Childhood immunizations: a practical approach for clinicians.

Family physicians can play a key role in reversing the resurgence of vaccine-preventable illnesses by making sure that patients are fully immunized. Childhood immunization schedules have recently changed. A second dose of measles, mumps and rubella (MMR) vaccine should be given at age four to six years. It has been recommended that hepatitis B vaccine be administered routinely to all infants in the United States. Both hepatitis B vaccine and hepatitis B immunoglobulin should be given to offspring of hepatitis B carriers. Haemophilus b conjugate vaccine (HbCV) should be administered to all infants, beginning at two months of age. Vaccines can be safely administered to patients with mild illnesses, allergic rhinitis, low-grade fever or penicillin allergy, as well as to those taking antibiotics. If indicated, several vaccines, such as diphtheria, tetanus and pertussis, oral poliovirus, HbCV and MMR, can be given simultaneously.