Delayed vax age 6?

[chocs4me]

My oldest ds is age 6 and as yet unvaxed due me finding it impossible to make a decision on this issue - its soooo hard!! Anyway i think we are ready to start getting him vaxed - he is big and strong and i cant remember the last time he was ill. Just really worried that once he is vaxed he might start getting ill a lot and i will regret it and my worst fears realised - but anyway....

I was looking up the uk schedule and what brands of vax they use - it seems like he cant have the primary DTap etc vaxs, (pediacel-that they have at 2,3 4, months) because he is too old (not suitable after age 4 the info says) and i cant seem to find an alternative that is suitable for his age for primary vaccination of the DTap-IPV variety.

I found a canadian delayed scheduly where it says they use Tdap in anyone older than 7 who hasnt been vaxed as a baby but i cant find any information on what is done in the UK.

Anyone any ideas what happens? I would rather have some clue what i'm talking about and have checked out the brands before going to talk to the GP.

Hiya, I've had a look in the BNF.

Pediacel (Dtap with haemophilis b) is licensed for 2months to 10 years and can be given as 3 primary doses one month apart during that time. They should then get a booster 3 years of the same vax or the d(low dose) tetanus pertisis (acellular) and polio (repevax). If they are over 10 they recommend the later as the booster.
The ADTP without hb (infanrix-IPV) doesn't seem to be recommended for primary vaccination and has a dose for booster
I had a look at the US schedule which has a catch up programme for DTaP(only) for a child aged between 4 and 6
A first dose then a further 2 doses four weeks apart then a final 'booster' after 6 months. I don't know the brands the currently recommend though.

In America the acellular pertusis containing vaccines are not licenced for children between 7-10 but there are recommendations made for these circumstances. Can post more about that if it would help

Hth

PIMA - thanks for the info! I was hoping to be able to avoid him having the 5 in 1 especially since he doesnt need the hib component because at his age the combined hib/MenC (Menitorix), one jab, is enough apparently to cover both.

I would be interested in the US recommendations so i have something to take the doctors with me. I dont suppose you know if NHS GPs have any flexibility with what vaccines they give? Its looking like the 5in1 is the standard and my concerns/preferences probably wont be entertained :0/

Hiya
I think some GPs can be quite accommodating, but they are tied by what is available on the NHS formularly. IE if it is a vaccination that is not on the NHS formulary they will not stock it and can write an NHS prescription for it.

Having reviewed what seems to be available it seems that the only vaccines available on the NHS that contain the appropriate primary loading concentration for Diptheria Tetanus and accellular pertusis is the 5 in 1.
I would stress that I am not an expert in paediatrics and would definitely discuss this with your GP. It may be that if you are convinced this is not the right decision for you that a private clinic might be the alternative.

In terms of the US schedule:
This is from a US source
Diphtheria-tetanus-pertussis ? Three federally licensed combined diphtheria-tetanus-acellular pertussis (DTaP) vaccines are available in the United States for the first five doses: Daptacel, Infanrix, and Tripedia . The Tripedia formulation contains trace amounts of thimerosal (ie, ≤0.00012 percent).
reference
American Academy of Pediatrics. Pertussis. In: Red Book: 2009 Report of the Committee on Infectious Diseases, 28th ed, Pickering, LK (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2009. p.504.
available here

Sorry this wasn't quite the solution you were looking for.

It is worth knowing what is available in the UK though, because even if you go private, they might not be able to advise you on what route is best, just give you the shots. We got ours a dTaP/IPV booster at a private GPs and needed to be able to tell them the name of the vaccine - from then it was just a question of money (£75 for the doctor (15mins) 2x £5 for the vaccine).

Thanks for the info - thats brilliant just what i was looking for!

I was looking at private clinics - the nearest one i can find to us is still quite a treck but i will see what else i can find! DOctors get paid well!! £75 for 15 mins!!

oh and keep meaning to ask - info i've found about pediacel on netdoctor and medicines.org .uk both say it is not to be used after a childs fourth birthday yet you said the BNF says its licensed till age 10 - i was wondering if you know what the reason is for the difference?

Hiya Chocs.
From what I can see looking at the product information and the product monograph (which is slightly different in each country) the leaflet suggests use between 2 months and 4 years but uses the phrase 'in accordance with official applicable recommendations'

The product information gives the efficacy and safety based on the population recommended and so out with that age the product can still be used 'off label' as long as reasonable guidelines exist to support the clinical benefit of its use. In essence the product can not be guaranteed by the manufacturer to do for your child what it would for the normal dosing schedule however a body of public health doctors have agreed based on the information available that to offer it to the age of 10 will offer more benefit than risk. I couldn't comment on how the age difference would affect the efficacy of the vaccine, but in terms of safety I cant think of any reason why there would be any great differenced to the adverse effects on the product information. (obviously I would strongly suggest that you discuss this with your own doctor to ensure your decision is completely informed and comfortable)
This is the catch up schedule recommended in the UK green book

these are the standard brands used in the normal immunisation schedule

From what I can see the 5 in 1s that are readily available on the NHS are Infanrix-IPV + Hib®, Pediacel®. There may be more, but it can depend on where you are locally
HTH [hsmile]

Thanks again PIMS! Brilliant info - that chart is fab - looks like if i could hold off with the vax till he was 10 he would be getting a lot less vax's but just not sure i am comfortable waiting quite that long!!

Such a shame there is so little choice and that they want to put the vaxes in such huge groups - 5 in 1 just seems mad, although i understand the benefit of less needles so less additives etc overall, it still seems a little too much especially since at the age 6 stage the 3 hibs are unneccessary anyway.

More ruminating to do know!! :0))

5 in one vaccines may seem mad but your child could be exposed to all 5 of those diseases in the same day - would that be better?

Where exactly would they be to be exposed to them all in one day Sashh?