Paul Quesenberry MD Meritus Family Medicine Residency Program

Paul Quesenberry MD Meritus Family Medicine Residency Program Director Immunizations Update

Disclosures I have no actual or potential conflicts of interest in relation to this program/presentation.

Objectives Review of childhood immunizations Review of adult immunizations Discuss plans for travel abroad (missions trips) Rationale for addressing parental questions about immunization aversion: autism, vaccines created from aborted fetal tissue, and vaccines causing illness Discuss vaccines for immigrants Understand vaccine cost

Vaccine Resources • cdc. gov/vaccines • For travel cdc. gov then look under “Traveler's” and then by country to which you are travelling. Start at least 6 months prior to leaving.

Pediatric Immunization Schedule

Adult Immunization Schedule

Perspective How many deaths world wide are still attributable to vaccine preventable illnesses? 1. Measles 2. Pertussis 3. Diptheria 4. Rotovirus

Vaccine Preventable Diseases • Mumps • Diphtheria • Hemophilis influenza • Pertussis (Whooping type b (Hib) Cough) • Hepatitis A • Pneumococcus • Hepatitis B • Polio • Human Papilloma Virus • Rotavirus (HPV) • Influenza • Measles • Meningococcus • Rubella (German Measles) • Tetanus • Varicella (Chickenpox)

Vaccine Preventable Diseases • Herd immunity plus aggressive immunization has made most of these diseases rare. • Most current residents and medical students haven’t seen these diseases.

Herd Immunity • Most of population immunized • Disease itself still exists, but spread prevented by lack of available hosts • Unimmunized person less likely to come in contact with infected person

Vaccine Preventable Diseases • To comprehend why we immunize, you • Need to have basic childhood disease knowledge • Need to know the combinations of vaccines available to prevent the illnesses

Vaccination never been proven associated with autism Vaccine Safety • In 2010, Lancet retracted the 1998 article • Was initial paper linking MMR with autism • There are multiple web-based sites that have false information regarding vaccine risks

Vaccines and Aborted Fetal Tissue

Objections to the HPV vaccine • Why should I immunize my daughter against a sexually transmitted virus? Many conservative parents don’t want to think about a vaccine for an STI particularly at the age of 11 -15. • Why should I consider the vaccine for my son who does not have a cervix? • Reports of syncope and the lack of bona fide cancer prevention data on the vaccine

Foreign-Born Children • Foreign-received vaccine valid if • Same age and dosing intervals as US • Written documentation • If not valid, two options: • Repeat series • Serology testing • May not predict disease protection • Requires accurate interpretation

Lots of pros. So what’s the con? Vaccines are expensive!!

Vaccines Are Expensive VFC PRIVATE PAY VACCINE DTa. P $17. 61 -18. 19 $24. 05 -30. 84 Pediarix® (DTa. P, Hep B, IPV) $57. 97 $76. 95 Pentacel® (DTa. P, IPV, Hib) $58. 33 $96. 14 IPV $13. 30 $33. 53 HPV $168. 10 $217. 11 Hib $9. 23 -13. 09 $10. 55 -26. 23 Hepatitis A $19. 29 -19. 58 $31. 95 -32. 66 Hepatitis B $9. 23 -13. 09 $23. 05 -23. 95 CDC Vaccine Price List Prices last reviewed/updated: Jan 2, 2019 https: //www. cdc. gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index. html

Vaccines Are Expensive VACCINE VFC PRIVATE PAY MMRV $125. 11 $214. 37 MMR $21. 05 $75. 04 Meningococcal $73. 83 -91. 81 $122. 31 -126. 95 Rotavirus $70. 49 -92. 85 $82. 89 -117. 45 PCV 13 $131. 77 $180. 05 Varicella $98. 24 $129. 30 Remember: These are the costs for 1 dose. Many series require 3 or 4 doses. https: //www. cdc. gov/vaccines/programs/vfc/awardees/vaccine-management/price-list/index. html

Resources • www. cdc. gov/vaccines • (National Immunization Program) • www. immunize. org/childrules • (Immunization Action Coalition) • www. cdc. gov/vaccines/programs/iis/contact-state. htm • State Health Department immunization programs • Epidemiology and Prevention of Vaccine- Preventable Diseases. The Pink Book: Course Textbook 13 th Edition: http: //www. cdc. gov/vaccines/pubs/pinkbook/in dex. html