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CHILDHOOD
IMMUNIZATIONS
Virginia Keane, MD
Associate Professor, Pediatrics
University of Maryland School of
Medicine
Shots Hurt! Why Do We Have
To Give Them?
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Vaccines work!
Vaccines are THE most effective
preventive measure that modern medicine
has derived
Vaccine Effect on Morbidity
Disease
Baseline
morbidity
1998 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
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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
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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
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The proteins and
sugars on the walls of
viruses and bacteria
are FOREIGN
Your body makes
antibodies to fight
them off
Theory of Vaccines
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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
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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
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Killed Vaccines: Diptheria, Pertussis,
Tetanus, Hepatitis B, Polio
Live Attenuated: Measles, Mumps,
Rubella, Varicella, Polio
Conjugated: HIB, PCV
Diptheria
Bacterial:
Corynebacterium
diptheriae
Person to person
Severe throat infections,
can obstruct breathing
Myocarditis can be fatal
Tetanus
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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
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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
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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
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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
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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
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Viral, herpes family
“chicken pox”
Usually mild, self
limited :fever, rash
Can get pneumonia,
cerebellitis,
encephalitis, even
death
Measles
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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
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Viral disease
characterized by fever
and swelling of saliva
glands
Orchitis common,
sterility rare
Sporadic cases and
outbreaks still occur
Rubella
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Viral, humans only
“German Measles”
Low grade fever,
joint pains, swollen
glands, rash
Congenital rubella:
mental retardation,
cataracts, heart
deformities
Pneumococcal Conjugate
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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
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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 Schedule
Age
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 Use
Vaccine
Diseases
Schedule
Adverse effects
DTaP
Diptheria, Tetanus, 2,4,6, 15 mos
Pertussis
4 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, 69mos
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
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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
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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