Immunizations in pediatrics & public health

Question 1

Immunization vs. Vaccination

Answer 1

– Immunization: the process of rendering a subject immune, or of becoming
immune.
– Vaccination: the introduction of vaccine into the body to produce
immunity

Question 2

T/F Passive immunization (introducing immunoglobulin) is NOT vaccination

Answer 2

T

Question 3

Types of ImmunizaAon

Answer 3

• Active → An’gen introduced
  – Types: live, killed, or derivative (a protein or polysaccharide of a microorganism) or a toxoid (deactivated toxin)
  – Acquired immunity is long term immunity (years to lifetime)
• Meaningful immunity → 2 to 4 weeks after vaccination
  – Live versions more efficacious & provide longer lasting immunity than nonliving vaccines
• Passive → Antibody introduced (immunoglobulin)
  – Results in immediate protecQve immunity
  – Immunity is short term (3-6 months

Question 4

Acquired Immunity

Answer 4

-Activates the host immune system to
create immunoglobulins (antibodies) to
combat a foreign antigen, both now
& in the future

Question 5

Passive Immunity

Answer 5

-Supplies host with immunoglobulins
(antibodies) for immediate ability to
combat foreign antigens → which
ability wanes after the short term

Question 6

IMMUNIZATION PEARL

Answer 6

The more similar a vaccine is to the disease-
causing form of the organism, the better the
immune response to the vaccine

Question 7

Live Attenuated virus vaccine

Answer 7

• Fight viruses & some bacteria
• Do replicate
• Fewer doses needed to maintain immunity

Question 8

Inactivated Virus vaccine

Answer 8

• Fight viruses & bacteria
• Do not replicate
• Cannot cause disease or infecAon
• Requires mulAple doses to maintain immunity
• Types
  – InacAvated Whole Viral
  – Subunit
  – Polysaccharide
  – Conjugate Toxoid

Question 9

Adjuvants (ingredients in vaccines)

Answer 9

• Enhance immune response to an anAgen
• Aluminum (found water, food, even air)
  – 4 mg total in all recommended vaccines
• For comparison - In the same 1me period…
  – 10 mg from breasGeeding
  – 40 mg from regular infant formula
  – 120 mg from soy based infant formula

Question 10

Vaccine ingredients for virus inactivation & bacterial toxification

Answer 10

• Formaldehyde
  – Diluted in the process, but residual quanQQes may be found
• So small it poses no safety concern

Question 11

Gelatin in vaccines

Answer 11

• A vaccine stabilizer to protect active ingredients during
  manufacture, transport & storage
• Made from the skin or hooves of pigs
• Religious concerns (Jews, Muslims, & Seventh Day Adventists)
  – Dietary rules prohibit pig products
  However, ALL major religious groups have approved the use of gelatin-containing vaccines

Question 12

Ethyl Mercury (Thimerosal) in vaccines

Answer 12

• Originally added to multi-dose vials of vaccine
  – preservative against bacteria
• Thimerosal contains a form of mercury
  – ethyl mercury

Question 13

Ethyl mercury vs. Methylmercury

Answer 13

– Thimerosal in vaccines → No signs of mercury poisoning
* Symptoms of mercury poisoning are different than those of autism
– Manufacturing of multidose vials stopped in late 90s
* except multidose Flu shot vials

Question 14

Fetal Cells are used to make 5 vaccines

Answer 14

– Rubella
– Chickenpox
– Hepatitis A
– Shingles
– Rabies

Question 15

T/F Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine.

Answer 15

T

Question 16

All vaccines can be administered at the
same visit as all other vaccines
Exception:

Answer 16

• Children with functional or anatomic
  asplenia
• PCV13 & menactra should be separated
  at least 4 weeks

Question 17

Systems that help in Ensuring Vaccines are Safe:

Answer 17

• Vaccine Adverse Event ReporQng System (VAERS)
  – Surveillance system by FDA & CDC
  – Parent & provider reporQng
• Vaccine Safety Datalink (VSD)
  – Conduct populaQon based research on immunizaQon
  safety quesQons
  – Evaluate immunizaQon safety hypotheses that arise from
  medical literature, passive surveillance systems,
  adjustments to immunizaQon schedules, & introducQon
  of new vaccines
• VAERS raises the quesQon; VSD answers it

Question 18

USIIS

Answer 18

Utah Statewide Immunization Information System
* Access immunization records for new & current paQents
* Consolidate immunizations from all providers into a single record
* Saves staff time locating immunization records
* Prevents missed immunization opportunities

Question 19

Herd or community immunity

Answer 19

• Protection of an individual from
  infection by virtue of the other
  members of the population
  being incapable of transmitting the
  virus to that individual
• Immunization of ~9 in 10 can generally
  protect the one unimmunized person by
  interrupting transmission

Question 20

Facts & Tips for
Talking with
Parents about HPV

Answer 20

Most common STI - spread by vaginal, anal, oral sex
* More than 120 types, categorized as:
– Low –risk- includes types 6 & 11- cause of genital warts
– High- risk- carcinogenic- includes types 16 & 18
* High- risk HPV types are found in 99% of cervical cancers
* Cancer of the vulva, vagina, penis, anus, oropharynx
* High Incidence
* No specific treatment- medical management
* No approved test to determine person’s “HPV status”

Question 21

HPV VACCINE

Answer 21

• Gardasil 9- HPV9
  – male & female age 11-26
  – types 16,18,6,11 plus -adds 5 addi[onal types which contribute
  to an ~addi[onal 15% of cervical cancers