Childhood Immunisations and Development

1. Childhood Immunisations and Development By Dr Sarah Ramruttun-Mulcock GPVTS

2. Brief Overview • Introduction • Practice AKT questions • Revision of the diseases we vaccinate against • Small group work • More AKT questions • Child development- Red Flags • Even more AKT questions!! • Summary and answers

3. Introduction • Why learn about immunisations/child development? • Pass the AKT!! Area that is regularly tested and regularly deemed weak in exams • Condensed curriculum: • National immunisation programmes and the GPs role in promoting and organising immunisation. • Normal growth and development, management of delayed development and failure to thrive • Be able to talk confidently with parents about the immunisations (how many injections, after effects, what does it protect against) • Health promotion...herd immunity, reduce illnesses normally caused by the diseases

4. Now for the Practice!! • Have a go!! • Questions have been lifted from passmedicine • Gives an idea of what to expect....... • GUESS!!

5. Overview of Diseases • Diphtheria (D): Corynebacteriumdiphtheriae. Throat and chest infection. Rare in UK. • Tetanus (T): Clostridium tetani (found in soil) Severe muscle contractions- fatal. • HaemophilusInfluenzae type b (Hib): causes pneumonia and meningitis. Most risk below age of 4. • Pertussis (aP): Whooping cough, Bordetellapertussis. Prolonged, distressing cough. Can lead to pneumonia and encephalitis • D/ aP/Hib/: fragmented vaccines, extracts of the organism/ virus used • Tetanus: detoxified exotoxins

6. Overview of Diseases • Poliomyelitis (IPV): infection through the gut, then on to cause meningitic type illness. Affects nerves resulting in muscle wasting which can cause paralysis of 1+ limbs. Affects breathing in some cases. Was given orally, now injected. • Pneumococcus (PCV): causes pneumonia, meningitis. Extremes of age are most vulnerable to this disease. Introduced in 2006. • Group C meningococcus (Men C): meningitis and septicaemia. • PCV/ Men C: fragmented vaccines

7. Overview of Diseases • Measles: miserable feverish illness with rash. Koplik spots – white spots on buccal mucosa. Increasing incidence due to children not being immunised • Mumps: Inflammation and swelling of salivary glands. May cause permanent deafness in one ear. • Rubella: mild illness with rash, starts on the face and then spreads. • MMR and BCG are live attenuated vaccines ( also oral polio, yellow fever and oral typhoid)

8. Overview of Diseases • Human Papillomavirus (HPV): • affects skin and mucosa • HPV 16 & 18 involved in most cases of cervical cancer • Cervarix (endorsed by government) 3 injections; 2nd given 1-2 months, 3rd at 6m • Gardasil: protects against viral warts, covers HPV 6, 11, 16 and 18

9. Group Work • 2 small groups to devise imms schedule • Match the corresponding ages to the relevant vaccines • Each vaccine at the correct time scores a point • Winning group gets a treat!!

10. Correct Schedule • At Birth: BCG/Hep B (if high risk) • 2 months: DTaP/ IPV/ Hib+ PCV • 3 months: DTaP/ IPV/ Hib+ Men C • 4 months: DTaP/ IPV/ Hib+ PCV + Men C • 12-13m: MMR+ Hib/Men C + PCV • 3-5yrs: MMR +DTaP/ IPV • 12-13yrs: HPV • 13-18yrs: DT/IPV • DT always given with IPV, given with aP apart from 1yr/18yr • Hib not given after age of 4 yrs • 2 lots of MMR back to back • PCV/Men C given up to the age of 1 yr

11. Correct Schedule

12. More AKT questions • Re- answer previous AKT questions • Added some “curve- ball” questions • Answers revealed at the end

13. Child Development • Not something that is easily taught or learnt • Even as a parent.....each child is different • Development is most rapid during the first four years of life • Key is to notice the abnormal from the normal • May be useful to split the periods of development: - The newborn baby - The supine infant (6-8 wks) - The sitting infant (6- 9 m) - The mobile toddler (18- 24m) - The communicating child (3-4 yrs)

14. Red flags in Development • Does not roll over in either direction by the end of 4 months of age yellow flag • Does not respond to sounds or turns head to locate sound by age 7 months red flag • Cannot stand when unsupported age 12 months yellow flag • Does not speak at least 15 words and begin to use 2 word sentences by age 2 years red flag • Does not walk by 18 months or walks exclusively on tiptoes red flag • Cannot build a tower of more than 6-8 blocks by the age of 3 years yellow flag

15. Red flags in Development • Not jumping by the age of 30 months red flag • Not feeding themselves with finger food by the age of 14 months red flag • Not smiling by 1 month yellow flag • Not interested in pretend play by 2-3 years of age red flag • Doesn’t pass objects from one hand to another by age 9 months red flag

16. Even more AKT questions!

17. Answers Immunisations: • (b) Mumps is a live attenuated vaccine • (e) Hib/ Men C, MMR, PCV • (c) 5 • (a) Clean wound and IM tetanus Ig • (d) MMR with repeat dose at 3 months • (a) Child can have the vaccine

18. Answers Child development: • (e) 4 years • (b) 9 months • (c) 6 weeks (see handout on developmental milestones)

19. Summary • Gone through and (hopefully) learnt the immunisation schedule • Learnt about some of the red flags in child development • Answered AKT questions along the way • Wow the examiners with our impressive knowledge at the AKT exam!

20. Thank you for listening!! Any Questions..... Ask the Boss!!