Childhood

Vaccinations
By – Kirstie Lewis, Ariel Gilchrist, Val Jeffrey,
Marium Khan, Amanda Rupp
 Varicella
Vaccination

- Kirstie Lewis
Varicella (Chickenpox)
Background Information
- The Varicella vaccine is also known as the “chickenpox vaccine”.
o This is because the chickenpox is caused by the varicella-zoster
virus.
- This virus includes itchy red blisters, fever, body aches, headache and
drowsiness.
- Since the vaccine was licensed, the incidence of chicken pox has
greatly decreased.
o For example, before vaccine was created,100 deaths and over
11,000 hospitalizations each year due to chickenpox.
o The chickenpox used to be a very common and ‘universal
childhood experience’.
- It is hard to know how prevalent the disease still is, since not all cases
of chickenpox get reported to the CDC.
o The statistics that do exist show rates have fallen by 90%.
Varicella (Chickenpox)
Pathophysiology
- The vaccine is made up of the live attenuated varicella-
zoster virus.
o Attenuated meaning that the virus is weakened and
generally incapable of causing the disease.
- Administered in 2 doses  the first between 12-15
months old and the second dose, aka a booster, is
given between 4-6 years old.
o Varicella vaccine is recommended for all children
under 13, adolescents and adults who have never
had the virus.
o NOTICE – if you have had the virus, then you do not
need the vaccine
 Varicella (Chickenpox)
Pathophysiology
- Since 2005, the varicella vaccination has also been available
as part of the combination of MMRV (Measles, Mumps, Rubella
& Varicella)
- Requirements for the varicella vaccination vary from state to
state, but most require it in day cares, schools and colleges.
o proof of immunity can be vaccination or having virus
previously
 OH & PA require children to be vaccinated against
chickenpox
 Exceptions … child previously had disease, religious
convictions, doctor writes that it is contraindicated, etc
Varicella (Chickenpox)
“Why Vaccinate?”
- Even though most cases of
chickenpox are mild, there is a
percentage of cases that are
deadly.
o Infants are at a high risk of life-
threatening complications from
chickenpox
o For every 100,000 infants that get
the chickenpox, around 4 die.
Varicella (Chickenpox)
“Why Vaccinate?”

- There is no cure!
o treatment only includes pain medications
and topical ointments for the itching of
blisters
- The chickenpox virus can affect ANYONE and
there is no way of detecting susceptibility
Varicella (Chickenpox)
“Why Vaccinate?”
- The virus is extremely
contagious.
o It spreads through direct
contact—such as touching the
blister fluid and through
droplets—such as coughing
and sneezing.
 Varicella (Chickenpox)
“Why Vaccinate?”

- The chickenpox can cause complications in

pregnant woman, such as spreading to their baby.
o If not treated quickly, 1 out of every 3 of these
infected infants will die.
 Varicella (Chickenpox)
“Why Vaccinate?”

- The varicella-zoster virus can cause

secondary issues including …
o Bacterial infection and scaring from
broken blisters.
o Many years later the virus can
reactivate causing a very painful skin
rash called herpes-zoster or “shingles”.
Varicella (Chickenpox)
Fears of this Vaccination …

- Some people are afraid

of the side effects.
oBut if present, side
effects are rare and
mild.
 Including – pain,
redness, swelling,
itching and rash at
the injection site.
Varicella (Chickenpox)
Fears of this Vaccination …
- Some believe since the vaccine in composed of a
live attenuated form of the virus, that it could then
cause the virus itself.
o Small chance of this … only 2% of children who are
injected acquire a mild virus consisting of no more than
six blisters.
- Even with being vaccinated, there is still a chance
of developing the chickenpox later in life, but virus
is then more mild and has a faster recovery period
o Key to remember that 90% of those who are
vaccinated will never catch the chickenpox
 Varicella (Chickenpox)
Who should NOT get this vaccine?

- Pregnant women
- Anyone allergic to gelatin (gelatin-
free vaccine available) or neomycin
- Those who have a compromised
immune system
- Those receiving high doses of steroids
- Those going through cancer
treatment
- Anyone who has received blood
products in the last five months
TDaP Vaccination

-Ariel Gilchrist
 TDaP—What is it?
• Stands for Tetanus, Diphtheria and Acellular Pertussis
• Tetanus—”Lockjaw”; potentially fatal bacterial infection that
causes painful muscle spasms
• Diphtheria—a serious infection of the nose and throat that
causes a sheet of thick gray matter to cover the back of the
throat making it hard to breath
• Acellular Pertussis—”Whooping Cough”; a highly contagious
respiratory tract infection
TDaP and DTaP—Know the
Difference
• TDaP for children 6 and under
• DTaP for children 11 and older
• DTaP is also known as a “booster”
• DTaP has less diphtheria and pertussis proteins—
this causes less pain, redness, and tenderness
• Both TDaP and DTaP are inactive so they don’t
cause illness
TDaP—When to Get Vaccinated?
• CDC recommendations for TDaP Vaccination:
− 2 months
− 4 months
− 6 months
− 15-18 months
− 4-6 years
• Pregnant women should get a TDaP booster every
pregnancy to protect their baby from pertussis
• TDaP is also given after cuts and burns to prevent
tetanus
• TD booster is recommended every 10 years
TDaP—Why Vaccinate?
• There is no cure for tetanus
• All these diseases can cause premature and preventable
death
• Before TDaP there were 200,000 cases of diphtheria and
pertussis and hundreds of cases of tetanus
• Incidence of tetanus and diphtheria have dropped by 99%
and pertussis by 80% since TDaP
• It will protect your children; they are the most at risk!
TDaP—Risks
• N/V/D
• Headache
• Fever
• Chills
• Sore joints
• Syncope (Fainting)
• Severe shoulder pain—call the doctor
• Allergic reaction—get immediate help!
• If you experience a problem call the National Vaccine Injury
Program or visit their website
 TDaP—Who Shouldn’t Get
Vaccinated
• If you’ve had a severe allergic reaction to any part of the TDaP vaccine
• Anyone who had coma or long repeated seizures within 7 days after a
childhood dose of DTP or DTaP, or a previous dose of Tdap, should not
get Tdap, unless a cause other than the vaccine was found. They can still
get Td.
• Talk to your doctor if you:
− Have seizures or another nervous system problem,
− Had severe pain or swelling after any vaccine containing diphtheria,
tetanus or pertussis,
− Ever had a condition called Guillain Barré Syndrome (GBS)
− Aren't feeling well on the day the shot is scheduled.
Influenza Vaccine

- Val Jeffery
Influenza
Background Information

■ The first influenza pandemic broke out in 1918, aka “The Spanish Influenza”
■ At the time, scientists believed the flu was caused by bacteria & not a virus
■ Estimated 30-50 million deaths between 1918-1919
■ The first working vaccine was discovered by Jonas Salk, and was used in U.S. military
personnel during WWII
■ Only fought against one strain, H1N1 (Type A Influenza)
 Influenza
Background Information

■ Three types of Influenza viruses

– Human influenza Type A & B cause
flu epidemics every year in the U.S
– Influenza Type C cause mild
respiratory infections and do not
escalate to epidemic
Influenza
Background Information
■ Influenza A viruses are divided into subtypes based on two proteins that
reside on the virus’ surface: Hemagglutinin (H) and Neuraminidase (N)
■ There are 18 (H) subtypes and 11 (N) subtypes
Influenza
Background Information
■ The most current influenza A viruses that are found in vaccines are
(H1N1) and (H3N2)
■ Influenza B viruses are not categorized by subtypes, but by lineage
and strains – the most current being, “B/Yamagata” and “B/Victoria”
also included in current vaccines
■ Currently, around 24,000 deaths occur annually from the flu
Influenza
Pathophysiology
■ S/Sx of the flu: Fever, cough, runny nose, sore throat, muscle/body aches,
fatigue and headaches
– Some experience vomiting and diarrhea – occurs more in children
than adults
■ Complications: Dehydration, sinus and ear infections, and pneumonia
Influenza
Pathophysiology – Quadrivalent Vaccine
■ The quadrivalent vaccine consists of both influenza A and influenza B viruses
■ A trivalent vaccine is also available, but only covers one influenza B virus instead of both
■ It is recommended by the CDC that everyone ≥ 6 months receive the vaccine
■ If getting vaccinated for the first time, children between the ages of 6 months and 8
years of age are required 2 doses of the vaccine.
– The first dose given as soon as the vaccine becomes available
– The second dose given 28 days after the first
– After first vaccination, children should receive one flu shot annually
Influenza
Pathophysiology – Quadrivalent Vaccine
Minor Problems After Major Problems After
Shot: Shot:
– Soreness, redness or swelling ■ Increased risk of Guillain-Barre
at the injection site Syndrome (1-2 cases per 1 million)
– Hoarseness ■ Seizure (young children who get
– Sore, red or itchy eyes pneumococcal vaccine and/or DTaP
– Cough vaccine at the same time)
– Fever
– Aches
– Headache
– Fatigue
Influenza
Reasons to Vaccinate
■ People who are at high risk for developing serious complications from the flu virus
include:
– Children younger than 2 years of age
– Adults 65 years or older
– Pregnant women (and two weeks postpartum)
– American Indians and Alaskan Natives
Influenza
Reasons to Vaccinate
■ Medical conditions predisposing people to serious flu complications
include:
– Asthma
– Neurological/neurodevelopmental conditions
– Chronic lung diseases
– Heart diseases
– Hematologic disorders
– Endocrine, kidney and liver disorders
– Metabolic disorders
– Cancer, HIV/AIDS or chronic steroid users
– BMI of ≥ 40
Influenza
Common Myths & Fears
“The flu shot gave me the flu”
■ FALSE. There is no live virus in flu
shots. The vaccine is made in two
ways: one with “inactivated” virus, or
one with no virus at all =
“recombinant influenza vaccine.”
■ You may have had an underlying viral
condition before you received the
vaccine, and exacerbation of the
illness occurred post-vaccination.
“Two shots = double immunity”
■ FALSE. Studies have shown that
another dose of the influenza
vaccine within the same season
does not benefit the receiver, even
in older adults with compromised
immune systems.
■ It is recommended you get an
annual shot since the strains
change per year.
Influenza
Common Myths & Fears

“Pregnant women shouldn’t get “Antibiotics can fight the flu”

the flu shot”
■ FALSE. The sooner the better for women ■ FALSE. It’s a viral infection, gosh.
who are pregnant.
■ Infants whose mothers get the flu shot
while pregnant have a lower risk of flu
illness and flu-related hospitalizations
during the first 6 months of life.
Measles, Mumps, Rubella (MMR)
Vaccine

- Marium Khan
 Basic Information
■ MMR is an abbreviation for measles, mumps, and rubella
■ MMR are the three common childhood illnesses up until the mid-1970s
■ Vaccines are available for each of these diseases
■ However, in the 1980s they were combined into a single "three-in-one" MMR shot
■ Each year in the United States, nearly 10 million doses of MMR are distributed
■ The first dose of MMR vaccine is recommended at 12 through 15 months of age
■ The second dose is recommended at 4 through 6 years of age
– The second dose can be given at an earlier age (for example, during an outbreak or before traveling
abroad) provided that it is given at least 28 days after the first dose
– Infants aged 6 through 11 months who travel abroad should receive one dose of MMR vaccine before
departure.
– Children administered MMR vaccine before their first birthday should receive two more doses of MMR
vaccine
Picture of measles rash on the back of a child in 1980 Mumps on a child’s face

Rubella on the chest of a child

 Pathophysiology
■ Measles
– Caused by virus that replicates in the nose and throat of an infected child or adult
– S/S: fever, rash, cough, runny nose, and red, watery eyes
– Complications can include ear infection, diarrhea, pneumonia, brain damage, and death.
■ Mumps
– Caused by the mumps virus, which spreads easily from person to person through infected saliva
– S/S: fever, headache, muscle aches, tiredness, loss of appetite, and swollen salivary glands
– Complications can include swelling of the testicles or ovaries, deafness, inflammation of the brain
and/or tissue covering the brain and spinal cord (encephalitis/meningitis) and, rarely, death.
■ Rubella
– Caused by virus that's passed from person to person through direct contact with respiratory secretions
s.a. mucous
– S/S: fever, sore throat, rash, headache, and red, itchy eyes
– If a woman gets rubella while she is pregnant, she could have a miscarriage or her baby could be born
with serious birth defects.
 MMR Side Effects
■ Most people show no side effects
■ Sore arm from the shot
■ Fever
■ Mild rash
■ Temporary pain and stiffness in the joints, mostly in teenage or adult women who did not already
have immunity to the rubella component of the vaccine
■ Some people may experience swelling in the cheeks or neck
■ MMR vaccine rarely causes a temporary low platelet count, which can cause a bleeding disorder
that usually goes away without treatment and is not life threatening
■ Very small risk of febrile seizures (seizures or jerking caused by fever)
– Rare and are not associated with any long-term effects
– Risk increases as infants get older, it is recommended that they get vaccinated as soon as
recommended
 “Why Vaccinate?”
■ These diseases are serious, highly contagious, and can be deadly
■ Even though outbreaks of measles, mumps, and rubella in the United States are not as common
as they were before widespread use of vaccine, these diseases still occur in this country
■ In 2006 a record number of cases of mumps were reported in the United States
■ In 2008, the United States had the highest number of reported cases of measles in more than 10
years
■ Most of these measles cases occurred among school-age children whose parents chose not to
have them vaccinated
■ A number of these case-patients were hospitalized, including infants and young children
■ Two persons have died from measles in the United States since 2001
■ People who decide not to vaccinate their children put their children and others at risk for getting
these diseases
 Is MMR linked with Autism?
■ In 1998, Dr. Andrew Wakefield, a British surgeon and medical researcher, was the lead author
on a study linking the MMR vaccine to a heightened risk of autism in the vaccine’s recipients
■ The study focused on twelve children with chronic intestinal disorders, all with a history of
normal mental development, who, after receiving MMR vaccines, suddenly began to show signs
of mental regression and who were eventually diagnosed with autism spectrum disorders (ASD)
■ In this study, Dr. Wakefield theorized that the MMR vaccine somehow caused the intestinal
infections, which subsequently spread to the brain and caused the onset of autistic behaviors
■ To guard against this, he proposed that a set of three vaccines be administered instead, one
each for measles, mumps, and rubella
■ If administered at different times, the three diseases would not have a chance to interact,
thereby eliminating the chance that they would cause the autism-inducing intestinal infections
■ In 2007, if was found that Wakefield “changed and misreported results in his research, creating
the appearance of a possible link with autism”
■ Even though the Wakefield study was eventually retracted and the results were even found to
be faked, some parents still don't like the idea of giving the MMR vaccine to their children
 Who should Not get this vaccination
■ Anyone who has ever had a life-threatening allergic reaction to the antibiotic neomycin, or any other component of MMR
vaccine
■ If you are currently sick, you should wait until you are better to get the MMR vaccine
■ Anyone who had a life-threatening allergic reaction to a previous dose of MMR vaccine should not get another dose
■ Pregnant women should not get MMR vaccine and should avoid getting pregnant for 4 weeks after vaccination with MMR
vaccine.
■ Tell your doctor if the person getting the vaccine:
– Has HIV/AIDS, or another disease that affects the immune system
– Is being treated with drugs that affect the immune system, such as steroids
– Has any kind of cancer
– Is being treated for cancer with radiation or drugs
– Has ever had a low platelet count (a blood disorder)
– Has gotten another vaccine within the past 4 weeks
– Has recently had a transfusion or received other blood products
Important Immunization Information
for Health Professionals
- Amanda Rupp
Vaccine Storage and Handling
Common Errors by Health Professionals
■ Doses administered too early
■ Wrong vaccine, dosage, or route
■ Vaccine which was not stored properly administered
■ Vaccine administered to a patient with a contraindication for that vaccine
■ Wrong diluent used to reconstitute the vaccine or only the diluent was administered
■ Expired vaccine or diluent administered
■ http://philadelphia.cbslocal.com/2015/10/07/new-jersey-nurse-flu-syringes/
 Strategies to Prevent Errors
■ Adhere to “Rights of Medication Administration”
■ Staff training, education, reference material
■ Rotate vaccines so those with shortest expiration dates are in front
■ Check frequently to remove any expired vaccines
■ Do not store sound-alike and look-alike vaccines next to each other
■ Store pediatric and adult vaccines on separate shelves
■ Administer only vaccines that you have prepared
■ Triple check your work before administering a vaccine
 Vaccine Administration

■ Draw vaccines into syringes immediately

before administration
■ Never mix vaccines in the same syringe
unless they are specifically approved for
mixing
■ Record vaccine and administration
information, including lot numbers and
injection sites, in the patient's chart.
 Time allowed between
Liquid diluent (may Diluent storage
Vaccine product name reconstitution and use, as
contain vaccine) environment
stated in package insert

Tetanus 0.4% sodium chloride 24 hrs Refrigerator

Refrigerator or room
M-M-R II Sterile water 8 hrs
temp

DTaP DTaP-IPV Immediately Refrigerator

Refrigerator or room
Flu Vaccine Sterile water 30 min
temp
For infants and toddlers who are getting a vaccine, parents can:
1. Hold the child on their lap.
2. Place the child’s arms under one of their own arms and around their back and apply gentle
pressure for a secure, hug-like hold.
3. Use their free arm and hand to hold the child’s other arm gently but securely.
4. Anchor the child’s feet firmly between their thighs.
For older children who are getting a vaccine, parents can:
1. Hold their child on their lap, or have the child stand in front of the seated parent.
2. Embrace their child during the process.
3. Anchor both of the child’s legs between their thighs.
Keys to Successful Pediatric Vaccinations

■ Maintain a positive attitude through facial expressions, body

language, and comments
■ Use a soft and calm tone of voice
■ Make eye contact, even with small children
■ Explain why vaccines are needed
■ Be honest and explain what to expect
Evidence-Based Strategies to Ease Pain

■ Injection technique – aspiration may increase pain

■ Order of injections – administer most painful vaccine last
■ Tactile stimulation – rub/stroke near injection site prior to
and during injection
■ Distraction - playing music, books, pretending to blow away
the pain, deep breathing techniques
Mahoning County District Board of Health
All childhood vaccines are available including
DTaP, Tdap, Hib, IPV, Hepatitis A, Hepatitis B, HPV, MMR, Varicella, Prevnar.

Austintown: Struthers:
District Board of Health Mauthe Park
50 Westchester Dr 156 Smithfield St
Austintown, OH 44515 Struthers, OH 44471

Boardman: Goshen:
Boardman Park Goshen Administration Building
375 Boardman-Poland Rd. 14003 W. South Range Rd/Rt 165
Youngstown, OH 44512 Salem, OH 44460

Call 330-270-2855 ext. 125 to make an appointment, or visit

www.mahoninghealth.org
Vaccines for Children Program