What vaccinations are recommended for a 4-year-old child?

From the Guidelines

At age 4, children should receive the DTaP-IPV (Kinrix) vaccine as the fifth dose of DTaP and fourth dose of IPV, as it has been shown to have comparable safety and reactogenicity profiles to separately administered DTaP and IPV vaccines 1. This vaccine is crucial for maintaining immunity against diphtheria, tetanus, pertussis, and polio, and its administration at this age has been endorsed by the Advisory Committee on Immunization Practices (ACIP) 1. The DTaP-IPV vaccine is administered as an intramuscular injection, preferably into the deltoid region, and has been found to have similar immunogenicity to separately administered DTaP and IPV vaccines, with or without a co-administered second dose of MMR vaccine 1. Some key points to consider when administering the DTaP-IPV vaccine include:

• The vaccine should not be administered to children aged <4 years or >7 years, unless inadvertently administered for an earlier dose of the DTaP and/or IPV series, in which case the dose should be counted as valid and does not need to be repeated provided minimum interval requirements have been met 1
• The standard schedule for IPV should be 4 doses administered at 2 months, 4 months, 6 through 18 months, and 4 through 6 years of age 1
• The benefits of protection against potentially serious diseases far outweigh the minimal risks of vaccination, and the vaccine has been extensively tested for safety and effectiveness 1

From the FDA Drug Label

INFANRIX is indicated for active immunization against diphtheria, tetanus, and pertussis as a 5-dose series in infants and children aged 6 weeks through 6 years (prior to the seventh birthday). The series consists of a primary immunization course of 3 doses administered at 2,4, and 6 months of age (at intervals of 4 to 8 weeks), followed by 2 booster doses, administered at 15 to 20 months of age and at 4 to 6 years of age.

The pertussis vaccine (IM) can be given to a 4-year-old child as part of the 5-dose series, specifically as the fifth dose (booster dose) administered at 4 to 6 years of age 2.

• The diphtheria toxoid (IM) is also approved for use in children from 6 weeks through 6 years of age (prior to 7th birthday) 3.
• The decision to administer the vaccine should be based on the individual child's medical status and the potential benefits and possible risks of vaccination.
• It is essential to follow the recommended dosage and administration schedule for the vaccine.

From the Research

Vaccines for 4-Year-Old Children

• The recommended vaccines for 4-6 year old children in the US include diphtheria-tetanus-acellular pertussis (DTaP), inactivated poliovirus (IPV), measles-mumps-rubella (MMR), varicella (V), and influenza vaccines 4.
• A study found that concomitant administration of varicella vaccine with DTaP-IPV and MMR did not impact the immunogenicity of diphtheria, tetanus, pertussis or poliovirus antigens, and both vaccine regimens were well tolerated 4.
• Another study showed that a combined DTaP-IPV vaccine was noninferior to separately administered DTaP and IPV vaccines with respect to DTaP antigen booster response rates and poliovirus antibody geometric mean titers ratios, and provided immunogenicity and reactogenicity that is comparable to separately administered DTaP and IPV vaccines 5.

Immunogenicity and Safety

• A phase III study found that MMR-RIT elicited immune responses that were not inferior to those of MMR II in terms of GMCs and seroresponse rates when administered alone or when co-administered with DTaP-IPV and VV, and demonstrated similar reactogenicity profiles 6.
• A randomized, controlled study in infants found that a combined DTaP-IPV vaccine was well tolerated and had immunogenicity similar to the control vaccines 7.
• A clinical evaluation of a DTaP-HepB-IPV combined vaccine found that it was generally safe, well tolerated, and induced immunogenicity similar to licensed vaccine components administered separately 8.

Vaccine Administration

• The studies suggest that co-administration of multiple vaccines, such as DTaP-IPV, MMR, and VV, is safe and effective, and can provide protection against multiple diseases in a timely and efficient manner 4, 5, 6.
• The use of combined vaccines, such as DTaP-IPV and DTaP-HepB-IPV, can reduce the number of injections required and may provide a safe and effective alternative to the current multiple-injection immunization regimen 5, 8.