john manaloor md, faap - pediatric infectious diseases october 5 th, 2011 pediatric vaccine update
TRANSCRIPT
![Page 1: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/1.jpg)
John Manaloor MD, FAAP - Pediatric Infectious Diseases
October 5th, 2011
PediatricVaccineUpdate
![Page 2: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/2.jpg)
Disclosure
I have never had a significant financial interest or other relationship with the manufacturer(s) of the product(s) or provider(s) of the service(s) that will be discussed in this presentation.
John Manaloor MD, FAAP
![Page 3: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/3.jpg)
~ Benjamin Franklin
“I long regretted bitterly, and still regret that I had not given it to him by inoculation. This I mention for the sake of parents who omit that operation, on the supposition that they should never forgive themselves if a child died under it, my example showing that the regret may be the same either way, and that therefore, the safer should be chosen.”
![Page 4: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/4.jpg)
Sources of GOOD Information
www.cdc.gov/vaccines/recs/ACIP
www.aap.org
www.cispimmunize.org
www.fda.gov/cber
www.immunize.org
www.immunizationinfo.org
www.vaccinesafety.edu
![Page 5: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/5.jpg)
Vaccines preventable diseasesAnthrax
Diphtheria
Hemophilus Influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Influenza
Japanese Encephalitis
Lyme Disease
Measles
Meningococcal Disease
Mumps
Pertussis
Pneumococcal Disease
Polio
Rabies
Rotavirus
Rubella
Tetanus
Tuberculosis
Typhoid Fever
Varicella (Chickenpox)
Yellow Fever
Zoster (Shingles)
Anthrax
Diphtheria
Hemophilus Influenzae type b
Hepatitis A
Hepatitis B
Human Papillomavirus
Influenza
Japanese Encephalitis
Lyme Disease
Measles
Meningococcal Disease
Mumps
Pertussis
Pneumococcal Disease
Polio
Rabies
Rotavirus
Rubella
Tetanus
Tuberculosis
Typhoid Fever
Varicella (Chickenpox)
Yellow Fever
Zoster (Shingles)
![Page 6: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/6.jpg)
![Page 7: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/7.jpg)
WHO Region Total number of cases
Countries Genotype Identified
African 2 Kenya (1), Nigeria (1) B3 (2)
Eastern Mediterranean
2 Pakistan (1), Jordan (1) D4 (1)
European 25 France (12), Italy (4), Poland (1), Romania (1), Spain (1), United Kingdom (4), France/United Kingdom*(1), France/Italy/Spain/Germany *(1)
D4 (11), G3 (1)
Americas 1 Dominican Republic†(1) D4 (1)
South-East Asia 16 India (15), Indonesia (1) D8 (5), D4 (1)
Western Pacific 7 China (2), Philippines (4), Philippines/Vietnam/Singapore/Malaysia*(1)
H1 (1), D9 (2)
70% of importations among U.S. residents traveling abroad*Patient visited more than 1 country during the incubation period † Likely acquired disease from French tourist
Measles, United States, January – June 17, 2011 Source of Importations
![Page 8: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/8.jpg)
Measles – Outbreak 2011
MMWR May 24, 2011
![Page 9: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/9.jpg)
Measles – Outbreak 2011
MMWR May 24, 2011
![Page 10: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/10.jpg)
Measles – Exposure Management
Exposure:
• 6-11 mos
• Community outbreak or travel to endemic
• provide extra dose
• School or day care: give vaccine if <2 doses
• Household exposure: provide IG* if not vaccinated,+ vaccine at appropriate interval
*IG 0.25 mL/kg; 0.5 mL/kg immunocompromised
![Page 11: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/11.jpg)
MMR and VZV: Previously Recommended Schedule
• 1st dose @ 12-15 months
• 2nd dose @ 4-6 years
• May be given as early as 4 weeks after first
• 6-11 month old may receive MMR if at increased risk
• Extra dose (3rd) will be necessary
• Varicella: 2 doses, same time as MMR
![Page 12: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/12.jpg)
MMRV and Febrile Seizure
Vaccine Safety Datalink (VSD),* a collaboration between CDC and eight MCOs
Febrile Sz 7-10 days post
1st dose
Febrile Sz 7-10 days post
2nd dose
MMR + V 4.2/10,000 0/64,663
MMRV 8.5/10,000 1/84,653
![Page 13: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/13.jpg)
Klein NP, et al. Pediatrics 2010;126:e1-8.
![Page 14: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/14.jpg)
MMRV and Febrile Seizure
“One additional febrile seizure occurred among every 2,300 children vaccinated with a first dose of MMRV vaccine compared with children vaccinated with a first dose of MMR vaccine and varicella vaccine administered at the same visit.” …
“…Postlicensure data do not suggest that children who received MMRV vaccine as a second dose had an increased risk for febrile seizures after vaccination compared with children who received a second dose of MMR vaccine and varicella vaccine at the same visit.”
MMWR May 7, 2010
![Page 15: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/15.jpg)
MMRV
• First dose(12-47 months): MMR + Varicella
• Unless the parent or caregiver expresses a preference for MMRV
• Second dose: MMRV generally preferred.
• Personal or family (i.e., sibling or parent) history of seizures of any etiology is a precaution for MMRV vaccination. Children with a personal or family history of seizures of any etiology generally should be vaccinated with MMR vaccine and varicella vaccine.
MMWR May 7, 2010
![Page 16: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/16.jpg)
Neisseria meningitidis• Aerobic gram-negative bacteria
• At least 13 serogroups based on characteristics of the polysaccharide capsule
• Most invasive disease caused by serogroups A, B, C, Y, and W-135
• Relative importance of serogroups depends on geographic location and other factors (e.g. age)
• Aggressive illness that can lead to death within 24-48 hours of the first symptoms
![Page 17: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/17.jpg)
![Page 18: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/18.jpg)
![Page 19: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/19.jpg)
![Page 20: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/20.jpg)
Rosenstein N et al. N Engl J Med 2001;344:1378-1388
![Page 21: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/21.jpg)
Quadrivalent Conjugate Vaccine
![Page 22: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/22.jpg)
Meningococcus - group B
Rappuoli R F1000 Medicine Reports 2011, 3:16 (doi:10.3410/M3-16)
![Page 23: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/23.jpg)
![Page 24: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/24.jpg)
Incidence of Meningococcal Disease in Infants <12 months,United States, 1998-2007
*Other includes serogroups W-135, nongroupables, other, and unknownABCs cases from 1998-2007 and projected to the U.S. population
![Page 25: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/25.jpg)
![Page 26: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/26.jpg)
![Page 27: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/27.jpg)
Meningococcal disease
Conclusions: • Amount of potentially preventable disease among
infants is low–Currently at nadir in disease incidence–Low proportion of serogroup C+Y disease–Declining incidence after first 6-8 months of life
Morbidity and mortality in infants is lower than in other age groups
![Page 28: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/28.jpg)
Meningococcal Vaccines for Infants and Toddlers
Hib-MenCY (GSK)–3 dose priming (2,4,6m) –+ 12-15 mo booster
MCV4 (Menactra-Sanofi)
– 9, 12-15 mo 2 dose series
Men4 (Menveo-Novartis)–3 dose priming (2,4,6m) –+ 12-15 month booster
![Page 29: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/29.jpg)
Working Group Interpretation:HibMenCY
HibMenCY is an effective vaccine for Hib and serogroup C and Y meningococcal disease after the second or third dose and for one year after the fourth dose
Evidence of waning immunity, especially for serogroup Y, indicates vaccine, unlikely to provide protection until age 11-12 years
![Page 30: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/30.jpg)
Infant Meningococcal VaccinationACIP Recommendations(Pending Approval)
1. NO routine recommendation for infant meningococcal vaccination
2. HibMenCY is safe and immunogenic. HibMenCY could be used to complete routine Hib vaccination series (4 doses of HibMenCY required for at least one year of persistence of functional antibody)
![Page 31: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/31.jpg)
Infant Meningococcal VaccinationACIP Recommendations (Pending Approval)
3. HibMenCY is recommended for infants <2 years at increased risk for meningococcal disease, e.g. persistent complement deficiencies; anatomic or functional asplenia, (HIV?)
4. HibMenCY can be given to infants <2 yearsa. in a community with a serogroup C or Y
meningococcal outbreakb. traveling to areas with high endemic rates of
serogroups C or Y meningococcal diseases (Does not protect against serogroups A and W-135)
![Page 32: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/32.jpg)
Rate of Meningococcal Disease by Single Age Year: All Serogroups
NETTS data, average annual rate, 2003 - 2006
11-12 year old recommendation
2 yr
![Page 33: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/33.jpg)
Estimated Annual Number of Cases of Meningococcal Disease, United States: Age 0 - 21 years
Active Bacterial Core surveillance (ABCs) cases from 1996-2005 and projected to the U.S. population
Serogroup B- BlueBlue
Serogroups A,C,Y,W-135- YellowYellow
![Page 34: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/34.jpg)
Rates of Meningococcal Disease(A/C/Y/W-135) by Age, 1998-2007
0
0.5
1
1.5
11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29
Age (years)
Rate
per
100
,000
Active Bacterial Core surveillance (ABCs), 1998-2007
![Page 35: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/35.jpg)
Meningococcal Disease Among Young Adults, United States, 1998-1999
•18-23 years old 1.4/100,000
•18-23 years old not college students 1.4/100,000
•Freshmen 1.9/100,000
•Freshmen in dorm 5.1/100,000
Bruce et al, JAMA 2001;286;688-93
![Page 36: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/36.jpg)
Adolescent Meningococcal Vaccination Program
ACIP Recommendation, Oct 2007:–11-12 year-olds at their pre-teen
vaccination visit–13-18 year-olds who have not been
previously vaccinated
Two licensed vaccines (MCV4)
–MenACWYD (Menactra)
–MenACWYCRM (Menveo)
![Page 37: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/37.jpg)
Coverage of Meningococcal Vaccination among 13-17 year-olds, NIS-Teen, 2006-2008
0
10
20
30
40
50
13 14 15 16 17
Age (years)
Per
cen
t C
ove
rag
e
20062007
2008
National Immunization Survey
![Page 38: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/38.jpg)
Adolescent Meningococcal Vaccine:
• Antibodies wane prior to peak incidence of disease
• Breakthrough cases as severe as in those who never received vaccine
• Anamnestic response occurs but is not rapid enough to prevent invasive disease (7-10 days)
![Page 39: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/39.jpg)
Will a single dose early adolescent vaccination program meet our prevention goals?
Goals–Protection through the peak
in risk during late adolescence
–Protection for college students, especially freshmen living in dormitories
Strategy– Vaccinate prior to period of
increased risk
![Page 40: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/40.jpg)
Adolescent Meningococcal Vaccine Options
1. Stay the course – no change; assess frequency of disease
• Waning immunity results in lack of protection at period of greatest risk
2. Move timing of single dose 15 to 16 years• Same cost• 11-15 year olds vulnerable
3. Booster dose (11-12 years and 16 years)• greatest number of cases prevented• cost per case prevented better than current policy
![Page 41: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/41.jpg)
Antigenic Drift and Shift
Drift – frequent• Minor changes within
subtypes
• Point mutations
• Occurs in both A and B subtypes
• May cause epidemics • (2003-2004 : A / H3N2/
Fujian emerged in instead of the previously predominant strain A /H3N2 / Panama
![Page 42: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/42.jpg)
Antigenic Drift and Shift
Shift – infrequent
• Major change• Development of new H or N antigen
• Exchange of gene segments between influenza stains in mammals
• Occurs in A subtypes only
• May cause pandemic
![Page 43: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/43.jpg)
Antigenic Drift and Shift Pandemics:•1918-19, “Spanish flu”:
•A (H1N1). >500,000 deaths in the U.S. •~50 million deaths globally
•1957-58, “Asian flu”: •A(H2N2). 70,000 deaths in the U.S.
•1968-69, “Hong Kong flu”: •A (H3N2). 34,000 deaths in the U.S.
•2009-2010, “Swine flu”:•A (H1N1). 2,117 deaths in the U.S. (282 pediatric deaths)
![Page 44: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/44.jpg)
Interpandemic attack rate ~30%Interpandemic hospitalization rate <2yo ~ 50%
![Page 45: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/45.jpg)
![Page 46: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/46.jpg)
Quote or statistic could go here. Either the same one throughout, or change from page to page.
![Page 47: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/47.jpg)
PLoSOne March 2011, 6:(3) e17616
C
![Page 48: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/48.jpg)
• 2011-12 U.S. seasonal influenza vaccine virus strains are identical to those contained in the 2010-11 vaccine
• Only fourth time in 25 years the vaccine has stayed the same in a consecutive season/year
• A/California/7/2009 (H1N1)-like
• A/Perth/16/2009 (H3N2)-like
• B/Brisbane/60/2008
Trivalent inactivated Influenza virus vaccines for children 2011-2012
![Page 49: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/49.jpg)
• Annual vaccination is recommended even for those who received the vaccine for the previous season
• Post-vaccination antibody titers decline over the course of a year
Trivalent inactivated Influenza virus vaccines for children 2011-2012
![Page 50: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/50.jpg)
• Children aged 6 months through 8 years require 2 doses of influenza vaccine (administered a minimum of 4 weeks apart) during their first season of vaccination to optimize immune response
• In previous seasons, children aged 6 months through 8 years who received only 1 dose of influenza vaccine in their first year of vaccination required 2 doses the following season.
• As vaccine strains are unchanged between this and the previous season, children in this age group who received at least 1 dose of the 2010-11 seasonal vaccine will require only 1 dose of the 2011-12 vaccine
Trivalent inactivated Influenza virus vaccines for children 2011-2012
MMWR August 26, 2011
![Page 51: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/51.jpg)
http://aapredbook.aappublications.org/flu/
![Page 52: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/52.jpg)
Influenza Vaccine and Egg Allergy
• Anaphylaxis and severe allergies (angioedema, respiratory distress; urticaria) following egg exposure are still a contraindication for influenza vaccine
• For other egg allergies/reactions:–Skin testing is no longer necessary–Use the lowest ovalbumin – containing influenza
vaccine (Ovalbumin content is listed in package inserts and/or Table 1 of http://www.aaaai.org/professionals/administering_influenza_vaccine.pdf)
![Page 53: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/53.jpg)
Vaccine Administration Options:
–Two-step graded challenge: 1/10 of vaccine followed in 30 minutes with remainder
–Single dose – observe 30 minutes
Appropriate resuscitative equipment should be available
Influenza Vaccine and Egg Allergy
![Page 54: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/54.jpg)
http://aapredbook.aappublications.org/flu/
![Page 55: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/55.jpg)
Questions About the Risk of Febrile Seizures After TIV
1. Was the risk in 2010-11 higher than in past influenza seasons?
2. What was the role of concomitant vaccines?
3. What age groups were affected?
4. What is the attributable risk?
5. What is the effect of 1st vs. 2nd dose TIV?
![Page 56: John Manaloor MD, FAAP - Pediatric Infectious Diseases October 5 th, 2011 Pediatric Vaccine Update](https://reader030.vdocuments.us/reader030/viewer/2022032516/56649c775503460f9492bf5c/html5/thumbnails/56.jpg)
Observation for the possible Risk of Febrile Seizures After TIV
• Largest excess risk was in 12-23 mo old children who received concomitant 1st dose TIV + PCV13 (+/- other vaccines)
• Attributable risk: 61 (95% CI 13 to 109) per 100,000 vaccinees
• ~1 in 1,640 vaccinees