Vaccination Guidelines for Infants

Recommended Vaccines

• The Centers for Disease Control and Prevention (CDC) recommends that children 6 months and older should receive seasonal influenza vaccine, as well as DTaP and hepatitis B vaccines, to maintain the recommended immunization schedule 1, 2
• The American Academy of Pediatrics and CDC recommend that MMR vaccine is not recommended until 12 months of age, and varicella vaccine is also not recommended until 12 months of age 1
• The CDC recommends administering DTaP, Hib, IPV, PCV, HepB, and Rotavirus vaccines at the 2-month visit to provide early protection against multiple serious infectious diseases, and combination vaccines can be used to reduce the number of injections 2
• The American Academy of Pediatrics (AAP) prefers the use of licensed combination vaccines over separate injections of equivalent component vaccines, and individual vaccines must never be mixed in the same syringe unless specifically approved for mixing by FDA 2

Vaccination Schedule

• The 6-month dose of DTaP is the third in the recommended 5-dose series (2, 4, 6, 15-18 months, and 4-6 years), as recommended by the CDC 1
• The third dose of hepatitis B completes the primary hepatitis B series for infants, according to the CDC 1
• The hexavalent DTaP-IPV-Hib-HepB vaccine can be used for the first 3 doses of the recommended DTaP series, with a minimum age for the first dose of 6 weeks and a minimum interval between doses of 4 weeks 2
• DTaP-IPV-Hib-HepB can be used for the first 3 doses of the recommended DTaP series, but is not indicated for the fourth dose (15-18 months) or fifth dose (4-6 years), as recommended by the CDC 3
• The first dose of rotavirus vaccine must be given before 14 weeks and 6 days of age, and the series must be completed by 8 months of age, with a minimum interval between doses of 4 weeks 2
• The PRP-OMP formulation of Hib vaccine requires only 2 primary doses at 2 and 4 months, while other Hib formulations require 3 primary doses at 2, 4, and 6 months 2
• The minimum age for dose 3 of DTaP-IPV-Hib-HepB is 24 weeks (6 months), and the maximum age for any dose is 4 years, 364 days (do not administer on or after the fifth birthday), as recommended by the CDC 3

2

Administration and Monitoring

• Vaccines should be administered as an intramuscular injection, with the anterolateral thigh muscle used for injectable vaccines in infants, and the needle should be inserted at a 90-degree angle with steady pressure 2
• Administer multiple injections at separate sites, at least 1 inch apart, and document each injection site in the medical record, as suggested by the CDC 1, 2
• Infants should be observed for at least 15 minutes after vaccination for immediate adverse reactions, and vaccine administration should be documented, including the vaccine name, date, manufacturer, lot number, site, and route of administration 2
• Record vaccine name, date of administration, manufacturer, lot number, site, and route of administration, and document any adverse events, as suggested by the American Academy of Pediatrics 4
• Higher rates of fever may occur with combination vaccines, with rates of 47.1%-47.4% with DTaP-IPV-Hib-HepB vs. 33.2%-34.4% with pentavalent vaccine 2

Special Considerations

• Verify the child's age and vaccination history, confirming the infant is approximately 2 months old, and check for any previous doses or contraindications, as recommended by the American Academy of Pediatrics 4
• Prepare the environment and supplies, including washing hands thoroughly, preparing a clean surface, and gathering necessary supplies, and have epinephrine available for emergency management of anaphylaxis, as suggested by the Centers for Disease Control and Prevention (CDC) 3
• Consider using combination vaccines to reduce the number of injections, and follow minimum intervals between doses for catch-up scheduling, as suggested by the CDC 1
• Whenever feasible, use the same manufacturer's product to complete the primary series, but vaccination should not be deferred if the specific product previously administered is unavailable or unknown, as recommended by the CDC 3
• Timely vaccination is crucial for optimal protection, especially for pertussis, although not directly cited, the general principle is supported by 1
• The CDC recommends that vaccines should be administered at separate sites, at least 1 inch apart, with proper documentation, although this is not directly cited, the general principle is supported by 1