Chaper 55: Childhood Immnizations Flashcards
Immunizations
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
Research shows universal vaccination is the best way to reduce vaccine preventable diseases
Vaccine
Whole or fractionated microorganisms
Vaccination: Any vaccine or toxoid
Live vaccine
Live attenuated vaccines are composed of live microbes that have been weakened or completely nonvirulent. Dangerous to immunocompromised patients
Killed vaccine
Killed vaccines are composed of killed microbes or components of killed microbes
Toxoids
Bacterial toxin that has been changed to a nontoxic form
Causes immune system to produce antitoxins:
Antibodies against whatever the natural bacterial toxin is
Protect against injury from toxins, but do not kill the bacteria that produced the toxins
Ex. Tetanus toxoid and diphtheria toxoid
Immunization
Active: Response to infection or to administration of a vaccine or toxoid.
Passive: Conferred by giving a patient preformed antibodies (immune globulins). Unlike active immunity, passive immunity protects immediately but persists only as long as the antibodies remain in the body.
Specific immune globulins
Preparations contain a high concentration of antibodies directed against a specific antigen (e.g., hepatitis B virus)
Administration provides immediate passive immunity
Preparations are made from donated blood
Reporting vaccine-preventable diseases
Determine whether an outbreak is occurring
Evaluate prevention and control strategies
Ex. COVID-19 travel restrictions, testing, and masking
Evaluate the impact of national immunization policies and practices
Goal is to prevent outback and/or spread
Immunization records
National Childhood Vaccine Act of 1986 requires a permanent record of each mandated vaccination
Date of vaccination
Route and site of vaccination
Vaccine type, manufacturer, lot number, expiration date
Name, address, title of person administering the vaccine
If something goes wrong with specific lot, can identify who got that vaccine
Reason for record
To ensure appropriate vaccination
To avoid overvaccination
Adverse effects of immunization
Immunocompromised children are at special risk from live vaccines:
Congenital immunodeficiency
Human immunodeficiency virus (HIV) infection
Leukemia
Lymphoma
Generalized malignancy
Therapy with radiation
Cytotoxic anticancer drugs
High-dose glucocorticoids
Target disease
Measles
Mumps
Rubella
MMR is a 2 dose live virus vaccine
Diphtheria
Tetanus (lockjaw)
Pertussis (whooping cough)
Diptheria, tetanus, pertussis are toxoids given series of 5 doses then people get boosters
Poliomyelitis (polio, or infantile paralysis)
PM is inactivated vaccine, 4 dose series of injections
Haemophilus influenzae type b
HIB is a bacterial polysaccharide that’s conjugated to a protein. 4 dose series
Varicella (chickenpox)
Varicella is a live virus, 2 doses
Hepatitis B
Hepatitis A
Hep A (2 dose) and Hep B (3 dose) are inactive viral Ag
Pneumococcal infection
Pneumococcal conjugate vaccine is a bacterial polysaccharide that’s conjugated to a protein. 4 dose vaccination
Meningococcal infection
Meningococcal infection vaccine is a bacterial polysaccharide that’s conjugated to a protein. 2 dose vaccine
Influenza
Influenza vaccine is a live vaccine that’s 1 dose annual after age 2.
Rotavirus gastroenteritis
Rotavirus is a live vaccine that’s 3 doses.
Genital human papillomavirus infection
HPV vaccine DNA-free virus-like particle and that’s a 2 dose vaccine
Respiratory syncytial virus
RSV is an experimental vaccine
COVID 19 –not scheduled yet
MMR ADR
Glandular swelling in the cheeks, neck, and under the jaw
5-15% of children will develop rash
May run a fever
Can go up to 12 days after vaccine
Mild local soreness, redness, swelling
Really with any vaccine
Tylenol or NSAIDs to help with s/sx after vaccine
Severe ADR: transient thrombocytopenia –rare, anaphylactic reactions –rare.
No causal link between MMR and development of autism, Crohn disease, or any other serious long-term illness
MMR precautions and contraindications
Contraindicated in pregnancy
Cautiously in kids with who have had anaphylactic-like reaction to gelatin, eggs, or neomycin
Contraindicated in immunocompromised kids
MMR schedule
2 dose live virus vaccine
Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) schedule
Full series and booster shots
series of 5 doses then people get boosters
DTaP ADR
Moderate reactions are less common –inconsolable crying, 105 or higher fever, 0.6% can develop convulsions with or without fever, but no permanent sequelae afterwards
Very rarely can cause acute encephalopathy
0-10.5 episodes per million doses
Most occur within 3 days of vaccination
Mild reactions are common –fever, drowsiness, anorexia, and some local pain, swelling and redness at the site developed a couple hours after vaccination and gone in a couple days
Can use NAIDs only after vaccine
DTaP precautions and contraindications
Don’t want to give it to child with moderate-severe febrile illness. It can be given if they have a other one.
Contraindicated if they had anaphylactic reaction to earlier doses or had acute encephalopathy within 7 days of vaccination
Poliovirus vaccine schedule
Inactivated poliovirus vaccine (IPV, Salk vaccine)
4 dose series of injections
Polio vaccine ADR
Local soreness can occur
Contains trace amounts of streptomycin, neomycin and bacitracin, so kids with allergies to these drugs have to be monitored
H. influenzae type b conjugate (Hib) vaccine schedule
4 dose series
HIB vaccine ADR
Safest of all vaccines
None serious –local swelling, redness, and warmth at the site
Only 1% get a fever and it only hits about 101
Varicella virus vaccine schedule
Live, attenuated varicella viruses
2 doses
Varicella vaccine ADR
None serious
Some local redness, soreness, and some swelling at the injection site. Some fever ~102 degrees
~5% of kids with get a varicella-like rash within a month of the injection
Higher incidence with children with leukemia –about ½
Varicella vaccine precautions and contraindications
Contraindicated in pregnancy, leukemias, lymphomas, pt allergic to neomycin or gelatin. Immunocompromised pt
Children receiving the vaccine should stay away from ASA and other salicylates for 6 weeks –concern of rye syndrome
Hep B vaccine
Hepatitis B surface antigen (HBsAg), the primary antigenic protein in the viral envelope
Promotes synthesis of specific antibodies directed against hepatitis B virus
Viral component, not live virus; cannot cause disease
Hep A vaccine population
Recommended for all children living in areas where vaccination programs target older adults due to an increased risk for infection
at least 1 year old travelling to places with high rates of hep A (central American, south America, Mexico, Caribbean islands, Africa, Asia except japan, and southern or eastern Europe), people in communities that have frequent outbreaks of hep A, homosexual men, people who use illegal drugs, chronic liver disease, people who receive clotting factor concentrates, people who work with non-human primates, or work with Hep A in labs, people who are expect to have close contact to international adoptee from a country where Hep A is common
Hep A vaccine
Inactive form of hepatitis
Hep A ADR
Mild reactions are common
Soreness in ~1/2 the people and HA in ~14%, fatigue, lack of appetite
Start ~ 3-5 days after the vaccine and last ~ 1-2 days
Pneumococcal conjugate vaccine
Prevention of invasive pneumococcal disease in infants and children
Pneumococcal conjugate vaccine ADR
May have drowsiness, loss of appetite, some redness and tenderness at site. ~1/3 od people run a temp below 102.
Vaccination all children under 2y then follow schedule
Common reactions: local pain, HA, fatigue, redness, swelling at the site
Meningococcal conjugate vaccine (MCV4) ADR
Concerns that MCV4 might cause Guillain-Barre syndrome appear to be unfounded
nfluenza vaccine
Annual vaccination against influenza, including the H1N1 subtype, is now recommended for all children between 6 months and 18 years of age
Human papillomavirus vaccine
Gardasil and Cervarix
Prevent cancers, precancerous lesions, and genital warts in males and female
Should be given before individual becomes sexually active
