Nursing Considerations for Common Pediatric Immunizations

IMMUNIZATION TYPE Diphtheria and pertussis vaccines and tetanus toxiod (DTaP) Route: Intramuscular Dosage: 0.5 mL May give at same time as all other vaccines in a separate site. SIDE EFFECTS Common: Redness,pain,swelling, nodule at injection site; temperature up to 101F (38.3C); drowsiness,irritability,fussiness; anorexia within 2 days of injection.Increase in frequency and magnitude of local reactions with doses 4 and 5 (e.g.,entire limb swelling). Serious: Allergic reaction, anaphylaxis; shock, fever above 102F (38.8C); febrile seizure; persistent inconsolable crying; coma or permanent brain damage. Common: Swelling and tenderness, irritability, tiredness. Serious: Allergic reaction or anaphylaxis. NURSING CONSIDERATIONS Use same brand for all doses where feasible. Prior to immunization, ask about previous reaction to immunization. DTaP may coincide with or hasten the recognition of a seizure disorder. In children with a history of seizures with or without fever, give acetaminophen at the time of vaccine and then every 4 hours for 24 hours. Shake vaccine before withdrawing. Solution will be cloudy. If it contains clumps that cannot be resuspended, do not use. Inform parents of the chance of increased reaction to doses 4 and 5. Defer the vaccine if the child has a progressive neurologic problem until the child is stable. The series does not need to be restarted, regardless of when the previous dose was given. Prior to immunization, ask if child has an allergy to neomycin, streptomycin, or polymyxin B (whichever of these antibiotics the specific vaccine to be used contains). Clear, colorless suspension. Do not use if it contains particulate matter, becomes cloudy, or changes color. All doses must be separated by at least 4 weeks. The series does not need to be restarted, regardless of when the previous dose was given. Prior to immunization, ask if child has an allergy to neomycin or gelatin. Observe the child with an egg allergy for 90 minutes after injection. Inquire about immunosuppression. Instruct adolescent girls of childbearing age to avoid pregnancy for 3 months after immunization. Give tuberculosis test at same time as MMR or 46 weeks later. If MMR and Varivax are not given on the same day, space them at least 28 days apart. Reconstituted vaccine is a clear, yellow solution. Give entire contents of reconstituted vial even if more than 0.5 mL. As college students are at greater risk due to decreasing immunity, make sure they have received a second MMR dose. Prior to immunization, check status of mothers hepatitis B test and presence of other liver disease.Note: If mother has HbsAg+, vaccine must be given to infant within 12 hours of birth along with hepatitis B immune globulin at the same time in another site with a new needle and syringe. Shake vaccine before withdrawing. Solution will appear cloudy. Minimum spacing for children and teens is 4 weeks between doses 1 and 2, and 8 weeks between doses 2 and 3. The last dose in an infant series should not be given before 6 months of age. Vaccine brands can be interchanged for 3-dose series. The series does not need to be restarted, regardless of when the previous dose was given. (continued)

Poliovirus vaccine (IPV) Route: Subcutaneous or intramuscular, depending on vaccine used Dosage: 0.5 mL May give at same time as all other vaccines in a separate site. Measles, mumps, rubella (MMR) vaccine Route: Subcutaneous Dosage: 0.5 mL May give at same time as all other vaccines in a separate site.

Common: Elevated temperature 12 weeks after immunization; redness or pain at injection site; noncontagious rash; joint pain. Serious: Allergic reaction, febrile seizure; meningitis (usually mild); encephalopathy; thrombocytopenia purpura; rare cases of coma and permanent brain damage.

Hepatitis B (HB) vaccine Route: Intramuscular Dosage: Engerix-B: 10 mcg or Recombivax HB: 5 mcg May give at same time as all other vaccines in a separate site.

Common: Pain or redness at injection site; headache; photophobia; altered liver enzymes. Serious: Allergic reaction or anaphylaxis; fever.

Nursing Considerations for Common Pediatric Immunizations (continued)

IMMUNIZATION TYPE Haemophilus influenza type B (Hib) Route: Intramuscular Dosage: 0.5 mL May give at same time as all other vaccines in a separate site. SIDE EFFECTS Common: Pain, redness, or swelling at site. Serious: Allergic reaction of anaphylaxis (extremely rare); fever. NURSING CONSIDERATIONS Prior to immunizations, ask if child is immunosuppressed. Solution is clear and colorless. If the first dose is given between 7 and 11 months of age, 3 doses are needed. If the first dose is given at 1214 months of age, give a booster dose in 8 weeks. If the first dose is given when the child is older than 15 months or younger than 5 years, only one dose is needed. Second and third doses can be given 48 weeks after the first. Use the same vaccine preparation for all doses of the primary series if possible. The series does not need to be restarted, regardless of when the previous dose was given. Clear, colorless, or slightly opalescent liquid. In addition to infants, this vaccine is a priority for children ages 25 with sickle cell disease, asplenia, or HIV infection, or in those who are immunocompromised. The vaccine is also a priority for Native American and Native Alaskan children ages 25 because of their increased risk for pneumococcal disease. The series does not need to be restarted, regardless of when the previous dose was given. Prior to immunization, ask if child is immunodeficient, on immunosuppression treatment, or has an allergy to neomycin or gelatin. Determine if a family member is immunocompromised. Clear, colorless to pale yellow liquid when reconstituted. Give the entire contents of the vial even if more than 0.5 mL. Instruct adolescent girls of childbearing age to avoid pregnancy for 3 months after immunization.

Heptavalent pneumococcal conjugate vaccine (PCV) Route: Intramuscular Dosage: 0.5 mL

Common: Soreness, swelling, redness at injection site; mild to moderate fever; irritability, drowsiness, restless sleep, decreased appetite, vomiting and diarrhea, rash or hives. Severe: Allergic reaction or anaphylaxis. Common: Pain or redness at injection site; fever up to 102F (38.8C) in children. Less commonly, a mild vaccinerelated rash may occur during first month after the injection. Severe: Allergic reaction or anaphylaxis; thrombocytopenia; febrile seizure; central nervous system manifestations. Rare reports of anaphylaxis reaction.

Varicella virus vaccine Route: Subcutaneous Dosage: 0.5 mL

Hepatitis A Route: Intramuscular Dosage: 0.5 mL, 1 mL over 17 years for Vaqta, 1 mL over 18 years for Havrix May give at same time as all other vaccines in a separate site. Influenza Route: Intramuscular (all ages), intranasal (5 years and older) Dosage: 0.25 mL in infants 635 months, 0.5 mL beginning at 3 years May give at same time as all other vaccines in a separate site.

Shake well, slightly opaque white suspension. Can be given for postexposure prophylaxis against hepatitis A. Immune globulin and vaccine can be given at same time in different sites. Vaccine brands can be interchanged.

Common after injection: May have soreness or swelling at injection site, fever, aches. Life-threatening allergic reactions are rare. Common after intranasal vaccine: Runny nose or nasal congestion, fever, headache or muscle aches, abdominal pain, and occasional vomiting.

Thawed intranasal vaccine is pale yellow, clear to slightly cloudy. Administered annually in autumn. Children with no history of influenza illness or vaccine need 2 doses 1 month apart. lntranasal dose is split (0.25 mL) with a dose divider clip. Administer in each nostril while child is sitting in an upright position.Insert the tip of the sprayer inside the nose and depress the plunger to spray. Children 8 years of age or younger who are receiving the influenza vaccine for the first time should get 2 doses separated by at least 4 weeks (injectable) and 6 weeks (intranasal). Must be reimmunized each year as immunity wanes.

Data from American Academy of Pediatrics. (2003). Red Book: Report of the Committee on Infectious Disease (26th ed.). Elk Grove Village, IL: Author; Immunization Action Coalition. (2004). Mosbys drug consult 2004. St. Louis: Mosby; Bindler, R.M., & L.B., Howry. (2005). Pediatric drug with nursing implications. Upper Saddle River, NJ: Prentice Hall.