4 Important Vaccines You Should Know About Even Though They Are Not in the Routine Immunization Program

General information about childhood preventive vaccines

The immunization schedule currently used in our country was developed similarly to European and American schedules. However, schedules are updated over the years; vaccine doses may be increased according to disease incidence, or new vaccines may be added or removed. For example, in our country and many European countries, measles cases had not been seen, but as cases increased, the measles vaccine was increased from a single dose to 2 doses in recent years. Once the disease was controlled, it began to be administered as a single dose again. Similarly, rising pertussis cases in the United States led to routine pertussis vaccination for pregnant women.

The reason the 4 vaccines discussed in the second section are not administered in our country is not that they are unnecessary/unsafe, but the economic burden of their cost. Although vaccines are a very important part of preventive healthcare, administering them to large populations creates an economic burden. Countries therefore calculate the cost/public benefit ratio of new vaccines very carefully. For example, in some Western European countries, liver cancer due to hepatitis B is rare, so only certain risk groups rather than the entire population are vaccinated.

Similarly, some European countries do not administer BCG or chickenpox vaccines. However, because approximately 12 thousand new tuberculosis cases occur each year in our country, BCG vaccination continues.

Under our country's vaccination program, the following vaccines are intended to be completed between your baby's birth and the start of kindergarten.

- Related topic: Flu and Pneumonia Vaccines—Do They Protect Against Coronavirus, and Who Should Receive Them and When? (Türkçe)

In the figure below, the Republic of Türkiye Ministry of Health Childhood Immunization Schedule can be seen:

Note: Infant vaccines are administered in the leg because babies lack muscle mass (up to 12 months). Except BCG, chickenpox and KKK.

Hepatitis B Vaccine

• It is an inactivated virus vaccine, administered by intramuscular injection in the arm.
• It should not be administered if a severe allergic reaction occurred to previous doses.

BCG Tuberculosis Vaccine

• It is a live bacterial vaccine with reduced disease-causing ability, administered by intradermal injection. BCG may be given from birth, but should be administered after completing 2 months for easier administration and stronger immunization. If BCG is to be given after month 3, a TCT (skin test) with ppd is performed first, and vaccination depends on the result.
• It should not be administered in conditions involving immune suppression, such as cancer, cancer treatment or use of cortisone-containing medicines, or during pregnancy.

Five-in-One Vaccine: Diphtheria, Pertussis, Tetanus, Inactivated Polio, Haemophilus Influenzae Type B (DaBT - İPA - Hib)

• A combined inactivated bacterial and viral vaccine effective against five diseases. It is administered by intramuscular injection in the leg or arm, depending on age.
• It should not be administered to people with progressive brain disease or a severe allergic reaction to previous doses.

Conjugate Pneumococcal Vaccine (KPA)

• An inactivated bacterial vaccine. It is administered by intramuscular injection in the leg or arm, depending on age.
• It should not be given to people who had a severe allergic reaction to previous doses.

Measles, Mumps and Rubella Vaccine (KKK)

• A live viral vaccine with reduced disease-causing ability, combined to protect against three diseases. It is administered by subcutaneous injection in the arm.
• It should not be administered following a severe allergic reaction to previous doses (egg allergies are not a contraindication), in immune-suppressing conditions such as cancer, cancer treatment or use of cortisone-containing medicines, or during pregnancy.

Oral Polio Vaccine (OPA)

• A live viral vaccine with reduced disease-causing ability, administered orally.
• It should not be administered in immune-suppressing conditions such as cancer, cancer treatment or use of cortisone-containing medicines, or when there is a known immune deficiency in the household.

Adult-Type Diphtheria–Tetanus Vaccine (Td)

• A combined inactivated bacterial vaccine effective against two diseases, administered by intramuscular injection in the arm.
• It should not be administered following a severe allergic reaction to previous doses.

Hepatitis A Vaccine

• An inactivated virus vaccine. It is administered intramuscularly in the arm (or leg if muscle mass is low).
• It should not be administered following a severe allergic reaction to previous doses or during pregnancy.

Chickenpox Vaccine

• A live viral vaccine with reduced disease-causing ability, administered by intramuscular injection in the arm.
• It should not be administered in severe immune deficiency, following a severe allergic reaction to previous doses, or during pregnancy.

DaBT - İPA: Diphtheria, Pertussis, Tetanus, Inactivated Polio Type B Vaccine (Four-in-One Vaccine)

• A combined inactivated bacterial and viral vaccine effective against four diseases, administered by intramuscular injection in the arm.
• It should not be administered to people with progressive brain disease or a severe allergic reaction to previous doses.

Note: Vaccination in patients whose immune system is weak for various reasons (such as chemotherapy or immunosuppressive medicines due to organ transplantation) should always be discussed with the patient's physician, even when the vaccine is not a live attenuated vaccine. This is because people with weak immune systems may not develop an adequate immune response.

*

There are other important vaccines you may consider for your children (and even yourself). Let us look at these important vaccines:

Vaccines Recommended "Outside" the Routine Immunization Schedule

Rotavirus Vaccine (RV)

Rotavirus is a highly contagious virus that can cause, in infants and young children, severe diarrhea . Diarrhea is usually accompanied by vomiting and fever. Untreated, it may cause severe dehydration and even death.

Diarrhea kills more than 500 thousand children worldwide each year, with approximately one-third of these deaths caused by rotavirus.

Rotavirus vaccine recommendations

The United States Centers for Disease Control and Prevention (CDC) recommends vaccination for most infants before exposure to the virus.

The rotavirus vaccine is given orally, with two or three doses recommended at 2, 4 and 6 months (if needed). The first dose should be given before 12 weeks, and the final dose must have been given and the course completed before 8 months.

Depending on the brand, the vaccine is administered in 2 or 3 doses. Both vaccines are given after month 2 at intervals of 4 weeks. The first dose must be given before 12 weeks.

It is important to note that some infants should not receive rotavirus vaccination. It is not recommended for infants who have had an allergic reaction to a rotavirus vaccine or have other severe allergies. The CDC also does not recommend vaccination for infants with severe combined immunodeficiency and other immune system problems or bowel obstruction.

Possible rotavirus vaccine side effects

Side effects are usually mild and resolve on their own. They include:

• temporary diarrhea or vomiting
• fever
• loss of appetite
• irritability

Bowel obstruction and allergic reactions have been reported as rare serious side effects.

Meningococcal vaccine

Meningococcal disease is a serious bacterial disease that can cause meningitis (inflammation of the protective layer around the brain and spinal cord) and bloodstream infection. Children may contract meningococcal disease through close contact with people with meningitis, sharing utensils such as forks, spoons and plates, kissing or breathing the same air as an infected person.

Meningococcal vaccine recommendations

2 vaccine doses are recommended. Because meningococcal infection in our country occurs most frequently below age 2, completing vaccination before age 2 is recommended (such as at months 9 and 13). In Western populations, two doses are recommended from ages 11-12 through 16. If the first dose is given after age 16, a second booster dose is not recommended. Some colleges require students to be vaccinated before coming to campus. Officials living in dormitories are also advised to receive meningococcal vaccination.

However, meningitis vaccination involves some detail because different vaccines are marketed and vaccination is undertaken for different reasons. For example, because meningitis B is common in the United Kingdom, an additional meningitis B vaccine is given. Meningitis B is almost never seen in Türkiye, so this vaccine is not popular in our country.

The 4-valent conjugate meningitis vaccine (A-C W-135 Y), meanwhile, is widely used in our country (Menectra and Nimenrix). Menectra is given in 2 doses after month 9, as discussed above. Nimenrix is a single dose from 12 months onward. Nimenrix does not yet have FDA approval. Comparative studies found that, despite being a single dose, Nimenrix was more effective than Menectra.

There is also a vaccine called Menveo. This is also a 4-valent meningitis vaccine (again, no meningitis B). It is administered from month 2, in a 2-4-6 schedule, as 3 doses.

Possible meningococcal vaccine side effects

Meningococcal vaccines are generally safe.

Mild side effects include:

• pain and redness at the injection site headache
• fatigue
• pain

One rare but severe side effect is Guillain-Barré syndrome, a disorder involving muscle weakness caused by the person's immune system damaging nerve cells.

Human papillomavirus (HPV)

HPV usually spreads through sexual contact. In the United States alone, approximately 14 million people acquire HPV each year, and approximately one in every 4 people has HPV.

Although HPV usually causes no signs or disease apart from genital warts, some subtypes are known to cause cancer. In women, HPV causes cervical and vaginal cancer; in men, penile cancer, head and neck cancer and anal cancer.

HPV-associated cancers can be seen below:

HPV vaccine recommendations

Although HPV vaccination is recommended for girls aged 9-26 and boys aged 9-21, the target age for both girls and boys is generally recommended as 11-12.

Possible HPV vaccine side effects

The HPV vaccine is considered safe and is recommended. Mild side effects that may occur include:

• pain
• redness,
• swelling at the injection site
• nausea
• fainting
• headache
• dizziness

Serious side effects are rare but may include:

• Guillain-Barré syndrome (muscle weakness due to nerve damage)
• loss of muscle strength
• blood clots

- Related topic: Australia Is Close to Completely Eliminating This Cancer with the HPV Vaccine

Tdap booster

Tdap boosters are vaccines that protect adults and children against three diseases.

These three diseases are:

• diphtheria (a serious infection of the nose and throat)
• tetanus (a bacterial disease that attacks the body's nervous system)
• pertussis (a highly contagious and severe infection of the respiratory system

The CDC reports that, since Tdap boosters began being administered, tetanus and diphtheria cases have decreased by 99 percent, and pertussis cases by 80 percent. In most United States states, some form of Tdap vaccination is required for children, adolescents and young adults.

Tdap booster vaccine recommendations

The vaccine is approved as a single dose for children aged 10 and older through age 64. The CDC recommends that people in this age range who have not previously received Tdap be vaccinated as soon as possible. Healthcare workers and people in close contact with newborn babies (including pregnant women) are also advised to receive Tdap.

Possible Tdap booster side effects

The Tdap vaccine is safe for most people.

Mild side effects may include:

• pain and redness at the injection site
• mild fever
• headache
• fatigue
• body aches

Rare serious side effects include:

• severe allergic reaction
• severe fever

Apart from the 4 vaccines listed above, two vaccines recently added to the Republic of Türkiye Ministry of Health Immunization Schedule are:

Chickenpox Vaccine

Until recently, families would have their children play with friends who had chickenpox so they could get through the illness at an early age. This was because the disease was easier to overcome early in life, whereas infection at an older age sometimes caused serious consequences such as bacterial infections and pneumonia.

Vaccination has eliminated this situation because being vaccinated is much safer than contracting the disease.

Chickenpox vaccine recommendations

All healthy children from 12 months to age 18 should receive 2 doses of chickenpox vaccine. The first vaccination is recommended between 12 and 15 months, and the second between ages 4 and 6.

Possible chickenpox vaccine side effects

Research suggests the chickenpox vaccine is safe for the vast majority of people.

Side effects are usually mild and may include:

• pain, redness and redness at the injection site
• fever
• heat rash

Rare but serious side effects may include:

• redness over the entire body
• seizure
• pneumonia
• meningitis

Hepatitis A vaccine

Hepatitis A is a virus that may cause sudden and severe liver disease. Vaccination against hepatitis A aims to prevent a condition called fulminant hepatitis , an inflammation of the liver that may lead to death. Symptoms of hepatitis A infection may include fatigue, stomach pain, nausea, and yellowing of the skin and whites of the eyes.

Hepatitis A vaccine recommendations

At the end of month 18, dose 1, and at the end of month 24, the second dose of hepatitis A vaccine should be given to all children.

Hepatitis A vaccination is also recommended for adults. People traveling to certain high-risk countries and those at risk of contracting hepatitis A (such as men who have sex with men, people using drugs and people with chronic liver disease) are advised to be vaccinated against hepatitis A.

Possible hepatitis A vaccine side effects

The hepatitis A vaccine is generally safe.

Mild side effects may include:

• pain around the injection site
• headache
• loss of appetite
• fatigue

• shortness of breath
• Guillain-Barré syndrome (muscle weakness due to nerve damage)
• thrombocytopenia (low platelet count)

Who should not be vaccinated?

Although many vaccines are recommended for most people, certain vaccines are not recommended for some individuals. For example, people with active disease or weakened immune systems may be unable to receive some vaccines. Certain vaccines may also have other specific restrictions.

In conclusion, the vaccines listed above have made a very important difference in preventing diseases and saved millions of lives worldwide. Vaccines can therefore be described as a success story for public health and physicians in preventive medicine.

For vaccination to be completed safely and rare adverse effects to be minimized, your doctor must know enough about your medical history. Please do not hesitate to discuss with your doctor which vaccines you and your child need and any other questions on this subject.

Can Cancer Patients Receive Flu or Pneumonia Vaccines?

AUTISM: Vaccines, Special Diets and Its Relationship with Cancer