IMMUNIZATIONS WOMEN-PREGNANCY BEFORE/DURING AND AFTER HEPATITIS B VACCINE Tdap VACCINE

OBJECTIVES OBJECTIVES Describe immunizations for pre-pregnancy, pregnancy and postpartum women Describe immunizations for pre-pregnancy, pregnancy and postpartum women Discuss the importance of Hepatitis B vaccine for women and infants Discuss the importance of Hepatitis B vaccine for women and infants Describe cocooning and the importance of ensuring Tdap vaccine Describe cocooning and the importance of ensuring Tdap vaccine

PRE-PREGNANCY IMMUNES ANY IMMUNATIONS PRIOR TO PREGNANCY ARE RECOMMENDED. THIS INCLUDES ALL CHILDHOOD AND ADOLESCENTS IMMUNIZATIONS.

IMPORTANT!!!! THIS IS EVERYONE’S JOB IF THEY ARE BEHIND IMMUNIZE!!!!

PREGNANCY IMMUNES FLU VACCINES FLU VACCINES TdAP TdAP

TETANUS Infection caused by Clostridium Tetani. Found in soil, dust, and animal feces. Infection caused by Clostridium Tetani. Found in soil, dust, and animal feces. Enters in body by puncture wounds, splinters, insect bites, burns etc. Enters in body by puncture wounds, splinters, insect bites, burns etc. Causes uncontrollable muscle spasms, Bacteria binds to motor nerve, spinal cord and brain stem leading to lock jaw, coma and DEATH!!! Causes uncontrollable muscle spasms, Bacteria binds to motor nerve, spinal cord and brain stem leading to lock jaw, coma and DEATH!!!

VACCINE IN 1948

WHO CARES? Annually worldwide there is 1 million cases of tetanus. The majority is infants. Annually worldwide there is 1 million cases of tetanus. The majority is infants. Most infants In 2000, WHO estimated that tetanus killed 200,000 babies Most infants In 2000, WHO estimated that tetanus killed 200,000 babies who get tetanus will DIE! who get tetanus will DIE!

TETANUS VACCINE Vaccine given to infants at 2 months, 4 months, and 6 months. Vaccine given to infants at 2 months, 4 months, and 6 months. Children get a booster at 4 or 5 years of age prior to school. It is the LAW. Children get a booster at 4 or 5 years of age prior to school. It is the LAW. Additional booster given at age 12. This should be a Tdap. Additional booster given at age 12. This should be a Tdap. Continued boosters every 10 years or every 5 year if puncture wound/burn Continued boosters every 10 years or every 5 year if puncture wound/burn

THINGS TO REMEMBER An immune mother passes antibodies thru her placenta to her baby If a pregnant mothers tetanus immune states is unknown, uncertain or more than 10 years VACCINATE! VACCINATE! Tdap is NOT contraindicated in pregnancy. Preferred to vaccinate in 2 nd and 3 rd trimester BUT VACCINATE!

INFLUENZA Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses)infectious diseaseRNA virusesfamilyOrthomyxoviridae Influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus.the airaerosols A single sneeze releases up to 40,000 droplets of virus.

INFLUENZA Influenza is associated with thousands a death a year. Ranging from 3,349 in , and 48,614 in flu season Influenza is associated with thousands a death a year. Ranging from 3,349 in , and 48,614 in flu season It is estimated 20,000 children under the age of 5 are hospitalized annual due to influenza It is estimated 20,000 children under the age of 5 are hospitalized annual due to influenza DEATHS in children in 2009 H1N1 were 345 DEATHS in children in 2009 H1N1 were 345 DEATHS in children in were 153 for seasonal influenza DEATHS in children in were 153 for seasonal influenza

INFLUENZA VACCINE Single dosage every flu season Single dosage every flu season Approved for children 6 months and older. Approved for children 6 months and older. Only contraindicated if allergic to eggs Only contraindicated if allergic to eggs Do not give attenuated (live) dose to pregnant women or asthmatics Do not give attenuated (live) dose to pregnant women or asthmatics GIVE TO ALL household members, people in contact with pregnant women or infants GIVE TO ALL household members, people in contact with pregnant women or infants

POSTPARTUM WOMEN MMR? MMR? VARICELLA? VARICELLA? TdAP? TdAP?

MEASLES, MUMPS + RUBELLA oh my!! All 3 diseases are very contagious All 3 diseases are very contagious Transmitted thru cough, sneeze or touch Transmitted thru cough, sneeze or touch First measles vaccine in First measles vaccine in out of every 1,000 children who get measles dies in the United States. (NNii, 2010) 3 out of every 1,000 children who get measles dies in the United States. (NNii, 2010) Death is more common in infants Death is more common in infants

MEASLES Symptoms begin 8-12 days after exposure Symptoms begin 8-12 days after exposure Presents as a cold with cough, sneeze, runny nose and pink eye. Presents as a cold with cough, sneeze, runny nose and pink eye. May have white spots on tongue ( Koplik’s sign) May have white spots on tongue ( Koplik’s sign) May have more serious infections like ear, pneumonia, croup or diarrhea. May cause encephalitis. May result in permanent brain damage. May have more serious infections like ear, pneumonia, croup or diarrhea. May cause encephalitis. May result in permanent brain damage.

COMPLICATIONS Pancreatitis Pancreatitis Sensorineural hearing loss Sensorineural hearing loss Encephalitis (rare only 1%) Encephalitis (rare only 1%) Meningitis Meningitis Spontaneous abortion (27%) in 1 st trimester Spontaneous abortion (27%) in 1 st trimester Testicular infections Testicular infections

RUBELLA Rubella, (German measles), was also very common before vaccination. Rubella, (German measles), was also very common before vaccination. Rubella Rubella may begin with 1-2 days of mild fever, mild and tender lymph nodes, usually in the back of the neck or ears. A rash will begin on the face and spreads downward. Rash maybe pink or light red spots. Rubella may begin with 1-2 days of mild fever, mild and tender lymph nodes, usually in the back of the neck or ears. A rash will begin on the face and spreads downward. Rash maybe pink or light red spots.fever Other symptoms include loss of appetite, mild conjunctivitis, a stuffy or runny nose, swollen lymph nodes in other parts of the body, and pain and swelling in the joints Other symptoms include loss of appetite, mild conjunctivitis, a stuffy or runny nose, swollen lymph nodes in other parts of the body, and pain and swelling in the jointsconjunctivitis VERY DANGEROUS in a pregnant woman. Causes growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems. VERY DANGEROUS in a pregnant woman. Causes growth retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone marrow problems.

Rubella Epidemiolgy Peaks in the springtime Peaks in the springtime Outbreaks before 1969 came in cycles: United States every 6-9 years, Europe every 3-5 years Outbreaks before 1969 came in cycles: United States every 6-9 years, Europe every 3-5 years Usual child age 5-9 years Usual child age 5-9 years Last epidemic in the U.S. was Last epidemic in the U.S. was Caused 30,000 still births and 20,000 birth defects due to congenital rubella Caused 30,000 still births and 20,000 birth defects due to congenital rubella

PREVENTION ONLY way to prevent is to VACCINATE!!! ONLY way to prevent is to VACCINATE!!! Vaccines are now combined in the MMR Vaccines are now combined in the MMR Given IM at 12-15months of age and then second dose at 4-6 years of age Given IM at 12-15months of age and then second dose at 4-6 years of age

VARICELLA

CHICKENPOX Caused by varicella-zoster virus Caused by varicella-zoster virus Highly contagious Highly contagious Symptoms may include low grade fever, abdominal pain, itchy rash, headache, malaise, cough, loss of appetite and sore throat Symptoms may include low grade fever, abdominal pain, itchy rash, headache, malaise, cough, loss of appetite and sore throat

VACCINATION Vaccine can be given alone or in combination with MMR. Called an MMRV Vaccine can be given alone or in combination with MMR. Called an MMRV Vaccine available in 1995 Vaccine available in 1995 Vaccine given at months of age Vaccine given at months of age Second vaccine given at 4-6 years of age Second vaccine given at 4-6 years of age

? WHY VACCINATE? Prior to vaccination 4 million children got chickenpox a year Prior to vaccination 4 million children got chickenpox a year Caused 100 deaths a year Caused 100 deaths a year Costs 400 million dollars in medical costs and lost wages for parents annually Costs 400 million dollars in medical costs and lost wages for parents annually

HEPATITIS HEPATITIS IS A VIRUS. Can be either acute or chronic. HEPATITIS IS A VIRUS. Can be either acute or chronic. In 2005, about 51,000 people became infected with hepatitis B (CDC, 2007) In 2005, about 51,000 people became infected with hepatitis B (CDC, 2007) About 1.25 million people in the United States have chronic HBV (CDC, 2007) About 1.25 million people in the United States have chronic HBV (CDC, 2007) Approximately 3,000-5,000 Americans die from diseases caused by Hepatitis B a year (CDC, 2007) Approximately 3,000-5,000 Americans die from diseases caused by Hepatitis B a year (CDC, 2007) Generally considered an adult disease for years due to sexual transmission or IV drug usage Generally considered an adult disease for years due to sexual transmission or IV drug usage

HEPATITIS + BABIES Approximately 90% of infants who acquire Hepatitis B infection at birth go on to become chronic carriers. (Tran, 2009) Approximately 90% of infants who acquire Hepatitis B infection at birth go on to become chronic carriers. (Tran, 2009) Estimated 15-25% of these carries will die of liver failure secondary to chronic hepatitis, cirrhosis or liver cancer. Estimated 15-25% of these carries will die of liver failure secondary to chronic hepatitis, cirrhosis or liver cancer.

HEPATITIS B VACCINE First Dose should be given to: First Dose should be given to: All newborns. If mom is infected with hepatitis baby also needs hepatitis B immune globulin. MUST be within 12 hours of birth. All newborns. If mom is infected with hepatitis baby also needs hepatitis B immune globulin. MUST be within 12 hours of birth. Older children, adolescents, or adults at any time. Vaccine is now preferred to be given by age 11 or 12. Older children, adolescents, or adults at any time. Vaccine is now preferred to be given by age 11 or 12.

Vaccine Second Dose: Second Dose: Child of an infected mother: between one and two months of age (at least one month after the first dose) Child of an infected mother: between one and two months of age (at least one month after the first dose) Child of an uninfected mother: between one and four months of age (at least one month after the first dose) Child of an uninfected mother: between one and four months of age (at least one month after the first dose) Older child, adolescent or adult: one to two months after first dose Older child, adolescent or adult: one to two months after first dose

Vaccine Third Dose: Third Dose: Child of an infected mother: at six months of age (at least two months after the second dose, and at least four months after the first dose) Child of an infected mother: at six months of age (at least two months after the second dose, and at least four months after the first dose) Child of an uninfected mother: between 6 and 18 months of age Child of an uninfected mother: between 6 and 18 months of age Older child, adolescent, or adult: four to six months after first dose Older child, adolescent, or adult: four to six months after first dose

BACK TO TETANUS Remember this is a serious disease. Remember this is a serious disease. WHO (2000) estimated that tetanus killed 200,000 babies WHO (2000) estimated that tetanus killed 200,000 babies The Tdap vaccine protects against Tetanus, Diphtheria and Pertussis The Tdap vaccine protects against Tetanus, Diphtheria and Pertussis

WHOOPING COUGH Whooping cough is caused by Bordetella pertussis. Whooping cough is caused by Bordetella pertussis. Annoying for adults. Life threatening to newborns and infants Annoying for adults. Life threatening to newborns and infants May start as a runny nose, low grade fever or cough. May start as a runny nose, low grade fever or cough. Gets its name because the cough is a “whoop” high pitched noise or gasp for breath Gets its name because the cough is a “whoop” high pitched noise or gasp for breath

try this link muchwhooping.wav muchwhooping.wav This is the sound of a 3 year old girl with whooping cough.

Tdap Cocooning This means everyone around the newborn (0 to 12 months) GETS VACCINATED! This means everyone around the newborn (0 to 12 months) GETS VACCINATED! It takes days to build up the immunity to pertussis after the vaccine. It takes days to build up the immunity to pertussis after the vaccine. Grandparents, friends, parents should plan ahead or stay away Grandparents, friends, parents should plan ahead or stay away

CONCLUSION We discussed the need to keep children, adolescents and adults up-to-date on vaccinations We discussed the need to keep children, adolescents and adults up-to-date on vaccinations Huge need to vaccinate pregnant women with Tdap and Influenza vaccines Huge need to vaccinate pregnant women with Tdap and Influenza vaccines Catch anyone up that you missed. Given the MMR, give Varicella if mom’s not protected Catch anyone up that you missed. Given the MMR, give Varicella if mom’s not protected

CONCLUSION Give Hepatitis B vaccine. Prevent death, cirrhosis of the liver and liver cancers! Give Hepatitis B vaccine. Prevent death, cirrhosis of the liver and liver cancers! Protect the newborn infant from whooping cough by cocooning them in a blanket of “LOVE” Lasting Ongoing Vaccinations to Everyone. Protect the newborn infant from whooping cough by cocooning them in a blanket of “LOVE” Lasting Ongoing Vaccinations to Everyone. When in doubt of what to do VACCINATE!! VACCINATE!! VACCINATE!! When in doubt of what to do VACCINATE!! VACCINATE!! VACCINATE!!

QUESTIONS????? PRESENTED BY LEAH M FLORE APRN, FNP, IBCLC PRESENTED BY LEAH M FLORE APRN, FNP, IBCLC HOPE YOU ENJOYED THE SHOW HOPE YOU ENJOYED THE SHOW