How would you evaluate client understanding of recommended vaccine schedule? Discuss this schedule.

 

Answer:-

SCHEDULE OF RECOMMENDED VACCINATIONS:-

-The CDC (Centers for Disease Control and Prevention) maintains a comprehensive schedule of recommended immunizations for infants, children, and adults.

- The schedule is reviewed annually to ensure that it is consistent with the most current evidence base as well as data from the Vaccine Adverse Events Reporting System.

-The CDC vaccination schedule is approved and recommended by the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians.

 -As part of maintaining its recommended vaccination schedule, the CDC(Centers for Disease Control and Prevention) collects yearly statistics on schedule completion rates-that is, what percentage of the population receives all of the recommended vaccinations at the recommended time.

-Although vaccination rates for several individual vaccines meet the Healthy People 2020 goals, the rate of completion of the standard vaccine schedule for children 19 to 35 months of age is consistently below goals. These rates rose from 66% nationwide in 2002 to a high of 77% in 2007 and have trended back down to a national average of 70% in 2009 and 73% in 2010, the last year rates were published.

- These rates are of particular concern because the cost of not vaccinating is so high.

 -To decrease rates of vaccine-preventable diseases and provide appropriate counsel to clients who may be wary of vaccines, it is important for healthcare providers to understand the basics of immunity, the best evidence for vaccination, the actual risks associated with vaccines, and the current CDC vaccination recommendations and schedule.

-This article identifies the current CDC vaccine recommendations, reviews the benefits of vaccination for children and pregnant women, and uses the current evidence base to answer common questions raised by vaccine-cautious parents.

 

BENEFITS OF VACCINATION:-

-There are both immediate and long-term benefits of vaccination for individuals, as well as advantages for the community at large.

-The community benefits of vaccination stem from reduction in morbidity and mortality, as well as of reduction in cost and loss of productivity due to sick days from work and school, doctor's visits, hospitalizations, and long-term disability.

-It is clear from these data that vaccination has had a staggering effect on the public health, reducing the disease burden for both individuals and communities.

 -Pertussis also known as whooping cough, is a perfect example both of the success of vaccines in decreasing morbidity and mortality and of the rising rates of disease caused by decreasing vaccination rates.

-As noted in the introductory paragraph, before routine and mandatory vaccination for pertussis, there were 150 000 to 260 000 annual cases of pertussis and up to 9000 annual deaths reported to the CDC.

-In 2001, there were only 7580 reported cases of pertussis in the United States; there were 181 pertussis fatalities from 2000 to 2008, with 166 of those deaths in children younger than 6 months.

-Such great reductions in illness and death demonstrate the significant role of vaccination in health promotion.

-Despite the clear benefits of pertussis vaccination, concerns over vaccine administration have led to a decrease in rates of vaccination.

-Since this decrease, the United States has seen an increase in pertussis infection rates, which rose to 16 858 in 2009, more than double the 2001 rate.

 -An analysis of the cost-benefit ratio of vaccination must take into account both the actual monetary cost of the vaccine and the costs of adverse events.

-These costs must then be weighed against the benefits of disease prevention, including the immediate and long-term costs of illness.

-An excellent example of this cost analysis was performed by Carabin who found that the average cost per measles case (including complications such as hospitalization) in several industrialized countries was $254 to $307 whereas the average cost per postvaccination adverse event was $1.43 to 1.93.

-When compared with the costs of vaccine-preventable diseases, the absolute monetary cost of any individual vaccine is quite low, even when the cost of adverse events is included.

-This is particularly true of combination vaccines such as the measles-mumps-rubella (MMR, $18.98) or diphtheria and tetanus toxoids and acellular pertussis (DTaP, $13.25).

 

VACCINATIONS BEFORE, DURING, AND AFTER PREGNANCY:-

-There are several unique vaccination recommendations specific to women who are pregnant or are trying to become pregnant.

-There are vaccine-preventable diseases that pose special risks to fetuses and newborns; vaccination of a woman before or during her pregnancy can reduce the incidence of these diseases.

-There are also vaccinations that should not be given to pregnant women.

-Healthcare providers have the dual responsibility of understanding the impact of vaccine-preventable diseases on both mother and fetus, as well as knowing the vaccine recommendations for pregnant women and how these differ from nonpregnant adults.

 -The CDC publishes vaccine guidelines for women before, during, and after pregnancy.

- The 4 specific vaccines with unique implications for pregnant women are rubella, hepatitis B, pertussis, and influenza.

-These will be discussed individually later, as will specific recommendations for women who are traveling while pregnant. -Live vaccines should not be given to pregnant women because there is a theoretical risk to the fetus from these types of vaccinations.

-These contraindicated vaccinations include rubella, live attenuated influenza, MMR, varicella, and zoster (shingles). In addition, the human papilloma virus vaccine is "not recommended."

 -A preconception healthcare visit is an ideal time to assess a woman's vaccination history, collect titers if necessary, and provide appropriate vaccinations if they are needed.

-Preconception counseling ensures that women are up to date on vaccinations and enables them to receive "missing" vaccinations before becoming pregnant.

-This is of particular value in the case of live vaccines such as rubella, which should not be given to pregnant women.

-Women who are already pregnant should be assessed for vaccination status, including titers, and counseled about which vaccines are safe in pregnancy and which should be given postpartum.

-Pregnant women should be assured that being up to date on their own vaccinations is the first step in protecting their infants from vaccine-preventable diseases.

 

1. Rubella:-

-Rubella (German measles) is a viral disease that typically causes a fever and skin rash for several days.

- In young adults, it is usually not a serious illness and is self-limiting in duration.

-The fetus of a pregnant woman infected with rubella is at risk for severe birth defects, including deafness, heart defects, cataracts, damage to the liver and spleen, mental retardation, and termination.

-The CDC recommends that women who intend to become pregnant be given the MMR vaccine if a titer result is nonimmune; these women should wait to become pregnant for at least 4 weeks after vaccination.

-Since rubella is a live-virus vaccine, it should not be given to pregnant women because of the potential risk to the fetus.

-Instead, pregnant women who are found to be nonimmune to rubella should be offered the vaccine once they have given birth.

 

2. Hepatitis B:-

-Hepatitis B is a viral infection that affects the liver.

- It can be either acute, lasting several weeks, or chronic and lifelong.

-It is spread through contact with body fluids.

-A pregnant woman who has hepatitis B can pass it to her infant during delivery.

-Acute hepatitis B is more likely to develop into chronic hepatitis B the younger it is acquired.

- It is estimated the 90% of infants affected with hepatitis B will develop chronic infection; most people with chronic hepatitis B were infected as infants or very young children.

-The CDC recommends that pregnant women be tested for hepatitis B as part of preconception care or upon presenting for prenatal care.

-Women who are at high risk for hepatitis B and not already immune should be offered the vaccination series.

-The vaccination may be given during pregnancy.

 -The CDC also recommends the first dose of hepatitis B vaccine be given to infants within 12 hours of birth, with additional doses per the vaccination schedule for children.

-This is especially important if the mother has hepatitis B.

-Infants of these women should also be given hepatitis B immune globulin.

-The combination of the hepatitis B vaccine and hepatitis B immune globulin given to the infants of hepatitis B-positive women can prevent most cases of chronic hepatitis B.

 

3. Pertussis:-

-Pertussis (whooping cough) is a bacterial illness that causes severe, violent coughing spells. Complications include pneumonia and death.

-The CDC vaccination schedule recommends infant vaccination at 2, 4, and 6 months of age, after which time most infants are protected.

-Since infant vaccination does not begin until 2 months, they are susceptible to pertussis infection before this time and are also at increased risk for complications and death.

-Adults who are infected with pertussis may not have symptoms, so an infected adult can pass pertussis to an infant without realizing it.

-To protect infants who are too young to be vaccinated, the CDC recommends that all adults who are in contact with an infant younger than 12 months receive the DTaP vaccine; ideally, it should be given at least 2 weeks prior to contact.

-In addition, pregnant women who have not previously had a DTaP vaccine should receive it in the second or third trimester of pregnancy, which provides some passive immunity against pertussis.

- If she is not given the vaccination during pregnancy, it should be given immediately postpartum.

 

4. Influenza:-

-Influenza is a respiratory virus that causes coughing, sneezing, fever, and body aches.

-It may lead to secondary infections such as ear or sinus infections or pneumonia.

-Because different strains of the virus are prevalent at different times, yearly influenza vaccination is recommended for everyone aged 6 months and older.

-As is the case with pertussis, infants younger than 6 months are at increased risk, both of getting influenza and of suffering complications.

-For this reason, anyone expecting contact with an infant should receive the influenza vaccine.

 -Because of normal physiologic changes in the heart and lungs during pregnancy, a pregnant woman who contracts influenza is at a greater risk for complications, hospitalization, and death.

-Infection with influenza also places pregnant women at higher risk of premature labor and delivery.

-For these reasons, any woman who is pregnant during influenza season should receive the inactivated influenza vaccination regardless of pregnancy trimester.

- Pregnant women should not receive the live attenuated influenza vaccine, which is administered via nasal spray, because of the theoretical harm to the fetus of a live-virus vaccination.

 -Swine influenza or "swine flu" is an influenza virus that causes illness in pigs.

-Although humans are not usually affected by these viruses, variant viruses have occasionally spread to humans, causing limited disease.

- Prior to 2009, the CDC recorded infection with these variant strains in approximately 1 person every 1 to 2 years.

- In 2009, a strain of variant swine flu (H1N1) emerged that not only caused illness in humans but was also easily transmissible among humans.

-This led to a pandemic; from April 2009 to April 2010, the CDC reported mid-level estimates of 61 million H1N1 cases, 274 000 hospitalizations, and 12 470 deaths.

-Since 2009, the seasonal influenza vaccine includes H1N1 and other similar swine influenza variants.

 

Vaccinations for travel:-

-International travel presents additional considerations for healthcare providers and pregnant women.

- There are multiple areas of the world where vaccine-preventable diseases are prevalent.

- In many of these areas, the prevalent diseases are not common or do not exist in the United States and travelers must be vaccinated before taking a trip. -While pregnancy is a precaution against giving some pretravel vaccinations, the CDC recommends vaccination if the risk of exposure outweighs the potential risks of the vaccine.

-Vaccinations for Japanese encephalitis, meningococcal meningitis (the conjugate vaccine is preferred over the polysaccharide), inactivated polio, rabies, and typhoid (the polysaccharide is preferred to the live attenuated vaccine) should all be given with caution to pregnant women.

- However, if a woman is traveling to an area with high incidence of these diseases and exposure is likely, the CDC suggests that the benefit of vaccine administration outweighs the potential risks.

 -The yellow fever vaccination requires that a risk-benefit analysis be made on a case-by-case basis.

-In some instances, the risk of vaccination outweighs that of exposure to yellow fever; in these cases, a pregnant woman may be issued a medical waiver, allowing her to travel without receiving the vaccination.

- If the risk of exposure to yellow fever is greater than the risk of vaccination, the vaccination may be administered.

 -Some travel locations may require vaccination against tuberculosis, MMR, or varicella.

-These vaccinations are contraindicated in pregnant women because of the risks to the fetus.

-A pregnant woman should delay travel until after delivery rather than receiving these vaccines.

-Women considering travel to countries that require vaccinations should be referred to a healthcare professional familiar with these vaccinations and with international travel.

 

Vaccination schedule:-

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