1. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc. Childhood Immunization

2. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.2 * Purpose is to protect against infectious diseases. * Most effective method is to create a highly immune population. * Universal vaccine is the goal. * Vaccines carry risk – but risks of disease are much greater.

3. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.3 * Definitions Vaccine Killed vaccines versus live vaccines Toxoid Vaccination Immunization; active versus passive Specific immune globulins

4. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.4 * A vaccine is a biological preparation that improves immunity to a particular disease * Contains whole or fractionated microorganisms * Once administered, the recipient’s immune system begins making antibodies against the microbe * Most of what we will be talking about will be vaccines

5. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.5 Two major classes of vaccines: * Killed – whole, killed microbes or microbial components * Live (attenuated) – composed of live viruses weakened in force or effect (diluted) rendered avirulent Why should caution be used with live vaccines in immunocompromised recipients?

6. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.6 Immunocompromised children are at special risk from live vaccines  Congenital immunodeficiency  HIV infection  Leukemia  Lymphoma  Generalized malignancy  Therapy with radiation  Cytotoxic anticancer drugs  High-dose glucocorticoids

7. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.7 * A bacterial toxin that has been changed to a non-toxic form * Once administered, the recipient’s immune system begins making antitoxins (antibodies directed against the natural bacterial toxin) * Antitoxins protect the recipient against injury from toxins, but do not kill the bacteria that produced it * e.g. Tetanus and diptheria

8. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.8 The administration of any vaccine or toxoid

9. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.9 Active * Develops in response to infection or to administration of a vaccine or toxoid * Endogenous production of antibodies * Takes weeks or months to develop but is long lasting Passive * Is obtained by giving a patient preformed antibodies (immunoglobulin's) * Provides immediate protection * Only lasts as long as the antibodies remain in the body 9

10. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.10

11. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.11

12. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.12 How far we have come...

13. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.13 * Reporting vaccine-preventable disease (PVDs) * Determine whether an outbreak is occurring * Evaluate prevention and control strategies * Evaluate the impact of national immunization policies and practices

14. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.14 * Measles * Mumps * Rubella * Diphtheria * Tetanus (lockjaw) * Pertussis (whooping cough) * Poliomyelitis (polio or infantile paralysis)

15. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.15 * Haemophilus influenzae type b * Varicella (chickenpox) * Hepatitis B * Hepatitis A * Pneumococcal infection * Meningococcal infection * Influenza * Rotavirus gastroenteritis * Genital human papillomavirus infection

16. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.16 * Measles, mumps, and rubella virus vaccine (MMR) * Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) * Poliovirus vaccine * Haemophilus influenza type b conjugate vaccine

17. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.17 * Combo vaccine of 3 live viruses (preferred) * Recipient makes antibodies against MMR * Effective response: 97% of recipients within 2 to 6 weeks * 2 nd dose increases protection (at least 1 month after first) * First dose should not be given until the child is ≥ 12 months old

18. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.18 * A/E: local soreness, erythema, swelling. Within 1 -2 weeks some may have swelling of cheeks, neck and under jaw. May have rash, fever * Admin: MMR – sc MMRV – sc or IM * Contraindicated in: ? Egg allergy Gelatin allergy Pregnancy Neomycin Low platelets

19. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.19 * Varicella virus vaccine * Hepatitis B vaccine * Hepatitis A vaccine * Pneumococcal conjugate vaccine * Meningococcal conjugate vaccine * Influenza vaccine * Rotavirus vaccine * Human papillomavirus vaccine

20. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.20 Routine immunization schedule for infants and children

21. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.21 Vaccines administered to an individual should be recorded in three locations: * The personal immunization record held by the person or his or her parent/guardian * The record maintained by the health care provider who gave the immunization * The local or provincial registry.

22. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.22 Include the following in each method of recording: * trade name of the product * disease(s) against which it protects * date given (day, month and year) * dose * site and route of administration * manufacturer * lot number * name and title of person administering the vaccine

23. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.23 Jane is a 10-year-old student at a local elementary school where you are on clinical rotation with the school nurse. She comes to the nurse’s office complaining that she has a headache, she doesn’t feel well, and she has a rash on her belly that is bothering her. After you and the school nurse make your assessments, you call Jane’s mother and ask her to come pick up Jane because you suspect that she has chickenpox.

24. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.24 1. Jane’s mother arrives at the school. She says, “You’re wrong. Jane can’t have chickenpox. I made sure she got the vaccine so I wouldn’t have to go through chickenpox with her.” What is your best response? 2. Jane’s mother continues, “I have a 1-month-old baby at home, and I don’t think I’ll bother having him vaccinated for chickenpox. What good did it do Jane?” What is your best response?

25. Elsevier Inc. items and derived items © 2010 by Saunders, an imprint of Elsevier Inc.25