Pediatrics [VACCINATIONS]

Introduction Vaccine Comments

Vaccination recommendations change very year. Since every clinic and Egg Allergy Nothing made with eggs
pediatrician has a CDC chart with the latest and greatest, don’t - Influenza*
memorize vaccine standards. Instead, learn about how to catch people - Yellow fever
up, contraindication conditions, and the signs and symptoms of the Immunodeficient No live vaccines!
diseases the vaccines protect. - MMRV
- Live attenuated influenza (IN)
Immunity (Step 1 Review) Anaphylaxis Never get that Vaccine again
Immunity comes in multiple forms. When exposed to an antigen, the OK to give the Prior local reactions, current illness or
innate immune system develops an active immunity by acquiring vaccine again if fever, family history of ___, autism fear
defense against the future antigen (known as adaptive immunity). This
antigen can be a vaccine or an organism / toxin. In some cases, it’s *Recombinant influenza vaccination is not made with eggs and can be
important to deliver passive immunity. This is done with intravenous used in those 18 years and up. If reaction is only a rash, the inactivated
influenza vaccination can be used with 30 minutes of monitoring.
immunoglobulin (IVIG) to bind up toxins or bugs that the body can’t
fight. Maternal antibodies serve this purpose as well, which is why
Vaccine Comments
immunodeficiency diseases appear after 6 months (when maternal
antibodies wear off) and why pediatricians recommend breast feeding Hep B Mom: Baby: Hep B Ig and Hep B Vacc NOW
(IgA is secreted in breast milk). Finally, if enough people get Mom: Baby: Hep B within 2 months
immunized there will be no one to inoculate - protection by herd Mom: ? Baby: Hep B NOW, check mom’s HBsAg
immunity (aka “community immunity”). DTaP Kids get 5 doses: 3 doses in 1st year and
2 doses between 1-4 years
Contraindications and Reactions Td (booster) or Tdap at least once in Adolescence
There are two worries. Anyone with an egg allergy could have a and the q10yrs
reaction to vaccines grown in eggs (influenza*, yellow fever). You need 3 total doses lifetime (see below)
Additionally, previous anaphylaxis to a vaccine is a contraindication Hib Disease doesn’t confer immunity in those <2y so
to future administrations of that the offending vaccine. Live vaccines give Hib vaccine. Doesn’t cover non-typeable. Hib
can also be dangerous for the immunocompromised (live attenuated causes epiglottitis + meningitis.
influenza, MMRV). There are a few contraindications mentioned later MMRV Vaccine and booster before school
that are related to specific vaccines. Prior local reactions, current illness Pneumo Two types – 23 and 13 valent
or fever, family history of ANYTHING, and fear of autism are NOT coccal Complete 13 as infant, add 23 if + risk factors
contraindications – give the damn vaccine. to all immunocompromised and asplenic pts.
Meningo To everyone vs meningitis…
Getting diseases we vaccinate against coccal Required for College and Military
The diseases that we prevent with DTaP should not occur. Yet they do. HPV All boys and girls aged 9-26 years
They occur in kids who immigrate to the US, and so have not had Prevents cancer.
medical care, or in those misguided in their belief that choice is more Hep A/B 2 doses for A,
important than health and safety (the so-called “anti-vaxxers”). It’s 3 doses for B
important that “anti-vaxxer” not be identified as a political movement, Pick up where you left off
but an insignificantly small portion of the population that choose to Flu Everyone. Period.
ignore overt and obvious medical literature at the cost of the health of Health care workers before winter months.
their children (and the rest of the world). Given annually

Diphtheria Managing A Wound With < 3 Lifetime Doses (or unknown)

Patients get a high fever, dyspnea, and dysphagia. Visual inspection Type of Wound
of the pharynx reveals a grey pseudomembrane adherently fixed that Clean Dirty
bleeds if removal’s attempted. Secure an airway. Prevent death with Tdap Tdap +TIG
antibiotics after securing the airway while giving antitoxin. Do not TIMING DOESN’T MATTER IF < 3 Lifetime Doses
touch the membrane.
Managing A Wound With > 3 Lifetime Doses
Tetanus Type of Wound
Following a dirty wound (penetrating metal, burns, feces, soil, saliva) Clean Dirty
the bacteria produces a toxin resulting in lock jaw and painful spasms. >10y Tdap > 5y Tdap
Prevent disease with tetanus immunoglobulin (TIG) to bind up the <10y Home < 5y Home
toxin and give the toxoid to induce immunity. If symptoms have already No TIG needed if > 3 lifetime doses
started, give sedation+intubation (time), muscle relaxers (for pain),
and IV antibiotics (metronidazole). The test question will be about Dirty wounds consider 5 yrs & 3 doses – TIG + TDap vs TDap
managing a dirty wound. See to the right. Clean wounds consider 10 yrs & 3 doses – TDap vs Home

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 Pediatrics [VACCINATIONS]

Pertussis (Whooping Cough) Disease Comments
Patients begin in a general, vague but infectious catarrhal state (days Pertussis Catarrhal stage (inconspicuous)
of rhinorrhea and low-grade fever). They then progress to the Paroxysmal Phase (coughing spells, whoops)
paroxysmal phase with hundreds of coughing spells interspersed with Resolution Phase (regular cold symptoms)
inspiratory “whoop.” Give the child and contacts erythromycin to Diphtheria Grey pseudomembrane in oropharynx
decrease the contagion. Baby has to live out the disease through the Airway, Antibiotics, Antitoxin
resolution phase. Tetanus Dirty Wound, Lock Jaw, Spasms
TIG (Block toxin) and Toxoid (Vaccinate)
Contraindications to DTaP Lethal dose < Immune Dose
There are a few contraindications specific to DTaP that will be covered Tube, Sedate, MTZ
here. They all relate to previous doses. An absolute one is history of
encephalopathy (<7 days from dose). Relative ones include fever
>40°C within 48 hours, shock within 48 hours, persistent crying (3+
hours within 48 hours), or seizures within 3 days. If there’s a bad
reaction to DTaP, try TD (no aceullular pertussis). If there’s bad
reaction to that, try TT (tetanus toxoid).

MMRV
This can be given with or without the varicella component. The MMRV – everyone
manifestations are covered in the infectious rashes section. The - No pox parties
contraindications will be discussed here. An absolute contraindication - Varicella vaccine prevents shingles
is pregnancy. Relative contraindications include recent IVIG - All patients 60 and up - Zostavax
administration (decreases vaccine’s efficacy). Administration of this
vaccine can cause fever (and therefore febrile seizures), rash, and joint
pain. These are all transient. Autism spectrum is not an adverse
reaction.

HPV HPV
The goal is to prevent cervical cancer. Recommended for both boys - You do prevent cancer
and girls and can be administered between the ages of 9-26. Parents - You do NOT increase sex, STIs, or
generally express concern over making their “promiscuous” by giving pregnancy
the shot. Studies show no difference in sexual activity related
outcomes between those with and without immunization. Most
common adverse reaction is syncope so 15 minutes of seated or supine
observation is recommended after administration.

Rotavirus Rotavirus… intussusception

Causes significant diarrhea in infants and children. It’s a live virus
vaccine given orally. Questions will typically ask about
intussusception. The original vaccine did cause a significant amount of
this which prompted its removal. The current vaccines have a slight risk
and are absolutely contraindicated in those with previous
intussusception.

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