CHILDHOOD IMMUNIZATIONS

Virginia Keane, MDAssociate Professor, PediatricsUniversity 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 Disease Baseline

morbidity1998 morbidity % decrease

smallpox 48,164 0 100

diptheria 175,885 1 100

pertussis 147,241 7405 95

tetanus 1314 41 97

polio 16,316 1 100

measles 503,282 100 100

mumps 152,209 666 >99

rubella 47,745 364 >99

Congenital rub. 823 7 >99

Hemophilus B 20,000 61 >99

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

DiptheriaBacterial:

Corynebacterium diptheriae

Person to personSevere throat infections,

can obstruct breathingMyocarditis 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 ScheduleAge 1982 2002

birth HepB, BCG

1 month HepB

2 months DTP,OPV DTaP,IPV, HIB, PCV

4 months DTP,OPV DTaP,IPV, HIB, PCV

6-9 months DTP DTaP, HIB, PCV

12-15 months MMR MMR,HepB, HIB, IPV,PCV

15-18 DTP,OPV DTaP, Varicella

4 years DTP,OPV MMR, DTaP

total 7 diseases, 6 shots 11 diseases, 22 shots

Vaccines in UseVaccine Diseases Schedule Adverse effects

DTaP Diptheria, Tetanus, Pertussis

2,4,6, 15 mos4 years

Local reaction,fever, crying,

IPV polio 2,4,12 mos,4yrs Local reaction

MMR Measles, mumps, rubella

12mos, 4yrs Fever, joint pain, rash

Varicella Chicken pox 12 mos, 2 for teens Local,Fever,rash

HepB HepatitisB Birth, 1mo, 6-9mos

Local, fever

PCV Strep pneumoniae 2,4,6,15 mos Local, fever

HIB Hemophilus 2,4,6,12 mos Local,fever

Expanded Program on Immunization (DOH)

Vaccine Age (1st dose)

# of doses

Dose Interval Route

Bacillus Calmette-Guérin Birth 1 0.05 mL None Intradermal

Diptheria-Pertussis- Tetanus 6 weeks 3 0.5 mL 4 weeks Intramuscular

Oral Polio Vaccine 6 weeks 3 2 drops 4 weeks Oral

Hepatitis B Birth 3 0.5 mL 0 – 6 – 8 weeks

intramuscular

Measles 9 months 1 0.5 mL None Subcutaneous

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