re: [Gnumed-devel] one more vaccinations detail

[scaredycat]

> I guess that you will never get enough hard facts to have this decided by
> some logic.
this did make me look at the guidelines.

There seems to be no "restart" of vaccination schedules (see liz's comments)

mainly  *minimum number of doses*, possibly different in different age 
groups,

and *minimum intervals*,  possibly different between different dose  number.

The au guidelines  dropped the 18 month booster DTPa fairly recently,
and have a 4 dose minimum  for DTPa with minimal intervals 1,1, 6 
months.  Standard times is 2,4,6 mo, 4yrs.
10 yrs later, before leaving school, a  booster with lower antigen 
content dTpa ; dTpa is for preventing neonatal pertussis ,
so also recommended pre-pregnancy or after delivery, or if involved 
with child-care, or active grandparent.

DTPa is not given over 8 years old, and the primary aim thereafter seems 
to have dipth-tet immunization, so dT is used to make up
at least 3 immunizations ( 3 to cover tet), min interval 1 month. Adults 
with hx of min 3 tet containing vaccines, have 2 tet vaccines
at 10 yr intervals, and finally at 50yrs.


Polio ( now recommend inactivated IPV) is minimum 3 dose with 1 month 
min interval, but recommended 4th dose,  at same time as DTPa.

MMr is 2 doses > 12mo, min interval 1month.

rubella is still pregnancy screened.

Meningicoccal conjugate is
  2mo<= x < 4 , 3 doses;
  4mo <= x < 12, 2 doses;
               min interval 1 month

   x >=12mo , 1 dose.
  
varicella is
 1yr <= x < 14 yrs, 1 dose
  >14 yrs, 2 doses,  min interval 1 month.

Hep B is
  if birth dose (< 1 wk ) given,
       3 paed doses, min interval 1 month, 1 month
  else
       3 paed doses,  min intervals 1 month,  2 month

alternate adolescent (11-15yrs)
 2  adult doses, min interval 4 months apart,
   
HIB  has 2 types , purified polysaccharide (PRP)
outer membrane protein( -OMP), and other carrier ( -OC)
PRP-OMP is more antigenic then PRP-OC
catch-up start age:
0 < 6        : PRP-OMP  2 min doses, 1 mo min interval;  PRP-OC , 3 min 
doses, 2 mo min interval; both  +booster min 2 months, pref at 12mo old
6 - < 12   : PRP-OMP same ; PRP-OC 2 min doses, then same
12 < 15   : PRP-OMP  and PRP-OC , 1 dose + 1 booster , min interval 2 
mo, pref 18 mo old
15mo-5 yrs : single dose ( PRP -OMP or OC)

Comvax is PRP-OMP ( seems most common brand here)

Pneumococcal - deciding 3 , 2 , or 1 doses of 7-valent , and whether and 
when to have 23-valent.

start 2-6 months is always 3 doses, min interval 2 months,
start 7mo - 17mo is always 2 doses, min interval 2 months,
 thereafter  ,
lower , medium or high risk, is
 lower -18mo -23mo,  1 dose  7 valent
 medium - 18mo -  5yrsmo  1 dose,   
 high  - 18 - 5 yrs,   2 doses , min interval 2 months.

medium and high - may follow with 23 valent , min interval 2 mon, pref 
age 4 yrs.

In au,  high risk might be medical conditions, and medium living in 
Central Australia when indigenous.

That's the easy part ( thanks for the motivation to read the schedule)  
: reference ( 'catch-up schedules' pp42-52, 'pneumoccoccus' pp223- 234, 
AIH 8th ed)

hope this helps in the task of encoding catch-up details.