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Case Study: Jennifer and James

Case Study: Jennifer and James. Amy B. Middleman, MD, MSEd, MPH Assistant Professor, Department of Pediatrics, Adolescent Medicine Section, Baylor College of Medicine August 22, 2012. Jennifer and James. 12-year-old twins In your practice since birth

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Case Study: Jennifer and James

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  1. Case Study: Jennifer and James Amy B. Middleman, MD, MSEd, MPH Assistant Professor, Department of Pediatrics, Adolescent Medicine Section, Baylor College of Medicine August 22, 2012

  2. Jennifer and James • 12-year-old twins • In your practice since birth • The month is May and this is a routine visit • Both are up to date on vaccines through age 5 years

  3. Jennifer • Had a Tdap at age 10 years • Experienced syncope with that vaccine • She was evaluated in the emergency department and was released • The twins’ grandmother lives with them • Grandmother is receiving chemotherapy

  4. What Vaccines Does Jennifer Need? • Jennifer has already received Tdap; it is licensed for one-time use only at this time • MCV4 • HPV #1 (HPV2 or HPV4) • Confirm receipt of 2 doses of varicella and MMR vaccines; 3 doses of hepatitis B vaccine • Consider hepatitis A vaccine

  5. Any Contraindications? • Jennifer has no contraindications to vaccines • Syncope is a known consequence of procedures involving needles that disproportionately affects adolescents • Adolescents should be observed in a sitting or lying position for 15 minutes after injections • Grandmother’s chemotherapy does not affect the administration of adolescent vaccines

  6. James • No vaccines since age 5 years • Diagnosed with Guillain-Barre syndrome (GBS) at age 8 years • GBS secondary to Campylobacter infection • The twins’ grandmother lives with them • Grandmother is receiving chemotherapy

  7. What Vaccines Does James Need? • Tdap • MCV4 • HPV #1 (HPV4 only) • Confirm receipt of 2 doses of varicella and MMR vaccines; 3 doses of hepatitis B vaccine • Consider hepatitis A vaccine

  8. Any Contraindications? • James has no contraindications to vaccines • History of GBS secondary to an infection is not a precaution to vaccination • History of GBS secondary to a specific vaccine is a precaution associated with that vaccine • James should receive all recommended vaccines (and should be observed for 15 minutes after administration)

  9. And, of course… • Both pre-teens should have an appointment made for later in the fall to receive the influenza vaccine (as soon as supply becomes available)

  10. Provider Recommendation • Strong provider recommendation has been shown to be key to parental acceptance • It is critical to let parents know how safe and effective vaccines are • Parents must know that the diseases we vaccinate against still exist and some are epidemic (e.g., pertussis) • Please make a strong case for primary prevention of disease

  11. Vaccines Work Adapted from Immunization Action Coalition, www.immunize.org/catg.d/p4037.pdf. Accessed Dec. 2010.

  12. Thank You!

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