Childhood Immunization Risk of Non-Vaccinated Children Bertha P. Rojas, Pharm.D. PGY-1 Pharmacy Resident South Miami Hospital Objectives Understand the definition of herd immunity Identify vaccine-preventable childhood diseases Discuss the measles outbreak in California Immunity Presence of antibodies Passive Active http://textbookofbacteriology.net/innate.html Vaccines.gov Immunization, 2015 1
Passive Immunity Antibodies produced by another human being or animal Effective Protection diminishes over time Vaccines.gov Immunization, 2015 Active Immunity Contraction of disease Vaccination Usually permanent Vaccines.gov Immunization, 2015 Herd Immunity Community Immunity Situation in which a sufficient proportion of a population is immune to an infectious disease, making its spread from person to person unlikely Offers protection to those unable to be vaccinated CDC Vaccines and Immunizations, 2015 2
Herd Immunity Vaccines.gov Community Immunity, 2015 Herd Immunity Vaccines.gov Community Immunity, 2015 Herd Immunity Vaccines.gov Community Immunity, 2015 3
Childhood Preventable Diseases Childhood Preventable Diseases Virus Hepatitis A and B Influenza Measles Mumps Polio Rotavirus Rubella (German measles) Varicella (chickenpox) Bacteria Diphtheria Haemophilus influenzae type b Pertussis (whooping cough) Pneumococcal Disease Tetanus (lockjaw) CDC Childhood Preventable Disease, 2015 Childhood Preventable Diseases Immunity 90-100% of the time 1 to 5% fail to develop immunity More than one dose may be needed to stimulate immune response Measles Single dose 95% Second dose almost 100% Vaccines.gov, 2015 CDC Vaccines and Immunizations, 2015 4
Healthy People 2020 Set of goals and objectives Guide national health promotion Disease prevention U.S. Department of Health and Human Services Healthypeople.gov, 2010 Healthy People 2020 Target for vaccine coverage: 90% all vaccines 80% Rotavirus 85% HepA Healthypeople.gov Immunization and Infectious Diseases, 2010 Vaccine-specific coverage among children 19-35 months, National Immunization Survey, 1994-2014 Abbreviations: MMR = measles, mumps, and rubella vaccine; DTP/DTaP = diphtheria, tetanus toxoids, and pertussis vaccine / diphtheria, tetanus toxoids, and acellular pertussis vaccine; Hib = Haemophilus influenzae type b vaccine; HepB = hepatitis B vaccine; PCV = pneumococcal conjugate vaccine; HepA = hepatitis A vaccine. CDC NIS, 2014 5
Diphtheria Bacterium Corynebacterium diphtheriae Transmitted through airborne droplets or direct contact with respiratory secretions Symptoms Sore throat, fever, malaise CDC Diphtheria, 2015 Diphtheria May produce toxin Heart failure Paralysis In 1921 206,000 cases and 15,520 deaths Since 2004 1 case reported CDC The Pink Book, 2015 Pertussis Whooping Cough Bacterium Bordetella pertussis Transmitted via respiratory droplets Symptoms Prolonged paroxysmal cough Inspiratory whoop CDC Pertussis, 2015 6
1940s > 200,000 cases 2012 47,693 2014 32,971 cases Pertussis CDC The Pink Book, 2015 Clostridium tetani Found in soil Tetanus Transmitted via damaged human tissue Symptoms Generalized rigidity Convulsive spasms CDC Tetanus, 2015 Tetanus Lockjaw In the late 1940s 500-600 cases per year 2001 2008 29 cases per year CDC The Pink Book, 2015 7
Highly infectious Airborne Measles Can be infectious 4 days prior to developing rash Symptoms begin with: Fever Cough Runny nose Red eyes CDC Measles, 2015 CDC Measles, 2010 Before 1963 500,000 cases 500 deaths 1989 1991 55,622 cases 123 deaths Measles No history of vaccination in 90% of fatal cases CDC The Pink Book, 2015 8
2011 220 cases Unvaccinated person 2013 to 2014 http://media.graytvinc.com/images/measles+alert1.jpg Measles cases more than doubled in the region of the Americas WHO Measles, 2014 CDC The Pink Book, 2015 CDC Measles by Year, 2015 https://disneyland.disney.go.com/attractions/disneyland/sleeping-beauty-castle-walkthrough/ 9
CDC Measles Outbreak, 2015 Measles Outbreak in California 131 cases were linked to the 2014 California outbreak 42 directly linked Remaining were secondary 57 were unvaccinated CDPH Measles Outbreak, 2015 Vaccine Administration Aseptic technique Infants < 12 months Anterolateral thigh Children > 12 months Anterolateral thigh or deltoid Adolescents and young adults Deltoid CDC Vaccine Administration, 2015 10
Vaccine Administration Separate sites http://www.nyc.gov/html/doh/html/data/chi31-4_administering.html Inactivated Hepatitis B Vaccine Three-dose series Administered at birth, 1-2, and 6-18 months of age Recombivax-HB IM 5 mcg/0.5 ml Merck Prescribing Information 11
Engerix-B IM Hepatitis B Vaccine 10 mcg/0.5 ml Contraindications Allergy or hypersensitivity reaction to yeast GlaxoSmithKline Prescribing Information, 2015 Hepatitis B Vaccine Catch-Up 4 weeks between first and second dose May be administered at 4 months of age 8 weeks between second and third dose At least 16 weeks after first dose 12
Rotavirus Vaccine Live 6 weeks of age Rotarix PO Two-dose series 2 and 4 months of age 1 ml/dose GlaxoSmithKline Prescribing Information, 2014 Rotavirus Vaccine RotaTeq PO Three-dose series 2, 4, and 6 months of age 2 ml/dose Merck Prescribing Information, 2014 Rotavirus Vaccine Catch-Up Maximum age for first dose in the series is 14 weeks, 6 days Maximum age for final dose is the series is 8 months, 0 days 4 week interval between doses 13
Diphtheria, Tetanus, & Acellular Pertussis (DTaP) Inactivated < 7 years of age 5 dose series Ages 2, 4, 6, 15-18 months, and 4-6 years Daptacel and Infanrix IM 0.5 ml/dose Sanofi Pasteur Prescribing Information GlaxoSmithKline Prescribing Information, 2013 DTaP Vaccine Catch-Up Between 9 and 12 months and 19 months to 3 years of age 5 th dose not necessary if 4 th dose administered at 4 years of age Four weeks Between 1 st, 2 nd, and 3 rd dose Six months Between 3 rd, 4 th, and 5 th dose 14
Tetanus, Diphtheria, & Acellular Pertussis (Tdap) 7 years of age 1 dose for adolescents 11-12 years of age Adacel and Boostrix IM 0.5 ml/dose Contraindications Spasms, epilepsy, encephalopathy Sanofi Pasteur Prescribing Information, 2014 GlaxoSmithKline Prescribing Information, 2015 15
Hib Conjugate Vaccine Inactivated Infants 6 weeks to 6 months ActHib Reconstituted, IM 0.5 ml/dose Three doses at 2, 4, and 6 months of age Sanofi Pasteur Prescribing Information, 2014 Hib Conjugate Vaccine PedvaxHIB IM 0.5 ml/dose Two doses at 2 and 4 months of age Contraindications Hypersensitivity Merck Prescribing Information, 2010 Hib Conjugate Vaccine Catch-Up At 9 months and 18 months to 4 years of age If 1 st dose between 12 to 14 months of age Second and final dose at least 8 weeks apart 16
Pneumococcal Vaccine Inactivated Four-dose series 2, 4, 6, and 12-15 months Prevnar 13 IM 0.5 ml/dose Pfizer Prescribing Information, 2015 Pneumococcal Vaccine Catch-Up At 9 months and 18 months to 4 years of age Healthy unvaccinated children between the ages of 24 and 59 months One dose 17
Poliovirus Vaccine Inactivated Age 6 weeks and older 4 doses 2, 4, 6-18 months, and 4-6 year of age IPOL IM or SubQ 0.5 ml/dose Protect from light Sanofi Pasteur Prescribing Information, 2015 Poliovirus Vaccine Catch-Up Ages 19 months to 3 yrs and 7-17yrs Not recommended for ages 18 yrs Fourth dose is not necessary if 4 years of age when third dose was administered 4 weeks between 1 st, 2 nd & 3 rd dose 6 months between 3 rd and 4 th dose 18
6 months Annually Influenza Vaccine Ages 6 months to 8 years and first dose 2 doses needed 4 weeks apart Influenza Vaccine Live attenuated vaccine Flumist Intranasal 2 to 49 years of age Contraindications Hypersensitivity to egg products Flublok and Flucelvax - 18 years old CDC Influenza, 2015 19
Live Measles, Mumps, Rubella (MMR) Vaccine Children 12 months Two-dose series 12-15 months and 4-6 years of age Four week interval M-M-R II 0.5 ml/dose SubQ, reconstituted Merck Prescribing Information, 2015 Measles, Mumps, Rubella MMR Vaccine Contraindications Hypersensitivity to neomycin Current febrile respiratory illness Immunosuppressive therapy Immunodeficiency states Blood dyscrasias Pregnancy 20
MMR Vaccine Catch-Up 18 months to 3 years of age 7 years of age At least 4 weeks apart Varicella Vaccine Live Children 12 months Two-dose series 12-15 months and 4-6 years of age Varivax 0.5 ml/dose SubQ Reconstitute, freeze, protect from light Merck Prescribing Information, 2013 21
Varicella Vaccine Contraindications Neomycin or gelatin Immunosuppressed or immunodeficient Immunosuppressive therapy Untreated tuberculosis Febrile illness Pregnancy Varicella Vaccine Catch-Up 18 months to 3 years of age 7 years of age Minimum interval between doses: 3 months Ages 7-12 years 4 weeks 13 years of age 22
Hepatitis A Vaccine Inactivated Two-dose series 12 through 23 months separated by 6 to 18 months Havrix IM 0.5 ml/dose GlaxoSmithKiine Prescribing information, 2014 Hepatitis A Vaccine Catch-Up 2 years of age Two doses 6 month minimum interval between doses Compresses Epinephrine Managing Vaccine Adverse Reactions 1:1000 (1 mg/ml) 0.01 mg/kg/dose Max 0.5 mg/dose Diphenhydramine 1 2 mg/kg/dose Max 50 100 mg/day 23
Vaccine Adverse Event Reporting System (VAERS) How to report: Online Fax Mail Anyone can report All adverse events 24
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Florida Law Pharmacists requirements May administer vaccine to an adult within the framework of an established protocol under a supervising physician licensed under chapter 458 or 459 Vaccines listed in the Adult Immunization Schedule as of February 1, 2015, by the United States Centers for Disease Control and Prevention Florida Statutes Chapter 465, 2015 Florida Law Immunizations or vaccines recommended by the United States Centers for Disease Control and Prevention for international travel as of July 1, 2015 Board of Pharmacy approved certification program Maintain records at least 5 years Florida Statutes Chapter 465, 2015 Vaccine Information Statements (VISs) CDC document informing vaccine of risks and benefits Federal Law Provided prior to the vaccination Regardless of age Regardless of setting 26
Vaccine Information Statements (VISs) Diphtheria, Tetanus, Pertussis Measles, Mumps, Rubella Polio hepatitis A and B Haemophilus influenzae type b (Hib) Influenza pneumococcal conjugate Meningococcal Rotavirus Human papillomavirus (HPV) Varicella (chickenpox only) Vaccine Information Statements (VISs) Immunization Action Coalition VIS, 2013 True or False A form of immunity that occurs when vaccination of a significant portion of a population provides a level of protection for non-immune individuals is called herd immunity True 27
True or False T/F: Rotavirus is not a vaccine preventable disease False T/F: As per the World Health Organization, the number of reported measles cases in the region of the Americas has more than doubled from 2013 to 2014 True Questions? Childhood Immunization Risk of Non-Vaccinated Children Bertha P. Rojas, Pharm.D. PGY-1 Pharmacy Resident South Miami Hospital 28