Immunizations

People who should NOT get influenza live virus vaccine (nasal spray)

-Persons aged <2 years or those aged 50 years and older; persons with any of the underlying medical conditions -Children aged 2--4 years with wheezing or asthma, or whose medical record indicates a wheezing episode has occurred during the preceding 12 months; -Children or adolescents receiving aspirin or other salicylates -Persons with a history of GBS after influenza vaccination; -Pregnant women

People who should get influenza vaccine

1. People at high risk for complications from the flu chronic illness, nursing home residents 2. People who could spread the flu to high risk individuals. (health care, daycare workers) 3. People over 50 years of age (account for 91% of deaths from the flu). 4. People in nursing homes/long-term care facilities 5. Children 6months or older 6. Pregnant women

Types of flu vaccines

2 types of flu vaccine: 1. Flu shot: An inactivated vaccine (containing killed virus) given by injection 2. Nasal spray: Live attenuated Influenza vaccine contains weakened live viruses Only in healthy people 2-49 years Licensed in 2003

Pneumococcal Vaccine

A 13 valent Streptococcus vaccine (PCV13) that has been approved for children less than 2 years of age Strep pneumoniae is responsible for many bacterial infections in children (meningitis, otitis media, sinusitis, pneumonia) Useful in kids who are in daycare Given at 2,4,6 months and then boosted at12-15 months Administer 1 dose of PCV13 to all healthy children aged 24 through 59 months who are not completely vaccinated for their age. Not generally given to children greater than age 5 years but may be given to certain high risk children (ie:asplenia)

Gardisil (HPV)

A US government advisory committee on immunization practices has voted to recommend that all US girls and women aged 11 to 26 should receive Merck & Co's cervical cancer vaccine Gardisil as a matter of routine. Gardasil is designed to prevent the majority of human papillomavirus (HPV)-related clinical diseases, those caused by HPV 6, 11, 16 and 18. HPV types 16 and 18 account for approximately 70% of cases of cervical cancer, whilst HPV 6 and 11 cause approximately 90% of genital wart cases.

Hemophilus Influenza (HIB)

Administer a 2-3 dose primary series and a booster dose at 12-15 months Primary series given at 2,4,6 months Prevents some serious infections such as bacterial meningitis, epiglotitis, pneumonia Generally not given to children over the age of 4 years

DTaP (Diptheria and tetanus toxoids and acellular pertussis)

Administer a 5-dose series of DTaP vaccine at ages 2,4,6,15-18 months, and 4-6 years The 4th dose may be administered as early as 12 months provided at least 6 months have passed since the 3rd dose The 5th dose is not necessary if the 4th dose was administered at age 4 years or older

Where are immunizations given

All immunizations are given INTRAMUSCULARLY except VIMM (varicella, IPVpolio, MMR, and meningitis.)

Mumps

Also known as "epidemic parotitis" Can cause inflammation of the testes and ovaries May cause sterilization

Fever in children

An elevated temperature is one of the most common symptoms in children Is something of great concern to parents Most fevers are of short duration and with limited consequences. If child is less than 3 months of age, pediatrician needs to be notified of fever

Who should get meningitis vaccine

College freshmen living in dorms Microbiologists US military Anyone traveling to Africa/ Hajj Anyone with a damaged spleen Anyone with an immune system disorder People exposed to meningitis

Diptheria

Commonly given with tetanus/pertussis in infancy Boosted before kindergarten Boosters are then given every 10 years for the rest of life with tetanus

DTaP vs Tdap

DTaP is approved for children under age 7. Tdap, which has a reduced dose of the diphtheria and pertussis vaccines, is approved for adolescents starting at age 11 and adults ages 19 to 64 The current recommendation is that one dose of the Tdap vaccine be substituted for one dose of the Td vaccine between the ages of 11 and 64 Pregnant women are also advised to get the Tdap vaccine, preferably between 27 and 36 weeks' gestation.

What Acyclovir Does

Decreases the number of chicken pox lesions. The number of lesions goes down a little bit but is certainly not eliminated. Decreases the length of time new lesions show up. Decreases the number of days children have a fever. The fever goes away about one day earlier with acyclovir.

Acyclovir (Zovirax)

Drug which disrupts replication of the DNA of the chicken pox virus. When the DNA can't replicate, neither can the virus. Studies have shown that early use of Acyclovir (started within the first 24 hours of the rash) does seem to modify the symptoms of the infection but only modestly.

Influenza

Flu causes 36,000 deaths and more than 200,000 hospitalizations per year in the US. Takes about 2 weeks to develop antibodies Now recommended for children for children 6 months and older Cannot be given to children with egg allergies Administered in the fall and is repeated yearly because the influenza viruses change from year to year

HPV new guidelines 2017

For persons initiating vaccination before their 15th birthday, the recommended immunization schedule is now 2 doses of HPV vaccine. The second dose should be administered 6-12 months after the first dose Persons who initiated vaccination with 9vHPV, 4vHPV, or 2vHPV before their 15th birthday, and received 2 doses of any HPV vaccine at the recommended dosing schedule (0, 6-12 months), or 3 doses of any HPV vaccine at the recommended dosing schedule (0, 1-2, 6 months), are considered adequately vaccinated. If the vaccination schedule is interrupted, the series does not need to be restarted. The number of recommended doses is based on age at administration of the first dose For persons initiating vaccination on or after their 15th birthday, the recommended immunization schedule is 3 doses of HPV vaccine. The second dose should be administered 1-2 months after the first dose, and the third dose should be administered 6 months after the first dose

Vaccines in 1950s

Four vaccines: diphtheria, tetanus, pertussis and smallpox. Because three of these vaccines were combined into a single shot (DTP), children received five shots by the time they were 2 years old and not more than one shot at a single visit

Gardisil cont..

Gardasil is approved by the FDA for girls and women ages 9 to 26. Generally given after age 11 years-has to be given before sexually active Originally was a series of 3 injections given over a 6 month period of time Dose 2 given 2 months after the first Dose 3 given 6 months after the first Also a bivalent vaccine Cervarix

Rubella (German Measles)

Given as part of the MMR at 12-15 months, booster at 4-6 years Controversial because of ? Autism link Direct contact spread Communicable 7 days before rash to 5 days after rash Rash first appears on face Isolate child from pregnant women

Tetanus

Given in infancy, then booster before kindergarten Booster every 10 years for life Good for 10 years unless a deep wound, then every 5 years

Hepatitis B (HBV)

HBV infections can lead to fatal consequences in adulthood. Type of Hepatitis that is spread by parenteral use, sexual contact and blood and body fluids The incidence of HBV infections increases dramatically during the teenage years Done as a series of 3 injections Now done in infancy-used to start at age 10-11

Hep A vaccine

Hepatitis A is spread through fecal/ oral contact Also shellfish from contaminated water Common in fall, early winter Poor sanitation Now given at age 1 year Second dose needs to be at least 6 months apart from 1st dose Recommended for international travel In the western part of the US, has been a childhood immunization for years

Current Vaccinations

Hib vaccine was added in the late-1980s. 1990s, hepatitis B and varicella vaccines were added and the polio vaccine shot (IPV) replaced the oral polio vaccine (OPV). In the year 2000, the pneumococcal vaccine was added and in 2004 the influenza vaccine was added. Now, children could receive as many as 22 shots by 2 years of age and five shots in a single visit! In 2006, Hepatitis A and Rotavirus were added to infant vaccinations and HPV and chickenpox and pertussis booster to childhood vaccinations

General Immunization Contraindications

If child had an anaphylactic reaction to a previous immunization If child had an anaphylactic reaction to any immunization constituent (eggs) Fever

Influenza dosing infants/children

If less than 9 years of age and receiving for the 1st time, receive 2 doses 4 weeks apart Dose is: 0.25 ml in kids 6mos-35 months Dose is: 0.5 ml in children 3 years and above. Dose is: 0.2 ml nose spray

Polio

In 1999, recommended a change to all injectable polio immunizations Given at 2,4,6-18 months, booster at 4-6 years The final dose should be given after the 4th birthday and at least 6 months after the 3rd dose Direct contact spread Period of communicability unknown

Injection Guidelines

Injections are given in the vastus lateralis The dorsogluteal muscle is NEVER used until a child has been walking for awhile

What Acyclovir Does Not Do

It does not decrease the complications of chicken pox (e.g. infected skin lesions) It does not make the person less infectious to other people since the most infectious period of chicken pox occurs before the rash shows up. It does not seem to lower the immunity to chicken pox after the infection. However, the long term effects acyclovir has on immunity are still being studied.

Environmental measures for fever

May be used if tolerated by the child and do not cause shivering Minimize clothing/increase exposure to air Reducing room temperature Increasing air movement Use of tepid moist compresses applied to body Lose 15% of body heat through the head Can place in tub of water (not cool) or shower

Meningococcal Vaccines

Meningococcal conjugate vaccine (Menactra) was licensed in 2005 - Newer vaccine Menveo Both can prevent 4 types of meningococcal disease Protect about 90% of those who receive the vaccine Both are now given to children at their routine pre-adolescent visit (11-12 years) with a booster at 16 years

Meningitis

Meningococcal disease is a serious illness (bacterial) Leading cause of bacterial meningitis in kids 2-18 yrs 2600 people get meningococcal disease in the US each year 5-10% of these people die 11-19% lose limbs, become deaf, have chronic neurological problems, suffer seizures and strokes

Vaccines in 1980s

Mid-1980s seven vaccines: diphtheria, tetanus, pertussis, measles, mumps, rubella and polio. Because six of these vaccines were combined into two shots (DTP and MMR), and one, the polio vaccine, was given by mouth, children still received five shots by the time they were 2 years old and not more than one shot at a single visit.

Hep B series

Monovalent Hep B vaccine administered to all newborns before discharge from hospital The second dose is administered at 1-2 months Should use monovalent Hep B if given before 6 weeks Minimal interval is 4 weeks from the 1st to the second The final dose should not be given any earlier than 24 weeks of age

People who should NOT get influenza vaccine

People with a severe allergy to eggs People with a severe flu vaccine reaction in the past People who have gotten Guillain-Barre in the past from a flu vaccine Children less than 6 months of age.

Contraindications for MMR/varicella

Pregnancy Altered immunologic state (HIV/AIDS, leukemia) On immunosuppressive drugs

Chicken Pox (Varicella)

Recommended 2 dose series Immunized at 365 days of age (Must be 1 year) First licensed in 1995 Can get mild case even if immunized Recommend a booster at 4-6 years Second dose can be given at least 4 weeks after the first dose Communicable by direct contact or droplet infection Communicable 1 day before rash to when all lesions are crusted over Look like little pimples/very itchy Maintain strict isolation Benadryl/Aveeno baths

Pertussis (Whooping Cough)

Recommended for children 6 weeks through 6 years who have no reason not to be immunized Usually given at 2,4,6 months and boosted at kindergarten and again at 10-12 years The acellular form is associated with fewer side effects Acellular pertussis vaccines contain only the parts of the pertussis bacterium thought to be important for immunity, while whole-cell vaccines, such as the DTP vaccines currently used in the United States for infants, contain the whole, killed bacterium.

Rotavirus

Rotavirus is the leading cause of severe gastroenteritis in children throughout the world Studies have shown that the vaccine prevents 74% to 87% of all rotavirus episodes Given orally to young infants

Contraindications for DTaP

Seizures within 3 days of previous DTaP Inconsolable crying for > 3 hours within 48 hours of receiving a previous DTaP

Pertussis Spread

Spread by direct contact or droplet spread Communicability may extend 4 weeks after coughing begins Have seen a resurgence in middle school age kids Need to do a pertussis screen in anyone with a history of coughing Treated with erythromycin/ azithromycin

Fever management

The primary reason to treat the fever is to treat the discomfort "Fever is your child's friend" Include pharmacological measures and environmental measures

HPV vaccination for males

The quadrivalent vaccine Gardisil has been approved for use in boys at ages 11-12 (can be given ages 9-21 years) The bivalent vaccine has not been approved for use in boys Many head and neck cancers as well as anal cancers have been associated with the HPV virus in men

Immunization Controversy

There is controversy regarding the use of thimerosal, a preservative used since the 1930's in some multi-dose preparations. There are no preservatives in single-dose vials. In July, 1999, the American Academy of Pediatrics agreed that thimerosal should be reduced or eliminated in vaccines as a precautionary measure. Some people feel that thimerosal is linked with increased autism rates. Research has disproved this.

Rotavirus Vaccine

Trade name: RotaRix or RotaTeq Minimum age is 6 weeks of age Given either as a 2 dose administration (RotaRix RV-1) at 2 and 4 months of age or a 3 dose pattern (RotaTeq RV-5) at 2,4, and 6 months If at any time RotaTeq is used in the series, the infant should have the 3 dose series The Rotavirus vaccine should not be initiated for infants 15 weeks, 0 days or older The maximum age for the final dose in the series is 8 months, 0 days

Pharmacological fever management

Tylenol (acetominophen), Ibuprofen (Motrin, Advil) **Motrin and Advil are not approved for children less than 6 months of age Can be alternated

Measles (Rubeola)

Virus Given at 12-15 months as part of MMR 2nd given before kindergarten (4-6 years) The minimum time between doses is 4 weeks Kopliks' spots-(small red spots with a blue white center seen on the buccal mucosa opposite the molars) Communicable from 4 days before to 5 days after the rash

When are immunizations held

if child has a febrile illness