Deborah L. Ungerleider, MD, LLC
Deborah L. Ungerleider, MD, LLC

Immunizations

These immunizations protect your child against serious life-threatening diseases. If your child's immunizations are not up-to-date, call our office for an appointment.

 

IMMUNIZATION SCHEDULE

 

Age of Child                             Immunization                                    
 

Birth                                      Hepatitis B

1 month                                 Hepatitis B

2 months                                DTaP, IPV, Hib, RotaTeq

3 months                                Prevnar

4 months                                DTaP, IPV, Hib, RotaTeq

5 months                                Prevnar

6 months                                DTaP, Hib, RotaTeq, Influenza*****

8 months                                Hepatitis B, Prevnar

12 months                              Varivax, Prevnar, Hepatitis A, MMR

15 months                              Hib

18 months                              DTaP, IPV, Hepatitis A

4 years                                  Varivax****

5 years                                  DTaP, IPV, MMR

11-12                                    Tdap, Menactra, Gardasil***

16-21                                    Menactra******

College                                  Hepatitis A, Men B                                    
 

Explanation of abbreviations:

DTaP      =             diphtheria, tetanus, acellular pertussis (whooping cough)

Tdap      =             adult tetanus, diphtheria, acellular pertussis

MMR     =             measles, mumps, rubella

Hib         =             Hemophilus influenzae type b

Hepatitis B=         Hepatitis B

Varivax=               Varicella (chickenpox)

IPV         =            inactivated polio vaccine

Prevnar=               pneumococcal vaccine**

Menactra=            meningococcal (meningitis) vaccine******

Rota Teq=             rotavirus

Gardasil=              Human Papilloma Virus

 

*Hepatitis B should be done at any age if not done in infancy.               

** Prevnar should be done at any age 2 or under if not done in infancy. The newer Prevnar 13 is now used for the primary series; however, anyone age 14 months through 59 months who received Prevnar 7, should also receive 1 dose of Prevnar 13.  This also applies to children age 14-71 months of age who are at high risk for invasive pneumococcal disease.

***Gardasil for females and males age 11-26, series of 2-3, depending on age at which started..

****Varivax booster is recommended for anyone older than 4-6 who has had one prior Varivax

***** Influenza vaccine is recommended for all children 6 months of age and up and is required for preschool and day care centers.

******Menactra is now given for 2 doses, one at age 11-12 and a booster at age 16 or older. If the first Menactra was given at or after age 16, no booster is needed.

 

 

 



 

MEASLES, MUMPS AND GERMAN MEASLES (RUBELLA)

 

Measles is a serious communicable disease that produces a high fever, cough and rash that lasts for one to two weeks. Measles outbreaks have occured in the United States and, in particular, in New Jersey and New York. One out of every ten children who contract measles will have an ear infection or pneumonia, and measles can cause encephalitis in some children, producing seizures, spasms, twitching, jerking or staring spells, hearing loss and mental retardation. This happens to about one out of every thousand children reported to have the disease. In the United States one child out of five hundred to ten thousand who gets measles dies. Babies and adults who contract measles are more often sicker and more likely to suffer longer or die than an elementary school child or teenager with the measles.

      

Mumps causes fever, headache and swollen and painful glands under the jaw. Mumps can be a very serious disease that lasts for several days. It is passed from person to person and can cause inflammation of the brain such as meningitis in about one out of every ten people that get it. Before there was a mumps vaccine, many children had hearing loss by mumps and one out of every four teenage adult males with mumps had painful swelling of the testicles for several days called orchitis.

           

Rubella (German Measles) is a mild disease that lasts for a short time. However, when a pregnant woman contracts the disease, it could be very dangerous for her unborn baby. Up to half of the women who contract rubella when they are pregnant will lose their babies or have babies born blind, deaf, mentally retarded or with heart disease. People who contract rubella usually have fever, swollen glands and a rash that lasts up to three days and sometimes soreness in the joints and swelling.

 

MMR is the combination vaccine used to prevent the above diseases. Reactions to the mumps component are rare, but appear as a little swelling of the glands in the cheeks under the jaw. It lasts for a few days. Reactions to the rubella component (German Measles) are also rare, but are known to be lymph gland swelling in the neck or a rash for one to two days, occurring one to two weeks after the immunization is given. A transient arthritis or stiff joints may occur one to three weeks after the immunization, but is more common in adults. The measles vaccine can result in a fever and rash about 7 to 10 days after the injection. The symptoms need no treatment.

 

POLIO

 

Polio is a disease caused by a virus. Some children who get this disease become paralyzed. This means they are unable to move their body parts and they may even die from the disease. The serious cases of polio cause severe muscle pain and make a person unable to move arms, legs or have difficulty breathing without the help of a machine. Mild cases of polio may only last a few days and may cause the person to have a fever, sore throat, stomachache and headache. There are no drugs to cure people with polio. How sick people get with the disease and how much they recover is different from person to person. Most people who are afflicted by polio will have some weakness in the arm or leg for the rest of their lives or be paralyzed. Many will be seriously disabled.

 

IPV is the vaccine given for all polio vaccine doses. The IPV is injectable as opposed to oral. Since it is not a live virus vaccine, there is not the risk of contracting polio from the vaccine. Patients who will be living in third world countries may still benefit from having the oral vaccine.

 

DIPHTHERIA, TETANUS AND PERTUSSIS (WHOOPING COUGH)

 

Diphtheria is a very serious disease. It can make a person unable to breathe, cause paralysis and heart failure; about one out of every ten people that gets diphtheria dies.

 

Tetanus (sometimes called lockjaw) is a very serious disease that can occur after a cut or a wound lets the germ into the body. Tetanus makes a person unable to open his or her mouth or swallow and causes muscle spasms. In the United States tetanus kills three out of every ten people who get the disease.

 

Pertussis (commonly called whooping cough) may be a mild or serious disease. It's passed from one person to another. Pertussis can cause spells of coughing or choking that make it hard to eat, drink or breathe. The coughing can last for several weeks. Pertussis is most dangerous to children less than one year old. Even with modern medical care, complications occur. Most children are so sick they have to be hospitalized. As many as sixteen out of one hundred babies will get pneumonia. As many as two out of one hundred will have convulsions. About one out of two hundred will have brain problems lasting the rest of their life. About one in two hundred babies will die. Serious illness is less likely in older children and adults.

 

Pertussis Vaccine Concerns: The pertussis vaccine scare has made some parents postpone their child's immunizations. Keep in mind that pertussis is a very dangerous disease. The chance (1:3000) of getting whooping cough without the vaccine is much greater than the risk (1:300,000) of having a neurological reaction to the vaccine. The American Academy of Pediatrics has stated clearly that "the risk of suffering and death caused by whooping cough is far greater than the possible side effects of the vaccine." The pertussis vaccine should be withheld initially only in children with seizures or serious neurologic disease.

 

The pertussis vaccine we use currently is an acellular pertussis vaccine. It is combined with diphtheria and tetanus and is called DTaP or TDaP (for ages 11 and up). This vaccine has been shown to have fewer reactions than the DTP vaccine and is just as effective.

 

VACCINE AGAINST HEMOPHILUS INFLUENZAE TYPE b

 

Hemophilus influenzae b is a bacterium that causes several life-threatening diseases (e.g., meningitis, epiglottitis, and pneumonia) in young children. This vaccine, first released in mid-1985, gave over 90% protection against these diseases. New "conjugate" vaccines licensed in 1988 have provided 98% protection and can be administered at an earlier age.

 

All side effects have been minor. Pain or swelling at the injection site occurs in 1.5% of children and mild fevers occur in 7%.

 

If your child is over 15 months of age, the vaccine can still be helpful if given through age 5 (American Academy of Pediatrics, Committee on Infectious Diseases, 1988).

 

VARIVAX (VARICELLA, I.E. CHICKENPOX VACCINE)

 

Varicella: Although varicella is a fairly benign disease in most healthy children, there are potential complications. Also, the disease can be much more severe in adolescents and adults. There is also a high cost to families in terms of lost work and school time.

 

Varivax, the vaccine for chickenpox is given to children over 1 year of age, who have not yet had chickenpox. The vaccine is a live attenuated vaccine, as is the MMR vaccine. It is required by law in New Jersey for all children in day care 19 months of age or older and school age children born after January 1, 1998.

 

The recommendations are for children 12 months-12 years to receive 2 doses of the vaccine at least 3 months apart. All children routinely should receive the first dose at 12-15 months of age and a 2nd dose at age 4-6. From age 13 and up, they should receive 2 doses spaced 1-2 months apart (if they have not already had chickenpox).

 

Immunodeficient children should not receive the vaccine, but family members may. Children on high dose steroids should not receive the vaccine unless they have been off steroids for a period of time. There is no evidence showing that the vaccine will prevent the disease if received after exposure.

 

The reactions to the vaccine may be rash(7-8%), local pain or redness at the injection site(20-30%), fever(15%) and occasionally headache, fatigue and upper respiratory infection symptoms.

 

HEPATITIS B IMMUNIZATION

 

Hepatitis B: The American Academy of Pediatrics has recommended universal immunization of infants, children and adolescents against Hepatitis B. Hepatitis B is a virus for which there is no cure. It is one of the many types of Hepatitis, but is usually the one that causes the most illness.

 

It may lead to a chronic infection of the liver and a serious disease. It may not show signs of infection until years later when the patient develops liver failure and/or liver cancer.

 

Hepatitis B virus is transmitted in several ways: (1) from mother to infant at the time of birth, (2) children living in the same household with a Hepatitis B carrier, (3) through sexual intercourse or through sexual contact with infected blood, (4) drug use, (5) swimming in water contaminated by raw sewage and (6) blood and blood products.

 

The Hepatitis B vaccination is a recombinant vaccination and is genetically engineered. It contains no serum or blood products as the old vaccination did. No serious reactions have been associated with this vaccine and most children have no side effects. Occasionally there may be fussiness and soreness, swelling or redness where the shot was given. These symptoms can occur within 24-48 hours after the shot.

 

The American Academy of Pediatrics has recommended the use of this safe vaccination to eradicate Hepatitis B from this generation of young people. More than 95% of the children who receive all the recommended doses of Hepatitis B vaccination are protected against the illness by the Hepatitis B virus. It is a series of three immunizations. The first injection is given, followed by the second injection one to two months later and a third injection at six to eighteen months later.

 

It is now New Jersey law that all school children born after January 1, 1996 have the Hepatitis B vaccine.

 

PREVNAR (PNEUMOCOCCAL VACCINE)

 

Pneumococcal disease: Each year in the U.S. invasive pneumococcal disease is responsible for approximately 40,000 deaths, 3000 cases of meningitis, 50,000 cases of bacteremia (bacteria in the bloodstream) and 7,000,000 cases of otitis media (ear infections).

 

Prevnar: The pneumococcal vaccine (Prevnar) is now available to protect infants and children from the invasive diseases this bacteria (streptococcus pneumoniae) can cause (meningitis, pneumonia and some ear infections).

 

This is a safe and effective vaccine. The most common side effects (if any) are: fever, local reaction at the injection site and irritability.

 

The vaccine is recommended routinely for 2 month to 2 year olds and for those 2-5 year olds who are at increased risk.

 

There is a newer Prevnar 13 (covers more strains) is now used for the primary series;  however,  anyone age 14 months through 59 months  who received the original vaccine, Prevnar 7, should also receive 1 dose of Prevnar 13.  This also applies to children age 14-71 months of age who are at high risk for invasive  pneumococcal disease.

 

MENINGOCOCCAL VACCINES

 

Meningitis is an infection of the spinal fluid, usually caused by a virus or one of several types of bacteria. Viral meningitis is less severe and resolves without specific treatment. There are three types of bacterial meningitis, for which we have vaccines and antibiotic treatment. Younger children receive vaccines for Hemophilus influenzae type b (HIB) and pneumococcal (Prevnar) meningitis.

 

Meningococcal meningitis is the third type of bacterial meningitis, which is often fatal because of its rapid progression and its high level of contagiousness. Symptoms of meningitis are high fever, headache, stiff neck and also may include nausea, vomiting, extreme light sensitivity, confusion and sleepiness. A rash may also occur with meningococcal meningitis.

 

Menactra: Although meningococcal meningitis may occur at any age, certain lifestyle factors may increase the risk of contracting and spreading the disease. These are direct contact with an infected individual, especially through saliva, crowded living conditions and active or passive smoking. Until a few years ago, the vaccine that was available to protect against this disease (Menomune) was given primarily to those adolescents/young adults going off to college, because of the above risk factors. That vaccine had been shown to last for approximately 3-4 years. The American Academy of Pediatrics now recommends the newer meningococcal vaccine (Menactra), which lasts longer.

 

The recommended ages for the vaccine are:

  • 11-12 year olds (required in New Jersey for entry to 6th grade)
  • adolescents older than this who have not had the vaccine yet
  • 16 year olds and older should have a 2nd Menactra (booster), unless the first was given at age 16 or older
  • college freshman living in dormitories (many colleges, including all New Jersey colleges, require this vaccine). If your child had their vaccine prior to this, they do not need another.
  • other groups at high risk (those with underlying medical conditions or those traveling to areas with a high incidence of meningococcal disease). The vaccine is now also approved for 2-10 year olds in this category

 

Meningitis B: Serogroup B meningococcal (MenB) vaccine can help prevent meningococcal disease caused by serogroup B.  Other meningococcal vaccines are recommended to help protect against serogroups A, C, W, and Y, i.e. the Menactra vaccine that we already give at age 11 and 16.

 

Two serogroup B meningococcal vaccines have been licensed by the Food and Drug Administration.

 

These vaccines are recommended routinely for people 10 years or older who are at increased risk for serogroup B meningococcal infections, including:

  • People at risk because of a serogroup B meningococcal disease outbreak
  • Anyone whose spleen is damaged or has been removed
  • Anyone with a rare immune system condition called “persistent complement component deficiency”
  • Anyone taking a drug called eculizumab (also called Soliris®)
  • Microbiologists who routinely work with N. meningitidis isolates

 

These vaccines may also be given to anyone 16 through 23 years old to provide short term protection against most strains of serogroup B meningococcal disease; it is especially recommended before college, or for anyone still attending college.

 

The recommended schedule depends on which vaccine you get:

  • Bexsero® is given as 2 doses, at least 1 month apart, or
  • Trumenba® is given as 3 doses, with the second dose 2 months after the first and the third dose 6 months after the first.
  • The same vaccine must be used for all doses. We will be giving the Bexsero vaccine in our office.

 

ROTATEQ (ROTAVIRUS VACCINE)

 

Rotavirus is a virus that causes severe diarrhea, often with vomiting and fever, mostly in babies and young children. It occurs mainly between November and May. It can cause severe dehydration, leading to hospitalization and occasionally death. It is very contagious and although good handwashing and hygiene may help to prevent spread of the disease, it has not been effective enough.

 

Rotateq: There is now a vaccine which can protect children from rotavirus disease. It is given orally, not by injection. The vaccine is only given to babies and the series should be completed by 32 weeks of age. It is a series of 3 doses, at 2 months, 4 months and 6 months of age.

 

There are no significant side effects to the vaccine. Children are slightly (1-3%) more likely to have mild, temporary diarrhea or vomiting within 7 days of getting the rotavirus vaccine than children who have not gotten the vaccine.

 

If your child or a household member is immunocompromised, your child may not be able to receive this vaccine as it is a live vaccine.

 

GARDASIL (HUMAN PAPILLOMAVIRUS VACCINE)

 

Gardasil is a vaccine that helps protect against the following diseases caused by certain Human Papillomavirus (HPV) types: cervical cancer (cancer of the lower end of the uterus or womb), abnormal and precancerous cervical lesions, vaginal and vulvar lesions, anal cancer, oropharyngeal (back of throat, tongue and tonsils) cancer, genital warts and warts in the throat. Gardasil helps prevent these diseases – but it will not treat them.

 

HPV is a common virus. In 2005, the Centers for Disease Control and Prevention (CDC) estimated that 20 million people in the United States had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people the virus goes away on its own. When the virus does not go away it can develop into cervical cancer, anal cancer, penile cancer, oropharyngeal (back of throat, tongue and tonsils) cancer, precancerous lesions, or genital warts and warts in the throat, depending on the HPV type.

 

In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. A male or female of any age who takes part in any kind of sexual activity that involves genital contact is at risk. Many people who have HPV may not show any signs or symptoms. This means that they can transmit the virus to others and not know it.

 

Cancer of the cervix is a serious disease that can be life-threatening. This disease is caused by certain HPV types that can cause the cells in the lining of the cervix to change from normal to precancerous lesions. If these are not treated, they can turn cancerous.

 

Genital warts are caused by certain types of HPV. They often appear as skin-colored growths. They are found on the inside or outside of the genitals. They can hurt, itch, bleed, and cause discomfort. These lesions are usually not precancerous. Sometimes, it takes multiple treatments to eliminate these lesions.

 

Vaccination does not substitute for routine cervical cancer screening. Females who receive Gardasil should continue cervical cancer screening.

 

As with all vaccines, Gardasil may not fully protect everyone who gets the vaccine. Gardasil will not protect against diseases due to non-vaccine HPV types. There are more than 100 HPV types; Gardasil 4 helped protect against 4 types (6, 11, 16, and 18). These 4 types had been selected for Gardasil because they cause approximately 70% of cervical cancers and 90% of genital warts. There is now a newer vaccine, Gardasil 9, which protects against 5 additional strains. This vaccine will not protect you against HPV types to which you may have already been exposed. Gardasil works best when given before any contact with these types of HPV.

 

Gardasil is approved for females and males 9 through 26 years of age, but is currently recommended for ages 11-26. It is given as a series of 2 or 3 injections; for the 2-dose series (if started before 15 years of age) the second dose is 6 months after the first and for the 3-dose series (for 15-26 year olds), the second is 2 months after the first and the 3rd is 6 months after the first.

 

The side effects, if any are pain, swelling, itching and redness at the injection site and, rarely, fever.


 

HEPATITIS A

 

Hepatitis A is a liver disease caused by the Hepatitis A virus. The virus is spread by close personal contact and sometimes by eating food or drinking water contaminated by the virus. It is found in the stool of people with the disease. It can cause “flu-like” symptoms, jaundice (yellow skin or eyes), abdominal pain and diarrhea. It is quite contagious within households.

 

There is a vaccine for this virus, which has been given to people traveling to certain countries. There are now some new recommendations for this vaccine. It is now recommended that the following people should routinely receive the vaccine:

  • Children age 12 months- 23 months
  • People 1 year and up traveling to high risk countries (see the CDC website at www.cdc.gov/travel)
  • Children and adolescents in states where it is law to have the vaccine because of higher incidence of disease or if there is an outbreak of Hepatitis A.
  • At college entrance, if has not already had.

 

The vaccine is given as 2 doses 6-12 months apart.

 

 

INFLUENZA VACCINE

 

Fluzone: There are currently two types of influenza (flu) vaccine that we use in Pediatrics. One is an injectable vaccine (shot), called Fluzone.  This is recommended for children who are 6 months to 24 months old, children with underlying medical illnesses (i.e., asthma, diabetes, cardiac disease) and children in households where there is an immunocompromised person.

 

Flumist is the other vaccine, which is given intranasally. This vaccine, which has been shown to be even more effective than the shot in past years, can be given to children 2 years old and up, who do not have any of the risk factors listed above. However, this vaccine was determined to not be effective against the current strains of influenza and is therefore not being given in the 2016-2017 season. At this point, there is no further information as to whether or not it will be used next year.

 

The current American Academy of Pediatrics recommendation is that all children, ages 6 months through 18 years of age receive an Influenza vaccine.

 

PEOPLE WHO SHOULD NOT RECEIVE SOME VACCINATIONS

 

  • People who have progressive or undiagnosed neurologic diseases such as convulsions or are on steroid medication, or any other illness that the physicians would indicate other than a minor illness or a common cold.
  • People allergic to an antibiotic called neomycin or who have cancer, AIDS or other immunosuppressive diseases.
  • People receiving gamma globulin within the last three months or a person who thinks they are pregnant should not receive immunizations without consulting the physician.

 

If your child has received a vaccination and has any unusual behavior or appears ill within 72 hours of the vaccination, please do not hesitate to call the office.

 

If you feel your child has in any way been harmed by an immunization, please feel free to discuss the immunization with us and we will then refer you to the National Vaccine Injury Act information form.

 

We believe that immunizations have had a positive impact on the public health, therefore this office accepts only patients who will be immunized. Medical exemptions must be documented by your previous pediatrician. We are prepared to discuss any questions you may have.

 



 



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Deborah L. Ungerleider, MD, LLC

44 Godwin Ave Suite 100

Midland Park, NJ 07432

 

(201) 444-8389

 

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