Tag: MenB

Vaccines for Kids with Asplenia

Asplenia means lack of a spleen or a spleen that doesn’t work.

Although the spleen is an important organ that helps your body fight infections, in addition to other functions, it is certainly possible to live without a spleen.

Asplenia

There are many reasons a child might have asplenia, including:

  • congenital asplenia (children born without a spleen), sometimes associated with severe cyanotic congenital heart disease, such as transposition of the great arteries
  • surgical removal (splenectomy) secondary to trauma or anatomic defects
  • surgical removal to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.

And some children simply have a spleen that doesn’t work (functional asplenia) or doesn’t work very well because of sickle-cell disease and some other conditions.

Vaccines for Children with Asplenia

Because the spleen has such an important function in helping fight infections, without a spleen, a child is at increased risk for infections.

Specifically, there is a risk for severe infections from the Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis bacteria.

Fortunately, there are vaccines that protect against many subtypes of these bacteria, including:

  • Hib – protects against Haemophilus influenzae type B
  • Meningococcal conjugate vaccines – Menactra or Menveo, which protect against 4 common types of the Neisseria meningitidis bacteria – serogroups ACWY
  • Serogroup B Meningococcal vaccines – Bexsero or Trunemba, which protect against Neisseria meningitidis serogroup B
  • Prevnar 13 – protects against 13 subtypes of Streptococcus pneumoniae
  • Pneumovax 23 – protects against 23 subtypes of Streptococcus pneumoniae

Although Prevnar, Hib, and the meningococcal vaccines (Menactra or Menveo and Bexsero or Trunemba) are part of the routine immunization schedule, there are additional recommendations that can change the timing for when kids get them if they have asplenia.

Some kids need extra protection from vaccines.
Some kids need extra protection from vaccines. Photo by Janko Ferlic.

According to the latest recommendations, in addition to all of the  other routine immunizations that they should get according to schedule, children with asplenia should get:

  • one dose of the Hib vaccine if they are older than age 5 years “who are asplenic or who are scheduled for an elective splenectomy” and have not already vaccinated against Hib. Unvaccinated younger kids should get caught up as soon as possible. In general though, Hib is given according to the standard immunization schedule. This recommendation is about kids who are behind on the shot.
  • two doses of a meningococcal conjugate vaccine, either Menactra or Menveo, two months apart once a child with asplenia is at least two years old and a booster dose every five years. Infants with asplenia can instead get a primary series of Menveo at 2, 4, 6, and 12 months, with a first booster dose after three years, and a second booster after another five years. Older infants can get Menactra at 9 and 12 months, again, with a first booster dose after three years, and a second booster after another five years. While these vaccines are recommended for all kids, those with asplenia get them much earlier than the standard age.
  • either a two dose series of Bexsero or a three dose series of Trunemba, once they are at least 10 years old. The Men B vaccines are only formally recommended for high risk kids, others can get it if they want to be protected.
  • between one to four doses of Prevnar, depending on how old they are when they start and complete the series. Keep in mind that unlike healthy children who do not routinely get Prevnar after they are 5 years old, older children with asplenia can get a single dose of Prevnar up to age 65 years if they have never had it before. Like Hib, this recommendation is about kids who are behind on the shot.
  • a dose of Pneumovax 23 once they are at least two years old, with a repeat dose five years later and a maximum of two total doses. Kids who are not high risk typically don’t get this vaccine.

Ideally, children would get these vaccines at least two to three weeks before they were going to get a planned splenectomy. Of course, that isn’t always possible in the case of the emergency removal of a child’s spleen, in which case they should get the vaccines as soon as they can.

More About Asplenia

In addition to these vaccines, preventative antibiotics are typically given once a child’s spleen is removed or is no longer working well. Although there are no definitive guidelines for all children who have had a splenectomy, many experts recommend daily antibiotics (usually penicillin or amoxicillin) until a child is at least 5 years old and for at least 1 year after their splenectomy.

Other less common bacteria that can be a risk for children with asplenia can include Escherichia coli, Staphylococcus aureus, Salmonella species, Klebsiella species, and Pseudomonas aeruginosa. Vaccines aren’t yet available for these bacteria, so you might take other precautions, such as avoiding pet reptiles, which can put kids at risk for Salmonella infections.

Children with asplenia are at increased risk for severe malaria and babesiosis (a tickborne illness) infections. That makes it important to take malaria preventative medications and avoid mosquitoes if traveling to places that have high rates of malaria and to do daily tick checks when camping, etc.

A medical alert type bracelet, indicating that your child has had his spleen removed, can be a good idea in case he ends up in the emergency room with a fever and doctors don’t know his medical history.

Keep in mind that since there are many different causes of asplenia, the specific treatment plan for your child may be a little different than that described here. Talk to your pediatrician and any pediatric specialists that your child sees.

What to Know about Vaccines for Children with Asplenia

Children with asplenia typically need extra vaccines and protection against pneumococcal disease, Hib, and meningococcal disease.

More about Vaccines for Children with Asplenia

Understanding the Recommendations to Get a Men B Vaccine

A lot of folks, even some pediatricians, are still confused about the recommendations for the meningococcal B vaccines.

Remember, two vaccines, Bexsero and Trumenba, are approved to protect against serogroup B meningococcal disease.

The Men B Vaccine for High Risk Kids

There is no confusion about the recommendation that high risk kids should get vaccinated against meningococcal B disease.

“Certain persons aged ≥10 years who are at increased risk for meningococcal disease should receive MenB vaccine.”

ACIP on Use of Serogroup B Meningococcal Vaccines in Persons Aged ≥10 Years at Increased Risk for Serogroup B Meningococcal Disease: Recommendations of the Advisory Committee on Immunization Practices, 2015

Who’s high risk?

In addition to microbiologists who work with the Neisseria meningitidis bacteria, you are considered to be high risk if you are at least 10 years old and:

  • MenB vaccines are routinely given during outbreaks on college campuses.
    MenB vaccines are routinely given during outbreaks on college campuses.

    have a persistent complement component deficiency, including inherited or chronic deficiencies in C3, C5–C9, properdin, factor D, or factor H

  • have anatomic or functional asplenia, including sickle cell disease, children with congenital asplenia, and children who’s spleen was removed (splenectomy) to prevent complications of other conditions, such as ITP, hereditary spherocytosis, pyruvate kinase deficiency, Gaucher disease, and hypersplenism, etc.
  • are taking the medication eculizumab (Soliris), which is used to treat two rare blood disorders, atypical hemolytic uremic syndrome (aHUS) and paroxysmal nocturnal hemoglobinuria (PNH)
  • could be exposed in a serogroup B meningococcal disease outbreak

And, if high risk, you should either get a 3 dose series of Trumenba or a 2 dose series of Bexsero.

Keep in mind that traveling is not usually a risk factor for Men B, but can be for the other meningococcal vaccines.

The Men B Vaccine for Healthy Teens

But what if you aren’t at high risk?

While teens should routinely get vaccinated with other meningococcal vaccines, Menactra or Menveo, that provide protection against serogroups A, C, W, Y,  the recommendation for Men B vaccination is more permissive.

“A MenB vaccine series may be administered to adolescents and young adults aged 16–23 years to provide short-term protection against most strains of serogroup B meningococcal disease. The preferred age for MenB vaccination is 16–18 years.”

ACIP on Use of Serogroup B Meningococcal Vaccines in Adolescents and Young Adults: Recommendations of the Advisory Committee on Immunization Practices, 2015

When given to healthy teens who are not at high risk for meningococcal disease, both Bexsero and Trumenba can be given as a two dose series.

A Permissive Recommendation for Men B Vaccines

This permissive recommendation for Men B is what has got folks confused…

“The recommendation is labeled as “Category B,” meaning that individual clinical decision-making is recommended. A Category A recommendation means a vaccine is recommended for everyone in an age-group or risk factor group.”

ACIP endorses individual choice on meningitis B vaccine

So there is a recommendation for older teens to get vaccinated with the Men B vaccines, it just isn’t the clear cut, get the vaccine, kind of recommendation that we are used to. The recommendation instead says that you can get the vaccine if you want to be vaccinated and protected against meningococcal B disease.

And that’s where the confusion comes from, as over 75% of doctors don’t even know what a category B recommendation really means! That’s not surprising though, as the Advisory Committee on Immunization Practices doesn’t often make category B recommendations for vaccines.

So why did the Men B vaccines only get a permissive recommendation? After all, Bexsero is routinely given to all infants in the UK at 8 weeks, 16 weeks, and 1 year as part of their routine childhood immunization schedule.

Things that factored into the decision for a permissive recommendation seemed to include that:

  • routine vaccination of all teens would prevent about 15 to 29 cases of Men B and two to five deaths each year, as there are about 50 to 60 cases and five to 10 deaths each year in children and young adults between the ages of 11 and 23 years, and giving it only to kids going to college would only prevent about nine cases and one death each year
  • there are some concerns about how effective the MenB vaccines might be, but only because vaccine effectiveness “was inferred based on an immunologic marker of protection,” as it is difficult to otherwise test how well the vaccine works because the disease has a low prevalence and there is no data yet about how long the protection will last, as they are new vaccines. Still, from 63 to 88% of people get protective levels of antibodies after getting the MenB vaccines and the protection should last for at least two to four years.
  • data on safety was limited, but there were no “no concerning patterns of serious adverse events”
  • the vaccine likely won’t reduce the nasopharyngeal colonization by MenB bacteria, so might not contribute to herd immunity

If you are still confused, you will hopefully be reassured that a combination, pentavalent MenABCW-135Y meningococcal vaccine is in the pipeline and once available, will almost certainly be recommended for all teens, replacing the need to get separate meningococcal vaccines for protection.

Making a Decision About the MenB Vaccines

So do you get your kids the Men B vaccine series?

“Pediatricians are encouraged to discuss the availability of the MenB vaccines with families.”

AAP on Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older

The one thing that is very clear is that you should make your decision after talking to your pediatrician about the risks and benefits of getting vaccinated.

Although many people think that there is no recommendation for healthy teens to get a Men B vaccine, that isn’t really true. There just isn’t a recommendation for routine vaccination of all teens.

It is true that the Men B vaccines aren’t required by most colleges, although some are starting to require them, just like they do Menactra or Menveo.

“The treating clinician should discuss the benefits, risks, and costs with patients and their families and then work with them to determine what is in their best interest.”

AAP on Recommendations for Serogroup B Meningococcal Vaccine for Persons 10 Years and Older

What are the benefits? Your child doesn’t get Men B disease, a disease that is often life-threatening.

What are the risks? In addition to extremely rare risks that you can see with any vaccine, like anaphylaxis, there are the risks that the vaccine doesn’t work, as no vaccine is 100% effective, pain from the shot, or that your child is never exposed, so didn’t actually need the shot, since Men B disease is pretty rare.

“The CDC has estimated the risk of anaphylaxis is 1.3 cases/1 million doses following administration of any vaccine. Thus, the vaccine benefit from prevention of death from MenB disease is approximately equal to the risk of anaphylaxis from MenB vaccine administration.”

H. Cody Meissner, MD on MenB vaccines: a remarkable technical accomplishment but uncertain clinical role

Although thinking about it this way, the risk of anaphylaxis vs the benefit of preventing Men B deaths seems to be equal, remember that anaphylaxis is often treatable.

What are the costs? Men B vaccines are expensive, but are covered by insurance and the Vaccines for Children Program. Still, someone is always paying for them.

What other factors come into play? Some teens are getting caught up on their HPV vaccines and are getting a booster dose of the other meningococcal vaccine at around this same time. While they can certainly all be given together, some pediatricians prioritize getting kids vaccinated and protected with Gardasil and Menactra or Menveo, and so don’t focus on the Men B vaccines.

Still, the vaccine is safe and it works, so the question really may come down to – is it necessary? Or is Men B so rare, that it is worth taking a chance and skipping this vaccine.

What to Know About the Recommendations to Get a Men B Vaccine

Talk to your pediatrician and see if your child should get the Men B vaccine series.

More on Understanding the Recommendations to Get a Men B Vaccine

Doing the Math on Kennedy, Vaccines and Mercury

Although most anti-vaccine folks have moved on to aluminum by now, some are still sticking by thimerosal as their favorite “toxin” in vaccines to blame for causing so-called vaccine-induced diseases.

“Well, here are the numbers. And the numbers change every year. I think in 2012, there were 185 million doses of flu doses manufactured in this country. And I think fewer than 10 million were thimerosal-free. Over 90 percent had huge, huge doses of mercury.”

An interview with Robert Kennedy Jr. on vaccines

Really?

Huge, huge doses of mercury?

Thimerosal Timeline

Although it was never actually linked to any significant side effects, as a “precautionary measure,” the AAP recommended that thimerosal (mercury) be removed from childhood vaccines in 1999.

Thimerosal was removed from the hepatitis B, DTaP, and Hib vaccines, the only routinely used, non-flu vaccines that ever had thimerosal, in 2001. It is important to note that thimerosal-free versions of the DTaP and Hib vaccines were already available in the late 1990s though.

By January 2003, remaining stocks of vaccines with thimerosal expired.

Also in 2003, thimerosal-free flu vaccines became available, including thimerosal-free flu shots and FluMist, the nasal spray flu vaccine.

Doing the Math on Kennedy, Vaccines and Mercury

Robert F. Kennedy, Jr seems to get a lot of things wrong.

Is he right about the number of thimerosal-free flu vaccines in 2012?

Let’s do the math.

Ever since thimerosal-free flu vaccines became available in 2003, the supply has increased each year.

  • 2007-08: 112 million doses, with 10-12 million doses of thimerosal-free flu vaccine from Sanofi Pasteur, 7 million doses of thimerosal free FluMist, plus Afluria was thimerosal-free, and flu vaccines with trace thimerosal from Novartis and GSK
  • 2008-09: 110 million doses, with 50 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine and only 25% infants and toddlers are fully vaccinated against flu
  • 2009-10: 114 million doses, with 50 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2010-11: 155 million doses, with 74 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2011-12: 132 million doses, with 79 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2012-13: 134 million doses, with 62 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine, including 13 to 14 million doses of FluMist. While 76% of infants and toddlers were vaccinated, only 50% of pregnant women got a flu shot.
  • 2013-14: 134 million doses, with 62 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine. 13 million doses of FluMist.
  • 2014-15: 147 million doses, with 98 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine. 14 to 15 million doses of FluMist.
  • 2015-16: 146 million doses, with 116-118 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2016-17: 145 million doses, with 120 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine
  • 2017-18: 155 million doses, with 130 million doses of thimerosal-free or preservative-free (trace thimerosal) influenza vaccine

So Kennedy was wildly wrong about the number of thimerosal-free flu vaccines that were available in 2012. And he is certainly wrong about the number of thimerosal-free flu vaccines that are available today.

“Over 90 percent had huge, huge doses of mercury. Not trace amounts as the industry likes to claim. Trace amounts means less than 1 microgram. They contain 25 micrograms, which is 25 times trace amount and over 100 times what EPA’s safe exposure levels are. … So today, in the last three or four years, that number has been reduced to 48 million.”
Which number has been reduced to 48 million?
“I believe this year there were 150, around 150 million flu doses manufactured and 48 million of those, or a third, were loaded with mercury.”

An interview with Robert Kennedy Jr. on vaccines

What about his theory about the way the “industry” uses the term trace amounts?

The thimerosal content of flu vaccines has always been clearly labeled, whether it is 25mcg, or less than 1mcg, a trace amount.
The thimerosal content of flu vaccines has always been clearly labeled, whether it is 25mcg, or less than 1mcg, a trace amount.

There has never been a conspiracy to hide the thimerosal content of flu shots or any other vaccines. Those with trace amounts of thimerosal clearly have less than or equal to 1mcg per dose. Others were either thimerosal free or contained a standard amount of thimerosal, 25mcg.

Not surprisingly, this isn’t the first time Kennedy has tried to mislead people about  vaccines.

“There is no question that meningococcal meningitis is a serious disease that can cause death and disability, but we need to ensure that the solution is not worse than the problem. There is every reason to believe that mandatory meningococcal B vaccines for every college student could kill more students than the disease they protect against. Before we relinquish our rights, pay millions and sicken students, we should do the math.”

Robert F. Kennedy, Jr.: Doing the math on meningitis vaccinations

A few years ago, Kennedy responded to a resolution that had been passed by the University of Colorado-Boulder student government about new meningococcal B vaccines.

Students at the University of Colorado Boulder passed a resolution supporting menB vaccines.
Students at the University of Colorado Boulder passed a resolution supporting MenB vaccines.

For some reason, he devoted a good deal of time talking about the “hefty mercury load” that kids could get from Menomune, a vaccine that doesn’t cover the meningococcal B strain and which has largely been replaced by the newer Menactra (2006) and Menveo (2010) vaccines. In fact, Menomune was discontinued last year.

What to Know About Robert F Kennedy, Jr

Kennedy seems to mislead people about thimerosal and vaccines at every opportunity he can.

More on Robert F Kennedy, Jr

Meningitis Vaccines

Meningitis is classically defined as an inflammation of the membranes that cover the brain and spinal cord.

Infections that can cause meningitis include:

  • viruses – also called aseptic meningitis, it can be caused by enteroviruses, measles, mumps, and herpes, etc.
  • bacteria – Streptococcus pneumoniae, Neisseria meningitidis, Listeria monocytogenes, Haemophilus influenzae type b (Hib), Group B strep
  • a fungus – Cryptococcus, Histoplasma
  • parasites – uncommon
  • amebas – Naegleria fowleri

There are even non-infectious causes of meningitis, including the side-effects of medications and certain systemic illnesses.

Meningitis Vaccines

Teens and young adults need two different kinds of meningococcal vaccines to get full protection.
Teens and young adults need two different kinds of meningococcal vaccines to get full protection.

Fortunately, many of these diseases that cause meningitis are vaccine-preventable.

You don’t often think about them in this way, but all of the following vaccines are available to prevent meningitis, including:

  • Hib – the Haemophilus influenzae type b bacteria was a common cause of meningitis in the pre-vaccine era, in addition to causing epiglottitis and pneumonia
  • Prevnar – you mean it’s not just an ear infection vaccine?
  • MMR – both measles and mumps can cause meningitis
  • Menactra and Menveo – serogroup A, C, W, Y meningococcal vaccines
  • Bexsero and Trumenba – serogroup B meningococcal vaccines

But just because your child has been vaccinated doesn’t mean that you are in the clear if they are exposed to someone with meningitis. They might still need preventative antibiotics if they are exposed to someone with Hib or meningococcal meningitis.

Still, getting fully vaccinated on time is the best way to prevent many of these types of meningitis and other life-threatening diseases.

What to Know About Meningitis Vaccines

Learn which vaccines are available to provide protection against bacterial and viral meningitis.

More on Meningitis Vaccines

Vaccine-Preventable Diseases

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Today, in the United States, children typically get:

  • 36 doses of 10 vaccines (HepB, DTaP, Hib, Prevnar, IPV, Rota, MMR, Varivax, HepA, Flu) before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases.

While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Vaccine-Preventable Diseases

Of course, kids in the United States don’t get all available vaccines and aren’t protected against all possible vaccine-preventable diseases. Some vaccines are just given if traveling to a high risk area or in other special situations.

Vaccine-preventable diseases (in the United States, children and teens are routinely protected against the diseases highlighted in bold) include:

  1. adenovirus – a military vaccine
  2. anthrax – vaccine only given if high risk
  3. chicken pox – (Varivax, MMRV)
  4. cholera – vaccine only given if high risk
  5. dengue – vaccine not available in the United States
  6. diphtheria – (DTaP/Tdap)
  7. hepatitis A – (HepA)
  8. hepatitis B – (HepB)
  9. hepatitis E – vaccine not available in the United States
  10. HPV – (Gardasil)
  11. Haemophilus influenzae type b – (Hib)
  12. influenza
  13. measles – (MMR, MMRV)
  14. meningococcal disease – (MCV4 and MenB and MenC)
  15. mumps
  16. pneumococcal disease – (Prevnar13 and PneumoVax23)
  17. pertussis – (DTaP/Tdap)
  18. polio – (bOPV and IPV)
  19. Q-fever – vaccine not available in the United States
  20. rabies – vaccine only given if high risk
  21. rotavirus – (RV1, RV5)
  22. rubella – (MMR, MMRV)
  23. shingles – vaccine only given to seniors
  24. smallpox – eradicated
  25. tetanus – (DTaP/Tdap)
  26. tick-borne encephalitis – vaccine not available in the United States
  27. tuberculosis – (BCG) – vaccine only given if high risk
  28. typhoid fever – vaccine only given if high risk
  29. yellow fever – vaccine only given if high risk

Discontinued vaccines also once protected people against Rocky mountain spotted fever, plague, and typhus.

These vaccine-preventable diseases can be contrasted with infectious diseases for which no vaccines yet exist, like RSV, malaria, norovirus, and HIV, etc., although vaccines are in the pipeline for many of these diseases.

What To Know About Vaccine Preventable Diseases

Available vaccines are helping to eliminate or control a number of vaccine-preventable diseases, like polio, measles, and diphtheria, but a lot of work is left to be done.

More About Vaccine Preventable Diseases

Updated June 16, 2018

Vaccines in Special Situations

In addition to getting routine vaccines, there are some special situations in which kids need extra vaccines or extra dosages of vaccines.

800px-infant_with_cochlear_implant
Children with a cochlear implant need the Pneumovax 23 vaccine.

Traveling out of the country and being pregnant are almost certainly the most common special situation when it comes to vaccines.

Vaccines for High Risk Conditions

Other special situations include children with high risk conditions, such as:

  • complement component deficiencies – Menveo or Menactra, MenB
  • chronic heart disease – PPSV23
  • chronic lung disease (not including asthma) – PPSV23
  • diabetes mellitus – PPSV23
  • CSF leaks – PPSV23
  • cochlear implants – PPSV23
  • chronic liver disease – PPSV23
  • cigarette smoking – PPSV23
  • sickle cell disease – PPSV23
  • congenital or acquired asplenia – Menveo or Menactra, PPSV23, MenB
  • congenital or acquired immunodeficiencies – PPSV23
  • HIV infection – PPSV23
  • chronic renal failure – PPSV23
  • nephrotic syndrome – PPSV23
  • leukemia – PPSV23
  • lymphoma – PPSV23
  • hodgkin disease – PPSV23
  • iatrogenic immunosuppression – PPSV23
  • solid organ transplant – PPSV23
  • multiple myeloma – PPSV23

In general,  the 23-valent pneumococcal polysaccharide vaccine, PPSV23 or Pneumovax 23, should be given when a high risk child is at least 2 years old and at least 4 weeks after their last dose of Prevnar 13. Some will need an additional booster dose of Pneumovax 23 after five years.

Remember, most children routinely get 4 doses of Prevnar 13 when they are 2, 4, 6, and 12-15 months old.

And while most kids just get one dose of PPSV23, others, especially those with any type of immunosuppression, get a repeat dose every five years.

Getting Revaccinated

Are there ever situations when kids need to get revaccinated?

While it might be hard to believe, there are more than a few reasons that kids get revaccinated.

The most obvious is when kids lose their vaccine records, although checking vaccine titers might help avoid repeating some or all of your child’s vaccines.

Children who have had a hematopoietic cell transplant (HCT) should routinely get revaccinated:

  • starting with inactivated vaccines six months after the transplant, including a 3-dose regiment of Prevnar 13, followed by PPSV23, a 3-dose regiment of Hib, and a yearly flu shot and other inactivated vaccines
  • continuing with a dose of MMR 24 months after the transplant if they are immunocompetent and possibly the chicken pox vaccine

Children who are adopted in a foreign country also often need to repeat all or most of their vaccines. Again, titers can often be done to avoid repeating doses.

Other Special Situations

Other special situations in which your child might need to get vaccinated off the standard immunization schedule might include:

  • missing one or more vaccines and needing to catch-up
  • getting exposed to rabies (cats, dogs, raccoons, skunks, bats, foxes, and coyotes)
  • having a wound that is not considered clean and minor (usually “wounds contaminated with dirt, feces, soil, and saliva; puncture wounds; avulsions; and wounds resulting from missiles, crushing, burns, and frostbite”) if it has been more than five years since their last dose of tetanus vaccine (or a clean and minor wound and it has been more than 10 years)
  • getting exposed to chicken pox (or shingles) or measles and not being fully vaccinated (two doses of the chicken pox and two doses of the MMR vaccines) or naturally immune, as a vaccine within 72 hours may decrease their risk of getting sick

Do your kids have a medical condition that might put them at high risk for a vaccine-preventable disease?

Do they need a vaccine that other kids don’t routinely get?

For More Information on Vaccines in Special Situations

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Meningococcal Vaccines

There are several different types of meningococcal vaccines, including:

  • Menactra and Menveo – meningococcal conjugate vaccines that protect against serogroups A, C, W, Y
  • Bexsero and Trumenba – meningococcal conjugate vaccines that only  protect against serogroup B
  • Menomune – an older meningococcal polysaccharide vaccine that protects against serogroups A, C, W, Y (discontinued in 2017)
  • MenHibrix – meningococcal conjugate vaccine that only  protect against C, Y and Hib (discontinued in 2016)

Children routinely get their first dose of either Menactra or Menveo when they are 11 to 12 years old and a booster at age 16 years.

In addition, “Young adults aged 16 through 23 years (preferred age range is 16 through 18 years) may be vaccinated with either a 2-dose series of Bexsero or a 3-dose series of Trumenba vaccine to provide short-term protection against most strains of serogroup B meningococcal disease. ”

For more information:

Updated February 7, 2018