1 / 14

077B INFANT & CHILD IMMUNIZATION (1)

077B INFANT & CHILD IMMUNIZATION (1). “Discuss the population health benefits of immunization programs” Probability of contracting communicable disease depends on probability that contacts are already immune, are carriers or have the disease

sahara
Download Presentation

077B INFANT & CHILD IMMUNIZATION (1)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. 077B INFANT & CHILD IMMUNIZATION (1) • “Discuss the population health benefits of immunization programs” • Probability of contracting communicable disease depends on probability that contacts are already immune, are carriers or have the disease • If sufficient proportion of population is immune, then disease will not spread (herd immunity) • Prevention is usually cheaper and more effective than treatment (if treatment even exists) • Possibility of eradicating some diseases • Implications for school attendance (Ontario) • Mandatory choice vs. mandatory immunization • Exclusion from school for non-immunized children during outbreak

  2. Standard immunizationsAge 0-17 • Diphtheria • Tetanus • Pertussis • Polio • H. influenzae B • Mumps • Measles • Rubella • Hepatitis B • Chickenpox (varicella) • Pneumococcus • Meningococcus • Influenza • HPV Taken from: Canadian Immunization Guide, 2007

  3. Pneumococcal vaccines (1) • 1,200 cases in Ontario, 2009; pneumonia and meningitis; 4% case fatality rate • Prevnar 13—13 valent pneumococcal conjugate vaccine to protect under age 6 years • Introduced fall 2010 • Routine doses at 2, 4, 12 months of age • 4 doses at 2, 4, 6 and 15 months if chronic disease • Replaced Prevnar (7 valent) due to emergence of 3, 7F and 19A as frequently reported serotypes • 19A is becoming resistant to first line antibiotics • Conjugated with diphtheria toxoid but does not protect against diphtheria • At 12 months, child receives Prevnar 13, Meningococcal C conjugate and MMR vaccines

  4. Pneumococcal vaccines (2) 2. Pneumococcal polysaccharide 23 valent vaccine • Anyone age 2 or older with chronic conditions: moderate-severe respiratory, cardiac, cirrhosis, renal, diabetes, asplenia, sickle-cell, CSF leak, immune deficiency, cochlear implant recipients • U.S. adding any asthma and cigarette smoking • Booster dose 3-5 years later • Age 65 years or older—everyone • Residents of nursing homes and chronic care facilities—everyone • 50-80% effectiveness among the immunocompetent

  5. Meningococcal vaccines • Meningococcal C Conjugate Vaccine • Give one dose at 12 months • May be offered in Grade 7 or age 14-16 for those unimmunized • Meningococcal ACYW-134 Quadrivalent Conjugate Vaccine 2-55 years if asplenic, complement, properdin or factor D deficiency, or cochlear implant recipient • Meningococcal ACYW-135 Quadrivalent Polysaccharide Vaccine Over 55 years for same indications as (2)

  6. Human Papilloma Vaccine (HPV) (1) • Protects against 4 strains of HPV • Types 16 and 18 (linked to 70% of cervical cancer and 80% of anal cancer) • Types 6 and 11 (linked to 90% of anogenital warts) • Gardasil: all 4 types; age 9-26 • Health Canada approved to prevent cancer and warts in females but warts only in males • U.S. FDA approved to prevent cancer and warts in females and males • Cervarix: types 16 and 18, females 9-26

  7. Human Papilloma Vaccine (HPV) (2) • Need three doses (at times 0, 2 and 6 months) • Give prior to sexual activity, once active, with previous pap abnormalities or have had a previous HPV infection • However, 40% of women become infected with HPV within 16 months after initiation of sexual activity • Ontario: grade 8 girls in school • Routine vaccination of boys would be useful

  8. 077B INFANT & CHILD IMMUNIZATION (2) • “State that a lapse in immunization schedule does not require re-instituting the initial series, merely giving it at the next visit” • You can give a dose too early; you cannot give a dose too late

  9. 077B INFANT & CHILD IMMUNIZATION (3) • “Communicate to patients and parents about vaccine benefits and risks” • Obtain an immunization history on all children • Late immunization is still very effective • Immigrants require special attention • Depends on availability of good records; countries have different immunization coverage • When in doubt, start the series again; see Canadian Immunization Guide

  10. 077B INFANT & CHILD IMMUNIZATION (4) • Travel • Update regular immunizations • High risk exposure: BCG, cholera, hepatitis A, typhoid, rabies • Meningococcal quadrivalent for meningitis belt and Hajj • Influenza if the right season • Follow legal requirements • Yellow fever (strict) • Cholera (some countries may require; medical exemption letter can be provided)

  11. 077B INFANT & CHILD IMMUNIZATION (3) • “Discuss misconceptions about immunization contraindications” • Following are not contraindications: • Mild/moderate local reactions to previous dose • Mild acute illness with or without fever • Taking antibiotics • Allergy to penicillin, duck, molds, pollens • Positive Mantoux TB skin test • TB skin test at same time or one month after live vaccine dose • Breast feeding • Asplenia • Prior febrile seizure reaction (consider prophylactic acetaminophen)

  12. 077B INFANT & CHILD IMMUNIZATION (4) • “List possible complications of immunization” • Seizures (secondary to fever) • Anaphylaxis (differentiate from fainting) • Neurological damage (rarely associated) • Casual rather than causal relationship • e.g., no good evidence for MMR causing autism • Introduction of acellular pertussis reduced febrile seizures dramatically and was much more protective

  13. 077B INFANT & CHILD IMMUNIZATION (5) • “Discuss immunization of immuno-compromised children (e.g., asplenia, chronic diseases or seizures)” • Asplenia (surgical or congenital/functional) • No contraindication to any vaccine • Particularly need protection against encapsulated bacteria: Streptococcus pneumoniae, Haemophilus influenzae B, Neisseria meningitidis (A,C,Y, W135), to which these individuals are highly susceptible. • Immunosuppression • Avoid live vaccines • Follow regular immunization schedule • High dose steroids can mute immune response • Congenital immunodeficiency • Read the Canadian Immunization Guide!

More Related