Back-to-school immunization update

By Vicki Louk Balint

Trying to keep up with immunization schedules can overwhelm even the most diligent, organized parents. Relocation, or a change in employment, physician or insurance coverage—even a disruption in family routine—can result in a missed booster shot and confusion over what a child needs at what age and at what time.

New state legislation that goes into effect July 20 may help provide easier access to vaccines. It authorizes pharmacists, with a prescription, to give vaccines to children ages 6 to 17. It also allows pharmacists to give flu shots to children 6 years old and up without a prescription.

But just when you think you’re on top of what your child needs, there’s change. That’s because disease experts and doctors review the latest scientific data and then evaluate how best to protect children from deadly diseases such as pertussis or measles, both recently on the rise in Arizona.

To keep parents up to date, the Arizona Partnership for Immunization, or TAPI, offers information at whyimmunize.org on current schedules for babies, children and teens. There’s even a “catch up” schedule for those who’ve missed a shot. Here are some of the most recent changes, as announced by the American Academy of Pediatrics—and why they matter.

Hepatitis B (HepB)

New: Guidance on administering hepatitis B vaccine to children who do not receive the recommended birth dose.

Background: Most hospitals in Arizona routinely administer the hepatitis B vaccine (with parental consent) unless the infant’s pediatrician specifically asks that the dose be given in his/her office at the first visit after birth

“Unfortunately, families sometimes change doctors, leave the area or for some other reason miss that first visit at the pediatrician—resulting in a missed birth dose,” says CIGNA medical director Andrea Houfek, M.D., who serves on TAPI steering committee.

NextCare’s Howard Podolsky, M.D. notes that physicians may elect to delay the birth dose for babies who are immune-suppressed or compromised, born with congenital issues requiring urgent medical attention or suffering from failure-to-thrive syndrome. Some babies’ parents simply do not have access to the vaccine at their child’s birth.

Why it matters: Hepatitis B vaccine can prevent a form of liver cancer. The Hepatitis B virus is spread through contact with the blood and body fluids of an infected person.

Pneumococcal disease

New: The use of 13-valent pneumococcal conjugate vaccine has replaced the 7-valent pneumococcal conjugate vaccine.

Background: Pneumococcal infection is caused by a bacteria that has many different “strains.” According to the National Foundation for Infectious Diseases, pneumococcal disease is a leading cause of serious illness in children and adults throughout the world.

Why it matters: The 13-valent vaccine protects against six additional pneumococcal strains. Parents should be aware that the greater the valence, the higher the likelihood of a potential reaction to the vaccine, says Podolsky. Possible side effects may include local irritation at the site of the injection, low-grade fever, chills or aches and pains for one to two days following the vaccine.

Pertussis (Tdap)

New: In response to recent pertussis outbreaks around the country, the AAP recommends a dose of Tdap in 7- to 10-year-old children who are not adequately immunized against pertussis.

Background: Immunizations may not be up to date because of a parental decision not to vaccinate or because the child was born with congenital issues requiring urgent medical attention, suffered from failure-to-thrive syndrome, has an unknown immunization status due to adoption or foster care or because the family lacked access to immunization.

Why it matters: Pertussis, or whooping cough, can be a relatively mild disease in older children or adults, with symptoms similar to the common cold. But for babies, the disease can lead to serious illness or death. Parents of infants too young to be immunized may not even realize their baby has been exposed to this highly contagious bacterial disease.

“Pertussis is easily transmitted through a cough, so the best way to protect young infants is to make sure older children and adults are vaccinated,” says Houfek. “We call that ‘cocooning’ infants—surrounding them with a protective circle of immunized people who won’t inadvertently expose them to the disease.”

Anyone exposed to active pertussis—including family members, patients sitting in the waiting room, staff and other healthcare providers coming in contact with a diagnosed child—should be treated with prophylactic (preventive)antibiotics, says Podolsky.

Meningococcal disease (MCV4)

New: Guidance on a booster dose of the conjugated meningococcal (MCV4) vaccine.

Background: This disease is spread by exchange of respiratory droplets through close, personal contact with others who are infected (kissing, coughing, sneezing). Pre-teens and teens are at higher risk because they often live in close quarters with peers at camps, boarding schools or dormitories and tend to share drinks or cigarettes.

The symptoms of meningococcal disease mimic the flu and other common viral illnesses, according to the Arizona Department of Health Services, which is why it can be misdiagnosed as something less serious. Symptoms may include sudden high fever, headache, stiff neck, nausea, vomiting, confusion and exhaustion. As the disease progresses, a purplish rash may also appear.

Why it matters: When MCV4 vaccine was first recommended for adolescents in 2005, researchers expected that protection would last for 10 years. Recent data suggests it wanes in most adolescents within five years. So a single dose at the recommended age of 11 or 12 may not offer protection through the adolescent years, when risk for meningococcal infection is highest (ages 16 though 21).

“If we didn’t recommend a booster dose, says Podolsky, “adolescents at highest risk would not be well protected.”

Human Papillomavirus (HPV)

New: Guidance on administering human papillomavirus vaccines to males ages 9 to 18 to reduce their likelihood of acquiring genital warts.

Background: Two vaccines (Cervarix and Gardasil) can protect females against the types of HPV that cause most cervical cancers. Both vaccines are recommended for 11- and 12 year-old girls, and for females age 13 through 26 who did not get any or all of the three recommended doses when they were younger. The vaccines can be given to girls beginning at age 9.

Gardasil is now known to protect males against most genital warts and is available for boys and men ages 9 through 26.

Why it matters: HPV vaccines protect against the types of HPV that most commonly cause health problems.

Influenza

New: Instructions on influenza vaccine dosing based on a child’s history with the monovalent 2009 H1N1 vaccine.

Background: Infants and children age 6 months to 8 years should receive two doses (spaced by at least four weeks) if they are receiving influenza vaccine for the first time, or if they were vaccinated for the first time last year but for some reason only got one dose, says Houfek. If they did not receive any doses of the 2009 monovalent H1N1 influenza vaccine, or if the number of doses is unknown, they should receive two doses of the 2010-11 seasonal influenza vaccine.

Why it matters: Cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of spreading disease. Flu is more dangerous than the common cold for children says Podosky.

On the fence about whether to immunize? Vaccine resisters come in all varieties, says Houfek, who encourages parents to work with their child’s pediatrician to understand the science behind vaccines and vaccine-preventable disease.

“Parents should realize that deadly diseases do still exist and that the risk of those diseases far outweighs the risk of immunization,” says Houfek. “Consider the decision whether or not to immunize as if your child’s life depended on it, because it just might.”

Learn more

Find local resources for free or low-cost immunizations at RAK Resources.

RAK BLOGS

Read Vicki’s “Health Matters” blog.

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