Pediatric Vaccination

Vaccination Fever

(a)   Killed:                      Within 2 days

(b)  Attenuated/ Live:       Day 5~12

Vaccination	Timing
BCG	Day 1 (BW >2.5 kg)
HBV	Day 2~5 (BW > 2.2 kg)	1M	6M
DPT	2M	4M	6M	18M	7Y
OPV
Varicella	1Y (若不和MMR同時注射則需隔1個月)
MMR	1Y	7Y
JE (和DPT間隔1個月)	15M *2(隔兩週)	27M	7Y	(Mar ~ May施打)
HAV	2Y	2Y6M
Influenza	1st dose是6M以後 (2歲前每年免費)

(a) 新式3合1:        DTaP

(b) 4合1:               DTaP       +      Hib

(c) 5合1:               DTaP       +      Hib     +        IPV

(d) 6合1:               DTaP       +      Hib     +        IPV          +     HBV

õ6合1是1.5M(6W)開始打_{(避開HBV的第二劑)}，第二劑是3M

Attenuated/ Live Vaccine注意事項：

1.     3個月內避免懷孕

2.     有以下處置需延後一段時間：

甲、IVIg (IM)                 : 3M

乙、pRBC                      : 6M

丙、PLT, FFP, IVIg (IV) : 11M

常見自費疫苗：

1.     Rotavirus          : 1.5M(6W) à 3M；和OPV要間隔2週

2.     Pneumococcal  :

甲、13價       : > 2Y

乙、7價         : < 2Y

NICE Fever Guidelines for Kids

Points that are most useful to those of us assessing kids in ED.
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Temperature measurement myths dispelled
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The NICE guidance clarifies the numbers: 
(a) 0-3 m.o. with BT > 38 ==> RED 
(b) 3-6 m.o. with BT > 39 ==> AMBER
(C) >6 m.o. BT height does NOT correlate with severity of the illness

Diagnosis
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Consider signs of meningitis; UTI; pneumonia; meningococcal disease; herpes simplex encephalitis. But also don’t forget about septic arthritis or osteomyelitis (easily missed). As an additional point always think of Kawasaki disease in a fever lasting more than 5 days.

The importance of tachycardia
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This is one of the most valuable lessons I have learned and it has changed my practice over the last couple of years. I rarely send home a child with tachycardia when they have a fever of no clear focus.
NICE now says that tachycardia puts the child into amber.
Age <12 months HR >160
Age 12-24months HR>150
Age 2-5 years HR >140

Management – 3 months or older
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Investigate fever with no source if they have any red features – FBC, CRP, B/C and urine. Consider LP, CXR, UEC and gas if indicated.
Investigate fever with no source if there are any amber features unless deemed unnecessary by an experienced paediatrician. This is clearly the greyest area. My rule of thumb is that if they look well (clinical judgement), and are not tachycardic then I would not bother doing bloods – NICE doesn’t offer any further advice on this unfortunately.
Check urine for all children with fever and no source, even if they are green.

Antipyretics
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As well as the meds, children should not be over-wrapped or underdressed. And tepid sponging is not recommended.
Use either paracetamol or ibuprofen but only for a child who appears distressed and not simply to bring down the fever. Don’t give both agents together and only switch agents if the child remains distressed.

When to discharge
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Do not rely on the temp coming down with antipyretics to distinguish between serious and non-serious illness.
Any child with amber or red features should be reassessed after 1-2 hours.

When to admit
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Use your usual markers of clinical conditions but also other social factors should help with decision: social circumstances; parental anxiety and instinct; serious infectious contacts; travel abroad; repeated presentations; when the child has remained ill for longer than expected for a self-limiting illness.

How to discharge
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Give the parents advice on recognising red or amber signs by providing written information and/or arranging follow-up.

New in 2013 
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Assess children using the new traffic light system to predict risk of serious illness (red: high-risk, amber: intermediate-rish, green: low-risk)
Recognise the importance of tachycardia and that this puts children into the amber (intermediate-risk category)
Any child younger than 3 months with fever should be investigated
Alternate antipyretics and don’t use both at the same time
Recognise that lowering the temp does not prevent febrile convulsions