Catch-up vaccination/Adolescent vaccination

Catch-up vaccination / Adolescent vaccination

CATCH-UP IMMUNIZATION

 Many children miss their routine vaccine due to many reasons like illness or traveling etc. many things come in parent's mind and they ask many questions to doctor .here are the points that should be kept in mind while advising vaccination for a missed dose of vaccine or a totally unimmunized child.

Missed immunization does not require restarting of the entire series or additional doses of vaccine to the series for any vaccine in their recommended schedule.

Two or more inactivated vaccines can be given simultaneously or at any interval between doses without affecting the immune response of another vaccine.

An inactive vaccine can similarly be given simultaneously or at any interval with a live vaccine.

two live (intranasal/injectable) vaccines should either be given simultaneously or at least 4 weeks apart.

If a dose of DTP, IPV, Hib, pneumococcal conjugate, hepatitis A, hepatitis B, human papillomavirus (HPV), measles, mumps, rubella (MMR), or varicella vaccine is missed, subsequent immunization should be given at the next visit as if the usual interval had elapsed.

For the rotavirus vaccine, the same principle can be followed, though the upper age limit of last the dose should be maintained.

 Minimal interval recommendations should be followed for the administration of all missed doses.
for more information on the general instruction for vaccination click here General instructions for vaccination

ADOLESCENT IMMUNIZATION

 In India, routine immunization given to young children is very low. National Family Health Survey 4 (2015–16) shows that only 62.0% of children aged 12–23 months are fully immunized.

 There is also tremendous heterogeneity in the state- and district-level. It is very likely that many adolescents are partially immunized or unimmunized at all for many vaccine-preventable diseases.

A large number of adolescents are at greater risk of vaccine-preventable diseases as they are more exposed to infection due to their greater exposure in society.

 catch-up vaccination programs of adolescents, especially girls, not only will protect them but will also have a direct role in protecting young infants from diseases like pertussis.

 Getting adolescents vaccinated, however, is not very easy because of their many developmental changes at this stage. Even in countries with a well-established vaccination program, it has been difficult to implement second-dose measles, mumps, and rubella (MMR) vaccines to older children and adolescents leading to an outbreak of measles.

 For a successful adolescent vaccine program, there is a need to sensitize medical professionals, health workers, parents, and mainly to adolescents. Currently, the United States is the only country to have recommendations for adolescent immunization, which is regularly prepared and annually updated since 2005.

adolescents

 Adolescent's vaccination is highly cost-effective, vaccination of all in 10–19 years age group in the United States. For example in 2005 may prevent 0.4–1.8 million cases of pertussis and lead to 10-year savings of US $0.3–1.6 billion. 

Catch-up vaccination/Adolescent vaccination

IAP - immunization schedule for adolescents-2018, Age 7 to 18 year

Tdap Vaccine follow this

7–10 years  One dose (if indicated), 
11–12 years One dose,
13–18 years dose(if indicated)

MMR  Complete two-dose series

Varicella Complete two-dose series

Hepatitis B Complete three-dose series

Hepatitis A Complete two-dose series

Typhoid TCV Single dose

Influenza vaccine one dose every year
One dose every year

Japanese Encephalitis vaccine catch-up up to 15 year

NOTE-BCG vaccine can be given up to the age of 5 years  for catch-up vaccination

For routine immunization guideline of 2019 click-VACCINATION GUIDELINE 2019-2020 (IAP)

HUMAN PAPILLOMAVIRUS VACCINE HPV

 HPV is closely associated with the development of various anogenital and oropharyngeal cancers, of which cervical cancer is the most frequent; most infections are acquired very early during adolescence, at the time of initial sexual activities.

1. HPV vaccines-

The minimum age for vaccination is 9 years and the maximum age is 45 years.

HPV-related diseases are mainly due to a few types of HPV and three vaccines have been developed for use in many countries.

 1-Bivalent (HPV2) vaccine-contains types 16 and 18 (mainly responsible for cervical cancer), licensed and available in India.

2-Quadrivalent (HPV4) vaccine-has additionally type 6 and 11 (responsible for anogenital warts), licensed and available in India.

3-Nonavalent (HPV9) vaccine,-that over and above types 6, 11, 16, and 18, have types 31, 33,45, 52, and 58. Not yet available in India.

HPV DOSE SCHEDULE

HPV4 and HPV2 are recommended in a two-dose series (0 and 6–12 months)  for females aged 9–14 years of age.

Either HPV4 (0, 2, and 6 months) or HPV2 (0, 1, and 6 months) is recommended in a three-dose series for females aged 15–45 years. (like catch-up vaccination)

HPV4 can also be given in a three-dose series for males aged 11 - 12 years, but not yet licensed for use in males in India., 

 Extensive trials have shown the safety  and efficacy against precancerous lesions due to types 16 and 18 of HPV in 90–100% of cases.

 HPV vaccines should be given to adolescents before they start to engage in sexual activity. This is due to the fact that HPV  vaccines are inactive against the types of HPV previously acquired by a vaccine recipient and because antibody responses are the highest between the ages of 9 and 15 years. 

There are national differences in the recommendations of the subjects to whom the HPV vaccine should be administered. The most recent recommendation in the United States considers that adolescents of both sexes should be vaccinated at the age of 9–12 years. However, in Europe and many countries including India, the HPV vaccine is only recommended for girls.

Either vaccine may be used for females, but only quadrivalent or nonavalent

vaccine for males. American experts strongly support the vaccination of males because it provides a direct benefit for the vaccinated subjects, including the prevention of genital warts and anal cancer, and an indirect benefit for females through herd immunity. 

Catch-up vaccination for HPV

Administer the vaccine series to females (either HPV2 or HPV4) at

age 13 through 45 years if not previously vaccinated.

Administer the second dose 1–2 months after the first dose and

the third dose 6 months after the first dose.

2. Pneumococcal vaccines-

Pneumococcal conjugate vaccine (PCV) and pneumococcal polysaccharide vaccine (PPSV) both are used in a certain high-risk group of children.

A single dose of PCV may be administered to children aged 6 years through 18 years who have anatomic/functional asplenia, human immunodeficiency syndrome infection, or other immunocompromising condition, cochlear implant, or cerebral spinal fluid leak.

Administer PPSV at least 8 weeks after the last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant.

Single revaccination (with PPSV) should be administered after 5 years to children with anatomic/functional asplenia or an immunocompromising condition.

3. Meningococcal vaccine

Recommended only for certain high-risk groups of children, during outbreaks, children residing in endemic zones, and international travelers, including students going for study abroad and travelers to Hajj and sub-Saharan Africa. 

Both meningococcal conjugate vaccines (Quadrivalent and monovalent and polysaccharide vaccines (bi- and quadrivalent) are licensed in India.

Any dose not administered at the recommended age should be administered at a subsequent visit when indicated and feasible. The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines.

To read about behavioral problems and their solution in adolescents click the link below-
 Behavioral problems in children and adolescents