Transcript Immunizations - Pediatric Nursing

Immunizations
Childhood and Adolescent
Jan Bazner-Chandler
CPNP, MSN, CNS, RN
What Immunization Is
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Immunization is the process by which a subject is
rendered immune or resistant to a specific disease
Natural exposure – contact with the agent
Artificial exposure – parts of the infectious agent or
inactivated version is given for the purpose of becoming
immune to the disease agent it causes.
Childhood Immunization
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Childhood immunization schedule CDC
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www.CDC.gov/vaccines
Download children age 0 - 6
Download children age 7 - 18
American Academy of Pediatrics:
http://www.aap.org
Administering Immunizations
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Hand washing
Gloves NOT required (only if potential exposure to body
fluids from a lesion)
Proper equipment and means of needle disposal
Administering Immunizations
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1 or 3 mL syringe with 22-25 g needle
OSHA recommends needle safety device
Check expiration date
Document lot number on chart
Site:
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Thigh for infant less than 1 year
Upper outer triceps for greater than 1 year
Hepatitis B (HepB) Vaccine
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All infants should receive the first dose before
hospital discharge.
Second dose - 4 weeks after the first
Third dose - 16 weeks after the first dose and at least
8 weeks after the second dose
Infants born of HBsAg-postive mothers should
receive first immunization within 12 hours of birth as
well as HBIG.
Diphtheria, Tetanus, Acellular Pertussis
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DTaP
Given at 2, 4 and 6 months
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4th dose between 15 and 18 months
Last DTaP at the 4-6 year pre-K check up
1st Tdap at age 11-12 years or at least 5 years from last
DTap
Tetanus every 10 years after that
Diphtheria
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Called “strangling angel of children”
One of the most common causes of death among
children pre-vaccine era
Vaccine developed in 1920’
Tetanus
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Acute illness characterized by an acute onset of
hypertonia, painful muscular contraction (muscles of jaw
and neck, and generalized muscle spasms
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Clostridium tetani is found in soil, house dust, animal
intestines and human feces
Vaccine developed in 1924
Very few reported cases
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Pertussis
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Highly contagious disease involving the lungs and airways.
Caused by Bordetella pertussis found in nose, mouth and
throat of the infected person.
Overall increase in recent years in adolescents and adults.
Cocooning
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New term for 2010
Strategy to protect the newborn up to 6 month old from
pertussis or “whooping cough”
Booster available for adults Tdap
The goal to immunize all adults who interact with infants
to prevent pertussis
Polio
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Injection form given at 2 months, 4 months after 6
months and at kindergarten check-up
Oral not given due to shedding virus in stool
Incidence of polio
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WHO - 650 cases report
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Nigeria
Pakistan
Afghanistan
China
Haemophilus Influenza Type b
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Hib
Given at ages 2 and 4 months and 12 months
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Any child entering child care or pre-kindergarten under age 5
years in California are required to have Hib.
Not a standard immunization for children born outside the
USA
Why?
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Haemophilus influenzae type B (Hib) disease is a serious
disease caused by bacteria. It usually strikes children
under 5 years of age.
Leading cause of bacterial meningitis in children under 5
years
Pneumonia
Epiglottitis – severe swelling of epiglottis – resulting in
death for obstruction of breathing
Before Hib immunization 20,000 children per year had
the infectious disease with 1000 deaths per year.
Incidence
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Increase incidence in England, Wales and Pacific Islands
Measles, Mumps, Rubella
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MMR
Two doses:
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1st 12 months or older
2nd dose kindergarten visit
If no record of second dose it should be given at 11 to 12
year old visit
May develop a rash a week to ten days after immunization
Not immunized against wild strain – exposure would bring
milder case
Incidence of Measles
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Outbreak in LA in 2011
Contact point airplane
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12 month old who had not received the immunization yet
19 month un-immunized
220 cases in 2011 all of the results of US citizens returning
from international travel
New recommendation: if infant is traveling international MMR
is give as early as 9 months with a booster after 12 months
Mumps outbreak
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2010 in New York 1500 Orthodox Jews over had case of
mumps during a 7 month period.
One un-immunized child at camp from England spread the
disease.
Why a problem?
Complications
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Hearing loss
Testicle swelling - infertility
Varicella
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Chicken pox – recommended at 12 – 15 months and
second dose at 4-6 years or kindergarten visit
Un-immunized children over 13 years would receive two
doses at least 4 weeks apart
Varicella
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Contraindication: allergy to immunization, pregnancy or
possibility of pregnancy within 4 wks
Children on high dose immunosuppressive therapy or
immuno-compromised HIV / AIDS – vaccination can be
given if CD4 T-lymphocyte percentages or 15% or greater.
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Precautions:
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if blood, plasma or immune globulin given within the past 11
months.
Antiviral drugs 24 hours before or 14 days after immunization
Chicken Pox Parties
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Fact or fiction?
Shingles
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Varicella virus dormant in nerve roots
Shingles rash appears on one side of the face or body and
lasts from 2 to 4 weeks
Only someone who has had chickenpox can get shingles.
The virus stays in your body and can cause shingles many
years later.
New recommendation: a single dose of singles vaccine is
recommended for adults 60 years of age and older.
Pneumococcal Vaccine
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PCV - Prevnar
Recommended for all children 2 to 23 months and
certain populations up to 59 months
2, 4, 6 and 4th dose after 12 months of age
High risk populations
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Asthma
Sickle cell anemia
Cystic fibrosis
Human Papillomavirus
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HPV is the most common sexually transmitted virus
40 types of HPV
Spread through sexual contact
Can cause cervical cancer
Can also cause genital warts
Human Papillomavirus
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HPV series
Recommended for all girls 11-12 years
Can be given as young as 9 years
Get HPV before first sexual contact and by 26 years of
age
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1st dose
2nd dose 2 months after 1st dose
3rd dose 6 months after dose one
HPV
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Contraindications:
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Allergy to yeast or reaction to first immunization
HPV will not help if already infected
HPV - males
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Gardasil will protect males against genital warts.
Meningococcal meningitis
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Meningococcal disease is a serious illness
Leading cause of bacterial meningitis in 2 – 28 year old in
USA
Also called Neisseria meningtides
High risk populations
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High school students
College age students
Military – boot camp
Travel to third-world countries
Meningococcal polysaccharide Vaccine
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MPSV4
Prevents 4 types of meningococcal diseases – 2 out of 3
of the most common strains seen in the US
Recommendations
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MPSV4 recommended for all children at their routine
preadolescent visit (11 – 12 years)
College freshmen living in dorms
U.S. military recruits
Traveling to Africa
Persons exposed to meningitis outbreak
Influenza (Flu) Vaccine
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“Flu shot”: Inactivated vaccine containing the virus
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Approved for infants older than 6 months
Nasal spray flu vaccine: live, weakened flu viruses
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Approved for children over 5 years to 49 years.
When to get Flu Vaccination?
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October or November yearly
Contraindications to Flu Vaccine
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Children with severe allergy to chicken eggs.
Severe reaction to influenza vaccination in the past.
Less than 6 months of age.
Children who have developed Guillain-Barre
syndrome after previous immunization.
Do not give if child has moderate to severe illness
with fever until a later date.
Rotavirus
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Rotavirus causes severe diarrhea
Rotarix (RV1) or RotaTeq (RV5) given at 2, 4 and 6
months
First dose may be given as early as 6 weeks
Give final dose no later than 8 months of age
Contraindications: allergy to previous immunization or
allergy to latex (use RV5)
Precaution: moderate or severe illness, moderate to
severe acute gastroenteritis or pre-existing
gastrointestinal disease or history of Intussusception
Rotovirus
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Leading cause of severe acute gastroenteritis among
children worldwide.
527,00 deaths worldwide
85% in Africa and Asia
2 million hospitalized with severe dehydration
Premature Infants
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AAP currently recommends that all premature infants
receive full dose immunizations at the same
chronologic age as term infants even if hospitalized
Contraindications : significant febrile seizure, active
seizure disorders, encephalopathy
Infants with BPD (Bronchopulmonary dysplasia) or
RAD (Reactive Airway Disease) should receive
influenza immunizations
Infants with congenital heart and premature infants
immunization against Respiratory Syncytial Virus or
RSV.
Premature continued
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Hepatitis B may be deferred until discharge unless mother
is Hep B positive
Do NOT dilute dosages
Usually given when they reach at least 2 kg or 4.4 pounds
To Immunize or Not to Immunize
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Children on antibiotics
Children with minor illness – otitis, cough, diarrhea, sore
throat, low grade fever
Children with mild allergies
Breast feeding infants
Children with pregnant household contacts
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All can and should be immunized
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True Contraindications to immunization
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True allergic response
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Rash or hives after previous vaccination
Allergy to eggs or egg products should not be given influenza
vaccination
Reactions to Immunizations
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Fever greater than 103, shock or collapse, or inconsolable
crying for greater than 3 hours. (DTaP)
Low grade fever, fussiness, and soreness at injection site
are not reasons to prevent further vaccinations
Mild rash or fever may occur 10 days to 2 weeks after
MMR or Varicella
Interventions post immunization
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Tylenol every 4 hours for fussiness or low grade fever
Warm bath
NO ASPIRIN
NO Motrin for infants under 6 months of age
AAP recommends Tylenol for all ages due to confusion in
dosing.
Adolescents
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Hepatitis A (recommended only)
Pneumococcal if they have any chronic disease: heart, sickle
cell disease, cystic fibrosis, diabetes, or organ transplant or
receiving chemotherapy
Hepatitis B
MMR: second booster
D Tap
Varicella if no reliable history or negative titers
Meningococcemia for all college freshman and all military
Influenza yearly
Hepatitis A
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Recommended for children and adolescents living in
selected states or regions and for certain high risk groups
This would include California, Texas, and Arizona
2 doses 6 months apart
L.A. Unified Recommendations
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Complete health and immunization record
All new students must have written results of a PPD
test for tuberculosis within 12 months
If PPD is positive a chest x-ray is recommended
Treatment is recommended unless the child has some
immune suppressed condition.
PPD Waiver
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I hear by request exemption of the child from the
tuberculosis assessment requirement for school /
childcare entry because this is contrary to my beliefs. I
understand that should there be cause to believe that my
child is infected with active TB or should there be a
tuberculosis outbreak, my child may be temporarily
excluded from school.
Pre-school and Child Care
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Pre-kindergarteners must be immunized against
Haemophilus influenza type B or Hib.
This is not a standard immunization for children born
outside the United States
Hib would not be required for a child over 5 years of age.
Kindergarten
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Second MMR: Measles, Mumps, Rubella
Hepatitis B
Hepatitis A in high risk areas
D Tap: tetanus, diphtheria, pertussis
Communicable Diseases
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Chicken pox (varicella)
Measles (Rubeola)
Pertussis (Whooping Cough)
Rubella (German Measles)
Scarlet Fever
Mumps
Varicella
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Agent: varicella zoster virus
Incubation: 10 – 14 days
Transmission: respiratory
Period of communicability: 2 days before eruption of
vesicles until lesions crusted.
Prodromal phase: slight fever, malaise, pruritic rash;
macular to papular to vesicular.
Varicella
Varicella
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Communicability: children who have “chicken-pox” are
infectious for two days before the vesicles erupt until all
vesicles are crusted over (about 5 days).
Management of Varicella
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Isolation
Skin care: tepid bath, calamine lotion, clip finger nails.
Keep from scratching
Antihistamines for itching - Benadryl
No ASA (salicylate containing products) – acetaminophen
only.
Varicella vaccine now available.
Reyes Syndrome
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Almost always preceded by a viral illness, URI, Flu,
chickenpox
Linked to the use of aspirin or aspirin containing
medications (salicylates)
Assessment
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Persistent vomiting
Lethargy or sleepiness
Confusion, irrational or combative behavior
Seizures to coma
Measles or Rubeola
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Agent:Virus
Transmission: respiratory, blood and urine
Incubation period: 10 to 20 days
Period of Communicability: 4 days before and 5 days after
rash appears.
Prodromal stage: fever, cough, conjunctivitis, Koplik spots.
Blotchy rash starts on forehead
Measles Conjunctivitis
Koplik’s Spots on Palate
Rubella or German Measles
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Agent: Rubella virus
Source: nasopharyngeal secretions; secretions in blood,
stool, and urine.
Transmission: direct contact.
Incubation period: 14 to 21 days
Period of communicability: 7 days before to 5 days after
appearance of rash.
Rubella
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Rash first appears on face and rapidly spreads downward
Isolate from pregnant women
TORCH – affects fetus
Mumps
In mumps the parotid
glands swell and obscure
the angle of the jaw.
Mumps
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Disease caused by a virus that spreads through saliva
and infects many parts of the body especially the
parotid salivary gland.
Incidence has decreased to about 1,000 per year.
Two potential complications: encephalitis and orchitis
(inflammation of testicle)
Pertussis (Whooping Cough)
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Agent: Bordetella Pertussis
Source: Respiratory
Transmission: droplet spread or contact with
contaminated article.
Incubation period: 10 days
Period of communicability: before onset of paroxysms to
4 weeks after onset.
Interventions
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Erythromycin for the child and all contacts
Very dangerous for the neonate – most often the contact
is an adult with a chronic cough
May led to hospital admission – ventilator assist
Fifth Disease
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Fifth disease is a mild childhood illness caused by the
human parvovirus B19 that causes flu-like symptoms
and a rash. It is called fifth disease because it was fifth
on a list of common childhood illnesses that are
accompanied by a rash, including measles, rubella
(or German measles), scarlet fever (or scarlatina),
and scarlatinella, a variant of scarlet fever.
Fifth Disease
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Primarily seen in school-age children between ages 5 and
14 years.
Causes a reddish rash on the child’s face that looks as if
the child has been slapped.
Fifth Disease Symptoms
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Starts as a vague illness.
Fever, nasal congestion, sore throat, fatigue, muscle aches
and headache.
7-10 days later the facial rash appears (slapped cheeks
rash).
Light pink rash on arms and spreads to the trunk in a
lacelike pattern.
Fifths Disease