Pediatric Immunizations/ID

purpose of immunizations/vaccines

1. ↓ hospitalizations, sequelae, death from disease

2. Herd immunity, Community immunity 

challenges of Immunizations/Vaccines

1. Misinformation 

2. Parental concerns

   Our job: education 

CDC Strategies to Increase Vaccination Rates

1. feedback on practice/provider immunization rates

2. accurate records

3. recommend to parents w evidence-based communication

4. reminder messages to parents

5. reminder messages to providers

6. reducing missed opportunities to vaccinate

7. reducing barriers to vaccination within the practice.

what is a VIS

(Vaccine Information Statement)

standard format of vaccine info that includes risks and benefits

National Childhood Vaccine Injury Act (1986)→ Required to provide VIS for each vaccine

Which system is a national passive surveillance program for vaccine safety

VAERS (Vaccine Adverse Event Reporting System)

What is the purpose of the Clinical Immunization Safety Assessment (CISA) network

develop protocol to evaluate, diagnose, and treat vaccine-related adverse events

what are the two active surveillance systems

1. Vaccine Safety Datalink (VSD)

2. Biologics Effectiveness and Safety (BEST) Initiative

which vaccines have trace egg antigens

1. influenza

2. yellow fever

usually still okay to give to patients w egg allergy

be careful with giving polio vaccine to people with what allergies

1. neomycin

2. streptomycin

3. polymyxin B

what vaccines have gelatin

1. MMR

2. MMRV (mix of MMR and varicella)

3. VAR

neomycin is in what vaccines

1. MMR

2. IPV

3. VAR

T or F: there is link between childhood vaccines and autism

FALSE!

NO LINK BETWEEN CHILDHOOD VACCINES AND AUTISM 

what is the only oral vaccine

rotavirus

attenuated vaccine

live → weakened form of the live virus or bacteria

inactivated vaccines

Made from protein or piece of bacteria/virus

attenuated vaccines example

1. MMR

2. varicella

3. rotavirus

4. one type of flu

5. HPV

attenuated vaccines not safe for

1. pregnancy

2. immunocompromised

should you postpone vaccine if patient has a minor acute illness

no

→ can postpone if febrile tho

should you postpone vaccine if patient has a chronic illness

no contraindications,

who is more prone to chronic hep B infection

young children

hep B vaccine schedule

3 doses

1. birth

2. 1-2 months

3. 6 months

unique CI to hep B vaccine

allergy to yeast

what is the Leading cause of acute gastroenteritis related hospitalization and death worldwide

rotavirus

when do all doses of rotavirus vaccine have to be administered by

8 months

difference in RV 1 and 5 schedule

RV1 → 2 doses → 2 mon, 4 mon

RV 5 → 3 doses → 2 mon, 4 mon, 6 mon

what vaccine is CI for severe latex allergy

rotavirus 1 vaccine (RV1)

rotavirus vaccine CI

1. severe latex allergy (RV1), 

2. history of intussusception, 

3. ≥ 8 months of age, 

4. severe allergic reaction to vaccine or components

adverse effects of rotavirus vaccine

intussusception

pseudomembrane associated with

diptheria

what is associated w contaminated soil exposure to wound

tetanus

what populations have highest fatality from tetanus

1. newborn

2. IV drug users

3. diabetics

paroxysmal cough

whooping cough → pertussis

diphtheria tx

antitoxin and erythro or procaine penicillin G

pertussis tx

azithromycin

tetanus tx

metronidazole

who has the highest mortality from pertussis

<2 months old

DTAP vs TDAP

DTAP → <6y/o

TDAP afterwards

DTAP vaccine schedule

5 doses → 2mon, 4 mon, 6mon, 15-18mon, 4-6 yrs

how often should get TDAP booster

every 10 years

dose schedule for HIB vaccine

4 doses → 2m, 4m, 6mon, 12-18mon

What is the recommended treatment for a severe Hib infection such as meningitis

2nd or 3rd generation cephalosporin + dexamethasone

What is the most common causative organism of invasive bacterial disease in children before routine vaccination?

Streptococcus pneumoniae

serious complications of pneumococcal infection

1.  Hemolytic-uremic syndrome,

2. shock,

3. DIC

mainstay of treatment pneumococcal

penicillin

schedule for PCV13 vaccination in infants

4 doses: at 2, 4, 6, and 12–15 months

common adverse effects of PCV13?

Fever, irritability, sleepiness, difficulty sleeping

What type of virus causes poliomyelitis, and how is it transmitted

Neurotropic enterovirus (EV71, EV68); fecal-oral spread

hallmark neurological manifestation of polio

Acute flaccid asymmetric paralysis, occurring after symptom-free days, typically proximal > distal, lower > upper

treatment for poliovirus

supportive

polio vaccine dose schedule

4 doses → 2mon, 4mon, 6-18mon, 4-6yrs

two precautions before administering IPV

pregnancy and afrebile acute illness

when are flue shots given

inactivated (IM) → 6 month and older

attenuated (nasal) → 24 months and older

flue vaccine dose schedule

after 6 months of age start annual and its 2 doses until >9 years old

How is influenza primarily transmitted

respiratory droplets

what causes mumps

paramyxovirus

Congenital rubella syndrome

1. deafness, 

2. cardiac abnormalities, 

3. growth restriction, 

4. ocular anomalies, 

5. cerebral disorders, 

6. hematologic disorders

what vaccine can cause morbilliform rash as adverse reaction

MMR

MMR vaccine schedule

2 doses → 12-15 mon, 4-6 yrs

describe the stages of chickenpox characteristic lesion

1. red macules and papules on face and trunk->

2. clear vesicles on erythematous base “dew drop on a rose petal” ->

3. pustules ->

4. crust

Where on the body does the chickenpox rash usually start

Face and trunk

Which of the following is a serious complication of varicella when aspirin is used

Reye syndrome

If the MMR and VAR vaccines are not given on the same day, how far apart should they be administered

28 days

meningococcal tx

• Vancomycin + ceftriaxone empirical 

• Penicillin G, cefotaxime or ceftriaxone IV x 7 days after confirmed 

meningococcal vaccine scehdule

2 dose series -> 11-12 years, 16 years

when should pt get 2 vs 3 dose series for HPV

less than 15 y/o → 2 dose

• 11 ys, then 6-12 months after

over 15 y/o → 3 doses

• 1st dose after 15

• 2nd after 1-2 mon

• 3rd after 6 months

What is a key precaution to reduce fainting after HPV vaccination

Keep the patient seated or lying down for 15 minutes after the shot

cause of roseola infection

human herpes virus 6

erythema infectiosum cause

parovirus B19

slapped cheeks

erythema infectiosum - parovirus B19