Vaccniaction thoughts?

[boomba]

The other day I was wathcing that show The Drs on ch 10.It was about vaccs etc did anyone see it.Tthe mother of a young boy who says the vaxs started his autism bought up a great point and wanted to see if it has been discussed and why it isnt in play?

She basically said why is a baby who maybe 4 months but weighs say 6kgs getting the same dose as a 4mth weighing saying 8kgs?

I had to agree with her...I spose this comes into delay vaxing? I had never actually thought about it before. But she really makes a good point. she said it should come down to weight etc for how much a child gets.

I am not quoting it as i forgot most of it...just curious of your thoughts?

[Trillian]

That is one of my sticking points about it too (pardon the pun LOL) I just don't agree with a one size fits all dosing policy. Even at birth, my quite large babies were getting the exact same dosage size as the smaller babies and I don't see why they can't make incremented dosages. For panadol or other medication you can't give more than the specific dosage for that weight otherwise you would overdose them or not give them enough.

[skybie]

yep, thats one of the man reasons for our desicion!
While DD2 was born a very health 3550gms 4 weeks early, shes now a teeny tiny 6.3kgs and only just hanging into the stupid a## graph the stupid a## MCHN keeps reffering to!
So she's be getting the same dosage a bub of 7-8kgs would be getting if we had of gotten her done this month!
doesnt sit right with me

[boomba]

Thanks girls. I am really wishing I had done a bit more unbiased research beofre vaxing but I know now!
So am delaying the rest ...so glad I delayed all the birth ones

[Trillian]

Don't worry too much about it now. My older three are all fully vaxed bar DD2 hasn't had her 4yo needles. It is something that all parents should think about, regardless of whether you are for or against vaccination. I would like to know if there is an acutal reason for the one size fits all dosage or if it is just something that never occured to them?

[Heaven]

Yeah I saw it too Amber! We haven't had any vax for DD yet but will be getting a couple soon. I just really didn't feel comfortable giving my tiny perfect baby all that stuff.

I have a friend who is a midwife and she said she hates vaxing days in the nursery for the premmie babies bc they hook them all up to breathing machines before they give it to them in case they stop breathing and it's very nerve wracking.

[Shades]

Wow... I'd be thinking 'let's avoid doing things that tend to stop babies breathing!' rather than 'let's hook 'em all up first'.

[maz]

I so wish I knew about BB and these sort of things before I let me kids become pin cushions.

J man and I have talked in length about it and we both remember the nurse coming in and telling us that Tank had had his needles...we didnt even get asked

Bring on Mini me's 3 1/2 yo MCHN appointment....cause she isnt getting any of that poison pumped into her small 12kg frame any more!

[Mummato2]

J man and I have talked in length about it and we both remember the nurse coming in and telling us that Tank had had his needles...we didnt even get asked

Oh my god Maz - seriously????

We don't vax at all - and were asked numerous times with both kids if we were "sure we wanted to not vax the Hep B"

Man, that's negligence and all I can say is they're bloody lucky no bad reactions followed

[Janie]

Have been thinking alot about this lately, as DS2 is due for his 8 week vaccs next week, and probably won't be close to 3kgs! I'm not at all comfortable giving them to him so small, so we'll be delaying a little bit. Not too much of a tough choice as we are partial delay vaccers anyway.

I do think it's a relevant point, and would love more info on it. Is size/age the only basis for timing of vaccs? Or are there other factors? How do they decide when vaccs should be given?

ETA I think it's becoming more common for parents to decline the Hep B at birth. Our very conservative hospital didn't bat an eyelid when we declined, it was almost as if they were expecting it.

[Olive]

DD1 had all vax as per schedule but with DD2 we didnt do heb b at birth but did the others up until 12 months were we havent dont them yet, partly due to DD2 being constantly unwell since 7 months and partly because weve chosen to delay
amber i completely agree with the dose for weight issue

[Little Chicken]

Ok, sorry for the length of this but this is a reply to the weight and dose question about vaccines on a facebook group I subscribe to:

“Why is it that a 10 pound baby will recieve the same dose as a 5 pound baby?”

Ok so going by this question I’m first converting the weight measurements from pounds to kgs (because we generally don’t go by pounds anymore, much to my mother’s disgust! Lol).
5 pounds=2.26kgs
10pounds= 4.53kgs
(as converted on an online measurement conversion calculator)

Then I’m assuming that whilst Najla gave me these specific weights, that she is referring to any weight difference in children, however since these weights were given I’m going to use the Hepatitis B vaccine as my example in explaining this due to 2.26kgs referring more to an infant’s birth weight than that of an older child.
Again, I’m assuming Najla is concerned about this particular aspect of vaccination (that the doses are the same for all of the weights for children), because generally in children’s medicine we would calculate a dosage of a particular medication based on their weight and age (and other clinical factors may also weigh into the final dosage decision).

Ok so!

When looking at dosage, we have to look at many things but most importantly we look at the amount and the concentration- and we calculate and administer depending on these two items what is going to be the most effective and what is going to remain as safe as we can possibly make it. In all medication decisions the safety of the person comes first and foremost whilst making sure that the dose is also going to be effective. This is why when it comes to children we generally calculate medications on weight and age range (remember this last factor).

However, not ALL medications for children are based on weight and sometimes it is easy to forget this seeing as most of them are. Salbutamol for instance (used to treat Asthma in children, also more well known as Ventolin- the brand name), is not calculated based on a child’s weight. It is based on an age range issue (as well a past history and clinical indicators). It has been tested and deemed to be safe with dosages depending on an age range rather than weight. Up to 5-6 years old in an acute care setting we give either 2.5mg of Salbutamol via nebuliser or 6 puffs via the inhaler (as a side note- we also recommend using a spacer when using the inhaler as it is much more effective, not using it causes most of the medication to hit the back of the throat and really not doing a whole lot of good. But I digress), however from 6 years up right into adulthood, we either give 5mg of Salbutamol via the nebuliser or 12 puffs via the inhaler (and spacer! :P). See- not all medications for children are based on weight, some are based on an age range- what is the most safest and effective dose to give is the most important thing.

Now on to vaccinations!

Using the Hepatitis B vaccine as my example (explained why above), we can see from looking at The Australian Immunisation Handbook (9th edn 2008, published by the Aust. Government and the National Health and Medical Research Council NHMRC... you’ll have to excuse my non-harvard referencing, unless I’m getting marked on this you’ll just have to deal with the sloppiness cos I can’t be bothered- all the right info is there :P), Hepatitis B is generally given at birth, 2 months, 4 months, and 6 months of age. You will also notice if you turn to page 151 of the handbook that the amount that is given in the birth dose, being monovalent and not combined as the other doses generally are, is 0.5mls per dose. The birth dose being of the name HB-VAXII Paediatric formulation, the following doses generally being a combined vaccine of the name Infanrix Hexa. Infanrix Hexa ends up being reconstituted to 0.5mls also, but as the question is more so asking about ONE vaccine being the same for all weights, I’m going to say that our virtual infant is only receiving the HB-VAXII for all of his/her doses.

Ok, so why does the baby at birth get a 0.5ml dose when a baby at 6 months, generally weighing a fair bit more than an infant, also get a 0.5ml dose? It’s the term I asked you all to remember earlier- age range. Vaccines are made into the smallest amount possible that will cover both the aspects I talked about earlier- safety and effectiveness. The dose needs to be both safe and effective. When they conduct clinical trials into vaccines they look at the many aspects of the immune system and then they first trialled on animals, then adult humans and finally on children before being able to receive approval for use- this process taking many years. As an anecdotal piece of evidence, I was born in the mid 80’s when my mum heard on the news about the Chicken Pox (Varicella) vaccine being trialled and she was hoping it would be released in time for me to have it- however it wasn’t approved for use in the community until 2001, although it wasn’t funded by the Government until late 2005 (Immun. Handbook pgs. 373-374)

Anyways! Studies for each vaccine are conducted in the clinical trial phases, the whole trial process being another long story.

The trials have then had to prove conclusively that the dose of the HB-VAXII could be given at 0.5mls to babies of varying weights whilst still maintaining both the effectiveness and being the safest that we can possibly make it (until new developments come along ). However in adults 0.5mls is not enough to be effective so 1.0mls is given with the adult formulation. Each dose has been proved to be effective in getting the body to produce antibodies whilst being as safe as possbile (much safer than the diseases themselves!).

So the lowest amount that has been proven to be the most effective and the safest that it can be (at the same time as being effective) is 3 doses of 0.5mls from birth to 19 years of age, from 19 years old onwards we use the adult formulation of 3 doses of 1ml (being the dose that is the most effective and at the same time maintaining as much safety as possible). Although the product information also states that adolescents aged 11-15 are able to receive the adult dose, but having only 2 doses instead of 3. All of this info on doses and what ages we give them at I have accessed from the product information which is easily accessible online if you google the specific brand name and find the manufacturer’s link.

In terms of the Hep B vaccine, it’s also worth mentioning that when it comes to infants under 2kgs (like my niece) or for babies born at less than 32 weeks gestation, than as long as they are clinically stable it is fine to vaccinate at the discretion of the attending doctor and with parents permission of course. Generally those born under 32 weeks gestation aren’t exactly ‘clinically stable’ for a little while however. In both these cases if the vaccine is administered, it is recommended that titre’s (blood levels to Hep B antibodies) are undertaken at around 7 months of age and give a booster at 12 months of age if needed, or to not do the titre but just give the extra booster at 12 months of age- these would be the options given to parents. (all this info from the Immun. Handbook.)

ALSO

I suppose there would/could possibly be a way to calculate based on weight, but again maintaining the most effective and safe (as possible) dose for each weight- however there are more risks in doing this than in following the existing schedule that clinical trials in the manufacturing phase have proved to be ok for children of differing weights to have. The potential of higher risk comes from the potential human error aspect, everyone makes mistakes and by calculating the various vaccine doses by weight instead of already how we do it, there would potentially be more human errors in the calculation process, the drawing up process, remembering how much for each vaccine after calculating (when it comes to the ages that we give multiple shots)- although I would expect the dose to be written on the chart. In regards to the last potential error, we would generally draw up/prepare all the vaccines before administering so we aren’t drawing up one and then giving it, and then going back and drawing up the next one and then giving that one etc. Doing this would prolong the experience for the baby/child- and let’s face it, needles aren’t exactly the ‘nicest’ thing to have, so better to get them all done within a short period of time in the visit rather than prolong it (how awful would it be to let them calm down from having one needle only to then make them cry again! Although I have seen babies that don’t even get even a little upset lol!).
Doing it this way increases the risk of human error. Having pre-packaged vials/syringes that contain the exact dose that you need decreases the potential of human error when it comes to dosage. If the clinical trials show that effectiveness and safety (as much as possible) can be maintained for the varying weights and ages at the one single dose than having to calculate a specific dose per weight of child.