CHILDHOOD IMMUNIZATIONS
Virginia Keane, MDAssociate Professor, PediatricsUniversity of Maryland School of Medicine
Shots Hurt! Why Do We Have To Give Them? Vaccines work! Vaccines are THE most effective
preventive measure that modern medicine has derived
Vaccine Effect on Morbidity Disease Baseline
morbidity1998 morbidity % decrease
smallpox 48,164 0 100
diptheria 175,885 1 100
pertussis 147,241 7405 95
tetanus 1314 41 97
polio 16,316 1 100
measles 503,282 100 100
mumps 152,209 666 >99
rubella 47,745 364 >99
Congenital rub. 823 7 >99
Hemophilus B 20,000 61 >99
Vaccine Policy Recommended by an expert panel
convened by the CDC: the ACIP, Advisory Committee on Immunization Practice
Recommendations may then be adopted by professional organizations and state and local health departments
State and local health departments alter policy according to local needs
A Brief Intro to the Biology of Vaccines Antigens are substances our bodies view as
FOREIGN Our immune system recognizes FOREIGN
antigens and mounts an immune response, in the form of ANTIBODIES to eliminate it.
After the antigen has been eliminated the immune system retains a memory of that antigen: next time it appears the antibody response is faster and stronger!!
Germs Are Antigens The proteins and
sugars on the walls of viruses and bacteria are FOREIGN
Your body makes antibodies to fight them off
Theory of Vaccines Present the body with a germ antigen that
can not produce disease Body will produce antibodies to the germ This will prevent disease if the body later
encounters that germ, because the antibodies will fight off the germ before it has a chance to make you sick
Vaccine Types Live vaccines: attenuated, must reproduce
to produce immune response Killed vaccines: pieces (sugars or
proteins) of the germ wall, can not reproduce
Conjugated vaccines: germ sugar attached to a protein to enhance immune response
Vaccine Preventable Diseases Killed Vaccines: Diptheria, Pertussis,
Tetanus, Hepatitis B, Polio Live Attenuated: Measles, Mumps,
Rubella, Varicella, Polio Conjugated: HIB, PCV
DiptheriaBacterial:
Corynebacterium diptheriae
Person to personSevere throat infections,
can obstruct breathingMyocarditis can be fatal
Tetanus Bacterial infection: Clostridium tetani,
occurs in deep wounds Not transmissable person to person Bacteria makes a toxin that effects nerves,
causing trismus/lockjaw and severe muscle spasms
Adults should be vaccinated every ten years to maintain immunity
Pertussis Bacteria: Bortadella
Pertussis Starts as a cold,
progresses to pneumonia and encephalitis
“whooping cough” Adults serve as a
reservoir Newer acellular vaccine
has many fewer side effects
Haemophilus Influenzae B Bacterial infection: can cause ear and sinus
infections, skin infections(cellulitis), pneumonia, joint and bone infections, epiglottitis
Prior to vaccines was the most common cause of childhood bacterial meningitis(brain damage, deafness, death)
Hepatitis B Viral disease spread by sharing of body
fluids: blood, sexual fluids Most cases resolve, but it can lead to
chronic hepatitis, liver failure, liver cancer, and death
Immunization strategies targeting high risk individuals failed
Polio Viral, mostly asymptomatic,
can cause meningitis, gastroenteritis and paralytic polio
Last wild type case in US, 1979, west hemisphere 1991
Recent change from OPV(oral live attenuated) to IPV(inactivated,) due to ongoing incidence of vaccine associated cases
Varicella Viral, herpes family “chicken pox” Usually mild, self
limited :fever, rash Can get pneumonia,
cerebellitis, encephalitis, even death
Measles Viral disease, rapid
person to person to person transmission among susceptibles
High fever, red eyes, rash, misery
Outbreak in 1989-90 due to large number of unvaccinated kids
Mumps Viral disease
characterized by fever and swelling of saliva glands
Orchitis common, sterility rare
Sporadic cases and outbreaks still occur
Rubella Viral, humans only “German Measles” Low grade fever, joint
pains, swollen glands, rash
Congenital rubella: mental retardation, cataracts, heart deformities
Pneumococcal Conjugate Bacterial: Streptococcus
Pneumoniae Severe invasive
infections: pneumonia, meningitis, skin, bone and joint infections
Major cause of mortality in immuncompromised and children with sickle cell disease
New vaccine :seven serotypes
Other Vaccines Hep A: food borne viral hepatitis, vaccine to
people over 2 yrs in areas of outbreak Menigococcus: bacteria that causes meningitis,
not universally recommended, required by many colleges and the armed forces
Influenzae: Injection recommended only for high risk kids( chronic lung and some heart disease, immunocompromise, diabetics, sickle cell)
Vaccine ScheduleAge 1982 2002
birth HepB, BCG
1 month HepB
2 months DTP,OPV DTaP,IPV, HIB, PCV
4 months DTP,OPV DTaP,IPV, HIB, PCV
6-9 months DTP DTaP, HIB, PCV
12-15 months MMR MMR,HepB, HIB, IPV,PCV
15-18 DTP,OPV DTaP, Varicella
4 years DTP,OPV MMR, DTaP
total 7 diseases, 6 shots 11 diseases, 22 shots
Vaccines in UseVaccine Diseases Schedule Adverse effects
DTaP Diptheria, Tetanus, Pertussis
2,4,6, 15 mos4 years
Local reaction,fever, crying,
IPV polio 2,4,12 mos,4yrs Local reaction
MMR Measles, mumps, rubella
12mos, 4yrs Fever, joint pain, rash
Varicella Chicken pox 12 mos, 2 for teens Local,Fever,rash
HepB HepatitisB Birth, 1mo, 6-9mos
Local, fever
PCV Strep pneumoniae 2,4,6,15 mos Local, fever
HIB Hemophilus 2,4,6,12 mos Local,fever
Expanded Program on Immunization (DOH)
Vaccine Age (1st dose)
# of doses
Dose Interval Route
Bacillus Calmette-Guérin Birth 1 0.05 mL None Intradermal
Diptheria-Pertussis- Tetanus 6 weeks 3 0.5 mL 4 weeks Intramuscular
Oral Polio Vaccine 6 weeks 3 2 drops 4 weeks Oral
Hepatitis B Birth 3 0.5 mL 0 – 6 – 8 weeks
intramuscular
Measles 9 months 1 0.5 mL None Subcutaneous
Adolescent Vaccines Td: Tetanus, Diptheria booster: given at 10-14
years of age, and every ten years thereafter!! Hepatitis B: if not previously vaccinated: can get
a two dose regimen Varicella: if not previously given, two doses May see introduction of Pertussis booster in
future
Vaccine Rates 1989-1990 measles outbreak, >1000 cases,
many hospitalizations, several deaths Results of many studies revealed that the
main reason for the outbreak was the existence of a large number of UNIMMUNIZED children