Vaccines: Questions
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Learning Objectives:
- Identify useful resources for identifying which vaccinations are due
- Identify useful resources for questions and concerns about vaccination
- Understand the absolute and relative contraindications to immunization
- Understand common vaccine reactions and the VAERS (Vaccine Adverse Event Reporting System)
Primary References:
1. Recommended Immunization Schedule for Persons Aged 0–6 Years- 2008; http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2008/08_0-6yrs_schedule_pr.pdf
2. Catch-up Immunization Schedule for Persons Aged 4 Months–18 Years; 2008 http://www.cdc.gov/vaccines/recs/schedules/downloads/child/2008/08_catch-up_schedule_pr.pdf
3. GPGP specific immunization schedule (attached)
4. Responding to 7 common parental concerns about vaccines & vaccine safety. AAP. Available at: http://www.cispimmunize.org/pro/pdf/7ParentalConcerns2.pdf
5. Strategies for pediatricians: addressing concerns of vaccine-hesitant parents. Available at: http://www.cispimmunize.org/pro/pdf/Vaccine-HesitantParent_Final.pdf
6. AAP. Refusal to Vaccinate Form. Available at: http://www.cispimmunize.org/pro/pdf/RefusaltoVaccinate_revised%204-11-06.pdf
7. Vaccine safety and contraindications. In Pickering LK, ed. Red Book: 2006 Report on the Committee on Infectious Diseases. 27th edition. Elk Grove Village, IL: American Academy of Pediatrics, 2006: 39-41. http://aapredbook.aappublications.org/cgi/content/full/2006/1/1.5.18
8. VAERS Reportable Event Table. Available at http://vaers.hhs.gov/pdf/ReportableEventsTable.pdf
CASE:
You are in continuity clinic in December and you notice you have a family of three coming in. The oldest child, Julia, who is 11 years old and her brother Juan, who is 4 years old, were previous patients of another resident but they have been in the DR for the last two years; they now have a 4 month old sister, Daniela.
1. What resources can you use to decide which vaccines are due today? What about which ones they have? If they are not up to date, what resources can use to decide what they need to catch-up?
2. If they are all up to date for previous vaccines, which vaccines are they due for?
3. Their mother has been hearing some things about vaccine safety. She wants to know if there is mercury in the vaccine and whether the vaccines can cause autism. She also heard that the vaccine for diarrhea was taken off the market, so she wants to know if this vaccine different. While she is at it she wants to know about the safety of the meningococcal vaccine. Finally, she also is afraid that the influenza vaccination will give her kids the “flu”. How do you address these issues with her?
4. Their mother agrees to give the vaccines but first wants to make sure if it is ok to give the children the vaccines today. Daniela had a febrile seizure two weeks after her last set of shots, Juan has an egg allergy and Julia has a runny nose with a temperature to 100.3. Also, their grandmother who lives with them is undergoing chemotherapy and their uncle who also lives with then has endstage HIV.
5. Their mother calls you the next day. Daniela has a swollen thigh, Juan has a temperature to 102 and Julia had an anaphylaxis episode. Which of these, if any, need to be reported and to whom?