IMMUNIZATIOIMMUNIZATIONSNS

WOMEN-PREGNANCY WOMEN-PREGNANCY BEFORE/DURING AND AFTERBEFORE/DURING AND AFTER

HEPATITIS B VACCINEHEPATITIS B VACCINETdap VACCINETdap VACCINE

OBJECTIVESOBJECTIVES Describe immunizations for pre-Describe immunizations for pre-

pregnancy, pregnancy and pregnancy, pregnancy and postpartum womenpostpartum women

Discuss the importance of Hepatitis Discuss the importance of Hepatitis B vaccine for women and infantsB vaccine for women and infants

Describe cocooning and the Describe cocooning and the importance of ensuring Tdap vaccineimportance of ensuring Tdap vaccine

PRE-PREGNANCY PRE-PREGNANCY IMMUNESIMMUNES

ANY IMMUNATIONS PRIOR TO ANY IMMUNATIONS PRIOR TO PREGNANCY ARE PREGNANCY ARE RECOMMENDED.RECOMMENDED.

THIS INCLUDES ALL THIS INCLUDES ALL CHILDHOOD AND CHILDHOOD AND ADOLESCENTS ADOLESCENTS IMMUNIZATIONS.IMMUNIZATIONS.

IMPORTANT!!!!IMPORTANT!!!!

THIS IS EVERYONE’S JOBTHIS IS EVERYONE’S JOB

IF THEY ARE BEHIND IF THEY ARE BEHIND

IMMUNIZE!!!!IMMUNIZE!!!!

PREGNANCY IMMUNESPREGNANCY IMMUNES

FLU VACCINESFLU VACCINES TdAPTdAP

TETANUSTETANUS

Infection caused by Clostridium Infection caused by Clostridium Tetani. Found in soil, dust, and Tetani. Found in soil, dust, and animal feces.animal feces.

Enters in body by puncture wounds, Enters in body by puncture wounds, splinters, insect bites, burns etc.splinters, insect bites, burns etc.

Causes uncontrollable muscle Causes uncontrollable muscle spasms, Bacteria binds to motor spasms, Bacteria binds to motor nerve, spinal cord and brain stem nerve, spinal cord and brain stem leading to leading to lock jaw, coma and lock jaw, coma and DEATH!!!DEATH!!!

VACCINE IN 1948VACCINE IN 1948

WHO CARES?WHO CARES?

Annually worldwide there is Annually worldwide there is 1 million cases of tetanus. 1 million cases of tetanus. The majority is infants.The majority is infants.

Most infants In 2000, WHO Most infants In 2000, WHO estimated that tetanus killed estimated that tetanus killed 200,000 babies200,000 babies

who get tetanus will who get tetanus will DIE!DIE!

TETANUS VACCINETETANUS VACCINE

Vaccine given to infants at 2 months, Vaccine given to infants at 2 months, 4 months, and 6 months. 4 months, and 6 months.

Children get a booster at 4 or 5 years Children get a booster at 4 or 5 years of age prior to school. It is the LAW.of age prior to school. It is the LAW.

Additional booster given at age 12. Additional booster given at age 12. This should be a Tdap. This should be a Tdap.

Continued boosters every 10 years or Continued boosters every 10 years or every 5 year if puncture wound/burn every 5 year if puncture wound/burn

THINGS TO REMEMBERTHINGS TO REMEMBER

An immune mother passes antibodies An immune mother passes antibodies thru her placenta to her babythru her placenta to her baby

If a pregnant mothers tetanus immune If a pregnant mothers tetanus immune states is unknown, uncertain or more states is unknown, uncertain or more than 10 yearsthan 10 years VACCINATE! VACCINATE! VACCINATE!VACCINATE!

Tdap is NOT contraindicated in Tdap is NOT contraindicated in pregnancy. Preferred to vaccinate in pregnancy. Preferred to vaccinate in 22ndnd and 3 and 3rdrd trimester BUT VACCINATE! trimester BUT VACCINATE!

INFLUENZAINFLUENZA

Influenza, commonly referred to as the flu, is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses)

Influenza is transmitted through the air by coughs or sneezes, creating aerosols containing the virus.

A single sneeze releases up to 40,000 droplets of virus.

INFLUENZAINFLUENZA

Influenza is associated with thousands a Influenza is associated with thousands a death a year. Ranging from 3,349 in 1986-death a year. Ranging from 3,349 in 1986-1987, and 48,614 in 2003-2004 flu season1987, and 48,614 in 2003-2004 flu season

It is estimated 20,000 children under the It is estimated 20,000 children under the age of 5 are hospitalized annual due to age of 5 are hospitalized annual due to influenzainfluenza

DEATHS in children in 2009 H1N1 were 345DEATHS in children in 2009 H1N1 were 345 DEATHS in children in 2010-2011 were 153 DEATHS in children in 2010-2011 were 153

for seasonal influenzafor seasonal influenza

INFLUENZA VACCINEINFLUENZA VACCINE

Single dosage every flu seasonSingle dosage every flu season Approved for children 6 months and Approved for children 6 months and

older.older. Only contraindicated if allergic to eggsOnly contraindicated if allergic to eggs Do not give attenuated (live) dose to Do not give attenuated (live) dose to

pregnant women or asthmatics pregnant women or asthmatics GIVE TO ALL household members, GIVE TO ALL household members,

people in contact with pregnant women people in contact with pregnant women or infants or infants

POSTPARTUM WOMENPOSTPARTUM WOMEN

MMR?MMR? VARICELLA?VARICELLA? TdAP?TdAP?

MEASLES, MUMPS + MEASLES, MUMPS + RUBELLA oh my!!RUBELLA oh my!!

All 3 diseases are very All 3 diseases are very contagiouscontagious

Transmitted thru cough, sneeze Transmitted thru cough, sneeze or touchor touch

First measles vaccine in 1963. First measles vaccine in 1963. 3 out of every 1,000 children who get 3 out of every 1,000 children who get

measles dies in the United States. measles dies in the United States. (NNii, 2010)(NNii, 2010)

Death is more common in infantsDeath is more common in infants

MEASLESMEASLES

Symptoms begin 8-12 days after exposureSymptoms begin 8-12 days after exposure Presents as a cold with cough, sneeze, Presents as a cold with cough, sneeze,

runny nose and pink eye. runny nose and pink eye. May have white spots on tongue (May have white spots on tongue (Koplik’s Koplik’s

sign)sign) May have more serious infections like May have more serious infections like

ear, pneumonia, croup or diarrhea. May ear, pneumonia, croup or diarrhea. May cause encephalitis. May result in cause encephalitis. May result in permanent brain damage. permanent brain damage.

COMPLICATIONSCOMPLICATIONS

PancreatitisPancreatitis Sensorineural hearing lossSensorineural hearing loss Encephalitis (rare only 1%)Encephalitis (rare only 1%) MeningitisMeningitis Spontaneous abortion (27%) in 1Spontaneous abortion (27%) in 1stst

trimestertrimester Testicular infectionsTesticular infections

RUBELLARUBELLA RubellaRubella, (German measles), was also very common before , (German measles), was also very common before

vaccination. vaccination.

Rubella may begin with 1-2 days of mild Rubella may begin with 1-2 days of mild feverfever, mild and , mild and tender lymph nodes, usually in the back of the neck or tender lymph nodes, usually in the back of the neck or ears. A rash will begin on the face and spreads downward. ears. A rash will begin on the face and spreads downward. Rash maybe pink or light red spots. Rash maybe pink or light red spots.

Other symptoms include loss of appetite, mild Other symptoms include loss of appetite, mild conjunctivitis, a stuffy or runny nose, swollen lymph nodes conjunctivitis, a stuffy or runny nose, swollen lymph nodes in other parts of the body, and pain and swelling in the in other parts of the body, and pain and swelling in the joints joints

VERY DANGEROUS in a pregnant woman. Causes growth VERY DANGEROUS in a pregnant woman. Causes growth retardation; mental retardation; malformations of the retardation; mental retardation; malformations of the heart and eyes; deafness; and liver, spleen, and bone heart and eyes; deafness; and liver, spleen, and bone marrow problems.marrow problems.

Rubella EpidemiolgyRubella Epidemiolgy

Peaks in the springtimePeaks in the springtime Outbreaks before 1969 came in cycles: Outbreaks before 1969 came in cycles:

United States every 6-9 years, Europe United States every 6-9 years, Europe every 3-5 yearsevery 3-5 years

Usual child age 5-9 yearsUsual child age 5-9 years Last epidemic in the U.S. was 1962-Last epidemic in the U.S. was 1962-

19651965

Caused 30,000 still births and 20,000 Caused 30,000 still births and 20,000 birth defects due to congenital rubella birth defects due to congenital rubella

PREVENTIONPREVENTION

ONLY way to prevent is to ONLY way to prevent is to VACCINATE!!!VACCINATE!!!

Vaccines are now combined Vaccines are now combined in the MMRin the MMR

Given IM at 12-15months of Given IM at 12-15months of age and then second dose at age and then second dose at 4-6 years of age4-6 years of age

VARICELLAVARICELLA

CHICKENPOXCHICKENPOX

Caused by varicella-zoster virusCaused by varicella-zoster virus Highly contagiousHighly contagious Symptoms may include low Symptoms may include low

grade fever, abdominal pain, grade fever, abdominal pain, itchy rash, headache, malaise, itchy rash, headache, malaise, cough, loss of appetite and sore cough, loss of appetite and sore throatthroat

VACCINATIONVACCINATION

Vaccine can be given alone or Vaccine can be given alone or in combination with MMR. in combination with MMR. Called an MMRVCalled an MMRV

Vaccine available in 1995Vaccine available in 1995 Vaccine given at 12-15 months Vaccine given at 12-15 months

of ageof age Second vaccine given at 4-6 Second vaccine given at 4-6

years of ageyears of age

? WHY VACCINATE?? WHY VACCINATE?

Prior to vaccination 4 million Prior to vaccination 4 million children got chickenpox a children got chickenpox a yearyear

Caused 100 deaths a yearCaused 100 deaths a year Costs 400 million dollars in Costs 400 million dollars in

medical costs and lost wages medical costs and lost wages for parents annuallyfor parents annually

HEPATITIS HEPATITIS HEPATITIS IS A VIRUS. Can be either HEPATITIS IS A VIRUS. Can be either

acute or chronic. acute or chronic. In 2005, about 51,000 people became In 2005, about 51,000 people became

infected with hepatitis B infected with hepatitis B (CDC, 2007)(CDC, 2007)

About 1.25 million people in the United About 1.25 million people in the United States have chronic HBV States have chronic HBV (CDC, 2007)(CDC, 2007)

Approximately 3,000-5,000 Americans Approximately 3,000-5,000 Americans die from diseases caused by Hepatitis B die from diseases caused by Hepatitis B a year a year (CDC, 2007)(CDC, 2007)

Generally considered an adult disease Generally considered an adult disease for years due to sexual transmission or for years due to sexual transmission or IV drug usageIV drug usage

HEPATITIS + HEPATITIS + BABIESBABIES Approximately 90% of infants who Approximately 90% of infants who

acquire Hepatitis B infection at birth acquire Hepatitis B infection at birth go on to become chronic carriers. go on to become chronic carriers. (Tran, 2009)(Tran, 2009)

Estimated 15-25% of these carries Estimated 15-25% of these carries will die of liver failure secondary to will die of liver failure secondary to chronic hepatitis, cirrhosis or liver chronic hepatitis, cirrhosis or liver cancer.cancer.

HEPATITIS B VACCINEHEPATITIS B VACCINE

First Dose should be given to:First Dose should be given to: All newborns. If mom is infected All newborns. If mom is infected

with hepatitis baby also needs with hepatitis baby also needs hepatitis B immune globulin. MUST hepatitis B immune globulin. MUST be within 12 hours of birth. be within 12 hours of birth.

Older children, adolescents, or Older children, adolescents, or adults at any time. Vaccine is now adults at any time. Vaccine is now preferred to be given by age 11 or preferred to be given by age 11 or 12. 12.

VaccineVaccine

Second Dose:Second Dose: Child of an infected mother: between Child of an infected mother: between

one and two months of age (at least one and two months of age (at least one month after the first dose) one month after the first dose)

Child of an uninfected mother: Child of an uninfected mother: between one and four months of age between one and four months of age (at least one month after the (at least one month after the first dose) first dose)

Older child, adolescent or adult: one Older child, adolescent or adult: one to two months after first dose to two months after first dose

VaccineVaccine

Third Dose:Third Dose: Child of an infected mother: at six Child of an infected mother: at six

months of age (at least two months months of age (at least two months after the second dose, and at least after the second dose, and at least four months after the first dose) four months after the first dose)

Child of an uninfected mother: Child of an uninfected mother: between 6 and 18 months of age between 6 and 18 months of age

Older child, adolescent, or adult: four Older child, adolescent, or adult: four to six months after first dose to six months after first dose

BACK TO TETANUSBACK TO TETANUS

Remember this is a serious Remember this is a serious disease. disease.

WHO WHO (2000) (2000) estimated that estimated that tetanus killed tetanus killed 200,000 babies 200,000 babies

The Tdap vaccine protects The Tdap vaccine protects against Tetanus, Diphtheria against Tetanus, Diphtheria and Pertussis and Pertussis

WHOOPING COUGHWHOOPING COUGH

Whooping cough is caused by Whooping cough is caused by Bordetella pertussis. Bordetella pertussis.

Annoying for adults. Life threatening Annoying for adults. Life threatening to newborns and infantsto newborns and infants

May start as a runny nose, low grade May start as a runny nose, low grade fever or cough. fever or cough.

Gets its name because the cough is a Gets its name because the cough is a “whoop” high pitched noise or gasp “whoop” high pitched noise or gasp for breathfor breath

try this link www.whoopingcough.net/cough-child-muchwhooping.wav

This is the sound of a 3 year old girl with whooping cough.

Tdap CocooningTdap Cocooning

This means everyone around the This means everyone around the newborn (0 to 12 months) GETS newborn (0 to 12 months) GETS VACCINATED!VACCINATED!

It takes 10-14 days to build up the It takes 10-14 days to build up the immunity to pertussis after the immunity to pertussis after the vaccine.vaccine.

Grandparents, friends, parents should Grandparents, friends, parents should plan ahead or stay awayplan ahead or stay away

CONCLUSIONCONCLUSION

We discussed the need to keep We discussed the need to keep children, adolescents and adults up-children, adolescents and adults up-to-date on vaccinationsto-date on vaccinations

Huge need to vaccinate pregnant Huge need to vaccinate pregnant women with Tdap and Influenza women with Tdap and Influenza vaccinesvaccines

Catch anyone up that you missed. Catch anyone up that you missed. Given the MMR, give Varicella if Given the MMR, give Varicella if mom’s not protectedmom’s not protected

CONCLUSIONCONCLUSION

Give Hepatitis B vaccine. Prevent death, Give Hepatitis B vaccine. Prevent death, cirrhosis of the liver and liver cancers!cirrhosis of the liver and liver cancers!

Protect the newborn infant from Protect the newborn infant from whooping cough by cocooning them in a whooping cough by cocooning them in a blanket of “blanket of “LOVELOVE” Lasting Ongoing ” Lasting Ongoing Vaccinations to Everyone.Vaccinations to Everyone.

When in doubt of what to do When in doubt of what to do VACCINATE!! VACCINATE!! VACCINATE!! VACCINATE!! VACCINATE!!VACCINATE!!

QUESTIONS?????QUESTIONS????? PRESENTED BY LEAH M FLORE APRN, FNP, IBCLCPRESENTED BY LEAH M FLORE APRN, FNP, IBCLC HOPE YOU ENJOYED THE SHOWHOPE YOU ENJOYED THE SHOW