VACCINES:

1. VACCINES: Bridging Immunization Success to Today’s Wellness Presentation File:Stoll, Barbara_Friday Session C2 Health Consultants For Child Care 2012

2. Health Consultants For Child Care Presenter: Barbara H. Stoll, R.N., B.A.N, P.H.N. Owner/Manager Child Care Health Consultant / Educator www.healthconsultantsforchildcare.com Health Consultants For Child Care 2012

3. Learning Objectives / Key Concept Support: 1. Vaccine success: review the diseases that vaccines prevent. 2. Today’s wellness: Vaccine facts vs myths * Risk – benefit perception * World Wide Web – scientific evidence vs opinion * Vaccine adverse event reporting system * Reliable sources of vaccine information Health Consultants For Child Care 2012

4. Combination Vaccines Health Consultants For Child Care 2012

5. Diphtheria, Tetanus, & Pertussis • Diseases caused by bacteria • DTaP is safer version of an older vaccine called DTP. (changed in 1997) • Acellular vaccine– more effective, fewer reactions • 5 doses; 4 required for child care • 2mo, 4mo, 6mo,15-18mo, 4-6yr • Indicate vaccine type on form ( nationwide increase of pertussis, adults need booster update too; Tdap, Adacel) Health Consultants For Child Care 2012

6. “Whooping Cough Outbreak - health officials have confirmed 94 cases in Wright County, MinnesotaMDH May 14, 2010Minnesota statistics: 2009 1,134 confirmed cases 2010 1000 confirmed cases Health Consultants For Child Care 2012

7. Polio • Caused by virus that invades nervous system • Spreads person to person by stool or nasal secretions • 1 in 200 infections—irreversible paralysis • 4 doses; 3 required for child care • 2mo, 4mo, 6-18mo, 4-6yr • Initial vaccine was IPV (inactivated), then switched to OPV (oral), now back to IPV • OPV: live virus vaccine better at keeping disease from spreading to other people but caused polio in 1 in 2.4 million • 1997 switched back IPV, since getting Polio in US is low risk. Since 2000 only IPV used in US, other countries still use OPV • 2005—4 cases in unimmunized MN Amish community • 2010 world cases: 1,288 Health Consultants For Child Care 2012

8. Measles, Mumps, Rubella (MMR) • Viruses that spread from person to person through the air • Must be given on or after “1st” birthday • Required for children 15mo and older • 2nd dose at 4-6 yr (needed for complete protection) • May be given as combination vaccine with varicella (chicken pox) vaccine MMRV (Proquad) Health Consultants For Child Care 2012

9. Haemophilus Influenza type B (HIB) • Severe bacterial infection affecting infants and children <age 5 • Spread by air and direct contact • May be no symptoms but germs can spread into lungs and bloodstream, causing bacterial meningitis • Before vaccine 20,000 children in US <5 got severe Hib disease, 1,000 deaths. 99% decrease in 1993 after start of vaccine; 1,300 cases • 2008-MN reported 5 children aged 5mo thru 3 yr, 1 death, all un or under vaccinated • Largest # of cases in MN since 1992 • 12/07 nationwide shortage, due to production problems, bacteria in manufacturing equip., not in vaccine lots, no vaccine related problems. • Children in group care at increased risk for Hib, monitor records closely • 3-4 doses • 2mo, 4mo, 6mo, 12-15 mo • 1 dose for 12 mo or > required • 1 dose for previously unvaccinated children 15-59 mo • Not for children age 5 and > Health Consultants For Child Care 2012

10. Varicella (Chicken Pox) • Respiratory virus • Vaccine preventable, 1995 • 100 deaths per year in US before vaccine • Exclusion- until all pox are crusted over • Breakthrough disease; booster now required • Vaccine schedule • 1st dose: 12 – 18 mo ( ’04 required for child care or disease date; Sept 2011 requires Dr diagnosis, added to Reportable Disease list)) • Booster at 4 -6 year PE, required for kindergarten (or 7th grade entry) Health Consultants For Child Care 2012

11. Shingles (Herpes Zoster) Reactivation of chickenpox virus which lies dormant in a spinal or cranial nerve root after someone has had chickenpox. • Symptoms start with prickly, tingling pain along nerve path (back, chest, face, leg). Red blistery rash appears 1-3 days later, crusting over, disappearing in 3-5 weeks. Nerve pain can last long time. • Cannot occur in someone who has not already had chickenpox. • Does not spread person to person as shingles. • Contact with the fluid from shingles blisters can cause chickenpox to someone who has never had chickenpox before. • Exclusion – None, if blisters can be covered by clothing or bandage. If not, until lesions scabbed over. • Treatment – antiviral medications may help. Health Consultants For Child Care 2012

12. Pneumococcal Conjugate Vaccine (PCV) • A streptococcus pneumoniae bacteria spread by coughing, sneezing or direct contact with secretions • PCV (baby vaccine) protects now against 13 most common strains of pneumococcal bacteria • Replaced HIB as leading cause of invasive disease in children; pneumonia, blood infections, meningitis • 4 doses • 2mo, 4mo, 6mo, 12-15mo • Healthy children between 2nd and 5th BD’s who have not competed series should get 1 dose, unhealthy; 2 doses • Not for > age5 Health Consultants For Child Care 2012

13. Hepatitis B • Highly infectious virus that enters the blood stream and attacks the liver • Spread by blood and other internal body fluids, needles and maternal transfer • Infection may turn into a “chronic carrier” • Adult infection 6%-10% become “carriers” • Childhood infection 30%-50% become “carriers” • Maternal transfer rate - 90% become “carriers” • Two documented cases of transmission in child care • Preventable disease by vaccination • Hep B vaccine – started in 1991 • 3 shots; 6 months apart, usually started at birth • On MN child care immunization record, but not mandated • Mandated for Kindergarten entrance • Recommended by OSHA for child care providers Health Consultants For Child Care 2012

14. Rotavirus • Leading cause of diarrhea worldwide • United States • >400,000 doctor visits • >200,000 ER visits • 55,000-70,000 hospitalizations and • 20-60 deaths • Baby vaccine • Prevent 74% all cases, 98% severe cases, & 96%hospitalizations • 2-3 doses between 2-6-mo, depending on brand used • RotaTeq, Rotarix (live virus vaccine) Health Consultants For Child Care 2012

15. Influenza • Respiratory flu, not stomach flu • Seasonal flu kills 36,000 in US annually • Need new flu shot each year • Shot is killed virus vaccine, nasal vaccine is live virus • I dose annually for all over 6 mo • 1st time for kids needs 2 doses Health Consultants For Child Care 2012

16. Spread by fecal/oral contamination (poop on food) Cross contamination of food by infected cook or food server Poor handwashing techniques No handwashing Contaminated items such as toys, tables, chairs, floor Anal/oral sex Contaminated water, ice, raw shellfish harvested from sewage-contaminated water Universal vaccination to all children at 12 to 23 months. Two dosages 6 months apart. Currently on MN child care immunization record, but not required. Recommended for child care providers. Other high risk groups, ie Travel out of U.S. Hepatitis A Health Consultants For Child Care 2012

17. Factors Contributing to Vaccine Safety ConcernsContemporary Pediatrics 2/2010 Risk – benefit perception: We are not seeing diseases like we used to, the focus has shifted to adverse events. The World Wide Web: Discriminating between reliable science-based web sites and unreliable web sites; blogs, YouTube, etc. An issue of trust Distinguishing cause from coincidence ie. Autism concerns Health Consultants For Child Care 2012

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19. Risk - Benefit Perception Myth: “Disease rates have dropped due to improved hygiene, not vaccination” • Better conditions (less crowded housing, better nutrition, etc.) have had an impact on disease rates. BUT, the only real decrease in a vaccine preventable disease (VPD) has occurred after the introduction of a vaccine to prevent it. • This also true for newer vaccines like Hib (1987) and varicella (1995), which were introduced during times of modern hygiene. • When developed countries (U.K., Sweden, Japan) stopped using DTP vaccine, their pertussis rates jumped dramatically. Health Consultants For Child Care 2012

20. Myth: “Natural infection is better than immunization” • Infection usually does cause better immunity than vaccination. • However, the price paid for natural disease can include paralysis, retardation, liver cirrhosis/cancer, deafness, blindness, pneumonia, or death; which are far more dangerous than any posed by shots. • Many young parents think these infections are trivial. Which only means they’ve never seen them. Health Consultants For Child Care 2012

21. The World Wide Web Myth: “Drug companies make big profits from vaccines.” Vaccines are not high-profit products. Vaccine sales are dwarfed by prescription sales (2003 data: $2 bil vaccine sales; $243 bil prescription sales). Costs for research, development, and compliance with standards are high. Decreasing government funding for buying vaccines causes instability in the vaccine market. If vaccines are highly profitable, why do only 4 companies produce almost all of the U.S. childhood vaccines now, when there used to be 25 companies producing vaccines? Health Consultants For Child Care 2012

22. Myth: “There are dangerous “hot lots” of vaccines” • The Food and Drug Administration regulates the production of vaccines carefully. • The concept of “hot lots” is based on the presumption that more reports to VAERS mean that a vaccine lot is more dangerous. • Reports to VAERS prove nothing about causality. • As the size of vaccine lots varies widely (a lot may vary from several hundred thousand to several million), it’s not unexpected that some lots would generate more reports (i.e., the larger lots). Health Consultants For Child Care 2012

23. Myth: “Vaccine Adverse Event Reporting System (VAERS) data prove that vaccines are dangerous” • VAERS data cannot “prove” anything: • Anyone can report anything… no proof of causality is required. • Only reports of special interest (e.g., hospitalizations) are verified. When checked, many reports are not accurate. • Reports include many non-serious reactions. • The number of reported adverse events is influenced by publicity. • VAERS is properly used to detect early warning signals and generate hypotheses. Health Consultants For Child Care 2012

24. Myth: “MMR vaccine causes autism”Journal Retracts 1998 Autism Report Jan 2010 • 1998 - Dr Andrew Wakefield published article in British Medical journal (The Lancet) claiming vaccines, specifically, Measles, Mumps, Rubella (MMR), and the mercury based preservative, thirmerosal, was the culprit to autism. This resulted in worldwide decrease of vaccination rates and increase of vaccine preventable diseases. • 1992 (Europe), 2001 (U.S.) – thirmerosal removed from vaccines, autism continues to be on the rise. • Over 25 science-based studies around the world have found no link between autism and vaccines. • 2004 - Dr. Wakefield’s colleges retracted their findings. • Jan. 2010 - The Lancet, based on Britain’s General Medical Council, formally retracted the paper from the published record citing: • Wakefield guilty of dishonesty and irresponsibility. • Wakefield’s study involved 12 children, 11 boys and 1 girl. • Did not disclose he was involved in legal claims against the vaccine maker. • Acted with “callous disregard“ for the children’s welfare. • Misused public funds. • “Undermined confidence in vaccines when in fact it wasn’t true at all” Health Consultants For Child Care 2012

25. Myth: “The preservative thimerosal causes autism” • The form of mercury found in thimerosal is ethylmercury, not methylmercury, which is the form that has been shown to damage the nervous system. • Although no evidence of harm has been proven, thimerosal was taken out of vaccines as a precaution and “because it can be” (due to single dose vials, other preservative options) • Since 2001, with the exception of some influenza vaccines, thimerosal has not been used as a preservative in routinely recommended childhood vaccines. Health Consultants For Child Care 2012

26. “Didn’t the courts just decide that vaccines cause autism?” • The Vaccine Injury Compensation Program awarded ONE family a monetary settlement for a very specific situation. • The child, Hannah Poling, was born with a rare genetic disorder (mitochondrial disorder). The health of individuals with mitochondrial disorder can deteriorate after many types of stresses, including contracting a vaccine-preventable disease. • In this case, the government concluded that vaccines aggravated a rare underlying metabolic condition in one child, not that vaccines cause autism in general, or even that vaccines are contraindicated for all children with mitochondrial disorder. Health Consultants For Child Care 2012

27. Myth: “Aluminum in vaccines hurts children” • Aluminum is used in some vaccines as an adjuvant—an ingredient that improves the immune response. Adjuvants can allow for use of less vaccine and have been used for this purpose for more than 70 years. • Aluminum is the most common metal found in nature. It is in the air and in food and drink. Infants get more aluminum through breast milk or formula than vaccines. • Most of the aluminum in the body is quickly eliminated. Health Consultants For Child Care 2012

28. Myth: “Giving an infant multiple vaccines can overwhelm its immune system” • Vaccines use only a tiny proportion of the immune system’s ability to respond; in theory, a child could respond to 10,000 vaccines. • Using this estimate, 11 vaccines would “use up” 0.1% of an infant’s immune system. • Though children receive more vaccines than in the past, today’s vaccines contain fewer antigens (e.g., sugars and proteins). Smallpox vaccine alone contained 200 proteins: the 11 currently recommended routine vaccines contain fewer than 130 immunologic components. Health Consultants For Child Care 2012

29. Conclusion • “Immunizations – the most important public health intervention in history, after safe drinking water.” • Saves millions of lives & prevents millions of cases of disease. • “Community immunity” protects everyone Health Consultants For Child Care 2012

30. Conclusion cont…Excerpts from Contemporary Pediatrics 2/2010 • Ironically, the success of the immunization program has reduced the perceived risk of vaccine-preventable diseases. • As scientific evidence is increasingly dismissed as mere opinion, more children remain unvaccinated and disease rates are increasing. • If the pattern continues, unwanted outcomes & deaths will continue to rise, “these diseases will become true threats in the public eye”. Health Consultants For Child Care 2012