Vaccine Preventable Diseases and the Healthcare Provider Meg Fisher, MD Medical Director, The Children’s Hospital Monmouth Medical Center An affiliate of the Saint Barnabas Health Care System Long Branch, NJ
Vaccine Preventable Diseases and the Healthcare Provider Meg Fisher, MD Medical Director, The Children’s Hospital Monmouth Medical Center An affiliate.
Apr 01, 2015
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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 setting
List 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 practitioners
Distribution always a problem
Web site for vaccine shortages:
www.cdc.gov/vaccines/vac-gen/shortages
None currently
Vaccine Safety
Concerns are limiting vaccine use
Rates 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 system
Vaccine safety datalink
Clinical immunization safety assessment
National Vaccine Injury Compensation Program
Established by National Childhood Vaccine Injury Act
No fault compensation program
http://www.hrsa.gov/vaccinecompensation/
Report suspected adverse events to VAERS
Advisory Committee on Immunization Practices
Provides advice for CDC
Multidisciplinary panel with many liaisons
www.cdc.gov/vaccines/recs/acip
Pediatricians well represented
Hepatitis B vaccine
All providers with blood exposure
Three doses: 0, 1, 6 mo
Titers to prove response to vaccine
If < 10 mIU/ml, repeat series and titer
Older 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 schools
Consider 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 others
Formulated yearly on best guess
Two A strains, one B
Start when you get it and continue all season
Influenza Vaccines
A/California/7/2009 (H1N1)-like
A/Perth/16/2009 (H3N2)-like
B/Brisbane/60/2008-like
Inactivated, live cold adapted
Influenza Vaccine ScheduleYearly – start when you get it
Children under 3 years: lower dose
Child 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 States
Mumps outbreak over in NJ
MMRV combination – more fever
We should be immune: born before 1957, + titer or received 2 doses of vaccine
Varicella VaccinePrevents serious illness
Outbreaks persist
Second dose now recommended for all
Routine at 4-5 years, MMRV
Catch up for older
Zoster vaccineZostavax
Approved May 2006
Age 60 and above; now 50 and above
Protect yourself when the time comes
Tdap: Boostrix, AdacelTetanus, diphtheria, pertussis booster
For teens (both) and adults (Adacel)
Licensed in spring 2005
Should alter epidemiology and protect infants
Protect yourself and your staff
Targeted adultsAnyone caring for young infants
Cocoon the infants by immunizing contacts
Healthcare people
Pregnant women in late 2nd, 3rd trimester
Give 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 years
Pregnant 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 dose
Highest risk: initial 2 dose series followed by booster doses every 5 years
At risk healthcare: microbiologists only
Rotavirus vaccines
The old: Rotashield
Rhesus rotavirus reassortant
Licensed 8/98
Withdrawn 10/99
Intussusception risk < 1/10,000
Rotavirus vaccinesThe new: RotaTeq, Rotarix
RotaTeq: human-bovine reassortant
Well tolerated, effective, over 70,000
Licensed February 2006
Rotarix: monovalent, human strain
Licensed and used outside US
Safety Issues
Porcine circoviruses: no harm
Rates of intussusception among vaccine recipients closely studied; post-licensure
studies results vary
Benefits greatly outweigh risks
Haemophilus influenzae type b
Disease dramatically decreased in US
Conjugate vaccine eliminates carriage
Keep vaccinating!
Streptococcus pneumoniaeDramatic decrease in US since PCV7
Decrease in adult disease as well
PCV13 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 countries
Live oral: not in US since 2000, source of some recent outbreaks
Inactivated: safe effective, 4 dose series, last/extra dose at 4 to 6 years
Hepatitis A Vaccines
Inactivated
Two doses, 6 months apart
Prior to 2006: at risk or in high incidence state
Now: at risk and all children at age 1
Catch up is reasonable
HPV VaccinesVirus-like particles genetically engineered
Quadravalent and bivalent vaccines
Well tolerated and immunogenic
Three dose series
Universal for girls; permissive for boys
Websites
www.aap.org
www.cdc.gov
www.immunizationinfo.org
www.vaers.org
Smiling is a contagious condition!
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