Children Buttocks
2021年4月4日Register here: http://gg.gg/ox8t3
*Children Buttocks
*Boils Children’s Buttocks
*Warts On Children’s Buttocks
*Pimples Children’s Buttocks
*Children’s Buttocks Rash
Find child buttocks stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Thousands of new, high-quality pictures added every day. The buttocks should not be routinely used as a vaccination site for infants and children; and, to avoid injury to the sciatic nerves, they are generally not used in adults, The central region of the buttocks should be avoided for all injections; the upper, outer quadrant should be used only for the largest volumes of injection or when multiple. I even got stuck next to a mother with her two daughters, one of whom was rocking some butt pants, on a 50+ hour train journey from Shanghai to Urumuqi and had the pleasure of witnessing (smelling, to be exact) the youngest one putting her bottomless pants to good use on the floor right next to my sleeper berth seemingly every 30 minutes or so for the duration of the trip. Above his head to the wall hanging, a tablet: Nil Similius Insano Quam Ebrius (For example, the Old Sing, as beeping the boy). In addition, a parrot in a birdcage. Right sweeps a woman’s buttocks of a child, while an old man grabs her chest. From the womb of his mother a child urinates on a dog standing on the table. A man must surrender. Buttocks: Expose one side of the buttocks. With an alcohol wipe draw a line from the top of the crack between the buttocks to the side of the body. Find the middle of that line and go up 3 inches. From that point, draw another line down and across the first line, ending about halfway down the buttock.
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.
This revision of the ’General Recommendations on Immunization’ updates the 1980 statement.* Changes from that statement clarify information on possible interference with the immune response by spacing immunobiologics. Recommendations for vaccinating persons with allergies are revised. New sections dealing with many aspects of immunization procedures have been added. INTRODUCTION
Recommendations for immunization of infants, children, and adults are based on facts about immunobiologics and scientific knowledge about the principles of active and passive immunization and on judgments by public health officials and specialists in clinical and preventive medicine. Benefits and risks are associated with the use of all products--no vaccine is completely safe or completely effective. The benefits range from partial to complete protection from the consequences of disease, and the risks range from common, trivial, and inconvenient side effects to rare, severe, and life-threatening conditions. Thus, recommendations on immunization practices balance scientific evidence of benefits, costs, and risks to achieve optimal levels of protection against infectious or communicable diseases.
These recommendations describe this balance and attempt to minimize the risk by providing specific advice regarding dose, route, and spacing of immunobiologics and by delineating situations warranting precautions or contraindicating their use. These recommendations may apply only in the United States, as epidemiological circumstances and vaccines may differ in other countries. The relative balance of benefits and risks may change as diseases are brought under control or eradicated. For example, because smallpox has been eradicated throughout the world, the very small risk from smallpox vaccine now exceeds the risk of smallpox; consequently, smallpox vaccination of civilians is now indicated only for laboratory workers directly involved with smallpox or closely related orthopox viruses (e.g., monkeypox, vaccinia, and others). *Replaces previous recommendations on this subject in MMWR 1980;29:76,81-83. DEFINITIONS
*
Immunobiologic: Immunobiologics include vaccines, toxoids,
and antibody containing preparations from human or animal donors, including globulins and antitoxins. These products are used for immunization.
*
Vaccine: A suspension of attenuated live or killed microorganisms (bacteria, viruses, or rickettsiae), or fractions thereof administered to induce immunity and thereby prevent infectious disease.
*
Toxoid: A modified bacterial toxin that has been rendered nontoxic but that retains the ability to stimulate the formation of antitoxin.
*
Immune globulin (IG): A sterile solution containing antibody from human blood. It is a 15%-18% protein obtained by cold ethanol fractionation of large pools of blood plasma. It is primarily indicated for routine maintenance of certain immunodeficient persons, and for passive immunization against measles and hepatitis A.
*
Specific immune globulin: Special preparations obtained from donor pools preselected for a high antibody content against a specific disease, e.g., Hepatitis B Immune Globulin (HBIG), Varicella Zoster Immune Globulin (VZIG), Rabies Immune Globulin (RIG), and Tetanus Immune Globulin (TIG).
*
Antitoxin: A solution of antibodies derived from the serum of animals immunized with specific antigens (diphtheria, tetanus) used to achieve passive immunity or to effect a treatment. B. Vaccination and immunization: Today, these terms are often
used interchangeably. The words vaccination and vaccine derive from vaccinia, the cowpox virus once used as smallpox vaccine. Thus, vaccination originally meant the inoculation of vaccinia virus to render individuals immune to smallpox. Some people still prefer that the term vaccination be restricted to this use, but many have come to use the term in a more general sense, to denote the administration of any vaccine or toxoid without regard to whether the recipient is successfully made immune.
Immunization is a more inclusive term denoting the process of inducing or providing immunity artificially by administering an immunobiologic. Immunization can be active or passive.
Active immunization denotes the production of antibody or antitoxin in response to the administration of a vaccine or toxoid. Passive immunization denotes the provision of temporary immunity by the administration of preformed antitoxin or antibodies (e.g., immunoglobulin, maternal antibodies). Three types of immunobiologics are used for passive immunization: (1) pooled human IG, (2) specific IG preparations, and (3) antitoxin.
Although there is lack of consensus that vaccination and immunization are completely synonymous, these words are used interchangeably in ACIP statements when referring to active immunization. Regardless of which term is used, it must be emphasized that administration of an immunobiologic cannot be automatically equated with the development of (or conferring of) adequate immunity because of a variety of specific factors, many of which are discussed in this statement.
C. Antigen(s): Substance(s) inducing the formation of antibodies. In some vaccines, the antigen is highly defined (e.g., pneumococcal polysaccharide, hepatitis B surface antigen, tetanus or diphtheria toxoids); in others, it is complex or incompletely defined (e.g., killed pertussis bacteria, live, attenuated viruses). IMMUNOBIOLOGICS
The specific nature and content of immunobiologics may differ. When immunobiologics against the same infectious agents are produced by different manufacturers, active and inert ingredients among the various products may differ. Practitioners are urged to become familiar with the constituents of the products they use. The constituents of immunobiologics include:
*
Suspending fluid: This frequently is as simple as sterile
water or saline, but it may be a complex fluid containing small amounts of proteins or other constituents derived from the medium or biologic system in which the vaccine is produced (serum proteins, egg antigens, cell-culture-derived antigens).
B. Preservatives, stabilizers, antibiotics: These components of vaccines are used to inhibit or prevent bacterial growth in viral culture or the final product, or to stabilize the antigen. They include such materials as mercurials and specific antibiotics. Allergic reactions may occur if the recipient is sensitive to one of these additives.
C. Adjuvants: An aluminum compound is used in some vaccines to enhance the immune response to vaccines containing inactivated microorganisms or their products (e.g., toxoids and hepatitis B virus vaccine). Vaccines with such adjuvants must be injected deeply in muscle masses, since subcutaneous or intracutaneous administration may cause local irritation, inflammation, granuloma formation, or necrosis. ROUTE, SITE, AND TECHNIQUE OF IMMUNIZATION
*
Route: There is a recommended route of administration for
each immunobiologic. To avoid unnecessary local or systemic effects and/or ensure optimal efficacy, the practitioner should not deviate from the recommended route of administration.
B. Site: Injectable immunobiologics should be administered in an area where there is minimal opportunity for local, neural, vascular, or tissue injury. Subcutaneous injections are usually administered into the thigh of infants and in the deltoid area of older children and adults. Intradermal injections are generally given on the volar surface of the forearms, except for human diploid cell rabies vaccine, with which reactions are less severe in the deltoid area.
In the past, the upper, outer quadrant of the buttocks was the usual site of intramuscular vaccination. The buttocks should not be routinely used as a vaccination site for infants and children; and, to avoid injury to the sciatic nerves, they are generally not used in adults, The central region of the buttocks should be avoided for all injections; the upper, outer quadrant should be used only for the largest volumes of injection or when multiple doses need to be given, such as when large doses of IG must be administered. The site selected should be well into the upper, outer mass of the gluteus maximus and away from the central region of the buttocks.
Currently, preferred sites for intramuscular injections are the anterolateral aspect of the upper thigh and the deltoid muscle of the upper arm. In most infants, the anterolateral aspect of the thigh provides the largest muscle mass and, therefore, is the preferred site. In older children, the deltoid mass is of sufficient size for intramuscular injection. An individual decision must be made for each child, based on the volume of the injected material and the size of the muscle into which it is to be injected. Many practitioners prefer to continue using the anterolateral thigh until age 3 years before switching to the deltoid area. In adults, the deltoid is generally used for routine intramuscular vaccine administration.
C. Techniques: Before giving the injection, the needle is inserted in the site, and the syringe plunger is pulled back to see if blood appears; if so, the needle should be withdrawn and a new site selected. The same procedure is followed until no blood appears. A separate needle and syringe should be used for each injection. Disposable needles and syringes should be discarded in labeled containers to prevent accidental inoculation or theft. If more than one vaccine preparation is administered, each should be given at a different site. DOSAGE
The recommended doses of immunobiologics are derived from theoretical considerations, experimental trials, and clinical experience. Administration of dose volumes smaller than those recommended, such as split doses or intradermal administration (unless specifically recommended), may result in inadequate protection. Exceeding the recommended dose volumes might be hazardous because of excessive local or systemic concentrations of antigens.
Some practioners use divided doses of vaccine (particularly diphtheria and tetanus toxoids and pertussis vaccine (DTP)) to reduce reaction rates. There has not been adequate study of the efficacy of such practices by serologic confirmation or clinical efficacy or of the effects on the subsequent frequency and severity of adverse reactions. The Committee does not recommend dividing doses of any vaccine. AGE AT WHICH IMMUNOBIOLOGICS ARE ADMINISTERED
Several factors influence recommendations concerning the age at which vaccine is administered (Tables 1-3). These include: age-specific risks of disease, age-specific risks of complications, ability of individuals of a given age to respond to the vaccine(s), and potential interference with the immune response by passively transferred maternal antibody. In general, vaccines are recommended for the youngest age group at risk with an acceptable level of antibody response following vaccine administration. For example, while infants as young as 6 months of age may be at risk for measles, most are protected by maternal antibody, which may inhibit successful active immunization at this age. In the United States, measles vaccine is routinely administered at 15 months of age, by which time maternal antibody is no longer detectable.
In certain measles epidemics, public health officials may recommend measles vaccine for infants as young as 6 months of age. Although a smaller proportion of those given vaccine before the first birthday develop antibody to measles, compared with older infants, the higher risk of disease during an epidemic may justify earlier immunization. Such infants should be reimmunized at the recommended age for measles vaccination to achieve protection. SPACING OF IMMUNOBIOLOGICS
*
Multiple doses of same antigen: Some products require more
than one dose for full protection. In addition, it is necessary to give periodic reinforcement (booster) doses of some preparations to maintain protection. In recommending the ages and/or intervals for age for measles vaccination to achieve protection. SPACING OF IMMUNOBIOLOGICS
*
Multiple doses of same antigen: Some products require more
than one dose for full protection. In addition, it is necessary to give periodic reinforcement (booster) doses of some preparations to maintain protection. In recommending the ages and/or intervals for multiple doses, the Committee takes into account current risks from disease and the objective of inducing satisfactory protection. Intervals between doses that are longer than those recommended do not lead to a reduction in final antibody levels. Therefore, it is unnecessary to restart an interrupted series of an immunobiologic or to add extra doses. By contrast, giving doses of a vaccine or toxoid at less than recommended intervals may lessen the antibody response; doses given at less than recommended intervals should not be counted as part of a primary series.
B. Different antigens: Experimental evidence and extensive clinical experience have strengthened the scientific basis for giving certain vaccines at the same time. Most of the widely used antigens can safely and effectively be given simultaneously. This knowledge is particularly helpful in circumstances that include imminent exposure to several infectious diseases, preparation for foreign travel, or uncertainty that the patient will return for further doses of vaccine.
In general, inactivated vaccines can be administered simultaneously at separate sites. It should be noted, however, that when vaccines commonly associated with local or systemic side effects (such as cholera, typhoid, and plague vaccines) are given simultaneously, the side effects theoretically might be accentuated. When practical, these vaccines should be given on separate occasions.
Field observations indicate that simultaneous administration (on the same day) of the most widely used live-virus vaccines has not resulted in impaired antibody response or increased rates of adverse reactions. Observation of children indicates that antibody responses to trivalent oral polio vaccine (OPV) given simultaneously with licensed combination measles-mumps-rubella (MMR) vaccine are comparable to those obtained when the same vaccines are given at separate visits. It is reasonable to expect equivalent immunologic responses when other licensed combination or live, attenuated-virus vaccines or their component antigens are given simultaneously with OPV. While data are lacking on potential interference with antibody responses to measles, mumps, rubella, and/or trivalent oral polio vaccines administered at different times within 1 month of one another, there are theoretical concerns and data showing that the immune response to a live virus vaccine might be impaired if the vaccine is administered within the month following another live virus vaccine. When feasible, live virus vaccines not administered on the same day should be given at least 1 month apart.
No data indicate that simultaneous administration of individual measles, mumps, or rubella antigens at different sites yields different results from administration of the combined vaccines in a single site.
Data on the response to simultaneous administration of diphtheria and tetanus toxoids and pertussis vaccine (DTP), OPV, and MMR vaccine are lacking. However, field experience and antibody data regarding simultaneous administration of either DTP and measles vaccine or DTP and OPV indicate that the protective response is satisfactory and adverse reactions do not increase. Therefore, simultaneous administration of all these antigens is recommended when individuals require multiple antigens and there is doubt that the recipient will return to receive further doses of vaccine. Children l5 months of age or older who have received fewer than the recommended number of DTP and OPV doses fall into this category (Table 2). Simultaneous administration of pneumococcal polysaccharide vaccine and whole-virus influenza vaccine gives satisfactory antibody response without increasing the occurrence of adverse reactions. Simultaneous administration of the pneumococcal vaccine and split-virus influenza vaccine may also be expected to yield satisfactory results. However, it should be kept in mind that influenza vaccine should be administered annually to the target population, whereas, under current recommendations, pneumococcal polysaccharide vaccine should only be administered in a single dose.
An inactivated vaccine and a live, attenuated-virus vaccine can be administered simultaneously at separate sites, with the precautions that apply to the individual vaccines. Some data suggest that the simultaneous administration of cholera and yellow fever vaccines may interfere with the immune response to each other. Decreased levels of antibodies have been observed when the vaccines are administered within 3 weeks of each other, compared with administration of the vaccines at longer intervals. However, there is no evidence that protection to either of these di
https://diarynote.indered.space
*Children Buttocks
*Boils Children’s Buttocks
*Warts On Children’s Buttocks
*Pimples Children’s Buttocks
*Children’s Buttocks Rash
Find child buttocks stock images in HD and millions of other royalty-free stock photos, illustrations and vectors in the Shutterstock collection. Thousands of new, high-quality pictures added every day. The buttocks should not be routinely used as a vaccination site for infants and children; and, to avoid injury to the sciatic nerves, they are generally not used in adults, The central region of the buttocks should be avoided for all injections; the upper, outer quadrant should be used only for the largest volumes of injection or when multiple. I even got stuck next to a mother with her two daughters, one of whom was rocking some butt pants, on a 50+ hour train journey from Shanghai to Urumuqi and had the pleasure of witnessing (smelling, to be exact) the youngest one putting her bottomless pants to good use on the floor right next to my sleeper berth seemingly every 30 minutes or so for the duration of the trip. Above his head to the wall hanging, a tablet: Nil Similius Insano Quam Ebrius (For example, the Old Sing, as beeping the boy). In addition, a parrot in a birdcage. Right sweeps a woman’s buttocks of a child, while an old man grabs her chest. From the womb of his mother a child urinates on a dog standing on the table. A man must surrender. Buttocks: Expose one side of the buttocks. With an alcohol wipe draw a line from the top of the crack between the buttocks to the side of the body. Find the middle of that line and go up 3 inches. From that point, draw another line down and across the first line, ending about halfway down the buttock.
Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: mmwrq@cdc.gov. Type 508 Accommodation and the title of the report in the subject line of e-mail.
This revision of the ’General Recommendations on Immunization’ updates the 1980 statement.* Changes from that statement clarify information on possible interference with the immune response by spacing immunobiologics. Recommendations for vaccinating persons with allergies are revised. New sections dealing with many aspects of immunization procedures have been added. INTRODUCTION
Recommendations for immunization of infants, children, and adults are based on facts about immunobiologics and scientific knowledge about the principles of active and passive immunization and on judgments by public health officials and specialists in clinical and preventive medicine. Benefits and risks are associated with the use of all products--no vaccine is completely safe or completely effective. The benefits range from partial to complete protection from the consequences of disease, and the risks range from common, trivial, and inconvenient side effects to rare, severe, and life-threatening conditions. Thus, recommendations on immunization practices balance scientific evidence of benefits, costs, and risks to achieve optimal levels of protection against infectious or communicable diseases.
These recommendations describe this balance and attempt to minimize the risk by providing specific advice regarding dose, route, and spacing of immunobiologics and by delineating situations warranting precautions or contraindicating their use. These recommendations may apply only in the United States, as epidemiological circumstances and vaccines may differ in other countries. The relative balance of benefits and risks may change as diseases are brought under control or eradicated. For example, because smallpox has been eradicated throughout the world, the very small risk from smallpox vaccine now exceeds the risk of smallpox; consequently, smallpox vaccination of civilians is now indicated only for laboratory workers directly involved with smallpox or closely related orthopox viruses (e.g., monkeypox, vaccinia, and others). *Replaces previous recommendations on this subject in MMWR 1980;29:76,81-83. DEFINITIONS
*
Immunobiologic: Immunobiologics include vaccines, toxoids,
and antibody containing preparations from human or animal donors, including globulins and antitoxins. These products are used for immunization.
*
Vaccine: A suspension of attenuated live or killed microorganisms (bacteria, viruses, or rickettsiae), or fractions thereof administered to induce immunity and thereby prevent infectious disease.
*
Toxoid: A modified bacterial toxin that has been rendered nontoxic but that retains the ability to stimulate the formation of antitoxin.
*
Immune globulin (IG): A sterile solution containing antibody from human blood. It is a 15%-18% protein obtained by cold ethanol fractionation of large pools of blood plasma. It is primarily indicated for routine maintenance of certain immunodeficient persons, and for passive immunization against measles and hepatitis A.
*
Specific immune globulin: Special preparations obtained from donor pools preselected for a high antibody content against a specific disease, e.g., Hepatitis B Immune Globulin (HBIG), Varicella Zoster Immune Globulin (VZIG), Rabies Immune Globulin (RIG), and Tetanus Immune Globulin (TIG).
*
Antitoxin: A solution of antibodies derived from the serum of animals immunized with specific antigens (diphtheria, tetanus) used to achieve passive immunity or to effect a treatment. B. Vaccination and immunization: Today, these terms are often
used interchangeably. The words vaccination and vaccine derive from vaccinia, the cowpox virus once used as smallpox vaccine. Thus, vaccination originally meant the inoculation of vaccinia virus to render individuals immune to smallpox. Some people still prefer that the term vaccination be restricted to this use, but many have come to use the term in a more general sense, to denote the administration of any vaccine or toxoid without regard to whether the recipient is successfully made immune.
Immunization is a more inclusive term denoting the process of inducing or providing immunity artificially by administering an immunobiologic. Immunization can be active or passive.
Active immunization denotes the production of antibody or antitoxin in response to the administration of a vaccine or toxoid. Passive immunization denotes the provision of temporary immunity by the administration of preformed antitoxin or antibodies (e.g., immunoglobulin, maternal antibodies). Three types of immunobiologics are used for passive immunization: (1) pooled human IG, (2) specific IG preparations, and (3) antitoxin.
Although there is lack of consensus that vaccination and immunization are completely synonymous, these words are used interchangeably in ACIP statements when referring to active immunization. Regardless of which term is used, it must be emphasized that administration of an immunobiologic cannot be automatically equated with the development of (or conferring of) adequate immunity because of a variety of specific factors, many of which are discussed in this statement.
C. Antigen(s): Substance(s) inducing the formation of antibodies. In some vaccines, the antigen is highly defined (e.g., pneumococcal polysaccharide, hepatitis B surface antigen, tetanus or diphtheria toxoids); in others, it is complex or incompletely defined (e.g., killed pertussis bacteria, live, attenuated viruses). IMMUNOBIOLOGICS
The specific nature and content of immunobiologics may differ. When immunobiologics against the same infectious agents are produced by different manufacturers, active and inert ingredients among the various products may differ. Practitioners are urged to become familiar with the constituents of the products they use. The constituents of immunobiologics include:
*
Suspending fluid: This frequently is as simple as sterile
water or saline, but it may be a complex fluid containing small amounts of proteins or other constituents derived from the medium or biologic system in which the vaccine is produced (serum proteins, egg antigens, cell-culture-derived antigens).
B. Preservatives, stabilizers, antibiotics: These components of vaccines are used to inhibit or prevent bacterial growth in viral culture or the final product, or to stabilize the antigen. They include such materials as mercurials and specific antibiotics. Allergic reactions may occur if the recipient is sensitive to one of these additives.
C. Adjuvants: An aluminum compound is used in some vaccines to enhance the immune response to vaccines containing inactivated microorganisms or their products (e.g., toxoids and hepatitis B virus vaccine). Vaccines with such adjuvants must be injected deeply in muscle masses, since subcutaneous or intracutaneous administration may cause local irritation, inflammation, granuloma formation, or necrosis. ROUTE, SITE, AND TECHNIQUE OF IMMUNIZATION
*
Route: There is a recommended route of administration for
each immunobiologic. To avoid unnecessary local or systemic effects and/or ensure optimal efficacy, the practitioner should not deviate from the recommended route of administration.
B. Site: Injectable immunobiologics should be administered in an area where there is minimal opportunity for local, neural, vascular, or tissue injury. Subcutaneous injections are usually administered into the thigh of infants and in the deltoid area of older children and adults. Intradermal injections are generally given on the volar surface of the forearms, except for human diploid cell rabies vaccine, with which reactions are less severe in the deltoid area.
In the past, the upper, outer quadrant of the buttocks was the usual site of intramuscular vaccination. The buttocks should not be routinely used as a vaccination site for infants and children; and, to avoid injury to the sciatic nerves, they are generally not used in adults, The central region of the buttocks should be avoided for all injections; the upper, outer quadrant should be used only for the largest volumes of injection or when multiple doses need to be given, such as when large doses of IG must be administered. The site selected should be well into the upper, outer mass of the gluteus maximus and away from the central region of the buttocks.
Currently, preferred sites for intramuscular injections are the anterolateral aspect of the upper thigh and the deltoid muscle of the upper arm. In most infants, the anterolateral aspect of the thigh provides the largest muscle mass and, therefore, is the preferred site. In older children, the deltoid mass is of sufficient size for intramuscular injection. An individual decision must be made for each child, based on the volume of the injected material and the size of the muscle into which it is to be injected. Many practitioners prefer to continue using the anterolateral thigh until age 3 years before switching to the deltoid area. In adults, the deltoid is generally used for routine intramuscular vaccine administration.
C. Techniques: Before giving the injection, the needle is inserted in the site, and the syringe plunger is pulled back to see if blood appears; if so, the needle should be withdrawn and a new site selected. The same procedure is followed until no blood appears. A separate needle and syringe should be used for each injection. Disposable needles and syringes should be discarded in labeled containers to prevent accidental inoculation or theft. If more than one vaccine preparation is administered, each should be given at a different site. DOSAGE
The recommended doses of immunobiologics are derived from theoretical considerations, experimental trials, and clinical experience. Administration of dose volumes smaller than those recommended, such as split doses or intradermal administration (unless specifically recommended), may result in inadequate protection. Exceeding the recommended dose volumes might be hazardous because of excessive local or systemic concentrations of antigens.
Some practioners use divided doses of vaccine (particularly diphtheria and tetanus toxoids and pertussis vaccine (DTP)) to reduce reaction rates. There has not been adequate study of the efficacy of such practices by serologic confirmation or clinical efficacy or of the effects on the subsequent frequency and severity of adverse reactions. The Committee does not recommend dividing doses of any vaccine. AGE AT WHICH IMMUNOBIOLOGICS ARE ADMINISTERED
Several factors influence recommendations concerning the age at which vaccine is administered (Tables 1-3). These include: age-specific risks of disease, age-specific risks of complications, ability of individuals of a given age to respond to the vaccine(s), and potential interference with the immune response by passively transferred maternal antibody. In general, vaccines are recommended for the youngest age group at risk with an acceptable level of antibody response following vaccine administration. For example, while infants as young as 6 months of age may be at risk for measles, most are protected by maternal antibody, which may inhibit successful active immunization at this age. In the United States, measles vaccine is routinely administered at 15 months of age, by which time maternal antibody is no longer detectable.
In certain measles epidemics, public health officials may recommend measles vaccine for infants as young as 6 months of age. Although a smaller proportion of those given vaccine before the first birthday develop antibody to measles, compared with older infants, the higher risk of disease during an epidemic may justify earlier immunization. Such infants should be reimmunized at the recommended age for measles vaccination to achieve protection. SPACING OF IMMUNOBIOLOGICS
*
Multiple doses of same antigen: Some products require more
than one dose for full protection. In addition, it is necessary to give periodic reinforcement (booster) doses of some preparations to maintain protection. In recommending the ages and/or intervals for age for measles vaccination to achieve protection. SPACING OF IMMUNOBIOLOGICS
*
Multiple doses of same antigen: Some products require more
than one dose for full protection. In addition, it is necessary to give periodic reinforcement (booster) doses of some preparations to maintain protection. In recommending the ages and/or intervals for multiple doses, the Committee takes into account current risks from disease and the objective of inducing satisfactory protection. Intervals between doses that are longer than those recommended do not lead to a reduction in final antibody levels. Therefore, it is unnecessary to restart an interrupted series of an immunobiologic or to add extra doses. By contrast, giving doses of a vaccine or toxoid at less than recommended intervals may lessen the antibody response; doses given at less than recommended intervals should not be counted as part of a primary series.
B. Different antigens: Experimental evidence and extensive clinical experience have strengthened the scientific basis for giving certain vaccines at the same time. Most of the widely used antigens can safely and effectively be given simultaneously. This knowledge is particularly helpful in circumstances that include imminent exposure to several infectious diseases, preparation for foreign travel, or uncertainty that the patient will return for further doses of vaccine.
In general, inactivated vaccines can be administered simultaneously at separate sites. It should be noted, however, that when vaccines commonly associated with local or systemic side effects (such as cholera, typhoid, and plague vaccines) are given simultaneously, the side effects theoretically might be accentuated. When practical, these vaccines should be given on separate occasions.
Field observations indicate that simultaneous administration (on the same day) of the most widely used live-virus vaccines has not resulted in impaired antibody response or increased rates of adverse reactions. Observation of children indicates that antibody responses to trivalent oral polio vaccine (OPV) given simultaneously with licensed combination measles-mumps-rubella (MMR) vaccine are comparable to those obtained when the same vaccines are given at separate visits. It is reasonable to expect equivalent immunologic responses when other licensed combination or live, attenuated-virus vaccines or their component antigens are given simultaneously with OPV. While data are lacking on potential interference with antibody responses to measles, mumps, rubella, and/or trivalent oral polio vaccines administered at different times within 1 month of one another, there are theoretical concerns and data showing that the immune response to a live virus vaccine might be impaired if the vaccine is administered within the month following another live virus vaccine. When feasible, live virus vaccines not administered on the same day should be given at least 1 month apart.
No data indicate that simultaneous administration of individual measles, mumps, or rubella antigens at different sites yields different results from administration of the combined vaccines in a single site.
Data on the response to simultaneous administration of diphtheria and tetanus toxoids and pertussis vaccine (DTP), OPV, and MMR vaccine are lacking. However, field experience and antibody data regarding simultaneous administration of either DTP and measles vaccine or DTP and OPV indicate that the protective response is satisfactory and adverse reactions do not increase. Therefore, simultaneous administration of all these antigens is recommended when individuals require multiple antigens and there is doubt that the recipient will return to receive further doses of vaccine. Children l5 months of age or older who have received fewer than the recommended number of DTP and OPV doses fall into this category (Table 2). Simultaneous administration of pneumococcal polysaccharide vaccine and whole-virus influenza vaccine gives satisfactory antibody response without increasing the occurrence of adverse reactions. Simultaneous administration of the pneumococcal vaccine and split-virus influenza vaccine may also be expected to yield satisfactory results. However, it should be kept in mind that influenza vaccine should be administered annually to the target population, whereas, under current recommendations, pneumococcal polysaccharide vaccine should only be administered in a single dose.
An inactivated vaccine and a live, attenuated-virus vaccine can be administered simultaneously at separate sites, with the precautions that apply to the individual vaccines. Some data suggest that the simultaneous administration of cholera and yellow fever vaccines may interfere with the immune response to each other. Decreased levels of antibodies have been observed when the vaccines are administered within 3 weeks of each other, compared with administration of the vaccines at longer intervals. However, there is no evidence that protection to either of these di
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