DTaP:

This combination vaccine with the acellular pertussis component has a remarkable record of efficacy and safety, with reduced side effects compared to the original DPT.  The three vaccines given together induce a better protective response in your child than each one given separately. Please let the nurse know if your child has had a bad reaction to any of the doses of this vaccine.

Hepatitis A vaccine:

This inactivated vaccine against hepatitis A was first marketed in 1993. It is given as a series of 2 injections with long lasting immunity, at least 10 yrs or longer. The vaccine has been studied extensively in children 1 year of age or older and is safe to use in this group, therefore, we are recommending that it be included as part of routine childhood immunization anytime after age 1. This is now a routine childhood vaccine in USA. Currently, there are no recommendations for booster injections after the primary series.

Hepatitis B vaccine:

It has become a routine childhood immunization.  It is often given at birth, one month, and six months, but it can be started any time.  Hepatitis B is a potentially fatal form of hepatitis that can be acquired from mother-child transmission, non-sterile needles, sexual activity, or blood transfusions that haven’t been screened. We recommend this vaccine for all children. 

HIB:    Hemophilus influenza is a bacteria which can cause meningitis or epiglottitis in children.  Either infection can be fatal.  Routine childhood immunization has drastically decreased the incidence of these diseases.  If your child did not receive this vaccine according to the schedule above, it can still be given on the modified schedule shown here: 

            Starting Age 2-6 Months:  As Listed Above.

            Starting Age 7-11 Months:  Two injections two months apart and a third

                        injection at 15-18 months of age.

            Starting Age 12-14 Months: Two injections 2-3 months apart.

            Starting Age 15 Months to 5 years: One injection.

Japanese Encephalitis vaccine: Japanese encephalitis (JE) is a viral infection of the brain. Although many people get infected with the JE virus without becoming ill, among those who get clinical disease, 1/3^rd will recover, 1/3^rd will die and 1/3^rd will have some kind of permanent disability. The virus that causes JE is carried by culex mosquitoes which breed in flooded rice fields. Mosquitoes feed on infected pigs and wild birds and infected mosquitoes transmit JE virus to humans and animals while feeding. Since human infection is incidental, there is no person to person transmission. JE is endemic in the Terai and has been confirmed to occur in the Kathmandu valley since 1996. The highest risk months are August, September and early October. We recommend this vaccine to persons who live in the Terai and people who will stay in the Kathmandu in the high risk months of August – October. The vaccine that has been used until recently was the inactivated vaccine called Biken made in Japan but production of this vaccine has been phased out. Currently available vaccine is the live attenuated SA14-14-2 vaccine produced by Chengdu Institute in China. It has an excellent safety profile and over 200 million doses have been used in the past 20 years. This vaccine is expected to obtain WHO licensure in 2009 and has not yet been used in the Western world. Vero cell vaccines of the SA 14-14-2 strain are expected to be available in 2009 in the west. We are starting to use the live SA 14-14-2 vaccine at our clinic. Side effects are minimal with the live vaccine and single dose can be protective for about 5 years although manufacturers are currently recommending 2 doses 1 year apart that could be started as early as 9 months of age.  For immunizing your child, you could consider the live vaccine now or wait until next year when Vero cell JE vaccines should be available. 

MMR: Measles, mumps, and rubella are all caused by viruses and each has the potential to cause a serious illness with complications, and rubella infection in a pregnant woman can cause serious birth defects.  The vaccine utilizes live viruses that have been changed so that they induce immunity but can`t cause disease themselves.  2 doses of the vaccine are recommended to induce long lasting immunity.

Meningococcal Meningitis:  This is a very safe and highly effective vaccine against the bacteria Neisseria meningitidis, which can cause a severe brain infection, or a total body infection. The disease is acquired through the respiratory tract and can be rapidly fatal.  Kathmandu valley experienced epidemics in 1983 and 1984.  Widespread vaccination occurred in 1984, and helped stop the epidemic. The vaccine is a single shot that has to be repeated every two years in children under 5, then once every 3-5 years. We are currently stocking 2 kinds of meningitis vaccines, the A&C vaccine and also the quadrivalent vaccine Menomune which consists of A, C,Y and W135. For Nepal, A&C is sufficient. Quadrivalent vaccine is needed for the Hajj, travel to parts of Africa and in some colleges in USA.  

Polio Vaccine: As polio is eradicated from most countries of the world, inactivated injectable polio vaccine (IPV) is replacing the use of oral polio vaccine (OPV)to abolish the extremely rare vaccine associated poliomyelitis (1 in 2.4 million doses used in the U.S). We are now recommending the inactivated polio vaccine for childhood immunization and stock few doses of the oral vaccine.  Both vaccines can be interchangeably used.

Pneumococcal Conjugate vaccine (Prevnar): This is a recommended vaccine that has been available at the CIWEC Clinic for a number of years. This vaccine has been found to protect against pneumococcal infections like pneumonia and meningitis in infants and children. It is given along with other childhood vaccines at 2, 4, 6 months of age and a 4^th dose between 12-15 months. Mild pain and redness at the injection site or a low grade fever can occur in a small number of children receiving this vaccine. 

Rabies Vaccine:

Rabies vaccine can be given before one is bitten by a potentially rabid animal (pre-exposure immunization).  This immunization offers some protection against unnoticed or--in the case of children--unreported exposures to rabid animals.  Pre-exposure immunization also greatly simplifies the post-exposure treatment. Besides, there is a world-wide shortage of rabies immune globulin making rabies pre-immunization a necessity.  We feel that all children should be pre-immunized with the rabies vaccine, because they may not always tell you when they have been around stray animals.  The pre-immunization series consists of three injections on days 0, 7, and 28.  We recommend beginning the series for children at around 24-36 months, when they are starting to be more independent of their parents. In children under 5 years, we recommend a booster in three years and boosters every ten years thereafter. The vaccine is highly purified, and is relatively free of side-effects.

Typhoid Vaccine:  Typhoid fever is an infection caused by bacteria Salmonella typhi and paratyphi. The disease is highly endemic in Nepal, and is acquired through eating contaminated food or water. Typhim Vi is a highly purified typhoid vaccine which can be given from age 2 in children. One injection is effective for 2 years, and side effects are minimal. This vaccine does not protect against  paratyphi infections.

Varicella (chicken pox): This is a highly contagious infection caused by a virus. It is usually a mild, short lived disease in small children but can be severe if it occurs in adolescents, adults or pregnant women. Varicella vaccine is a live-virus vaccine that is given at one year of age at the same time as the MMR vaccine.  Because 15% of children getting a single dose of varicella vaccine have come down with chicken-pox, 2 doses of this vaccine are now recommended for full protection. First dose is given at 12-15 months of age and second dose between 4-6 years. Side effects from the vaccine are very few and mild that my include redness or pain at injection site, low grade fever or rash.

Human Papillomavirus Vaccine (HPV): This is a new vaccine that is recommended for females aged 11-12 years as a 3 dose series at 0, 2 and 6 months. It can be started as early as 9 years and catch up vaccination is recommended for females ages 13-26 years of age who have previously not been immunized. 75% of cervical cancers in women are related to human papilloma viruses and this vaccine will help prevent cervical cancer by preventing infection. The vaccine is currently made available at CIWEC by prior request due to high cost of the vaccine. If you would like your children to receive this vaccine, please let the clinic nurse know so that we can bring the vaccine for these individuals.