Subject: Exhibit A Primary Immunization
Effective Date: 2/2002
Page: 1 of 2
Revised Date:
Immunization Guidelines And Schedule For Infants, Children, and Youth
Birth:
2 Months:
4 Months:
6 Months:
12-15 Months:
4-6 Years:
College Entry:
Every 10 Years:
Hep. B #1
DTaP
DTaP
DTaP
DTaP
DTaP
MMR
Td (Adult)
Hib.
Hib.
Hib
Hib
IPV
IPV
Hep.B #2
IPV
Hep. B #3
IPV
Varicella
MMR
MMR
Td

Second dose MMR vaccine may be given to anyone through 18 years of age.
Two doses are required by law for children prior to school entry and entering into
college/university for the first time on or after July 1,1994.

Hib maybe given as early as 6 weeks age. HbOC Haemophilus b Conjugate
vaccine (HIB vaccine) is given to children between the ages of 2 months and 5
years. If HIB vaccine type other than the HbOC is given, please refer to the HIB
immunization table for the administration schedule and document manufacturer’s
name. Ped VAX Hib is given at 2 months, 4 months, and 12-15 months and only
requires three doses, or one dose if given after 15 months. Document
manufacturer’s name.

DTaP is preferred for all doses of Pertussis vaccination series. Whole-cell
Pertussis vaccinations remains an acceptable alternative. DTaP continues to be
recommended for fourth and fifth doses for children who have received wholecell DTP for the initial three doses but preferred for all doses. The fourth dose of
DTaP may be administered as early as 12 months of age, provided 6 months have
elapsed since the third dose and if the child is considered unlikely to return at age
15 months.

State supplied vaccine recommended for routine vaccination of all children
between 2 months and 18 years of age, susceptible children who are entering sixth
grade, and susceptible persons who will have close contact with persons at high
risk of complications form Varicella (e.g., susceptible family contacts of immunocompromised individuals). It is available for all susceptible VFC-eligible
children born on or after January 1, 1983.

All children should receive a total of four doses of IPV at 2, 4, 6-18 months, and
4-6 years of age. Children with one or more doses of oral poliovirus vaccine
(OPV) should complete their polio schedule with IPV for a total of four polio
doses. OPV should be used only for the following special circumstances.
________________________________________________________________________
Subject: Exhibit A Primary Immunization
Page: 2 of 2
Effective Date: 2/2002
Revised Date:
Prevnar

Optional vaccine
DOSAGE AND ADMINISTRATION
Routine Vaccine Schedule For Infants And Toddlers
Dose 1
Dose 2
Dose 3
Dose 4
2 Months
4 Months
6 Months
12-15 Months
May be given as
Should be
early as 6 weeks of
Dosing interval is 4-8 weeks
administered at least
age
2 months after third
dose
Vaccine Schdule For Previously Unvaccinated Children > 7 Month Of Age
Age at first dose
Total number of doses
Dosing information
Two doses at least 4 weeks
apart; third dose after 12
7-11 Months
3
months of age and at least 2
months after the second
dose
12-23 Months
2
Two doses at least 2 month
apart
>24 Months through 5 years
1
One dose
Prevnar recommended at 2-5 years for children with asthma, sickle cell and HIV. The 2
dose administered 2 months apart.
________________________________________________________________________
Subject: Exhibit B Primary Immunization
Page: 1 of 2
Effective Date: 2/2002
Revised Date:
1. Mass vaccination campaigns to control outbreaks of paralytic polio.
2. Unvaccinated children who will be traveling in less than 4 weeks to areas
where polio is endemic.
3. Children of parents who do not accept the recommended number of
vaccine injections. These children may receive OPV only for the third or
fourth dose or both; in this situation, health-care providers should
administer OPV only after discussing the risk for vaccine-associated
paralytic polio with parents or caregivers.
Special Note

State supplied hepatitis B vaccine may be administered to any one through the age
of 18 Any one over the age of 18 receiving the hepatitis B vaccine must pay the
flat rate.

Infants born to women who are known to be HbsAg-positive: Should receive the
first dose of Hepatitis B vaccine and Hepatitis B Immune Globulin (HBIG) within
12 hours of birth and should continue with the second and third doses of vaccine
at 1-2 months and six months of age respectively, with testing for HbsAg at 1215 months of age.

If the third primary dose of IPV is administered for AAP and other major
authorities, only children at increased risk of exposure to tuberculosis should be
tested and only ppd (Purified Protein Derivative) by Mantoux method should be
used. Routine tuberculin skin testing of children with no risk factors residing in
low prevalence areas is not indicated.

Give ppd to children with the following risk factors:
1. Close contacts to a case of TB diaease.
2. Children with clinical or radiographic symptoms suggestive of TB.
3. Children immigrating within the past 5 years form high-prevalence
countries (e.g., Asia, Africa, Latin American, or the Pacific Islands).
4. Children who are HIV infected (annually).
5. Children with continuous exposure to high-risk adults (e.g., HIV infected
persons, homeless, injected drug users, migrant farm workers) (every 2-3
years).
6. Children living in locally identified high prevalence areas as determined
by local health department TB control programs (baseline).
________________________________________________________________________
Subject: Exhibit B Primary Immunization
Page: 2 of 2
Effective Date: 2/2002
Revised Date:
Immunizations For Children Not Immunized In Infancy
Primary Schedule (15 Months through 6 Years of Age)
Schedule
Vaccine
First Visit
DTaP
MMR
IPV
Hep. B
HbOC
Varicella
2nd Visit (2 Mos. after first dose)
DTaP
IPV
Hep. B
3rd Visit (2 Mos. after second dose)
DTap
4th Visit (6-12 Mos. after third dose)
DTaP
IPV
Hep. B
5th Visit (4-6 Years of age)
DTaP
IPV
MMR
Booster (every 10 years)
Td (Adult)

If the fouth DTP/third IPV dose is given on or after the fourth birthday, a fifth
DTP/fourth IPV is not necessary.

HbOC Haemophilus b Conjugate vaccine (HIB vaccine) is given to children
between the ages of 2 months and 5 years. If HIB vaccine type other then the
HbOC is given, please refer to the HIB immunization table for the administration
schedule and document manufacturer’s name. Ped VAX Hib is given at 2
months, 4 months, and 12-15 months and only required three doses, or one dose if
given after 15 months.

State supplied Hepatitis B vaccine may be administered to any child up through
the age of 18 years. Three doses of Hepatitis B is required for all children born
after July 1, 1994.

State supplied vaccine is recommended for routine vaccination of all susceptible
children between 12-18 months of age, susceptible children who are entering sixth
grade, and susceptible persons who will have close contact with persons at high
risk of complications form Varicella (e.g. susceptible family contacts of
immunocompromised individuals). It is available for all susceptible VFG-eligible
children born on or after January 1, 1983.
________________________________________________________________________
Subject: Exhibit C Primary Immunization
Page: 1 of 1
Effective Date: 2/2002
Revised Date:
Youth Schedule 7 Through 18 Years Of Age- State Vaccine
Schedule
Vaccine
First Visit
Td (Adult)
Hep. B
IPV
Varicella
MMR
Hep. A
2nd Visit (1-2 mos. after first dose)
Td (Adult)
Hep. A
IPV
MMR
3rd Visit (6-12 mons. After second dose)
Td (Adult)
Hep.A
IPV
Boosters (Every 10 years)
Td (Adult)
Hep. B
Lost Immunization Records:
North Carolina’s immunization Law requires proof of minimum immunization for
youngsters in day care, students in kindergarten through grade 12, and students beginning
college. Students of any age whose immunization record cannot be produced must be
reimmunized.

Second dose MMR vaccine may be given to anyone through 18 years of age. Two
doses are required by law for children prior to school entry and entering into
college/university for first time on or after July 1, 1994.

The Hepatitis B vaccine may be administered to any child up through the age of 18
years. Three doses of Hepatitis B is required for all children born after July 1, 1994.

Susceptible children 13 years of age or older should receive two doses at least one
month apart of Varicella.

Hep A for those at risk due to travel, give at least 4 weeks before departure-private
pay.
________________________________________________________________________
Subject: Exhibit D Primary Immunization
Page: 1 of 2
Effective Date: 2/2002
Revised Date:
Precautions And Contraindications
Anyone With A Previous Allergic Reaction To A Vaccine Should Not Take That
Vaccine
Polio Vaccine
1. It is prudent on theoretical grounds to avoid routine polio vaccination of pregnant
women.
2. Defer IPV for patients of household contacts of persons with immune deficiency
diseases or with suppressed immune responses.
Measles/Mumps/Rubella (Combined Vaccines):
1.
2.
3.
4.
5.
Persons with anaphylactic reaction to ingestion eggs.
Anaphylactic reaction to topically or systemically administered Neomycin.
Women known to be pregnant and lactating women.
Patients with immune deficiency disease or with suppressed immune response.
Persons who have received blood transfusions or immune globulin within the past
five months.
Pertussis-Containing Preparations: If any of the following adverse events occur after
DTap, further vaccination with a vaccine containing pertussis antigen is contraindicated.
1.
2.
3.
4.
Allergic hypersensitivity.
Fever of 40.5 degrees Celsius (105 degrees Fahrenheit) or greater within 48 hours.
Collapse or shock-like state (hypotonic-hyporesponsive episode within 48 hours).
Persisting, inconsolable crying lasting 3 hours or more or an unusual, highpitched cry occurring within 48 hours.
5. Convulsion(s) with or without fever occurring within 3 days. (All children with
convulsions, especially those with convulsions occurring within 4-7 days of
receipt of DTap should be considered a contraindication to further doses of
DTap).
6. Encephalopathy occurring within 7 days; this includes severe alterations in
consciousness with generalized or focal neurologic signs. (A small but
significantly increased risk of encephalopathy believe that an encephalopathy
occurring within 7 days of DTap should be considered a contraindication to
further doses of DTap.
Varicella Vaccine:
1. Anaphylactic reaction to neomycin or gelatin.
________________________________________________________________________
Subject: Exhibit D Primary Immunization
Page: 2 of 2
Effective Date: 2/2002
Revised Date:
2.
3.
4.
5.
Moderate or severe illness.
Pregnancy and lactating women.
Persons with immune deficiency disease or with suppressed immune responses.
Persons who have received blood transfusion or immune globulin within the past
five months.
________________________________________________________________________
Subject: Exhibit E Primary Immunization
Page: 1 of 1
Effective Date: 2/2002
Revised Date:
Adverse Reaction Report:
All reactions occurring within 28 days following immunization and severe enough to
require medical attention should be immediately reported to the Local Health Department
and to the State’s MSAEFI Coordinator at (919) 733-7752.
Tetanus Prophylaxis In Wound Management
Clean, Minor
Wounds
History of Absorbed
Tetanus Toxoid
Unknown or <3 doses
Td
Yes
3 or more doses
1. Unless more than 10 years since last dose.
2. Unless more than 5 years since last dose.

Use DTap vaccine for children under seven years of age.
All Other
Wounds
Td
Yes
________________________________________________________________________
Subject: Exhibit F Primary Immunization
Page: 1 of 1
Effective Date: 2/2002
Revised Date:
Hepatitis vaccine is available from Immunization Branch, Department of Health and
Human Services, for the following indications and should be administered to:
1. Infants born to Hepatitis B surface antigen (HBsAg) positive mother;
2. Household contacts of chronic Hepatitis B (HBV) carriers; (two HBsAg + tests
separated by a minimum of six months);
3. Sexual (non-household) contacts of chronic HBV carriers;
4. Infants less than 12 months of age whose mother or primary caregiver has acute
HBV infection.
5. Susceptible contacts to known HBV infected persons who are at high risk for
further exposure because of the following behaviors:



Intravenous drug use.
Male homosexual/bisexual activity
Heterosexual activity with multiple partners
Hepatitis B vaccine may be administered to the following if purchased by funds other
than the above:
 Workers who are at risk of exposure to blood or body fluids