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Suffered from Meningitis. Given two doses of meningitis vaccine. Should it be given again? Chickenpox vaccine same as Varicella vaccine?

DOCTOR OF THE MONTH - Feb 2013
Feb 2013
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Question
Hello Doctor.
I am the father of a 8 year old boy, and have some clarifications regarding his vaccinations. (details in attached excel file)
1) Weight 27 kgs, Height 130 cms are the current weight and height (normal)
2) The child had suffered from Meningitis in July 2011 (has recovered fully after treatment).
3) Request your advise in addressing these gaps and the subsequent vaccination schedule from hereon.
a) Meningococal vaccine-
it was first given to the child in Dec 2007. However, the child developed meningitis in July 2011. Post his recovery, another dose of Meningococal vaccine was PROBABLY given in August 2011 (do not fully remember as i have lost the records).SHould it be given now ? Or later ? WHich specific vaccine ?
b) Pneumococal vaccine- It was first given to the child in December 2007. Doctor had advised it should be repeated 5 years later.It has not been given on completion of 5 years.
c) Hepatitis A- is supposed to be given after 2 yrs of age, and thenafter. However,we are not sure and have forgotten whether it was given then, or later. Even later, perhaps it was given once - but not sure.
So it is possible it was given 0 times or 1 time or 2 times. But i am not sure and not finding any records for the same.
Please advise- should it be given now ? If yes, when, and how many times ?
d) Typhoid vaccine was given once at the age of 2 years. But never after that.
Should it be given now ?
Please suggest the name of the vaccine.
e) Varicella- most probably, it was given at the age of 1 year. After that, it has not been given to the child. Not sure- if at all, it was given in August 2011.
SHould it be given now ?
An additional clarification- Is chickenpox vaccine same as the Varicella vaccine.
Please suggest specific name of the vaccine that should be given
f) Is there a recommended vaccine for Swine Flu ? if yes, which one, and when / how often should it be given
4) Based on this, what would be the optimal schedule of giving the vaccines ? Which of these can be given together ? How many of these are ok to be given together ? At what gap should the rest of the vaccines be given ?
Are there any side effects ?
What should be done now ? Thank you for your time XXXXXXX
Posted Sun, 16 Jun 2013 in Child Health
 
 
Answered by Dr. E Venkata Ramana 3 hours later
Hi XXXXXXX

Thank you for your query on Healthcare Magic.

I went through the complete description given by you and I couldn't find any attached excel file along with this query.

My advise to your queries are:

1.Your son weight and height is in normal range as per the growth charts.

2. Meningococcal vaccine is not included in the routine vaccine schedule and it is
reserved for high risk individuals who are prone for infection with
meningococcal bacteria like with complement component deficiencies.

So I advise you to take the opinion of your regular pediatrician depending on the child requirement for it.

3. If pneumococcal vaccination is given completely ( 3 doses at 6, 10, 14 weeks
age and a booster at 12 to 15 months age) according to schedule , further
vaccination is not needed unless child is having a risk for invasive
pneumococcal illness.

4. The schedule for received two injections of Hepatitis A, there is no need for any further dose.

5. Typhoid vaccine is given after the age of 2 years and booster to be given at
every 3 years interval.

Typhoid vaccine can be given now.

The names of available vaccines are Typhim Vi and Typbar.

6. As per the previous single dose of varicella was enough. At present two doses
are required on at the age of 15 months and the second dose at the age of 5
years.

As he received one dose previously, he can be offered the second dose.

Chicken pox and varicella vaccines are same and refer to one vaccine type only.

There are many varicella vaccine preparations are available like okavax, varilrix.

7. Swine flu vaccine is indicated whenever there is endemic or epidemic swine flu
and it is not indicated routinely.

8. It is very difficult to advise you the timing and combination of vaccines
administration that are due for him online, but what I advise you is to consult
your regular pediatrician for the advise on his due and catch up vaccination.

The doctor will review his immunization and clinical history and he will plan a specifically tailored immunization plan for your son.

Hope I have answered your query, if you have any clarification please let me know and I request you to send the file of his immunization schedule along with the next follow up query.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffered from Meningitis. Given two doses of meningitis vaccine. Should it be given again? Chickenpox vaccine same as Varicella vaccine? 1 hour later
Dear Dr. Venkata XXXXXXX
Thank you for your email.
I have attached my comments and the vaccination schedule in this document below (instead of the excel file).
Request you to please revert on my comments . The schedule is also as below.
Thank you XXXXXXX

---------------------------------------------------------------------------------------------------------------



Hi XXXXXXX

Thank you for your query on Healthcare Magic.

I went through the complete description given by you and I couldn't find any attached excel file along with this query.

My advise to your queries are:

1.Your son weight and height is in normal range as per the growth charts.

2. Meningococcal vaccine is not included in the routine vaccine schedule and it is
reserved for high risk individuals who are prone for infection with
meningococcal bacteria like with complement component deficiencies. So I advise you to take the opinion of your regular pediatrician depending on the child requirement for it.

Question- As explained in the history, child had Meningitis at the age of 6 (despite having taken a meningococcal vaccine at the age of 3). So does this make him a high risk individual ? After he was cured of meningitis, doctor also administered another round of the vaccine. Please advise on this point very carefully as this is the most important point.



3. If pneumococcal vaccination is given completely ( 3 doses at 6, 10, 14 weeks
age and a booster at 12 to 15 months age) according to schedule , further
vaccination is not needed unless child is having a risk for invasive
pneumococcal illness.

Question- Pneumococal has only been given once (at the age of 2y7m). He was not given the vaccine at 6.10.14 weeks of age) How do we ascertain if the child is at risk for invasive pneumococcal illness.

4. The schedule for received two injections of Hepatitis A, there is no need for any further dose.

Question-
He has received only one dose of Hep A, at the age of ~ 3 years. Now he is 8 years old. Should we give him the vaccine now ? Which one ? Please suggest the name.

5. Typhoid vaccine is given after the age of 2 years and booster to be given at
every 3 years interval.

Typhoid vaccine can be given now. The names of available vaccines are Typhim Vi and Typbar.

Quesstion-
Ok. This is clear. We will give him this vaccine. Can it be given along with any other, or should it be given on a stand alone basis ?

6. As per the previous single dose of varicella was enough. At present two doses
are required on at the age of 15 months and the second dose at the age of 5
years.

As he received one dose previously, he can be offered the second dose. Chicken pox and varicella vaccines are same and refer to one vaccine type only. There are many varicella vaccine preparations are available like okavax, varilrix.

Question-
There confusion in my records as we were travelling extensively during that time and I have lost some of the records. So I am not sure if he has been given this one time or two times. In case he has been given this two times, is it advisable to administer it a third time ? Is there a test by which we can determine if this has been administered in the past.

7. epidemic swine flu
and it is not indicated routinely.

Ok. Clear.

8. It is very difficult to advise you the timing and combination of vaccines administration that are due for him online, but what I advise you is to consult your regular pediatrician for the advise on his due and catch up vaccination.

The doctor will review his immunization and clinical history and he will plan a specifically tailored immunization plan for your son.

Hope I have answered your query, if you have any clarification please let me know and I request you to send the file of his immunization schedule along with the next follow up query.

Question-
The details of his vaccination schedule as given are below. Request you to please advise so that the child’s vaccination procedure can be completed over the next few weeks.
Thank you very much

Regards.
Replied by Dr. E Venkata XXXXXXX ,
                         
Age (DoB 23-March-2005)     Vaccine     Due on      Given on     Others     
Birth     BCG     23-Mar-05     26-Mar-05           
Birth     OPV first     23-Mar-05     26-Mar-05           
Birth     Hepatitis B first vaccine     23-Mar-05     26-Mar-05           
                             
6 weeks     DPT first     17-May-05     9-May-05     Head circumference 37 cm     
6 weeks     OPV second     17-May-05     9-May-05     Head circumference 37 cm     
6 weeks     Hepatitis B second     17-May-05     9-May-05     Head circumference 37 cm     
6 weeks     HIB first     17-May-05     9-May-05     Head circumference 37 cm     
                             
10 weeks     DPT second     17-Jun-05     15-Jun-05           
10 weeks     OPV third     17-Jun-05     15-Jun-05           
10 weeks     HIB second     17-Jun-05     15-Jun-05           
                             
14 weeks     DPT third     17-Jul-05     25-Jul-05           
14 weeks     OPV fourth     17-Jul-05     25-Jul-05           
14 weeks     Hepatitis B third     17-Jul-05     25-Jul-05           
14 weeks     HIB third     17-Jul-05     25-Jul-05           
                             
9 months     Measeles     17-Dec-05     17-Dec-05           
                             
15-18 months     MMR     17-Jun-06     8-Jun-06           
15-18 months     DPT first booster     17-Jun-06     8-Jun-06           
15-18 months     OPV fifth     17-Jun-06     8-Jun-06           
15-18 months     HIB booster     17-Jun-06     8-Jun-06           
                             
After 1 year     Varicella           Most probably given - not sure           
                             
                             
2 years     Typhoid vaccine     Mar-07     Jun-07           
                             
                             
After 2 years     Hepatitis A           Most probably given in 2007 end- not sure           
                             
2y7months     Meningococal vaccine           21-Dec-07           
2y7months     Pneumococal vaccine           21-Dec-07           
                             
5 years     DPT second booster     23-Mar-10     3-Apr-10           
5 years     OPV sixth     23-Mar-10     3-Apr-10           
5 years     MMR     23-Mar-10     3-Apr-10          
                             
WAS DUE IN 2010     Typhoid     June-July 2010     NOT GIVEN     Height on 24/9/2012 is 130 cm, weight ~ 26 kgs     
WAS DUE IN 2010     Varicella     June-July 2010     NOT GIVEN           
WAS DUE IN 2010     Hepatitis A     June-July 2010     NOT GIVEN           
                             
6 years                 What was given in Aug 2011 ? Not sure (probably Meningitis and Hep A – but not sure and I have lost my records. Is there a way to carry out tests and find out)     Meningitis in July 2011. Hospitalized. Antibiotics. Cured.      
                       Not confirmed if bacterial or viral meningitis as reports were inconclusive     
7 years                             
                             
8 YEARS     Advice sought     May-13           Height on 10/3/2013 is 130 cm, weight ~ 26.74 kgs     
                             
10 years     TT third booster     23-Mar-15                 
                             
15 years     TT fourth booster     23-Mar-20                 

 
 
Answered by Dr. E Venkata Ramana 18 hours later
Hi XXXXXXX

Thank you for getting back.

1.Coming to meningococcal vaccine:

Your son had been treated for meningitis in July'11. But the organism is not known. So this is not considered as a high risk group for meningococcal vaccine.

The high risk group is children with functional or anatomical asplenia(splenectomy), complement component deficiencies, travel plans to high endemic or epidemic meningococcal infection rates.

Meningitis is caused by many types of bacteria and viruses, but in your child the cause of organism for meningitis is not known, so we can't say he is a high risk individual for meningococcal infection. But your doctor might have advised this vaccination empirically as your child developed meningitis of unconfirmed etiology or with taking the account of your travel history.

2. After the age of 18 months, only one single dose of pneumococcal conjugate vaccine is sufficient. As your child received it at the age of 2 year 7 months, no further dose is required.

High risk individuals for pneumococcal disease are children with asplenia, nephrotic syndrome, and CSF leaks.

3. As he received one dose of Hepatitis A injection at the age of 3 years and not received second dose after 6 months at that time, I advise you to go for a fresh schedule of 2 doses at present with a gap of 6 months between two injections.

The available Hepatitis A vaccines are Havrix, Avaxim, and Biovac A. You can opt any one of the vaccine among them.

4. Typhoid vaccine can be given along with the other vaccines.

5.
a). If he had been given two doses of varicella vaccine previously, a third dose is not required.

b). Test is available to know the presence of varicella specific protective antibodies (VZV specific antibodies) in the serum.

If there is a protective level of antibodies in the serum, no further varicella vaccine is required.

I went through his vaccine schedule.

As per the above discussion, you can consult the pediatrician and opt for relevant vaccination of the child.

And one more suggestion from my side-Instead of TT at 10 years age, Tdap can be offered to the child. But you discuss this matter with your pediatrician before opting for it.

Hope I tried to clarify your concerns regarding your son vaccination, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
Follow-up: Suffered from Meningitis. Given two doses of meningitis vaccine. Should it be given again? Chickenpox vaccine same as Varicella vaccine? 25 hours later
Dear Dr. Venkata XXXXXXX

First of all, many thanks for your detailed explanation and response. I am quite clear on most aspects, but for a few, which i am putting below-

1) Meningitis- You are right, it was not known in 2011 when my son had meningitis, wheter it was caused by bacterial or viral organisms. So that is unknown. Also, thanks for clarifying that it implies he is not in a high risk category.
However, there is a reasonable amount of travel that we do; and thus, i was thinking if it is worthwhile to still take a preventive vaccine for meningitis. Request your views on this whether he should still take a preventive vaccine or not. If yes, which one would you advise.

2) Hepatitis A- As advised by you, he will go for the two vaccine schedule (with a 6 month gap). I merely need your reconfirmation that it is not likely to have any adverse impact on the child.

3) For Varicella, you have recommended the varicella specific protective antibodies (VZV specific antibodies) test. Please let me know what the test is called and whether it is a blood test. What should i tell the pathological lab while doing this test

4) Finally, can you please clarify what is Tdap. is it a substitute for TT ? When can it be taken ? How long will its effects last.

Thank you again for your time and patience,

With best wishes,
XXXXXXX
 
 
Answered by Dr. E Venkata Ramana 1 hour later
Hi XXXXXXX

Thank you for getting back and for your kind appreciation.

1).

It is worth to take preventive vaccination before planning a travel to some endemic areas.

The type of vaccination depends on the area to which you are planning to travel.

If you are traveling to an area of high endemic rate for meningococcal disease, it is advised to administer meningococcal vaccine before traveling.

The vaccines available ARE Mencevax A+C (GSK), Meningococcal A+C (Sii & Aventis Pasteur).

2).

Hepatitis-A vaccine is a safer vaccine if it is given taking routine precautions during vaccination and the adverse effects are minimal.

3).

The test name is Varicella Zoster Virus Antibody Panel (IgG,IgM). It is a blood test. It is usually done by well sophisticated labs.

4).

Tdap contains TT, and the reduced doses of diphtheria and pertussis. It can be taken at the age of 10 years in place of TT with your pediatrician advise.

Tdap is being advised to continue the protection against diphtheria and pertussis in addition to tetanus.

Hope I have answered your query, if you have any clarification please let me know.

Regards.
Above answer was peer-reviewed by
 
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