pediatrics immunization presentation 2018pedconference.net/system/files/handouts/231_Smith.pdf ·...
Transcript of pediatrics immunization presentation 2018pedconference.net/system/files/handouts/231_Smith.pdf ·...
6/3/18
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NANCY SMITH, DNP, CRNP, FNP-BC ASSISTANT PROFESSOR
SALISBURY UNIVERSITY
Update on Childhood Immunization Schedule Changes
and Promoting Compliance
Disclosure
� I have no actual or potential conflict of interest related to this presentation.
� I have no relevant financial relationships with any commercial interest relative to the subject of this lecture.
Introduction
� Three million people worldwide die every year from vaccine-preventable diseases
� Multiple barriers to immunizations � Public safety vs. personal freedom??
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MEASLES MUMPS PERTUSSIS
Recent Vaccine Preventable Outbreaks in US
§ Travelers with measles § Majority were unvaccinated § Ohio- Amish travel
unvaccinated § California- Disneyland § Minnesota-Fear Autism
Number of Measles Cases by Year
Year Cases
2010 63
2011 220
2012 55
2013 187
2014 667
2015 188
2016 86
2017 118
2018 13*
Measles Outbreaks U.S.
Measles Cases and Outbreaks. https://www.cdc.gov/measles/cases-outbreaks.html Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables. https://www.cdc.gov/mmwr/publications/index.html
§ Predominantly college-aged students living in the Midwest
§ 18 to 22 years old, most of whom had had the requisite two doses of mumps vaccine in childhood
Mumps Cases Reported U.S.
*Preliminary data reported to CDC’s National Center for Immunization and Respiratory Diseases, updated monthly. Mumps outbreaks are not reportable. Mumps Cases and Outbreaks. https://www.cdc.gov/mumps/outbreaks.html Morbidity and Mortality Weekly Report (MMWR), Notifiable Diseases and Mortality Tables. https://www.cdc.gov/mmwr/publications/index.html
Year Cases 2010 2,612 2011 404 2012 229 2013 584 2014 1,223 2015 1,329 2016 6,366 2017 5,629 2018 304**
Number of Mumps Cases by
Year
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Pertussis Cases Reported U.S.
Sources: https://www.cdc.gov/pertussis/surv-reporting/cases-by-year.html https://www.cdc.gov/pertussis/surv-reporting.html https://wonder.cdc.gov/nndss/static/2016/annual/2016-table2k.html
§ More than 20,000 cases per year in recent years
§ For U.S. infants under 1 year old: – 2,041 cases in 2016 – 6 deaths in 2016
Number of Pertussis Cases
by Year Year Cases
2012 48,277
2013 28,639
2014 32,971
2015 20,762
2016 17,972
Pertussis Incidence 1990-2016
N A T I O N A L C E N T E R F O R I M M U N I Z A T I O N A N D R E S P I R A T O R Y D I S E A S E S ( 2 0 1 8 )
Childhood Immunization Update
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Smallpox
Polio Diphtheria Pertussis Tetanus Measles
1964 (6) Polio
Diphtheria Pertussis Tetanus Measles Rubella Mumps
1985 (7)
Polio Diphtheria Pertussis Tetanus Measles Rubella Mumps
Hib HepB
Varicella
1995 (10) 2018 (16)
Polio Diphtheria Pertussis Tetanus Measles Rubella Mumps
Hib
HepB HepA
Chickenpox Pneumococcal
Influenza Meningococcal
Rotavirus HPV
Vaccines Included in the Routine Child/Adolescent Immunization Schedule
Serogroups ACWY (MPSV4)
Serotype B (MenB)
� Menactra® or Menveo®
� Two doses 11 through 18 years old
� First dose 11 or 12 years old
� Booster dose at age 16
� Bexsero® or Trumenba®
� Increased risk age 10 yrs and older
� 16 through 18 years preferred
Meningococcal Vaccines
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Meningococcal Incidence in Adolescents and Young Adults by Serogroup, 2009–2013
0.0
0.1
0.2
0.3
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
INC
IDE
NC
E P
ER
10
0,0
00
Serogroup B Serogroup C and Y
NNDSS data supplemented with additional serogroup data from ABCs and state health departments
AGE (years)
MenACWY Second Dose
Age for MenB
Serogroup B Indications
� Serogroup B meningococcal disease outbreak � 10 years or older who are at increased risk:
¡ Spleen is damaged or has been removed ¡ Rare immune system condition ¡ Eculizumab (Soliris®) ¡ Microbiologists
� Anyone 16 through 23 years-based on the clinical judgment of the provider
Girls & Boys can start HPV vaccina=on at age 9
Preteens should finish the HPV vaccine series before their 13th birthday
Plus girls 13-‐26 years old who haven’t started or
finished HPV vaccine series
Plus boys 13-‐21 years old who haven’t started or
finished HPV vaccine series
HPV Vaccination -11 or 12 Years
Source: Meites et al. MMWR. 2016.
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New recommendations HPV Vaccine Dosing Schedules
Starting BEFORE the 15th birthday
� 2 doses ÷ 0, 6–12 ÷ 5 months
minimum interval between dose 1 and dose 2
Starting ON OR AFTER the 15th birthday* � 3 doses ÷ 0, 1–2, 6 ÷ Second dose 1–2
months after the first dose
÷ Third dose 6 months after the first dose
Mumps
� Optional third dose of a mumps-containing vaccine during a mumps outbreak.
� Recommendation in October 2017 after noting an increase in cases and outbreaks since 2006
� People in close contact settings
Influenza
� The nasal spray Flumist vaccine-live attenuated influenza vaccine (LAIV) is NOT recommended for use in the U.S.
� The American Academy of Pediatrics (AAP) recommends annual flu shots for everyone 6 months of age and older, including children and adolescents.
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Pertussis TDAP
� Tdap should be administered to children 7 through 10 years of age who were underimmunized or who have an incomplete vaccine history
� Pregnant women � A single dose should be given to adults who
have contact with infants, even if they are older than 65, and for health care workers of any age.
The Way Forward Talking to Parents
Promoting Compliance !
Vaccine Conversations with Parents
§ Vaccines Safety § Diseases Vaccines
Prevent § If You Choose Not to
Vaccinate, Understand the Risk and Your Responsibilities
www.cdc.gov/vaccines/conversations
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� Participatory versus presumptive approach
� Give your strong recommendation ¡ Use science and anecdotes
� Listen and respond to parents’ questions ¡ Realize that success comes in many
forms
Talking with Parents
� Written for parents of children
� English and Spanish
Infant Immunization FAQs
www.cdc.gov/vaccines/parents/parent-‐ques=ons.html