CME Designation The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The AAP designates this live activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is acceptable for a maximum of 1.00 AAP credits. These credits can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Members of the American Academy of Pediatrics. The American Academy of Physician Assistants (AAPA) accepts certificates of participation for educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by ACCME. Physician assistants may receive a maximum of 1.00 hours of Category 1 credit for completing this program. This program is accredited for 1.00 NAPNAP CE contact hours of which 0.25 contain pharmacology (Rx) content per the National Association of Pediatric Nurse Practitioners (NAPNAP) Continuing Education Guidelines. 1
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Practicing Safety: A Child Abuse and Neglect Prevention Project€¦ · Why Age Matters • HIB vaccine given at < 6 wks can induce immunologic tolerance to HIB antigen • Response
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CME Designation The American Academy of Pediatrics (AAP) is accredited by the Accreditation
Council for Continuing Medical Education (ACCME) to provide continuing medical
education for physicians.
The AAP designates this live activity for a maximum of 1.00 AMA PRA Category 1
Credit(s)™. Physicians should claim only the credit commensurate with the extent of
their participation in the activity.
This activity is acceptable for a maximum of 1.00 AAP credits. These credits can be
applied toward the AAP CME/CPD Award available to Fellows and Candidate
Members of the American Academy of Pediatrics.
The American Academy of Physician Assistants (AAPA) accepts certificates of
participation for educational activities certified for AMA PRA Category 1 Credit™
from organizations accredited by ACCME. Physician assistants may receive a
maximum of 1.00 hours of Category 1 credit for completing this program.
This program is accredited for 1.00 NAPNAP CE contact hours of which 0.25
contain pharmacology (Rx) content per the National Association of Pediatric Nurse
“In 1736 I lost one of my sons, a fine boy of four years old, by the smallpox taken in the common way. I long regretted bitterly and still regret that I had not given it to him by inoculation. This I mention for the sake of the parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it; my example showing that the regret may be the same either way, and that, therefore, the safer should be chosen.”
Tell the stories: Tetanus in 2012
http://www.abc.net.au/local/stori
es/2013/06/06/3776327.htm
“Auckland parents Ian and
Linda Williams thought they
had made an informed choice
not to vaccinate their children,
but after their son ended up in
intensive care with a tetanus
infection they realised they
had made a terrible mistake.”
Diphtheria, Tetanus & Pertussis
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Diphtheria skin lesion on leg, neonatal tetanus, and conjunctival hemorrhages and bruising from coughing from pertussis
Pertussis
Immunity wanes:
• 76% of cases in
adolescents & adults
• May be mild and
undiagnosed in older
ages
• 91% of deaths < 6 mos.
of age
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30 yrs+
20-29 yrs
10-19 yrs
5-9 yrs
0-4 yrs
3 of 4 cases of infant pertussis contracted from family member
Bisgard KM et al. Infant pertussis: who was the source? Ped Inf Dis J 2004;23(11):985-9.
DTaP Vaccine
• Routine: 4 doses • at 2, 4, 6, and 15-18 months
• Dose #1: as early as 6 weeks
• Dose #4: as early as 12 mos. if 6 months since
dose #3 and child unlikely to return at 15-18
months
Do NOT give DTaP or DT to > 7 yrs
Dose #4 on or after 4th birthday then dose #5
not needed
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Tdap Vaccine
Routine: 1 dose Tdap at 11-12 yo then Td every 10 years
Pregnant women: 1 dose during each pregnancy
Catch up: 1 dose Tdap from 13-18 yo NEW: Catch up: By 7-10 yo, if not fully
immunized against pertussis, should receive 1 dose TdaP, NOT Td (. Then no Tdap at 11-12 yo
NEW: No minimal interval between Td & Tdap for children 7 to 18 yo
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Influenza disease
200,000 hospitalizations and 36,000 deaths each flu season
Highest rates of infection: children
Highest rates of serious illness and death: > 65 yrs. and < 2 yrs, and high-risk
Complications: pneumonia, AOM, worsening of reactive airway disease
Cartoon from the 1918 flu pandemic
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Influenza vaccine
Annually for all children 6 mo – 18 yo
Annually for all contacts of children 5
18 yo at risk of influenza complications
(asthma, congenital heart disease, etc.)
Educational poster from the 1918 flu pandemic
Influenza vaccine continued
2 types of influenza vaccines:
•TIV, Trivalent inactivated: injection for ≥6mo
• No live virus, just antigens
• Quadrivalent inactivated vaccines are being
licensed
•LAIV, Live attenuated, quadrivalent: (FluMist)
intranasal for healthy, 2-49 yo
• Cold-adapted: survives and replicates only at
T<25°C (nose/throat). Warm temp of LRT
destroys virus, so cannot cause disease
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Common Schedule Questions
Q. Can we use Pediarix at the 2, 4 and 6 month
visit if the child had a dose of Hep B in the
newborn nursery?
A. Yes, it is okay to give the birth HepB + 3 doses of
Pediarix (4 doses of HepB total)
Common Schedule Questions
Q. My patients often miss their 15 and 18
month well visits and the recommended
vaccines. How can we make sure these
kids are up to date?
A. Consider giving the 4th DTaP at the 12
month visit (valid per ACIP if ≥ 4 months
since dose #3)
Common Schedule Questions
Q. But we already give MMR and varicella at the 12 month
visit, isn’t that too many vaccines to give at once?
A. No. The ACIP recommends simultaneous vaccination
unless contraindicated. At the 12 month visit, you could give
MMR, Varicella, HepA, DTaP, Hib, PCV and influenza (in
season).
A 2007 study of Chinese immigrants to US receiving MMR varicella, HepA,
DTaP/Td, Hib, PCV7 and influenza found no allergic reactions/serious side effects (pain at injections site and fever most common)
Hua L. Hongtao H. Shunqin W. Jinping G. Jiandong C. Zhaoliang L. Xinwen F. Simultaneous vaccination of Chinese applicants for a United States immigrant visa. Travel Med Infect Dis. 2008
May;6(3):130-6
Common Schedule Questions
Q. Sometimes when kids come in for well visits, we find
out they also have an ear infection. Isn’t being sick or
having a fever a contraindication to vaccination?
A. No. A mild acute illness, such as otitis media or a URI
is NOT a contraindication, nor is a fever < 104.8.