Whats New With Vaccinating Little Kids

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• Whats New With Vaccinating Little Kids

Gina Holland, RN and Denise Martin,
RN Regional Immunization Nurse Consultants
2007 North Carolina Immunization Conference
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Recommended Schedule
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(No Transcript)
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• Varicella and Varicella Vaccines

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• Varicella Age-Specific Incidence United States,
  1990-1994

Rate per 100,000 population. National Health
Interview Survey data
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Varicella Vaccine Recommendations

• Routine vaccination at 12-15 months of age
• Routine second dose at 4-6 years of age
• Two doses recommended for all persons older than
  4-6 years who do not have evidence of varicella
  immunity
• Second dose recommended for persons of any age
  who have only received one dose

Recommendation as of June 2007
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Varicella Vaccines

• Varivax
• MMRV (ProQuad)

State-supplied
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Varicella Vaccine-MinimumInterval Between Doses
3 months 4 weeks

• 12 months through
• 12 years of age
• 13 years of age or
• older

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Rotavirus Disease in the United States

• Annually responsible for
• More than 400,000 physician visits
• More than 200,000 emergency dept visits
• 55,000 to 70,000 hospitalizations
• 20 to 60 deaths
• Annual direct and indirect costs are estimated at
  approximately 1 billion

3 months 4 weeks
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Rotavirus Vaccine

• RotaTeq

State-supplied
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Rotavirus Vaccine Recommendations

• Routine immunization of all infants without
  contraindications
• Administered at 2, 4, and 6 months of age
• Minimum age of first doses is 6 weeks
• First dose should be administered between 6 and
  12 weeks of age (until age 13 weeks)
• Do not initiate series after 12 weeks of age

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Rotavirus Vaccine-MinimumInterval Between Doses

• Minimum interval between doses is 4 weeks
• Maximum age for ANY doses is 32 weeks
• Do not administer on or after age 32 weeks, even
  if fewer than three doses have been administered

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Rotavirus Vaccine Recommendations

• Administer simultaneously with all other
  indicated vaccines
• Breastfeeding infants should be vaccinated on
  usual schedule
• Vaccinate infants who have recovered from
  documented rotavirus infection
• Do not repeat dose if infant spits out or
  regurgitates vaccine administer remaining doses
  on schedule

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Influenza Vaccines

• Fluarix
• Fluvirin
• Fluzone
• Flulaval
• FluMist ( 5 years and older)

State-supplied
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Influenza Vaccine Recommendations
Two doses may be needed for some children
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Hepatitis A
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Hepatitis A Vaccines

• Havrix
• Vaqta

State-supplied
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Hepatitis B Vaccines

• Engerix-B
• Recombivax HB
• HepB/Hib (Comvax)
• DTaP/IPV/HepB (Pediarix)

State-supplied
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Hepatitis B Recommendations

• Three doses
• One dose by age three months
• Second dose before age five months
• Third dose by age 19 months and not before 24
  weeks of age

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Pediarix
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Haemophilus influenza type b

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Hib Vaccines

• ActHIB
• HibTITER
• PedvaxHIB
• HepB/Hib (Comvax)
• DTaP/Hib (TriHIBit)

State-supplied
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Hib Recommendations
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Hib Detailed Vaccination Schedule
All conjugate Hib vaccines interchangeable 3
dose primary if more than one brand is used
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Polio Vaccines

• IPOL
• DTaP/IPV/HepB (Pediarix)

State-supplied
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Measles, Mumps, and Rubella Vaccines

• CombinationMMR (M-M-R II) MMRV (ProQuad)
• Measles (Attenuvax)
• Mumps (Mumpsvax)
• Rubella (Meruvax II)

State-supplied
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DTP Group Vaccines

• DTaP
• DAPTACEL
• Infanrix
• Tripedia
• DT
• DTaP/IPV/HepB (Pediarix)
• DTaP/Hib (TriHIBit)

State-supplied
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• Diphtheria, Tetanus, and Acellular Pertussis

• DTaP and DT administered up to 7 years of age
• Td administered 7 years of age
• Tdap administered ages 10 years to 64 years
  (depending on brand)

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Pneumococcal Vaccines

• Pneumococcal Conjugate (Prevnar)
• Pneumococcal Polysaccharide (Pneumovax 23)

State-supplied
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Pneumococcal Conjugate (Prevnar) Recommendations
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Pneumococcal Polysaccharide Recommendations
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Eligibility

• Who is eligible to receive state-suppliedvaccine?
  
• Who should I give privately purchased vaccine to?
• North Carolina UCVDP Coverage Criteria (3/02/2007)

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Coverage Criteria
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Use of State-Supplied Vaccine

• The Coverage Criteria helps to determine who is
  eligible for state-supplied vaccines.

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Let Us Define

• VFC Eligible
• Underinsured

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Coverage Criteria
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Coverage Criteria and PCV7
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Coverage Criteria and Rotavirus
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4 Day Rule
2
4
1
3
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4 Day Rule and Minimum Intervals
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• Vaccine Administration

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Importance of Proper Vaccine Administration
Technique

• Promote optimal antibody response
• Reduce risk of local adverse reactions

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Subcutaneous (SubQ) Tissue

• Injection into the fatty tissue below the dermis
  and above the muscle
• Usual sites are thigh and upper outer triceps
  area of the arm
• Gauge 23 to 25
• Length 5/8 inch
• Needle inserted at a 45o angle

45 Angle
Dermis
Fatty Tissue (SubQ)
Muscle Tissue
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Intramuscular (IM) Tissue

• Site selection depends on
• persons age
• muscle development
• Use anatomical landmarks to locate site
• Gauge 22 to 25
• Length
• Newborn 5/8 inch
• Infants 1 inch
• Toddlers and Older Children (through 10 yrs) - 1
  inch

90Angle
Dermis
Fatty Tissue
Muscle Tissue
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Intramuscular (IM) Sites
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Intramuscular (IM) Sites
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Immunization Sites
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Administering Vaccines Dose, Route, Site, and
Needle Size

• Epidemiology and Prevention of Vaccine-Preventable
  Diseases 10th Edition
• Pink Book
• Appendix D-5 (packet)

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Vaccine Adverse Reactions

• Adverse reaction
• extraneous effect caused by vaccine
• side effect
• Adverse event
• any event following vaccination
• may be true adverse reaction
• may be only coincidental

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Vaccine Adverse Reactions

• Local
• pain, swelling, redness at site of injection
• common with inactivated vaccines
• usually mild and self-limited
• Systemic
• fever, malaise, headache
• nonspecific
• may be unrelated to vaccine
• Allergic
• due to vaccine or vaccine component
• rare
• risk minimized by screening
• Vaccine Adverse Event Reporting System (VAERS)
  www.vaers.hhs.gov

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Contraindication

• A condition in a recipient that greatly increases
  the chance of a serious adverse reaction

Precaution

• A condition in a recipient that might increase
  the chance or severity of an adverse reaction,
  or
• Might compromise the ability of the vaccine to
  produce immunity

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Contraindications and Precautions
Permanent contraindications to vaccination

• severe allergic reaction to a vaccine component
  or following a prior dose
• encephalopathy not due to another identifiable
  cause occurring within 7 days of pertussis
  vaccination

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Invalid Contraindications to Vaccination

• Mild illness
• Antimicrobial therapy
• Disease exposure or convalescence
• Pregnant or immunosuppressed person in the
  household
• Breastfeeding

• Preterm birth
• Allergy to products not present in vaccine or
  allergy that is not anaphylactic
• Family history of adverse events
• Tuberculin skin testing
• Multiple vaccines

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North Carolina Immunization Registry (NCIR)

• Pediarix (3rd/4th Hep B) invalid dose
• School Health Nurses

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Resources

• North Carolina Immunization Branch Website
  www.immunizenc.com
• CDCs publication Epidemiology and Prevention of
  Vaccine Preventable Diseases 10th Edition Pink
  Book
• CDC/National Immunization Program
  (NIP)http//www.cdc.gov/vaccines/
• Immunization Action Coalition www.immunize.org

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Questions?

• Gina Holland, RN
• Regional Immunization Nurse Consultant
• North Carolina Immunization Branch
• Telephone [phone]
• Denise Martin, RN
• Regional Immunization Nurse Consultant
• North Carolina Immunization Branch
• Telephone [phone]

Resources Epidemiology and Prevention of
Vaccine-Preventable Diseases, 2007 (Slides)
Epidemiology and Prevention of Vaccine-Preventable
Diseases 10th Edition Pictures CDC Public
Health Image Library Epidemiology and
Prevention of Vaccine-Preventable Diseases 10th
Edition