DISCLAIMER: This information is based on my own personal research, as a parent. It is not health advice, nor is it a recommendation. You should seek advice from a trusted health professional before making any decisions about immunisation for yourself or your child. This information is in no way endorsed by my employer, NSW Health, and I am posting as a parent and a member of the public, and not in my capacity as a nurse.
Okay, Schmickers' Immunisation Schedule, Version 1.0
First of all, a lot of this is being cobbled together from notes - both paper notes, and mental ones. It is all based on either our own research, or advice from a trusted paediatrician, but the standard disclaimer applies - this is my own personal opinion, not as a nurse, but as a parent, and while you are free to do with it as you want, I am not responsible for the consequences, should there be any apart from having happy, healthy children. So please, don't sue me.
First, for reference, the current Australian National Immunisation Program Schedule:
Source: http://www.immunise.health.gov.au/in...f/Content/nips, accessed 20th January 2008Birth
- Hepatitis B (hepB) [See footnote a]
2 months
- Hepatitis B (hepB) [See footnote b]
- Diphtheria, tetanus and whooping cough (acellular pertussis) (DTPa)
- Haemophilus influenzae type b (Hib) [See footnotes c & d]
- Polio (inactivated poliomyelitis IPV)
- Pneumococcal conjugate (7vPCV)
- Rotavirus
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4 months
- Hepatitis B (hepB) [See footnote b]
- Diphtheria, tetanus and whooping cough (acellular pertussis (DTPa)
- Haemophilus influenzae type b (Hib) [See footnotes c & d]
- Polio (inactivated poliomyelitis IPV)
- Pneumococcal conjugate (7vPCV)
- Rotavirus
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6 months
- Hepatitis B (hepB) [See footnote b]
- Diphtheria, tetanus and whooping cough (acellular pertussis (DTPa)
- Haemophilus influenzae type b (Hib) [See footnote c]
- Polio (inactivated poliomyelitis) (IPV)
- Pneumococcal conjugate (7vPCV) [See footnote e]
- Rotavirus [See footnote j]
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12 months
- Hepatitis B (hepB) [See footnote b]
- Haemophilus influenzae type b (Hib) [Seefootnote d]
- Measles, mumps and German measles (rubella) (MMR)
- Meningococcal C (MenCCV)
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12-24 months
- Hepatitis A (Aboriginal and Torres Strait Islander children in high risk areas) [See footnote f]
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18 months
- Chickenpox (varicella) (VZV)
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18-24 months
- Pneumococcal polysaccharide (23vPPV) (Aboriginal and Torres Strait Islander children in high risk areas) [See footnote g]
- Hepatitis A (Aboriginal and Torres Strait Islander children in high risk areas)
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4 years
- Diphtheria, tetanus and whooping cough (acellular pertussis) (DTPa)
- Measles, mumps and German measles (rubella) (MMR)
- Polio (inactivated poliomyelitis) (IPV)
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10-13 years
- Hepatitis B
- Chickenpox (varicella) (VZV) [See footnote h]
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12-18 years (School based program)
- Human Papillomavirus (HPV) [See footnote k]
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12-26 years (Community based program)
- Human Papillomavirus (HPV) [See footnote l]
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15-17 years
- Diphtheria, tetanus and whooping cough (acellular pertussis) (dTPa)
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15-49 years
- Influenza (flu) (Aboriginal and Torres Strait Islander people who are medically at-risk)
- Pneumococcal polysaccharide (23vPPV) (Aboriginal and Torres Strait Islander people who are medically at-risk)
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50 years and over
- Influenza (flu) (Aboriginal and Torres Strait Islander people)
- Pneumococcal polysaccharide (23vPPV) (Aboriginal and Torres Strait Islander people)
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65 years and over
- Influenza (flu)
- Pneumococcal polysaccharide (23vPPV)
Now, Michael's Immunisation Schedule.
Unlike the NIPS, I would like our schedule to be more accommodating to the needs of the individual child. Accordingly, I have separated the schedule out into three broad groups, which I term "Low Risk", "High Risk", and "Special Needs".
The reason that I stratify children in this way is because, at the age groups we are examining, especially in the pre-school age groups, there are marked differences in the needs of families who have children who attend child care, or who have children in this age group who have siblings or other close social contacts who attend child care or school, and those families who do not. As a result, I believe it is justifiable to be more aggressive in our preventative treatment of children who are exposed to an increased risk of contracting the more serious vaccine-preventable diseases.
LOW RISK
Birth:
None
2 Months:
None
4 Months:
None
6 Months:
None
12 Months:
None
2-3 Years:
Tetanus* / Diptheria-Tetanus-Pertussis (DTPa)
4 Years / Before School:
Haemophilus Influenzae Type B (HIB)
Meningococcal
Pertussis (Whooping Cough)* / Diptheria-Tetanus-Pertussis (DTPa)
High School:
Varicella (Chicken Pox) (Only children who have not previously been infected)
NOTES:
Children in low-risk social situations are unlikely to contract vaccine preventable diseases during infancy. The incidence of serious side effects for most infant vaccine-preventable diseases is low, and was continuing to reduce before the introduction of global immunisation programs. As a result, as long as our children remain in a "low risk" group - that is, no signficant family or social contacts who are in childcare, under parental supervision during play - we believe the risks inherent in giving immunisations before the age of 2 (that is, the need to give multiple doses to achieve a good immunological response) are not warranted. Instead, we intend to give them single doses at a later age, when their immune systems are mature enough to mount a sufficient immune response after one exposure.
The government recommends the chicken pox vaccine (varicella) at the age of 18 months. While chicken pox is known to very rarely cause an inflammation of the lining of the brain, the varicella vaccine is very new and not extensively used. We suggest that it be withheld until high shcool age, and only given to those children who have not previously been infected with chicken pox, as the symptoms of chicken pox become worse as a person becomes older.
Certain immunisations recommended by the government are not included in this schedule. This is because we believe that the risks associated with these immunisations do not outweigh the likelihood of contracting the disease and the associated risk factors if the disease is contracted. These include:
Hepatitis B - this vaccine is now given to all children, even though hepatitis B is spread through contact with infected body fluids. We believe children in a low risk group are not at risk of exposure to hepatitis B and thus, do not require this vaccination.
Pneumococcal Conjugate - this virus can result in meningeal infections, such as meningitis or meningococcal sepsis, but requires close contact with infected children and, during infancy, requires repeated boosters to attain a good immunological response. While giving it at the age of 2-3 would be an option, the outcomes for children who are infected are considerably better after the age of 2, so we do not include it on our schedule.
Polio - the only cases of this disease in decades have been as a result of exposure by immunocompromised people to the vaccine itself! Polio no longer exists in Australia.
Rotavirus - rotavirus causes serious dehydration only in children under the age of six months. It is spread by faecal contamination from children who are infected. Before the age of six months, children are not independently mobile, so it is generally not difficult to prevent rotavirus infection in the low-risk group.
Measles-Mumps-Rubella - Of these three diseases, measles is the most concerning, as it does rarely cause an inflammation of the brain in some children that can lead to long-term complications. However, there is a mounting body of anecdotal evidence that suggests a link between immunisations in general, and the MMR immunisation in particular, and the onset of autism. Recently, immunisatio researchers have acknowledged this link, and have called for more research in order to find the cause. As a result, we suggest that the use of the MMR should be considered with caution. If it is decided that it be used, we think some consideration should be given to delaying it from 12 months to 2-3 years, or older, in order that the requirement for a second booster (normally given at 4 years) can be omitted.
* Tetanus - In an ideal world, we would give a single tetanus booster injection by itself once the child begins walking, as there becomes a risk of a penetrating injury to the feet once the child becomes mobile which could result in tetanus. However, tetanus for children is only available as part of the diptheria-tetanus-pertussis vaccine. We do not believe immunisation for diptheria is required in this country, as it does not exist, and vaccination for pertussis is not warranted at this age in children in this risk group, as whooping cough requires extensive contact with ill children (approximately three to four hours of close contact) to be spread.
* Pertussis - See the note for tetanus, above. We hold pertussis until this age so that only one dose is required to confer a good immunological response, and once the child enters school and has unsupervised play with potentially sick children, the chances of contracting pertussis are increased.
HIGH RISK
Birth:
None
2 Months:
Pertussis (Whooping Cough)* / Diptheria-Tetanus-Pertussis (DTPa)
Haemophilus Influenzae Type B (HIB)
Pneumococcal Conjugate
Rotavirus (if in childcare before 6 months)
4 Months:
Pertussis (Whooping Cough)* / Diptheria-Tetanus-Pertussis (DTPa)
Haemophilus Influenzae Type B (HIB)
Pneumococcal Conjugate
Rotavirus (if in childcare before 6 months)
6 Months:
Pertussis (Whooping Cough)* / Diptheria-Tetanus-Pertussis (DTPa)
Haemophilus Influenzae Type B (HIB)
Pneumococcal Conjugate
Rotavirus (if in childcare before 6 months)
12 Months:
Haemophilus Influenzae Type B (HIB)
Meningococcal
2 Years:
Tetanus* / Diptheria-Tetanus-Pertussis (DTPa)
4 Years / Before School:
Pertussis (Whooping Cough)* / Diptheria-Tetanus-Pertussis (DTPa)
High School:
Varicella (Chicken Pox) (Only children who have not previously been infected)
NOTES:
Children who are in child care or day care spend extensive periods of time mixing with other children without parental supervision. As a result, there is an increased potential for children in this group to contract vaccine-preventable diseases at a young age. This also applies to children who have siblings, as sibling also spend extensive amounts of time together.
The government recommends the chicken pox vaccine (varicella) at the age of 18 months. While chicken pox is known to very rarely cause an inflammation of the lining of the brain, the varicella vaccine is very new and not extensively used. We suggest that it be withheld until high shcool age, and only given to those children who have not previously been infected with chicken pox, as the symptoms of chicken pox become worse as a person becomes older.
Certain immunisations recommended by the government are not included in this schedule. This is because we believe that the risks associated with these immunisations do not outweigh the likelihood of contracting the disease and the associated risk factors if the disease is contracted. These include:
Hepatitis B - this vaccine is now given to all children, even though hepatitis B is spread through contact with infected body fluids. We believe children in a low risk group are not at risk of exposure to hepatitis B and thus, do not require this vaccination.
Polio - the only cases of this disease in decades have been as a result of exposure by immunocompromised people to the vaccine itself! Polio no longer exists in Australia.
Rotavirus - rotavirus causes serious dehydration only in children under the age of six months. It is spread by faecal contamination from children who are infected. Before the age of six months, children are not independently mobile, so it is generally not difficult to prevent rotavirus infection, unless they are in childcare at this age. If so, the rotavirus immunisation may be warranted.
Measles-Mumps-Rubella - Of these three diseases, measles is the most concerning, as it does rarely cause an inflammation of the brain in some children that can lead to long-term complications. However, there is a mounting body of anecdotal evidence that suggests a link between immunisations in general, and the MMR immunisation in particular, and the onset of autism. Recently, immunisatio researchers have acknowledged this link, and have called for more research in order to find the cause. As a result, we suggest that the use of the MMR should be considered with caution. If it is decided that it be used, we think some consideration should be given to delaying it from 12 months to 2-3 years, or older, in order that the requirement for a second booster (normally given at 4 years) can be omitted.
SPECIAL NEEDS
Birth:
Hepatitis B (Children born into social environments where there is a high risk of body fluid contamination or injury or transmission from infected social contacts)
2 Months:
Hepatitis B (Children born into social environments where there is a high risk of body fluid contamination or injury or transmission from infected social contacts)
4 Months:
Hepatitis B (Children born into social environments where there is a high risk of body fluid contamination or injury or transmission from infected social contacts)
6 Months:
Hepatitis B (Children born into social environments where there is a high risk of body fluid contamination or injury or transmission from infected social contacts) OR AT 12 MONTHS
12 Months:
Hepatitis B (Children born into social environments where there is a high risk of body fluid contamination or injury or transmission from infected social contacts) OR AT SIX MONTHS
2 Years:
Hepatitis A (Children living in social environments where there is a high risk of body fluid contamination or injury or transmission from infected social contacts)
4 Years / Before School:
Mumps* / Measles Mumps Rubella (MMR) (Males Only)
High School:
Human Papilloma Virus ("Cervical Cancer Vaccine", HPV) (Females Only)
Rubella* / Measles Mumps Rubella (MMR) (Females who have no immunity to rubella only)
Measles-Mumps-Rubella - see notes regarding the MMR vaccine above. Of these diseases, two are of interest to specific groups. Mumps is generally a short-lived disease with few serious side effects, for females. For males, however, there is a rare side effect of orchitis, or inflammation of the testes, that can result in infertility later in life due to scarring. Ideally, if it were possible, we would immunise males only, and imminuse them specifically for mumps, as opposed to the MMR combination. We suggest waiting until before school, as at school, the risk of transmission increases and the immune system is mature enough that a single dose of the MMR is usually sufficient to provoke a good immunological response.
For females, rubella (german measles) is a concern, as, if contracted during pregnany, it can cause fetal abnormalities. However, this is only a concern for girls and women of childbearing age. Ideally, if it were possible, we would immunise females only, and immunise them specifically for rubella, as opposed to the MMR combination. We see no reason to give this immunisation any earlier than high school / the commencement of menstruation, for the obvious reason that pre-pubescent girls are unlikely to fall pregnant.
Human Papilloma Virus ("Cervical Cancer Vaccine", HPV) - while this is a new vaccine, and so little information is known about it's long-term use, by the time it is given the immune system is fully matured. Given that cervical cancer is insidious, often fatal, and difficult to detect, we have no problems in recommending it's use at this age.
Whew! Now I have sore fingers...
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