meg fisher, md medical director, the children’s hospital
DESCRIPTION
Monmouth Medical Center. An affiliate of the Saint Barnabas Health Care System. Vaccine Preventable Diseases and the Healthcare Provider. Meg Fisher, MD Medical Director, The Children’s Hospital. Long Branch, NJ. Disclosures. I have no disclosures. - PowerPoint PPT PresentationTRANSCRIPT
Vaccine Preventable Diseases and the Healthcare Provider
Meg Fisher, MDMedical Director,The Children’s Hospital
Monmouth Medical CenterAn affiliate of the Saint Barnabas Health Care System
Long Branch, NJ
Disclosures
I have no disclosures.
I will be mentioning off label uses of vaccines.
Objectives Describe the vaccine preventable diseases that relate to the healthcare
provider in the acute care settingList and discuss vaccines needed to
prevent these diseases
ImmunizationPublic health success story
Rates of all vaccine preventable illnesses have plummeted:
Smallpox, diphtheria, tetanus, polio, measles, mumps, rubella, Haemophilus influenzae type b almost gone in the US
Immunization RatesDon’t get complacent!
Infection is just a plane ride away!
Test your knowledge
Identify these infections
Courtesy of the American Academy of Pediatrics and the Centers for Disease Control and Prevention
Courtesy of the Centers for Disease Control and Prevention
Courtesy of his mother
Courtesy of the Centers for Disease Control and Prevention
Courtesy of the Centers for Disease Control and
Prevention
Courtesy of eMedicine and ADAM
Courtesy of the Centers for Disease Control and Prevention
Courtesy of the Centers for Disease Control and Prevention
Courtesy of the Centers for Disease Control and Prevention
Courtesy of the Centers for Disease Control and Prevention
Courtesy of the WHO and theCenters for Disease Control and Prevention
Courtesy of the WHO and the Centers for Disease Control and Prevention
Courtesy of the Centers for Disease Control and Prevention
Vaccine Preventable DiseasesHepatitis B, rotavirus, diphtheria, tetanus,
pertussis, polio, Haemophilus influenzae type b, Streptococcus pneumoniae, influenza, measles, mumps, rubella,
varicella, hepatitis A, Neisseria meningitidis, human papillomavirus
Shortages?Major dilemma for practitionersDistribution always a problemWeb site for vaccine shortages:
www.cdc.gov/vaccines/vac-gen/shortages None currently
Vaccine Safety
Concerns are limiting vaccine useRates in New Jersey have fallen dramatically
www.cdc.gov/vaccinesafety
Immunization SafetyStarts during development
Continues through all stages of licensure and during postlicensure use
Vaccine adverse event reporting systemVaccine safety datalink
Clinical immunization safety assessment
National Vaccine Injury Compensation Program
Established by National Childhood Vaccine Injury Act
No fault compensation programhttp://www.hrsa.gov/vaccinecompensation/ Report suspected adverse events to VAERS
Advisory Committee on Immunization Practices
Provides advice for CDCMultidisciplinary panel with many liaisons
www.cdc.gov/vaccines/recs/acip Pediatricians well represented
Hepatitis B vaccineAll providers with blood exposure
Three doses: 0, 1, 6 moTiters to prove response to vaccine
If < 10 mIU/ml, repeat series and titerOlder less likely to respond
Exposure to HBsAg + BloodImmune: education re preventing exposures
Non-responder or not immunized: HBIG plus education re preventing exposures
Immunized but not tested: test and give HBIG if negative
Hepatitis B VaccineNew dilemma:
Adolescents immunized as children may have low or no antibody levels at entry to college,
nursing schools, medical schoolsConsider giving one dose and repeat titer
If negative, finish the series and repeat titer
“I had a little bird.
His name was Enza.
I opened the window.
And in flew Enza.”
A chant popular during the influenza pandemic of 1918
RecommendationsAll people 6 months of age and older
Healthcare personnel: mandates recommended by IDSA, PIDS, AAP and othersFormulated yearly on best guess
Two A strains, one BStart when you get it and continue all season
Influenza VaccinesA/California/7/2009 (H1N1)-like
A/Perth/16/2009 (H3N2)-likeB/Brisbane/60/2008-like
Inactivated, live cold adapted
Influenza Vaccine ScheduleYearly – start when you get it
Children under 3 years: lower doseChild under 9: two doses first season*
Contraindicated in persons with anaphylaxis to chicken or eggs
Measles, Mumps, RubellaMeasles and rubella no longer endemic in
the United StatesMumps outbreak over in NJ
MMRV combination – more feverWe should be immune: born before 1957,
+ titer or received 2 doses of vaccine
Varicella VaccinePrevents serious illness
Outbreaks persistSecond dose now recommended for all
Routine at 4-5 years, MMRVCatch up for older
Zoster vaccineZostavax
Approved May 2006Age 60 and above; now 50 and aboveProtect yourself when the time comes
Tdap: Boostrix, AdacelTetanus, diphtheria, pertussis boosterFor teens (both) and adults (Adacel)
Licensed in spring 2005 Should alter epidemiology and
protect infantsProtect yourself and your staff
Targeted adultsAnyone caring for young infants
Cocoon the infants by immunizing contactsHealthcare people
Pregnant women in late 2nd, 3rd trimesterGive to the entire household, preferably
before delivery
Latest from ACIP Off label use of the vaccine:
Use Tdap for incompletely vaccinated children down to age 7 years
Use Tdap in adults over 65 yearsPregnant women in the 2nd or 3rd trimester
Tdap at any interval following T or Td
Meningococcal vaccinesPolysaccharide vaccine rarely used today
Conjugate vaccines originally recommended: Adolescents age 11-12 yr (pre-teen visit) Adolescents age 15 yr (high school entry) Incoming college freshmen in dorms
High risk groups
Latest RecommendationsBooster dose for adolescents: age 16 or
5 years after the first doseHighest risk: initial 2 dose series followed
by booster doses every 5 yearsAt risk healthcare: microbiologists only
Rotavirus vaccinesThe old: Rotashield
Rhesus rotavirus reassortantLicensed 8/98
Withdrawn 10/99Intussusception risk < 1/10,000
Rotavirus vaccinesThe new: RotaTeq, Rotarix
RotaTeq: human-bovine reassortantWell tolerated, effective, over 70,000
Licensed February 2006Rotarix: monovalent, human strain
Licensed and used outside US
Safety Issues
Porcine circoviruses: no harmRates of intussusception among vaccine recipients closely studied; post-licensure
studies results varyBenefits greatly outweigh risks
Haemophilus influenzae type b
Disease dramatically decreased in USConjugate vaccine eliminates carriage
Keep vaccinating!
Streptococcus pneumoniaeDramatic decrease in US since PCV7
Decrease in adult disease as wellPCV13 now replaces PCV7
Polysaccharide vaccine PPSV23 for high risk children and adults
Polio Virus VaccinePolio eliminated from most of the world
But in 2010 spread to over a dozen countriesLive oral: not in US since 2000, source of
some recent outbreaksInactivated: safe effective, 4 dose series,
last/extra dose at 4 to 6 years
Hepatitis A VaccinesInactivated
Two doses, 6 months apartPrior to 2006: at risk or in high incidence state
Now: at risk and all children at age 1Catch up is reasonable
HPV VaccinesVirus-like particles genetically engineered
Quadravalent and bivalent vaccinesWell tolerated and immunogenic
Three dose seriesUniversal for girls; permissive for boys
Websiteswww.aap.orgwww.cdc.gov
www.immunizationinfo.orgwww.vaers.org
Smiling is a contagious condition!