal bacteria)

Symptoms A skin infection with moist, purulent, yellow crusted sores surrounded by redness. Spreads forming new sores. Usually found on the face.

Method of Direct contact with secretions from open sores and nose.

Spread Can also be spread person-to-person via hands.

Incubation Staphylococcal: 4 - 10 days from date of contact. Streptococcal: 1 - 3 days from date of contact.

Communicable period If untreated, as long as sores are present, or 24 hours after antibiotic therapy has been started.

Control Avoid close contact with infants and debilitated people. Keep out of school or daycare for 24 hours after start of antibiotics. Wash clothes and linens. Provide separate towels and soap. Suggested Treatment See physician for antibiotic therapy.

Prevention Keep affected areas clean and covered, if wet. Encourage children not to touch sores. Keep nails short and clean. Wash hands frequently. Avoid sharing toilet articles.

 

Influenza (virus)

Symptoms Fever, headache, muscular aches and pains, exhaustion, running nose, sore throat. Sometimes nausea, vomiting, diarrhea, but this is more common in children.

Method of Spread by sneezing and coughing, particularly in crowded

Spread conditions, and by direct contact with nose and throat secretions.

Incubation Usually 1 - 3 days from date of contact.

Communicable period Probably 3 - 5 days in adults, up to 7 days for young children.

Control Avoid crowded areas. Carefully dispose of tissues.

Prevention Annual flu vaccine if you are 65 or older, if you are at high risk, if you are a household contact of a person who is at high risk for complications from influenza or if you are a health care worker or first responder. Good basic personal hygiene (e.g., hand-washing and covering mouth and nose when sneezing

 

Measles “red measles” (Rubeola virus)

Symptoms Fever, inflamed eyes, dry cough, runny nose, dusky red blotchy rash 3 - 7 days later spreading downwards from face, white spots in mouth. Confirm with blood test.

Method of Spread Spread by sneezing or coughing, or by direct contact with nose and throat secretions. Highly contagious.

Incubation 7 - 18 days from exposure to onset of fever, usually 14 days until rash appears.

Communicable period From just before the symptoms start to 4 days after the rash appears. Control Exclude from school and non-family contacts until 4 days after rash appears. Immunize sus- ceptible contacts. Immune globulin available for infants under 1 year, immuno-compromised people, and those who can not have the vaccine due to medical reasons.

Suggested Treatment See physician. Notify health unit. Control fever, encourage fluids, dim lights or wear sunglasses if eyes are sensitive to light.

Prevention 2 doses of measles vaccine (age 12 months and 18 months).

 

Meningococcal Meningitis (bacteria)

Symptoms Sudden onset with fever, intense headache, nausea, vomiting, stiff neck, and often a pinpoint rash. Confirm with test of blood and cerebral spinal fluid (CSF).

Method of Spread Spread by direct contact with nose and throat secretions.

Incubation 2 - 10 days from exposure to onset of fever, usually 14 days until rash appears.

Communicable period Until 24 hours after start of appropriate antibiotic therapy.

Control See physician immediately. Monitor household and other close contacts for symptoms. Antibiotics are provided for those at increased risk. Special attention should be paid to young children in daycare.

Suggested Treatment Hospitalization. Appropriate antibiotic therapy. Notify health unit.

Prevention Immunization during outbreaks, where appropriate.

 

Mononucleosis (Epstein-Barr virus)

Symptoms Acute fever, sore throat, swollen glands, tiredness.

Method of Person-to-person spread via saliva, or articles contaminated

Spread with saliva.

Incubation 4 - 6 weeks from date of contact.

Communicable Prolonged.

period

Control Careful hand-washing, careful disposal of articles soiled with nose and throat discharges.

Suggested See physician. Promote rest, increase fluids, good nutrition.

Treatment Control fever.

Prevention Good hygiene, careful hand-washing.

 

Mumps (virus)

Symptoms Fever, headache and inflammation of the salivary glands causing the cheeks to swell painfully. Sometimes there is no swelling.

Method of Spread by sneezing or coughing, or by direct contact with

Spread nose and throat secretions.

Incubation Usually 16 - 18 days from date of contact.

Communicable From 7 days before onset of swelling to 9 days after. Most

period infectious 2 days before onset of illness.

Control Exclude from school, daycare and workplace until 9 days after onset of swelling, if there are susceptibles. Immunize susceptibles.

Suggested Treatment Notify health unit.

Prevention Measles, mumps, rubella vaccine (given at age 12 months and 18 months).

 

Pertussis “Whooping cough” (bacteria)

Symptoms Runny nose, repeated violent coughing followed by characteristic whoop, sometimes followed by vomiting. Confirm with lab test (swab).

Method of Spread Direct contact with nose and throat secretions of infected people, also by sneezing and coughing.

Incubation 6 - 20 days from date of contact.

Communicable period Highly communicable in the early stages before the cough, and for about 3

weeks after. Not infectious after 5 days antibiotic therapy.

Control Keep away from young children and infants. Ensure contacts under age 7 complete immunization series. Antibiotics offered for household and close contacts. Carefully dispose of contaminated tissues.

Suggested Treatment Antibiotic treatment. Notify health unit.

Prevention Age-appropriate immunization.

 

Pink Eye

Symptoms Teary, red, irritated itchy eyes with swollen lids and thick yellow discharge. Sensitive to sunlight.

Method of Spread Contact with discharge from eyes and nose of infected persons, often through contaminated fingers, make-up applicators, eye droppers, etc.

Incubation 1 - 3 days from date of contact.

Communicable period During active infection. Young children and the aged are more susceptible.

Control If there is a thick white or yellow discharge (often with eyelids stuck together, or crusted eyelashes), fever, eye pain or eyelid redness, the child should not attend school or day care, and should be seen by a doctor. The doctor can advise if the child can return to school or daycare, or should stay home (usually for 1 to 3 days). The child may be asked to stay home until an antibiotic has been taken for a full day, or the symptoms (discharge, pain) get better.

Suggested Treatment See physician. Avoid touching eyes, and wash hands often.

Prevention Promote good personal hygiene and careful hand-washing. Keep hands away from eyes. Do not share towels or bed linen, or toys that are held close to the face.

 

Roseola Infantum “Sixth Disease” (virus)

Symptoms Fever appears suddenly, lasting 3 - 4 days, followed by a raised red rash on the trunk, later spreading to the rest of the body, lasting 1 - 2 days. Most common in infants and preschoolers.

Method of Spread Unknown.

Incubation 5 - 15 days from date of contact.

Communicable period Probably greatest during fever, before rash appears.

Control Avoid contact with other children.

Suggested Treatment Control fever with acetaminophen.

Prevention None.

 

Rubella “german measles” (virus)

Symptoms Often but not always, a slightly raised, red pinpoint rash, spreading from behind the ears to the face and downwards. Children usually have few symptoms, but adults may have fever, head- ache, joint pain, tiredness, runny nose and inflammation of eyes. Confirm with blood test.

Method of Spread Spread by sneezing or coughing, or by direct contact with secretions from nose and throat of infected person.

Incubation 14 - 23 days from date of contact.

Communicable period 1 week before and at least 4 days after onset of rash. Infants with congenital rubella may be infectious for months after birth.

Control Keep home for 7 days after onset of rash. Pregnant contacts should have blood test done to test for susceptibility.

Suggested Treatment Control fever. Notify health unit.

Prevention MMR immunization. Prevent contact with non-immune pregnant women, especially those in their first 3 months of pregnancy.

 

Rubeola: see Measles

 

RSv (Respiratory Syncytial virus)

Symptoms Fever, chills, headache, general malaise, respiratory tract symptoms.

Method of Spread Direct contact with infected respiratory secretions, and through food and water contaminated with feces.

Incubation 1 - 10 days from date of contact.

Communicable period Just prior to and until the end of the active disease.

Control Practice good personal hygiene, wash hands carefully before preparing food, avoid contact with young children, debilitated or aged people, or patients with other illnesses.

Suggested Treatment Symptomatic treatment. Do not use antibiotics, cold medicines, antihista- mines or decongestants. Drink plenty of fluids.

Prevention Promote good personal hygiene and hand-washing.

 

Shingles (varicella-zoster virus)

Symptoms Blister-type rash along nerve pathway, pain, and paresthesia (numbness or tingling sen- sation).

Method of Reactivation of chickenpox at nerve site. Direct contact

Spread with fluid from vesicles (blisters) may spread chickenpox to those who have not had the dis- ease.

Incubation Usually 14 - 21 days from date of contact.

Communicable period From 2 days before lesions appear and up to 7 days after.

Control No need to exclude from school if the rash is well-covered and the person is feeling well. Prevention Prevent contact with pregnant women or people whose immunity may be reduced due to disease or drug/ radiation therapy. See Health File #44.

 

Streptococcal (bacteria)

  1. Scarlet Fever

Symptoms Sandpaper-like rash, blanching on pressure. Strawberry-like tongue. Sometimes fever, nausea, vomiting, sore throat, headache. During recovery skin on hands and feet may peel.

Method of Spread Close contact with patient or carriers.

Incubation 1 - 3 days from date of contact.

Communicable If untreated, 10 - 21 days or longer. 24 hours after start of

period antibiotic therapy.

Control Stay at home as long as directed by physician. Exclude case from food-handling occupa- tions. Careful disposal of tissues soiled with nose and throat discharges.

Suggested Treatment Antibiotic treatment therapy. Ensure full course of antibiotics to prevent rheu- matic heart disease. Control fever with acetaminophen.

Prevention Careful hand-washing and food-handling.

  1. Strep Throat

Symptoms Fever, very sore throat, swollen glands, pustular tonsils. Confirm with throat culture.

Method of Spread Close contact with patient or carriers.

Incubation 1 - 3 days from date of contact.

Communicable period If untreated, several weeks or months. With antibiotic therapy, 24 hours.

 

Gastrointestinal (Stomach or Bowel) Infections Campylobacter (bacteria)

Symptoms Abdominal pain, diarrhea, fever, nausea, vomiting, malaise. Symptoms usually pass in 2- 5 days. Confirm by stool specimen.

Method of Spread Ingesting contaminated food or unpasteurized (raw) milk, or contact with feces of infected people, particularly infants, or animals, especially kittens and puppies.

Incubation Usually 1 - 10 days from date of contact.

Communicable period During course of infection or sometimes longer.

Control Exclude from food-handling occupations, daycare, and patient care in hospitals while sick. Promote careful hand-washing.

Suggested Treatment Notify health unit. Drink plenty of fluids.

Prevention Careful food-handling and cooking of food from animal sources. Pasteurize milk. Wash hands carefully after handling poultry.

 

Cryptosporidiosis (parasite)

Symptoms Major symptom is diarrhea, which may be profuse and watery, as well as cramps, vomiting in children. Fever, general malaise, nausea and vomiting less often.

Method of Spread Contaminated water supply, person-to-person from fecal contamination, also spread from animals to children (e.g., petting animals then hand-to-mouth transfer).

Incubation Usually 1 - 12 days from date of contact, with an average of 7 days.

Communicable period During course of infection or sometimes longer. Cysts remain viable for 2 - 6 months in a moist environment.

Control Wash hands thoroughly after toileting, and in particular children should wash hands after petting animals.

Suggested Treatment Rehydration where necessary. Notify health unit.

Prevention Promote good personal hygiene and hand-washing. Boil water from unsafe sources for 2 minutes before consuming.

 

Escherichia Coli E. coli

Symptoms Early symptoms include loose or watery diarrhea, with or without blood or mucus. Mild to severe stomach cramps. Possible vomiting. Possible fever. Later symptoms (depending on strain of E. coli) may include dehydration, irritability and fatigue, paleness of skin and decrease in urine output — all of which may indicate the onset of hemolytic uremic syndrome (HUS) (see below).

Method of Spread Eating contaminated food, particularly under-cooked hamburger, or contact with feces of infected people or animals. May also be spread by eating raw fruits and vegetables or drinking unpasteurized milk or juices. Drinking water can also be a method of spread, if contaminated by infected meat or feces.

Incubation As short as 12 hours from date of contact, but up to 5 days. Usually 2 - 4 days.

Communicable period For duration of diarrhea, and sometimes longer — up to 3 weeks for children.

Control Promote careful hand-washing before handling food and after changing diapers or using toilet. Drink only pasteurized milk and juice products. Refrigerate and cook meat thoroughly, particularly ground meat. Wash fruits and vegetables well before eating.

Suggested Treatment Appropriate tests and treatment. Notify health unit. Give plenty of fluids dur- ing diarrhea episodes. Note: HUS is a very serious illness, requiring hospital intensive care. If the later symptoms listed above develop, refer for hospitalization immediately.

Prevention Promote safe food-handling and preparation, including proper refrigeration and cooking. Do not drink unpasteurized milk or juice. Practice frequent hand-washing and good personal hygiene. Avoid diapering and food preparation in the same area. Protect drinking water supplies.

 

Giardiasis “Beaver fever” (parasite)

Symptoms Sometimes no symptoms, but may have chronic diarrhea, abdominal cramps, bloating, fatigue, weight loss. Confirm by stool specimen.

Method of Contaminated water supply. Person-to-person by hand-to-mouth

Spread transfer of cysts, especially in institutions and daycares.

Incubation 3 - 25 days from date of contact.

Communicable period During entire period of infection.

Control Wash hands carefully after toileting. Investigate source of infection.

Suggested Treatment Appropriate drug therapy. Notify health unit.

Prevention Promote good personal hygiene and hand-washing. Protect water supplies. Careful dis-posal of sewage.

 

Hemolytic uremic Syndrome (HuS)

Symptoms Early symptoms (from E. coli infection) are diarrhea with blood, vomiting, and stomach cramps. May develop fever. Later symptoms include irritability and fatigue, dehydration, pale skin (anemia), and reduced urine production.

Method of Spread The organism (E. coli 0157:H7, which can lead to HUS in a small percentage of those infected with E. coli) is spread by person-to-person contact, or by eating contaminated foods (see E. coli, above). Can also occur from contact with person infected with Shigella dysenteria.

Incubation E. coli incubation usually takes 3 - 4 days from date of contact. HUS usually develops within 1 - 2 weeks of diarrheal onset.

Communicable period HUS cannot be spread from person-to-person. However, the organism (E. coli) which causes the syndrome can be spread by poor hand-washing or improper food-handling (see E. coli, above).

Control Control is the same as for E. coli (see above).

Suggested Treatment HUS requires the immediate attention of a physician. This illness is very serious, with death resulting in a small number of cases (3 - 5 percent). HUS is caused by a toxin which breaks down blood cells, leading to anemia, a bleeding tendency (due to loss of platelets in the blood) and acute kidney failure.

Prevention The same as with E. coli.

 

Pinworms (parasite)

Symptoms Itching of the anal area, restless sleep, irritability, occasionally secondary infection of scratches. Adult worms may be observed in the anal area.

Method of Spread Infective eggs are in feces and get into mouth via unwashed hands.

Incubation Life cycle is 2 - 6 weeks from date of contact.

Communicable period As long as eggs are produced by adult worms. Eggs may remain infective in the environment for about 2 weeks.

Control See physician for drug treatment. Change and wash underwear and bed linen daily. Clean and vacuum living areas daily for a few days following treatment.

Suggested Treatment May need to treat the whole family at the same time. Keep nails short. Patient should shower daily.

Prevention Promote good personal hygiene and careful hand-washing before eating and preparing food. Maintain clean toilet facilities.

 

Salmonellosis (bacteria)

 

Symptoms Sudden onset, headache, abdominal cramps, nausea, vomiting, diarrhea, fever. Confirm with stool specimen.

Method of Spread Eating contaminated food, undercooked food, raw eggs and milk, meat and poultry. May also be spread by pet turtles, chicks, ducklings or fecal-oral transmission.

Incubation 6 - 72 hours from date of contact.

Communicable period Throughout the course of infection.

Control Exclude cases from occupations involving food-handling, daycare and care of hospitalized, elderly and immunocompromised persons while sick and until stool tests normal. Consider stool cultures for any contacts in similar occupations.

Suggested Treatment Control fever. Encourage fluids. Notify health unit.

Prevention Thoroughly cook all food from animal sources. Refrigerate prepared foods. Educate food handlers. Promote careful hand-washing.

 

Skin Conditions and Infestations

Lice Head Lice Pediculosis (insect)

Symptoms Small white eggs (nits), firmly attached to hair shaft especially around ears and nape of neck. Itchiness. Grey-white, sometimes brown, adult lice. 1 - 2 mm long.

Method of Spread Direct contact with infested people and articles (i.e., combs, hairbrushes).

Incubation Nits hatch in 7 days from date of contact, and reach maturity 8 - 10 days later.

Communicable period Until all lice and nits are destroyed or removed from scalp.

Control Lice shampoo and nit removal. Check family members and other close contacts. Provide information and education to daycare and school children and their parents.

Suggested Treatment Treat the case with special shampoo/rinse available at drug store. Follow package directions carefully. Remove nits. Wash clothes and linens in hot water, or dry clean. Re-treat in 7 - 10 days.

Prevention Check young children routinely. Do not borrow or share combs, hair accessories or other head gear.

 

Ringworm (fungus)

Symptoms Ring-shaped patches of temporary baldness, with small yellowish crusts. Examination under UV light (Wood’s lamp) shows yellow-green fluorescence.

Method of Spread Direct skin-to-skin contact. Also indirectly through contact with articles contami- nated by infected people or animals.

Incubation 10 - 14 days from date of contact.

Communicable period As long as active infection is present.

Control Look for sources of infection, particularly in pets, farm animals and household contacts. Launder clothes and linens.

Suggested Treatment Appropriate medication. Wash affected areas daily and keep clean and dry. Notify health unit when several cases appear in groups of children.

Prevention Good personal hygiene.

 

Scabies (mite)

Symptoms Tiny blisters or burrow lines in skin, often seen in skin folds between fingers, wrists, elbows, thigh and abdomen. Intense itching, particularly at night.

Method of Spread Direct skin-to-skin contact with infested people.

Incubation 2 - 6 weeks from date of contact before itching appears. If previously exposed, itching may occur in 1 - 4 days.

Communicable period Until mites and eggs are destroyed with appropriate treatment.

Control Exclude from school or work until day after treatment.

Suggested Treatment Launder linen and clothes in hot water, or isolate them for 4 days. Purchase special lotion from drug store and follow directions carefully. Treat all family members simultaneously. Itching may last 1 - 2 weeks after treatment. Antihistamines may help relieve itching. Cut fingernails and wash hands carefully to prevent secondary infections.

Prevention Education about scabies. Good personal hygiene, frequent bathing and washing of clothes and linens.

 

Swimmer’s Itch (parasite)

Symptoms Mild skin irritation and very severe, itchy red rash.

Method of SpreadFrom contact with larval parasites in water during swimming or wading. Parasite larvae originate from infected water snails.

Incubation Itching begins almost immediately, and may last 2 - 5 days and up to 2 weeks.

Communicable Not communicable from person to person. In chronic cases,

period eggs may be passed from a human’s urine or feces into bodies of water.

Control No specific control measures.

Suggested Treatment Avoid scratching. Can use calamine, antihistamines, lukewarm baths with baking soda, apply cool compresses.

Prevention Apply waterproof sunscreen prior to swimming. Towel-dry right after leaving the water. Ideally, shower immediately after swimming, then towel-dry.

 

 

 

 

References

  1. A Quick Guide to Common Childhood Disease. British Columbia Ministry of Health and Ministry Responsible for Seniors
  2. British Columbia, Ministry of Health. Communicable Disease Control Policy.Chin, James. ed.,
  3. Control of Communicable Diseases Manual 17th edition, American Public Health Association 2000. Mott, S.R., James, S.R., Sperhac, A.M.,
  4. Nursing Care of Children and Families 2nd edition, Addison Wesley, 1990.
  5. Report of the Committee on Infectious Diseases, 2000 Red Book, American Academy of Pediatrics, 2000.

 

Recommended Immunization Schedules for Persons Aged 0 - 18 Years

UNITED STATES, 2012

FIGURE 1: Recommended immunization schedule for persons aged 0 through 6 years—United States, 2012 (for those who fall behind or start late, see the catch-up schedule [Figure 3])

schedule [Figure 3])

 

Vaccine ▼

Age ►

Birth

1 month

2 months

4 months

6 months

9 months

12 months

15 months

18 months

19–23 months

2–3 years

4–6 years

Range of recommended ages for all children

Hepatitis B1

Hep B

Hep B

 

Hep B

 

 

 

Rotavirus2

 

 

RV

RV

RV2

 

 

 

 

 

 

 

Diphtheria, tetanus, pertussis3

 

 

DTaP

DTaP

DTaP

see footnote3

 

DTaP

 

 

DTaP

Range of recommended ages for certain high-risk groups

Haemophilus influenzae type b4

 

 

Hib

Hib

Hib4

 

Hib

 

 

 

 

Pneumococcal5

 

 

PCV

PCV

PCV

 

PCV

 

 

PPSV

Inactivated poliovirus6

 

 

IPV

IPV

IPV

 

 

IPV

Influenza7

 

 

 

 

Influenza (Yearly)

Range of recommended ages for all children and certain high risk groups

Measles, mumps, rubella8

 

 

 

 

 

 

MMR

see footnote8

MMR

Varicella9

 

 

 

 

 

 

Varicella

see footnote8

Varicella

Hepatitis A10

 

 

 

 

 

 

Dose 110

HepA Series

Meningococcal11

 

 

 

 

 

MCV4 – see footnote11

 

This schedule includes recommendations in effect as of December 23, 2011. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Vaccination providers should consult the relevant Advisory Committee on Immunization Practices (ACIP) statement for detailed recommendations, available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS) online (http://www.vaers.hhs.gov) or by telephone (800-822-7967).

 

1. Hepatitis B (HepB) vaccine. (Minimum age: birth)

At birth:

• Administer monovalent HepB vaccine to all newborns before hospital discharge.

• For infants born to hepatitis B surface antigen (HBsAg)–positive mothers, administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth. These infants should be tested for HBsAg and antibody to HBsAg (anti-HBs) 1 to 2 months after completion of at least 3 doses of the HepB series, at age 9 through 18 months (generally at the next well-child visit).

• If mother’s HBsAg status is unknown, within 12 hours of birth administer HepB vaccine for infants weighing ≥2,000 grams, and HepB vaccine plus HBIG for infants weighing <2,000 grams. Determine mother’s HBsAg status as soon as possible and, if she is HBsAg-positive, administer HBIG for infants weighing ≥2,000 grams (no later than age 1 week).

Doses after the birth dose:

• The second dose should be administered at age 1 to 2 months. Monovalent HepB vaccine should be used for doses administered before age 6 weeks.

• Administration of a total of 4 doses of HepB vaccine is permissible when a combination vaccine containing HepB is administered after the birth dose.

• Infants who did not receive a birth dose should receive 3 doses of a HepBcontaining vaccine starting as soon as feasible (Figure 3).

• The minimum interval between dose 1 and dose 2 is 4 weeks, and between dose 2 and 3 is 8 weeks. The final (third or fourth) dose in the HepB vaccine

series should be administered no earlier than age 24 weeks and at least 16 weeks after the first dose.

2. Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV-1 [Rotarix] and RV-5 [Rota Teq])

• The maximum age for the first dose in the series is 14 weeks, 6 days; and 8 months, 0 days for the final dose in the series. Vaccination should not be initiated for infants aged 15 weeks, 0 days or older.

• If RV-1 (Rotarix) is administered at ages 2 and 4 months, a dose at 6 months is not indicated.

3. Diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine.

(Minimum age: 6 weeks)

• The fourth dose may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose.

4. Haemophilus influenzae type b (Hib) conjugate vaccine. (Minimum age: 6 weeks)

• If PRP-OMP (PedvaxHIB or Comvax [HepB-Hib]) is administered at ages 2 and 4 months, a dose at age 6 months is not indicated.

• Hiberix should only be used for the booster (final) dose in children aged 12 months through 4 years.

5. Pneumococcal vaccines. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV])

• Administer 1 dose of PCV to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.

• For children who have received an age-appropriate series of 7-valent PCV (PCV7), a single supplemental dose of 13-valent PCV (PCV13) is recommended for:

- All children aged 14 through 59 months

- Children aged 60 through 71 months with underlying medical conditions.

• Administer PPSV at least 8 weeks after last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant. See MMWR 2010:59(No. RR-11), available at http://www.cdc.gov/ mmwr/pdf/rr/rr5911.pdf.

6. Inactivated poliovirus vaccine (IPV). (Minimum age: 6 weeks)

• If 4 or more doses are administered before age 4 years, an additional dose should be administered at age 4 through 6 years.

• The final dose in the series should be administered on or after the fourth birthday and at least 6 months after the previous dose.

7. Influenza vaccines. (Minimum age: 6 months for trivalent inactivated influenza vaccine [TIV]; 2 years for live, attenuated influenza vaccine [LAIV])

• For most healthy children aged 2 years and older, either LAIV or TIV may be used. However, LAIV should not be administered to some children, including 1) children with asthma, 2) children 2 through 4 years who had wheezing in the past 12 months, or 3) children who have any other underlying medical conditions that predispose them to influenza complications. For all other contraindications to use of LAIV, see MMWR 2010;59(No. RR-8), available at http://www.cdc.gov/mmwr/pdf/rr/rr5908.pdf.

• For children aged 6 months through 8 years:

- For the 2011–12 season, administer 2 doses (separated by at least

4 weeks) to those who did not receive at least 1 dose of the 2010–11 vaccine. Those who received at least 1 dose of the 2010–11 vaccine require 1 dose for the 2011–12 season.

- For the 2012–13 season, follow dosing guidelines in the 2012 ACIP influenza vaccine recommendations.

8. Measles, mumps, and rubella (MMR) vaccine. (Minimum age: 12 months)

• The second dose may be administered before age 4 years, provided at least 4 weeks have elapsed since the first dose.

• Administer MMR vaccine to infants aged 6 through 11 months who are traveling internationally. These children should be revaccinated with 2 doses of MMR vaccine, the first at ages 12 through 15 months and at least 4 weeks after the previous dose, and the second at ages 4 through 6 years.

9. Varicella (VAR) vaccine. (Minimum age: 12 months)

• The second dose may be administered before age 4 years, provided at least 3 months have elapsed since the first dose.

• For children aged 12 months through 12 years, the recommended minimum interval between doses is 3 months. However, if the second dose was administered at least 4 weeks after the first dose, it can be accepted as valid.

10. Hepatitis A (HepA) vaccine. (Minimum age: 12 months)

• Administer the second (final) dose 6 to18 months after the first.

• Unvaccinated children 24 months and older at high risk should be vaccinated. See MMWR 2006;55(No. RR-7), available at http://www.cdc.gov/ mmwr/pdf/rr/rr5507.pdf.

• A 2-dose HepA vaccine series is recommended for anyone aged 24 months and older, previously unvaccinated, for whom immunity against hepatitis A virus infection is desired.

11. Meningococcal conjugate vaccines, quadrivalent (MCV4). (Minimum age: 9 months for Menactra [MCV4-D], 2 years for Menveo [MCV4-CRM])

• For children aged 9 through 23 months 1) with persistent complement component deficiency; 2) who are residents of or travelers to countries with hyperendemic or epidemic disease; or 3) who are present during outbreaks caused by a vaccine serogroup, administer 2 primary doses of MCV4-D, ideally at ages 9 months and 12 months or at least 8 weeks apart.

• For children aged 24 months and older with 1) persistent complement component deficiency who have not been previously vaccinated; or 2) anatomic/functional asplenia, administer 2 primary doses of either MCV4 at least 8 weeks apart.

• For children with anatomic/functional asplenia, if MCV4-D (Menactra) is used, administer at a minimum age of 2 years and at least 4 weeks after completion of all PCV doses.

• See MMWR 2011;60:72–6, available at http://www.cdc.gov/mmwr/pdf/wk/mm6003. pdf, and Vaccines for Children Program resolution No. 6/11-1, available at http://www. cdc.gov/vaccines/programs/vfc/downloads/ resolutions/06-11mening-mcv.pdf, and MMWR 2011;60:1391–2, available at http://www.cdc.gov/mmwr/pdf/wk/mm6040.pdf, for further guidance, including revaccination guidelines.

 

 

FIGURE 2: Recommended immunization schedule for persons aged 7 through 18 years—United States, 2012 (for those who fall behind or start late, see the schedule below and the catch-up schedule)

Vaccine ▼

Age ►

7–10 years

11–12 years 1

3–18 years

Range of recommended ages for all children

Tetanus, diphtheria, pertussis1

1 dose (if indicated)

1 dose

1 dose (if indicated)

Human papillomavirus2

see footnote2

3 doses

Complete 3-dose series

Meningococcal3

see footnote3

Dose 1

 

Booster at 16 years

Range of recommended ages for catch-up immunization

Influenza4

Influenza (yearly)

Pneumococcal5

see footnote5

Hepatitis A6

Complete 2-dose series

Hepatitis B7

Complete 3-dose series

Range of recommended ages for certain high-risk groups

 

Inactivated poliovirus8

Complete 3-dose series

Measles, mumps, rubella9

Complete 2-dose series

Varicella10

Complete 2-dose series

             

 

This schedule includes recommendations in effect as of December 23, 2011. Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines. Vaccination providers should consult the relevant Advisory Committee on Immunization Practices (ACIP) statement for detailed recommendations, available online at http://www.cdc.gov/vaccines/pubs/acip-list.htm. Clinically significant adverse events that follow vaccination should be reported to the Vaccine Adverse Event Reporting System (VAERS) online (http://www.vaers.hhs.gov) or by telephone (800-822-7967).

 

1. Tetanus and diphtheria toxoids and acellular pertussis (Tdap) vaccine.

(Minimum age: 10 years for Boostrix and 11 years for Adacel)

• Persons aged 11 through 18 years who have not received Tdap vaccine should receive a dose followed by tetanus and diphtheria toxoids (Td) booster doses every 10 years thereafter.

• Tdap vaccine should be substituted for a single dose of Td in the catchup series for children aged 7 through 10 years. Refer to the catch-up schedule if additional doses of tetanus and diphtheria toxoid–containing vaccine are needed.

• Tdap vaccine can be administered regardless of the interval since the last tetanus and diphtheria toxoid–containing vaccine.

2. Human papillomavirus (HPV) vaccines (HPV4 [Gardasil] and HPV2

[Cervarix]). (Minimum age: 9 years)

• Either HPV4 or HPV2 is recommended in a 3-dose series for females aged 11 or 12 years. HPV4 is recommended in a 3-dose series for males aged 11 or 12 years.

• The vaccine series can be started beginning at age 9 years.

• Administer the second dose 1 to 2 months after the first dose and the third dose 6 months after the first dose (at least 24 weeks after the first dose).

• See MMWR 2010;59:626–32, available at http://www.cdc.gov/mmwr/pdf/wk/mm5920.pdf.

3. Meningococcal conjugate vaccines, quadrivalent (MCV4).

• Administer MCV4 at age 11 through 12 years with a booster dose at age 16 years.

• Administer MCV4 at age 13 through 18 years if patient is not previously vaccinated.

• If the first dose is administered at age 13 through 15 years, a booster dose should be administered at age 16 through 18 years with a minimum interval of at least 8 weeks after the preceding dose.

• If the first dose is administered at age 16 years or older, a booster dose is not needed.

• Administer 2 primary doses at least 8 weeks apart to previously unvaccinated persons with persistent complement component deficiency or anatomic/functional asplenia, and 1 dose every 5 years thereafter.

• Adolescents aged 11 through 18 years with human immunodeficiency virus (HIV) infection should receive a 2-dose primary series of MCV4, at least 8 weeks apart.

• See MMWR 2011;60:72–76, available at http://www.cdc.gov/mmwr/pdf/wk/mm6003.pdf, and Vaccines for Children Program resolution No. 6/11-1, available at http://www.cdc.gov/vaccines/programs/vfc/downloads/resolutions/06-11mening-mcv.pdf, for further guidelines.

4. Influenza vaccines (trivalent inactivated influenza vaccine [TIV] and live, attenuated influenza vaccine [LAIV]).

• For most healthy, nonpregnant persons, either LAIV or TIV may be used, except LAIV should not be used for some persons, including those with asthma or any other underlying medical conditions that predispose them to influenza complications. For all other contraindications to use of LAIV, see MMWR 2010;59(No.RR-8), available at http://www.cdc.gov/mmwr/pdf/rr/rr5908.pdf.

• Administer 1 dose to persons aged 9 years and older.

• For children aged 6 months through 8 years:

- For the 2011–12 season, administer 2 doses (separated by at least 4 weeks) to those who did not receive at least 1 dose of the 2010–11 vaccine. Those who received at least 1 dose of the 2010–11vaccine require 1 dose for the 2011–12 season.

- For the 2012–13 season, follow dosing guidelines in the 2012 ACIP influenza vaccine recommendations.

5. Pneumococcal vaccines (pneumococcal conjugate vaccine [PCV] and pneumococcal polysaccharide vaccine [PPSV]).

• A single dose of PCV may be administered to children aged 6 through 18 years who have anatomic/functional asplenia, HIV infection or other immunocompromising condition, cochlear implant, or cerebral spinal fluid leak. See MMWR 2010:59(No. RR-11), available at http://www.cdc.gov/mmwr/pdf/rr/rr5911.pdf.

• Administer PPSV at least 8 weeks after the last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant. A single revaccination should be administered after 5 years to children with anatomic/functional asplenia or an immunocompromising condition.

6. Hepatitis A (HepA) vaccine.

• HepA vaccine is recommended for children older than 23 months who live in areas where vaccination programs target older children, who are at increased risk for infection, or for whom immunity against hepatitis A virus infection is desired. See MMWR 2006;55(No. RR-7), available at http:// www.cdc.gov/mmwr/pdf/rr/rr5507.pdf.

• Administer 2 doses at least 6 months apart to unvaccinated persons.

7. Hepatitis B (HepB) vaccine.

• Administer the 3-dose series to those not previously vaccinated.

• For those with incomplete vaccination, follow the catch-up recommendations (Figure 3).

• A 2-dose series (doses separated by at least 4 months) of adult formulation Recombivax HB is licensed for use in children aged 11 through 15 years.

8. Inactivated poliovirus vaccine (IPV).

• The final dose in the series should be administered at least 6 months

after the previous dose.

• If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered, regardless of the child’s current age.

• IPV is not routinely recommended for U.S. residents aged18 years or older.

9. Measles, mumps, and rubella (MMR) vaccine.

• The minimum interval between the 2 doses of MMR vaccine is 4 weeks.

10. Varicella (VAR) vaccine.

• For persons without evidence of immunity (see MMWR 2007;56[No. RR- 4], available at http://www.cdc.gov/mmwr/pdf/rr/rr5604.pdf), administer 2 doses if not previously vaccinated or the second dose if only 1 dose has been administered.

• For persons aged 7 through 12 years, the recommended minimum interval between doses is 3 months. However, if the second dose was administere

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