Vaccination

The Secret of Great Health Care

Your Subtitle text

Vaccination

Vaccinations

Free Health Ebook Chapter on Vaccinations

Immunizations (Vaccinations) and clean water are two factors that have significantly improved life expectancy. Immunizations (Vaccinations) have almost abolished many diseases and have significantly reduced others.

Vaccination rates are not as good as they should be. There is a lot of patient non-compliance. In addition there are many cases of missed opportunities because of patients and providers not considering the recommendations.

Utilization of the preventative worksheet supplied in this book will help make sure that immunizations are taken care of. If you take responsibility for your immunization you will likely be in compliance. Doctors of younger children do a much better job at making sure their patients get all recommended vaccinations when compared to adult doctors.

The next section will look at some common diseases that are controlled with vaccinations.

Tetanus, Diphtheria, Pertussis

The tetanus/diphtheria (Td) booster should be given every 10 years in the adults. Children and adults have different vaccinations for this. Children get the DTaP vaccine in five doses at:

2 months
4 months
6 months
15-18 months
4-6 years

The DTaP is not approved for children over the age of 7. The components of the vaccination are still needed after the age of 7. At the age of 11-12 the child should get a dose of Tdap (which is a slightly different concoction).

If the above schedule was followed than a dose of Td should be given every 10 years.

Adults (under 65) who have never had a dose of Tdap should have one (must wait at least 2 years after the last dose of Td). The dose of Tdap is given in place of one of the Td doses. Some adults over the age of 65 may be candidates for a dose of Tdap if they have never gotten a dose of Tdap and have contact with children under 12 months old.

Health care workers and new mothers should be highly encouraged to have a dose of Tdap if they never had one before.

The Tdap differs from the Td by the addition of the pertussis component. Pertussis, also known as whooping cough, is making a comeback. It has been seen more commonly in adults and another booster vaccination is therefore recommended.

Tetanus is a bacterium that enters the skin and affects the central nervous system leading to difficulty swallowing, drooling, fever, irritability, convulsions, respiratory or cardiac arrest and death.

Diphtheria is uncommon in the United States with only 5 reported cases between 2000-2004. It is mainly spread via respiratory secretions and typically infects the respiratory tract but may infect other mucous membranes or skin wounds. The bacteria can lead to heart (cardiac arrhythmia, heart failure) or nerve problems (slurred speech, double vision, difficulty swallowing).

Pertussis infects the respiratory tract and is transmitted by respiratory droplets. About half of the cases occur in those before age 2, but it may occur in adulthood.

Hepatitis A

Hepatitis A – which can cause severe liver disease – can be prevented by sanitation as well as immunizations. Vaccines are given as a 2 dose series – six months apart – starting at the age of 12 months and older.

Hepatitis A immunization may be needed in those with diseases of the blood or liver, those who travel to areas that have high rates of hepatitis A, those who have sex with more than one person, men who have sex with men or those who use street drugs.

Hepatitis B

Hepatitis B should be given to all newborns before to discharge from the hospital. A second dose is administered at age 1-2 months and the third dose is given after 24 weeks of age.

Hepatitis B immunization may be needed in the older adult who is receiving hemodialysis, those who are exposed to blood products, inject drugs intravenously, and those who have sex with more than one partner or those with sexual transmitted disease.

Hepatitis B virus is transmitted via sexual contact or through blood. Individuals infected with hepatitis B will get sick between 6 weeks and 6 months. Of those affected with acute hepatitis B, 1-2% of adults with intact immune systems go on to develop chronic disease, but this percentage is higher in those adults who have poor immune systems (HIV or cancer) or in children. Those with chronic infection have no symptoms but are at increased risk for cirrhosis and cancer of the liver.

Those with an acute infections will have fatigue, muscle and joint aches, stomach pain as well as poor appetite. Recover usually occurs over 2-3 weeks, but some have a longer recovery.

Immunization programs are the most important intervention in prevention of hepatitis B. Other interventions to reduce transmission rates include: practicing safe sex and avoiding contact with any blood products.

Haemophilus Influenza type B

Haemophilus influenzae type B vaccine is given as a four dose series to patients at:

2 months
4 months
6 months
12-15 months

Haemophilus influenzae can cause different types of infections. Meningitis is the most serious and acute manifestation of infection and accounts for the highest levels of death and disability. Other diseases caused by Haemophilus influenzae include: blood stream infections, skin infections, pneumonia, joint infections and epiglottitis (an infection in the throat that can lead to respiratory failure).

Regular immunizations have appreciably lessened the incidence of Haemophilus influenzae with young children and infants having less than 1 case per 100,000 people.

Human Papillomavirus Vaccine

The human papillomavirus (HPV) vaccine is a newer vaccine that is to be given as a three dose series. The first dose at age 11-12 or 13 –18 if not previously vaccinated. The second dose is given 2 months after the first dose and the third dose is given 6 months after the first dose.

The HPV vaccine prevents the human papillomavirus, which is the most common sexually transmitted disease in the United States. Most infections will go away on their own, but sometimes they can lead to cervical cancer. HPV is the leading cause of cervical cancer.

The vaccine will protect against cervical cancer, but does not completely eradicated the disease.

Influenza (the flu)

Vaccination is the best way to prevent the flu. It is effective in healthy kids and adults. It prevents flu in 70-90% of cases when there is a good match between virus circulating and the viruses that were in the vaccine. When there is a poor match the vaccine prevents 0-50% of the cases of the flu.

While recommendations change from year to year, it is generally recommended for everyone at high-risk for complications or people who have close contact with high risk individuals. The vaccine should be given to everyone over 50 or under 19 (but older than 6 months); those with chronic diseases such as diabetes, asthma, heart disease, chronic lung disease, kidney disease, anemia, immunocompromised, or muscle or nerve disorders; nursing home residents; pregnant women; people who live in crowded conditions; and health care workers.

The vaccine takes two weeks to be effective. It is recommended to get the influenza shot in October or November, but getting it later is still effective. The influenza season peaks in most years in January or February, but can occur as early as November and as late a May. Once vaccinated the patient should be protected throughout the year. Older adults are at greater risk from pneumonia after coming down with influenza; this finding persists even if they have been vaccinated.

Some people should not get the vaccine including those with:

Severe allergy to chicken eggs
Severe reaction in the past to the influenza vaccination
Moderate to severe illness with fever
A history of Guillain-Barre syndrome within 6 weeks of getting an influenza vaccine
An age under 6 months

The injectible vaccine is given one time to most people. Children younger than 9, who were vaccinated with only one dose in the past or are being vaccinated for the first time, should get 2 doses (4 weeks apart).

A nasal spray – FluMist – can also be given to vaccinate against influenza. It is more effective than the injected vaccine in preschool and elementary-school children. It is a live vaccine and is not appropriate for all patients. It should not be given to those younger than 2 or older than 49, it should not be given to pregnant women, and it is not indicated in anyone who is at risk for a complication from influenza. Side effects include: headache, sore throat, cough, runny nose, achy muscles and wheezing.

Mumps, Measles and Rubella (MMR)

Mumps, Measles and Rubella (MMR) is typically given to as a 2 dose series. One given at 12-15 months of age and the other at 4-6 years old.

Immunization against Mumps, Measles and Rubella (MMR) may be needed in people born after 1957 that have not had 2 immunizations with MMR or documented immunity to the diseases.

The MMR vaccine is a live virus vaccine and should not be given to women who are pregnant or plan to become pregnant or immunocompromised patients.

Measles – a major cause of worldwide death and disability in children – is an acute viral illness transmitted by breathing in infected droplets. There are periodic outbreaks in the United States, but its prevalence is low thanks to an effective vaccination programs. In 2006, unvaccinated patients accounted for 49 cases in the United States.

Measles presents with a fever, rash, stuffy nose, sore throat, sneezing and red eyes. The rash starts on the face and behind the ears approximately 4 days following the onset of symptoms

Complications of measles include: ear infections, pneumonia, encephalitis, labor problems and spontaneous abortion in pregnant women. Therefore the disease is very serious if contracted during pregnancy

Mumps is another virus that usually present with inflammation of the salivary glands. It is also associated with fever and feeling run down.

Rubella – a virus transmitted by breathing in infected droplets – and is associated with feeling run down, fever, rash, swollen lymph nodes and cough.

One of the biggest risks with rubella is the congenital rubella syndrome. It is rare today with seven to 23 cases of rubella and 0-3 cases of congenital rubella syndrome occurring every year. Congenital rubella can lead to birth defects especially hearing loss. It is much more common in the developing world with more than 100,000 cases reported every year in the developing world.

Women should not be pregnant when they receive the immunization and be immunized before becoming pregnant. They should not become pregnant until antibodies are present and should be placed on birth control pills for at least 3 months after inoculation.

Meningococcal

This vaccination is recommended for those between 11-18-years-old. It can be given to certain individuals at high risk between 2 and 10-years-old. It is usually a one time dose but some individuals need a booster.

Meningococcal disease is a very serious infection that can cause meningitis (an infection in the fluid around the spinal cord and the brain). It is most common in very young children (less than one), as well as college freshman who live in a dorm, those with certain health problems such as lack of a spleen or a complement component deficiency.

Polio

Polio vaccine should be given:

At 2 months
At 4 months
At 6-18 months
A booster at 4-6 years

Poliomyelitis virus is present in the throat and in the stool. Infection occurs when a small amount of fecal material is taken in the mouth often from poor hygiene practices. The virus can be present in the stools for several weeks.

Wild-type poliovirus infection has not been reported in the United States since 1979. A few cases of vaccine stimulated polio were reported with the oral vaccination, which was changed in 1998 . The oral form of the vaccine is not available in the United States but can be used in other parts of the world. The disease is less commonly seen across the globe over the last 20 years. In 2004, 6 countries – Afghanistan, Egypt, India, Nigeria, Niger and Pakistan – had wild poliovirus transmission.

Pneumococcus

There are two different types of pneumococcal vaccinations.

Pneumococcal polysaccharide vaccine (PPV)
Pneumococcal conjugate vaccine (PCV)

Children should get the pneumococcal conjugate vaccine (PCV). It is given at

2 months
4 months
6 months
12-15 months

Children who are not fully vaccinated by the age of 2 should receive a one time dose of PCV between 24-59 months.

Individuals between 2 and 64-years-old are eligible for the PPV vaccination if they meet certain criteria including: diabetes, cochlear implant, heart or lung disease, liver problems, alcoholism, sickle cell disease, certain cancers, kidney problems, HIV, no spleen or damaged spleen, organ transplant, those on long-term steroids, on cancer medication or a history of radiation. Any adult over the age of 19 who is a smoker should have a PPV.

Pneumococcus vaccine should be given to everyone over the age of 65.

Rates of vaccination are not good. For those between the age of 18 and 64 who are deemed high risk only 18% every received the pneumococcal vaccine and only 60% of people over the age of 65 have received the vaccination .

Shingles

The most recently developed vaccine (licensed in 2006) that is recommended for the older adult is the shingles vaccine. It is a one-time dose and is recommended to be given at the age of 60.

Shingles is a painful skin rash that presents with redness and blisters. It typically lasts about 2-4 weeks and affects one area of the body (along a nerve).

Rotavirus

Rotavirus vaccine – which can prevent a common gastrointestinal infection – is administered as a sequence of two or three vaccinations (depending on the medication) at 2 and 4 months or 2, 4 and 6 months. It should not be given after 32 weeks.

Rotavirus is the most common cause of severe diarrhea in young children and infants. It leads to many emergency room visits and even some hospitalization.

Varicella (Chicken Pox)

The varicella vaccine – a live vaccine to prevent chickenpox – should be administered between 12-15 months and then a second dose given between the ages of 4 and 6-years-old.

Everyone should have this vaccine if they do not have immunity to the disease. Immunity is defined as:

History of chicken pox or shingles
Blood tests showing immunity
Born before 1980 (except for pregnant women, health care workers and those with a disease of the immune system)

Chickenpox is a viral illness that is most common under the age of 15. It is highly contagious. It presents with a fever, headache and an itchy rash. The rash presents as blisters that occur on the face and trunk. It lasts 5-10 days. It is more severe in older children and adults. What can you do?

The current immunization schedule is updated on-line at the CDC website. Please review the following link to the CDC website for a complete listing of the vaccine schedule:

at http://www.cdc.gov/vaccines/recs/schedules/default.htm

Schedules are available for

Children 0-6
Children 7-18
Catch up schedule
Adult vaccination schedule

Utilize the preventative health care worksheet to assure that you are up to date on all of your vaccinations. Record the date of your last vaccination on preventative health care worksheet in the appendix and make sure you are within the recommended guideline. If not, talk to your doctor.