childhood immunizations n.
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  1. CHILDHOOD IMMUNIZATIONS Virginia Keane, MD Associate Professor, Pediatrics University of Maryland School of Medicine

  2. Shots Hurt! Why Do We Have To Give Them? • Vaccines work! • Vaccines are THE most effective preventive measure that modern medicine has derived

  3. Vaccine Effect on Morbidity

  4. Vaccine Policy • Recommended by an expert panel convened by the CDC: the ACIP, Advisory Committee on Immunization Practice • Recommendations may then be adopted by professional organizations and state and local health departments • State and local health departments alter policy according to local needs

  5. A Brief Intro to the Biology of Vaccines • Antigens are substances our bodies view as FOREIGN • Our immune system recognizes FOREIGN antigens and mounts an immune response, in the form of ANTIBODIES to eliminate it. • After the antigen has been eliminated the immune system retains a memory of that antigen: next time it appears the antibody response is faster and stronger!!

  6. Germs Are Antigens • The proteins and sugars on the walls of viruses and bacteria are FOREIGN • Your body makes antibodies to fight them off

  7. Theory of Vaccines • Present the body with a germ antigen that can not produce disease • Body will produce antibodies to the germ • This will prevent disease if the body later encounters that germ, because the antibodies will fight off the germ before it has a chance to make you sick

  8. Vaccine Types • Live vaccines: attenuated, must reproduce to produce immune response • Killed vaccines: pieces (sugars or proteins) of the germ wall, can not reproduce • Conjugated vaccines: germ sugar attached to a protein to enhance immune response

  9. Vaccine Preventable Diseases • Killed Vaccines: Diptheria, Pertussis, Tetanus, Hepatitis B, Polio • Live Attenuated: Measles, Mumps, Rubella, Varicella, Polio • Conjugated: HIB, PCV

  10. Diptheria Bacterial: Corynebacterium diptheriae Person to person Severe throat infections, can obstruct breathing Myocarditis can be fatal

  11. Tetanus • Bacterial infection: Clostridium tetani, occurs in deep wounds • Not transmissable person to person • Bacteria makes a toxin that effects nerves, causing trismus/lockjaw and severe muscle spasms • Adults should be vaccinated every ten years to maintain immunity

  12. Pertussis • Bacteria: Bortadella Pertussis • Starts as a cold, progresses to pneumonia and encephalitis • “whooping cough” • Adults serve as a reservoir • Newer acellular vaccine has many fewer side effects

  13. Haemophilus Influenzae B • Bacterial infection: can cause ear and sinus infections, skin infections(cellulitis), pneumonia, joint and bone infections, epiglottitis • Prior to vaccines was the most common cause of childhood bacterial meningitis(brain damage, deafness, death)

  14. Hepatitis B • Viral disease spread by sharing of body fluids: blood, sexual fluids • Most cases resolve, but it can lead to chronic hepatitis, liver failure, liver cancer, and death • Immunization strategies targeting high risk individuals failed

  15. Polio • Viral, mostly asymptomatic, can cause meningitis, gastroenteritis and paralytic polio • Last wild type case in US, 1979, west hemisphere 1991 • Recent change from OPV(oral live attenuated) to IPV(inactivated,) due to ongoing incidence of vaccine associated cases

  16. Varicella • Viral, herpes family • “chicken pox” • Usually mild, self limited :fever, rash • Can get pneumonia, cerebellitis, encephalitis, even death

  17. Measles • Viral disease, rapid person to person to person transmission among susceptibles • High fever, red eyes, rash, misery • Outbreak in 1989-90 due to large number of unvaccinated kids

  18. Mumps • Viral disease characterized by fever and swelling of saliva glands • Orchitis common, sterility rare • Sporadic cases and outbreaks still occur

  19. Rubella • Viral, humans only • “German Measles” • Low grade fever, joint pains, swollen glands, rash • Congenital rubella: mental retardation, cataracts, heart deformities

  20. Pneumococcal Conjugate • Bacterial: Streptococcus Pneumoniae • Severe invasive infections: pneumonia, meningitis, skin, bone and joint infections • Major cause of mortality in immuncompromised and children with sickle cell disease • New vaccine :seven serotypes

  21. Other Vaccines • Hep A: food borne viral hepatitis, vaccine to people over 2 yrs in areas of outbreak • Menigococcus: bacteria that causes meningitis, not universally recommended, required by many colleges and the armed forces • Influenzae: Injection recommended only for high risk kids( chronic lung and some heart disease, immunocompromise, diabetics, sickle cell)

  22. Vaccine Schedule

  23. Vaccines in Use

  24. Expanded Program on Immunization (DOH)

  25. Adolescent Vaccines • Td: Tetanus, Diptheria booster: given at 10-14 years of age, and every ten years thereafter!! • Hepatitis B: if not previously vaccinated: can get a two dose regimen • Varicella: if not previously given, two doses • May see introduction of Pertussis booster in future

  26. Vaccine Rates • 1989-1990 measles outbreak, >1000 cases, many hospitalizations, several deaths • Results of many studies revealed that the main reason for the outbreak was the existence of a large number of UNIMMUNIZED children