Category: Vaccine Education

Did Your Hepatitis B Antibody Test Come Back Negative?

Hepatitis B can be prevented.Three doses of the hepatitis B vaccines have been shown to provide long lasting protection in most people.

Do you need to get your titers checked to make sure you are immune?

Usually not. Simply being fully vaccinated with the  vaccine is  good enough evidence that you are immune in most, but not all circumstances.

A few circumstances in which you might need to be tested can include:

  • a baby who was born to a HBsAg (hepatitis B surface antigen) mother
  • being a healthcare worker who has a job and who is in a work setting that puts them at higher risk for exposure to blood or body fluids from patients who are positive for HBsAg
  • being immunocompromised, so you are not sure if the vaccine is going to work, or patients requiring chronic dialysis
  • someone who has sex or shares needles with a person who has a chronic hepatitis B infection

The screening test for vaccine immunity that is done checks the persons level of anti-HBs (antibody to the hepatitis B surface antigen). It should be done one to two months after your last dose of hepatitis B vaccine, but not later.

“Persons determined to have anti-HBs concentrations of ≥10 mIU/mL after receipt of the primary vaccine series are considered immune, and the result should be documented. Immunocompetent persons have long-term protection and do not need further periodic testing to assess anti-HBs levels.”

CDC on Immunization of Health-Care Personnel

The alternative to screening healthcare workers after they complete their vaccination series is to do postexposure management. In this method, in the case of a needlestick or other blood or body fluid exposure, both the source patient and the health care worker are tested and postexposure prophylaxis is given as necessary.

Don’t pregnant women get tested for hepatitis B? They do, but not to see if they are immune from immunization. They routinely have a HBsAg test to see if they have a chronic hepatitis B infection, which can be passed on to their baby.

Other screening tests that can be done include anti-HBc (antibody to hepatitis B core antigen) and IgM anti-HBc (IgM subclass to hepatitis B core antigen). These two tests can help you figure out if a person has an acute infection or is immune from a past infection.

Non-Immune Hepatitis B Titer Levels

Why check the anti-HBs level?

Because of the devastating effects of chronic hepatitis B infections, it is good to have all of the information you can get to help prevent a possible infection if you are exposed to blood or body fluids while working.

Having a positive anti-HBs level, typically defined as a level of ≥10 IU/mL, means that you are immune and protected.

But what if your level is negative? What if your level is <10 IU/mL after you have already gotten three doses of hepatitis B vaccine?

Then you get another dose of hepatitis B vaccine and the level is checked again in one to two months. If it is still <10 IU/mL, then you get two more doses of hepatitis B vaccine and the level is checked again in one to two months.

If you are still negative after six or more doses of hepatitis B vaccine, then you are considered a non-responder. You would then require postexposure testing and possible prophylaxis if you are exposed to a patient’s blood or body fluids.

What If You Lost Your Hepatitis B Immunity?

There is a reason that they don’t recommend testing more than one to two months after your last dose of hepatitis B vaccine.

“Studies indicate that immunologic memory remains intact for at least 20 years and confers protection against clinical illness and chronic HBV infection, even though anti-HBs levels that once measured adequate might become low or decline below detectable levels. If one is challenged with HBV, people whose immune systems are competent will mount an anamnestic response and develop protective anti-HBs.”

Immunization Action Coalition on Hepatitis B Questions

It is known that anti-HBs levels can decrease over time.

Fortunately, this does not lead to waning immunity in typical circumstances. Because of an anamnestic response, the hepatitis B vaccine provides long lasting protection, even if your antibody levels appear to have dropped.

Avoiding Hepatitis B

Since health care workers should practice universal precautions whether or not they are immune to hepatitis B, being a non-responder isn’t going to change how you do things too much.

Plus, there are other diseases that are not yet vaccine preventable that you could get if you are stuck with a needle, so you are hopefully still very careful, no matter how immune you are to hepatitis B.

Still, it is very nice to have one less thing to worry about in this situation.

“Unvaccinated or incompletely vaccinated persons who experience a workplace exposure from persons known to be HBsAg-positive should receive 1 dose of hepatitis B immune globulin HBIG (i.e., passive vaccination) as soon as possible after exposure (preferably within 24 hours).”

CDC on Immunization of Health-Care Personnel

If you are a non-responder and and are exposed to hepatitis B, then one thing that is different is that you will likely require two doses of HBIG (hepatitis B immune globulin) for protection. Others can get one dose of HBIG and can repeat the hepatitis B vaccine. Those who are fully vaccinated and known to be immune likely won’t have to do anything to protect themselves from hepatitis B, although each incident should be investigated to make sure.

But it is not just healthcare workers who are at risk for accidental needlesticks. What if a healthcare worker sticks themselves and then you or your child? Or what if your child gets stuck with a discarded needle at the park?

What to Know About Hepatitis B Titers

Get vaccinated and follow the latest guidelines if you are exposed to hepatitis B, especially if you are a non-responder to the vaccine with low titer levels.

More on Hepatitis B Titers and Immunity

Did Your Rubella Titer Come Back Negative?

Two doses of the MMR vaccines give the great majority of people long lasting immunity to measles, mumps, and rubella. Well, measles and rubella anyway. Unfortunately, the mumps part of the vaccine has some issues with waning immunity.

Do you need to get your titers checked to make sure you are immune?

Usually not. Simply being fully vaccinated with the MMR vaccine is  good enough evidence that you are immune in most, but not all circumstances

Getting or being pregnant is one of those circumstances in which it is important to know for sure. It is really one of the only circumstances. Health care works are no longer routinely tested after they are vaccinated, as proof of vaccination is good evidence of immunity for the MMR vaccine.

The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for rubella.
The American College of Obstetricians and Gynecologists recommends that all pregnant women be screened for rubella.

That screening test is a rubella serum IgG levels or as it is more commonly known as, a titer level.

Non-Immune Rubella Titers

Why check it?

Because of the devastating effects of congenital rubella syndrome, all pregnant women are screened early in their pregnancy.

Babies with congenital rubella syndrome may have cataracts and many other birth defects.
Babies with congenital rubella syndrome may have cataracts and many other birth defects. Photo courtesy PHIL

Having a positive rubella titer, typically defined as a IgG level of ≥10 IU/mL, means that you are immune and protected.

But what if your rubella titer is negative? What if your level is <10 IU/mL?

We know that levels of vaccine-induced rubella antibodies can decrease over time, but unlike mumps and pertussis, this does not seem lead to waning immunity with rubella.

Still, the current recommendations from the Advisory Committee on Immunization Practices (ACIP) are that:

  1. Vaccinated women of childbearing age who have received one or two doses of rubella-containing vaccine and have a rubella serum IgG levels that is not clearly positive should be administered one additional dose of MMR vaccine, with a maximum of three doses.
  2. After this additional dose, they do not need to be retested for serologic evidence of rubella immunity.
  3. Since MMR is a live vaccine, the additional dose should not be given during pregnancy or within a month of when you plan to get pregnant. You can get it while you are breastfeeding though.

How much should you be concerned about a negative rubella titer?

Although congenital rubella syndrome is not uncommon in other countries that don’t routinely vaccinate for rubella, there has not been a case of congenital rubella syndrome in the United States since – 2017.

That’s right, we have actually had two cases of congenital rubella syndrome in the US this year! In past years, these cases have all been linked to pregnant women becoming infected outside the US though, as there are thought to be very few rubella infections locally.

And two cases is a far cry from when rubella caused 2,100 neonatal deaths and 20,000 infants to be born with congenital rubella syndrome during an epidemic in the mid-1960s, before the first rubella vaccine was available.

That’s because vaccines work.

Wait, then why do some of these folks have a negative titer when they are tested?

While the easy answer is to say that they aren’t immune, it is more complicated than that. For example, some of the negative results could be false negatives (a negative test result that really should be positive). Others could possibly have low antibody levels, but they are still immune. Still, since one dose of a rubella containing vaccine is only about 97% effective, some of them could be non-responders.

Will a second or third booster dose of vaccine help increase your antibody levels? Yes, but in this situation, they will likely just rise temporarily. The second or third dose of MMR isn’t technically a booster dose, but rather a dose for those who didn’t respond to the previous doses, particularly for the measles component.

Avoiding Rubella

With a negative rubella titer, especially if you have not been previously vaccinated with one or more rubella-containing vaccines, you should likely try to avoid anyone who might have rubella.

There aren’t a lot of guidelines on how to avoid rubella though.

If you want to avoid rubella, avoid folks who aren't vaccinated against rubella.
If you want to avoid rubella, avoid folks who aren’t vaccinated against rubella. Photo courtesy of PHIL

That probably surprises you, especially with all of the information out there on how to avoid the flu, measles, mumps, and other infectious diseases, but it shouldn’t.

Symptoms of a rubella infection can include swollen lymph glands, low grade fever, a mild case of pink eye, and a red rash that can be hard to see, unless the person is overheated, like after a bath. Most importantly, people with rubella can be contagious for another few weeks, even as all of the symptoms have gone away. Also, like most viral infections, they were contagious for a few days even before they developed their first symptoms. And, believe it or not, some people with rubella might have no symptoms at all and still be contagious.

So how do you avoid someone who doesn’t even know that they are sick and are still contagious?

You basically want to try and away from anyone who might become sick and contagious…

While that sounds impossible, avoiding kids and adults who are intentionally unvaccinated, especially those who are intentionally unvaccinated and have recently traveled out of the country, can be a good start.

And like someone with a medical exemptions to getting vaccinated, if you have been vaccinated and lost your immunity to rubella, feel free to hide in the herd. This is one of the reasons everyone gets vaccinated!

What to Know About Rubella Titers

Get vaccinated and follow the latest guidelines if you are pregnant and your rubella titer is negative.

More on Rubella Titers and Immunity

Precautions vs Contraindications When Vaccinating Your Kids

Believe it or not, there are some anti-vaccine folks who believe that all vaccines are dangerous and unnecessary. And they believe that pediatricians push vaccines on kids in all situations, using a one-size-fits-all kind of immunization schedule.

Of course, neither is true.

Vaccines are safe and necessary.

There are some true medical contraindications and precautions to getting vaccinated though. Still, it is important to remember that even more things are simply “conditions incorrectly perceived as contraindications to vaccination.”

Contraindications To Vaccinating Your Kids

There are actually some good reasons to delay or skip one or a few of your child’s vaccines, but only in some very specific situations.

These very specific situations are called contraindications and are what count as medical exemptions.

“A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons.”

CDC on Vaccine Contraindications and Precautions

Fortunately, there are not that many of these contraindications, they are usually specific to just one or a few vaccines, and they are usually, but not always, temporary.

That’s why it would be really unusual to get a true permanent medical exemption for all vaccines. Even if you had a severe allergy to a vaccine that contained yeast, latex, or gelatin, since vaccines contain different ingredients, you would very likely be able to safely get the others.

Remember, your doctor can’t, or at least shouldn’t, just make up contraindications and exemptions to help you avoid getting your kids vaccinated and help you keep them in school.

“I do not believe vaccines had anything to do with my child’s autism. I never noticed any change in his speech, behavior or development with vaccines. I believe the protection and benefits of vaccines far outweigh the risks!”

Michele Han, MD, FAAP

Autism, for example, has been shown to not be associated with vaccines, so it is not a contraindication to getting vaccinated. That’s why many parents vaccinate and protect their autistic kids!

Precautions To Vaccinating Your Kids

In addition to contraindications to getting vaccinated, there is an accompanying list of  precautions.

“A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity (e.g., administering measles vaccine to a person with passive immunity to measles from a blood transfusion administered up to 7 months prior). A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Again, we are fortunate that most of the conditions that are listed as precautions are temporary.

The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.
The vaccine information sheet that you get with each vaccine will list contraindications and precautions on who should not get the vaccine.

In fact, the most common is having a “moderate or severe acute illness with or without fever.”

Don’t want to get your child vaccinated when he or she has a severe illness?

Don’t worry.

Your pediatrician usually doesn’t want to vaccinate your child in that situation either.

It is easy enough to wait a few days or a week to get vaccinated, when the illness has passed, keeping in mind that a “mild acute illness with or without fever” is neither a precaution nor a contraindication to getting vaccinated. So you can still get your child their recommended vaccines if they just have a cold, stomach bug, or ear infection, etc.

What to Know About Precautions and Contraindications to Vaccines

Although there are some true medical exemptions or contraindications and precautions to getting vaccinated, most are vaccine specific and many are temporary, so they shouldn’t keep you from getting your child at least mostly vaccinated and protected.

More on Precautions and Contraindications to Vaccines

The Value and Cost Savings of Getting Vaccinated

We often hear a lot about the benefits of vaccines.

Even the schools were closed in San Antonio when polio came to Texas in 1946.
How much would it cost to close all of the schools in a big city today?

Well, most of us do.

But can getting vaccinated really help save us money?

Cost Savings of Getting Vaccinated

Vaccines are expensive, so it probably doesn’t make a lot of sense to many people that saving money is one of the big benefits of getting vaccinated.

That’s just because vaccines work so well.

“Analyses showed that routine childhood immunization among members of the 2009 US birth cohort will prevent ∼42 000 early deaths and 20 million cases of disease, with net savings of $13.5 billion in direct costs and $68.8 billion in total societal costs, respectively.”

Zhou et al on Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009

Few of us remember the pre-vaccine era when there were polio and diphtheria hospitals and “pest houses” at the edge of town.

We don’t remember when outbreaks of vaccine-preventable diseases would close schools and these diseases were more deadly, not because they were more severe, but simply because they were more common.

Costs Associated With Getting Sick

If we don’t remember these diseases and outbreaks, we certainly don’t remember how much it cost to control and treat them.

We should though.

Just look at how much it costs to control the recent measles outbreaks that continue to plague us.

“The estimated total number of personnel hours for the 16 outbreaks ranged from 42,635 to 83,133 and the corresponding total estimated costs for the public response accrued to local and state public health departments ranged from $2.7 million to $5.3 million US dollars.”

Ortega-Sanchez on The economic burden of sixteen measles outbreaks on United States public health departments in 2011

Not including the direct costs for outpatient visits and inpatient care, recent outbreaks have cost anywhere from $3,000 to $50,000 per case to contain. Why the difference? Localized outbreaks, like in a church group or among a single family, will be easier and less expensive to contain, as they will likely involve fewer contacts to track down to see if they were exposed and are already vaccinated.

Again, these costs don’t include the costs of going to your doctor or the ER because your child is sick, getting hospitalized, or lab tests, etc.

It also doesn’t include the costs associated with living under quarantine, which is happening in many of the recent outbreaks.

Getting sick is expensive.

How much is a liver transplant?

How much does it cost to treat someone with cervical cancer?

How much does it take to care for a child with congenital rubella syndrome?

How do anti-vax folks usually counter this important message?

They typically say that taking care of a vaccine-injured child is expensive too. While that can be true, the problem is with their idea of what constitutes a vaccine injury. While vaccines are not 100% safe and they can rarely cause serious or even life-threatening reactions, most of what they describe as vaccine-induced diseases, from autism to SIDS, are not actually associated with vaccines.

The Value of Vaccination

So yes, getting vaccinated is cost effective.

“Cost-effectiveness analysis has become a standard method to use in estimating how much value an intervention offers relative to its costs, and it has become an influential element in decision making. However, the application of cost-effectiveness analysis to vaccination programs fails to capture the full contribution such a program offers to the community. Recent literature has highlighted how cost-effectiveness analysis can neglect the broader economic impact of vaccines.”

Luyten et al on The Social Value Of Vaccination Programs: Beyond Cost- Effectiveness

The value of getting vaccinated goes way beyond saving money though.

Most of the ways this has been studied in the past still leaves out a lot of important things, including:

  • increased productivity later in life following vaccination
  • improved cognitive and educational outcomes
  • community-level health gains through herd effects
  • prevention of antibiotic resistance
  • vaccination-related benefits to macroeconomic factors and political stability
  • furthering moral, social, and ethical aims

Why are these important?

“Vaccination has greatly reduced the burden of infectious diseases. Only clean water, also considered to be a basic human right, performs better. Paradoxically, a vociferous antivaccine lobby thrives today in spite of the undeniable success of vaccination programmes against formerly fearsome diseases that are now rare in developed countries.”

Andre et al on Vaccination greatly reduces disease, disability, death and inequity worldwide

If you are making a decision to get vaccinated vs. trying to hide in the herd, you want to have all of the information about the benefits of vaccines, not just about the risks, or what you might think are risks.

Vaccines Are Expensive

Although getting vaccinated is certainly cost-effective, that doesn’t erase the fact that vaccines are expensive.

If they weren’t so expensive, then we likely still wouldn’t have so many deaths from vaccine-preventable diseases in the developing world, where the problem is access to vaccines, not vaccine-hesitant parents.

“We conclude that the vaccination portion of the business model for primary care pediatric practices that serve private-pay patients results in little or no profit from vaccine delivery. When losses from vaccinating publicly insured children are included, most practices lose money.”

Coleman on Net Financial Gain or Loss From Vaccination in Pediatric Medical Practices

Parents should also be aware that vaccines are expensive for the average pediatrician too, who no matter what anti-vax folks may claim about bonuses, aren’t making much or any money on vaccinating kids.

And because vaccines work, pediatricians also don’t make as much money when vaccinated kids don’t get diarrhea and dehydration that is prevented by the rotavirus vaccine, recurrent ear infections that are prevented by Prevnar, or a high fever from measles, etc., all things that would typically trigger one or more office visits.

It should be clear that the only reason that pediatricians “push vaccines” is because they are one of the greatest achievements in public health.

A great achievement at a great value.

What to Know About the Cost Savings of Getting Vaccinated

There is no question that there is great value in getting fully vaccinated on time and that getting immunized is a very cost effective way to keep kids healthy.

More on the Cost Savings of Getting Vaccinated

Vaccines are Necessary

We know that vaccines are safe, even if they can have some side effects and risks.

And we know that vaccines work, even if they don’t work 100% of the time.

In fact, vaccines work so well, that they have eliminated or controlled many of the vaccine-preventable diseases that we still get vaccinated against.

Are Vaccines Still Necessary?

So that leaves some people asking themselves – even if the benefits of vaccines far outweigh their risks, are vaccines still necessary?

“So what I did on my schedule is, I took a more logical look at hepatitis B, and I realized that babies have no risk of catching this disease, so let’s not do the hep B vaccine while a baby’s young and small and more vulnerable.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

After all, most of us don’t travel to developing countries or do other things to put ourselves or our kids at risk of getting a vaccine-preventable disease, right?

And we probably don’t have conditions that put us at high risk of getting sick either?

So isn’t it safe to just skip or delay many of the shots on the routine immunization schedule?

Shouldn’t some of them just be optional now?

Vaccines Are Necessary

Alternative vaccine schedules? Optional vaccines? No risk of getting diseases? Those are the arguments you will see on many anti-vaccine websites and forums, but they certainly aren’t logical arguments.

“The reason I delay the polio vaccine on my alternative schedule is that we don’t have polio in the United States. We haven’t had it here for over 30 years. We’ve been very fortunate because the vaccination program for polio has been so successful, now we’re reaping the rewards of not having to worry about this disease.”

Dr. Robert W. Sears on Why Partial Vaccinations May Be an Answer

Did you know that an unvaccinated group of Amish children got infected with polio in 2005?

Or that an otherwise healthy, unvaccinated 22-year-old U.S. resident became infected with polio vaccine virus, developing paralytic polio, while traveling in Costa Rica in a university-sponsored study-abroad program in 2005? It turns out that the granddaughter of the host family that she was staying with lived next door and had recently been vaccinated with the OPV vaccine, which does shed, and in this case caused her to develop vaccine-associated paralytic polio.

And did you know that there was a lethal case of vaccine-derived poliomelitis in Minnesota in 2009?

Apparently Dr. Bob didn’t either.

“We know that a disease that is apparently under control can suddenly return, because we have seen it happen, in countries like Japan, Australia, and Sweden. Here is an example from Japan. In 1974, about 80% of Japanese children were getting pertussis (whooping cough) vaccine. That year there were only 393 cases of whooping cough in the entire country, and not a single pertussis-related death. Then immunization rates began to drop, until only about 10% of children were being vaccinated. In 1979, more than 13,000 people got whooping cough and 41 died. When routine vaccination was resumed, the disease numbers dropped again.”

CDC on What Would Happen If We Stopped Vaccinations?

But while polio is now on the brink of elimination, most other vaccine-preventable diseases are not. And that is why we see outbreaks any time vaccination rates drop:

  • measles – in addition to the outbreaks in the United States, there have been much bigger outbreaks across Europe, with much deadlier consequences
  • pertussis – yes, some of our pertussis outbreaks are because of waning immunity and occur in fully vaccinated children, but there were even larger outbreaks in Japan, Sweden, Italy, Ireland, Australia, and other countries in the 1970s and 1980s when immunization rates dropped, cases soared, and children died.
  • diphtheria – few people even know what diphtheria is anymore, but it is still around and causes outbreaks when immunization rates drop.
  • rubella – want to know what happens when you don’t vaccinate for rubella? just look at Japan – they had 14,357 cases of rubella and at least 31 cases of congenital rubella syndrome in 2013.
  • Hib – a 2008 outbreak in Minnesota during a temporary vaccine shortage likely reflected “increasing carriage and transmission affecting those with suboptimal primary series vaccination coverage, or a weakening of herd immunity”
  • tetanus – although tetanus isn’t contagious, we are seeing more cases in kids and pregnant women who aren’t vaccinated, as the bacteria which causes tetanus is present in spores in dirt and dust almost everywhere
  • polio – although polio is now endemic in only three countries, Afghanistan, Nigeria, and Pakistan, there are other countries where outbreaks can still occur, including the DR Congo and Syrian Arab Republic and many other high risk countries. This includes outbreaks of circulating vaccine derived polio virus, which increased this year in non-endemic countries, especially Syria because of years of poor immunization rates because of war.

Vaccines are necessary to avoid these kinds of outbreaks.

What Happens When We Don’t Vaccinate?

It should be very clear that everyone can’t try to hide in the herd.

We know what happens when  too many people don’t vaccinate their kids.

At least those of us who understand herd immunity know what happens…

In Ukraine, for example, there was a “massive epidemic” of diphtheria and other vaccine-preventable diseases in the Newly Independent States of the former Soviet Union in the early 1990s.

“This epidemic, primarily affecting adults in most Newly Independent States of the former Soviet Union, demonstrates that in a modern society diphtheria can still spread explosively and cause extensive illness and death.”

Diphtheria in the Former Soviet Union: Reemergence of a Pandemic Disease

In Ukraine alone, there were 17,387 cases of diphtheria and 646 deaths from 1992 to 1997. Also high, were cases of measles (over 23,000 cases in 1993) and pertussis (almost 7,000 cases in 1993).

Vaccine preventable diseases are just a plane ride away.
Vaccine preventable diseases are just a plane ride away.

Need a more recent example?

Just look at the tragedy unfolding in Venezuela. In addition to all of the hardships the people are facing, because of a weakened health system, poor surveillance, and a lack of preventative measures, including immunizations, they are seeing a rebound of diphtheria, measles, and other infectious diseases.

After being eliminated in 1992, there have been at least 450 cases of diphtheria in Venezuela since 2016 and at least 7 deaths.

Vaccines are necessary.

Vaccine-preventable diseases will come back if we stop vaccinating our kids.

And tragically, they aren’t yet gone in many parts of the world, even those that are well controlled in more developed countries. That’s why we often say that these diseases are ‘just a plane ride away.’

Just remember that the planes travel both ways. It isn’t just you traveling to high risk areas. Sometimes folks who are sick with vaccine preventable diseases bring them home and start outbreaks.

Get educated. Get vaccinated.

What to Know About Why Vaccines Are Necessary

Until a disease is eradicated, vaccines at herd immunity levels remain necessary to keep it from returning and causing outbreaks.

More About Why Vaccines Are Necessary

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Vaccine Schedule for Children with Down Syndrome

Has someone got you thinking that you need to skip or delay some vaccines for your child with Down syndrome?

Just because your child has Down syndrome doesn't mean that you should skip or delay any of their vaccines.
Just because your child has Down syndrome doesn’t mean that you should skip or delay any of their vaccines. Photo by Melissa Wall (CC BY 2.0)

Are you now on the fence and looking for a specific vaccine schedule for children with Down syndrome?

Vaccine Schedule for Children with Down Syndrome

Vaccine schedules for children with Down syndrome are quite easy to find.

They are the same as the vaccine schedules for every other children!

Unless they have another medical contraindication, there is no reason to skip or delay any of your child’s vaccines just because they have Down syndrome.

“Administer pneumococcal vaccine, as well as other vaccines recommended for all children unless there are specific contraindications.”

American Academy of Pediatrics Health Supervision for Children With Down Syndrome

In fact, because people with Down syndrome can be more susceptible to some infections, it is extra important that they be vaccinated on time, including that they get a yearly flu shot.

Do they need any extra vaccines?

Many  experts recommend that children with Down syndrome get a dose of the Pneumovax vaccine (pneumococcal polysaccharide vaccine or PPSV23) when they are at least two years old and at least eight weeks after completing their Prevnar 13 series. While the ACIP guidelines for Pneumovax doesn’t specifically mention Down syndrome, they do say that the vaccine is important for some children with chronic medical conditions and immune system problems.

“Well child care: immunizations; If chronic cardiac or pulmonary disease, give 23-valent pneumococcal vaccine age > 2 years.”

National Down Syndrome Society Guide for New and Expectant Parents

Talk to your pediatrician to see if your child with Down syndrome needs Pneumovax, especially if they get sick a lot or have chronic heart or lung problems. Some kids might even need a second dose of Pneumovax five years after the first dose.

What to Know About Vaccines and Down Syndrome

Your child with Down syndrome should be fully vaccinated on time without any delays, as there are no contraindications and he or she could be at increased risk for some infections.

More About Vaccines and Down Syndrome

 

Buying a Vaccine Refrigerator

Except for a few vaccines that must be frozen, vaccines must be refrigerated.

vaccine-refrigerator
Vaccines must be stored properly at the right temperature or they will lose their potency. Photo by Suplee/NIST

These vaccines should be stored in a vaccine refrigerator at a temperature between 36°F and 46°F (2°C and 8°C), with a target of 40°F (5°C).

You can’t just put vaccines in any old refrigerator though.

Buying a Vaccine Refrigerator

Although there are many types of refrigerators in which you could store your vaccines, ideally, a pediatrician’s best and safest option is a biologic-grade, full-sized, stand-alone refrigerator.

You have options though.

A dormitory style refrigerator is not one of them. However, although it is discouraged, you can use a stand-alone household refrigerator. Just don’t store anything besides vaccines in it at the same time! And make plans to replace it with a medical-grade refrigerator as soon as you possibly can.

Choosing the Best Vaccine Storage Refrigerator

Among the key features to look for when buying a vaccine refrigerator, include:

  • an electronic, microprocessor controlled, digital thermostat, avoiding a mechanical or analog thermostat or dial
  • user programmable temperature alarming in case the refrigerator temperature begins to get too hot or too cold
  • remote alarm contacts
  • an external temperature display so that you don’t have to open the refrigerator door to check the air temperature
  • adjustable wire shelving, instead of solid shelving, to improve circulation
  • a probe access port to allow the entry of a temperature probe wire
  • interior fan-forced air circulation to equalize the temperature throughout the refrigerator
  • a solid door, instead of a glass door, as a solid door will maintain the refrigerator’s temperature longer if the power goes out, although a glass door can help with inventory control
  • an audible door alarm, so that you are alerted if the door is left open
  • a self-closing door
  • a keyed door lock with multiple keys
  • a refrigerator that is large enough to fit all of your inventory without any crowding, especially when you have a full stock of vaccines, including flu vaccines, at your busiest time of year (this is your maximum stock level or calculated peak dose inventory). Remember that you also need extra space for water bottles to help stabilize the temperature during power failures.

And make sure your new vaccine storage refrigerator fits where you want to put it and that the door opens in the direction (right vs left hinged, as they are usually not reversible) that you need it to.

How big of a vaccine refrigerator do you need? The Missouri Dept of Health and Human Service provide a rough guide.
How big of a vaccine refrigerator do you need? The Missouri Dept of Health and Human Service provide a rough guide.

Biologic grade vaccine refrigerators are available from the following companies:

Choosing a vaccine refrigerator can be confusing, especially since most seem to have all of the features that the CDC and other experts recommend that you look for.

To make it a little easier, consider starting your search with these popular vaccine storage refrigerators (not endorsements):

Since price is going to be a factor, be sure to ask the sales rep for your medical supplies which vaccine refrigerators they can get the best deals on.

And make sure your refrigerator meets any other requirements that you have, especially if you are a Vaccines for Children provider.

What to Know About Buying a Vaccine Refrigerator

Do your research and choose a vaccine storage refrigerator that can easily store all of vaccines without crowding and which has key features to keep them safe and at the proper temperature.

More About Buying a Vaccine Refrigerator

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