Appointment next week - need to have my plan in order

[WhiteHorse]

My son will have an appointment next week with our family doc. The appointment is specifically to discuss vaccines, since he has had nothing since 6 mos old. When I called to make the appt, all I wanted to do was a flu vax, but they wanted to see him and discuss catching up. Yeah, I know. I am asking to get a lecture. BUT I do want to catch up, just probably not as fast as the doc will want. My son's ped kicked us out of his practice because I would not do 5 shots in one visit - so back to the family doc, hopefully not as hard core as the ped. Cross your fingers for me!. I want to have a plan written down so I dont go in there and just go along with his schedule out of ignorance..

To comply with the minimum state "schedule" my son needs:

2 MMR

2 Varicella

1 Hep B

1 HIB

1 Polio

2 DTaP

I could do a combo, Pentacel which would cover DTaP, HIB and Polio. He has had these before, I dont think any reactions. However, somewhere I read that HIB should be given with Prevnar. ??? Anyone know why?

Also I was wondering if it would be worth trying to do flu separately from all the others since he's never had that one before?

Anyone have any suggestions?

[ma2two]

Are you sure your state absolutely requires 2 MMR for school? It is not advertised, but most, if not all states allow a titer test after the first MMR.

The 2nd MMR is not a booster shot. It is meant to catch the 2-5% of kids who don't develop sufficient antibodies from the first shot. Here is a brochure regarding New Jersey's law, but the information is the same everywhere. 

http://www.state.nj.us/health/cd/documents/antibody_titer_law.pdf

Yes, the flu should be done separately. If you do more than one vaccine at a time and there is a reaction, there will be no way to know which vaccine caused it. A child can react to a vaccine even if he has not reacted previously to it.

I'm sure this goes without saying, but don't let him get a flu shot with mercury.

[WhiteHorse]

does anyone know how long of an interval is ok after the flu shot to get another shot?

[ma2two]

The "official" word is that it can be given on the same day as other vaccines. But my thinking is at least 30 days. I'm partly basing that on the Vaccine Injury Table  

http://www.hrsa.gov/vaccinecompensation/vaccineinjurytable.pdf which shows that government-recognized vaccine injuries can happen as late as 28 or 30 or 42 days after vaccination.

[ASusan]

I just made a 15-month schedule for our son, who is 4, to receive all the vaxes he "needs" to enter kindergarten. (He is in daycare and has an exemption now, and we will probably keep his exemption so that if the school/state should "require" more in the future, we will be on record with having an exemption.) BUT, we want to do vaxes for many reasons, not the least of which is the possibility of international travel.

In making the schedule, I kept to a "rule" of one vaccine a month. This is what I had read in several places. It gives enough time to prepare the body - additional C and D vitamins for the week prior to a vax, for example. And it gives enough time to recover. Also allows for proper spacing that some vaxes require. Almost all that require more than one shot require you to wait 2 months between doses, or 4 months between the 2-3 doses...Doing one a month allows the spacing to stay where it needs to be. In creating the schedule, I always allowed a "buffer" month for cases of these spacings (If a vax required 1 month between doses, I scheduled 2 months.) The reason I did this is that if you get a vax TOO SOON, you may be required to get it again. There is no such requirement for getting it "too late." So, we would not accidentally do a second vax 3 weeks and 4 days after the first. There is always at least one buffer month. (during which we might get another vax, though).

It took me the better portion of an afternoon, off and on, to make the schedule. I used an excel file, with months across the top and vaxes down the side. I put the required spaces in grey text between doses, and when I was moving them around, I cut and pasted the doses AND the boxes of grey text, so I would not forget the proper spacing.

The reason my plan is 15 months is that I also put typhoid in, for international travel.

Here are the spacing requirments for some of the vaxes you have to do (plus some of my notes). Varicella also has spacing, but I can't remember what it is.

1. MMR...2 doses (the 2nd dose is at least 28+ days apart from the first). Must be done at allergist’s office because of egg allergy. Check titers before doing second injection and withhold if he demonstrates immunity.

2. Hep B...3 doses. The 2nd is 28+ days from the first; the 3rd is 16+ weeks after the first & 8 weeks after the 2nd.

3. Polio - 3 doses

4. Tetanus/Diphtheria/Pertussis...4 doses DTaP. Check for spacing requirements.

5. Varicella - 2 doses. Check titers before doing second injection and withhold if immunity is demonstrated.

[ASusan]

This is a version of my scheduling, so you can better see how I did it, and how many months are required for proper spacing. It also is too wide to post here, but you get the idea...

Vaccine

48 mos

49 mos

50 mos

51 mos

52 mos

53 mos

54 mos

55 mos

56 mos

57 mos

58 mos

59 mos

60 mos

61 mos

62 mos

Oct ‘11

Nov

Dec

Jan ‘12

Feb

Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

MMR

MMR 1

(1)

MMR 2

HepB

HepB 1

(1)

HepB 2

(1)

(2)

HepB 3

IPV

IPV 1

(1)

IPV 2

(1)

(2)

(3)

(4)

(5)

(6)

IPV 3

DTaP

DTaP 1

(1)

DTaP 2

(1)

DTaP 3

(1)

(2)

(3)

(4)

(5)

(6)

DTaP 4

Varicella

Varicella 1

(1)

(2)

(3)

Varicella 2

Typhoid

Typhoid

Edited by ASusan - 9/30/11 at 3:19pm

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[Jugs]

OP: When we decided to start vaxing my 3-year-old, I had intended on spacing them out as much as possible. However, it was very traumatic for her, as she is terrified of the needle, so we switched gears and decided to use combo vaxes to cut down on the number of injections. Here's what we did this year:

Visit 1: Pediarix (DTaP-HepB-Polio)
Visit 2: MMR, Hib
Visit 3: Pediarix
Visit 4: Varicella, Prevnar 13
Visit 5: Pediarix
Visit 6: (optional) Flu Mist

That took care of the bare minimum needed for nursery school, plus the flu vax. Then, sometime between now and kindergarten, she'll get:
Kinrix (DTaP-Polio)
MMR, Hep A
Varicella, Hep A
Flu Mist (annually)

Hope that helps

[WhiteHorse]

Thanks for all the replies and helpful info. Yes, Ohio requires 2 MMRs and 2 Varicellas for school. We are planning to homeschool, but in the case that it doesn't work out well (son is very headstrong towards me in particular) I want the option of sending him to school. If I do send him, he has 2 more years to start K as his birthday past the Nov 1 cutoff.

I also believe my son will have a trauma with the shots. I plan to ask for some combos, even though reactions are harder to track this way. If he does react, I will prob ask for an exemption going forward. My plan also is to wait until Spring to do the MMR, when he is healthy and not fighting cold after cold! He is on his 3rd one already.

[ma2two]

Quote:

Originally Posted by WhiteHorse 

Yes, Ohio requires 2 MMRs and 2 Varicellas for school. 

"A student who presents laboratory evidence of immunity shall be exempt from the second dose requirement."

The above quote applies to the requirements for measles, mumps, and rubella vaccination.

http://www.odh.ohio.gov/odhPrograms/dis/immunization/imunchsc.aspx (click on "Director's Journal.")

[Jugs]

In the event that he does have a serious reaction, you could always go forward on a spaced-out schedule, or stop altogether. I look at this way: the minor discomforts associated with vaccination (soreness, irritability, pain with the injection, fear) are pretty much inevitable, while serious reactions are much rarer. Why prolong the inevitable at the risk of a reaction that, in all likelihood, will not happen, kwim? Not with my oldest, he has a history of serious reaction so when he needed a few to be up-to-date, I did his one at a time, as a precaution.

[ASusan]

OP - my schedule posted above was/is for Ohio, starting K in 2 yrs, because my son does not meet the Aug. 1 cutoff with an Oct birthday. I believe it is the case that you can bypass the second MMR and varicella vaxes with a titer check, as PP suggests. This is why that point is in notes. (but Typhoid is NOT required - that is for possible international travel.)

And in Ohio, you do not need to ask for an exemption. You complete a philosophical exemption on your own and turn it in instead of the vax record. No doctor's (or clergy!) permission required. We turned ours in 3 years ago to daycare, and while we update his medical record each year, including all his allergy information, unexpired epi-pen, and possible meds, and the doctor signs it, we have not had to "update" the vax exemption. And our daycare is very rigid when it comes to having the proper paperwork on file and up-to-day because they are run by Head Start.

[ASusan]

Wait, wait - we need only

1 Hep B

1 HIB

1 Polio

2 DTaP

and we need 1 Hi??

Could you post the link where you got these Ohio requirements from? They don't correspond to what I uncovered recently. I'll go look for the link I was using...

[ASusan]

And I'm sorry to be nosy, and you don't have to answer this publicly on a forum, but where are you that has a Nov  cut-off? Ohio cut-offs are Aug 1 or Sept 30.

Not that it would make a difference if your child has a birthday after Nov 1.

[Super~Single~Mama]

Originally Posted by ASusan 

And I'm sorry to be nosy, and you don't have to answer this publicly on a forum, but where are you that has a Nov  cut-off? Ohio cut-offs are Aug 1 or Sept 30.

Not that it would make a difference if your child has a birthday after Nov 1.

Forum crashing to answer this - my new state has an Oct 1st cut-off, my old state (NY) had a Dec. 31 cut-off (which I didn't like b/c it meant some kids went to school at 4yo!).  Anyway, all states do it very differently for some reason.

[ASusan]

I understand that states are different with respect to cut-offs. I grew up in NY, and started school at four (turned 5 later that week), so Ohio seems super-early to me. But the OP said she was in Ohio, and afaik, Ohio mandates 1 of 2 cut-offs: Aug 1 or Sept 30. Again, not that it matters because OP states that her DS's birthday is in November.

[WhiteHorse]

ASusan, you are right, the cutoff is Sept 30 according to OH code. However, an OHDOE administrator is a friend of mine and told me otherwise, but I think she is wrong. Doesn't matter, his bd is 11/14. So he has 2 more years to go.

We went to our appt and the doc was cool with our requests. We did one shot (DTaP) and he will have an HIB in 2 weeks. We are selecting brands based on ingredients (he is allergic to egg and dairy).

[ASusan]

I'm glad your appointment went smoothly with the doctor and your requests to space things out.

Are you willing to share the brand information here?

DS is allergic to egg (and wheat and peanut). He's never tested IgE positive to dairy, but he does seem to react to it, and we intentionally avoid it for him.

And I'm still wondering about the Hib. According to what I've read, Ohio doesn't require the Hib for kindy attendance. (I'm looking to get by here with the absolute minimum.)

[ASusan]

Coming back to answer my own question re HIB. The document linked on this page - http://www.odh.ohio.gov/odhPrograms/dis/immunization/imunchsc.aspx - says that HIB is required for preschool/daycare attendance but NOT for Kindergarten attendance.

[WhiteHorse]

Here is the list of ingredients. Lactalbumin and Casamino acid are milk ingredients.

http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/excipient-table-2.pdf

We are doing HIB because we have an infant, and there is a possibility we might need to do daycare if I find the right job. Sorry for the short reply NAK!