Pediatric Vaccination: Addressing Combination Vaccine Concerns

Q: Pediatric Vaccination: Addressing Combination Vaccine Concerns

Dear Penguin Mama,<br>Hello,<br>Question 1： My child is currently 1.5 years old and needs to receive the hexavalent vaccine. <br>However, there is a shortage of the hexavalent vaccine across Taiwan. <br>The Department of Health has suggested that the pentavalent vaccine can be ad

Five-in-one and six-in-one issues?

Hello Doctor,
Question 1: My child has been receiving the hexavalent vaccine since birth at 1.5 months, 3 months, and 6 months.
I found online that the hepatitis B vaccine is administered at 1 month and 6 months, each at 0.5 ml.
However, the hepatitis B component in the hexavalent vaccine is only 0.25 ml.
Therefore, to receive a complete four doses of the hexavalent vaccine, a total of 1 ml must be administered.
Now my child is 1.6 years old and needs to receive the hexavalent vaccine, but there is a shortage.
What should we do? Should we administer the pentavalent vaccine along with the hepatitis B vaccine? Can the oral polio vaccine be given at the same time? (The first oral dose was given at 1.3 years along with the second dose of Japanese encephalitis.)
Question 2: Can the pentavalent vaccine be administered simultaneously with the hepatitis A vaccine? If the pentavalent vaccine must be given along with the hepatitis B vaccine, that would mean three doses at once, which may be too much for the baby.
Could you please advise which vaccine should be prioritized for administration?
Question 3: My daughter is now 3.7 years old.
Initially, I did not realize that the dosage of the hepatitis B component in the hexavalent vaccine is 0.25 ml, which is different from the standalone hepatitis B vaccine at 0.5 ml.
Her vaccination schedule was as follows:
1 month -- Hepatitis B vaccine 0.5 ml
2 months -- Pentavalent vaccine
4 months -- Pentavalent vaccine
6 months -- Hexavalent vaccine 0.25 ml
1.6 years -- Pentavalent vaccine (with a 0.25 ml deficit)
Will this result in ineffective vaccination? Now that she is 3.7 years old, does she need to receive catch-up vaccinations? Is there still time to do so?

Qì'é māmā, 30~39 year old female. Ask Date: 2008/10/19

Dr. Pei Rensheng reply Pediatrics

Dear Penguin Mama,
Hello,
Question 1: My child is currently 1.5 years old and needs to receive the hexavalent vaccine.
However, there is a shortage of the hexavalent vaccine across Taiwan.
The Department of Health has suggested that the pentavalent vaccine can be administered instead; the quadrivalent or trivalent vaccines can also be given.
There is no need to administer the hepatitis B vaccine again.
Of course, the oral polio vaccine can be given simultaneously.
Question 2: The pentavalent vaccine can be administered alongside the hepatitis A vaccine.
If the pentavalent vaccine, hepatitis B vaccine, and hepatitis A vaccine are all required, I recommend that the pentavalent vaccine and hepatitis B vaccine be given first (as they are government-recommended subsidized vaccines).
Question 3: My daughter is currently 3.7 years old.
Initially, I did not notice that the dosage of the hepatitis B vaccine in the hexavalent vaccine is 0.25 ml, which is different from the standalone hepatitis B vaccine at 0.5 ml.
My daughter's vaccination timeline is as follows: at 3 days old: received hepatitis B vaccine 0.5 ml; at 1 month: received hepatitis B vaccine 0.5 ml; at 6 months: received the hexavalent vaccine, which includes hepatitis B vaccine 0.25 ml; at 1.6 years: received the pentavalent vaccine with a dosage short by 0.25 ml.
This will not render the vaccination ineffective.
As stated in Question 1, the Department of Health has clearly recommended that there is no need to administer the hepatitis B vaccine again.
Therefore, there is no need for a catch-up vaccination.
Wishing you health and happiness!
Sincerely,
Dr.
Pei Ren-Sheng,
Director of Pediatrics, Taoyuan Hospital, Department of Health

Reply Date: 2008/10/19

More Info

When it comes to pediatric vaccinations, particularly regarding combination vaccines, there are several important considerations to keep in mind. Your questions touch on various aspects of vaccination schedules, dosages, and potential combinations, which are crucial for ensuring that children receive adequate protection against infectious diseases.

Question 1: Combination Vaccination and Dosage Concerns
You mentioned that your child has been receiving the hexavalent vaccine (which includes protection against six diseases, including hepatitis B) at 1.5 months, 3 months, and 6 months. The concern arises from the fact that the hexavalent vaccine contains only 0.25 ml of hepatitis B vaccine, while the standard hepatitis B vaccine is typically administered at 0.5 ml. To achieve the recommended total dosage of hepatitis B vaccine, it is indeed necessary to ensure that the child receives the full series of vaccinations.

In the event that the hexavalent vaccine is unavailable, it is generally acceptable to administer the pentavalent vaccine (which covers five diseases) along with a separate dose of the hepatitis B vaccine. This approach ensures that your child receives the necessary protection against hepatitis B while still benefiting from the other vaccines included in the pentavalent formulation. Additionally, administering the oral polio vaccine (OPV) simultaneously is typically safe and can be done during the same visit, provided that the healthcare provider is aware of the vaccination history.

Question 2: Simultaneous Vaccination with Hepatitis A
Regarding your question about administering the pentavalent vaccine alongside the hepatitis A vaccine, it is generally permissible to give multiple vaccines during the same visit. The Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) support the simultaneous administration of vaccines when appropriate, as this can help ensure that children are fully vaccinated without unnecessary delays.

If you are considering administering the pentavalent vaccine and the hepatitis B vaccine together, it is important to consult with your healthcare provider. They can help determine the best approach based on your child's vaccination history and current health status. If you decide to proceed with this combination, it is advisable to space out the injections to different sites on the body (e.g., one in each arm) to minimize discomfort.

Question 3: Concerns About Hepatitis B Dosage
Your concern regarding the dosage of hepatitis B vaccine received by your child is valid. The difference in dosage (0.25 ml from the hexavalent vaccine versus 0.5 ml from the standalone hepatitis B vaccine) could potentially impact the immune response. However, the immune system is quite resilient, and children often respond well to the vaccines they receive, even if there are slight variations in dosage.

Since your child is now 3.7 years old and you are questioning the adequacy of the previous vaccinations, it is advisable to consult with your pediatrician. They can assess whether your child is up to date on vaccinations and whether any booster doses are necessary. In many cases, if a child has received the majority of their vaccinations on schedule, they may not require additional doses, but this should be confirmed by a healthcare professional.

Conclusion
In summary, it is crucial to follow the recommended vaccination schedule and ensure that your child receives the appropriate dosages of vaccines. If there are concerns about vaccine availability or dosage, consulting with a healthcare provider is the best course of action. They can provide tailored advice based on your child's health history and current vaccination needs. Vaccination is a key component of public health, and ensuring that children are fully vaccinated helps protect not only their health but also the health of the community at large.

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