5 Cases of Vaccine Catch-up: How Many Shots Needed and When?
A steep drop in age-appropriate vaccinations during the months of peak of COVID-19 spread means that catch-up is now a priority. How would you get these 5 patients current?
On March 13, 2020, a national health emergency was declared in the United States 2 months after the first identified case of COVID-19 was reported. Lock downs were ordered to varying degrees across the country and most Americans tried to avoid other humans as much as possible. This included trips to doctor offices and even to emergency departments.
One week after the emergency was declared a precipitous drop in vaccine ordering and vaccine administration occurred--less so for children younger than age 2 years versus those aged 2- to 18- years, but still, many children and adolescents will need catch-up shots.
How many shots will be needed and at what intervals for these 5 patients?
1. An adolescent was due to receive his second Gardasil (HPV) shot in January 2020, 12 months after his first dose at age 14. He turned 15 on May 1, 2020. Which of the above statements is NOT true?
Answer: A (Not true.) As long as the first dose is given before age 15 and at least 6 months has passed between the two shots, a third dose is not needed.
2. A 12-month-old missed his 12-month shot visit last April and is now due MMR, Varicella, Prevnar, Hib, hepatitis A, and DTaP. Mom tells you she has “done a little research” and would like to get the MMR, Hib, and Prevnar vaccines today and return later for the others. Which of the above is the appropriate guidance?
Answer: D. He can receive any of the vaccines at any time in the future with the exception of the varicella vaccine since if not given on the same day, one needs to wait 4 weeks between 2 live vaccines.
3. A 15-month-old is in your office for the first time. He received his first and only Hib shot (PRP-OMP or Pedvax Hib) at a different office at 3 months of age. Due to COVID-19, he hasn’t received any vaccines since. How do you counsel mom?
Answer: D. A single dose of either type of Hib vaccine is all that is needed if given after 15 months of age.
4. A mom is in your office with her 12-month-old, born at the height of the pandemic. She has had several telehealth visits, but the baby has not received any vaccinations yet. Which of the above is true?
Answer: C. A child only needs 1 shot of Prevnar if given on or after age 24 months. A child who received a first Prevnar before
age 12 months will need 2 more doses.
5. A 11-month-old is in your office. He received a DTaP vaccine at age 2 months and none since as mom felt uncomfortable coming to the office during the height of the pandemic. Now she wants to get him caught up as quickly as possible. You give him his 2nd dose today and tell her he can get dose 3, when?
Answer: C. There is always a 6-month minimum period between doses 3 and 4 of DTaP. A 6-month minimum is also required between doses 4 and 5 of DTaP.
