1 / 45

Immunizations

Immunizations . Childhood and Adolescent Jan Bazner-Chandler CPNP, MSN, CNS, RN. What Immunization Is. Immunization is the process by which a subject is rendered immune or resistant to a specific disease Natural exposure – contact with the agent

murray
Download Presentation

Immunizations

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Immunizations Childhood and Adolescent Jan Bazner-Chandler CPNP, MSN, CNS, RN

  2. What Immunization Is • Immunization is the process by which a subject is rendered immune or resistant to a specific disease • Natural exposure – contact with the agent • Artificial exposure – parts of the infectious agent or inactivated version is given for the purpose of becoming immune to the disease agent it causes.

  3. Childhood Immunization • Childhood immunization schedule American Academy of Pediatrics • http://www.cispimmunize.org/ • Download children age 0 - 6 • Download children age 7 - 18 http://www.cispimmunize.org/

  4. Hepatitis B (HepB) Vaccine • All infants should receive the first dose soon after birth or before hospital discharge. • Second dose should be given at least 4 weeks after the first • Third dose 16 weeks after the first dose and at least 8 weeks after the second dose • Last dose should not be administered before age 24 months • Infants born of HbSAd-postive mothers should receive first immunization within 12 hours of birth

  5. Diphtheria, Tetanus, Acellular Pertussis • DTaP • Given at 2, 4 and 6 months • 4th dose between 15 and 18 months • Last DTaP at the 4-6 year pre-K check up • 1st Td at age 11-12 years or at least 5 years from last DTap • Every 10 years after that • A booster of Tetanus / Pertussis - teens

  6. Polio • Injection form at 2 months, 4 months after 6 months and at kindergarten check-up • Oral not given due to shedding in urine

  7. Haemophilus Influenza Type b • Hib • Given at ages 2 and 4 months • Last dose at 12 months • Any child entering child care or pre-kindergarten under age 5 years would be required to have Hib. • Not a standard immunization for children born outside the USA

  8. Measles, Mumps, Rubella • MMR • Two doses: • 1st 12 months or older • 2nd dose kindergarten visit • If no record of second dose it should be given at 11 to 12 year old visit • May develop a rash a week to ten days after immunization • Not immunized against wild strain – exposure would bring milder case

  9. Varicella • Chicken pox – recommended at any visit after 12 months for susceptible children (those who lack a reliable history of chicken pox) • Susceptible children over 13 years would receive two doses at least 4 weeks apart

  10. Pneumococcal Vaccine • PCV - Prevnar • Recommended for all children 2 to 23 months and certain populations up to 59 months • 2, 4, 6 and 4th dose after 12 months of age • Asthma • Sickle cell anemia • Cystic fibrosis

  11. Human Papillomavirus • HPV is the most common sexually transmitted virus • 40 types of HPV • Spread through sexual contact • Can cause cervical cancer • Can also cause genital warts

  12. Human Papillomavirus • HPV series • Recommended for all girls 11-12 years • Can be given as young as 9 years • Get HPV before first sexual contact • 1st dose • 2nd dose 2 months after 1st dose • 3rd dose 6 months after dose one

  13. HPV • Contraindications: • Allergy to yeast or reaction to first immunization • HPV will not help if already infected

  14. Meningococcal • Meningococcal disease is a serious illness • Leading cause of bacterial meningitis in 2 – 28 year old in USA

  15. Meningococcal polysaccharide Vaccine • MPSV4 • Prevents 4 types of meningococcal diseases – 2 out of 3 of the most common strains seen in the US

  16. Recommendations • MCV4 recommended for all children at their routine preadolescent visit (11 – 12 years) • College freshmen living in dorms • U.S. military recruits • Traveling to Africa • Persons exposed to meningitis outbreak

  17. Premature Infants • AAP currently recommends that all premature infants receive full dose immunizations at the same chronologic age as term infants even if hospitalized • Contraindications include: significant febrile seizure, active seizure disorders, encephalopathy (DTaP) • Infants with BPD or RAD should receive influenza immunizations • Infants with congenital heart and premature infants immunization against RSV.

  18. Premature continued • Hepatitis B may be deferred until discharge unless mother is Hep B positive • OPV should not be given in NICU • Do NOT dilute dosages • Usually given when they reach at least 2 kg or 4.4 pounds

  19. To Immunize or Not to Immunize • Children on antibiotics • Children with minor illness – otitis, cough, diarrhea, sore throat, low grade fever • Children with mild allergies • Breast feeding infants • Children with pregnant household contacts

  20. True Contraindications • True allergic response • Rash or hives after previous vaccination • Allergy to eggs or egg products should not be given influenza vaccination • Allergic to streptomycin should not be given IPV or influenza vaccination

  21. Reactions to Immunizations • Fever greater than 103, shock or collapse, or inconsolable crying for greater than 3 hours. (DTaP) • Low grade fever, fussiness, and soreness at injection site are not reasons to prevent further vaccinations • Mild rash or fever may occur 10 days to 2 weeks after MMR or Varicella

  22. Interventions • Tylenol every 4 hours for fussiness or low grade fever • Warm bath • NO ASPIRIN • NO Motrin for infants under 6 months of age • Motrin is every 6 hour dosing / Tylenol every 4 hour dosing

  23. Adolescents • Hepatitis A (recommended only) • Pneumococcal if they have any chronic disease: heart, sickle cell disease, cystic fibrosis, diabetes, or organ transplant or receiving chemotherapy • Hepatitis B • MMR: second booster • Td every 10 years after age 16 • Varicella if no reliable history or negative titers • Meningococcemia for all college freshman and all military • Influenza yearly • Pertussis Booster

  24. Hepatitis A • Recommended for children and adolescents living in selected states or regions and for certain high risk groups • This would include California, Texas, and Arizona

  25. Live Vaccines • MMR and Varicella • Pregnancy • HIV + • Immunodeficiency • Chemotherapy: not given until 6 months after treatment is completed.

  26. L.A. Unified Recommendations • Complete health and immunization record • All new students must have written results of a PPD test for tuberculosis within 12 months • If Manoux test is positive a chest x-ray is required • Treatment is recommended unless the child has some immune suppressed condition.

  27. PPD Waiver • I hear by request exemption of the child from the tuberculosis assessment requirement for school / childcare entry because this is contrary to my beliefs. I understand that should there be cause to believe that my child is infected with active TB or should there be a tuberculosis outbreak, my child may be temporarily excluded from school.

  28. Pre-school and Child Care • Pre-kindergarteners must be immunized against Haemophilus influenza type B or Hib. • This is not a standard immunization for children born outside the United States • Hib would not be required for a child over 5 years of age.

  29. Kindergarten • Second MMR: Measles, Mumps, Rubella • Hepatitis B • Hepatitis A in high risk areas • Td: tetanus and diphtheria

  30. Communicable Diseases • Chicken pox (varicella) • Measles (Rubeola) • Pertussis (Whooping Cough) • Rubella (German Measles) • Scarlet Fever • Mumps

  31. Varicella • Agent: varicella zoster virus • Transmission: respiratory • Period of communicability: 1 day before eruption of vesicles. • Prodromal phase: slight fever, malaise, pruritic rash; macular to papular to vesicular.

  32. Varicella

  33. Management of Varicella • Isolation • Skin care: tepid bath, calamine lotion, clip finger nails. • Keep from scratching • Antihistamines for itching - Benadryl • No ASA – acetaminophen only. • Varicella vaccine now available.

  34. Measles or Rubeola • Agent: Virus • Transmission: respiratory, blood and urine • Incubation period: 10 to 20 days • Period of Communicability: 4 days before and 5 days after rash appears. • Prodromal stage: fever, cough, conjunctivitis, Koplik spots.

  35. Rubella or German Measles • Agent: Rubella virus • Source: nasopharyngeal secretions; secretions in blood, stool, and urine. • Transmission: direct contact. • Incubation period: 14 to 21 days • Period of communicability: 7 days before to 5 days after appearance of rash.

  36. Rubella • Rash first appears on face and rapidly spreads downward • Isolate from pregnant women • TORCH – effects fetus

  37. Management of Scarlet Fever • Respiratory precautions for 24 hours. • Oral antibiotic for 10 days. • Treat sore throat with analgesics, gargles, lozenges, and antiseptic throat spray. • Encourage fluids. • See PMD if fever persists.

  38. Mumps In mumps the parotid glands swell and obscure the angle of the jaw.

  39. Pertussis (Whooping Cough) • Agent: Bordelella Pertussis • Source: Respiratory • Transmission: droplet spread or contact with contaminated article. • Incubation period: 10 days • Period of communicability: before onset of paroxysms to 4 weeks after onset.

  40. Interventions • Erythromycin for the child and all contacts • Very dangerous for the neonate – most often the contact is an adult with a chronic cough • May led to hospital admission – ventilator assist

  41. Scarlet Fever

More Related