1. Meg Fisher, MD Medical Director, The Children’s Hospital
Vaccine Preventable Diseases and the Healthcare Provider
Meg Fisher, MD
Medical Director,
The Children’s Hospital
Monmouth Medical Center
An affiliate of the Saint Barnabas Health Care System
Long Branch, NJ

2. I will be mentioning off label uses of vaccines.
Disclosures
I have no disclosures.
I will be mentioning off label uses of vaccines.

3. List and discuss vaccines needed to prevent these diseases
Objectives
Describe the vaccine preventable diseases that relate to the healthcare provider in the acute care setting
List and discuss vaccines needed to prevent these diseases

4. Immunization Public health success story
Rates of all vaccine preventable illnesses have plummeted:
Smallpox, diphtheria, tetanus, polio, measles, mumps, rubella, Haemophilus influenzae type b almost gone in the US

5. Infection is just a plane ride away!
Immunization Rates
Don’t get complacent!
Infection is just a plane ride away!

6. Identify these infections
Test your knowledge
Identify these infections

7. Courtesy of the American Academy of Pediatrics
and the Centers for Disease Control and Prevention

8. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

9. Courtesy of his mother

10. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

11. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

12. Courtesy of eMedicine and ADAM

13. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

14. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

15. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

16. Centers for Disease Control and Prevention
Courtesy of the
Centers for Disease Control and Prevention

17. Courtesy of the WHO and the Centers for Disease Control and Prevention

18. Courtesy of PA AAP

19. Courtesy of the WHO and the Centers for Disease Control and Prevention

20. Courtesy of the
Centers for Disease Control and Prevention

21. Vaccine Preventable Diseases
Hepatitis B, rotavirus, diphtheria, tetanus, pertussis, polio, Haemophilus influenzae type b, Streptococcus pneumoniae, influenza, measles, mumps, rubella, varicella, hepatitis A, Neisseria meningitidis, human papillomavirus

22. Shortages? Major dilemma for practitioners
Distribution always a problem
Web site for vaccine shortages:
None currently

23. Vaccine Safety www.cdc.gov/vaccinesafety
Concerns are limiting vaccine use
Rates in New Jersey have fallen dramatically

24. Immunization Safety Starts during development
Continues through all stages of licensure and during postlicensure use
Vaccine adverse event reporting system
Vaccine safety datalink
Clinical immunization safety assessment

25. National Vaccine Injury Compensation Program
Established by National Childhood Vaccine Injury Act
No fault compensation program
Report suspected adverse events to VAERS

26. Advisory Committee on Immunization Practices
Provides advice for CDC
Multidisciplinary panel with many liaisons
Pediatricians well represented

28. Hepatitis B vaccine All providers with blood exposure
Three doses: 0, 1, 6 mo
Titers to prove response to vaccine
If < 10 mIU/ml, repeat series and titer
Older less likely to respond

29. Exposure to HBsAg + Blood
Immune: education re preventing exposures
Non-responder or not immunized: HBIG plus education re preventing exposures
Immunized but not tested: test and give HBIG if negative

30. Hepatitis B Vaccine New dilemma:
Adolescents immunized as children may have low or no antibody levels at entry to college, nursing schools, medical schools
Consider giving one dose and repeat titer
If negative, finish the series and repeat titer

31. “I had a little bird. His name was Enza. I opened the window.
And in flew Enza.”
A chant popular during the influenza pandemic of 1918

32. Recommendations All people 6 months of age and older
Healthcare personnel: mandates recommended by IDSA, PIDS, AAP and others
Formulated yearly on best guess
Two A strains, one B
Start when you get it and continue all season

33. Influenza Vaccines A/California/7/2009 (H1N1)-like
A/Perth/16/2009 (H3N2)-like
B/Brisbane/60/2008-like
Inactivated, live cold adapted

34. Influenza Vaccine Schedule
Yearly – start when you get it
Children under 3 years: lower dose
Child under 9: two doses first season*
Contraindicated in persons with anaphylaxis to chicken or eggs

35. Measles, Mumps, Rubella
Measles and rubella no longer endemic in the United States
Mumps outbreak over in NJ
MMRV combination – more fever
We should be immune: born before 1957, + titer or received 2 doses of vaccine

36. Varicella Vaccine Prevents serious illness Outbreaks persist
Second dose now recommended for all
Routine at 4-5 years, MMRV
Catch up for older

37. Zoster vaccine Zostavax Approved May 2006
Age 60 and above; now 50 and above
Protect yourself when the time comes

38. Tdap: Boostrix, Adacel Tetanus, diphtheria, pertussis booster
For teens (both) and adults (Adacel)
Licensed in spring 2005
Should alter epidemiology and protect infants
Protect yourself and your staff

39. Targeted adults Anyone caring for young infants
Cocoon the infants by immunizing contacts
Healthcare people
Pregnant women in late 2nd, 3rd trimester
Give to the entire household, preferably before delivery

40. Latest from ACIP Off label use of the vaccine:
Use Tdap for incompletely vaccinated children down to age 7 years
Use Tdap in adults over 65 years
Pregnant women in the 2nd or 3rd trimester
Tdap at any interval following T or Td

41. Meningococcal vaccines
Polysaccharide vaccine rarely used today
Conjugate vaccines originally recommended: Adolescents age yr (pre-teen visit) Adolescents age 15 yr (high school entry) Incoming college freshmen in dorms High risk groups

42. Latest Recommendations
Booster dose for adolescents: age 16 or years after the first dose
Highest risk: initial 2 dose series followed by booster doses every 5 years
At risk healthcare: microbiologists only

43. Rotavirus vaccines The old: Rotashield Rhesus rotavirus reassortant
Licensed 8/98
Withdrawn 10/99
Intussusception risk < 1/10,000

44. Rotavirus vaccines The new: RotaTeq, Rotarix
RotaTeq: human-bovine reassortant
Well tolerated, effective, over 70,000
Licensed February 2006
Rotarix: monovalent, human strain
Licensed and used outside US

45. Safety Issues Porcine circoviruses: no harm
Rates of intussusception among vaccine recipients closely studied; post-licensure studies results vary
Benefits greatly outweigh risks

46. Haemophilus influenzae type b
Disease dramatically decreased in US
Conjugate vaccine eliminates carriage
Keep vaccinating!

47. Streptococcus pneumoniae
Dramatic decrease in US since PCV7
Decrease in adult disease as well
PCV13 now replaces PCV7
Polysaccharide vaccine PPSV23 for high risk children and adults

48. Polio Virus Vaccine Polio eliminated from most of the world
But in 2010 spread to over a dozen countries
Live oral: not in US since 2000, source of some recent outbreaks
Inactivated: safe effective, 4 dose series, last/extra dose at 4 to 6 years

49. Hepatitis A Vaccines Inactivated Two doses, 6 months apart
Prior to 2006: at risk or in high incidence state
Now: at risk and all children at age 1
Catch up is reasonable

50. HPV Vaccines Virus-like particles genetically engineered
Quadravalent and bivalent vaccines
Well tolerated and immunogenic
Three dose series
Universal for girls; permissive for boys

51. Websites www.aap.org www.cdc.gov www.immunizationinfo.org

53. Smiling is a contagious condition!