Pediatric immunization update

The practise of immunization is dif­ficult given the rapid advances in science and the pace at which new products come on the market. This is further complicated by the delay of new products being placed on the provincial schedule. 

There are many international and national expert opinions on how immunizations should be given (see NACI, www.phac-aspc.gc.ca/naci-ccni/; CPS, www.cps.ca; AAP, www.aap.org; BCCDC, www.bccdc.org/content.php?item=193). The BC Pediatric Society (BCPS) feels we can help with the practical application of this information.

BC children should have the best in immunization practice available to them. Every opportunity should be taken to ensure children and their parents have up-to-date information on immunizations:

• Primary care providers should briefly discuss immunizations at all pertinent visits.
• Information on vaccines currently not part of the provincial schedule should be provided in the form of discussion, written information, or both.
• Consultants should discuss immunizations as part of office or hospital consultations.

For more information, please see the “Vaccines fact sheet” below, review the BC immunization schedule, and read our suggestions on how to use both the new vaccines and the products currently on the market  at www.bcpeds.ca.

—Todd Sorokan, MD
President, BCPS

VACCINES FACT SHEET 
(These vaccines not part of BC provincial schedule)

Rotavirus vaccine (Rotateq): Oral vaccine for use in infants starting at 6–12 weeks of age to prevent gastroenteritis and admission to hospital from five serotypes of rotavirus for two seasons.

Hepatitis A vaccine: A hepatitis A vaccine is recommended in many countries as part of their routine series after the age of 12 months. Certainly if your patients are traveling or in day care, it is a consideration.

Meningococcal A,C,Y,W-135 conjugate (Menactra): Menactra can be used in any child 2 years and older and should then also be considered as a substitute for the Men-C given at 11 years/grade 6 for added protection against the three extra serotypes. The serotypes causing disease vary from year to year and are unpredictable. The addition of the added serotypes has the potential to prevent a number of cases of invasive meningococcal disease every year (likely an extra 25% of the preventable cases). It will also boost the Men-C given at 2 months and 1 year and offer greater protection for travel.

Traveler’s diarrhea vaccine (Dukoral): Oral vaccine that protects against enterotoxigenic E. coli. and cholera. The first dose needs to be started two weeks before travel so that two doses are finished at least 1 week before travel.

Human papillomavirus vaccine (Gardasil): Quadravalent vaccine offers excellent protection against genital warts and cervical cancer. The provincial program will not cover girls now in grade 9 and older, so the vaccine should be considered for this group of young women now. See the excellent position statement at the Canadian Pediatric Society web site at www.cps.ca).