National Immunization Partners Program Second Visit

1
National Immunization Partners ProgramSecond
Visit

Interamerican College of Physicians and Surgeons
2
Topics second visit

• Catch-up Immunization Schedule for Persons Aged 4
  Months Through 18 Years Who Start Late or Who Are
  More Than 1 Month BehindUnited States 2009
• Immunization Schedules for Adults
• Diseases Vaccines Facts
• Vaccines for Children Program (VFC)
• Vaccine Myths
• Immunization Resources
• Independent Study Material
• Website Recommended to book mark in your
  Computer

3
Catch-up Immunization Schedule for Persons Aged 4
Months Through 6 Years
4
CATCH-UP SCHEDULE FOR PERSONS AGED 7 THROUGH 18
YEARS
5
Recommended Adult Immunization Schedule United
States, 2009www.cdc.gov/mmwr/PDF/wk/mm5753-Immuni
zation.pdf
6
Vaccines that might be indicated for adults based
on medical and other indications United States,
2009
7
Diseases Vaccines Facts

• Diphtheria and Diphtheria Toxoid Vaccine
• Tetanus and Tetanus Toxoid Vaccine
• Pertussis and Pertussis Vaccine
• Rotavirus and Rotavirus vaccine
• Polio and Polio Vaccine
• Haemophilus influenzae type B and Hib Vaccine
• Influenza and Influenza vaccine
• Measles and Measles Vaccine
• Mumps and Mumps Vaccine
• Rubella and Rubella Vaccine
• Varicella and Varicella Vaccine
• Herpes zoster and Single vaccine
• Hepatitis A and Hepatitis A Vaccine
• Hepatitis B and Hepatitis B Vaccine
• Human papilloma virus vaccine and HPV Vaccine
• Pneumococcal Disease and Pneumococcal Vaccine
• Meningococcal Disease and Meningococcal Vaccine

8
Corynebacterium Diphtheriaehttp//www.cdc.gov/vac
cines/vpd-vac/diphtheria/default.htm

• Aerobic gram-positive bacillus
• This germ produces a poisonous toxin which
  frequently causes heart and nerve problems
• Insidious onset of exudative pharyngitis
• Exudates spreads within 2-3 days and may form
  adherent membrane
• Fever usually not high but patient appears toxic

• Membrane may cause Respiratory obstruction

9
Clostridium Tetanihttp//www.cdc.gov/vaccines/vpd
-vac/tetanus/default.htm

• Anaerobic gram spore-forming bacteria
• Estimated gt215,000 deaths worldwide in 1998
• Generalized tetanus descending symptoms of
  trismus (lockjaw), difficulty swallowing, muscle
  rigidity and spasms

10
Pertussis Pathogenesishttp//www.cdc.gov/vaccines
/vpd-vac/pertussis/default.htm

• Highly contagious respiratory infection caused by
  Bordetella Pertussis
• Estimated 285,000 deaths worldwide in 2001
• Attachment to cilia of ciliated epithelial cells
  in respiratory tract
• Local tissue damage in
• respiratory tract
• Systemic disease may
• be toxin mediated

11
Vaccine Dtap, Tdap

• DTaP and pediatric DT used through age 6 years
• Tdap Td for person gt 7 years
• One dose of DTap, at each of the following ages
  2, 4, 6, and 15-18 months and 4-6 years
• A single dose of Tdap is recommended for
  adolescents 11 or 12 years of age, or in place of
  one Td booster in older adolescents and adults
  age 19 through 64
• Td is a tetanus-diphtheria vaccine given to
  adolescents and adults as a booster shot every
• 10 years
• Tdap is similar to Td but also containing
  protection against Pertussis

12
Rotavirus Disease in the United States Annually
Responsible For http//www.cdc.gov/vaccines/vpd-v
ac/rotavirus/default.htm

• More than 400,000 Physician Visits
• 55,000-70,000 hospitalizations
• More than 200,000
• emergency dept visits
• 20-60 Deaths

13
Rotavirus vaccine (Rota)

• The new rotavirus vaccine is recommended in a
• 3-dose schedule at ages of
• 2 months
• 4 months
• 6 months of age
• Administer the first dose at age 612 weeks
• Do not start the series later than age 12 weeks
• Administer the final dose in the series by age 32
  weeks
• Do not administer a dose later than age 32 weeks
• Data on safety and efficacy outside of these age
  ranges are insufficient

14
Poliovirushttp//www.cdc.gov/vaccines/vpd-vac/pol
io/default.htm

• Entry into mouth
• Enterovirus (RNA)
• Three serotypes 1, 2, 3
• Replication in pharynx, GI tract, local
  lymphatic
• Hematology spread to lymphatic and central
  nervous system
• Viral spread along nerve fibers
• Destruction of motor neurons

15
Inactivated Polio Vaccine

• Contains 2-phenoxyethanol, neomycin,
  streptomycin, polymyxin B
• Only IPV is available in the United States
• Schedule begun with OPV should be completed with
  IPV
• Any combination of 4 doses of IPV and OPV by 5
  years constitutes a complete series
• Routine vaccination of US residents gt 18 years of
  age not necessary or recommended
• May consider vaccination of travelers to
  polio-endemic countries and selected laboratory
  workers

Age Vaccine Minimum interval 2
months IPV ---- 4
months IPV 4 wks 6-18 months IPV
4 wks 4-6 years IPV 4 wks
16
Haemophilus influenzae type bhttp//www.cdc.gov/v
accines/vpd-vac/hib/default.htm

• Severe bacterial infection, particularly among
  infants
• Aerobic gram Negative bacteria
• Polysaccharide capsule
• Six different serotypes (a-f) of polysaccharide
  capsule
• 95 of invasive disease caused
• by type b
• Cause 3 million cases of meningitis and severe
  pneumonia, approximately 386,000 deaths worldwide
  per year in children aged lt5 years

17
Haemophilus influenzae type b VaccineUse in
Older Children and Adults

• Generally not recommended for persons older than
  59 months of age
• But think about if patient have sickle cell
  anemia, or if the immune system is weakened
  because of
• HIV/AIDS or other diseases that affect the immune
  system
• Treatment with drugs such as long-term steroids
• Cancer treatment with x-rays or drugs
• Bone marrow or organ transplant
• Damaged spleen or no spleen

18
Haemophilus influenzae type b VaccineRoutine
Schedule

• Vaccine 2 mo 4 mo 6 mo 8-12 months
• HBOC X X X X
• PRP-T X X X X
• PRP-OMP X X X
• PedvaxHIB or ComVax

19
Influenza http//www.cdc.gov/vaccines/vpd-vac/fl
u/default.htmdisease

• The flu is a contagious respiratory illness
  caused by influenza viruses
• Every year in the United States, on average 5
  to 20 of the population gets the flu
• More than 200,000 people are hospitalized from
  flu complications, and about 36,000 people die
  from flu
• People who should get vaccinated each
  year are
• Children aged 6 months until their 5th birthday,
  Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical
  conditions
• People who live in nursing homes and other long
  term care facilities Who Should
  Not Be Vaccinated
• People who have a severe allergy to chicken eggs
• People who have had a severe reaction to an
  influenza vaccination in the past
• People who developed Guillain-Barré syndrome
  (GBS) within 6 weeks of getting an influenza
  vaccine previously
• Children less than 6 months of age
• People who have a moderate or severe illness with
  a fever should wait to get vaccinated until their
  symptoms lessen

20
Influenza and pneumonia death rates per 100,000,
by age United States, 2004

• Age in Years Infl. and Pneumonia Inf. Pneum.
• 45-54 4.6
  0.1 4.5
• 55-64 10.8 0.2
  10.7
• 65-74 34.6 0.5
  34.0
• 75-84 139.3 2.2
  137.0
• 85 and over 582.6 11.4
  571.2
• The death rate from influenza and pneumonia is
  nearly 130 times higher among persons 85 years of
  age and over than among persons 4554 years of
  age. This increase in risk with age is
  substantially larger than that seen for heart
  disease, cancer, stroke, and other leading causes
  of death.
• Age-adjusted influenza and pneumonia death
  rates per 100,000 population aged 65 and over, in
  N Y is 181.2

21
Trends in Influenza and Pneumonia Among Older
Persons in the United Stateshttp//www.cdc.gov/nc
hs/data/ahcd/agingtrends/08influenza.htmT2

• Between 1997 and 2006, the rate of persons aged
  65 years and over with an annual influenza
  vaccination remained relatively stable and was 64
  percent in 2006
• New York 63.9
• Florida 60.7
• New Jersey 65.5
• Texas 65.2
• Colorado 76.5
• Minnesota 76.4
• South Dakota 75.4
• The rate for lifetime Pneumococcal vaccination
  increased from 43 percent in 1997 to 56 percent
  in 2002
• Remained at 56 to 57 percent through 2006
• Non-Hispanic black and Hispanic persons continue
  to have significantly lower vaccination rates
  than those of non-Hispanic white persons

22
Influenza-related deaths in children are tragic

• 10 child deaths from laboratory confirmed
  influenza-related complications have been
  officially reported during the 2007-08 flu season
• Nine of these deaths occurred from January 1
  February 2, 2008. This increase in reports of
  deaths among children coincides with an increase
  in flu activity in the country

23
Timing of Influenza Vaccine Programs

• Providers should begin offering vaccine soon
  after it becomes available, if possible by
  October
• To avoid missed opportunities for vaccination,
  providers should offer vaccine during routine
  healthcare visits or during hospitalizations
  whenever vaccine is available

24

• Influenza and Complications Among Nursing Home
  Residents

RR1.9
RR2.0
RR2.5
RR4.2
Inactivated influenza vaccine. Genesee County,
MI, 1982-1983
25
Inactivated Influenza Vaccines (TIV) Live,
attenuated influenza vaccine (LAIV)

• Minimum age 6 months for trivalent inactivated
  influenza vaccine TIV
• 2 years for live, attenuated influenza vaccine
  LAIV)
• Administer annually to children aged 6 months
  through 18 years
• For healthy nonpregnant persons aged 2 through
  49 years, either LAIV or TIV may be used
• Children receiving TIV should receive 0.25 ml if
  aged 6 through 35 months or 0.5 ml if aged 3
  years or older
• Administer 2 doses (separated by at least 4
  weeks) to children aged younger than 9 years who
  are receiving influenza vaccine for the first
  time or who were vaccinated for the first time
  during the previous influenza season but only
  received 1 dose

26
FluMist Contraindicated

• The FluMist vaccine is contraindicated in those
  with asthma
• children under age 2 years, and children under
  age 5 years who have recurrent wheezing because
  there is an increased risk of exacerbation of
  that symptom
• It also should not be given to children
  receiving concomitant aspirin, or therapy
  containing aspirin

27
Measles Clinical Featureshttp//www.cdc.gov/vacci
nes/vpd-vac/measles/default.htm

• Maculopapular, becomes confluent
• Begins on face and head
• Persists 5-6 days
• Highly contagious viral illness
• Paramyxovirus (RNA)
• Hemagglutinin important surface antigen
• One antigenic type
• Rapidly inactivated by heat and light

28
Measles United States, January 1April 25, 2008
http//www.icps.org/index/article_list.php?id4t
ypeson

• From January 1 through April 25, 2008, CDC
  received a total of 64 reports of confirmed
  measles cases in the U.S. This is the highest
  number reported for the same time period since
  2001
• Cases have been reported from the 9 states
  outbreaks are ongoing in 4 Wisconsin, Arizona,
  Michigan, and New York
• 14 patients were hospitalized no deaths have
  been reported
• These cases and outbreaks resulted primarily from
  failure to vaccinate, many because of personal or
  religious belief exemption
• Spread of measles has been controlled or limited
  due to
• 1. high vaccination coverage in the U.S.
• 2. excellent two-dose vaccine performance
• 3. rapid and effective public health
  responses

29
Mumps Clinical Featureshttp//www.cdc.gov/vaccine
s/vpd-vac/mumps/default.htm

• Incubation period 14-18 days
• Prodrome of myalgia, malaise
• headache, low-grade fever
• Parotitis in 30-40
• Paramyxovirus
• Respiratory transmission of virus
• Replication in nasopharynx and regional lymph
  nodes
• Viremia 12-25 days after exposure with spread to
  tissues
• Multiple tissues infected during viremia

30
Rubella Clinical Featureshttp//www.cdc.gov/vacci
nes/vpd-vac/rubella/default.htm

• Toga virus
• Respiratory transmission of virus
• Incubation period 14 days
• Maculopapular rash 14-17 days after exposure
• Replication in nasopharynx and regional lymph
  nodes

31
Congenital Rubella Syndrome

• Deafness, Cataracts,
• Heart defects
• Microcephaly, Mental retardation
• May lead to fetal death or premature delivery
• Severity of damage to fetus depends on
  gestational age
• Up to 85 of infants affected if infected during
  first trimester
• Most reported rubella in the U.S. since the
  mid-1990s has occurred among foreign-born
  Hispanic adult

32
Measles, Mumps, Rubella

• MMR Vaccine indications
• First dose to all infants gt12 months of age
• Second dose is recommended routinely at age 4-6
  years
• Adult born before 1957 can be considered immune
  to measles
• Adult born during or after 1957 should received
  gt1 dose
• Second dose is for the adult who have recently
  exposed to measles, mump outbreak

33
Autism Controversy

• Melinda Wharton Deputy Director of the
  National Center of Immunization and Respiratory
  Diseases at CDC. Said in February 2008, about
  aluminum, formaldehyde and ether.
• Theres parents that have lots of concerns about
  vaccines and vaccine ingredients. But all of the
  things that are included in vaccine manufacturing
  are there for a reasonto make vaccine safe and
  effective. And theres now been a good deal of
  research around vaccines and autism. And that
  research does not support an association between
  vaccines and autism
• Removed thimerosal, mercury, from childhood
  vaccines was done in 1999, Thimerosal was removed
  from vaccines because we are concerned about
  mercury. The U.S. Public Health Service and the
  American Academy of Pediatrics called to be
  removed from vaccines administered to young
  children.
• The only vaccine we routinely give to young
  children that still contains thimerosal as a
  preservative is some formulations of influenza
  vaccine

34
Decisions of the U.S. Court of Federal Claims in
Omnibus Autism Proceeding February 12, 2009

• The U.S. Court of Federal Claims divided the
  claims into three different theories
• Theory 1 MMR in combination with
  thimerosal-containing vaccines can cause autism.
• Theory 2 Thimerosal-containing vaccines alone
  can cause autism.
• Theory 3 The MMR vaccine alone can cause autism
• Each of the Special Masters ruled that the
  measles-mumps-rubella vaccine, whether
  administered alone or in conjunction with
  thimerosal-containing vaccines,
• were not causal factors in the development of
  autism or autism spectrum disorders

35
Varicella Clinical Features http//www.cdc.gov/vac
cines/vpd-vac/varicella/default.htm

• Herpes virus (DNA)
• Incubation period 14-16 days
• Generally appear first on head most concentrated
  on trunk
• Successive crops (2-4 days) of pruritic vesicles
• Primary infection results in varicella
  (chickenpox)
• Recurrent infection results in herpes zoster
  (shingles)
• Respiratory transmission of virus
• Replication in nasopharynx and
• regional lymph nodes

36
Congenital Varicella Syndrome

• Results from maternal infection during pregnancy
• Period of risk may extend through first 20 weeks
  of pregnancy
• Low birth weight, atrophy of extremity with skin
  scarring, eye and neurologic abnormalities

37
Varicella VaccineMMRV (ProQuad)

• In Children
• Routine Vaccination at 12-18 months of age
• Recommended for all children without evidence of
  varicella Immunity by 13th birthday
• Adolescents and adults
• All persons gt 13 years of age without evidence of
  varicella Immunity
• Two doses separately by 4-8 weeks
• Do not repeat first dose because of extended
  interval between doses
• MMRV (ProQuad)
• Combination measles, mumps, rubella and varicella
  vaccine
• Approved children 12 months through 12 years of
  age (up to age 13 years)
• Titer of varicella vaccine virus in MMRV is more
  than 7 times higher than standard varicella
  vaccine

38
Shingleshttp//www.cdc.gov/vaccines/vpd-vac/shing
les/default.htm
Pain, itching or tingling of the skin which is
followed by a painful skin rash of blister-like
lesions, usually localized to a small area on one
side of the body, and often the face or trunk.
Other symptoms can include fever, headache,
chills and upset stomach.

• Shingles is a painful skin rash caused by the
  varicella zoster virus (VZV)
• Pain, itching or tingling of the skin which is
  followed by a painful skin rash of blister-like
  lesions, usually localized to a small area on one
  side of the body

39
Herpes zoster vaccination

• A single dose of zoster vaccine is recommended
  for adults aged
• gt60 years regardless of whether they report a
  prior episode of herpes zoster
• Persons with chronic medical conditions may be
  vaccinated
• unless a contraindication or
• precaution exists for their
• condition

40
Hepatitis A Clinical Featureshttp//www.cdc.gov/v
accines/vpd-vac/hepa/default.htm

• Picornavirus (RNA)
• Entry into mouth
• Viral replication in the liver
• Virus present in blood and feces 10-12 days after
  infection
• Virus excretion may continue for up to 3 weeks
  after onset of symptoms
• Incubation period 28 days
• Children generally asymptomatic, adults
  symptomatic

41
Hepatitis A Vaccine Recommendations

• International travelers
• Men who have sex with men
• Persons who use illegal drugs
• Persons who have clotting-factor disorders
• Persons with occupational risk
• Persons with chronic liver disease

42
Recommendation for Routine Hepatitis A

• All children should receive hepatitis A vaccine
  at
• 12-23 months age
• Children who are not vaccinated by 2 years of age
  can be vaccinated at subsequent visits
• Adult 1 dose and 1 booster dose 6-18 months
  after first dose
• Children and adolescent 1 dose and 1booster
  doses 6-18 months after first dose
• International travelers
• Men who have sex with men
• Persons who use illegal drugs
• Persons who have clotting-factor disorders
• Persons with occupational risk
• Persons with chronic liver disease

43
Hepatitis B Virus Infectionhttp//www.cdc.gov/vac
cines/vpd-vac/hepb/default.htm

• Hepadnaviridae family (DNA)
• gt300 million chronically infected worldwide
• Established cause of chronic hepatitis and
  cirrhosis
• Human carcinogencause of up to 80 of
  hepatocellular carcinomas

44
Hepatitis B Complications

• Fulminant hepatitis
• Hospitalization
• Cirrhosis
• Hepatocellular carcinoma
• Death

45
Hepatitis B Perinatal Transmission

• If mother is positive for HBsAg and HBeAg
• 70-90 of infants infected
• 90 of infected infants become chronically
  infected
• If positive for HBsAg only
• 10 of infants infected
• 90 of infected infants become chronically
  infected

46
Hepatitis B Pregnant Women

• All pregnant women should be tested for HBsAg
• Pregnant women who are identified as being at
  risk for HBV infection should be vaccinated
• Pregnant women at risk for HBV infection should
  be counseled concerning other methods to prevent
  HBV infection

47
Hepatitis B

• Doses at Birth or 1-2 months and 6-18 months
  with interval 4, 4 and 8 wks
• Infants who mothers are HBsAg or unknown should
  receive the third dose at 6 months of age and
  least 16 wks of interval of first
• Dose Routine vaccination recommended through age
  18 years
• Integrate into routine adolescent immunization
  visit
• Three doses (first one, 1month, 5months)
• Third dose must be separated from first dose by
  at least 16 wks

48
HPV Disease Burden in the United
Statedwww.cdc.gov/cancer/hpv/statistics/

• A large study that covered 83 of the U.S.
  population during 19982003 estimated that about
  24,900 HPV-associated cancers occur each year
• More than 17,300 HPV-associated cancers occur
  yearly in women, and almost 7,600 occur yearly in
  men
• Cervical cancer is the most common HPV-associated
  cancer among women, and head and neck (oral
  cavity and oropharyngeal) cancers are the most
  common HPV-associated cancers among men

49
Cervix, Vulvar, Vaginal,or Penile pre-cancers,
and cancers lesion
50
Human papilloma virus vaccine

• Give the first dose of the HPV vaccine series to
  females at age 1112 years
• Give the second dose 2 months after the first
  dose
• The third dose 6 months after the first dose
• Give the HPV vaccine series to females at age
  1318 years if not
• previously vaccinated

51
Neisseria meningitidishttp//www.cdc.gov/vaccines
/vpd-vac/mening/default.htm

• Aerobic gram-negative bacteria
• Severe acute bacterial infection
• Cause of meningitis, sepsis, and focal infections
• Abrupt onset of fever, meningeal symptoms,
  hypotension, and rash
• Fatality rate 9-12 up to 40 in
  meningococcemia
• Epidemic disease in sub-Saharan Africa
• Current polysaccharide vaccine licensed in 1978
• Conjugate vaccine licensed in 2005
• At least 13 Sero groups based on characteristics
  of the polysaccharide capsule
• Most invasive disease caused by sero groups A,
  B, C, Y, and W-135
• Relative importance of sero groups depends on
  geographic location and other factors (e.g. age)
• Antecedent URI may be a contributing factor

52
Neisseria meningitidis Risk factors for invasive
disease

• Host factors
• Terminal complement pathway deficiency
• Asplenia
• Genetic risk factors
• Exposure factors
• Household exposure
• Demographic and socioeconomic factors and
  crowding
• Concurrent upper respiratory tract infection
• Active and passive smoking

53
Meningococcal vaccine

• Persons who received MPSV 3 or more years
  previously and who remain at increased risk for
  meningococcal disease should be revaccinated with
  MCV
• Meningococcal conjugate vaccine (MCV)
• Administer at age 11 or 12 years, or at age 13
  through 18 years if not previously vaccinated
• Administer to previously unvaccinated college
  freshmen living in a dormitory
• MCV is recommended for children aged 2 through 10
  years with terminal complement component
  deficiency, anatomic or functional asplenia, and
  certain other groups at high risk. See MMWR
  200554(No. RR-7).
• Persons who received MPSV 5 or more years
  previously and remain at increased risk for
  meningococcal disease should be revaccinated with
  MCV.

54
Streptococcus Pneumoniaehttp//www.cdc.gov/vaccin
es/vpd-vac/pneumo/default.htm

• Gram-positive bacteria
• More than 80 serotypes described by 1940
• First U.S. vaccine in 1977
• 90 known serotypes
• Polysaccharide capsule important virulence factor
• Pneumococcal Pneumonia
• Estimated 175,000 hospitalizations per year in
  the United States
• Up to 36 of adult community-acquired pneumonia
  and 50 of hospital-acquired pneumonia
• Case-fatality rate 5-7, higher in elderly
• Pneumococcal Bacteremia
• More than 50,000 cases per year in the United
  States
• Rates higher among elderly and very young infants
• Case-fatality rate 20 up to 60 among the
  elderly

55
Pneumococcal Meningitis

• Estimated 3,000 - 6,000 cases per year in the
  United States
• Case-fatality rate 30, up to 80 in the elderly
• Neurologic sequelae common among survivors
• Children at Increased Risk of Invasive
  Pneumococcal Disease
• Functional or anatomic asplenia, especially
  sickle cell disease
• HIV infection
• Alaska Native, African
• American, American Indian
• Child care attendance

56
Pneumococcal Vaccine

• Pneumococcal conjugate vaccine is recommended for
  all children less than 24 months old
• For children between 24 and 59 months old who are
  at high risk of disease
• Older children and adults with risk factors ( 65
  years old or older, have a serious long-term
  health problem such as heart disease, sickle cell
  disease, alcoholism, leaks of cerebrospinal
  fluid, lung disease (not including asthma),
  diabetes, or liver cirrhosis, multiple myeloma
  cancer treatment with x-rays or drugs treatment
  with long-term steroids bone marrow or organ
  transplant kidney failure HIV/AIDS lymphoma,
  leukemia, nephrotic syndrome damaged spleen or
  no spleen)
• For an Alaskan Native or from certain Native
  American populations. May receive the
  Pneumococcal polysaccharide vaccine, (Pneumovax
  and Pnu-Immune).
• Revaccination with pneumococcal polysaccharide
  vaccine
• One-time revaccination after 5 years for
  persons with chronic renal
• failure or nephrotic syndrome functional or
  anatomic splenia immunosuppressive conditions.
  For persons aged gt65 years, one-time
  revaccination if they were vaccinated gt5 years
  previously and were aged lt65 years at the time

57
Vaccines for Children Program
http//www.cdc.gov/vaccines/programs/vfc/contacts-
state.htm

• CDC Vaccines for Children (VFC) Coordinators In
  New York City Angel Lapaz
• VFC Coordinator
• Dept of Health, Bureau of Immunization
• 2 Lafayette Street, 19th Floor
• New York, N.Y. 10007
• Phone [phone] Fax [phone]
  alapaz_at_health.nyc.gov
• New York Gary RinaldiNew York State Dept of
  Health, Immunization Program
• Coming Tower Bldg., Room 649
• Albany, N.Y. 12237
• Phone [phone]
• Fax [phone]
• see other State List Update in the note page of
  this Slice or at the website above

58
Vaccine Myths

• Is it okay for my baby to have so many shots at
  once?
• Dont infants have natural immunity?
• Havent we gotten rid of most of these diseases
  in this country?
• I heard that some vaccines can cause autism. Is
  this true?
• Cant I just wait until my child goes to school
  to catch up on immunizations?
• Why does my child need a chickenpox shot? Isnt
  it a mild disease?
• My child is sick right now. Is it okay for her to
  still get shots?
• Where can I get more information?

59
Independent Study Material

• Epidemiology and Prevention of Vaccine-
  Preventable Disease, The Pink Book, 10Th edition,
  National Immunization Program
• Chapters 5 through 20, Appendices A, B, C, D, E.
• http//www.cdc.gov/nip/ed/
• http//www.cdc.gov/node.do/id/0900f3ec8000e2f3
  
• http//www.cdc.gov/nip/recs/child-schedule.htm

60
For more Information

• Contact the National
• Immunization Program (NIP)
• E-mail NIPInfo_at_cdc.gov
• Hotline 800.CDC.INFO
• Website www.cdc.gov/nip

61
Can you book mark the following web site in your
computer?

• Those website will help you to review and
  update yourself
• www.cdc.gov/mmwr/PDF/wk/mm5753-Immunization.pdf
• http//www.cdc.gov/vaccines
• http//www.cdc.gov/vaccinesafety/
• http//www.cdc.gov/vaccines/programs/vfc/default.h
  tm
• http//www.icps.org/index/article_list.php?typeso
  nid40
• www.cdc.gov/vaccines/pubs/pinkbook/pink-slides.htm