Vaccination Schedule and Recommendations for Infants- Initial and Follow-Up Immunizations
Q1. What vaccines does she get? What combinations are available at your clinic?
The 2-month-old baby is recommended to receive an extra six vaccines in order to help her develop strong immunity from a young age. These include:
The Hepatitis B (HepB) second dose
Rotavirus RV vaccine first dose
The Diphtheria, tetanus, and whooping cough (pertussis) (DTaP) first dose
PCV13 first dose for Pneumococcal disease
The Haemophilus influenza Type B disease (Hib) first dose.
IPV first dose for Polio
The clinic has all the vaccines available, and if not currently available, a request can be made to avail of the missing vaccine.
Q2. The child returns at 12 months after completing her primary series of vaccines at 2, 4, and 6 months of age. Her vaccines are right on schedule, and her parents have no concerns; she is developing normally, and her exam is normal. What vaccines can she get today?
Vaccination is highly recommended for children to strengthen their immunity and improve their bodies’ antimicrobial resistance (Buchy et al., 2020). By the 12th month, the child has received most of the doses for the various vaccines. The recommended vaccines that a 12-months old baby should receive include;
The Measles, Mumps, and Rubella (MMR) first dosage,
The Diphtheria, tetanus, and whooping cough (pertussis) (DTaP) fourth dose,
HepA vaccine first dose for Hepatitis A,
The Hib vaccine fourth dose for Haemophilus influenza type b disease,
IPV third dose for Polio,
Varicella first dose for protection against Chickenpox,
Pneumococcal conjugate vaccine (PCV13) fourth dose for Pneumococcal disease,
The child will also be required to receive her HepB vaccine, the Third dose at the moment or later before she turns 18 months old, and the Influenza (Flu) vaccine every other year.
Q3. Which groups of patients are at higher risk for pneumococcal disease and need PPSV23 early, starting at 2 years old?
The risk for pneumococcal disease and the need for early PPSV23 starting at 2 years old is high in patients with:
Cases of spleen issues such as a damaged spleen,
Leakage of the fluid around the brain and spinal cord,
Chronic kidney, heart, and pulmonary diseases,
Severe diabetes
Kidney disorders,
Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking, such as oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort.
St. John’s wort is a herbal medicine used in the management of anxiety and depressive disorders. The use of St John’s wort herbal products alongside estrogen combined or progestogen-only hormonal contraceptives has been shown to decrease the effect of the contraceptives (Valmiro et al., 2021). This is because St John’s wort interacts with hormonal contraceptives, increasing the metabolism of the active ingredients, reducing the pill’s effectiveness, and increasing the risk of unplanned pregnancy. Therefore, oral contraceptive pills should not be taken with St John’s wort and related products. St. John’s wort also interacts with fluoxetine oral (Prozac), increasing the production of serotonin with a risk of increased blood pressure.
Q5. What is echinacea used for, and how is it taken?
Echinacea is a herbal supplement usually taken as a dietary supplement that has been used as an alternative drug for the treatment of infections such as the common cold. According to Catanzaro et al. (2018), echinacea is an herbal immune stimulant that helps strengthen the human immune system to offer more protection against infections. How echinacea is taken depends on how it has been prepared and recommended by a physician. The herbal supplement can be taken orally or topically applied.
Q6. Is it safe for this mother to give her child echinacea?
Echinacea is safe for children. However, care must be taken as some children may be allergic to the herbal supplement, which may result in unwanted and unexpected allergic reactions and health issues. The mother needs to first check whether the child has any allergies to echinacea products.
References
Buchy, P., Ascioglu, S., Buisson, Y., Datta, S., Nissen, M., Tambyah, P. A., & Vong, S. (2020). Impact of vaccines on antimicrobial resistance. International Journal of Infectious Diseases, 90, 188-196.
Catanzaro, M., Corsini, E., Rosini, M., Racchi, M., & Lanni, C. (2018). Immunomodulators inspired by nature: a review on curcumin and echinacea. Molecules, 23(11), 2778., M., Corsini, E., Rosini, M., Racchi, M., & Lanni, C. (2018). Immunomodulators inspired by nature: a review on curcumin and echinacea. Molecules, 23(11), 2778.
Valmiro, D. J., Pinto, L. M., Barbosa, L. N., de Araújo, L. B. C., & Gonzaga, R. V. (2021). Drug interactions between herbal medicines and oral contraceptives. Research, Society and Development, 10(13), e372101321331-e372101321331.
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Question 
A healthy 2-month-old full-term infant with no concerns was brought to your clinic by her parents. Her exam was routine, and she received her Hepatitis B #1 in the nursery.
Vaccination Schedule and Recommendations for Infants- Initial and Follow-Up Immunizations
Q1. What vaccines does she get? What combinations are available at your clinic?
Q2. The child returns at 12 months after completing her primary series of vaccines at 2, 4, and 6 months of age. Her vaccines are on schedule, and her parents have no concerns; she is developing normally, and her exam is normal. What vaccines can she get today?
Q3. Which groups of patients are at higher risk for pneumococcal disease and need PPSV23 early, starting at 2 years old?
A 25-year-old woman comes to your office asking for oral contraceptive refills. She stated that she was feeling depressed and heard about St. John’s wort used in depression, which she started taking a week ago.
Q4. How might concomitant administration of St. John’s wort affect the efficacy of drugs this patient is taking, such as oral contraceptives? Discuss another example of a possible drug interaction that might occur with St. John’s wort.
The 25-year-old woman stated that her 4-year-old child had been coughing and sounded congested. She wants to know if echinacea might help her child.
Q5. What is echinacea used for, and how is it taken?
Q6. Is it safe for this mother to give her child echinacea?