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OPV vaccine contraindications

Contraindications of OPV. Contraindications of OPV Indian Pediatr. 1999 Mar;36(3):318-9. Author Y Paul. PMID: 10713850 No abstract available. MeSH terms Child, Preschool Contraindications Female Humans Poliovirus Vaccine, Oral. OPV is administered multiple times to ensure immunity to all three types of poliovirus. Indication : Poliomyelitis prophylaxis; Poliomyelitis eradication; Contraindications : The poliovirus vaccine should be used with caution in patients with a history of neomycin hypersensitivity or streptomycin hypersensitivity because these agents may be used in the preparation of OPV CONTRAINDICATIONS No adverse effects are produced by giving OPV to a sick child. In case of diarrhoea, the dose received will not be counted as part of the immunization schedule and it should be repeated after recovery. Immune deficiency Individuals infected with human immunodeficiency virus (HIV), both asymptomati Contraindications (conditions in a recipient that increases the risk for a serious adverse reaction) to vaccination are conditions under which vaccines should not be administered. Because the majority of contraindications are temporary, vaccinations often can be administered later when the condition leading to a contraindication no longer exists Contraindications for Childhood* Immunization Do not administer the vaccine indicated directly above the symbol when the symptom or condition to the left is present moderate to severe (with or without fever

Contraindications General All infants should be immunized except in these three rare situations: 1. Anaphylaxis or a severe hypersensitivity reaction is an absolute contraindication to subsequent doses of a vaccine. Persons with a known allergy to a vaccine component should not be vaccinated. 2 Vaccination of preterm infants. In most cases, preterm infants (born before 37 weeks' gestation), regardless of birth weight, should be vaccinated at the same chronological age and according to the same schedule and with the same precautions as for full-term infants and children (Table 18)137,274-279

Contraindications of OPV - PubMe

Live vaccines are usually contraindicated in immune-suppressed individuals, including those with malignant disease or receiving chemotherapy. However, because immune-suppressed individuals are at great risk of certain infections, the question of vaccination needs to be assessed by a specialist. 4.5. False contraindications to vaccinatio Vaccine Contraindications1 Precautions1 Hepatitis B (HepB) • Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component • Hypersensitivity to yeast • Moderate or severe acute illness with or without fever • Infant weighing less than 2000 grams (4 lbs, 6.4 oz)2 Rotavirus (RV5 [RotaTeq], • RV1 [Rotarix] Fearing VAPP in immunocompromised, the MOH regulated contraindications for vaccination candidates and household contacts. In this study we estimate the size of the contraindicated population to OPV vaccination. Method: We studied vaccination candidates aged 2-9 and 14-23 months and probable household contacts. Using the rate of contraindications extracted for each study group from a medical records database, a statistical model was built to estimate the probability of contraindications in. WebMD provides common contraindications for poliovirus vaccine injection. Find out what health conditions may be a health risk when taken with poliovirus vaccine injectio

Monovalent OPVs for type 1 (mOPV1) and type 3 (mOPV3) poliovirus were licensed again in 2005, thanks to successful action taken by the GPEI. They elicit the best immune response against the serotype they target of all the vaccines. Monovalent OPV type 2 (mOPV2) has been stockpiled in the event of a cVDPV2 outbreak However, OPV doses noted as given during a vaccination campaign do not count as valid because such campaigns may have used monovalent or bivalent OPV. If the history is of a complete series of IPV, at least one dose should be administered on or after 4 years of age and at least 6 months after the previous dose

People given oral polio vaccine (OPV) can shed the oral vaccine virus in their faeces for up to 6 weeks after 1 dose, 6 or for several years if they are immunocompromised. Oral vaccine strains that are shed for many years or that infect people who are immunocompromised may mutate into neurovirulent strains. 10-1 OPV Vaccine Contraindications: Thermometer on the vaccine bottle: the internal square has the same or darker colour as that of the surrounding circle Severe allergy: anaphylaxis after a previous vaccine dose Severe allergy: anaphylaxis to a vaccine component, such as: Neomycin, Streptomycin, Polymyxine B, or other vaccine components. The live, attenuated oral polio vaccine (OPV) is not recommended for persons with HIV infection outside resource-limited settings if the inactivated polio vaccine (IPV) is available. Considerations for use of live, attenuated influenza vaccine (LAIV), MMR, varicella, and zoster vaccines in HIV infection are examined in the appropriate sections. completed an IPV or OPV vaccine series. SEROLOGICAL TESTING: Serological testing is not recommended before or after immunization. CONTRAINDICATIONS: 1. History of anaphylactic reaction to any poliocontaining vaccine, or to any component of - IMOVAX® POLIO. PRODUCT COMPONENTS: Potential allergens: neomycin, streptomycin, polymyxin B, calf serum protein

Cautions for Poliovirus Vaccine Inactivated Contraindications. IPV (IPOL) Hypersensitivity to any ingredient in the vaccine (including phenoxyethanol, formaldehyde, neomycin, streptomycin, polymyxin B). Anaphylaxis or anaphylactic shock within 24 hours after a previous dose of IPV. DTaP-IPV (Kinrix immunization with OPV are not contraindications to completing the primary series of immunization with IPOL vaccine. Children Incompletely Immunized Children of all ages should have their immunization status reviewed and be considered for supplementa

WHO | OPV (Oral Polio Vaccine) bivalent Types 1 and 3 (10 dose vial)

Oral-polio-vaccine - Mechanism, Indication

  1. The oral polio vaccine (OPV) contains live attenuated virus, which can, in rare cases, cause a paralysis known as vaccine‐associated paralytic polio (VAPP), and also vaccine‐derived polioviruses (VDPVs) due to acquired neurovirulence after prolonged duration of replication. The incidence of poliomyelitis caused by wild polio virus (WPV) has.
  2. Parents of children receiving OPV vaccine should be informed that infants can excrete poliovirus for up to 5 days following vaccination, so household contacts and caregivers of these infant should have up-to-date polio immunization
  3. 6 disease of 11.4 cases/100,000 population declined to 0.5 cases by the time oral poliovirus vaccine 7 (OPV) was introduced in 1961. Incidence continued to decline thereafter to a rate of 0.002 t
  4. Infection, with oral poliovirus vaccine (OPV) or wild poliovirus, also induces development of secretory IgA antibody. In addition, infection results in virus shedding and, hence, in possible spread of virus to contacts (more likelywith wild than with vaccine virus)
  5. OPV is contraindicated in children who have immunosuppressive conditions due to congenital immunodeficiency (agammaglobulinemia or hypogammaglobulinemia), cancer (leukemia or lymphoma), immunosuppressive chemotherapy, or acquired immunodeficiency syndrome (AIDS)
  6. ister at least one 0.5 mL dose of IPV. Additional doses to complete the series may be given if time permits. Completely vaccinated and at increased risk of exposure: One 0.5 mL dos
  7. The other main difference between this 5-in-1 vaccine and the one used in the UK is that it contains whole-cell pertussis vaccine (wP) rather than acellular pertussis vaccine (aP). Whole-cell pertussis vaccine is made using killed whole pertussis bacteria and may lead to a greater risk of side effects such as high fever and seizures (fits)

WebMD provides common contraindications for BCG vaccine injection. Find out what health conditions may be a health risk when taken with BCG vaccine injectio Persons in close contact with a recently vaccinated child may very rarely be at risk of vaccine-associated paralytic poliomyelitis. CONTRAINDICATIONS No adverse effects are produced by giving OPV to a sick child. In case of diarrhoea, the dose received will not be counted as part of the immunization schedule and it should be repeated after. childhood vaccinations The infant and childhood immunization program in Canada has led to extraordinary decreases in serious infections with diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, hepatitis B, measles, mumps and rubella. There is a danger that this successful immunization program may lead to complacency about vaccine preventable illnesses such that parents, and. Contraindications for MMR vaccination include history of a severe (anaphylactic) reaction to a previous dose or to any component of the vaccine (such as gelatin or neomycin), pregnancy and immunosuppression. The attenuated vaccine strain of measles is propagated in chick embryo cell culture and is grown in a buffered salt solution (Medium 199.

dose of oral polio vaccine (OPV) at border points on arrival in Saudi Arabia All pilgrims and children aged two years and up in addition to pregnant women All pilgrims arriving from countries administering vaccines and contraindications for vaccination. (2) Yellow feve 2. Oral polio vaccine 2.1 What it is Oral polio vaccine (OPV) gives protection against the three types of virus that cause polio. It is a liquid that comes in two types of containers: small plastic bottles that work like droppers, and glass vials with droppers in a separate plastic bag. As from January 1996 all OPV vials supplied by WHO/UNICEF. USES: This medication is a vaccine. It causes your immune system to protect you from polio virus. HOW TO USE: This vaccine (OPV) is taken by mouth in a series of separate doses. The medication may be given directly from the bottle, mixed with certain liquids or on a sugar cube. Other doses may be given as the injection polio vaccine (IPV) Contraindications: Anaphylactic reaction to previous dose. ORAL POLIO VACCINE(OPV) INJECTABLE POLIO VACCINE(IPV) ORAL POLIO VACCINE INJECTABLE POLIO VACCINE (OPV) (IPV) 1.TYPE OF Live attenuated poliovirus Killed/Inactivated Vaccine VACCINE (2. Recommended vaccination schedules for immunocompetent children and adults are published annually by the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and.

ACIP Contraindications Guidelines for Immunization CD

The Immunization Practices Advisory Committee (ACIP) believes that, in the United States, polio immunization should rely primarily on oral poliovirus vaccine (OPV), with selected use of enhanced-potency IPV as specified in this document. However, this subject should be reviewed on a continuing basis, and an extensive review of polio vaccines. Sabin s Oral Polio Vaccine is a live-attenuated vaccine; Contains 3 serotypes of vaccine virus It replicates very efficiently in the gut, the primary site of infection and replication, Unable to replicate efficiently within nervous system tissue. Shed in stool for up to 6 weeks following vaccination Pros and Cons of Oral Polio Vaccine

For series that contain oral polio vaccine (OPV), either only OPV or mixed OPV-IPV: For all other contraindications to the use of LAIV, see the ACIP's 2019-2020 recommendations. Administer annually an age formulation and dose of influenza vaccine that is appropriate for patient's age and health status A primary vaccination series with either vaccine produces immunity to all three types of poliovirus in more than 95 percent of recipients. The primary series of OPV consists of three doses: two doses given 6 to 8 weeks apart and a third dose given at least 6 weeks and customarily 6 to 12 months after the second In this Viewpoint, we discuss two important issues of poliovirus vaccination: the sequence and timing of vaccinations and the screening of contraindications before vaccination. The relative risk of VAPP with different doses of OPV needs to be clarified In Canada, after using the live attenuated oral polio vaccine (OPV) for many years, its use was replaced with an inactivated poliomyelitis vaccine (IPV) in 1995/1996. The last indigenous case of wild poliovirus in Canada was in 1977. In 1994, Canada was certified as being free of wild poliovirus by the World Health Organization Inactivated polio vaccine (with tetanus and diphtheria) should be given to adults and children according to the UK schedule, regardless of CD4 count, viral load or ART therapy [1, 4]. Live oral polio vaccine (OPV) is contraindicated in travellers with HIV (regardless of CD4 cell count) and their close contacts [1]

Of All the Problems in the World, Why Polio?

Reintroducing OPV in Israel on the journey to global polio

Santa Barbara Vaccines Awareness: PolioMODULE 2 – Contraindications - WHO Vaccine Safety Basics

Perceived vaccination contraindications that are not part of established contraindications included in national and international guidelines was the most common reason for healthcare providers not to vaccinate children during hospital stay. Among caregivers of under- OPV DPT Vaccination status Definitio It has been estimated that 10- 30 million of the 98 million people who received a polio shot actually received a vaccine that contained SV40 (Shah and Nathanson, 1976). In addition, about 10,000 volunteers who received an experimental oral polio vaccine (OPV) between 1959-1961 may have been exposed to SV40

Bcg opv ipv vaccines and catchup vaccination (immunization)

The minimum interval between doses of rotavirus vaccine is 4 weeks. All doses should be administered by 8 months, 0 days of age. Recommendations in this statement also address the maximum ages for doses, contraindications, precautions, and special situations for administration of rotavirus vaccine According to the World Health Organization, as of April 2016, trivalent oral polio vaccine (OPV) was replaced with either bivalent or monovalent OPV. In order to ensure protection against all 3 poliovirus types, any doses of OPV received on or after April 1, 2016 are not considered as a valid dose within the routine BC Immunization Schedule Vaccine group: Combination vaccines. Registered for primary immunisation in infants aged ≥6 weeks and as a booster in children aged ≤6 years. DTPa - IPV — diphtheria-tetanus-acellular pertussis-inactivated poliovirus combination vaccine. Each 0.5 mL monodose pre-filled syringe contains: ≥30 IU diphtheria toxoid. ≥40 IU tetanus toxoid The need for tetanus toxoid (active immunization), with or without TIG (passive immunization), depends on both the condition of the wound and the patient's vaccination history (Table 5; see also Precautions and Contraindications). Rarely has tetanus occurred among persons with documentation of having received a primary series of toxoid injections

Common and Rare Side Effects for poliovirus vaccine injectio

IMOVAX® Polio [Inactivated Poliomyelitis Vaccine (Vero Cell Origin)] is a sterile suspension of three types of inactivated poliomyelitis vaccine: type 1 (Mahoney), type 2 (MEF1) and type 3 (Saukett). This vaccine is prepared from types 1, 2 and 3 of poliovirus cultured on Vero cells, purified and then inactivated by formaldehyde Sequence of vaccination of infant at 4 months of age at the visit of vaccination Step l: Give OPV first Step 2: Give IPV to Right thigh Step 3: Give Pentavalent vaccine to Left thigh Contraindications Should not vaccinate if: Known or documented allergy to vaccine components, including: Streptomycin, Neomycin, Polymyxin

Opv - Gpe

The incidence of poliomyelitis in the United States declined rapidly after the licensure of inactivated poliovirus vaccine (IPV) in 1955 and live oral polio vaccine (OPV) in the 1960s. The last cases of indigenously acquired polio in the United States occurred in 1979 and in the Americas in 1991 According to the agency 1 in 2.7 million oral doses results in vaccine-associated paralytic polio. Although there have been reports of contaminated vaccine even after the eradication of polio in India. The data from the WHO show that there were 17 cases of vaccine-derived poliovirus cases recorded in India between 2000 and 2017 Inactivated Polio Vaccine (IPV) is an injectable form of polio vaccine which can be administered alone or in combination with other vaccines like OPV (oral polio vaccine), diphtheria, tetanus, pertussis, hepatitis B, and haemophilus influenza. Q-2 What are the Contraindications for IPV? There are two contraindications for IPV In other countries, where polio disease is still a major problem, oral polio vaccine (OPV) is given. Timing and dose — The injected polio vaccine series in the United States includes four doses; the first and second doses are given at 2 and 4 months of age. The third dose is usually given at 6 to 18 months of age, and a fourth dose is. Gut microbiota were identified using 16S ribosomal RNA sequencing 28 days before, 14 days before, and at the last dose of OPV. Vaccine-induced type 2-specific mucosal IgA showed a decrease after.

Ask the Experts: Polio Vaccine

The DPT vaccine or DTP vaccine is a class of combination vaccines against three infectious diseases in humans: diphtheria, pertussis (whooping cough), and tetanus. The vaccine components include diphtheria and tetanus toxoids and either killed whole cells of the bacterium that causes pertussis or pertussis antigens. The whole cells or antigens will be depicted as either DTwP or DTaP, where.

OPV (ORAL POLIO VACCINE) - CONTRAINDICATIONS Long-term steroid therapy or any other drug that affects the immune system. Chemotherapy or radiotherapy. AIDS or HIV infection, or another disease that affects the immune system. In case of household contacts belonging to anyone of the above mentioned three groups, the child should not get OPV. Severe allergic reaction to previous dose of OPV. vaccine (OPV) • OPV has not been found harmful when administered to asymptomatic HIV-positive children. However, if available, inactivated polio Health personnel commonly misperceive some conditions as contraindications to vaccination, when in fact they are not (so called false contraindications). General t contraindications for childhood vaccination; OPV - Sabin vaccine Hib vaccine (HbOC) first six months 12 months Measles, mumps, rubella Hib (PRP-OMP schedule only) MMR Hib vaccine (PRP-OMP) second 12 months 18 months Diphtheria, tetanus, pertussis Hib (HbOC schedule only) DTPa or DTP contraindications before vaccination. The relative risk of VAPP with different doses of OPV needs to be clarified. For all countries using OPV, WHO suggests administration of multiple doses of bivalent OPV and at least one dose of IPV.1 However, in countries with high vaccination coverage (eg, 90-95%) and low ris Has the child been previously immunized with oral polio vaccine (OPV)? Yes: Give vaccine. A series that has been started with OPV may be completed with the IPV preparation that is in DTaP- IPV- Hib vaccine. Not Contraindications High fever within 48 hours following last dose of DTaP-IPV-Hib vaccine

Poliomyelitis The Australian Immunisation Handboo

For full prescribing information and contraindications for vaccinations, please consult individual package inserts. OPV (0) BCG 6 weeks Oral polio vaccine Rotavirus vaccine Diphtheria-tetanus-acellular pertussis-injectable polio-Haemophilus influenzae b- Hepatitis B vaccine A change in the recommendations for routine immunization of children is indicated because of the reduced risk of exposure to wild-type polio viruses and the continued occurrence of vaccine-associated paralytic poliomyelitis after oral polio vaccine (OPV). All children should receive four doses of vaccine before the child enters school. Regimens of sequential inactivated polio vaccine (IPV) and. Contraindications and Precautions. Oral polio vaccine (OPV no longer available in U.S.) Vaccination Schedule. Primary series in childhood with IPV alone, OPV alone, or IPV/OPV sequentially; IPV booster only if needed for travel after age 18 years.. 3 Rev: 4/22/21 Pre-Entrance Health Form Instructions Polio • Inactivated (IPV) • Oral poliovirus (OPV no longer available inU.S.) VACCINATION SCHEDULE: Primary series in childhood with IPV alone, OPV alone, or IPV/OPV sequentially; IPV booster only if needed for travel after age 18 years. MAJOR INDICATIONS: IPV for certain international travelers to areas or countries where polio is.

[2] Oral poliovirus vaccine (OPV) is a live-attenuated vaccine that is no longer used in the United States [1]. Vaccine Effectiveness: At least 90% of recipients of two doses of IPV develop immunity to all three poliovirus types, and at least 99% develop immunity after three doses. The exact duration of immunity is unknown but appears to be. as contraindications to additional doses of vaccine (interval - see package insert) Measles, mumps and rubella in any combination; MMR, MMRV, MM : A. Anaphylaxis or anaphylactic shock (7 days) B. Encephalopathy or encephalitis (15 days) C. Shoulder Injury Related to Vaccine Administration (7 days) D. Vasovagal syncope (7 days) E OPV is no longer available in the US and is not recommended for routine immunization. (7) Previous clinical poliomyelitis (usually due to only a single poliovirus type) or incomplete immunization with OPV are not contraindications to completing the primary series of immunization with IPOL vaccine All OPV-vaccinated subjects will receive one of the nOPV2 candidates and all IPV- vaccinated subjects will receive one of the nOPV2 candidates or placebo in a double-blinded manner. For the whole study duration the subjects and blinded study staff responsible for safety evaluation will not have any information of what has been administered vaccines can be given simultaneously provided that they are administered at different anatomical sites. However, if injectable live-virus vaccines are not administered on the same day, their administration should be separated by an interval of at least 4 weeks. Live oral polio vaccine (OPV) and the live oral Ty21a typhoid vaccine can be.

Kuwait Government Online Guidelines For Vaccination

Telephone (202) 783-3238. Immunization Practices Advisory Committee Membership List, November 1991. This supplementary statement provides information on and recommendations for the use of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP). One such vaccine was recently licensed, ACEL-IMUNE toxoid-containing vaccine Polio: Inactivated (IPV) Or Oral Poliovirus (OPV- no longer IPV alone, OPV alone or IPV/OPV sequentially; IPV booster only if needed for travel after age 18 years Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component students and travelers to areas or countries wher Vaccine-associated paralytic poliomyelitis (VAPP) is a rare adverse reaction that can occur in a recipient of live oral poliovirus vaccine (OPV) or the people that they come in contact with. It can occur in people that are healthy and in people with immune system abnormalities

Pregnant travelers should not take Polio vaccine - Gynaecologists - Dental News Pakistan

Immunizations and HI

Immunization

Of the 421 children vaccinated, 257 received DTPa and 94 a monovalent acellular pertussis vaccine with or without diphtheria, tetanus, Hib, MMR, OPV, or Hep B vaccines. Forty eight (10%) children were not vaccinated following clinical review The flu shot is a vaccine that is given to reduce your risk of getting influenza (a viral infection often called the flu). In patients with cancer and weakened immune systems, it's important to prevent the flu because it can be serious and sometimes life-threatening. It is recommended that cancer patients get the flu shot that has an inactive. OPV and should avoid contact with excreted OPV virus (such as exposure to a child vaccinated with OPV in the previous 6 weeks). Because OPV is no longer given in the United States, this situation would arise only if a child receives OPV overseas. 6 . 6. Travelers staying in a polio-infected country longer than 12 months may receiv

The DTaP/IPV/Hib/HepB vaccine, also commonly known as the 6-in-1 vaccine, helps protect your child against diphtheria, tetanus, pertussis (whooping cough), polio, Haemophilus influenzae type b (Hib) and hepatitis B. Find out more about the 6-in-1 vaccine, and when and where to get it o As of April 2016, trivalent polio vaccine (OPV) was replaced with either bivalent or monovalent OPV. o In order to ensure protection against all 3 poliovirus types, individuals presenting with a record of OPV received on or after this date will require re-immunization with IPV or an IPV-containing vaccine for any of these doses. Close contacts of children who received OPV have a small but increased risk of infection with vaccine-derived polio virus because, following receipt of OPV poliovirus can be present in the throat for 1 to 2 weeks and can remain in feces for several weeks

Poliovirus Vaccine Inactivated Monograph for Professionals

The resulting vaccine is called oral (attenuated) polio vaccine (OPV). In the 1960s, Sabine's vaccine was licensed. This vaccine is in the form of oral drops. Contraindications of polio. This vaccine works by exposing you to a small dose of the virus, which causes the body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body. Polio vaccine is for use in adults and children who are at least 6 weeks old MMR (measles, mumps and rubella) vaccine. The MMR vaccine is a safe and effective combined vaccine. It protects against 3 serious illnesses: measles. mumps. rubella (german measles) These highly infectious conditions can easily spread between unvaccinated people. Getting vaccinated is important, as these conditions can also lead to serious. A negative reaction usually means you have never been infected with the bacteria that cause TB. With a negative reaction, the skin where you received the PPD test is not swollen, or the swelling is very small. This measurement is different for children, people with HIV, and other high-risk groups. The PPD skin test is not a perfect screening test

1. Should newborn vaccination programmes continue as planned during the COVID-19 pandemic? Yes, Given that institutional deliveries should be maintained in most situations, newborn vaccination (e.g. BCG, OPV, Hepatitis B) should remain a priority and vaccines given according to national immunization schedules. 2 The Td, DT, DTaP, and Tdap vaccines have different indications for use and treat specific infectious bacterial diseases. Tetanus is a bacterial infection of the nervous system, also known as lockjaw. Symptoms include muscle stiffness, difficulty swallowing, muscle spasms, and seizures. Death occurs in approximately 10% to 20% of those infected. A killed mumps virus vaccine was licensed for use in the United States from 1950 through 1978. This vaccine induced antibody, but the immunity was transient. From 1967, the year of licensure of live mumps vaccine, until 1978, the number of doses of killed mumps vaccine administered is unknown, but appears to have been limited

Inactivated or subunit vaccine. is an immunogen that cannot replicate in the host. A nucleic acid-based vaccine (usually DNA) cannot replicate in humans, is taken up by cells, in which it directs the synthesis of the vaccine antigen(s). Comparative Properties of Active Vaccines. live vaccines. subunit, inactivated vaccines. genetic vaccines. The national NHS HPV vaccination programme uses a vaccine called Gardasil. Gardasil protects against 4 types of HPV: 6, 11, 16 and 18. Between them, types 16 and 18 are the cause of most cervical cancers in the UK (more than 70%). These types of HPV also cause some anal and genital cancers, and some cancers of the head and neck In general, catch-up immunisation can be provided over three visits across 4 months in adolescents and adults (i.e. by giving the 3 rd doses of dTpa-containing and hepatitis B vaccine at the same visit). Children 4-9 years of age will require a 4 th dose 6 months after the primary course Guidance for medical exemptions for vaccination can be obtained from the contraindications, indications, and precautions described in the vaccine manufacturers' package insert and by the most recent recommendations of the Advisory Committee on Immunization Practices (ACIP) availabl