1. TM Prepared for your next patient. Discussion of Changes to the 2013 Immunization Schedules H. Cody Meissner, MD Floating Hospital for Children Tufts University School of Medicine

2. TM Disclaimers  Statements and opinions expressed are those of the authors and not necessarily those of the American Academy of Pediatrics.  I have no relevant financial relationships with the manufacturers of any commercial products and/or providers of commercial services discussed in this presentation.  I do not intend to discuss an unapproved/investigative use of a commercial product/device in the presentation.

3. TM Licensed Vaccines in the United States Routine childhood use:  Diphtheria, tetanus, pertussis  Haemophilus influenzae type b  Hepatitis A  Hepatitis B  Human papillomavirus  Influenza  Measles, mumps, rubella  Meningococcal  Pneumococcal  Poliomyelitis  Rotavirus  Varicella Special settings :  Adenovirus  Anthrax  Herpes zoster (shingles)  Japanese encephalitis virus  Rabies  Typhoid  Vaccinia (smallpox)  Yellow fever

4. TM N OTE : The above recommendations must be read along with the footnotes on pages 6–8.

5. TM Pertussis Deaths in the United States, 2000-2009 Younger than 3 Months 3 Months and Older Total 17519194 (90%) (10%)

6. TM Tdap and Pregnancy  Administer Tdap during each pregnancy, irrespective of previous Tdap history.  Optimal timing for Tdap is between 27 and 36 weeks gestation to maximize antibody transfer.  For women not previously vaccinated with Tdap, if Tdap not administered during pregnancy, administer Tdap immediately postpartum.

7. TM Infant Meningococcal Vaccination  Infants at increased risk of meningococcal disease  Complement deficiency  Asplenia  Outbreaks due to vaccine serotype  Travel to endemic area  Infants not at increased risk of meningococcal disease  Vaccine not recommended for routine use

8. TM Thank You Boston Floating Hospital, circa 1920

9. TM For more information… On this topic and a host of other topics, visit www.pediatriccareonline.org. Pediatric Care Online is a convenient electronic resource for immediate expert help with virtually every pediatric clinical information need. Must-have resources are included in a comprehensive reference library and time-saving clinical tools. www.pediatriccareonline.org