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Immunization in Children and Adults who have Thalassemia
General Recommendations
Children who have thalassemia trait should be treated and immunized in
a manner identical to all other children. The United States Center for
Disease Control (CDC) has recently published an immunization schedule
for 1998. This schedule represents the latest recommendations of this
United States Government body. Their recommendations cover Hepatitis B
vaccination, to be completed in the first year of life. Diphtheria, tetanus,
and pertussis vaccination initially completed in the first 18 months of
life with booster vaccination between 4 and 6 years and an adult tetanus
booster between 14 and 16 years. Haemophilus influenzae conjugate vaccination
completed by 15 months. Polio vaccination completed by 4 to 6 years, the
first two vaccine doses optionally being the Salk IPV killed vaccine followed
by the Sabin live oral vaccine. Measles, mumps and rubella vaccination
completed by the age of 4 to 6 years. Varicella vaccine is recommended
before the age of 18 months.
Hepatitis A Vaccine
Children who have thalassemia intermedia or thalassemia major receive
the above vaccines. In addition transfused children who test negative
for Hepatitis A should be immunized against this virus whether or not
they have been infected with Hepatitis C. Infection with Hepatitis A after
infection Hepatitis C can lead to fulminant
disease. It is not know whether late infection with this virus can cause
worse hepatitis in individuals co-infected with other hepatitis viruses
or with severe hemosiderosis.
Pneumococcal Vaccination
All children are immunized against Streptococcus pneumoniae with the 23-valent
pneumococcal polysaccharide vaccine prior to splenectomy and boosters
given every five years if their pneumococcal immunoglobin titers are negative.
The conjugate pneumococcal vaccine is now available and should be considered
for infants who have the possibility of early splenectomy; children who
have Hemoglobin H Constant Spring might fall into this category. Children
who have sickle thalassemia syndromes such as Sickle Beta Zero Thalassemia
and Sickle Beta Plus Thalassemia should also receive either the conjugate
vaccine as infants or the polysaccharide vaccine if they are over two
years old. All children should receive boosters if they have negative
titers to Streptococcus pneumoniae.
Influenza Vaccine
All children who have thalassemia intermedia or major should receive the
influenza vaccine beginning at the age of six months (split vaccine with
a booster the first season). Children who have other risk factors should
also receive this vaccine. <next>
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