Tag: immunization schedule

Vaccine Education for Pediatric Offices

Pediarix, Hib, Prevnar, and Rota vaccines have been prepared for an infant at her well child visit.
Pediarix, Hib, Prevnar, and RotaTeq vaccines have been prepared for an infant at her well child visit. Photo by Vincent Iannelli, MD

Why get educated about vaccines if you work in a pediatric office?

In addition to learning how to give vaccines properly, it can help you answer any questions parents might have and help them understand that vaccines are safe, vaccines work, and vaccines are necessary to protect our kids.

Who needs to get educated about vaccines?

Everyone of course. While it’s great if all of the medical assistants and nurses have done their research about vaccines, you will have missed opportunities to get kids vaccinated and protected if the folks making appointments aren’t.

Learning the Immunization Schedule

How do you know when to give a particular vaccine to an infant, child, or older teen when they come to the office, besides the fact that someone else ordered it or the school says they need it?

You can learn the rules of the immunization schedule.

There is more to it than just looking a child’s age and seeing which vaccines they are due for though.

Has the child missed any vaccines, which means you might need to use the catch-up immunization rules?

Do they have any contraindications or reasons to not get a vaccine today?

“There is no ‘alternative’ immunization schedule. Delaying vaccines only leaves a chil​d at risk of disease for a longer period of time; it does not make vaccinating safer.

Vaccines work, plain and simple. Vaccines are one of the safest, most effective and most important medical innovations of our time. Pediatricians partner with parents to provide what is best for their child, and what is best is for children to be fully vaccinated.”

Karen Remley, MD, Executive Director, American Academy of Pediatrics​

Does the child have any high risk conditions, which mean they might need an early or extra vaccine?

In addition to reviewing the latest immunization schedules, studying a summary of recommendations for child and teen immunizations can help you quickly learn when kids need vaccines.

Giving Vaccines Safely

Once you know when it’s time to give the right vaccine to the right child at the right time, you want to make sure that you are giving it to them properly.

You also want to make sure staff knows how to reduce pain associated with giving shots, keeps thorough records, and disposes of needles and syringes properly.

Storing Vaccines Safely

Vaccines must be stored properly.

For example, while some vaccines must be refrigerated, others must be frozen.

What happens if vaccines aren’t stored at the proper temperature?

If a vaccine gets too warm or too cold, it can lose some of its potency and it probably won’t work well. That can mean vaccinated kids don’t get the immunity you expect and are left unprotected to one or more vaccine-preventable diseases. Hopefully, the office discovers the problem before any kids have gotten the vaccine though and they are just left throwing out some unusable vaccines.

The California VFC Program offers
The California VFC Program offers “Do Not UnPlug” signs so that vaccines don’t get ruined.

Fortunately, there are plenty of resources to help office staff get trained about:

  • appropriate vaccine refrigerators and freezers
  • monitoring vaccine temperature with a digital data logger and certified calibrated buffered thermometer probe
  • vaccine temperature best practices
  • keeping a vaccine inventory log
  • handling vaccine deliveries
  • having a plan for refrigerator failure
  • having a plan for power failure and disasters
  • avoiding preventable errors

Does your office have a plan to keep their vaccines at a safe temperature? What about if the power goes out? Will they still be safe?

Other Vaccine Issues

Anyone who administers vaccines to kids should also know:

  • that they need to provide a copy of the latest Vaccine Information Statement from the Centers for Disease Control and Prevention (CDC) to the child’s parent or guardian before giving each vaccine
  • the answers to common questions that parents ask about vaccines
  • to explain common and more rare side effects that parents might be possible after vaccines, so that they aren’t surprised
  • how to report possible adverse reactions to VAERS
  • how to report a vaccine error to VERP
  • that children, especially teens, should be observed for 15 minutes after they are vaccinated to make sure they don’t develop syncope (fainting)
  • strategies to improve your office’s immunization rates
  • how to counter the bad advice Dr. Sears and the use of an alternative or non-standard, parent-selected, delayed protection vaccine schedule
  • the most common vaccine errors, so you can better avoid them

It is also important for all staff to know their office’s vaccine policy. Does your office have one?

What To Know About Vaccine Education for Pediatric Offices

Vaccines are safe, necessary, and still needed to protect all of our kids from vaccine-preventable diseases. Help make sure everyone in your office is educated about the latest immunization schedule and understands how to give and store vaccines safely.

More on Vaccine Education for Pediatric Offices

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Immunization Schedules from Other Countries

The latest immunization schedule from the CDC and AAP.
The latest immunization schedule from the CDC and AAP.

Why does the United States give so many more vaccines than other countries?

The easy answer might be that we want to protect kids from more vaccine-preventable diseases. Of course, it is much more complicated than that.

But why does it matter?

It still matters because Jenny McCarthy has pushed the idea that we have an ‘autism epidemic‘ in the United States because “other countries give their kids one-third as many shots as we do.”

And some folks still believe her.

They also believe anti-vaccine myths and misinformation linking giving more vaccines to having higher infant mortality rates.

Immunization Schedules from Other Countries

Which vaccines a country routinely gives often depends on the risk a diseases poses to the people that live there. For example, some countries routinely give the BCG and Japanese encephalitis vaccines, but only give the hepatitis B vaccine in high risk situations.

And while many folks still push the myth that the United States gives many more vaccines than other developed countries, you just have to look at their immunization schedules to see that it isn’t true.

Remember that in the United States, children typically get:

  • 36 doses of 10 vaccines before starting kindergarten that protect them against 14 vaccine-preventable diseases
  • at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine

So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases. While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.

Immunization Schedules from Europe

How do immunization schedules from European countries differ from the United States?

Austria's immunization schedule for 2017 includes all of the same vaccines as the US schedule.
Austria’s immunization schedule for 2017 includes all of the same vaccines as the US schedule, plus the vaccine for Japanese encephalitis (if high risk).

Surprisingly, they don’t differ by that much, despite what you may have heard or read.

And in many European countries, even if you don’t get more vaccines overall, you do get more dosages at an earlier age, often with two dosages of MMR and the chicken pox vaccine by the time your child is 15 to 24 months old.

The latest immunization schedule from Germany.
The latest immunization schedule from Germany.

Some vaccines, like hepatitis A and chicken pox aren’t routine in every European country, like Iceland and Sweden, but many countries give vaccines that we don’t, like BCG and MenC. And even Iceland and Sweden have recently added the HPV vaccine to their schedule and Sweden may soon add the rotavirus vaccine too.

Immunization Schedules from Other Countries

Many countries, in addition to those in Europe, have vaccine schedules that are very similar to the one that is used in the United States.

The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and Japanese encephalitis vaccines.
The 2017 Immunization Schedule for South Korea includes all of the US vaccines, plus BCG and   Japanese encephalitis vaccines.

Just look at the immunization schedules for Australia, Canada, Israel, South Korea, or Taiwan, etc.

What about Japan? They must give fewer vaccines than we do in the United States, right? After all, aren’t they the country that banned the use of the HPV vaccine?

Although that myth is still pushed by many anti-vaccine websites, the HPV vaccine is not banned in Japan. It was removed as a vaccine that is actively recommended in 2013, but it still available and is still on the Japanese immunization schedule.

The 2016 routine and voluntary immunization schedule in Japan.
The 2016 routine and voluntary immunization schedule in Japan.

All of our other vaccines are also on the Japanese immunization schedule. In addition, they give infants the BCG and Japanese encephalitis vaccines.

What to Know About Immunization Schedules from Other Countries

Many countries use a similar immunization schedule and give the same types of vaccines as we do in the United States.

More On Immunization Schedules from Other Countries

Catch-Up Immunization Schedules

It is surprisingly easy to get behind on your child’s immunizations, even if you are trying to stay on schedule.

How do you miss a shot?

Your child could have been sick when they were supposed to get their vaccines, your pediatrician might have been out of one or more vaccines, or you might have simply missed one of your child’s well checkups.

Catching Up On Vaccines

A catch-up immunization schedule
A catch-up vaccination schedule program can help you figure out when to get the vaccines your child has missed.

If your child gets behind and misses one or more vaccines, be sure to get caught up as soon as possible.

If your child needs to get caught up quickly, like to start daycare or school, to travel out of the country, or because of a disease outbreak in your area, you can even use an accelerated immunization schedule, using minimum intervals between doses.

Depending on your child’s age, you might even be able to skip a few doses or vaccines.

For example, with rotavirus vaccines, vaccination should not be started if an infant is already 15 weeks old and the final dose must be given by 8 months of age.

And if your child gets their first dose of Hib after they are 15 months old, they don’t need any more doses. And they wouldn’t need any doses at all if they are already 5 years old.

Prevnar, IPV, and DTaP might also need to given on an alternative schedule when given on a catch-up schedule.

Specifically, your child might be able to skip:

  • the fifth dose of the DTaP vaccine, if the fourth dose was given at age 4 years or older.
  • the fourth dose of the IPV vaccine, if the third dose was given at age 4 years or older.
  • one or more doses of Prevnar, depending on when the other doses were given

Is this a good way to get out of getting some doses or vaccines?

Of course not. In addition to missing out on those vaccines, your child is missing out on the protection from those vaccines.

For More Information on Catch-Up Immunization Schedules

Historical Immunization Schedules

Technically, the first official immunization schedule that was approved by the ACIP, AAP, and AAFP – a harmonized immunization schedule, just like we have today – was published in 1995.

Past Immunization Schedules

Of course, there were immunization schedules before that, including these immunization schedules that were published by the AAP in 1983, 1989, and 1994:

schedule1983s
Eleven doses of four vaccines protected kids against seven vaccine-preventable diseases in 1983.

The Hib vaccine was added in 1985.

schedule1989s
Twelve doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989.

Next came the hepatitis B vaccine and expanded age ranges for the Hib vaccine.

schedule1994s
Seventeen doses of five vaccines protected kids against eight vaccine-preventable diseases in 1989 (plus the later Td booster).

What’s still missing?

Vaccines and protection against rotavirus, hepatitis A, chicken pox, flu, pneumococcal bacteria, meningococcal bacteria, and HPV.

Even Older Immunization Schedules

While the anti-vaccine movement often claims that kids now get too many vaccines (the too many too soon argument), not understanding that they get far fewer antigens than they once did, with far more protection, most of them will be surprised that some children got even more immunizations that the 1980s schedules they long for.

schedule1940s
A schedule of immunizations from a 1948 AAP Round Table Discussion on the Practical and Immunological Aspects of Pediatric Immunizations

So in the 1940s, some children received:

  • 3 doses of the pertussis vaccine
  • 2 doses of the smallpox vaccine
  • 3 doses of the typhoid vaccine
  • 3 doses of a DT vaccine
  • a DPT booster
  • a tetanus booster
  • a typhoid booster
  • 2 pertussis boosters

Some children also received a flu vaccine and pneumococcal vaccine.

With reference to the influence viral vaccine we have endeavored to give it those children who have repeated, frequent, severe upper respiratory tract infection.

Dr. Francis A Garbade – Galveston, Texas 1948

And in 1938, the AAP’s Special Committee on Prophylactic Procedures  Against  Communicable Diseases published a pamphlet,  Routine measures for the prophylaxis of communicable diseases, which became the first Red Book.

Among its recommendations were vaccines to protect against seven infections, including:

  • diphtheria
  • pertussis
  • rabies
  • tetanus
  • tuberculosis
  • typhoid fever
  • small pox

It also mentions vaccines for erysipelas, scarlet fever, staphylococcal infections and chicken pox.

The bottom line is that many kids got a lot more vaccines in the old days than many parents realize or remember.

For More Information on Historical Immunization Schedules:

 

References on Historical Immunization Schedules
Offit, Paul A. Addressing Parents’ Concerns: Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System? Pediatrics. Vol. 109 No. 1 January 1, 2002 pp. 124-129
Pickering, Larry K. The Red Book Through the Ages. Pediatrics. November 2013, VOLUME 132 / ISSUE 5
Sako, Wallace. Practical and Immunolgic Aspects of Pediatric Immunizations. Pediatrics. 1948;2;722.

Translating Foreign Language Immunization Schedules

It can be hard to enough to read an immunization schedule if you don’t have a medical degree, what with all of the acronyms and all.

DTaP, MMR, and lot numbers, etc.

But what if the immunization schedule is in a foreign language?

foreign-language-immunization-schedules
A Chinese to English immunization record to help make translating records easier.

How much luck will you have reading it then?

Fortunately, there is help for English speakers who get an immunization schedule in Spanish, French, Chinese, or Arabic, etc. And you don’t need your own translator.

Check out the resources below.

For more information:

Vaccine Hesitant Parents

Every parent who skips or delays a vaccine isn’t so anti-vaccine that they believe every anti-vaccine myth and conspiracy theory on the Internet.

Some are simply scared or worried about what they have read or by what friends or family members have told them.

One study by Gust et al. has actually identified up to five categories of parents, including:

  • immunization advocates – the biggest group, who think that vaccines are necessary, safe, and important
  • go along to get alongs – think that vaccines are necessary and safe
  • health advocates – agree that vaccines are necessary, but aren’t so sure that they are safe
  • fence-sitters – slightly agree that vaccines are necessary and safe
  • worrieds – the smallest group, who slightly disagree that vaccines are necessary and strongly disagree that they are safe

The fence-sitters and worrieds, and some of the health advocates, are typically the ones who delay or skip one or more vaccines. They may even follow their own alternative parent-selected, delayed protection immunization schedules.

They are the vaccine-hesitant parents.

But what does it mean to be vaccine hesitant? Some people think of it as a kinder and gentler term, as opposed to someone who is anti-vaccine or a vaccine refuser.

The SAGE Vaccine Hesitancy Working Group says that:

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.

If you are hesitant about something, you are “slow to act or speak especially because you are nervous or unsure about what to do.” In general, you need reassurance and advice to address your concerns about what ever you are nervous or hesitant about.

That’s especially true when you talk about vaccine hesitancy. When a parent is worried and wants to skip or delay the MMR vaccine because they have been told it is going to make their child autistic or have read about toxins in vaccines, those are easy concerns for their pediatrician to address and refute.

That’s why many vaccine hesitant parents eventually get their kids caught up on all of their vaccines.

When a parent doesn’t want to believe the overwhelming evidence that vaccines are safe and necessary, then you are moving beyond vaccine hesitancy to someone who is truly anti-vaccine.

That’s not the vaccine hesitant parent though.

One study, “Validity and reliability of a survey to identify vaccine-hesitant parents,” described vaccine hesitant parents as a “heterogeneous group of parents who may purposefully delay or choose select vaccines, have moderate concerns about vaccine safety, and yet still want to trust and receive immunization information from their child’s provider.”

More importantly, the study also said that of vaccine hesitant parents,  “their child’s provider remains in a position of influence, their immunization attitudes are not extreme, and they are a larger group than those who completely reject vaccines.”

That makes it important to truly make dismissing families who don’t vaccinate from pediatric practices a very last resort that is saved for the “entrenched nonvaccinators” and antivaccination activists who are never going to change their minds.

After all, you can’t talk to your pediatrician about vaccines if you are no longer going to a pediatrician who advocates that vaccines are safe and necessary.

For more information:

 

Immunization Schedules

Each year, since 1995, the Advisory Committee on Immunization Practices (ACIP) of the CDC has reviewed the recommended immunization schedule, and it has then been approved by ACIP, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.

Before 1995, in 1994, 1989, and 1983, an immunization was simply published as part of the ACIP’s general recommendations.

Looking for an alternative to the ACIP immunization schedule?

According to the American Academy of Pediatrics:

No alternative vaccine schedules have been evaluated and found to provide better safety or efficacy than the recommended schedule, supported by the Advisory Committee on Immunization Practices of the CDC and the Committee on Infectious Diseases of the AAP (the committee that produces the Red Book).

Pediatricians who routinely recommend limiting the numbers of vaccines administered at a single visit such that vaccines are administered late are providing care that deviates from the standard evidence-based schedule recommended by these bodies.

Again, there are no alternative immunization schedules.

For more information: