Case Study: Jennifer and James

Amy B. Middleman, MD, MSEd, MPHAssistant Professor, Department of Pediatrics, Adolescent

Medicine Section, Baylor College of Medicine

August 22, 2012

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

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

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

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

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

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

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)

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)

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

Vaccines WorkDisease

Pre-vaccine Era Estimated Annual

Morbidity

Most Recent Reports/Estimates of US

Cases

Percent Decrease

Diphtheria 21,053 0 100

H. Influenzae (invasive, < 5 yrs)

20,000 243 99

Hepatitis A 117,333 11,049 91

Hepatitis B (acute) 66,232 11,269 83

Measles 530,217 61 >99

Mumps 162,344 982 99

Pertussis 200,752 13,506 93

Pneumococcal disease (invasive < 5 yrs)

16,069 4,167 74

Polio (paralytic) 16,316 0 100

Rubella 47,745 4 >99

Congenital rubella syndrome

152 1 99

Smallpox 29,005 0 100

Tetanus 580 14 98

Varicella 4,085,120 449,363 89

Adapted from Immunization Action Coalition, www.immunize.org/catg.d/p4037.pdf. Accessed Dec. 2010.

Thank You!