Pediatric Immunization: A Comprehensive Case Study

Immunization Case Study

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Immunization Case Study

This paper takes a closer look at the four cases related to the pediatric immunization. Each case is being analyzed with regards to the case scenario, requirement of the dosage of the drug, the series sequencing and the rationale of providing the drug. 

Case 1

The case is of a term newborn female baby, weighing 3.5 Kgs at the time of the birth. Scenario 1 The infant’s laboratory examinations have been found to be normal and so are her mother’s. In such a scenario, the vaccines that the baby gets within 24 hours after birth should be Hepatitis B (Hep B) Ist. dose (CDC, 2020). The brand names of vaccine can be Energix-B (GlaxoSmithKline), or Recombivax (Merck) HB (Hepatitis B Foundation, 2020). The dosage of drugs should be 0.5 ml of Energix – B (GlaxoSmithKline) or 0.5 ml of Recombivax (Merck) with 3 doses in sequence at birth, 1-2 months and 6-18 months respectively (Minnesota Department of Health, n.d.). The rationale of giving Hepatitis B Vaccine at the time of the birth is that it prevents the spread of Hepatitis B virus from entering bloodstream, attacking the liver and causing serious chronic hepatitis B damage that could last a lifetime (Immunization Action Coalition, n.d.). 

Scenario 2 

The mother has been found to be Hepatitis B positive. In such a case scenario, the baby should be given extra doses of Hepatitis B vaccine along with the shot of Human Immunoglobulin HBIG (0.06/kg*3.5=0.21 ml) within the period of 12 hours of birth and repeating the sequence as per the vaccination schedule (CDC, 2003). The rationale of giving HBIG is to help the baby fight with the virus as soon as they are born. The two vaccines should be administered in the opposite limbs (anterolateral thigh IM). 

Scenario 3 

The third scenario involves the situation in which the Hepatitis B status of woman is unknown. In such a case, the woman must undergo screening test to confirm if they have Hepatitis B or not. In case the mother has Hepatitis B strain then the case management of both mother and the daughter should be done accordingly. 

Case 2

The case is of a 2-month-old female infant in primary care clinic. She was a term newborn and had received the first shot of Hepatitis B while at the nursery. Both the infant and the parents have no concerns or contraindications to receiving vaccines. 

Scenario 1 

The vaccines that the child should receive at this visit and their dosage should be as follows: Hepatitis B – (2nd dose) of Energix -B or Recombivax HB, Diphtheria, Tetanus, and Whooping cough (pertussis) (1st dose) of Daptacel or Infanrix, Haemophilus influenzae type b disease (Hib) (1st dose) of ActHIB, Hiberix or PedvaxHIB, Polio (IPV) (1st dose) of IPOL, Pneumococcal disease (PCV13) (1st dose) of Prevnar 13, Rotavirus (RV) (1st dose) of Rotarix or RotaTeq (CDC, 2021). Please see Appendix 1 for Company names.

Scenario 2 

The child should visit the clinic for the next shot of vaccines at the age of 3-4 months. At this time, following vaccines should be administered to the infant:

Diphtheria, tetanus, and whooping cough (pertussis) (DTaP) (2nd dose) of Daptacel or Infanrix, Haemophilus influenzae type b disease (Hib) (2nd dose) of ActHIB, Hiberix or PedvaxHIB, Polio (IPV) (2nd dose) of IPOL, Pneumococcal disease (PCV13) (2nd dose) of Prevnar 13, Rotavirus (RV) (2nd dose) of Rotarix or RotaTeq (CDC, 2021).

Scenario 3

 The infant can also be given combination vaccines to prevent the needle injections.

Such combination vaccines at this stage are as follows: Pediarix, Kinrix and Pentacel (CDC, 2019). Table 1 below shows Vaccine name, combination and the diseases that they protect from. 

Table 1-Source: https://www.cdc.gov/vaccines/parents/why-vaccinate/combination-vaccines.html (See Appendix 1 for the Manufacturers’ names)

Case 3

The case is of a 5-year-old boy child who has got their vaccination up to date till the age

of 2 years. However, they have missed those vaccines between 2- 5 years. Following are the scenarios being discussed below:

Scenario 1 – Since the child has missed out only on one vaccine, Influenza, they can be recommended with Influenza vaccine this time around as the vaccine can be administered in children between 6 months through 8 years of age (CDC, 2019). Also, as the child has visited the clinic in the month of November, the time is ideal to get the vaccine administered around October end through the flu season which is, between October to January (CDC, 2019). The other vaccines to be recommended to this child include: Diphtheria, tetanus, and whooping cough (pertussis) (DTaP) (5th dose) of Daptacel or Infanrix, Polio (IPV) (4th dose) of IPOL, Measles, mumps, and rubella (MMR) (2nd dose) of M-M-R II, Chickenpox (Varicella) (2nd dose) of Varivax, and Influenza (Flu) (every year) of live attenuated FluMist Quadrivalent (CDC, 2021). 

Scenario 2 The anticipatory guidance for the child receiving flu vaccine at this age is that the child should get two doses of flu vaccine as the child did not have the vaccine administered between 3-4 years of age and should get at least two doses between 6 months through 8 years (CDC, 2019).

Scenario 3 In regards to the Influenza vaccine, there are some contraindications of the Flu vaccine, to name a few, allergies to flu vaccine such as gelatin, egg allergies, antibiotics or other ingredients (CDC, 2021). Also, there are some side-effects of Flu shot such as, headache, soreness, nausea, fever, muscle aches, to name a few (CDC, 2019).

Case 4 

The case presents an 11-year-old girl, who have come for a well-child check. They have their immunizations up to date. Her examinations are also sound and they are not contraindicated to the vaccination. Following are the scenarios being discussed below:

Scenario 1 The vaccines that are recommended at this visit include: Meningococcal disease (one dose of MenACWY vaccine), HPV (two doses) of Gardasil 9, Tetanus, diphtheria, and whooping cough (pertussis) (one dose of Tdap vaccine), which are Adacel or Boostrix, and Influenza (Flu) (one dose of vaccine every year) of FluMist Quadrivalent (CDC, 2021). 

Scenario 2 The mother of the child has asked to get one vaccine administered for school only but she needs to be counseled about the purpose of getting other vaccine shots also. She should be made acquainted with the fact that the effects of previous vaccines have now worn off and that the child needs to be protected from infections that could make adolescents sick. The risk of adolescence through older age increases if the vaccines are not administered timely (CDC, 2020). 

Scenario 3 Now since the mother of the child has agreed to proceed with the child’s Vaccination, she should also be made aware of the fact that the child would need further vaccines inoculated between the ages 13-18 years. These include, Influenza (Flu) (every year) of FluMist Quadrivalent, Meningococcal disease, Meningococcal conjugate (MenACWY) given at 16 years old (2nd dose) Menactra, Menveo, or MenQuadfi, and Serogroup B meningococcal (MenB) may be given, preferably at 16 through 18 years (2 doses) of Bexsero or Trumenba (CDC, 2021). 

References

CDC (2021) Recommended Child and Adolescent Immunization Schedule for ages 18 years or 

Younger. CDC. Available at https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf

CDC (2020) Vaccines at 13 to 18 Years. CDC. Available at 

https://www.cdc.gov/vaccines/parents/by-age/years-13-18.html

CDC (2020) Vaccines at 11 to 12 Years. CDC. Available at 

https://www.cdc.gov/vaccines/parents/by-age/years-11-12.html 

CDC (2019) Vaccine for Flu (Influenza). CDC. Available at 

https://www.cdc.gov/vaccines/parents/diseases/flu.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fparents%2Fdiseases%2Fchild%2Fflu.html

CDC (2019) U.S. Vaccine Names. CDC. Available at 

https://www.cdc.gov/vaccines/terms/usvaccines.html

Immunization Action Coalition (n.d.) Hepatitis B Shots Are Recommended for All New Babies.

Hepatitis B Vaccine Helps Protect Your Baby’s Future! IAC. Available at

https://www.immunize.org/catg.d/p4110.pdf 

Minnesota Department of Health (n.d.) Recommended Doses of Hepatitis B Vaccine. [online]

Available at https://www.health.state.mn.us/diseases/hepatitis/b/hcp/hbvrec.pdf

Appendix 1