Transcript Immunizations

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
American Academy of Pediatrics
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http://www.cispimmunize.org/
Download children age 0 - 6
Download children age 7 - 18
Hepatitis B (HepB) Vaccine
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All infants should receive the first dose soon
after birth or before hospital discharge.
Second dose should be given at least 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
Every 10 years after that
Polio
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Injection form at 2 months, 4 months
after 6 months and at kindergarten
check-up
Oral not given due to shedding in
stool.
Haemophilus Influenza Type b
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Hib
Given at ages 2 and 4 months
Last dose at 12 months
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Any child entering child care or prekindergarten under age 5 years would be
required to have Hib.
Not a standard immunization for children
born outside the USA
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
Varicella
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Chicken pox – recommended at 12
months and second dose at 4-6 years
or kindergarden visit
Susceptible children over 13 years
would receive two doses at least 4
weeks apart
Pneumococcal Vaccine
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PCV - Prevnar
Recommended for all children 2 to 23
months and certain populations up to 59
months
Asthma
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Sickle cell anemia
Cystic fibrosis
2, 4, 6 and 4th dose after 12 months of age
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
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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
Meningococcal
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Meningococcal disease is a serious
illness
Leading cause of bacterial meningitis
in 2 – 28 year old in USA
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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MCV4 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.
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 include: significant febrile
seizure, active seizure disorders,
encephalopathy (DTaP)
Infants with BPD or RAD should receive
influenza immunizations
Infants with congenital heart and premature
infants immunization against RSV.
Premature continued
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Hepatitis B may be deferred until
discharge unless mother is Hep B
positive
OPV should not be given in NICU
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
True Contraindications
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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
Allergic to streptomycin should not be
given IPV or 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
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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
Live Vaccines
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MMR and Varicella
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Pregnancy
HIV +
Immunodeficiency
Chemotherapy: not given until 6 months
after treatment is completed.
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 Manoux test is positive a chest x-ray is
required
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.
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 – acetaminophen only.
Varicella vaccine now available.
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.
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
Scarlet Fever
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Caused by group A Streptococcus
Rash is usually seen in children under age 18
years.
Rash appears on chest and abdomen – feels rough
like a piece of sandpaper
Redder in the arm pits and groin area.
Rash lasts 2-5 days
After rash disappears fingers and toes begin to peel
Face is flushed with a pale area around the lips.
Scarlet Fever
Management of Scarlet Fever
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Respiratory precautions for 24 hours.
Oral antibiotic for 10 days.
Treat sore throat with analgesics,
gargles, lozenges, and antiseptic
throat spray.
Encourage fluids.
See health care provider if fever
persists.
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