CHILDHOOD IMMUNIZATIONS 10 December 2009 Heather Schembari
Immunity Passive- Immunoglobulins are transported from mother to baby across the placenta. IgA is acquired through breast milk. Baby inherits mother s natural immunities Active- Humoral & cellular responses to pathogens after birth. B-cells and both helper & cytotoxic T- cells become active. Begins in the birth canal
Types of Vaccines Live attenuated- Disease causing microbes killed preventing them from mutating. Usually requires multiple doses due to weaker immune responses. Storage is easy Live/Attenuated- Weakened, but living. Elicit strong antibody responses. Lifelong immunity in 1-2 doses. Require refrigeration. More likely to mutate Subunit- Entire microbes are not always needed to generate an immune response. Less risk for adverse reactions with fewer antigens Also toxoid, conjugate, DNA, and recombinant
What If I Wait Too Long For the Next Dose? It is recommended to space out vaccine doses in 4 week intervals It is NOT necessary to restart a series due to immunological memory Complete the series as soon as possible to eliminate chances of weak immune responses allowing disease contraction
What Do They Put In There? The major ingredient of any vaccine is a killed or weakened form of the disease organism the vaccine is designed to prevent. In addition, vaccines can contain: Diluents- A diluent is a liquid used to dilute a vaccine to the proper concentration. It is usually saline or sterile water. Adjuvants. Adjuvants are chemicals added to vaccines to make them provide stronger immunity. Various forms of aluminum salts are the most commonly used adjuvants in vaccines. Preservatives. Preservatives are included in some vaccines (mainly ones that come in multidose vials that are used more than once) to prevent bacterial growth that could contaminate the vaccine. Stabilizers. Some vaccines contain stabilizers (for example, gelatin or lactose-sorbitol), to keep them safe and effective under different conditions or different temperatures. Remnants from manufacturing. Chemicals are often used during the vaccine manufacturing process, and then removed from the final product. For example, formalin might be used to kill a vaccine virus, or antibiotics might be used to prevent bacterial contamination. When these chemicals are removed, a tiny trace may remain. While some of these chemicals might be harmful in large doses, the trace amounts left in vaccines are too small to have a toxic effect
It s the Law In Nevada NRS 392.435 1. Unless excused because of religious belief or medical condition, a child may not be enrolled in a public school within this state unless his parents or guardian submit to the board of trustees of the school district in which the child resides or the governing body of the charter school in which the child has been accepted for enrollment a certificate stating that the child has been immunized and has received proper boosters for that immunization or is complying with the schedules established by regulation pursuant to NRS 439.550 for the following diseases: (a) Diphtheria; (b) Tetanus; (c) Pertussis if the child is under 6 years of age; (d) Poliomyelitis; (e) Rubella; (f) Rubeola; and (g) Such other diseases as the local board of health or the state board of health may determine.
I Don t Believe In That Child is exempt if the parents of the child has submitted to the board of trustees of the school district or the governing body of a charter school in which the child has been accepted for enrollment a written statement indicating that their religious belief prohibits immunization of such child or ward.
How Are These Transmitted? Diptheria- respiratory droplets (coughing & sneezing) Hepatitis A- fecal-oral route, or occasionally ingesting food contaminated with the virus Hepatitis B- when infected bodily fluids enter another person i.e. birth, sexual contact, syringes, direct contact with blood or open sores HIB- respiratory droplets Measles, Mumps & Rubella- close contact & respiratory droplets Polio- close contact Rotavirus- fecal-oral route, bodily fluids, ingestion of contaminated food or water Pertussis- respiratory droplets Tetanus- enters the body through a break in the skin. It is not transmitted from person to person
Path to Eradication Disease Pre-Vaccine Post Vaccine Diphtheria HIB 100k-200k cases 13k-15k deaths in 1921 20k serious infections 600+ deaths 1 case in 2002 Reduced by 98% Hepatitis A 75k-100k infections/yr 70-100 deaths 20k infections in 2004 Measles 894k cases in 1941 44 cases in 2002 Mumps 200k-300k cases/yr 20-30 deaths Tetanus 1300 cases/yr in 1920 s 25 cases/yr Annual cases in the hundreds Polio 50k/yr Eradicated from the entire Western Hemisphere Smallpox 300-500 million deaths/yr In 1980 declared worldwide eradication
Putting Your Children at Risk Poliomyelitis Tetanus Diptheria
Smallpox Haemophilus Influenza type B Pertussis- Whooping Cough
Secondary Damage As if the primary wasn t bad enough Diphtheria- heart, kidney, and nerve damage resulting in paralysis HIB- cellulitis, osteomyelitis, epiglottis inflammation, joint infections Pertussis- Pneumonia, encephalitis, pulmonary hypertension, and secondary bacterial super infections Hepatitis B- Chronic liver disease, cirrhosis and liver cancer Mumps- swelling of the brain, nerve damage, paralysis, seizures, fluid in the brain, sterility, testicular cancer Meningococcal disease- blood infections Varicella- 2 bacterial infections, severe dehydration, pneumonia, CNS irregularities
Beyond the Disease Cataracts from Rubella Liver cancer from Hepatitis B
Will Vaccines Overwhelm Children s Immune Systems? B & T cells present at 14 weeks Neonates are able to produce immune responses against foreign antibodies immediately after birth Infants can generate immune responses to multiple vaccines simultaneously Immunocompromised children may develop infections from attenuated pathogens, although some actually tolerate live vaccines, and it is recommended by the AAP that they receive live vaccines. These are usually identified by 6-8 mo Children with severe illnesses have an antibody-developing rate comparable to healthy children they are no more likely to have an adverse reaction Short term immunosuppression may occur, but they are at no greater risk for developing other infections, unlike bacterial & viral infections Conclusion Vaccines will not overwhelm or weaken a child s immune system, even if their immune system is busy fighting off other illnesses
But Vaccines Have Mercury & They Will Give My Child Autism! MYTH!! Thimerosal is a preservative containing Mercury that is used in many biological products. Thimerosal has been removed or reduced to trace amounts of 1µg or less in vaccines except that of influenza (12µg) Can t apply research from methylmercury to ethylmercury. In 2004, the IOM reported a casual association of mercury-containing vaccines & autism US courts have been ruling against families who claim their child s autism is connected to vaccines.
Andrew J. Wakefield started the hype In February 1998 Andrew Wakefield published an article in The Lancet medical journal declaring that mercury-based vaccines (MMR in particular) caused an inflammatory bowel disease & neurological disorders such as autism in children. His study included only 12 children (who does that?) The Sunday Times of London reported that some of the parents of those 12 children were recruited by a UK lawyer who was preparing a case against MMR manufacturers ALSO, they reported that Dr. Wakefield received 55,000, and another 400,000 by lawyers from that lawsuit. (conflict of interest) The GMC has allegations against him for serious medical misconduct for suppressing data, which he denies. He currently runs a clinic called the Thoughtful House in TX for autistic children funded by the parents of children with autism. After reviewing The Sunday Times's findings, Richard Horton, the editor of The Lancet, said he should never have published Wakefield's article linking MMR to autism. It was "fatally" flawed. Most of his coworkers withdrew their name from the study when they found out
Some Parents Will STILL Refuse To Get Their Children Vaccinated Someone may act as a carrier, and transmit a disease to others i.e. subclinical case Parents are encouraged to communicate ALL concerns with their family practitioner Putting children who are medically exempt from vaccinations at risk (HIV, leukemia, chemo patients, allergic reactions)
Why They Might Think It s Ok To Not Vaccinate Community Immunity- Indirect immunity via being surrounded by all immunized persons intercontinental travel poses a problem They may not understand the risk or severity Ramifications include resurges
Don t Stop Something That s Working Minnesota, Pennsylvania & New Jersey had an HIB outbreak that included hospitalizations Unvaccinated boy went to Europe, and contracted measles Pertussis outbreaks in US, Japan, Australia
I Already Got That Shot Booster shot- An additional dose of vaccine needed to boost the immune system Not enough B-cells may have been activated the first time More B-cells more antibodies stronger immune response Wait at least 2 months for antibodies to move into the bloodstream or they will eliminate the vaccine material before B-cells activated
Benefits Reaped Economic Value 27 vaccine preventable diseases (28 if you count H1N1) For the greater good of society The CDC says with every dollar spent on immunizations $6.30 is saved in direct medical costs an estimated $10.5 billion in the long run. Indirect costs jump to $18.40/dollar or $42 billion in the long run
That Small Chance Majority of side effects are minor: soreness, slight fever, aches, nausea, localized swelling, vomiting, fatigue Moderate side effects include: seizures, high fever, pain, stiffness Severe adverse reactions: life-threatening allergic reactions, deafness, coma, brain damage, death
Benefit Outweighs the Risk <1:100,000,000 have severe allergic reactions to MMR &DTaP Hep B allergic reactions occur once every 1.1 million doses Today s Polio vaccine has NeVeR caused problems For every million people vaccinated, between 14 and 52 could have a life-threatening reaction to smallpox vaccine those with weakened immune systems Varicella rarely causes pneumonia
Sources Cited http://www.nvic.org/vaccine-laws/state-vaccine-requirements/nevada.aspx http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2009/09_0-6yrs_schedule_pr.pdf http://www.cdc.gov/vaccines/vpd-vac/photo-all-vpd.htm http://www.millerandlevine.com/chapter/19/smallpox-virus-ns.jpg http://www.vaccineinformation.org/photos/ http://www.aap.org/immunization/families/overwhel http://www.vaccinateyourbaby.org/why/history/index.cfmm.pdf http://thimerosal-lawsuits.com/thim2.htm http://www.fda.gov/biologicsbloodvaccines/safetyavailability/vaccinesafety/ucm096228#t1 http://www.timesonline.co.uk/tol/news/uk/health/article4837798.ece http://briandeer.com/mmr/lancet-deer-1.htm http://www3.niaid.nih.gov/topics/vaccines/understanding/typesvaccines.htm http://www.medterms.com/script/main/art.asp?articlekey=20418 http://www.ecbt.org/advocates/economicvaluevaccines.cfm http://www.suite101.com/article.cfm/microbiology/35684/1