For almost a year now there has been a shortage of HIB vaccine, due to a production snag for one manufacturer last year (Merck, the makers of PedVaxHIB brand). Due to the shortage, doctors have been withholding the final dose of the vaccine (normally given at 15 months of age). HIB vaccine is designed to prevent HIB meningitis, a severe disease that only affects about 25 U.S. infants and young children each year (it used to run rampant back in the 1980s, but has now all but been eliminated).
Sanofi-Pasteur, the maker of ActHIB brand, has been trying to pick up the slack until Merck’s product becomes available again. While it is still unknown when the Merck brand will be ready, the CDC has now determined that there is enough ActHIB brand to go around, so toddlers can begin receiving their 15 month booster. This dose can be given at any time between 15 months and 60 months (5 years) of age. Any child who didn’t get their 15 mo booster can get the dose at any age up until 60 months.
There are two ways to get the 15 month booster: 1. get the ActHIB brand, or 2. Get Pentacel combination vaccine (which contains DTaP, ActHIB, and Polio) at 18 months. These are both made by Sanofi Pasteur. I think it is fine to go with Pentacel combo if your doctor doesn’t carry (or doesn’t have enough) separate ActHIB. Getting Pentacel may give a child an extra polio dose unnecessarily, but I think that’s ok if that’s your only choice. Talk to your doctor about that.
Parents may wonder if they should even bother with catching up on the missing HIB dose. Virtually all cases of HIB occur in children younger than 2 years. A few cases occur in kids 2 to 5 years each year. One 4 year old child died of HIB last year in Minnesota (unvaccinated). So, I think it is worthwhile for any child missing that last dose to go ahead and get it at their next check up, as long as it is before their 5th birthday. This vaccine can be given along with any other vaccines.
Any parent who wants to skip that dose because they feel this risk of HIB is minimal can choose to do so. In general, though, I feel it is important to finish. The 3 infant doses don’t provide lasting protection. Without the 4th dose, an infant is considered not very well protected.
There is ONE situation in which a child would not need a 4th dose, and that is if a baby’s 3rd dose was given at 15 months or later. In those cases, that 3rd dose works well enough that you don’t need a fourth.
One other situation in which only 3 doses are needed is if the Merck brand (PedVaxHIB) was used (prior to its recall in 2008) and 3 doses were given. With that brand, there is no 4th dose. With the ActHIB brand (Sanofi-Pasteur, whether single ActHIB or combo Pentacel), it’s 4 doses.
The CDC is recommending that children NOT rush in to the doctor to get caught up (unless it’s going to be a while until your next checkup – 6 months or more). If everyone rushes in, doctors are going to run out again. The CDC recommends that doctors resume giving any 15 month olds the shot on time, and any toddlers who come in for a check up after that (18 mo, 2 years, etc) should get the shot at that check up.
If your child is already scheduled to get two shots at a check up, I would come in on a separate month for the HIB.
Dr. Bob
Sanofi-Pasteur, the maker of ActHIB brand, has been trying to pick up the slack until Merck’s product becomes available again. While it is still unknown when the Merck brand will be ready, the CDC has now determined that there is enough ActHIB brand to go around, so toddlers can begin receiving their 15 month booster. This dose can be given at any time between 15 months and 60 months (5 years) of age. Any child who didn’t get their 15 mo booster can get the dose at any age up until 60 months.
There are two ways to get the 15 month booster: 1. get the ActHIB brand, or 2. Get Pentacel combination vaccine (which contains DTaP, ActHIB, and Polio) at 18 months. These are both made by Sanofi Pasteur. I think it is fine to go with Pentacel combo if your doctor doesn’t carry (or doesn’t have enough) separate ActHIB. Getting Pentacel may give a child an extra polio dose unnecessarily, but I think that’s ok if that’s your only choice. Talk to your doctor about that.
Parents may wonder if they should even bother with catching up on the missing HIB dose. Virtually all cases of HIB occur in children younger than 2 years. A few cases occur in kids 2 to 5 years each year. One 4 year old child died of HIB last year in Minnesota (unvaccinated). So, I think it is worthwhile for any child missing that last dose to go ahead and get it at their next check up, as long as it is before their 5th birthday. This vaccine can be given along with any other vaccines.
Any parent who wants to skip that dose because they feel this risk of HIB is minimal can choose to do so. In general, though, I feel it is important to finish. The 3 infant doses don’t provide lasting protection. Without the 4th dose, an infant is considered not very well protected.
There is ONE situation in which a child would not need a 4th dose, and that is if a baby’s 3rd dose was given at 15 months or later. In those cases, that 3rd dose works well enough that you don’t need a fourth.
One other situation in which only 3 doses are needed is if the Merck brand (PedVaxHIB) was used (prior to its recall in 2008) and 3 doses were given. With that brand, there is no 4th dose. With the ActHIB brand (Sanofi-Pasteur, whether single ActHIB or combo Pentacel), it’s 4 doses.
The CDC is recommending that children NOT rush in to the doctor to get caught up (unless it’s going to be a while until your next checkup – 6 months or more). If everyone rushes in, doctors are going to run out again. The CDC recommends that doctors resume giving any 15 month olds the shot on time, and any toddlers who come in for a check up after that (18 mo, 2 years, etc) should get the shot at that check up.
If your child is already scheduled to get two shots at a check up, I would come in on a separate month for the HIB.
Dr. Bob
Labels: Vaccine News
7 Comments:
At July 7, 2009 1:11 PM ,
Andrea said...
Thank you this was very helpful, as i am working on vaccines/shots for my 4 1/2 month old daughter.
At July 7, 2009 4:20 PM ,
Anonymous said...
Should i wait to give the 3rd dose od HIB to my 34 mths old(almost 3 yrs) because in our country we have swine flu cases??
Tks alot.
At July 8, 2009 4:38 PM ,
Anonymous said...
DONT vaccinate against spine flu.. iT is a relatively mild diseases.. The vaccine has been made in record time which menas you and your children will be the gunie pigs. In 1976, 46mil were vaccinated against swine flu, some, died and many left paralysed.. At least wait until they have tested it properly...
At July 14, 2009 2:29 PM ,
kelli b said...
Thanks for posting this helpful update. I am looking for some advice for my twin girls regarding their shots and the expiration dates of the vaccine. Their birthday is 11/07 so following your schedule they received their Mumps on their 1st birthday (nov 08). Our doctor is holding the Measles and Rubella doses for us as they ordered the vaccine as part of a kit of all three in separate doses. I was planning on continuing to follow your schedule and get the Rubella at 2 yrs (nov 09) and the Measles at 3 years (nov 10). However our 3rd does of the vaccines expire before then: Rubella expires (Aug 2010) and Measles expires (Mar 2010)...What would you recommend that I do? Switch the order and do Measles in Nov 2009 and then Rubella in July 2010 (before it expires and just a few months early)? Or should I just do the Rubella in Nov as planned and the Measles in July? thanks for your insight.
Kelli -mom to 20 mos old twin girls
eska1@yahoo.com
At July 21, 2009 6:42 PM ,
Anonymous said...
Tks alot for yr suggestion re swine flu vaccine. Infact i've read some articles about the symptoms that caused years ago. Its a big decision as getting the flu still can cause complications and taking d vacine we still hv no idea what are the side effects! So its a tough decision, but will wait , hopefully we can hv a positive outcome from the vacine and can protect us from getting this new flu as other new types of flu are being mentioned for this winter:(
At July 21, 2009 7:16 PM ,
Anonymous said...
In my opion you should never give a vaccine earlier then it should be. Give the vaccines according to their immunisation record book and the age that one should be vaccinated,( i suggest that you gv d shots about 2/3 mths after the actual month) as i saw a big difference how their body can re-act after the shot. With my 3 kid i always waited to see that she was 100% ok with no runny nose etc, even if the pead.normally tells you that once they don't hv fever the vaccine can be given. I dont agree so my advice is that you talk to yr doctor to re order another dated batch and in the meantime he can use it on for others. And you can still be assured that they will be vacinated accordingly.