Vaccination questions

[Seeking Squirrels]

My girls (6 & 2 if you can't see sig) have not received any vaccinations. I don't want this to turn into a vax debate and I'm trusting everyone on this site is able to refrain from excessive negativity over our prior decisions. Suffice it to say we feel like we fell prey to a lot of false information when DD6 was born and no longer think we made the best decision regarding vaccination. We would like to start getting them caught up.

 

We have been in discussion with their pediatrician who says they are good to go as soon as we give the word. But last I talked to her, we were still in the "starting to think about maybe" stage and so were not ready to discuss specifics yet. I can pay a co-pay to go in and sit down and decide with her which ones to do first. Or I can take them in for just the vax without a co-pay. Money is tight right now so I'd rather have at least a basic plan without going in to see her. She said it was unnecessary to see her again before starting unless I felt the need to or wanted her assistance in planning.

 

So, all of that to say.... I am interested in hearing opinions on what to start with. We want to go slow with one at a time (because we're still nervous about it). If you were starting from scratch with a 6 and 2 year old, what vax would you get first? Second? Are there any you wouldn't worry too much about for a while? What about the flu shot? Should we start there or start with some basics?

 

We feel really out of our element with this since we were very anti-vax for six years. It feels like we're making a 180 very quickly and it's left me a little anxious over all of it.Though I am now nearly 100% on the side of getting them, the sudden bursts of doubt over the decision are still coming. So any help or advice on any of this would be appreciated.

 

(Just to be clear, I am doing my own research on this and may see if I can even put a call in to their doc without a visit, but I still appreciate personal feedback.)

[busymama7]

I went through this last year. I have five kids to get caught up with. We started with the DPT or whatever the current abbreviation is. This was because a family we were in close contact with had confirmed whooping cough. I was super close to starting them anyway and that was the tipping point. I know most of them got another one but I'm not sure what right now. I allowed two for logistical reasons. But didn't want to do more. I need to get back in a keep going.

[Crimson Wife]

DTP, polio, and MMR are the ones you want to have. I would start with the MMR since there have been a number of measles outbreaks this year. DTP would be next, and finally polio. Give them 1 at a time and spread them out at least 2 months between shots.

 

[staceyobu]

I decided to fully vaccinate after having my kids on a very delayed schedule. It has been quite the ordeal catching up because older children are much more aware of what is going on.

 

Honestly, I would consider doing more than one at a time. There isn't any good evidence for a delayed schedule being better and your kids are going to give you hell if you drag them into a doctor 's office repeatedly for shots.

 

As far as prioritizing, I would go dtap and see if they have a combo MMR and varicella shot. Two sticks could potentially get you a lot of coverage.

 

I know how hard it is going from one side of such a hotly debated issue to the other. I hope things go smoothly and you continue to have a sense of peace with your decision. There is a lot of misinformation out there that is very difficult to sift through. And, we all certainly want to make the absolute best decisions for our children's health!

[SKL]

I would start with DTP and then I don't have a preference between polio and MMR.  I would hold off on the more minor ones until you see how your children react to vaxes and can better weigh the risks vs. benefits.  I would not get the chickenpox vax for a homeschooled child until age 9 or 10.  I would not get a flu vax.

[lovinmyboys]

I would start with dtap, hib (at least for the 2yr old), and mmr.

ETA: I would at least consider getting the flu shot. They can get the mist so you don't really have to worry about the ouch factor. I had the flu two years ago and I don't think I will ever skip a flu shot again. It was absolutely horrible.

 

Good luck!

[staceyobu]

I would also be curious to hear what changed your mind on this issue?

[Seeking Squirrels]

DTP, polio, and MMR are the ones you want to have. I would start with the MMR since there have been a number of measles outbreaks this year. DTP would be next, and finally polio. Give them 1 at a time and spread them out at least 2 months between shots.

Thank you, this is helpful. What about the flu vax? Would you not worry about including that at all?

 

I would start with DTP and then I don't have a preference between polio and MMR.  I would hold off on the more minor ones until you see how your children react to vaxes and can better weigh the risks vs. benefits.  I would not get the chickenpox vax for a homeschooled child until age 9 or 10.  I would not get a flu vax.

Can I ask why you would not get the flu vax?

 

 

The flu shot is what we are trying to decide on right now. If we're going to get it, now is the time so we should do it first. If we're not going to, then we can get started on the others. DH got one at work, I have never had one. DD6 and I both had h1n1 a few years ago and it was pretty bad. I still have some lingering side effects from it and DD was in the hospital for 3 days. I also had it pretty bad the year I was pg with DD6. Both DD's and I seem to get sick a lot through the winter. Because of all this I have been leaning toward getting it, but so far responses have not included it in the lineup, so I'm curious why or if our history changes that.

[Arcadia]

I would do the DTAP first because if you (general) step on a rusty nail you would be ask if your tetanus shot is current.

[staceyobu]

Yeah. I would get a flu shot. Nasal mist for your kids will be more effective and less painful if they meet the criteria. The downside of the flu vaccine is it won't last past this year. If you go MMR, dtap, your kids will have much longer immunity to those diseases. Flu is also not one of the most effective vaccines. I think it depends on if your mindset is start with flu and then continue on with others quickly, or if you are going to get flu and maybe not continue getting more in a timely fashion.

[kubiac]

You can get an adult flu shot at many pharmacies and it is usually covered by insurance.

 

FWIW getting two vaccinations at one appointment is considered totally normal for us. The nurses just use different arms (or different fleshy baby thighs) for the diff shots.

 

We fell behind on one kid just out of sheer laziness. (He'd been to the pediatrician a bunch of times, but we hadn't gotten a proper checkup in almost 2 years. Oops!) Doc gave us choice on what to get, discussed and decided measles and whooping cough were the priorities because of the multiple outbreaks in our state.

[SKL]

Thank you, this is helpful. What about the flu vax? Would you not worry about including that at all?

 

Can I ask why you would not get the flu vax?

 

 

The flu shot is what we are trying to decide on right now. If we're going to get it, now is the time so we should do it first. If we're not going to, then we can get started on the others. DH got one at work, I have never had one. DD6 and I both had h1n1 a few years ago and it was pretty bad. I still have some lingering side effects from it and DD was in the hospital for 3 days. I also had it pretty bad the year I was pg with DD6. Both DD's and I seem to get sick a lot through the winter. Because of all this I have been leaning toward getting it, but so far responses have not included it in the lineup, so I'm curious why or if our history changes that.

 

I would not get the flu vax for the following reasons.

• My family has no health or job reasons to make it especially important.
• It is very unlikely that a flu will cause significant or lasting problems (for us).
• The flu shot's effectiveness is hit-or-miss.
• The flu shot itself makes many people sick.
• I'm not a fan of shots.

   

[violamama]

I would follow the doc's plan (I am totally assuming she has a plan, since she said you don't have to come in before starting).

 

We have recent experience with this because many internationally adopted kids have to do catch-up plans as well. You may find it of interest to google an adoptive parents group to see what they have found worked for them. 

[Whereneverever]

We did this starting a year ago. I had four kids to catch up. It was scary at the beginning but they've done great, even my special needs kid. I started with dtap at the first appointment and then just did the regular CDC catch up schedule. I do do flu shots. My favorite post on them is this one. http://www.redwineandapplesauce.com/2013/10/28/setting-the-record-straight-dubunking-all-the-flu-vaccine-myths/

 

I am SO GLAD to be vaccinating my kids despite over a decade of not.

[Seeking Squirrels]

Yeah. I would get a flu shot. Nasal mist for your kids will be more effective and less painful if they meet the criteria. The downside of the flu vaccine is it won't last past this year. If you go MMR, dtap, your kids will have much longer immunity to those diseases. Flu is also not one of the most effective vaccines. I think it depends on if your mindset is start with flu and then continue on with others quickly, or if you are going to get flu and maybe not continue getting more in a timely fashion.

We would continue on quickly. Probably a month or two wait before getting the next shot. I mostly worry because of how bad it was for me the times I had the flu and the fact that I still have problems from it three and a half years later. DD bounced back quickly, but still, 3 days in the hospital (while I was home with it myself, no less) is not something I wish to repeat.

 

I would follow the doc's plan (I am totally assuming she has a plan, since she said you don't have to come in before starting).

 

We have recent experience with this because many internationally adopted kids have to do catch-up plans as well. You may find it of interest to google an adoptive parents group to see what they have found worked for them. 

We were never far enough along in deciding to vax for her to make a plan for them. Unless she already has a standard 'catch up from zero' plan that she would pass on. She said to just come in and go the vaccination counter and that was it. She didn't say which one to get first since I was pretty far from deciding to do it at all. She was more just explaining how it would work once we got to that point. She did say we could just go in anytime I think because she didn't want anything to hold us up from starting, but I don't think she really thought we'd be getting to that point any time soon.

 

Thank you for the idea of looking into what adoptive parents do. I do think I will also try calling in to their doc and find out if she has a recommended plan she can pass on without an appointment.

[creekland]

I'm in no way, shape, or form a professional, but with your history, I'd start with the flu vacc.

 

I'd also see if Alice is out there via pm.  IF I recall correctly, she's a pediatrician. 

 

Welcome aboard the vacc wagon.  I've yet to see a disease that was worse than the vacc with the rare exception for those who truly have issues with them - and those truly are rare. (I feel for those folks as they weigh reactions to the threat of disease.)  I had a friend who was permanently paralyzed from polio and I've seen a couple who have had whooping cough.  A vacc with very minor issues for a day - maybe two - or a lifelong condition or 6 weeks of awful rib hurting coughing.  To me, it's a no brainer.

 

We added the flu vacc last year even though we've never had the flu even with multiple exposures (via ps).  I simply couldn't come up with a good reason NOT to do it when I thought about it.

[Ausmumof3]

I personally am edgy about flu shots as a number of kids in an area close to us had major complications a couple of years ago. It was to do with a bad batch of vaccine and is resolved but I still have lingering doubts. I'd prioritise whooping cough as there have been outbreaks of it in recent years. For me I'd tend to go the ones that are most likely to have really nasty consequences if they do catch them first.

[Leav97]

Given your flu history, I would start with flu.  Then DTaP because of whopping cough.  Then MMR-V because of the Measles outbreaks in areas.

 

Polio has no known cases in the US and can wait a bit.  

 

If you have frequent contact with someone positive for Hep B consider that one next.

 

If you eat out a lot consider Hep A next.

 

 

If it helps I'm going through a similar process.

[wendyroo]

Just so you are prepared, the first time a child gets a flu shot or flu mist, they need two doses (a month apart) to reach full protection.

 

"Some children 6 months through 8 years of age require two doses of influenza vaccine. Children in this age group who are getting vaccinated for the first time, as well as some who have been vaccinated previously, will need two doses."

 

Wendy

[Reefgazer]

Go to the APA (Pediatric doc website) and start with the vacs they would start with. 

[Farrar]

In terms of money, my understanding is that child well visits cannot be charged under the new healthcare law. So if you want that sit down and you're not too far away from their birthdays then you could maybe do that.

 

We usually do the flu shots, but I do wonder if for someone who has been less sure if it would be a good way to start simply because there are a lot of minor adverse reactions. My boys had theirs last week and it definitely made them sick for a couple of days this go around. I'm not too fussed by that and it was not too bad, but I would hate for someone to feel real anxiety over it.

[catz]

On the flu shot.  We've had the flu in our house 3 times (H1N1, Influenza B, and ??? - got it from a kid with a confirmed case, but never found out the variety) since my kids were born.  We live in an urban area and we're out and about quite a bit.  We've never had the flu when we've had the shot.  We always do the flu mist.  We've never gotten sick from the shot, although we got our shots about 3 weeks ago now and all 3 of us has had a cold since.  But it does seem like a regular cold, and we have not been down hard with them and tis the season.  Anyway, we have a good track record with the flu shot and after the winter we gave it to my father with heart trouble (mercifully he had a shot, and had a minor version), we will not miss it again.  When we have had the flu we are down hard for 1-2 weeks, with lingering affects for weeks after.  And no one in my family has had complications or been hospitalized for it. It can really ruin a winter.  :(

 

Anyway - my kids are fully vaxed although we've scheduled some out.  We're holding off on HPV for the time being for my oldest (now 14).  Maybe when my dd is 12, I'll do both kids at the same time if the data on that one is looking good. 

[Lolly]

I would go with DPT and MMR on the first go round. I wouldn't worry about varicella until they are at least ten. Personally, I wouldn't do flu. 

[Alice]

I'm a pediatrician. There is a standard recommended schedule for those who haven't gotten vaccines yet or who are behind. It's here at the CDC:http://www.cdc.gov/vaccines/schedules/downloads/child/catchup-schedule-pr.pdf. The assumption with it is that you will be getting more than one at each visit, in order to catch up as fast as possible. So it will tell you what your kids need but not necessarily advise on which to do first. 

 

I know a lot of pediatricians are reluctant to tell people which vaccines to do in what order when they are doing them slowly or selectively. Part of this is that it's like we are being asked to choose which diseases we think are more serious or less of a risk. It's easy to say get Polio later as it's low-risk but much harder to choose between something like MMR and DtaP, both of which immunize against diseases that we are currently seeing outbreaks of. Or for littler kids to choose whether Hib meningitis or Pneumococcal meningitis is more of a concern. For liability reasons, a lot of pediatricians will just say "This is the recommended schedule. If you want to choose to do less, you have to make the choice of which ones to do." Just to give you some idea of why your pediatrician may or may not be willing to tell you which order to do them in. 

 

Because you will be going in a lot for the shots, I would pay the co-pay to go in the first time and develop a written plan that works for you. Then have the plan put in your chart and keep a copy for yourself. Then on the subsequent visits it will be easy to go in and know who is getting what and when without seeing the doctor each time. From my perspective, this makes it much easier for the nurses or whoever is giving the shot. Frequently we will have people come in on an alternative schedule but who don't know what vaccine they want that visit and then the doctor has to come and discuss it even though it was schedule as a nurse visit. This might not seem like a big deal, but it means working them into a tight schedule or that they are a doctor less familiar with that patient is trying to figure out what another doctor might have discussed with them last time.  It's complicated because when you start at a later age, the number of doses needed is less and some vaccines are no longer given. It just works better to have a plan. 

 

As for which ones to get...(understanding I'd have no problem doing multiple shots at once and would typically advise people to do that to catch up quickly)

Hep B, Polio, Hep A are recommended but are lower risk so I'd put them last.

 

Hib and Pneumococcus would be recommended for your 2 year old, but since you are late starting she will only need one dose of each. They both protect against meningitis. 

 

DtaP and MMR are high priority, we see current epidemics. 

 

Varivax (or chickenpox) is also recommended and I would probably put it before Polio/Hep B/Hep A but after the others. 

 

Flu shots are good and I recommend them. The Flumist was reported to be more effective in kids but it just was reported that it was not effective last year against H1N1. It would be recommended for both your kids that they get two flu shots one month apart this year if they have never had one before. Another thing with flu shot timing is that the MMR and Varivax and Flumist are all live vaccines. You can give them on the same day but if not on the same day they have to be a month apart. This is not true of the flushot which is not a live vaccine. 

 

When you make your plan for the vaccines, I think it makes sense to start slowly if you are worried. I do think it's actually harder on older kids to have to come more frequently for shots than to get 2 or 3 in one visit. But I typically leave that up to parental judgement. You can always decide to go more quickly once you get more comfortable. 

 

 

 

 

 

 

 

[Artichoke]

My advice is to only do one vaccine the first time in case you're child reacts poorly. It takes longer to vaccinate this way, but we have had to do this because of one ds' reactions. Be prepared when you go to the vaccine counter to know your plan and don't feel pressure to deviate from it. I've had this problem in our peds office when we've just gone in for shots and not seen the doc.

 

I'm not sure which vaccine to start with. The only vaccine that I wish we hadn't gotten was varicella since it's not as effective as once thought. We did eventually get it for the youngers when they hadn't acquired natural immunity.

 

Best wishes as you take care of your family.

 

Eta: agree a million and one times with Alice -- having a written plan is hugely important! We have our plan along with dc shot records in one folder that is taken to all wellness appointments and vaccine appointments. At our peds office, they enter everything done at the appointment directly in the computer so I can request an updated shot record on my way out.

[creekland]

I'm a pediatrician.  

 

Phew!  I remembered something correctly!  That makes this so-so day start turning into a better one!  :D

[SKL]

I know lots of kids do fine with multiple vaxes at once.  However, I watched my sister be sick for 6 months (as in not able to play outside at all for a whole summer and more) after being given MMR, DPT and polio at the same time around age 5.  She also developed lifelong epilepsy, which is documented to be caused sometimes by the MMR.  So I would not be in a huge hurry personally.  I do not see a reason to take the risk of bombarding an unvaxed child when you don't even know how she reacts to vaxes.  The diseases you're trying to avoid are all pretty rare in most US locations today.

[skimomma]

 

 

Hib and Pneumococcus would be recommended for your 2 year old, but since you are late starting she will only need one dose of each. They both protect against meningitis. 

 

 

Does this means neither of these would be given to an older child who is just getting their first vaccines?  Or are they just lower priority?

[skimomma]

The only vaccine that I wish we hadn't gotten was varicella since it's not as effective as once thought. 

 

This is a big concern for me.  Now that we have vaccinated it out of the general community and no one is getting natural immunity, I worry about the vaccine waning in effectiveness and then kids getting the disease as adults when it is far more dangerous.  Is there a booster schedule to address this?

[LLMom]

My children had never been vaccinated, and then we decided to put them in school.  We decided to fully vaccinate and had them all done at once.  (they were older so they didn't get some that they give littles) They had sore arms but were no worse for it. 

[LMV]

Alice's post is great and ACIP/CDC have a catchup schedule [which includes minimum intervals between doses and when you can get by with fewer doses because the child is older] which is what I think most pediatricians use. 

 

I know a lot of pediatricians are reluctant to tell people which vaccines to do in what order when they are doing them slowly or selectively. Part of this is that it's like we are being asked to choose which diseases we think are more serious or less of a risk. It's easy to say get Polio later as it's low-risk but much harder to choose between something like MMR and DtaP, both of which immunize against diseases that we are currently seeing outbreaks of. Or for littler kids to choose whether Hib meningitis or Pneumococcal meningitis is more of a concern. For liability reasons, a lot of pediatricians will just say "This is the recommended schedule. If you want to choose to do less, you have to make the choice of which ones to do." Just to give you some idea of why your pediatrician may or may not be willing to tell you which order to do them in. 

 

 

I don't disagree with this and I'm fortunate in that I'm not usually fielding this question because most people don't bring their kids to the ED for routine immunizations.  A few things I might add based on my experiences as an EM physician:

-Please do immunize against pertussis unless you have a contraindication. Yes, we are seeing outbreaks and yes very young children are dying.  In most cases these kids are too young to have started the DTaP series or developed sufficient immunity from the one DTaP they may have received and this is where herd immunity could play a significant role if it existed.

-Make Varicella a higher priority if your child has asthma or any disease which may require even short bursts of steroids because if they end up exposed to Varicella up to three months after that steroid burst then they will have an increased risk of disseminated varicella and a bad outcome. I am always a bit nervous giving steroids in the ED to unimmunized kids and I do question parents about Varicella exposure before doing it and caution them about it being different in this context and the role of VZIg after exposure and IV acyclovir for treatment (i.e. they can't just wait things out at home with confidence).  But sometimes you get stuck as a physician because you can't withhold the medicine that is allowing them to breathe today because it may be what contributes to them dying of disseminated varicella a few months later.  So you take a risk and you pray.  I also advocate that parents of kids who have need for even intermittent steroids discuss again with their pediatrician the risks and benefits of various immunizations because I think the benefit ratio shifts even more favorably in this context. 

-If your child has a dirty wound and has not received at least three doses of some form of tetanus vaccine (whether it be Td, Tdap, DTaP whatever) please inform whatever physician you are dealing with of this.  Your child should get TIG in this case.  Often last Tetanus is how nurses ask the question in the ED and many do not probe if the child has completed the standard series.  I do specifically ask and document this when I come across these patients in the ED but I think some people see the recent tetanus and are falsely reassured.

-If you happen to have a child with liver disease then make the Hep A and Hep B series a high priority.  Although Hepatitis A is rarely fulminant we do sometimes see this in children and it is both more likely and more consequential in kids with underlying disease.

[Crimson Wife]

Earlier this year, I had to get a copy of my shot records from the '80's to prove that I'd been vaccinated against measles (there was an outbreak in Berkeley, CA, and that's fairly close to where I live). The 3 vaccines I received were DTP, polio, and MMR. So I would say those are the minimum that everybody should have (though I do support parental rights to opt out entirely).

 

My kids have gotten some of the other ones like Prevnar & Hib but since your kids are older, I'm not sure it's worth bothering with those.

[Alice]

Does this means neither of these would be given to an older child who is just getting their first vaccines?  Or are they just lower priority?

 

Hib and Pneumococcus  aren't routinely given after the age of 5. The risk of those diseases diminishes greatly after that age in normal, healthy kids.There are some instances where they are still given, depending on individual risk. 

 

 

 

I don't disagree with this and I'm fortunate in that I'm not usually fielding this question because most people don't bring their kids to the ED for routine immunizations.  A few things I might add based on my experiences as an EM physician:

-Please do immunize against pertussis unless you have a contraindication. Yes, we are seeing outbreaks and yes very young children are dying.  In most cases these kids are too young to have started the DTaP series or developed sufficient immunity from the one DTaP they may have received and this is where herd immunity could play a significant role if it existed.

-Make Varicella a higher priority if your child has asthma or any disease which may require even short bursts of steroids because if they end up exposed to Varicella up to three months after that steroid burst then they will have an increased risk of disseminated varicella and a bad outcome. I am always a bit nervous giving steroids in the ED to unimmunized kids and I do question parents about Varicella exposure before doing it and caution them about it being different in this context and the role of VZIg after exposure and IV acyclovir for treatment (i.e. they can't just wait things out at home with confidence).  But sometimes you get stuck as a physician because you can't withhold the medicine that is allowing them to breathe today because it may be what contributes to them dying of disseminated varicella a few months later.  So you take a risk and you pray.  I also advocate that parents of kids who have need for even intermittent steroids discuss again with their pediatrician the risks and benefits of various immunizations because I think the benefit ratio shifts even more favorably in this context. 

-If your child has a dirty wound and has not received at least three doses of some form of tetanus vaccine (whether it be Td, Tdap, DTaP whatever) please inform whatever physician you are dealing with of this.  Your child should get TIG in this case.  Often last Tetanus is how nurses ask the question in the ED and many do not probe if the child has completed the standard series.  I do specifically ask and document this when I come across these patients in the ED but I think some people see the recent tetanus and are falsely reassured.

-If you happen to have a child with liver disease then make the Hep A and Hep B series a high priority.  Although Hepatitis A is rarely fulminant we do sometimes see this in children and it is both more likely and more consequential in kids with underlying disease.

 

These are all great points. Pertussis is everywhere and is definitely a high priority. We had two cases of measles in our practice last year. And I totally agree with the varicella and steroid issue. 

[LMV]

Does this means neither of these would be given to an older child who is just getting their first vaccines?  Or are they just lower priority?

 

-Hib usually isn't given to children who are over five.  However, if they have asplenia, need a splenectomy, have functional asplenia (ie. Sickle Cell etc) or have HIV then they should receive a single dose of Hib even if they are adolescent age.

-PCV-13 aka Prevnar [or one of the Strep. pneumoniae conjugate vaccines--it was preceded by PCV-7 which has been retired and there is also a polysaccharide Strep pneumoniae vaccine PPSV-23 aka Pneumovax] is also not generally given to healthy kids after age 5 but high risk kids  should still get PPSV-23 and or PCV-13.  If they need both it is generally recommended to give the PCV-13 first and then give the PPSV-23 2 months later.

[creekland]

However, if they have asplenia, need a splenectomy, have functional asplenia (ie. Sickle Cell etc) or have HIV then they should receive a single dose of Hib even if they are adolescent age.

-PCV-13 aka Prevnar [or one of the Strep. pneumoniae conjugate vaccines--it was preceded by PCV-7 which has been retired and there is also a polysaccharide Strep pneumoniae vaccine PPSV-23 aka Pneumovax] is also not generally given to healthy kids after age 5 but high risk kids  should still get PPSV-23 and or PCV-13.  If they need both it is generally recommended to give the PCV-13 first and then give the PPSV-23 2 months later.

 

Yeah, if I had to actually understand this I'd need google translate for a good part of it... Just mentioning it.   ;)

[Butter]

I'd either just go with the CDC catch-up schedule or go in order of what they are most likely to get (for example, DTaP and MMR would be a priority due to tetanus and pertussis and measles, but polio would be lower down on the list because an American child is not likely to get it).  Look at the CDC catch-up schedule to see the number of each shot (when catching up, fewer are needed in the series for some vaccines), which aren't needed at all (over 12 months HiB is usually skipped for example), and the interval required between each shot in a series.

[Southern Ivy]

I don't know if it's ok to post this; but in regards to the flu vaccine, I found this post to be incredibly helpful in my decision. 
http://www.intoxicatedonlife.com/2014/10/15/truth-about-flu-vaccine/

[Artichoke]

This is a big concern for me. Now that we have vaccinated it out of the general community and no one is getting natural immunity, I worry about the vaccine waning in effectiveness and then kids getting the disease as adults when it is far more dangerous. Is there a booster schedule to address this?

There's not a suggested adult booster schedule. Studies are pointing to the effectiveness of the varicella vaccine weakening at about the ten year mark.

[Joker]

I would get the flu shot. I was an extremely healthy person when I came down with the flu for the first time two years ago and I still have lingering effects. We now all get a shot and the only side effect we have is a sore arm.

[mamakelly]

I have been catching my kids up on their vaccinations. The CDC website was very helpful. I printed out their catch up schedule and spent several hours reading it, and making a plan. When kids are older they need less vaccines, different vaccines etcc so I wanted to be sure I was fully informed. Then I went to my pediatrician and we talked about my findings. He appreciated that I had done so much research. We put the plan in their chart, and now we just see a nurse for shots. 

[momto10blessings]

Does this means neither of these would be given to an older child who is just getting their first vaccines? Or are they just lower priority?

When I got my kids caught up on their vaccinations, my dr did not give those 2 to anyone 5 and up.

[lllll]

..

[mamaraby]

Both of my girls were unvaxxed - I talked about it with our family practice doc and we came up with a catch up plan. She was a bit more conservative than we were so it was probably slower than I anticipated, but honestly, at that point I just wanted to get it over with as fast as we could. We started with DTaP because after watching my ds struggle to breathe one winter day and going in an ambulance, the idea of one of my kids getting pertussis scares me something fierce. I believe we did that concurrent with IPV. MMR was next followed by Varicella and HepA. I'm holding off on HepB until they're old enough for HPV. We've done the flu vaccine every year for the last several years. Only one of my dds was young enough for Hib/Pneumococcus.

 

It took us more than a year to catch up. If I had to do it over again, I would have pushed to follow the CDC's more compact catch up schedule. It might be at one of the links give, but they have an online system that lets you enter your child's info and will generate a catch up schedule for you. When it comes to actually getting the vaccines, don't forget your county's health department. It might be a cheaper and/ore more convenient option.

 

ETA: As far as chicken pox is concerned, if you've had it then you are at risk for Shingles down the road which is not without its own risks. I chose the vaccine for all of my kids. I'd rather deal with the need for future boosters than both the risks of the disease and future Shingles.

[Lolly]

Both of my girls were unvaxxed - I talked about it with our family practice doc and we came up with a catch up plan. She was a bit more conservative than we were so it was probably slower than I anticipated, but honestly, at that point I just wanted to get it over with as fast as we could. We started with DTaP because after watching my ds struggle to breathe one winter day and going in an ambulance, the idea of one of my kids getting pertussis scares me something fierce. I believe we did that concurrent with IPV. MMR was next followed by Varicella and HepA. I'm holding off on HepB until they're old enough for HPV. We've done the flu vaccine every year for the last several years. Only one of my dds was young enough for Hib/Pneumococcus.

 

It took us more than a year to catch up. If I had to do it over again, I would have pushed to follow the CDC's more compact catch up schedule. It might be at one of the links give, but they have an online system that lets you enter your child's info and will generate a catch up schedule for you. When it comes to actually getting the vaccines, don't forget your county's health department. It might be a cheaper and/ore more convenient option.

 

ETA: As far as chicken pox is concerned, if you've had it then you are at risk for Shingles down the road which is not without its own risks. I chose the vaccine for all of my kids. I'd rather deal with the need for future boosters than both the risks of the disease and future Shingles.

FYI, the vaccine also results in a shingles risk.

[wapiti]

.

 

[LMV]

Does anyone know:  is there a risk of steroids associated with any other vaccine/illness?  I never heard this before and my kids have had a lot of steroids... all my kids have always been up to date on their vaccines, but now two of them have some immune abnormalities (including one who had steroids a few weeks after his latest vaccines, Tdap and meningitis, but before we knew about the immune issue) and I am second-guessing the wisdom of the vaccine schedule in their individual cases.

 

Another piggyback question:  are there any official vax schedule recommendations for kids with immune abnormalities, or is it all case-by-case?

 

The Varicella issue has been documented in the literature.  At the same time any one with a degree of immunosuppression is not going to handle illness as well as someone without.  Steroids usually have more impact on the cell mediated aspect of the immune system so viruses and fungi may be more of an issue than bacterial pathogens.  

 

A related issue is that you do want to avoid live viruses with immunocompromised hosts and generally it is recommended to wait three months after stopping steroids before giving live virus vaccines [like MMR, Varicella, Flu Mist, Rabies etc].  Obviously you can give the flu shot which is not live in place of Flu Mist and that is an option. Rabies can be an issue because many people are getting rabies vaccine only after a known or highly likely exposure. If they happen to be taking steroids for whatever reason then we really try to stop the steroids during the post exposure period, if for some reason we can't then we just have to give the immunoglobulin and the vaccine and pray. 

 

As far as a specific special schedule for immunocompromised kids I'm not aware of one [but maybe Alice is?].  There are recommendations about what to give when and what to hold but these are a bit tailored to the individual. Immunocompromised patients sometimes require extra immunizations or immunoglobulins as well [like giving PCV-13 and PPSV-23 both, or like giving TIG with dirty wounds to those who are HIV+ regardless of immunization status]. In general I think I would bring up these questions with your kids' pediatrician and or immunologist if they have one.

[Alice]

 

As far as a specific special schedule for immunocompromised kids I'm not aware of one [but maybe Alice is?].  There are recommendations about what to give when and what to hold but these are a bit tailored to the individual. Immunocompromised patients sometimes require extra immunizations or immunoglobulins as well [like giving PCV-13 and PPSV-23 both, or like giving TIG with dirty wounds to those who are HIV+ regardless of immunization status]. In general I think I would bring up these questions with your kids' pediatrician and or immunologist if they have one.

 

This. There isn't a specific immunocompromised schedule as far as I know. In general, it would depend on why and specific circumstances. For example, for kids with cancer sometimes the oncologists will have us wait on all vaccines because they are more at risk for complications. Usually at some point they will want them to go ahead and get immunized as the risks of the disease outweigh the risks of the vaccine. And sometimes the meds they are on will make the shots less effective, so they may get immunized but then need an extra booster at some point. There are extra shots recommended for kids without a spleen or without a spleen that works. 

[Seeking Squirrels]

I'm a pediatrician.

 

Thank you for your response. So if we get the flu shot, would we need to wait any specific amount of time before getting the dtap? After discussing, it's the flu and whooping cough we most want to protect against right now. This late in the season if we spread those two shots out over two months, we'll be halfway through the season before getting the second, especially with them needing two flu doses.

 

We are still a little nervous to do two at once because if there's any bad reactions, we want to know which one it was. Can we get the flu shot, wait two weeks and then get dtap? and then a couple weeks later get the follow up flu shot? Is this enough time to make note of minor reactions, or just pointless? That does of course mean going in for shots every two weeks for a bit and that would be hard on them.

 

Can we do flu and dtap together and would that be better? I think we want to do the shot, not the mist. I admit the live vaccine scares me a bit more, especially with how easily my oldest seems to get sick. I don't know if that really has any relevance, but it feels like it should.

 

I know a lot of this is probably six years of being immersed in the other side of camp talking. It's hard being at the point where I'm suddenly feeling like I want them caught up NOW but still scared to do any of it. :/

[Alice]

Thank you for your response. So if we get the flu shot, would we need to wait any specific amount of time before getting the dtap? After discussing, it's the flu and whooping cough we most want to protect against right now. This late in the season if we spread those two shots out over two months, we'll be halfway through the season before getting the second, especially with them needing two flu doses.

 

We are still a little nervous to do two at once because if there's any bad reactions, we want to know which one it was. Can we get the flu shot, wait two weeks and then get dtap? and then a couple weeks later get the follow up flu shot? Is this enough time to make note of minor reactions, or just pointless? That does of course mean going in for shots every two weeks for a bit and that would be hard on them.

 

Can we do flu and dtap together and would that be better? I think we want to do the shot, not the mist. I admit the live vaccine scares me a bit more, especially with how easily my oldest seems to get sick. I don't know if that really has any relevance, but it feels like it should.

 

I know a lot of this is probably six years of being immersed in the other side of camp talking. It's hard being at the point where I'm suddenly feeling like I want them caught up NOW but still scared to do any of it. :/

 

Yes, you can get DTaP and Flu together. And it also doesn't matter how apart they are. So you could get Flu, come back whenever you want to get DTaP. The second flu has to be a month after the first one but it doesn't matter how far apart from the DTaP. 

 

Most minor reactions will be 24-48 hours after the shot. With the flu shot it's not unusual to have some pain at the site, some fever and some mild overall muscle aches. And some people have no side effects. All of my kids and I got the flu shot this year and had nothing. Maybe a little soreness at the site. So spreading them out two weeks should give you plenty of time to see reactions for those particular shots. 

[Artichoke]

changed my mind.  

 

Edited March 10, 2017 by Artichoke