Is this common/acceptable practice? - Mothering Forums
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#1 of 6 Old 04-10-2011, 02:46 PM - Thread Starter
 
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We do delayed and selective vax for our kids.

With HiB, we started our daughter at 11mos. According to the vaccine insert, for babies who start the first dose at 11mos, they should be receiving 2 doses of the vax. She has already received 2 doses, spaced 8 weeks apart.

Well, I got a note from the public health office with the list of vaxes that are due for my daughter and it included one more shot of HiB. With vaccine insert on hand, I asked the public health nurse for clarification and she checked on her book (I guess it's a vaccination manual given by the state) and it does say on her book that my daughter should be receiving 3 doses (instead of 2).

The vaccine insert that I have is the one that comes with the vaccine as written by the manufacturer while the book that she has is one that is written by the state health officials, I guess.

I asked her why was there such a discrepancy and she said that it was probably because our state has a higher incidence of HiB so they want to take the extra precaution hence the extra shot.

However, I am of the understanding that and it was written on the vaccine insert as well that clinical trials were made on high incidence populations so wouldn't it be logical to assume that the recommendations were made based on the results of testing done on these high incidence populations? Why then is our state, in effect, going against manufacturer recommendations on the vaccine usage?

Is this common practice? To go against manufacturer recommendations?

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#2 of 6 Old 04-10-2011, 03:31 PM
 
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What insert are you looking at? If you look at the CDC catch-up schedule, it states that it is dependent on the age at the time of the doses - since the first dose was given prior to 12 mos of age, if the second dose was administered at under 15 mos of age then CDC says a third would be due. That's what health dept's usually go by where I live.

http://www.cdc.gov/vaccines/recs/schedules/downloads/child/catchup-schedule-pr.pdf
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#3 of 6 Old 04-10-2011, 03:39 PM - Thread Starter
 
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vaccine insert = literature that comes with the vaccine.

 

Like for the specific brand of vaccine given to my daughter,

 

http://www.merck.com/product/usa/pi_circulars/p/pedvax_hib/pedvax_pi.pdf

 

On page 8, Table 6, it has the dosing regimen per specific age.

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#4 of 6 Old 04-11-2011, 11:45 AM
 
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Quote:
2 to 14 Months of Age
Infants 2 to 14 months of age should receive a 0.5 mL dose of vaccine ideally beginning at 2
months of age followed by a 0.5 mL dose 2 months later (or as soon as possible thereafter).
When the primary two-dose regimen is completed before 12 months of age, a booster dose is
required (see below and TABLE 6). Infants born prematurely, regardless of birth weight, should be
vaccinated at the same chronological age and according to the same schedule and precautions
as full-term infants and children.46
15 Months of Age and Older
Children 15 months of age and older previously unvaccinated against Hib disease should
receive a single 0.5 mL dose of vaccine.
 

The pamphlet is worded a little funny IMO, it basically says if you start between 2 and 14 months but finish by 12 months than a booster would be required. So that would leave you to believe that if the 2 doses are started in that age range but finished after 12 months than the booster would not be needed, they probably should've actually put that part in there for clarification.

My question for you, why don't you just wait until 15 months? Then only 1 dose is needed.

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#5 of 6 Old 04-11-2011, 11:46 AM
 
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Oops, I just realized you already started at 11 months...just ignore my question :p

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#6 of 6 Old 04-12-2011, 04:23 PM
 
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The CDC/ACIP says :
Quote:
If the first 2 doses were PRP-OMP (PedvaxHIB or Comvax), and administered at
age 11 months or younger, the third (and final) dose should be administered at
age 12 through 15 months and at least 8 weeks after the second dose.
• If the first dose was administered at age 7 through 11 months, administer the
second dose at least 4 weeks later and a final dose at age 12 through 15 months.

So that's most likely what health departments will be inclined to do - especially if it's VFC vaccine they're using. I'm not especially familiar with that particular brand but I know that ACIP recommendation has been around since the early 90s.
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Vaccinations , Selective Vaccination , Delayed Vaccination , Hib

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