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Case Study: Jennifer and James Amy B. Middleman, MD, MSEd, MPH Assistant Professor, Department of Pediatrics, Adolescent Medicine Section, Baylor College of Medicine August 22, 2012
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Jennifer and James 12-year-old twins In your practice since birth The month is May and this is a routine visit Both are up to date on vaccines through age 5 years
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Jennifer Had a Tdap at age 10 years Experienced syncope with that vaccine She was evaluated in the emergency department and was released The twins’ grandmother lives with them Grandmother is receiving chemotherapy
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What Vaccines Does Jennifer Need? Jennifer has already received Tdap; it is licensed for one-time use only at this time MCV4 HPV #1 (HPV2 or HPV4) Confirm receipt of 2 doses of varicella and MMR vaccines; 3 doses of hepatitis B vaccine Consider hepatitis A vaccine
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Any Contraindications? Jennifer has no contraindications to vaccines Syncope is a known consequence of procedures involving needles that disproportionately affects adolescents Adolescents should be observed in a sitting or lying position for 15 minutes after injections Grandmother’s chemotherapy does not affect the administration of adolescent vaccines
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James No vaccines since age 5 years Diagnosed with Guillain-Barre syndrome (GBS) at age 8 years GBS secondary to Campylobacter infection The twins’ grandmother lives with them Grandmother is receiving chemotherapy
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What Vaccines Does James Need? Tdap MCV4 HPV #1 (HPV4 only) Confirm receipt of 2 doses of varicella and MMR vaccines; 3 doses of hepatitis B vaccine Consider hepatitis A vaccine
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Any Contraindications? James has no contraindications to vaccines History of GBS secondary to an infection is not a precaution to vaccination History of GBS secondary to a specific vaccine is a precaution associated with that vaccine James should receive all recommended vaccines (and should be observed for 15 minutes after administration)
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And, of course… Both pre-teens should have an appointment made for later in the fall to receive the influenza vaccine (as soon as supply becomes available)
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Provider Recommendation Strong provider recommendation has been shown to be key to parental acceptance It is critical to let parents know how safe and effective vaccines are Parents must know that the diseases we vaccinate against still exist and some are epidemic (e.g., pertussis) Please make a strong case for primary prevention of disease
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Vaccines Work Disease Pre-vaccine Era Estimated Annual Morbidity Most Recent Reports/Estimates of US Cases Percent Decrease Diphtheria21,0530100 H. Influenzae (invasive, < 5 yrs) 20,00024399 Hepatitis A117,33311,04991 Hepatitis B (acute)66,23211,26983 Measles530,21761>99 Mumps162,34498299 Pertussis200,75213,50693 Pneumococcal disease (invasive < 5 yrs) 16,0694,16774 Polio (paralytic)16,3160100 Rubella47,7454>99 Congenital rubella syndrome 152199 Smallpox29,0050100 Tetanus5801498 Varicella4,085,120449,36389 Adapted from Immunization Action Coalition, www.immunize.org/catg.d/p4037.pdf. Accessed Dec. 2010.
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Thank You!
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