Primary Series

Aka: Primary Series, Pediatric Vaccination, Immunization Schedule in Children

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II. Precautions

  1. See Immunization regarding risks of undervaccination
  2. Take every opportunity to catch up Vaccinations

III. 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

IV. Adverse Effects: Safety

  1. See Immunization

V. Contraindications

  1. See Vaccination

VI. Protocol: Vaccinations

  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

VII. Protocol: Vaccination Schedule Example

  1. Birth
    1. Hep B Vaccine
  2. Well Child Visit at 2 months
    1. Hep B Vaccine (2) typically combined with Hib
    2. Hib Vaccine (1)
    3. Pneumococcal Conjugate Vaccine (1)
    4. Diphtheria Tetanus Acellular Pertussis Vaccine (1)
    5. Inactivated Polio Vaccine (1)
    6. Rotavirus Vaccine (1)
  3. Well Child Visit at 4 months
    1. Hib Vaccine (2)
    2. Pneumococcal Conjugate Vaccine (2)
    3. Diphtheria Tetanus Acellular Pertussis Vaccine (2)
    4. Inactivated Polio Vaccine (2)
    5. Rotavirus Vaccine (2)
  4. Well Child Visit at 6 months
    1. Hep B Vaccine (3)
    2. Hib Vaccine (3, not required if using PedvaxHIB for series)
    3. Pneumococcal Conjugate Vaccine (3)
    4. Diphtheria Tetanus Acellular Pertussis Vaccine (3)
    5. Inactivated Polio Vaccine (3)
    6. Rotavirus Vaccine (3)
      1. Not required if Rotarix was used for first two Rotavirus Vaccines
  5. Well Child Visit at 12 months
    1. Measles Mumps Rubella Vaccine (1)
    2. Varicella Vaccine (1)
    3. Hepatitis A Vaccine (1)
  6. Well Child Visit at 15 months
    1. Pneumococcal Conjugate Vaccine (4)
    2. DTaP Vaccine (4) with Hib Vaccine (3-4)
  7. Well Child Visit at 18 months
    1. Hepatitis A Vaccine (2)
  8. Well Child Visit at 4 to 6 years
    1. Diphtheria Tetanus Acellular Pertussis Vaccine (5)
    2. Inactivated Polio Vaccine (4)
    3. Measles Mumps Rubella Vaccine (2)
    4. Varicella Vaccine (2)
  9. Adolescent Visit at 11-12 years
    1. Tetanus Diptheria acellular Pertussis (Tdap Vaccine)
    2. Meningococcal Conjugate Vaccine or MCV4 (1)
    3. Human PapillomavirusVaccine (Two doses 6-12 months apart)
  10. Adolescent Visit at 16 years
    1. Meningococcal Conjugate Vaccine or MCV4 (2)
    2. Catch up Human PapillomavirusVaccine with 3 dose series if not already completed

VIII. Preparations: Common Combination Vaccines used in the Primary Series

  1. Pediarix (DTaP-HepB-IPV)
    1. Hep B Vaccine
    2. Diphtheria Tetanus Acellular Pertussis Vaccine
    3. Inactivated Polio Vaccine
  2. Pentacel (DTaP-HepB-IPV)
    1. Diphtheria Tetanus Acellular Pertussis Vaccine
    2. Inactivated Polio Vaccine
    3. Hib Vaccine
  3. Kinrix or Quadracel (DTaP-IPV)
    1. Diphtheria Tetanus Acellular Pertussis Vaccine
    2. Inactivated Polio Vaccine
  4. ProQuad (MMRV)
    1. Measles Mumps Rubella Vaccine (1)
    2. Varicella Vaccine (1)

IX. 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. Pneumococcus Vaccine at 24 months
    4. Measles-Mumps-RubellaVaccine

X. Resources

  1. CDC ACIP Recommendations
    1. https://www.cdc.gov/vaccines/hcp/acip-recs/index.html
  2. CDC Immunization Schedules (last accessed 10/28/2020)
    1. https://www.cdc.gov/vaccines/hcp/imz-schedules/index.html

XI. References

  1. Ackerman (2015) Am Fam Physician 92(6): 460-8 [PubMed]
  2. Diggle (2000) BMJ 321:931-3 [PubMed]

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