Dr. Saul Greenberg MD FRCP(C)
2401 Yonge St. #206
Toronto, Ontario M4P 3H1
Tel: 416-485-4419  Fax: 416-485-2936


Pediacel, DPTP, dTP
Prevnar (Pneumococcus)
Hepatitis B
Measles Mumps Rubella (MMR)
Varicella (Chickenpox)
New Vaccines
Steps to reduce pain from immunization


This vaccine immunizes against Diphtheria, Tetanus, Pertussis, Polio and H. Influenza type B. It is given at 2,4,6 and 18 months. At 4-6 years, the above is given without H. Influenza type B (DPTP). Then every 10 years for diphtheria, tetanus and polio (dTP). If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.

Pediacel is a new and improved vaccine that replaces DPTP. Pediacel has an inactivated (P) pertussis. This was done because the P part of the vaccine caused the severe reactions some babies had: high fever and extreme irritability. Since using Pediacel there have been practically no severe reactions.

The diseases Pediacel vaccine prevents:

  • Diphtheria bacteria cause a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and even death.
  • Tetanus (Lockjaw) bacteria cause painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the person cannot open his mouth to swallow. Tetanus can lead to death.
  • Pertussis (Whooping cough) bacteria cause coughing spells so bad that it is hard for infants to eat, drink, or breathe. These can last for weeks. It can lead to pneumonia, seizures, brain damage, and death.
  • Polio is a serious disease caused by a virus. Sometimes it causes permanent paralysis (can't move arm or leg). It can kill people who get it, usually by paralyzing the muscles that help them breathe.
  • Hemophilus Influenza B (HIB) disease usually strikes children under 5 years of age. Before HIB vaccine, it was the leading cause of bacterial meningitis among children under 5 years old in North America. HIB can also cause pneumonia, epiglottis (severe swelling in the throat, making it hard or impossible to breathe), infections of the blood, joints, bones, and covering of the heart. All of these can result in death. Before HIB vaccine, about 20,000 children in the U.S. under 5 years old got severe HIB disease each year and nearly 1,000 died each year.

Reactions to Pediacel are mild:

Sore arm or leg, Fever, Fussy, Decreased Appetite, Tired, Vomiting. If these reactions occur, they usually start within 3 days and don't last long. Give your child Acetominophen every 4 hrs. or Ibuprofen every 6 hrs. at the correct dose for the 24 hours following vaccination.

Some children should not get Pediacel vaccine or should wait:

  • Children who have ever had a life-threatening allergic reaction to a previous dose of Pediacel vaccine should not get another dose.
  • Children who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting Pediacel vaccine. Children with simple colds without fever may get the vaccine.

Prevnar (Pneumococcal Conjugate Vaccine)

This vaccine immunizes against 13 types of Pneumoccocal bacteria. It is given at 2,4 and 12-15 months of age. Healthy children over 12 months require 2 doses and children over 24 months of age require only one dose of Prevnar. If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over. If your child is older than 2 months, and younger than 2 years, s/he can still be started on the series. Prevnar may be given at the same time as other childhood vaccines. Children under 3 yrs. of age who received Prevnar7 prior to 2011 will need to receive a booster dose of an improved Prevnar13 vaccine.

Pneumococcal disease is a serious bacterial disease that causes sickness and death. In fact, it is responsible for about 15 deaths each year among children under 5 years old in Canada. Pneumococcal disease is the leading cause of bacterial meningitis in Canada and the United States. (Meningitis is an infection of the covering of the brain). Each year pneumococccal disease causes many health problems in children under 5, including over 60 cases of meningitis; 1,000 blood infections; 2200 cases of hospitalized pneumonia and 9000 cases of non-hospitalized pneumonia, and about 200,000 ear infections.

Children under 2 years old are at highest risk for serious disease. Pneumococcus bacteria are spread from person to person through close contact. Pneumococcal infections can be hard to treat because the disease has become resistant to some of the antibiotics that have been used to treat it. This makes prevention of the disease even more important.

Prevnar is good at preventing this disease among these children, and also helps stop the disease from spreading from person to person. The vaccine’s protection lasts at least 3 years. Since most serious pneumococcal infections strike children during their first 2 years, the vaccine will protect them when they are at greatest risk. Some older children and adults may get a different vaccine called pneumococcal polysaccharide vaccine.

 Who should get Prevnar and when?

  • Children Under 2 Years of Age:
  • All healthy infants and toddlers should get 3 doses of Prevnar: at 2,4 and 12-15 months. Children who miss the first dose at 2 months should still get the vaccine. Children under 3 yrs. of age who received Prevnar7 prior to 2011 will need to receive a booster dose of an improved Prevnar13 vaccine.
  • Children Between 2 and 5 Years of Age who:
    - have sickle cell disease
    - have a damaged spleen or no spleen
    - have HIV/AIDS
    - have other disease that affect the immune system, such as diabetes or cancer.
  • Prevnar should also be considered for all other children between 2-5 years of age who:
    - take medications that affect the immune system, such as chemotherapy or steroids.
    - are of Alaska Native, American Indian or African American descent
    - attend group child care.

Reactions to Prevnar are mild:

  • Up to 3 out of 10 children had redness, tenderness, or swelling where the shot was given.
  • About 1 out of 10 children had a mild fever.

Less common reactions:

  • irritability
  • drowsiness
  • restless sleep
  • decreased appetite
  • vomiting diarrhea
  • rash or hives.

Hepatitis B Vaccine

This vaccine is given at 2,4, & 6 to 9 months of age. Older children can be started on the series at any age. Their second dose is given 1-2 months after the first, and the 3rd dose is given 4-6 months after the first. If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.

Hepatitis B is a serious viral disease:

  • It can cause short-term (acute) illness that causes loss of appetite, tiredness, diarrhea & vomiting, jaundice (yellow skin or eyes), and pain in muscles, joints, and stomach.
  • It can also cause long-term (chronic) illness that causes liver damage (cirrhosis), liver cancer, and death.

About 1.25 million people in the U.S. have chronic hepatitis B infection. Each year it is estimated that

  • 200,000 people, mostly young adults, get infected with hepatitis B virus.
  • More than 11,000 people have to stay in the hospital because of hepatitis B.
  • 4,000 to 5,000 people die from chronic hepatitis B.

Hepatitis B vaccine is the first anti-cancer vaccine because it can prevent a form of liver cancer.

Hepatitis B is spread through contact with the blood and body fluids of an infected person. However, people can get hepatitis B virus infection without knowing how they got it. About 1/3 of hepatitis B cases in the U.S. have an unknown source. A person can get infected in several ways:

  • during birth when the virus passes from an infected mother to her baby.
  • having intimate physical contact with an infected person
  • by injecting illegal drugs (dirty needles).
  • by being stuck with a used needle on the job.
  • by sharing personal items, such as a razor or toothbrush, with an infected person.

Reactions to Hep B vaccine are very uncommon. If they do occur, they are mild:

  • Soreness where the shot was given, lasting a day or two (1 out of 11 children).
  • Mild to moderate fever (1 out of 14 children).

What is the cost of the vaccine?

All 3 doses of Hepatitis B costs $60.00 for children under 11 yrs. old. For older children the cost is $40.00 per dose

Measles, Mumps, Rubella (MMR)

This vaccine immunizes against Measles, Mumps, and Rubella. It is given at 12-15 months, and at 4-6 years. It should either be given with the VZ (chickenpox vaccine) or at least one month before or after. If you miss a dose or get behind schedule, get the next dose as soon as you can. There is no need to start over.

The diseases MMR prevents are:

  • Measles virus cause rash, cough, runny nose, eye irritation, and fever. It can lead to ear infection, pneumonia, seizures, brain damage, and death.
  • Mumps virus cause fever, headache, and swollen glands. It can lead to deafness, meningitis, painful swelling of the testicles or ovaries, and, rarely, death.
  • Rubella (German Measles) virus cause rash, mild fever, and arthritis (mostly in women). If a woman gets rubella while she is pregnant, she could have a miscarriage, or her baby could be born with serious birth defects.

These diseases are spread by being around someone who has them. They spread from person to person through the air. They can be spread before a person realizes they are sick. Sometimes a person may have such a mild illness that it is never diagnosed, and the person thinks they just had a cold. Reactions to the MMR are very uncommon.

Mild reactions:

  • Fever (1 out of 6)
  • Mild rash (1 out of 20)
  • Swelling of glands in the groin or neck (rare)

If these problems occur, it is usually 7-12 days after the shot. They occur less often after the second dose.

Moderate reactions:

  • Seizure caused by fever (1 out of 3,000 doses)
  • Temporary pain and stiffness in the joints, mostly in teens or adults (1 out of 4)
  • Temporary low platelet count, which can cause a bleeding disorder (1 out of 30,000)

Severe reactions:

  • Serious allergic reaction (<1 out of a million)

Some people should not get the MMR or should wait:

  • Children who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of MMR vaccine.
  • Pregnant women should wait until after they have given birth. Women should not get pregnant for 3 months after getting the MMR.
  • Anyone with a disease that affects the immune system (like cancer, HIV/AIDS)
  • Anyone taking drugs that affect the immune system (like steroids)
  • Anyone taking cancer treatment with x-rays or drugs
  • Anyone who has had a low platelet count (a blood disorder)
  • Anyone who has recently had a transfusion or were given other blood products.
  • Children who have received the Chicken pox vaccine (VZ) less than a month ago. The MMR and VZ should either be given at the same time or at least one month apart.
  • Children who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting the MMR.

Varicella Zoster (Chicken Pox) Vaccine

Why vaccinate against Chickenpox?

Chickenpox is one of the most common childhood viral diseases. It is usually mild, but it can be serious, especially in young infants, adolescents, and adults. It can be spread from person to person through the air, or by contact with fluid from chickenpox blisters. It causes a rash, itching, fever, and tiredness.

  • In the average household, a child with chickenpox misses 8 or 9 days of school, and adult caretakers lose up to 2 days of work.
  • It can lead to severe skin infection, scars, pneumonia, brain damage, or death.
  • A person who has had chickenpox can get a painful rash called shingles years later.

Before use of the vaccine, about 4 million cases of chickenpox occurred each year in the US.

  • about 11,000 hospitalizations occurred each year in the US.
  • about 100 people died each year from chickenpox and its complications.
  • Half of these deaths were in children, most of whom were previously healthy.

The most common complications of chickenpox is bacterial superinfection of the skin and soft tissues. Chickenpox is a major risk factor for strep toxic shock syndrome and necrotizing fasciitis (flesh eating disease). Other complications include 

  • acute cerebellar ataxia, encephalitis, pneumonitis, and overwhelming viremia. 
  • seizure caused by fever
  • decreased platelet count (thrombocytopenia).

Varicella is much more likely to be severe or complicated in adults. Although adults make up only about 10% of cases, they account for more than half the deaths.

Varivax vaccine:

Varicella vaccine is a live, attenuated viral vaccine, meaning it is a weakened strain of the virus (like the MMR).

Vaccine Safety:

Studies done before licensing the vaccine found that it is was generally well tolerated with only local reactions, such as pain or swelling at the shot site, and these were mild and self-limited. 

Since licensure, more experience has been gained. As of April 1999, 16.1 million vaccine doses have been given. 

Of these, there have been 1,349 reports (less than 0.0001%) of children who developed a rash within 6 weeks after vaccination. Of 97 children with vesicular lesions available for analysis, the virus type was identified in 62 cases. 38 of these were the wild-type VZ showing that these children had already been infected with chickenpox before vaccination. These children averaged about 100 lesions and got sick 1-24 days (mean of 8 days) after vaccination. The 24 identified as the vaccine strain of VZ averaged about 50 lesions and became sick 5-42 days (mean of 21 days) after vaccination.

What about zoster (shingles)?

Chickenpox is caused by varicella-zoster virus. Zoster is a herpes type virus and all herpes viruses can stay dormant in the body, especially in the dorsal root and sensory ganglia (spinal nerves). Years or decades later, the virus can reactivate as zoster (shingles), usually when the person becomes elderly or immunocompromised.

As of April, 1999, 16.1 million vaccine have been given. Of these, there have been 205 reports of zoster after vaccination. However, the rate of reported (not necessarily confirmed) zoster after vaccination is much lower than that occurring after natural disease.

A large-scale study in the elderly is underway to see if the vaccine may prevent zoster. This is based on the fact that zoster occurs when a person’s cell-mediated immunity decreases and since the vaccine causes an increase in cell-mediated immunity, it is possible that vaccinating the elderly may boost their immunity and decrease their rate of zoster.

Vaccine virus transmission (Are children with a vesicular rash after vaccination contagious?)

As of April, 1999, 16.1 million vaccines given:

92 reports of possible secondary transmission occurring 10-15 days after vaccination of the primary child. Of 29 specimens obtained, 18 revealed wild-type virus, and only 3 confirmed the vaccine strain. All 3 cases occurred in children who developed a vesicular rash after vaccination. No cases occurred if the vaccinated child developed no rash. Each of the transmitted cases were mild.

How contagious a vaccinated child is depends on: whether a rash develops, how extensive the rash is, and the extent of the contact (household contacts are at much higher risk than casual contacts). So, do you vaccinate a child living with an immunocompromised or pregnant woman? Yes, because without vaccination the child may acquire natural chickenpox which would be a much greater risk for his contacts than the chances of developing a rash after vaccination.

Vaccine Effectiveness:

More than 95% of children 12 years of age and younger respond to a single dose of vaccine. Among persons 13 years of age and older, only about 80% respond. This age group should receive 2 varicella vaccines 4-8 weeks apart. This dosing gives a greater than 95% response.

Can a child still get chickenpox after vaccination?

About 1-4% of vaccinated children per year develop "breakthrough" disease when exposed to naturally occurring chickenpox. This occurs in children with low antibody levels after vaccination. Their disease tends to be mild with fewer skin lesions, lower fevers, and a faster recovery.

How protective is the vaccine?

86% effective against all forms of chickenpox disease and 100 % effective against moderate to severe disease.

Since licensure 6 years ago, the incidence of chickenpox has decreased in all age groups, including unimmunized persons. This suggests herd immunity. The vaccine works–we just need to vaccinate more children.

How long does the vaccine provide immunity?

Antibody levels have been followed for at least 10 years in children given the currently licensed vaccine, and for more than 20 years in children given earlier formulations. Nearly all children maintain antibody levels for as long as 20 years.

Will we produce a population of susceptible adults?

As more and more children are vaccinated, less and less wild-type disease will occur. Unvaccinated people will be less likely to acquire natural disease and will grow up to be susceptible adults. The only way to prevent this from occurring is to vaccinate all appropriate children 1 year of age and older and all susceptible persons at high risk for exposure or transmission.

Who should receive Varicella Zoster (Chickenpox) Vaccine?


All children 12-18 months of age who have not had chickenpox. Two doses of vaccine- a second dose at 4` to 6 yrs. of age

Older children who have not had chickenpox - preferably before 11-12 years of age. Two doses of vaccine - at least 3 months apart.

If there is any question as to whether a person has had chicken pox or not, it is best to give the VZ vaccine. There is no harm in receiving the vaccine even if you've already had the disease.

Susceptible adults: Persons who live or work in high-risk environments (preschool teachers, child-care givers, etc), Persons who live or work in moderate-risk environments (college students, inmates, military personnel, etc), non-pregnant women of child-bearing age, adolescents and adults living in households with children, international travelers. Persons 13 years of age and older should receive two doses 4-8 weeks apart.


Vaccination within 72 hours (and still may help as late as 5 days after exposure) of being exposed to chickenpox may limit or prevent disease, but may not always be protective (child may have been exposed earlier than suspected).

Who should not receive Varicella Zoster (Chickenpox) Vaccine?

  • Children who have ever had a life-threatening allergic reaction to gelatin, the antibiotic neomycin, or a previous dose of VZ vaccine.
  • Pregnant women should wait until after they have given birth. Women should not get pregnant for 1 month after getting the VZ.
  • Anyone with a disease that affects the immune system (like cancer, HIV/AIDS)
  • Anyone taking drugs that affect the immune system (like steroids)
  • Anyone taking cancer treatment with x-rays or drugs
  • Anyone who has had a low platelet count (a blood disorder)
  • Anyone who has recently had a transfusion or were given other blood products.
  • Children who have received the MMR less than a month ago. The VZ and MMR should either be given at the same time or at least one month apart.
  • Children who are moderately or severely ill at the time the shot is scheduled should usually wait until they recover before getting the VZ.

What is the cost of the vaccine?

The vaccine is free for 1 yr. olds and children who need a second dose and were born after Jan. 1, 2000.

Meningococcal Vaccine

Meningococcal Disease

Meningococcal disease is caused by the Neisseria meningitidis bacteria. These bacteria can cause meningitis and blood infection. About 10% of people with the disease will die. There are 5 different serogroups (or types) of these bacteria: A, B, C, W135 and Y.

What is the difference between serogroups?

Serogroup B is the most common cause of meningococcal disease in Canada. Serogroup C is next most common and most likely to cause outbreaks. Serogroup A is common in countries like Africa and a risk for travellers. There are vaccines for serogroups A and C, Y and W-135 and now a new vaccine against serogroup B.

Who gets Meningococcal Disease?

In Canada, infants less than 12 months are at highest risk of this infection, followed by children 1 to 5 years of age and adolescents 15 - 19 yrs. old. Recent epidemics of serogroup C in Canada have involved children, adolescents and young adults. Individuals with the following conditions are also at high risk:
Those without a spleen, with certain immunodeficiencies (e.g. HIV) and Sickle cell disease

What Meningococcal Vaccines are available?

Menjugate™ and Neis Vac-C are vaccines that protect against serogroup C disease. Menactra and Menveo protects against serogroups C, A .Y and W-135. Menactra can be given to children older than 9 months and Menveo can be given to children older than 2 yrs. of age. A new MenB vaccine (Bexsero) is now available for infants, childen and adolescents.

Who Should Get Meningococcal Vaccine?

Canada's National Advisory Committee on Immunization recommends Meningococcal C Vaccine for: Infants and children up to 2 years of age and adolescents. Menactra can also be considered for infants 9 mos of age and up and children who have not yet reached adolescence. Bexsero and Menactra or Menveo is recommended for adolescents even if they received MenC vaccine as an infant or toddler.

What are the side effects of Meningococcal vaccines?

Up to 50% of vaccine recipients complain of mild pain and redness at the injection site. 5% of vaccinees, particularly infants, experience transient fever. No serious side effects have been reported.

Can Meningococcal Vaccines be given at the same time as other vaccines?

Menincgoccal B and C vaccines can be given at the same time as other childhood vaccines, using a separate syringe at a separate site.

Is this the same vaccine that travellers get?

No. Travellers to areas such as Africa and Saudi Arabia need to get Menactra or Menveo, vaccines that protect against 4 serogroups of N. meningitidis: A, C, Y, and W-135. Menveo is not recommended for use in Canadian infants and children under 2 yrs. old. Menactra may given to children older than 9 mos. of age

What is the schedule for Meningococcal Vaccines?

For MenC vaccine the age at first dose is 2-4 mos. and a booster dose at 12 -15 mos. of age. If started at 12 mos and older, only 1 dose is needed. Protection is known to last for at least 1 to 2 years.

A meningococcal vaccine containing 3 additional serotypes, A, Y and W-135 (Menactra) may be given starting at 9 mos. of age. A second dose is recommended 2 months later. Menactra or Menveo is recommended for adolescents.

MenB vaccine (Bexsero) is given at 2,4 and 6 months of age and a booster at 1 to 2 years of age. If started after 6 months of age 2 doses are reommended 2 months apart and a booster at 1 to 2 yrs. of age. For children over 1 year of age or adolescents, 2 doses 2 months apart are recommended.

What is the cost of the vaccine?

Each dose of MenB vaccine costs $140.00

Influenza Vaccine

What is influenza?

Influenza (commonly known as “the flu”) is a serious, acute respiratory disease that is caused by a virus.  People who get influenza have a cough, fever, chills, sore throat, headache, muscle aches and fatigue.  People of any age can get influenza.  Most people who get influenza are ill for 2 to 7 days, although the cough may last for weeks.  However, some persons can get much sicker, and need to go to the emergency room or to the doctor’s office.  Influenza can lead to pneumonia, hospitalization, and even death in some people, particularly the elderly and those with chronic medical conditions, such as heart or lung problems.
Influenza spreads easily from infected persons to the nose and throat of others through coughing and sneezing. It is also spread through direct contact with surfaces and objects which have been contaminated by the influenza virus.

How well does influenza vaccine protect against the flu?

Protection from the vaccine develops about two weeks after the shot, and may last up to a year. The vaccine is 70% to 90% effective in preventing influenza illness in healthy adults. Persons who receive the vaccine can still get influenza, but if they do, it is usually milder than it would have been without the shot.

Who should get a flu shot?

Anyone over six months of age who wants to avoid getting the flu this season should consider getting the influenza vaccine. People at risk of getting severely ill from influenza disease or its complications, and people in close contact with them should consider themselves a priority for influenza immunization. The vaccine is considered safe for women at all stages of pregnancy, and for breastfeeding mothers.

Who should not get the influenza vaccine?

People in the following groups should not get the influenza vaccine:

  • Infants younger than 6 months of age (the current vaccine does not work well in this age group).
  • Anyone who has a serious allergy to eggs or egg products. A serious allergic reaction usually means that the person develops hives, swelling of the mouth or throat, or trouble breathing after eating eggs or egg products.
  • Anyone with a serious allergy to any of the other components of the vaccine which includes thimerosal (a mercury product which is found in contact lens solution), and may include neomycin or gelatin.
  • Anyone who has had a serious reaction to a previous dose of the influenza vaccine.
  • Persons with a history of Guillian-Barre Syndrome should consult with their physician before getting the vaccine.
  • Persons who are acutely ill with a fever at the time the shot is given should usually wait until they recover before getting the influenza vaccine.

What are the risks from influenza vaccine?

The influenza vaccine, like any medicine, is capable of causing side effects, which can be either mild or, rarely, severe. The risk of the vaccine causing serious harm is extremely small. Because the influenza vaccine does not contain live virus, you cannot get the flu from the vaccine.Almost all people who get the flu vaccine have no serious problems. Most people who get the vaccine have either no side effects, or mild side effects – such as soreness, redness or swelling where the shot was given. Some people may get a fever or muscle aches which start shortly after getting the flu shot, and last about 1 to 2 days. Life-threatening allergic reactions are very rare. If they do occur, it is within a few minutes to a few hours after the shot.

How often should I get my flu shot?

The influenza vaccine is given each year. This is because the virus which causes influenza changes often. The influenza vaccine is updated each year in response to the change in the virus. If they have never received the influenza vaccine before, children who are between 6 months of age and younger than 9 years of age require two doses of influenza vaccine at least one month apart. The two doses of vaccine help the child’s body make strong protection against influenza.

What should I watch for after receiving the influenza vaccine?

If a reaction to the vaccine was to happen, it usually happens shortly after the vaccine is given. You must remain in the clinic area for at least 15 minutes after the needle is given. In the days following the shot, you should see a doctor right away if any of these symptoms develop:

  • Hives
  • Swelling of the mouth or throat
  • Trouble breathing, hoarseness or wheezing
  • Paleness, weakness, a fast heartbeat or dizziness
  • Any other unusual condition or serious reaction to the vaccine.

What is the cost of the vaccine?

For the past 2 yrs. the Ontario government has supplied the vaccine at no cost.

Rotavirus Vaccine

What is the Rotavirus vaccine (Rotarix)?

The Rotavirus vaccine - given as drops in the mouth (oral) protects against a virus that infects the intestinal tract and causes severe diarrhea. The intestinal tract is the long, winding, tube that is part of the digestive tract. The intestine helps to process food, take out and absorb nutrients and water, and get rid of waste. Rotavirus disease in infants and children is a severe dehydrating gastroenteritis that occurs primarily in children aged 4 to 23 months, characterized by vomiting, fever, abdominal pain and watery diarrhea which may last 3 to 8 days. It can lead ato severe dehydration and electrolyte imbalance. The Rotavirus vaccine is the best way to protect your child against this kind of diarrhea and the things that go along with the disease, some of which can be serious and cause death such as dehydration. The vaccine is approved by Health Canada and is provided free as part of your child’s immunizations. This disease is easily spread from person to person. When you get your child vaccinated, you help protect others as well.

Who should get the Rotavirus (Rotarix™) vaccine?

he vaccine is given to babies two times as drops in the mouth. The first dose is given at 2 months of age, the second at 4 months. Both doses must be given before your baby is 6 months old. The infant may breastfeed or consume liquid or food, either before or after vaccination with the vaccine. The vaccine is given at the same time as other childhood immunizations.

Who should not get the Rotavirus (Rotarix™) vaccine?

Speak with a nurse or doctor if your child has had a life-threatening reaction to a previous dose of Rotavirus vaccine, or any component of the vaccine, including sorbitol (sugar substitute). Children over 6 months of age should not receive the vaccine because it has not been tested on children over 6 months of age. This vaccine has live but altered (weakened) rotavirus in it and should not be given to infants who have an immune system that is not working well. It should not be given to infants who might be in close contact with someone who has an immune system that is not working well. Good handwashing after diaper changes in needed. If your child has an ongoing problem in the intestinal tract s/he should not get the vaccine. If your child is sick with a fever or with diarrhea or vomiting s/he should wait to get the vaccine. Once a person has had a blocked bowel, from any cause, they are at higher risk for getting it again. It is suggested that if a child has had this they should not get rotavirus vaccine.

Possible Reactions after the Vaccine

Vaccines are very safe. It is much safer to get the vaccine than to get sick from rotavirus disease. Common symptoms after vaccine may include a fever, crankiness, vomiting, diarrhea, or a loss of appetite (about 3 in 100 babies). These reactions are mild and generally last 1 to 7 days. The rotavirus vaccine viruses can be passed in stools for about 1 week. Good handwashing after diaper changes is needed. In the late 1990s another rotavirus vaccine caused a rare problem called intussusception (bowel blockage). That vaccine is no longer given. Over 70,000 children have been given the new vaccine and intussusception does not occur more frequently in children who get the current Rotarix vaccine.

New Vaccines

What new vaccines will be available in the near future?

In the near future, several new vaccines will be recommended for children. A new meningococcal vaccine, containing serogroup B will protect children against the commonest type of meningococcal disease. This hopefully will be licensed for use in the next year. For adolescents, a vaccine against papillomavirus will be recommended to protect against acquiring the viruses that cause genital warts and cervical cancer.

What can I do to reduce my child’s pain from immunization?

Steps to reduce needle pain in babies:

  • 1. Cuddle your baby on your lap during the immunization.
  • 2. If you are breastfeeding, feed your baby before, during and after the needle. Breastfeeding calms and comforts both the baby and mother and can reduce baby’s pain.
  • 3. If you are not breastfeeding, sugar water can be given to infants less than 12 months. To make sugar water, mix one packet of sugar (1 teaspoon) with 10 ml of water (2 teaspoons). Give it to your baby with a cup, spoon or syringe just before the needle and discard the unused portion. DO NOT use sugar at home to calm upset or crying babies.
  • 4. Allow your baby to suck when receiving the needle.

Steps to reduce needle pain in babies and older children:

1. Tell your child about the vaccine.
  • Describe what will happen and how it will feel. Do not tell your child that it won’t hurt. Instead say the pain lasts a short time and feels like a “sting”, “poke” or “squeeze”.
  • School age children can be told at home before visiting the doctor.
  • Tell toddlers and preschoolers just before receiving the vaccine.
  • Answer your child’s questions.
    • Why do I need a vaccine? (“To help you stay healthy.”)
    • What will happen? (“The medicine will be put in your arm with a needle.”)
    • How will it feel? (“You may feel a poke or small sting that will last a few seconds.”)

2. Plan what to bring to the visit.

Before going to the doctor’s office, help your child choose items to bring that are interesting (e.g. toys, books) and provide comfort (e.g. favorite blanket, stuffed animal).

3. Consider using medications to numb the skin.

  • Three products are available in Canada without a prescription: EMLA® (lidocaine- prilocaine), Ametop® (amethocaine), or Maxilene ® (liposomal lidocaine). The products can take 30 to 60 minutes to work, depending on the brand.
  • Before using any medication, read the information provided and talk to your doctor or pharmacist to learn how, where and how much medication to apply.
4. Have your child sit up-right when receiving the vaccine.
Hug or cuddle young children in your lap for comfort. Do not lay your child flat.

5. Stay calm when your child receives the needle.

Your child can sense your feelings of worry which may increase his or her fear. The more fearful a child is before receiving a needle, the more pain he or she may feel.
  • Be yourself: use a normal voice, smile and be relaxed. Your child will feel that everything is okay.
  • Avoid words that can focus a child’s attention on the needle and increase fear such as: “It’ll be over soon and you’ll be okay”, “I’m sorry you have to go through this”, or “I know it hurts.”
  • Talk about things that can focus your child’s attention away from getting a needle. Involve your child when speaking to the doctor or nurse by helping them to remember:
    • an outing to the park;
    • a fun or interesting activity done at home or at school;
    • something your child learned or did that made you proud; or
    • an up-coming event or visit that your child is excited about.

    6. Take your child’s attention away from the needle with activities or toys.

  • Children can: play with a toy, stuffed animal, pop-up book, or game; listen to music or watch a handheld device or movie.
  • Parents can: sing a favorite song or read a favorite book to an infant, toddler or preschool child; or talk about things that are of interest or amusing to an older child.
  • 7. Ask your child to take a deep breath.

    Deep breathing reduces the pain from a needle and a child’s distress during immunization.
    • Practice counting and breathing deeply and slowly.
    • Just before the needle, take out a windmill, party blower or bottle of bubbles and ask your child to take a deep breath and blow on the object.
    • Tell an older child to take a deep breath at the time the needle is given, and blow the “sting of the needle away”.

    8. Praise and reward your child.

    • After the needle, tell your child he/she did well.
    • Positive recognition and rewards after the procedure such as stickers or certificates help a child feel good about the skills they learned during the procedure.

    9. Acetaminophen (e.g. Tylenol®, Tempra®) or ibuprofen (e.g. Motrin®, Advil®)

    • These medications are not recommended for use before your child receives a needle.
    • They can be used afterwards for minor reactions such as fever, irritability or a sore arm.
    • Use these medications as directed by your doctor.

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    The information contained on this web site is not a substitute for direct examination and treatment by a physician. If any of this material is unclear or confusing, or if you have additional questions or concerns, please call the office at (416)485-4419.