Unit 1: vaccines, universal screenings, developmental milestones, bright futures. Flashcards
universal screenings at birth?
hearing, bilirubin, PKU, congenital hypothyroid, sickle cell, CHD
PKU screen was done <24h of age. When should it be re-tested?
by 2nd week
untreated hyperphenylalaninemia results in?
intellectual disability, light complexion, eczema, seizures, hyperactivity
institute _____ dietary restrictions shortly after birth to prevent neurodevelopmental effects of ???
PKU
3 screening methods for PKU?
BIA: Guthrie Bacterial Inhibition Assay (BIA)
AFA: Automated fluorometric assay (AFA)
TMS: Tandem mass spectrometry (TMS)
newborn screening tests mandatory?
thyroid function & PKU
T or F: PKU testing should only be performed after the infant has ingested b.milk or formula
True. Abnormal results should be f/u w a venous T4 &; TSH
infant w abnormally pitched cry may indicate which genetic disorder?
hypothyroidism. due to lethargy & delayed mental responsiveness
two tests for sickle cell?
NO SOLUBILITY TESTS
- *hgb electropheresis
- HPLC: High performance liquid chromatography
- *DNA analysis
T or F? IEF & HPLC are both sensitive and specific for sickle cell?
true
what age do you perform confirmatory testing for sickle cell?
2 months
What prophylactic med should be started by 2mo for a sickle cell baby?
PCN
Important immunization for sickle cell babies?
Pneumococcal
at what age MUST hearing be confirmed by?
3 months
what well-checks include maternal depression screening?
1,2,4,6 months
“1,2,4,6, lets make sure that moms not sick!”
what age do primary teeth usually erupt?
7 months
when do you start oral health screenings?
6 months
which well-check visits include oral health screenings?
6 & 9mo. Dental home to be established by 12mo but PCP can continue to screen at every visit if child does not establish w dental home
child stands alone, follows 1-step commands, imitates peek-a-boo. age?
9-11mo
child lifts head, turns side-to-back, & smiles. what age?
1-2mo
child develops a mature pincer grasp. age?
12mo
child is building blocks w 3-4 cubes, can scribble, follows 2-step commands. age?
18mo
child verbalizes need to potty. age?
2y
child sits independently. age?
6-8mo
child crawls. age?
9mo
child runs. age?
18mo per CDC. unclear in Hay
child walks backwards. age?
30mo
(as if you’re making fun: “only a Thirrrrtyyyy moonnnth old would think walking backwards is cooooool”)
or
(“you take those 30 snakes right BACK where they came from)
child begin to use pronouns. age?
24mo
child holds crayon w fist. age?
30mo (“that kid has 30 crayons in his fists!”)
child holds crayon w fingers. age?
3y (takes 3 fingers to hold a crayon)
can a 4-5yo tie shoes?
no, only lace
child COPIES drawing a circle at what age?
3y
child copies a cross at what age?
4y (4 quadrants in cross)
child copies a triangle at what age?
5y
child draws vertical lines at what age?
2y (2 lines… parallel lines… parallel play)
child can scribble at what age?
18mo
child will imitate scribbling at what age?
15mo
child uses tricycle at what age?
3y
child alternates feet up the stairs. age?
4y
child kicks ball. age?
2y (takes 2 feet to kick a ball)
child throws ball. age?
18mo
child engages in parallel play. age?
2y
child engages in cooperative play. age?
4y (double that of parallel play milestone at 2)
child reaches w one hand. age?
6-8mo (passes from hand to hand. babbles)
child reaches w both hands & puts object in mouth. age?
3-5mo (drooly baby)
child has 4-word phrases. age?
4y (4 words, 4 years)
child says “you, me, and I” & makes 3 cube bridge. age?
3y (3 pronouns, 3 cubes)
child jumps w 2 feet. age?
2y (takes 2 feet to jump with 2 feet…..)
child has 4-20 words. age?
18mo (w/i word count range)
child has 1-2 word vocabulary at least. age?
12mo
child coos. age?
3-5mo
child babbles. age?
6-8mo
child draws person as circle. age?
4y (4 arcs make up a circle)
child draws a person w appendages & eyes but no torso. age?
4-5y (4-5 appendages = 4-5y)
child follows 1-step commands. age?
9mo
child follows 2-step commands. age?
18mo (double their 1-step @ 9mo)
when do you conduct anemia & lead testing?
12mo & 24mo (or 1 & 2y)
what ages do you perform developmental screening?
9, 18, 30mo (memory tool: some kids develop at 9, some at 18, some not until 30)
what ages are screened for ASD?
18 & 24mo
earliest age a child can be dx’d w ASD?
2y
4 most common EARLY characteristics of autism?
- consistent failure to orient to one’s name
- failure to regard people directly
- failure to use gestures
- failure to develop speech
what age should universal VISION screenings start?
3y (they can use a chart now, you no longer have to test red reflex to assess if the pt can see)
what tests are used for vision screening?
visual acuity using HOTV (letters) LEA (shapes)
what age can you stop screening for red reflex?
3y: when they start reading the chart
what is assessed in vision screening for birth-3y?
inspection, alignment, visual acuity, red reflex
what age should audiometry be performed?
birth, 4y
by age 3 what vaccines should you have?
4 Dtap 4 pvc13 3-4 HiB 3 hep B 3 RV 3 IPV 2 Hep A 1 influenza 1 varicella 1 MMR
(3 years ago, 3-4 Horses split 4 Dr. Peppers and 3 RIBs, 2 Ate 1 INch of VegeMite)
10 types total. 25-26 doses total (when counted uncombined) 4 = D&P 3-4 = H 3 = B, RV, IPV 2 = A 1 = In, V, M
3 allergies contraindicated for vaccine?
egg, yeast, gelatin
what vaccine should not be given for current gastroenteritis or hx of intussusception?
rotavirus
what vaccine should NOT be given to people w serious allergic rxn to YEAST?
Hep B (think B for bread or bakers’ yeast)
what vaccine has a small increased chance of febrile seizures when given w the flu vaccine?
PVC (think PNA + FLU would be a HIGH fever)
what vaccines are contraindicated in pregnancy?
“Vagina Is A Monster” =
Varicella, IPV, Hep A, MMR
children or adolescents receiving long-term Aspirin therapy should NOT receive what vaccine?
LAIV (flu)
What law requires VIS?
NVCIA: national vaccine childhood injury act (federal law)
Severe allergic reaction or encephalopathy not attributable to another cause w/i 7d of admin is a TRUE contraindication for which vaccine?
Dtap
What documentation is required for every vaccine admin?
manufacturer, vaccine lot #, expiration date, injection site, nurse signature, parent signature
T or F. Polyvalent pneumococcal vaccine (PNA23) is recommended for children under 2y w chronic disease (including DM)?
False.
polyvalent = PNA23 = 2y+
PVC13 = 6w+
only contraindication to Hep B vaccine?
prior anaphylactic rxn or severe hypersensitivity
live attenuated virus vaccines include?
MMR, RV, varicella
to stayin alive: “M-M-R-R, VARI alive, VARI alive”
severe allergy to _____ is contraindication for MMR?
the mycins
what type of immunity is developed after contracting chickenpox?
active natural
8 month old should have what vaccines?
3 Hep B
3 RV
3 PCV
2 IPV
“for 8 months, 3 Boys Raced Perilously 2 INdiana”
immunocompromised adults require which type of vaccine?
inactivated
a 2mo got vaccines & mom calls 12h later. states infant has fever 101F. what is most likely cause?
PERTUSSIS immunization
what vaccine can be given to kids <7 if they cannot tolerate the pertussis component?
TD
complete primary dentition (20 teeth) is usually present btwn what ages?
30-36mo
safest place in car for all kids <13?
middle back seat
how long should kids stay rear facing?
as long as possible. til they max out height, weight indicated by carseat
what age would be sitting w a booster?
8-12yo
when can child use lap & shoulder belt?
when belt lies across middle of chest & shoulder. lap belt lies across upper thigh. child is tall enough to sit against back seat w knees bent over edge of seat without slouching. TYPICALLY 10-11YO
whats an indication child has outgrown booster seat?
shoulders are above top harness slots, tops of ears reach top of seat
when should carseats be replaced?
after moderate-severe car crash
crib bars should be no more than _____ inches apart?
2 & 3/8 inches
crib mattresses should have no more than ____ fingers fitting btwn mattress & side of crib?
2
when should you remove crib bumpers?
when child can push up
what temp should water heater be set at?
120
signs of hunger in infant?
sucking, rooting, fussing, hands in mouth, crying is late sign
signs baby is full?
closes mouth, turns head
if baby sleeps past 4h what should mom do?
wake baby to eat
how often should mom breastfeed baby per day?
8-12x
how many wet diapers do you expect to see in babies?
6-8 wet diapers
how many stools should babies have a day?
3-4x (1/2 amount of wet diapers)
what color poops do you expect from breastfed baby?
yellow/green, seedy, pasty
if mom is vegan or had gastric bypass what does she need to supplement?
b12
moms exclusively breastfeeding need to supplement?
vitamin D
first 6mo of life diet should be?
breastmilk or iron-fortified formula ONLY
how often should mom bottle feed?
2oz Q2-3h (20oz/day)
what is essential for mom to do while bottle feeding?
look at baby to promote bonding. dont prop bottle
normal stool color for formula-fed baby?
yellow-brown pudding
how should temp be checked?
rectal
what temp warrants eval?
100.4 or higher (especially in <3mo)
babies should always be placed on _____ to sleep
back. “put baby BACK to sleep”
cord clamp is removed after ____ hours?
24
how long does it take for stump to dry up and fall off?
10-12d
how should mom clean umbilical stump?
water, air dry, keep diaper below stump
s/s infection = purulent drainage, foul odor, redness
circumcised babies need to keep what applied to wound for the first 24h?
petroleum gauze
how should mom care for circumcision?
clean with water, DOESNT NEED SOAP, monitor for infection
how long does it take circumcision to heal?
5-7d
T or F. pt must be given VIS before EVERY vaccine in a multi-dose series?
TRUE
pt has low-grade fever, runny nose, mild diarrhea. can they be vaccinated?
YES. mild illness is NOT contraindication
what medication is a reason to defer vaccination?
TAMIFLU
reasons to NOT receive vaccine?
chronic health condition (CA), weakened immune system (chemo, certain meds s/p transplant), prior severe allergic rxn to same vaccine
when is it ok for a child w cancer to receive a vaccine?
remission or 90d post chemo
how long should live virus vaccine be delayed if an immunoglobulin or blood product was given?
3-11mo
should a congenitally immunodeficient child be immunized with live vaccines?
Nooooooo
barriers to vaccines?
parental concerns, need for multiple visits, cultural differences, financial constraints
what type of immunity is developed in response to infection?
active
example of artificially acquired active immunity?
vaccines
T or F. active immunity is permanent
True
onset of active immunity is ?
2-4 weeks
passive immunity is short term or long term?
short term
how does a person get passive immunity?
given antibodies to a disease
how does passive immunity artificially occur?
injection of antibodies (gamma globulin- IVIG)
onset of passive immunity is? what is duration?
24h (immediate). 4-6mo
when a significant proportion of the population is vaccinated, what does this provide?
herd immunity
what specific population is herd immunity effective for?
the population who cannot safely receive vaccines (immunocompromised, etc)
when checking a newborns reflexes, what are you ensuring?
brain & nervous system function
how do you elicit the rooting reflex?
stroke corner of babies mouth, baby turns head & opens mouth
how long does ROOTING REFLEX last?
4mo (4 baby piglets rooting in the mud)
how do you elicit sucking reflex?
touch roof of mouth
when is sucking reflex fully developed?
36 weeks in utero (premies will have week suck)
how do you elicit moro reflex?
startle baby in response to sound
how long does MORO REFLEX last?
2 mo (“fool me twice shame on you”)
what is TONIC REFLEX?
“fencing” head is turned to one side & extends that arm, opposite arm bends up at elbow (they look like a fencer “on guard”)
how long does tonic reflex last?
5-7mo (fencing for 5-7 months)
how do you elicit grasp reflex?
stroke baby’s palm
how long does grasp reflex last?
5-6mo (“baby grasps onto 5-6 fav toys)
how do you elicit stepping reflex?
hold upright with feet touching solid surface
how long does stepping reflex last?
about 2mo (“twostep”)
when is developmental surveillance conducted?
EVERY PREVENTATIVE VISIT THRU CHILDHOOD
when is developmental screening conducted?
9, 18, 30mo
why is developmental surveillance important?
catch developmental disabilities
what are 3 things developmental surveillance & screenings promote?
healthy development, prevent delays, identify children w delays/disabilities EARLY
key components of developmental surveillance?
ask about child’s learning, development, behavior
at what age should a child walk and at what age should you be worried they are NOT walking?
12mo, 18mo
when should thyroid hormone replacement start for infants with congenital hypothyroidism?
within 2 weeks of birth. at LEAST within first month
what labs are monitored in sickle cell screening?
hemoglobin & reticulocytes
HGB’s: FS, FSC, FSA (S>A)
what is the name of the test that confirms sickle cell?
hgb electrophoresis
should soluability test be used to confirm sickle cell?
no, they won’t identify hgb variants except for S
what age group kids w sickle cell should be taking PCN prophylactically?
2mo-5y
what immunizations should be given for sickle cell kids?
PCV & polysaccharide vaccine
when do infants need to be referred to a dentist?
6m or 1st tooth, def by ONE YEAR
what common bacteria colonizes baby’s mouth and increases risk of carries?
streptococcus mutans
when should all babies have a carries risk assessment done?
6mo
when should oral hygiene start?
birth. clean gums w moist cloth. when teeth erupt brush w soft toothbrush & fluoride toothpast
when should kids be weaned from the bottle?
12-18mo
child lifts head with good head control. age?
3mo
child has ulnar grasp. age?
3-5mo (uses 3-5 fingers)
when do kids start to show signs of dominant hand?
not before 1y. most 18-30mo
when do you stop measuring head circumference?
2y
when do kids typically start to stay on the same growth curve on the growth chart?
18mo
when should BP screening start?
3y if not high-risk
when can kids have first TB test?
3mo
most common cause of death in kids?
MVA
what is the most common initial symptom of sickle cell? occurs in up to 50% of children before age 3.
hand-foot syndrome (dactylitis)
along with prophylactic PCN, what other daily med is recommended for sickle cell kids?
oral hydroxyurea
what are some risks AW bilateral congenital hearing loss?
family hx, facial/cranial abnormalities, being in NICU >2d
at which point should a child switch from the harness system to a booster with the seat belt?
5y. booster til 8 &/or 4’9”.
hepatitis b immune globulin (HBIG) provides?
passive immunity
what vaccine should be referred for a child with progressive neurological disorders until they are stable?
DTAP
baby is born to HBsAG-positive mother. what should you do for baby?
give hep B immune globulin (HBIG)
people who have not HAD chickenpox or the vaccine and should be targeted to do so include?
daycare workers, >8yo HIV patients with CD4 count >200
pregnancy should be ruled out and prevented for 3mo with what vaccine?
MMR, MMRV
should a child ride in a carseat on an airplane?
yes
needle length for newborns?
5/8”
needle length for 1-20mo?
1” in thigh
needle length for 1y-18y?
1 & 1/4” in thigh
untreated PKU leads to?
intellectual disability
hep B should not be given to a person w a hx of anaphylactic rxn to?
bakers’ yeast
most common route of Hep A transmission?
contaminated food or water
baby can roll from back-to-stomach. age?
6-7mo
when do they grasp cubes with raking motion?
3-5mo (ulnar grasp)
when to perform PKU screen for premature or ill infants?
7d
treatment for congenital hypothyroidism?
levothyroxine 10-15mcg/kg/day with serum monitoring done by 2w of life.
when is the latest confirmatory testing for sickle cell can be performed?
2mo
what can reduce the number of cariogenic bacteria? how often recommended?
CHG oral rinse, 3mo intervals
what is ankyloglossia?
tongue tie
parent edu for fluoride varnish?
don’t brush teeth til next morning. soft foods.
when does separation anxiety start?
8-9mo
milestones: laughs, anticipates food on sight, turns from back-to-side. age?
3-5mo
milestones: walks backwards, begins to hop on 1 foot, uses prepositions. age?
30mo
understands 2-step command, carries & hugs doll, feeds self. age?
18mo
throws ball, seats self in chair, dumps pellets from bottle?
18mo
oldest a baby can receive their 1st RV vaccine?
<15w
what blood lead level is considered abnormal? at what level would chelation be indicated? what level is considered urgent?
> 5 = abnormal. >45 chelation. >70 URGENT
when does word “no” affect child?
6-8mo
what age can infant track object with BOTH eyes?
3mo
when are universal screenings for lead?
1 & 2y
what can excessive fluoride intake cause?
dental fluorosis or mottled enamel
children taking what dose of corticosteroids should NOT be given a live vaccine?
> 20mg/day x14+d
when is flu vaccine given?
6mo then annually. <9 getting first vaccine should get 2 vaccines that flu season 1 month apart
when can children start receiving the the LAIV flu vaccine?
2y, under 2 must receive inactive
live virus admin?
can be given together. if NOT given together then MUST wait 4w
what is the difference btwn DTaP & Tdap?
Tdap has the booster dose of diptheria while Dtap is the initial immunization
what vaccines should be stored frozen?
varicella, MMR,
at what age do infants develop the concept of object permanence
9-12mo
what are the triad symptoms of ADHD?
impulsivity, innatention, hyperactivity
what subtype of ADHD do girls have a higher prevalence of? what about boys?
girls- innatention. boys-hyperactive
what does the AAP recommend regarding screen time?
none under age 2, over age 2 only 2h/d
newborn universal screenings:
hearing, bilirubin, PKU, congenital hypothyroidism, sickle cell, CHD
3-5d universal screenings
hearing, blood confirmations
1 & 2 month universal screenings (they’re the same)
hearing & blood if not done. MATERNAL DEPRESSION
4 month universal screening
MATERNAL DEPRESSION
6 month universal screenings
MATERNAL DEPRESSION, oral health, VERIFY early intervention for hearing
9 month universal screenings
DEVELOPMENTAL SCREEN
oral health
12 month universal screenings
ANEMIA
LEAD
oral health
15 month universal screenings
oral health
18 month universal screenings
DEVELOPMENTAL SCREEN
AUTISM SPECTRUM DISORDER SCREEN
oral health
2 year universal screening
AUTISM SPECTRUM DISORDER
LEAD
oral health
2.5y (30mo) universal screening
DEVELOPMENTAL SCREEN
oral health
3y universal screening
VISION (use HOTV or LEA)
oral health
4y universal screening
HEARING
VISION
oral health
vaccine schedule DR HIP mnemonic
Birth: B for Hep B
2m: B DR HIP (hepB, dtap, rv, hib, IPV, pnuemo)
4m: DR HIP (dtap, rv, hib, IPV, pneumo)
6m: B IN DR HIP (hepB, influenza, dtap, hib, IPV, pneumo)
12-18m: MAD HPV (MMR, hepA, dtap, hib, IPV, varicella)
4-6y: VARI DIM (varicella, dtap, IPV, MMR)
flu vaccine stuff
starts at 6m, goes until forever. if you’re under 9y and you’ve never had it you get 2 that year, 1 month apart.
contras = egg allergy
SE’s: fever, malaise, myalgia
RISK FOR febrile seizures when given w pneumo)
MMR vaccine stuff
ITS ALIIIIIIIVE.
contras: PREGNANCY, high-dose steroids, immunocomp, LATEX, NEOMYCIN, GELATIN
SE’s: FEBRILE SEIZURE, transient thrombocytopenia, encephalitis
IPV stuff
contras: PREGNANCY, mod-severe illness w or w/o fever, allergy to POLYMYXIN B, NEOMYCIN, STREPTOMYCIN
SE’s: uncommon
PVC13 stuff
contras: mod-severe illness w or w.o fever
SE’s: SITE RXN, fever, irritability, sleep changes, SEIZURES when given w flu vaccine
HiB stuff
nada. well tolerated. no contras.
Dtap stuff
contra: NEUROMUSCULAR dxs until clarified
SE’s: INCONSOLABLE CRY, fever, hypotonic-hyporesponsive episodes
RV stuff
ITS ALIIIIIIIVE. contras: mod-severe acute gastroenteritis, hx INTUSSUSCEPTION, severe combined immunodeficiency (SCID), LATEX ALLERGY
hep B stuff
contras: serious yeast allergy
SE’s: uncommon
hep A stuff
contras: PREGNANCY, mod-severe illness
SE’s: SITE rxn, HA, loss of appetite
varicella stuff
ITS ALIIIIIIVE. contras: PREGNANCY, febrile seizures, T cell abnormalities, allergy to gelatin, neomycin.
SE’s: site rxn
vaccines to defer for moderate-severe illness
moderate-to-severe like a hangover
“IPA beers”
IPV, PCV13, hepA
vaccines cause minor site rxn
“A Painful Vaccine To Me”
hepA, PCV13, varicella, tdap, meningicoccal
vaccines to defer for neuro issues/febrile seizure
“Mental Defects Matter”
MMR, Dtap, mening
vaccines w no rxns
“Baby is Happy”
hepB, IPV, HiB
1-2mo milestones (per Hay)
LIFTS & holds head turns SIDE-BACK follows objects with eyes drops toys alerts to voice recognizes parents vocalizes smiles spontaneously
3-5mo milestones (per Hay)
ulnar grasp reaches (2 hands) & bring to mouth raspberry sounds sit w support laughs anticipates food on sight turns BACK-SIDE
6-8mo milestones (per Hay)
sits alone for short period reaches w one hand scoops first then uses thumb "bye-bye" passes object hand-to-hand babbles ROLLS back-stomach inhibited by "NO"
9-11mo milestones (per Hay)
stands alone imitates pat-a-cake & peek-a-boo thumb & index to pick up pellet uses furniture to walk along follows 1-step commands
12mo milestones (per Hay)
walks alone "mama/dada" PINCER GRASP releases cube to cup after demonstration gives toys when asked builds 2-cube tower points to desired object says 1-2 other words
18mo milestones (per Hay)
3-4 cube tower throws ball seats self in chair dumps pellet from bottle walks up & down stairs WITH HELP says 4-20 words follows 2-step commands carries & hugs doll feeds self
24mo milestones (per Hay)
short phrases (2+words) kicks ball 6-7 cube tower points to named objects or pictures 2-foot jump stand on 1 foot uses pronouns verbalizes toilet needs puts on simple garment turns single pages domestic mimcry
30mo milestones (per Hay)
walks backwards hops on 1 foot uses prepositions copies circle crudely points to objects described by use refers to self as "I" holds crayon in FIST helps put things away carries on convos
3y milestones (per Hay)
holds crayon w FINGERS builds 9-10 cube tower 3-cube bridge copies circle gives first & last name rides tricycle dresses w supervision
3-4y milestones (per Hay)
climbs stairs with alternating feet buttons/unbuttons answers questions w plurals, personal pronouns, verbs places toy properly as instructed (in, on, under, etc) draws circle when asked to draw person knows own sex when asked gives full name draws circle on own feeds self takes of shoes & jacket
4-5y milestones per Hay
runs & turns without losing balance can stand on 1 leg for 10s buttons & laces (doesn't tie) counts to 4 able to give 2 of something by direction draws a person as a head, 2 appendages, possibly 2 eyes, NO TORSO IS THE IDEA HERE) knows days of the week answers questions appropriately copies a + sign in imitation self toilets (may need help wiping) plays outside at least 30m dresses self except for tying
PKU
phenylketonuria (PKU). autosomal recessive trait.
test at birth. state mandated.
dx = 240-1200 uM (4-20 mg/dL) but pterin levels normal
tx = if consistenly >360uM (6mg/dL) then treat w R-tetrahydrobiopterin & diet
untx = intellectual disability, hyperactivity, seizures, light complexion, eczema
MUST be tested by 2nd week of life if done <24h
congenital hypothyroidism
MUST BE SCREEN SHORTLY AFTER BIRTH.
dx: T4 & TSH. abnormals confirmed by venous sample (baby blood draw is usually heel stick)
tx: start hormone replacement asap
untx: thick tongue, large fontanels, poor muscle tone, hoarseness, umbilical hernia, jaundice, intellectual retardation
sickle cell
**sickle cell anemia & sickle B0 thalassemia =
ONLY hgbs S, F, A2
tx: PCN daily 2mo-5y
**sickle B+ thalaseemia = hgb S > hgb A & A2
**sickle hbg C = equal amts hgb S & C (but quantity of S
slightly > C)
DX GOLD STANDARD = hgb electrophoresis, HPLC, DNA analysis (NOT SOLUBILITY TESTS)
passive immunity per Dr Townsend
A person is given antibodies to a disease rather than producing them through his or her own immune system. This is short term immunity through introduction of antibodies to a disease. Can occur naturally as in the passage of antibodies from the mother to the fetus during pregnancy or artificially acquired through injection of antibodies such as gamma globulin. Onset is within 24 hours of the dose and duration is about 4-6 months.
active immunity per Dr Townsend
resistance developed in response to infection with an agent resulting in antibody production. Active immunity is usually permanent. Can be either naturally acquired through exposure and infection with the disease or artificially acquired through immunization. Onset is 2-4 weeks and duration is years to lifetime
Herd Immunity per Dr Townsend
This occurs when a significant portion of the population is vaccinated and that provides a portion of immunity for those that have not developed immunity.The population (herd) helps prevent disease in the unprotected population. The herd protects those who can not safely get vaccinations. Generally 90 -95% of the population should be to be vaccinated to have effective Herd immunity.
Vaccines for Children program
The Vaccines for Children (VFC) program is designed to help overcome cost as a barrier to childhood vaccination that can be a barrier for some. Under insured children must visit a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) to receive the covered vaccines.
permanent molars erupt at approximately what age?
12y
