Need help deciding on best approach

[vachi73]

Hi there! I am new to this forum, but often lurk.

My first two sons were fully vax'd. I don't know why, I just didn't really question it very much then.

We now have twin boys, almost 15 months, who were 2 months premature. At 12 months, I was concerned about their development (they were probably fine for adjusted age, 10 months, but they were nowhere close to "normal" for 12 month). So, at that WBV, I declined all vaccines. My ped was very supportive of my delay, but definitely prefers that I "eventually" do at least the majority of the vaccines (I think he would be fine with opting out of varicella, and probably guardisil, but I don't think they give that to boys these days. I digress.)

I have to decide in the next few days which of the 12 and 15 month vaccines I want to do. Here is the list of what they recommend, by age:

12 months: Hep A ("not mandatory" -- what does that mean, anyway?), Prevnar 13, and Varicella

15 months: Pentacel (DTaP, IPV, and Hib??), Hep B, and MMR

18 months: Hep A (again, "not mandatory")

My questions are these:

1. What does "not mandatory" mean for hep a? Does that refer to state rules, or what? I am baffled by that.

2. Prevnar 13 seems to be a very new vaccine, and one that treats a bunch of strains of strep. Is it safe??

3. What the heck is Pentacel? It sounds totally scary/lots of "stuff" in there.

4. Biggest question is this -- if you were me, with 15 month olds (13 adjusted), what would you choose for this visit, 18 months, 21 months, 24 months, etc.?

5. Assuming that I *am* ultimately going to do the first MMR, what is the optimum age/time for that? I am leaning toward waiting until at least 2, but I'm not sure if the shot itself changes after a certain age??

I am not that concerned about Hep A or B, nor varicella, at this time. Honestly, we rarely take the twins out (it's too hard with four under six!!) and the older boys are fully vax'd, so their risk is relatively small.

Oh no, I just thought about this -- I was planning to put them into mother's morning out in the fall ... will they have to be vax'd for that???!! argh!

TIA for any thoughts/suggestions/references. I am more than willing to do a lot of reading on this, but so much of it is just CDC fact sheets or scary stories ... hard to get a balanced review.

Cheers!

[carriebft]

1. What does "not mandatory" mean for hep a? Does that refer to state rules, or what? I am baffled by that.

The CDC now recommends Hep A for those at risk; this means those traveling to Hep A endemic areas, thoseliving or working in certain areas or with certain populations, those adopting, etc. It is not a universal recommendation.

2. Prevnar 13 seems to be a very new vaccine, and one that treats a bunch of strains of strep. Is it safe??

The only big issue I am seeing from the trials/studies of PCV 13 that we have right now is that it tends to cause more fever than other vaccines or the old PCV 7 and it has a reputation of being more painful than other vaccines. It protects a child from 13 strains of penumococcal bacteria.

3. What the heck is Pentacel? It sounds totally scary/lots of "stuff" in there.

Pentacel takes 3 single vaccines and places them in the same vial so that you get one needle stick instead of three. They take their brands of hib, DTaP and IPV and put them all in one. I actually like this combo and the studies on it as well as VAERS and post licensure show it has less reactions than the singles PLUS, depending on the singles brands you compare it to, it has less ingredients and "other stuff" in it.

The downsides are that if you have a reaction, you cannot be sure which part of the vaccine you reacted to. In addition, some may chose to delay Polio and you cannot do that with this vaccine if you want the DTaP and Hib portion.

Hib is a vaccine that protects against a bacteria called haemaphilus influenzae type b. It is a very serious bacteria when it turns invasive, causing many cases of meningitis, epiglotitis, pneumonia, etc. We rarely see cases these days due to vaccination, but most who do get the disease are unvaccinated or under vaccinated.

4. Biggest question is this -- if you were me, with 15 month olds (13 adjusted), what would you choose for this visit, 18 months, 21 months, 24 months, etc.? Assuming that I *am* ultimately going to do the first MMR, what is the optimum age/time for that? I am leaning toward waiting until at least 2, but I'm not sure if the shot itself changes after a certain age??

I put these questions together.

For your situation, pentacel is pretty useless. You could use it as your first vaccine but that would be the only time you would need it because once a child is as old as yours, they only need one hib dose to achieve sufficient protection. I would double check this with your doctor because the rule is "15 months and older" need only one dose. I am not sure how this pertains to adjusted age.

From there, I would need to know exactly what else you plan to do. I personally would concentrate on starting/completing the vaccines for illnesses you are likely to be at risk for plus those that are more deadly or dangerous for younger children. DTaP, Hib and PCV would be high on my start list.

MMR is more effective if you wait until 16-18months for dose #1. I would not (unless there were travel or other risk circumstances involved) get it before 16 months for my own kids for that reason.

[vachi73]

Thank you SO much for this! You have affirmed my thinking and helped me generate a plan for next week. Thank you!!

[vachi73]

I am going to PM you, too, but do you have a link to any research on the MMR being more effective after 16-18 months? My ped was interested in seeing it, if you have it! :)

I was able to choose exactly what I wanted today, and so far twins seem fine. Thanks again for your help!

[carriebft]

I sent you links to 3 studies that found better seroconversion after 15+ months, especially for the measles portion of the vaccine.