CHILDHOOD IMMUNIZATIONS Virginia Keane, MD Associate Professor, Pediatrics University of Maryland School of Medicine
Shots Hurt! Why Do We Have To Give Them? • Vaccines work! • Vaccines are THE most effective preventive measure that modern medicine has derived
Vaccine Effect on Morbidity
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
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!!
Germs Are Antigens • The proteins and sugars on the walls of viruses and bacteria are FOREIGN • Your body makes antibodies to fight them off
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
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
Vaccine Preventable Diseases • Killed Vaccines: Diptheria, Pertussis, Tetanus, Hepatitis B, Polio • Live Attenuated: Measles, Mumps, Rubella, Varicella, Polio • Conjugated: HIB, PCV
Diptheria Bacterial: Corynebacterium diptheriae Person to person Severe throat infections, can obstruct breathing Myocarditis can be fatal
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
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
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)
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
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
Varicella • Viral, herpes family • “chicken pox” • Usually mild, self limited :fever, rash • Can get pneumonia, cerebellitis, encephalitis, even death
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
Mumps • Viral disease characterized by fever and swelling of saliva glands • Orchitis common, sterility rare • Sporadic cases and outbreaks still occur
Rubella • Viral, humans only • “German Measles” • Low grade fever, joint pains, swollen glands, rash • Congenital rubella: mental retardation, cataracts, heart deformities
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
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)
Vaccine Schedule
Vaccines in Use
Expanded Program on Immunization (DOH)
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
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
