immunization update [autosaved] · months of age ! rotateq is a 3 dose series administered at 2, 4,...

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Immunization Update

Jennette Cole, RN, BSN, FNP-BC

New Mexico Nurse Practitioner Council Riding the Wave

April 11, 2014

Disclosure Statement

!  I am a family nurse practitioner who works in an outpatient pediatric clinic. I am not receiving any compensation for this presentation. I have no financial interest or conflict with the manufacturer of any product named in this presentation.

Disclosures

!  The information in this presentation is based solely on the recommendations of the Advisory Committee of Immunization Practices (ACIP) based through the CDC. All vaccine information reviewed in this presentation was retrieved directly through the respective CDC web pages

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Presentation Objectives !  After this presentation, the listener should be able to

!  Have a general overview of the importance of immunization

!  Be aware of how often the immunization schedule is updated and how to obtain the updated schedule

!  Discuss both standard and catch-up childhood immunization schedules

!  Discuss adult immunization schedules

!  Discuss common and severe side effects associated with immunizations

!  Discuss vaccinations for special populations

Immunization Schedule

!  Updated yearly by the Advisory Committee on Immunization Practices (ACIP)

!  The committee is composed of 15 experts in public health and clinical medicine and are not government employees

!  They work closely with the American Academy of Family Physicians, American Academy of Pediatrics, the American College of Physicians, the American College of Obstetricians and Gynecologists and the American College of Nurse-Midwives, who approve the immunization schedule

www.cdc.gov/vaccines/recs/acip

Immunization Schedule

!  The CDC’s website offers the most up-to-date information on immunization schedules and vaccines

!  The Immunization Action Coalition (IAC) releases weekly news and information on vaccines. This is a free subscription and can be found at: http://www.immunize.org/subscribe

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Childhood Immunization Schedule

!  Birth

!  2, 4 and 6 months

!  12 months

!  15-18 months

!  4 years

!  11 years

!  16-18 years

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Birth

!  Hepatitis B Vaccine

Image retrieved from: http://www.seethatdad.com/2013/02/19/tips-to-help-dads-enjoy-their-newborn/

2, 4 and 6 Months !  Hepatitis B

!  Rotavirus

!  DTaP (Diphtheria, tetanus & acellular pertussis)

!  Hib (Haemophilus influenzae type b)

!  PCV13 (Pneumococcal conjugate)

!  IPV (Inactivated poliovirus)

Image retrieved from: http://photography-on-the.net/forum/showthread.php?t=570109

12 Months !  Hepatitis A Vaccine

!  IPV

!  Hib

!  PCV13

!  MMR

!  Varicella

Image retrieved from: http://similac.com/baby-development/12-month-old-baby-tips-advice

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15 – 18 Months !  DTaP

!  2nd Hepatitis A vaccine

Images retrieved from: http://www.whattoexpect.com/toddler/18-month-old.aspx

2 Years Old

!  2nd Hepatitis A vaccine if not given at the 18 month well child visit

Image retrieved from: http://www.activitiesfor2yearolds.org/2-year-olds/

4 Years Old !  DTAP

!  IPV

!  MMRV

Image retrieved from: http://www.todaysparent.com/kids/preschool/your-4-year-old

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11 Years Old !  Tdap

!  Meningococcal Vaccine

!  HPV Vaccine

Image retrieved from: http://www.salon.com/2013/01/23/11_year_old_to_obama_trans_people_matter_too

16 – 18 Years Old !  Meningococcal Booster

Image retrieved from: http://thinkprogress.org/health/2013/12/04/3017741/stop-meningitis-outbreaks-college/

Adult Immunization Schedule !  Annual Flu Vaccine

!  Td booster every 10 years

!  60 years of age or older should receive the zoster vaccine

!  65 years of age or older should receive the PPSV23 vaccine

Image retrieved from: http://mycrazytown.com/happy-old-people

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Hepatitis B

Image retrieved from: http://articles.mercola.com/sites/articles/archive/2014/01/07/infant-hepatitis-b-vaccine.aspx

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Source: National Notifiable Diseases Surveillance System (NNDSS)

Hepatitis B Vaccine for Children !  Should be given at birth, 2 months, and 6 months

of age

!  May be given in a combination vaccine, which will give a total of 4 doses

!  Second dose should be administered 1-2 months after the first dose. Minimum spacing is 4 weeks

!  Third dose should be administered at least 8 weeks after the second dose AND at least 16 weeks after the first dose

!  The final dose in the series (3rd or 4th dose) should be administered no earlier than 24 weeks of age

Special Considerations

!  For infants born to hepatitis B surface antigen-positive (HBsAg) mothers, administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth

!  Need to test for HBsAg and antibody to HBsAg 1-2 months after they complete the HepB series

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Hepatitis B Vaccine for Adults !  Vaccinate adults with any of the following:

!  Sexually active individuals who are not in a mutually monogamous relationship; individuals who are being treated for STI’s; current or recent IV drug users; and men who have sex with men

!  Health care and public safety workers who are potentially exposed to blood and other infectious body fluids

!  Individuals with end-stage renal disease, HIV infection, chronic liver disease, or people under 60 years of age with diabetes

!  Household contacts and sex partners of hepatitis B surface antigen-positive individuals

!  International travelers to countries with a prevalence of chronic HBV infection

!  Adults in: STD treatment facilities, HIV treatment facilities, drug abuse treatment facilities, correctional facilities, facilities for individuals with developmental disabilities

Hepatitis B Vaccine for Adults

!  Administer missing doses to complete the 3-dose series of hepatitis B vaccine to individuals not vaccinated or not completely vaccinated

!  The 2nd dose should be given 1 month after the 1st dose. The 3rd dose should be given at least 2 months after the 2nd dose, and at least 4 months after the 1st dose

Side Effects

!  Common Side Effects

!  Soreness where the shot was given

!  Temperature of 99.9 or higher

!  Severe Side Effects

!  High fever

!  Unusual behavior

!  Severe allergic reaction: difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart rate or dizziness

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Who Should not Have the Hepatitis B Vaccine?

! Anyone with a life-threatening allergy to yeast

! Anyone who has had a life-threatening allergic reaction to a previous Hepatitis B vaccine

! Anyone who is moderately to severely ill when a dose is scheduled

Pregnancy Considerations

!  Pregnancy is not a contraindication to vaccination and Hepatitis B vaccination is recommended for pregnant women who are at risk for HBV infection during pregnancy

Image retrieved from: http://www.slocounty.ca.gov/health/prevention/mathealth.htm

Rotavirus Vaccine

Image retrieved from: http://www.travelonshoestring.com/2012/01/rotavirus-vaccination-must-for-every.html

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Estimated Number of Affected Children <5 Years of Age Pre-Rotavirus Vaccine

Image retrieved from: http://www.cdc.gov/vaccines/pubs/surv-manual/chpt13-rotavirus.html

Rotavirus Vaccine

!  Oral Vaccine

!  Should be given at 2, 4, and 6 months of age (depending on the brand of the vaccine)

!  Rotarix is a 2 dose series administered at 2 and 4 months of age

!  RotaTeq is a 3 dose series administered at 2, 4, and 6 months of age

!  Minimum age to administer the vaccine is 6 weeks

!  The maximum age to receive the Rotavirus vaccine is 14 weeks and 6 days

!  Do not give after 8 months of age

Side Effects

Common Side Effects

!  Irritability

!  Mild diarrhea or vomiting

Serious Side Effects

!  Risk for intussusception within a week after the 1st dose of the vaccine

!  Stomach pain with severe crying

!  Several episodes of vomiting

!  Blood in the stool

!  Weakness

!  Irritability

!  High fever



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Who Should not Have the Rotavirus Vaccine?

!  Babies with severe combined immunodeficiency (SCID)

!  A baby who has had a life-threatening allergic reaction to a dose of the rotavirus vaccine

!  Severe allergy to latex

!  A baby who is moderately or severely ill should wait to receive the vaccine

DTaP, Tdap and Td Vaccines

Image retrieved from: http://www.fishershypnosis.com/side-effects-of-dtap-vaccine.html

Facts About Pertussis

!  In 2012 there were over 48,000 reported cases of pertussis. This is the highest number of cases reported in the U.S. since 1955 when over 62,000 cases were reported

!  Worldwide, there are an estimated 16 million cases of pertussis and about 195,000 deaths a year

!  Approximately half of infants less than 1 year old who get pertussis are hospitalized

!  Vaccinated children and adults can get pertussis. They tend to have less severe cases than those unvaccinated

http://www.cdc.gov/pertussis/fast-facts.html

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Why is the Pertussis Rate Increasing?

!  Some reasons for the increased pertussis rate are: increased awareness, improved diagnostic testing, improved reporting, more circulation of the bacteria, and waning immunity

!  The DTaP vaccine we are currently using does not seem to be protecting us as long as the whole cell vaccine (DTP) that we used to use

!  We changed to the DTaP vaccine in the 1990’s due to the increased side effects that were associated with the DTP vaccine

Waning Effectiveness

!  The CDC states that the DTaP vaccine is effective for 8 and 9 out of every 10 children who receive all 5 doses of the vaccine between 4 and 10 years of age

!  7 out of 10 children were fully protected who were 5 or more years past their last DTaP dose

!  The CDC stresses that vaccines are the best way to prevent pertussis

http://www.cdc.gov/media/matte/2011/10_whooping_cough.pdf

DTaP Vaccine

!  Should be given at 2,4, and 6 months of age. Should then be given between 15-18 months and 4-6 years, for a total of 5 doses

!  DTaP should not be given to individuals 7 years of age or older

!  DTaP should not be given to infants under 6 weeks of age

!  Catch-up vaccination: the 5th dose of DTaP is not needed if the 4th dose was given at age 4 or older

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Side Effects Common Side Effects

!  Fever

!  Redness or swelling where the shot was given

!  Soreness or tenderness where the shot was given

!  Fussiness

!  Tiredness or poor appetite

!  Vomiting

Serious Side Effects

!  Seizures

!  Non-stop crying for 3 hours or more

!  High fever (over 105°F)



Who Should not Have the DTaP Vaccine?

!  Any child who has had a life-threatening allergic reaction to a dose of the DTaP vaccine

!  Any child who is moderately or severely ill should wait to receive the vaccine

!  Any child who has suffered a brain or nervous system disease within 7 days after a dose of DTaP

Tdap and Td Vaccines !  Tdap is usually administered at 11 years of age

!  Boostrix has a minimum age of 10 years old and Adacel has a minimum age of 11 years old

!  Any person 11 – 64 years of age who has not had a dose of Tdap should receive this vaccine

!  Td booster doses are every 10 years

!  Tdap can be administered regardless of interval from the most recent Td vaccine

!  Unvaccinated adults should complete the Td series by administering the 1st 2 doses at least 4 weeks apart and the 3rd dose 6-12 months after the 2nd . May give Tdap dose in lieu of a Td dose

!  Adults aged 65 years and older who will be having close contact with an infant less than 12 months old, and who have not had Tdap should receive a single dose of the vaccine

!  For other adults aged 65 years and older, a single dose of Tdap vaccine may be given instead of Td vaccine

!  The CDC is currently working on more information in regards to any further use of Tdap or Td in adults aged 65 years and older

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Side Effects Common Side Effects !  Pain, redness or swelling

at injection site

!  Mild fever of at least 100.4° F

!  Headache

!  Tiredness

!  Nausea, vomiting, diarrhea, stomach ache

!  Chills, body aches, sore joints, rash, swollen glands

Severe Side Effects !  Fever over 102° F

!  Swelling of the entire arm where the vaccine was given


Who Should not Have the Tdap Or Td Vaccine?

!  Anyone who has had a life-threatening allergic reaction to a dose of any tetanus, diphtheria, or pertussis containing vaccine

!  Anyone who is moderately or severely ill should wait to receive the vaccine

!  Anyone who has had a coma, or multiple seizures after a childhood dose of DTaP or DTP should not get the Tdap, unless another cause was found. You can still get the Td vaccine

Tetanus Vaccines and TIG for Wounds: 0 Months – 10 Years

Age (years)

Vaccination history Clean, minor wounds

All other wounds

0 through 6

Unknown or not up-to-date on DTaP series based on age

DTaP DTaP TIG

Up-to-date on DTaP series based on age

No indication No indication

7 through 10

Unknown or incomplete DTaP series

Tdap and recommend catch-up vaccination

Tdap and recommend catch-up vaccination TIG

Completed DTaP series AND <5 years since last dose

No indication

No indication

Completed DTaP series AND ≥5 years since last dose

No indication

Td, but Tdap preferred if child is 10 years of age

http://www.bt.cdc.gov/disasters/disease/tetanus.asp

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Tetanus Vaccines and TIG for Wounds: 11 Years and Older

Age Vaccination History Clean, Minor Wounds All Other Wounds

11 years and older

Unknown or <3 doses of tetanus toxoid containing vaccine

Tdap and recommend catch-up vaccination

Tdap and recommend catch-up vaccination TIG

3 or more doses of tetanus toxoid containing vaccine AND <5 years since last dose

No indication No indication

3 or more doses of tetanus toxoid containing vaccine AND 5-10 years since last dose

No indication Tdap preferred (if not yet received) or Td

3 or more doses of tetanus toxoid containing vaccine AND >10 years since last dose

Tdap preferred (if not yet received) or Td

Tdap preferred (if not yet received) or Td

http://www.bt.cdc.gov/disasters/disease/tetanus.asp

Pregnancy Considerations

!  Pregnant women should get a dose of Tdap at every pregnancy

!  For optimal timing, Tdap should be administered between 27 and 36 weeks gestation, as this maximizes the maternal antibody response and passive antibody transfer to the infant

!  Tdap may be given at any time during pregnancy

Hib Vaccine

http://www.nhs.uk/Conditions/vaccinations/Pages/5-in-1-infant-dtapipvhib-vaccine.aspx

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Hib Facts and Risk Factors

Hib Facts !  Incidence of Hib has

decreased 99% since the prevaccine era

!  Average of 68 reported cases of Hib per year

!  Most recent cases have been in unvaccinated or incompletely vaccinated children

Risk Factors !  Household crowding

!  Large household size

!  Child care attendance

!  School-aged siblings

!  Chronic disease

http://www.cdc.gov/vaccines/pubs/pinkbook/hib.html

Hib Vaccine

!  Should be given at 2, 4, and 6 months of age, with an additional dose between 12-15 months of age

!  Depending on the brand of the vaccine, the 6 month dose may not need to be given

!  ActHIB, MenHibrix, or Pentacel consists of 3 doses

!  PedvaxHib or COMVAX consists of 2 doses

!  One booster dose of any Hib vaccine should be given at 12-15 months of age

!  Hiberix is the exception and should only be used in the final dose of Hib in children 12 months – 4 years who have received at least 1 prior dose of the Hib vaccine

Hib Vaccine

!  Minimum age is to administer the vaccine is 6 weeks for all Hib brands of the vaccine, with the exception of Hiberix, which is 12 months of age

!  Hiberix contains tetanus toxoid conjugate, which should not be given to children under 12 months of age, and is usually administered between 15 months and 2 years of age

https://www.mims.com%2FHiberix.html&ei=AlsvU-i6BI6xqAG7hoHgAw&bvm=bv.62922401,d.aWc&psig=AFQjCNE0K3KtLXcZ-0ozqec6i2itsDB80g&ust=1395698753979502

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Catch-Up Dosaging for Hib !  Catch-up for Hib: If the 1st dose was given at ages 12 – 14

months, administer the 2nd (and final) dose at least 8 weeks after the 1st dose, regardless of the Hib vaccine used

!  If the first 2 doses were PedvaxHIB or COMVAX and administered at 11 months or earlier, the 3rd (and final) dose between 12 – 15 months and at least 8 weeks after the 2nd dose

!  If the 1st dose was given at age 7 – 11 months, give the 2nd dose at least 4 weeks later and a 3rd (and final) dose at age 12 – 15 months or 8 weeks after the 2nd dose, whichever is later, regardless of the Hib vaccine used

!  If the 1st dose is given younger than 12 months of age and the 2nd dose is given between 12 – 14 months of age, the 3rd (and final) dose should be given 8 weeks later

!  For children 15 months and older who have been unvaccinated, administer only 1 dose

Hib Vaccine and High-Risk Conditions !  Children aged 12 months – 59 months who are at an

increased risk for Hib disease who have received no Hib doses or 1 Hib dose before 12 months of age should receive 2 additional doses of Hib vaccine 8 weeks apart. If they received 2 or more doses before 12 months of age should receive 1 additional dose of Hib vaccine

!  Hib vaccine is not recommended for children older than 5 years old, with exception of children who are unimmunized and have anatomic or functional asplenia or children older than 5 years old with HIV. 1 dose of Hib vaccine should be given to these individuals

Side Effects

Common Side Effects !  Redness, warmth, or

swelling where the vaccine was given

!  Fever over 101° F

Severe Side Effects !  Severe allergic reaction:

difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart rate or dizziness

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Who Should not Have the Hib Vaccine?

!  Any child who has had a life-threatening allergic reaction to a dose of the Hib vaccine

!  Any child who is moderately or severely ill should wait to receive the vaccine

!  Babies less than 6 weeks of age should not get the Hib vaccine

!  Children over 5 years of age do not need the Hib vaccine


!  One dose of the Hib vaccine should be administered to individuals with functional or anatomic asplenia or sickle cell disease if they have not been vaccinated previously

!  Individuals who are undergoing an elective splenectomy if they have not previously been vaccinated should receive 1 dose of Hib 14 or more days before the procedure

!  Individuals who have completed a hematopoietic stem cell transplant should be vaccinated with a 3-dose regimen 6 – 12 months after a successful transplant, regardless of vaccination history. Doses should be separated by at least 4 weeks

Inactivated Polio Vaccine (IPV)

http://www.agoracosmopolitan.com/news/health/2012/02/26/3120.html

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Facts About Polio !  Polio can affect anyone at any age, but children under 5

years of age make up approximately 50% of polio victims

!  Polio cases have decreased more than 99% since 1988. It was during this time frame where a global effort was made to eradicate polio

!  As of 2012, only 5 countries in the world are infected with the virus: Afghanistan, Chad, Nigeria, Pakistan, and Niger

!  The recent outbreak of a “polio-like” illness in California has been linked to enterovirus 68, which is a rare virus that has been linked to severe respiratory illnesses in the past, and not poliomyelitis. Scientists are continuing to research this

https://www.dosomething.org/tipsandtools/11-facts-about-polio and http://www.cnn.com/2014/02/25/health/california-mystery-disease/

IPV

!  Should be given at 2, 4, and 6 months of age, with an additional dose between 4 – 6 years old


!  The final dose should be administered at age 4 years or older, and at least 6 months after the 3rd dose

Catch-Up Dosaging for IPV

!  In the first 6 months of life, minimum age and minimum intervals are only recommended if the person is at risk for exposure to the poliovirus

!  If 4 or more doses are administered before 4 years of age, an additional dose should be administered at 4 -6 years old and at least 6 months after the last dose

!  A 4th dose is not needed if the 3rd dose was given at 4 years or older and at least 6 months after the last dose

!  If both OPV and IPV were administered as part of a series, a total of 4 doses should be administered regardless of the patient’s age. IPV is not recommended for individuals 18 years and older

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Adult Considerations !  Most adults do not need IPV because they have already

been vaccinated as children

!  Adults who have never been vaccinated against polio should get 3 doses of IPV, with the first 2 doses separated by 1-2 months and the 3rd dose 6-12 months after the 2nd

!  Adults who have had 1 or 2 doses of the polio vaccine should finish the remaining doses. It doesn’t matter how long it has been since the earlier doses

!  Adults who have had 3 or more doses of polio vaccine in the past may get a booster of IPV. These are commonly individuals traveling to areas in the world where polio is common, laboratory workers who may handle the polio virus, and health care workers who treat patients who could have polio

Side Effects

Common Side Effects !  Very mild sore spot

where the injection is given.

Severe Side Effects !  Severe allergic reaction:

difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart rate or dizziness

Who Should not Have the IPV Vaccine?

!  Anyone with a life-threatening allergy to any component of IPV including the antibiotics neomycin, streptomycin or polymyxin B

!  Anyone who had a severe allergic reaction to a previous polio vaccine

!  Anyone who is moderately or severely ill at the time the vaccine is scheduled

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Combination Vaccines

!  Pediarix: Dtap, IPV, HepB. Given 2 months – 6 months

!  Pentacel: DTaP, IPV, Hib. Given at 2 months – 15 months

!  Comvax: Hib, HepB. Given at 2 months – 12 months

!  Kinrix: DTaP, IPV. Given at 4-6 years of age

!  MMRV: MMR and Varicella. Given at 4 years of age

!  Twinrix: HepA and HepB. Given at 18 years of age or older

Pneumococcal Conjugate Vaccine (PCV13)

Image retrieved from: http://www.thehealthmagazine.com/fda-extends-the-use-of-prevnar-vaccine-for-ages-50/

Pneumococcal Disease in Children

Quick Facts: !  S. pneumonia is the

leading cause of bacterial meningitis among children less than 5 years old

!  It is a common cause of acute otitis media in children

!  Bacteremia without a known site of infection is the most common clinical presentation

Before Routine Vaccination: !  Bacteremia accounted

for 13,000 cases each year

!  Meningitis accounted for 700 cases each year

!  Death accounted for 200 cases each year

!  Otitis media accounted for over 5 million cases each year

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PCV13

!  Should be given at 2, 4, and 6 months of age, with an additional dose between 12 – 15 months of age


!  Catch up vaccination: Administer 1 dose of the PCV13 vaccine to all healthy children 24 – 59 months who are not vaccinated

Side Effects

Common Side Effects

!  Drowsiness

!  Loss of appetite

!  Redness, tenderness, and/or swelling where the vaccine was given

!  Mild fever

!  Fussiness

!  Irritability

!  Temporary loss of appetite

Severe Side Effects

!  Very high fever (over 103°F)

!  Behavior changes


Who Should not Have the PCV13 Vaccine?

!  Anyone who has had a life-threatening allergic reaction to this vaccine, the earlier pneumococcal vaccine called PCV7, or to any vaccine that contains diphtheria toxoid (DTaP)


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Special Considerations for Children 2 – 5 Years Old !  Children 2 years – 5 years old with: chronic

heart disease; chronic lung disease; diabetes mellitus; cerebrospinal fluid leak; cochlear implant; sickle cell; asplenia; HIV; chronic renal failure; or other diseases treated with immunosuppressive drugs or radiation therapy !  should have 1 dose of PCV13 if 3 doses of PCV

(PCV 7 or PCV13) were given previously. If fewer than 3 doses were given previously, then administer 2 doses of PCV13 at least 8 weeks apart. They should also receive one dose of PPSV23 at least 8 weeks after the most recent dose of PCV13

Adult Considerations

!  PCV13 should be administered to patients who have no record of previous vaccination. May be given to adults over 50 years of age

!  Adults 19 years and older with immunocompromising conditions who have not received a PCV13 or PPSV23 vaccine previously should receive a single dose of PCV13 followed by a dose of PPSV23 at least 8 weeks later

!  Immunocompromised adults who have received 1 or more doses of PPSV23 should receive one dose of PCV13 at least 1 year after the last dose of PPSV23

Pneumococcal Polysaccharide Vaccine (PPSV23)

Image retrieved from: http://www.cdc.gov/pneumococcal/vaccination.html

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Pneumococcal Disease in Adults

!  90% of pneumococcal disease cases in the US are adults

!  As many as 175,000 people are hospitalized each year in the US due to pneumococcal pneumonia

!  There is a 5-7% fatality rate

!  Pneumococcal disease kills 1 in every 4-5 people 65 years old or older who contract it

http://www.adultvaccination.com/pneumococcal_vaccine_vaccination_adult_immunization.htm

PPSV23

!  Usually only one dose is needed

!  Given to all adults 65 years old or older

!  Given to adults younger than 65 years with: chronic heart disease; chronic lung disease; diabetes mellitus; cerebrospinal fluid leak; cochlear implant; sickle cell; asplenia; HIV; chronic renal failure; nephrotic syndrome; alcoholism; or other diseases treated with immunosuppressive drugs or radiation therapy

!  Residents of nursing homes or long-term care facilities

!  Adults who smoke cigarettes or are asthmatics

!  Should be administered to patients who have no record of previous vaccination

Side Effects

Common Side Effects !  Redness, tenderness,

and/or swelling where the vaccine was given

Severe Side Effects !  Fever

!  Muscle aches

!  Severe local reaction


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Who Should not Have the PPSV23 Vaccine?

!  Anyone who has had a life-threatening allergic reaction to PPSV


Special Considerations for Children 6 – 18 Years Old

!  Children 6 years – 18 years old with: chronic heart disease; chronic lung disease; diabetes mellitus; alcoholism, or chronic liver disease, who have not received PPSV23 should receive 1 dose of PPSV23. If PCV13 has been given in the past, then the PPSV23 should be given at least 8 weeks after any prior PCV13 dose

!  A single revaccination with PPSV23 should be administered 5 years after the first dose to children with sickle cell; asplenia; HIV; chronic renal failure; or other diseases treated with immunosuppressive drugs or radiation therapy; or solid organ transplants

Special Considerations for Adults

!  A one-time revaccination 5 years after the 1st dose of PPSV23 is recommended for adults 19 – 64 years old with chronic renal failure, asplenia, sickle cell, or immunocompromising conditions

!  Anyone who has received 1 or 2 doses of PPSV23 before 65 years old should receive another dose of the vaccine at 65 years old or later if at least 5 years have passed since their previous dose

!  No further doses of PPSV23 are needed for adults vaccinated with PPSV23 at or after 65 years old

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Hepatitis A Vaccine

Image retrieved from: http://livercancerconnect.org/

Hepatitis A Facts

http://www.dailytelegraph.com.au/warning-over-sumo-salad-hepatisis-a-diagnosis/story-e6freuy9-1226440692575

Hepatitis A Vaccine for Children

!  Should have 2 doses between 12 and 23 months of age; separated between 6-18 months

!  Minimum age to administer the vaccine is 12 months

!  Catch up vaccines: Any person aged 2 years or older should receive 2 doses of Hep A vaccine, separated by 6–18 months if immunity from Hepatitis A is desired

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Hepatitis A Vaccine for Adults !  Vaccinate any person seeking protection from the

hepatitis A virus

!  Anyone 1 year of age and older traveling or working in countries with intermediate to high prevalence of hepatitis A

!  Men who have sex with men

!  People who use street drugs

!  People with chronic liver disease or who are being treated with clotting factor concentrates

!  People who work with hepatitis A virus infected primates or who work with hepatitis A virus in a lab

!  Household members who are planning to adopt a child from a country with an intermediate to high prevalence of hepatitis A

Hepatitis A Vaccine for Adults

!  If using Havrix, administer in a 2 dose schedule at 0 months and then 6-12 months

!  If using Vaqta, administer in a 2 dose schedule at 0 months and then at 6-18 months

!  If using Twinrix, administer in a 3 dose schedule at 0, 1, and 6 months

Side Effects

Common Side Effects !  Soreness where the shot

was given

!  Headache

!  Loss of appetite

!  Tiredness

Severe Side Effects !  Serious allergic reaction:

difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, fast heart beat, or dizziness

!  High fever


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Who Should not Have the Hepatitis A Vaccine?

!  Anyone who has had a severe allergic reaction to a previous dose of Hepatitis A vaccine


!  Anyone who has a severe allergy to latex or alum

Measles, Mumps, and Rubella Vaccine (MMR)

Image retrieved from: http://www.microbiologyonline.org.uk/about-microbiology/microbes-and-the-human-body/vaccination

Measles Cases in the U.S. 1962-2011

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm

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Mumps Cases in the U.S. 1968-2011


Rubella and Congenital Rubella Syndrome Cases in the U.S. 1966-2011


MMR Vaccine

!  Should have 2 doses, administered at 12–15 months of age and 4–6 years of age

!  Minimum age to administer the vaccine is 12 months of age

!  Catch-up vaccination: All school-aged children and adolescents should have 2 doses of MMR vaccine. The minimal interval between doses is 4 weeks

!  Infants younger than 12 months old should get a dose of MMR if they are traveling out of the country. The dose will not be counted as part of their routine immunizations

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!  Adults born before 1957 are considered immune to measles and mumps

!  Adults born after 1957 should have documentation of 1 or more doses of MMR vaccine unless they have a contraindication to the vaccine or laboratory evidence of immunity to each of the diseases

!  Adults should have at least 1 dose of the vaccine if not previously vaccinated

!  Adults who are students in postsecondary educational institutions; work in a health care facility; or plan to travel internationally should have 2 doses of MMR vaccine if not previously documented. Doses should be given a minimum 28 days apart


!  Fever

!  Mild rash

!  Swelling of the glands in the cheeks or neck

Severe Side Effects !  Serious allergic reaction:

difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness

!  Seizure caused by fever, temporary pain and stiffness in the joints, mostly in teenage and adult women

!  Temporary low platelet count

!  Deafness, long-term seizures, coma or lowered consciousness, permanent brain damage (very rare)

Who Should not Have the MMR Vaccine?

!  Anyone who has had a life-threatening allergic reaction of the antibiotic neomycin

!  Anyone who has had a life-threatening allergic reaction of a previous dose of MMR or MMRV vaccine

!  Pregnant women should not get the MMR vaccine. Pregnant women should wait until after giving birth to receive the vaccine. Women should avoid getting pregnant for 4 weeks after receiving the MMR vaccine

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!  Individuals who have HIV/AIDS or another disease that affects the immune system; is being treated with drugs that affect the immune system, such as steroids; has any kind of cancer; is being treated for cancer with radiation or drugs; has ever had a low platelet count; has gotten another vaccine within the past 4 weeks; has recently had a transfusion or received other blood products may delay the vaccination until later or decline the vaccine

Varicella Vaccine

Image retrieved from: http://www.sheknows.com/health-and-wellness/articles/811191/the-chicken-pox-varicella-vaccine

Varicella Facts

!  Varicella declined 82% from 2000-2010 in the US

!  National hospitalization rates for varicella declined by 95% in people younger than 20 years of age

!  Varicella deaths declined by 98.5% in children less than 20 years of age during 2008-2009 when compared with 1990-1994.

!  Varicella deaths declined by 96% in adults less than 50 years of age and by 49% in adults 50 years of age or older

!  Varicella incidence among infants declined by 90% from 1995-2008

http://www.cdc.gov/chickenpox/hcp/monitoring-varicella.html

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Varicella Vaccine

!  Should have 2 doses, administered at 12 – 15 months of age and 4 – 6 years of age

!  Minimum age to administer vaccine is 12 months

!  Catch-up vaccination: All persons aged 7 – 18 years without evidence of immunity need to have 2 doses of varicella vaccine. For children 7 – 12 years old the recommended minimum interval between the doses is 3 months. For individuals 13 years and older, the minimum interval between doses is 4 weeks


!  All adults without evidence of immunity to varicella should receive 2 doses of the varicella vaccine or a 2nd dose if they have only received 1 dose

!  Pregnant women who do not have evidence of immunity should receive the 1st dose of varicella vaccine upon completion of the pregnancy and before discharge from the hospital. The 2nd dose should be administered 4-6 weeks after the 1st dose

Evidence of Immunity

!  Documentation of 2 doses of varicella vaccine at least 4 weeks apart

!  U.S.-born before 1980, except health care personnel and pregnant women

!  History of varicella based on diagnosis or verification of varicella disease by a medical provider

!  History of herpes zoster based on diagnosis or verification of herpes zoster disease by a medical provider

!  Laboratory evidence of immunity or confirmation of disease

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Side Effects

Common Side Effects

!  Soreness or swelling where the shot was given

!  Fever

!  Mild rash that can last up to 1 month after vaccination. It is possible for these people to infect other members of their household, but this is extremely rare

Severe Side Effects

!  Pneumonia

!  Severe allergic reaction to vaccine: difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness

!  High fever

!  Weakness


!  Seizure caused by fever

Who Should not Have the Varicella Vaccine?

!  Anyone who has had a life-threatening allergic reaction to a previous dose of the varicella vaccine, or anyone who is allergic to gelatin or the antibiotic neomycin

!  People who are moderately or severely ill at the time the vaccine is scheduled may wait to receive the vaccine

!  Anyone who has HIV/AIDS or another disease that affects the immune system; is being treated with drugs that affect the immune system, such as steroids, for 2 weeks or longer; has any kind of cancer; or is getting cancer treatment with radiation or drugs

MMRV Vaccine !  Combination MMR and Varicella Vaccine

!  Usually administered at the 4 year Well Child Check in lieu of the separate MMR and Varicella Vaccines

!  The first dose of MMRV vaccine has been associated with rash and higher rates of fever than MMR and varicella vaccines given separately

!  Seizures caused by fever are reported more often after MMRV when given between 12-23 months of age. These usually occur 5-12 days after the first dose

!  MMRV should not be given to children over 12 years of age

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!  Fever

!  Mild rash

!  Swelling of the glands in the cheeks or neck

Severe Side Effects

!  Pneumonia

!  Severe allergic reaction to vaccine: difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness

!  High fever

!  Weakness


!  Seizure caused by fever

!  Temporary low platelet count

Who Should not Have MMRV?

!  Had a life-threatening allergic reaction to a previous dose of MMRV or to the MMR or varicella vaccine, gelatin or the antibiotic neomycin

!  Have HIV/AIDS or another disease that affects the immune system

!  Is being treated with drugs that affect the immune system, including high doses of oral steroids for 2 weeks or longer

!  Has any kind of cancer

!  Is being treated for cancer with radiation or drugs

Who Should not Have MMRV?

!  Child with a history of seizures, or has a parent or sibling with a history of seizures

!  Has a parent or sibling with a history of immune system problems

!  Has ever had a low platelet count or another blood disorder

!  Recently had a transfusion or received other blood products

!  Might be pregnant

!  Anyone who is moderately or severely ill at the time the vaccine is scheduled should wait to receive the vaccine

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Shingles Vaccine (Zostavax)

Image retrieved from: http://www.fightshingles.org/duration.php

Shingles Rates by Age Group

http://www.nlm.nih.gov/medlineplus/shingles.html

Zostavax

!  One-time vaccine administered at people 60 years of age and older, regardless of prior episode of shingles

!  No maximum age limit for getting Zostavax

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Side Effects

Common Side Effects !  Redness, soreness,

swelling or itching at site of injection

!  Headache

Severe Side Effects !  Severe allergic reaction

to vaccine: difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness

!  Very high fever


Who Should not Have Zostavax? !  Had a life-threatening allergic reaction to gelatin or the

antibiotic neomycin

!  Have HIV/AIDS or another disease that affects the immune system

!  Is being treated with drugs that affect the immune system, including high doses of oral steroids for 2 weeks or longer

!  Has any kind of cancer

!  Is being treated for cancer with radiation or drugs

!  Might be pregnant


Human Papillomavirus Vaccine (HPV)

Image retrieved from: http://thesocietypages.org/girlwpen/2012/05/

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HPV Rates From 2006-2010

http://www.cdc.gov/cancer/hpv/statistics/cases.htm

HPV Vaccine !  Should have 3-doses administered with 2nd dose 1-2

months after the 1st dose, and the 3rd dose 6 months after the 1st dose

!  Usually administered at 11 years of age

!  Minimum age to administer vaccine is 9 years

!  May be given to both males and females

!  Females may have bivalent (HPV2) or quadrivalent (HPV4) vaccine. Males should only have the HPV4 vaccine

!  HPV2 is Cervarix and used less frequently

!  HPV4 is Gardasil and used more frequently

!  Catch-up vaccination: Use the intervals noted above for catch-up vaccination. Males may be vaccinated through 21 years of age and females may be vaccinated through 26 years of age


!  Men who have sex with men may receive the HPV vaccine through 26 years old

!  Vaccination is recommended for immunocompromised individuals through 26 years old

!  HPV vaccines are not recommended for use in pregnant women. If a women is found to be pregnant after starting the HPV series, she can complete the series at the completion of pregnancy. Women may receive the vaccine if breast feeding

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Side Effects

Common Side Effects !  Pain, redness or swelling

at injection site

!  Mild fever

!  Headache

!  Fainting after vaccination





Who Should not Have the HPV Vaccine?

!  Had a life-threatening allergic reaction to a previous dose of the HPV vaccine or an allergy to yeast


!  Anyone over 26 years of age

Meningococcal Conjugate Vaccine (MCV4)

Image retrieved from: http://www.stockrants.com/2011/04/22/sanofi-pasteur-announces-fda-approval-of-menactra-meningococcal-conjugate-vaccine-indication-for-infants.html

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Meningococcal Disease Risk Factors

!  More common among infants, adolescents and young adults

!  College students and other individuals in a community setting

!  Travelers to sub-Saharan Africa

!  Individuals who have functional or anatomic asplenia or who have complement component deficiency

!  Laboratory personnel who are exposed to meningococcal bacteria

!  U.S. military recruits

Meningococcal Conjugate Vaccine (MCV4)

!  Two brand names: Menactra or Menveo

!  Administer a single dose at 11-12 years of age, with a booster vaccine at 16 years old

!  Catch-Up vaccination: Administer Menactra or Menveo vaccine at 13-18 years old if not previously vaccinated. If the 1st dose is given at 13-15 years, a booster should be given at 16-18 years with a minimum interval of at least 8 weeks between doses. If the 1st dose is given at 16 years of age or older, a booster dose is not needed

Adult Considerations !  Adults with asplenia or persistent complement

component deficiencies should receive 2 doses of MCV4 and they should be administered at least 2 months apart

!  College students through 21 years of age who are living in a dorm should be vaccinated

!  Laboratory personal exposed to meningococcal disease, U.S. military recruits, and individuals who travel to countries where meningitis is common should be vaccinated

!  Meningococcal polysaccharide vaccine (MPSV4) is preferred for adults 56 years of age or older who have not received MSV4 previously and require a single dose only

!  Revaccination with MCV4 every 5 years is recommended for adults at increased risk of infection

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Side Effects

Common Side Effects !  Redness or pain at the

injection site

!  Mild fever





Who Should not Have MCV4 or MPSV4?

!  Had a life-threatening allergic reaction to a previous dose of the MCV4 or MPSV4 vaccines


Influenza Vaccines

Image retrieved from: https://centracare.org/category/announcements/

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Flu Vaccination Coverage

http://www.cdc.gov/flu/fluvaxview/coverage-1213estimates.htm

Flu Vaccine

!  Minimum age is 6 months for the inactivated flu vaccine (IIV) and 2 years for the live, attenuated vaccine (LAIV) (FluMist)

!  Children aged 6 months – 8 years who are receiving the vaccine for the first time should have 2 doses administered, separated by 4 weeks

!  Individuals 9 years of age and older should have 1 dose of flu vaccine annually

!  The live, attenuated vaccine can be used for healthy, non-pregnant individuals 2 years of age - 49 years of age

Side Effects for the Inactivated Flu Vaccine Common Side Effects !  Soreness, redness, or

swelling at injection site

!  Hoarseness; sore, red or itchy eyes; cough

!  Fever

!  Aches

!  Headache

!  Itching

!  Fatigue

Severe Side Effects !  Severe allergic reaction to

vaccine: difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness



!  Children who receive PCV13 the same day as the flu vaccine may have an increased risk for febrile seizures

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Side Effects for FluMist

Common Side Effects !  Runny nose, nasal

congestion, cough

!  Fever

!  Sore throat

!  Headache

!  Fever

!  Mild vomiting or diarrhea

Serious Side Effects !  Severe allergic reaction




Who Should not Have Either of the Flu Vaccines?

!  Anyone who has had a life-threatening allergy to a previous dose of the flu vaccine or a severe allergy to eggs. Individuals who have hives with eggs may still receive the flu vaccine

!  Anyone who has had Guillain-Barre Syndrome

!  Anyone who has had any other vaccines in the past 4 weeks


Who Should not Have FluMist?

!  Anyone who is pregnant

!  Anyone with asthma

!  Anyone who is immunocompromised or lives with someone who is immunocompromised

!  Child or adolescent on long-term aspirin therapy

!  Is younger than 2 years old or older than 49 years old

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Resources

!  CDC.gov offers the most up-to-date information regarding vaccines, disease outbreaks, and vaccine associated adverse effects

!  Immunize.org provides handouts for patients and staff members, as well as up-to-date information regarding vaccines. They also have a nice presentation that addresses how to address parental concerns about vaccines at: http://www.immunize.org/catg.d/s8030.pdf

!  Healthychildren.org is the American Academy of Pediatrics website for parents and has helpful information regarding vaccines

Questions?

Image retrieved from: http://allthingsd.com/20120717/ten-questions-for-new-yahoo-ceo-marissa-mayer-this-wont-hurt-a-bit-okay-just-a-little/

immunization update [autosaved] · months of age ! rotateq is a 3 dose series administered at 2, 4,...

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