1. CHILDHOOD IMMUNIZATIONS
Virginia Keane, MD
Associate Professor, Pediatrics
University of Maryland School of Medicine

2. Shots Hurt! Why Do We Have To Give Them?
Vaccines work!
Vaccines are THE most effective preventive measure that modern medicine has derived

3. Vaccine Effect on Morbidity
Disease
Baseline morbidity
1998 morbidity
% decrease
smallpox
48,164
100
diptheria
175,885 1
pertussis
147,241
7405 95
tetanus
1314 41 97
polio
16,316
measles
503,282
mumps
152,209
666
>99
rubella
47,745
364
Congenital rub.
823 7
Hemophilus B
20,000 61

4. 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

5. 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!!

6. Germs Are Antigens
The proteins and sugars on the walls of viruses and bacteria are FOREIGN
Your body makes antibodies to fight them off

7. 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

8. 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

9. Vaccine Preventable Diseases
Killed Vaccines: Diptheria, Pertussis, Tetanus, Hepatitis B, Polio
Live Attenuated: Measles, Mumps, Rubella, Varicella, Polio
Conjugated: HIB, PCV

10. Diptheria Bacterial: Corynebacterium diptheriae Person to person
Severe throat infections, can obstruct breathing
Myocarditis can be fatal

11. 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

12. 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

13. 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)

14. 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

15. 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

16. Varicella Viral, herpes family “chicken pox”
Usually mild, self limited :fever, rash
Can get pneumonia, cerebellitis, encephalitis, even death

17. Measles
Viral disease, rapid person to person to person transmission among susceptibles
High fever, red eyes, rash, misery
Outbreak in due to large number of unvaccinated kids

18. Mumps
Viral disease characterized by fever and swelling of saliva glands
Orchitis common, sterility rare
Sporadic cases and outbreaks still occur

19. Rubella Viral, humans only “German Measles”
Low grade fever, joint pains, swollen glands, rash
Congenital rubella: mental retardation, cataracts, heart deformities

20. 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

21. 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)

22. Vaccine Schedule Age 1982 2002 birth HepB, BCG 1 month HepB 2 months
DTP,OPV
DTaP,IPV, HIB, PCV
4 months
6-9 months
DTP
DTaP, HIB, PCV
12-15 months
MMR
MMR,HepB, HIB, IPV,PCV
15-18
DTaP, Varicella
4 years
MMR, DTaP
total
7 diseases, 6 shots
11 diseases, 22 shots

23. Vaccines in Use HIB Hemophilus 2,4,6,12 mos Local,fever Vaccine
Diseases
Schedule
Adverse effects
DTaP
Diptheria, Tetanus, Pertussis
2,4,6, 15 mos
4 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
HIB
Hemophilus
2,4,6,12 mos
Local,fever

24. 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
2 drops
Oral
Hepatitis B
0 – 6 – 8 weeks
intramuscular
Measles
9 months
Subcutaneous

25. Adolescent Vaccines
Td: Tetanus, Diptheria booster: given at 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

26. Vaccine Rates
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