1	Childhood Vaccines in the 2008 Xavier Sevilla M.D.FAAP Board Certified Pediatrician
2	Our amazing immune system… External: skin, nose, mouth, stomach acid Internal: White Blood Cells: Phagocytes Lymphocytes B Cells ( make antibodies ) T Cells ( kills infected cells) Complement
3	How Vaccines work? Toxins Tetanus Diphteria Whooping cough Inactivated ( killed ) bacteria or part of one Polio Hib Live Weakened Viruses: Measles, Mumps, Rubella Chickenpox
4	How vaccines work ? Individual Immunity Herd Immunity
5	What vaccines are available ? Hep B Diphteria, Tetanus, Pertussis Hemophilus Influenzae type b Pneumococcus Polio Measles, Mumps and Rubella Chickenpox Hepatitis A Influenza vaccine Human Papilloma Virus Meningococcus
6	Hemophilus Influezae type b Component / inactivated vaccine Meningitis, epiglottitis, pneumonia Struck 1 in every 200 children 1 in 4 of affected children suffered permanent brain damage 1 in 20 died Prior to vaccine 20,000 cases per year 2003 259 cases in the US
7	Strep Pneumoniae Component / inactivated vaccine Meningitis, pneumonia, blood infection Rarer than hib 188 per 100k children had invasive disease
8	Diptheria, Tetanus, Pertussis Inactivated toxins Whooping cough: Relatively common 25,000 cases a year 1:10 pneumonia 1:250 get seizures and encephalopathy Most succeptible are babies < 1 year Adults and older children very mild symptoms
9	Diptheria, Tetanus, Pertussis Tetanus: Not contagious. Bacteria C. tetani present in soil, dust, manure. Enters body through the skin Produces a toxin that causes muscle contractions Relatively uncommon 1300 cases per year prior to vaccine. Now 20 per year Diptheria: Produced by toxin produces paralysis, heart failure 2003 Last fatal case unvaccinated man travelled in Haiti
10	Measles Live attenuated vaccine In 1^st 20 years prevented : 17,400 cases of mental retardation 5,200 deaths 23 million cases worldwide Last outbreak in US 2005 Unvaccinated individual visited Romania 34 people infected, 3 hospitalized 2006 case in Manatee County
11	Mumps and Rubella Mumps Causes inflammation of the salivary glands 1 in 20,000 cases develop deafness 152,000 cases prior to vaccine now 231 per year Can cause male sterility Rubella Mild disease rash, joint pain, fever Unborn babies: congenital Rubella syndrome ( blind, deaf, heart problems, Mental retardation)
12	Polio Killed vaccine Transmitted like a stomach virus Before vaccine 16,316 cases per year. Not a single case of wild polio in the US since 1979 World wide 2000 cases in 2006 ( Afganistan, India, Pakistan, Nigeria)
13	Hepatitis B Inactivated/component vaccine Transmitted through blood, bodily fluids Infection from infected mother at birth, needle sharing, Sexual contact Causes Cirrhosis of the liver and liver cancer
14	Chickenpox 4 million cases per year prior to disease 1 in 500 children is hospitalized. 1 in 50 adults is hospitalized 4 out of 100,000 babies <1y die 1 in 100,000 older children die
15	Adverse Reactions : 1991-2001 Vaccine Adverse Event Reporting System 1.9 billion doses 11.4 reports per 100,000 doses Age Distribution: < 1 year 18.1% 1-6 years 26.7% 7-17 years 8% 18-64 years 32.6 % >65 years 4.9%
16	Adverse Reactions: Most common Adverse Reactions Fever 25.8% Pain at injection site 15.8% Rash 10.8% Redness 10.8% Deaths: One death attributed to the Tetanus on a 28 y old woman with Guillain-Barre
17	Adverse Reactions: Vaccine profile Rotavirus tetravalent 136 per 100k (withdrawn) Licensed August 1998 Caused intessuception in young children Withdrawn July 1999 DTP 26 per 100k . Replaced by DTaP ( now 12.5 per 100k)
18	Controversies with vaccines Thimerosal: January 2008 California study: increasing Autism when thimerosal taken out of vaccines Denmark stopped thimerosal 1991. Saw increase in Autism in subsequent years.
19	MMR autism link Wakefield 1998 , 12 patients United Kingdom, Sweden prior to MMR IOM report
20	Aluminum ??? Used as an adjuvant in vaccines Adults with normal kidneys can clear high amounts of aluminum Can babies do the same? Cochrane collaborative
21	resources www.aap.org www.cdc.gov www.vaccinesafety.edu www.thevaccinebook.com