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Not all people can afford to have their children vaccinated at a private clinic but I must say some are just so thrifty that they avail vaccines from health centers for free, then catch up at a private clinic for what’s not been provided. I don’t mind and I actually appreciate these parent’s reasons and practicality. I often do not have conflict of schedules except for the last (third) dose of hepatitis B vaccine.
The acceptable and recommended dose of hepatitis B vaccination is as follows:
1st dose: birth
2nd dose: minimum interval from the 1st dose is 4 weeks
3rd dose: minimum interval from the 2nd dose is 8 weeks but it is emphasized that the final/third dose should not be given earlier than 24 weeks. If given earlier, it should be readministered.
The problem with health centers is that they schedule the 3rd dose to be given 4 weeks after the 2nd dose. I instruct my patient to insist in health centers that the 3rd dose should be given by 6 months of life. Some do oblige but yesterday, one of my patients was insistently given as it is their “mandate” to do so. The other health workers who listen to my patient’s prodding learn, while those who are close minded just blindly follows the antiquated recommendations shoved into their system by whoever is responsible.
Reference: CDC MMWR – Immunization Management Issues (http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5416a3.htm?s_cid=rr5416a3_e)
IMMUNIZING PREMATURES OR THOSE WEIGHING <2KGS
Another confusion comes when dealing with low birth weight infants and/or weighing less than 2 kgs. The recommendation depends on the maternal hepatitis B status.
1. If mother is infected with hepatitis B
- both hepatitis B vaccine and hepatitis B immunoglobulin (HBIg) should be given within 12 hours from birth
- do not count the 1st dose of hepatitis B vaccine as part of the series
- administer another 3 hepatitis B vaccines with the following schedule: (a) single antigen vaccine at 1, 2-3, and 6 months of life, or (b) hepatitis B-containing combination vaccine at 2, 4, and 6/12-15 months
- test baby for HBsAg and anti-HBs at least 2 months from the last dose of vaccine but not earlier than 9 months of life.
2. Mother’s hepatitis B status is unknown
- administer both HBIg and single dose hepatitis B vaccine within 12 hours of birth
- test mother for HBsAg
- do not count the birth dose as part of the vaccine series
- administer 3 additonal dose of hepatitis B vaccine doses (as above)
- if mother turns out positive for hepatitis B infection, test baby for anti-HBs and HBsAg as scheduled above.
3. Mother is definitely not infected with hepatitis B
- delay 1st dose of hepatitis B vaccine until 1 month or hospital discharge provided weight is at least 2 kgs.
- give (a) single-antigen vaccine: 2nd dose at 2 months, 3rd dose at 6-18 months or (b) 2, 4 and 6/12-15 months