Immunizations

A “flu shot” against influenza is recommended for all Americans. Egg allergy is NO LONGER a contraindication to receiving this vaccine. We recommend that all our patients receive a flu vaccine each fall, and in particular those with asthma or other chronic respiratory or other medical conditions; smokers or those exposed to tobacco smoke.

Recommended as a 2-dose series at ages 12-15 months and 4-6 years of age but immunity may wane over time in some people.  Although there is no current official recommendation, we are able to check a person’s immunity through a blood test and can offer this as an option during the pre-college visit and for other high-risk situations if desired including upcoming travel.

An immunization used to combat a mosquito-borne viral infection found mainly in rural areas of Asia that can cause serious neurologic issues. It is recommended for longer term (>1 month) travel to areas where the infection is endemic. Recommended dosing intervals for JE vaccine have been a two-dose series given at day 0 and 28. Recent studies of immunity have allowed this dosing schedule to be changed to day 0 and 7-28 days for people ages >18.

Strongly recommended at age 11-12 years (or catch-up later in adolescence) to protect against the devastating infection of meningococcal meningitis. A second booster dose is recommended at age 16 or 5 years after the first dose. Menactra protects against meningitis serogroups A, C, W and Y. In New York State, Menactra (or Menveo) is required for entry into 7th grade and a booster dose after age 16 for entry into 12th grade.

Recent epidemics of meningitis, particularly on college campuses, have been caused predominantly by meningitis serogroup B, since this serotype is not present in Menactra or Menveo, both in wide use in recent years, and required by most colleges. In accordance with CDC guidelines, we recommend either of the Men B vaccines for our patients ages 16-23 years who are soon to attend or currently attend college or boarding school. Since meningitis B can occur at any age, we suggest our patients preferably receive the Men B vaccine at age 16-17, administered around the same time as the second Menactra. Younger patients, at least age 10, who are medically at high risk of acquiring meningitis B, may also receive this vaccine. Either vaccine can now be administered in a two-dose series, Bexsero at least one month apart and Trumenba at least 6 months apart. These two vaccines are comparably effective, and which one is chosen may depend on its availability or the patient’s schedule.

Human papilloma virus (HPV) is by far the most common sexually transmitted infection in the United States. The inactivated vaccine now protects against seven types of HPV (16, 18, 31, 33, 45, 52, 58) which cause 90% of cervical cancers (as well as other types of oral, anal and genital cancers in males and females) and two types (6, 11) which cause 90% of genital warts. We recommend this vaccine for our female and male patients at ages 9-14 years, to achieve an optimal immune response and generally before sexual activity begins; recommended also for older adolescents and young adults if not already immunized. The dosing schedule for 9-14 year olds is only two doses of HPV9 at least 6 months apart because of their superior immune response. Teens and young adults >15 years still need three doses, administered at 0, 2 and 6 months. Many of our patients have already received the Gardasil-4 vaccine, and the CDC has NOT recommended that these individuals be re-immunized with Gardasil-9; however, it is safe to re-immunize with Gardasil-9 if clinically indicated and/or if a patient requests re-immunization.

This vaccine protects against tetanus, diphtheria, and pertussis (whooping cough) and is recommended as a one-time booster at age 11-12 years or at any time in adolescence or adulthood if not already received. A booster shot of Tdap is recommended at least every 10 years thereafter. Booster doses of Tdap are also recommended for pregnant women and adults in close contact with infants.

Hepatitis A virus is transmitted via contaminated food or water or among close contacts, causing an illness with an abrupt onset of fever, nausea, abdominal pain and jaundice. The inactivated vaccine, in use since 1995, has recently been recommended to include all children in the United States between 1-2 years of age. The vaccine is administered as a two-dose series 6-12 months apart. We recommend this vaccine for our patients who have not already received it.

A second dose is recommended for individuals who previously received only one dose. Anyone who has had chickenpox disease does not need to be immunized.

Streptococcus pneumoniae (pneumococcus) causes pneumonia, meningitis, middle ear and blood infections. In November 2009 the CDC expanded its recommendation for use of the pneumococcal vaccine Pneumovax-23 to include individuals 19 years and older with asthma or who smoke. Children, adolescents and young adults with chronic illnesses including diabetes and liver disease should also receive Pneumovax-23. Children, adolescents and young adults with immuno-compromising conditions or on immunosuppressive medications, or lacking a functional spleen, should be immunized with both Prevnar-13 and Pneumovax-23, in sequence. The ideal schedule is to use Prevnar-13 followed at least 8 weeks later with Pneumovax-23. For those who already received only Pneumovax-23 (an older vaccine), Prevnar-13 is administered at least 8 weeks later in children and 12 months later in individuals who have turned 19.

Travel shots are available at our office for those adolescents and young adults who will be traveling to work, study or sightsee in countries where specific vaccines are recommended to decrease risk of acquiring serious infectious diseases. We are delighted to be included in these adventures by providing the needed immunizations, malaria prevention medication, and other travel advice. We administer all travel shots in our office (excluding Yellow Fever as it is in short supply); most commonly Hepatitis A, Typhoid (or we will provide an oral Typhoid vaccine prescription), Hepatitis B; boosters of Polio, Tetanus, MMR (measles, mumps, rubella); even, in certain situations, Rabies and Japanese encephalitis vaccines.

We suggest the following:

1. First consult the Center for Disease Control (CDC) website for information regarding your specific destination, including suggested immunizations and malaria prophylaxis.
2. Call us, if possible, at least six weeks in advance of the trip, so we may schedule a Travel Visit at the optimal time, and order any vaccines for you that we do not routinely stock.
3. If malaria medication is indicated, let us know the total number of days you will be in the at-risk location; the CDC website provides very detailed information regarding your specific itinerary.