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VACCINES
The Effectiveness of Immunizations
"Since coming into widespread use, immunizations have saved billions of lives around the world. They have enhanced the
quality of life, eliminated a huge burden of suffering and disability, and
contributed to the length of life. " As an example the chart below shows the
impact of immunization against rubella.
Reported rubella cases, United States,
1966-1997*
Rubella vaccine reduced rubella cases by 99.64% ,and congenital rubella syndrome (CRS) deaths by 99.99%.
Source:
U.S. Department of Health &
Human Services
http://www.hhs.gov/nvpo/concepts/intro6.htm
Congenital rubella syndrome (CRS) is an illness resulting from rubella
virus infection during pregnancy. When rubella infection occurs during early
pregnancy, serious consequences—such as miscarriages, stillbirths, and
congenital defects including cataracts, congenital heart disease, hearing
impairment, and developmental delay can result. "Although rubella has been eliminated
in the United States, it continues to be endemic in many parts of the world.
It is estimated that more than 100,000 infants are born with CRS annually
worldwide." [11]
SEE ALSO: are information sheets produced by the Centers for Disease
Control and Prevention (CDC) that explain to vaccine recipients, their parents,
or their legal representatives both the benefits and risks of a vaccine. Federal
law requires that VISs be handed out whenever (before each dose) certain
vaccinations are given.
Institute for
Vaccine Safety
H1N1
Flu Vaccination Resources
Find a Flu Clinic
Hepatitis A (Havrix
®)
Inactivated virus vaccine.
Each 1-mL adult dose of vaccine consists of 1440 EL.U. of viral antigen.
Indicated for active immunization against disease caused by hepatitis A virus (HAV)
for persons ≥12 months of age.
- Primary immunization for adults consists of a single 1-mL dose by
intramuscular injection and a 1-mL booster dose administered anytime
between 6 and 12 months later in order to ensure the highest antibody
titers.
(Single-Dose Vials and Prefilled Syringes)
The vaccine is considered safe for use during
pregnancy [1, 2]. Compatible with breast feeding [3]
Hepatitis B (Recombivax HB ®
)
Inactivated (recombinant)
noninfectious vaccine.
Each 1 mL dose contains 10 mcg of hepatitis B surface antigen.
Indicated for vaccination against infection caused by all known subtypes
of hepatitis B virus.
- Adults 19 years of age and older: 1-mL dose by intramuscular injection into the deltoid muscle, at initial
visit, then one month and six months after the first dose, for a total of
three doses
(1 mL single-dose vials, or single-dose prefilled syringe with one-inch
23 gauge needle is provided separately)
Pregnancy and lactation are not contraindications to
vaccine [4].The American College of Obstetricians and Gynecologists
recommends the use of hepatitis B vaccine for pregnant women at risk of
acquiring the disease [2]. Compatible with breast feeding '[3,5].
Influenza (Fluzone®)
Inactivated virus vaccine.
Indicated for active immunization against influenza disease caused by
influenza virus types A and B
- Adults 0.5 mL dose by intramuscular injection into the deltoid muscle
(0.5 mL syringe without needle, 0.5 mL Vial ; 5 mL vial. 5 mL vial
contains the preservative thimerosal)
The vaccine is recommended by the American College
of Obstetricians and Gynecologists " ...in the second and third trimester
during the flu season, and women at high risk for pulmonary
complications regardless of the trimester." [2] Pregnancy and lactation are not contraindications [5,6,7].
Pneumococcal (Pneumovax®)
Killed bacteria vaccine.
indicated for vaccination against pneumococcal disease
caused by those pneumococcal types included in the vaccine.
(Single dose and 5 dose vials)
The American College of
Obstetricians and Gynecologists does not consider the indications for the
vaccine to be altered by pregnancy. The vaccine is recommended for women
with asplenia, metabolic, renal, cardiopulmonoary diseases, smokers and
immunosuppressed patients [2,8]. Compatible with breast feeding [3].
Rubella (MERUVAX®II)
Live attenuated virus vaccine used to prevent infection by
the rubella virus.
The dose for any age is 0.5 mL of reconstituted vaccine administered subcutaneously, preferably into the outer aspect of the upper arm. A 25 gauge, 5/8" needle is recommended.
(Single-dose vials of lyophilized vaccine with vials of diluent)
Indicated for vaccination against rubella in persons 12 months of age or older. The American College of Obstetricians and Gynecologists (ACOG)
[2] recommends
that vaccination of women susceptible to rubella infection should be part of postpartum care.
Tdap (Adacel®
)[9, 10]
Sterile liquid suspension of tetanus and diphtheria toxoids
and acellular pertussis components
Indicated for active booster immunization for the prevention of tetanus,
diphtheria and pertussis as a single dose in persons 11 through 64 years of
age.
Single injection of one dose (0.5 mL) administered intramuscularly.
Adacel vaccine should not be combined through reconstitution
or mixed with any other vaccine.
CDC's Advisory Committee on Immunization Practices recommends" that
pregnant women who were not vaccinated previously with Tdap:
1) Receive Tdap in the
immediate postpartum period before discharge from hospital or birthing
center
2) May receive Tdap at an interval as short as 2 years
since the most recent Td vaccine,
3) Receive Td during pregnancy for tetanus
and diphtheria protection when indicated OR
4) defer the Td vaccine
indicated during pregnancy to substitute
Tdap vaccine in the immediate postpartum period if the woman is likely to
have sufficient protection against tetanus and diphtheria "
Health-care providers may choose to
administer Tdap instead of Td during pregnancy to add protection against
pertussis in persons at increased risk
for pertussis such as adolescents aged 11--18 years, health-care
personnel, and women employed in institutions in which a pertussis outbreak
is occurring or living in a community in which a pertussis outbreak is
occurring. Vaccinating
with tetanus toxoid--containing vaccines during the second or third
trimester is preferred.
The pregnant woman should
be informed of the lack of data confirming the safety and immunogenicity of
Tdap in pregnant women, the unknown potential for early protection of the
infant against pertussis by transplacental maternal antibodies, and the
possible adverse effect of maternal antibodies on the ability of the infant
to mount an adequate immune response to antigens in pediatric DTaP or
conjugate vaccines containing tetanus toxoid or diphtheria toxoid.
Health-care providers are encouraged to report vaccination of pregnant women
with Tdap, regardless of trimester, to the appropriate manufacturer's
registry. For ADACEL,® vaccination should be reported to sanofi pasteur,
telephone 1-800-822-2463 and for BOOSTRIX,® vaccination
should be reported to GlaxoSmithKline Biologicals, telephone 1-888-825-5249
[10]
(0.5mL prefilled syringes)
References:
1. Duff B, Duff
P.Hepatitis A vaccine: ready for prime time.Obstet Gynecol.
1998;91(3):468-71.
MEDLINE
2.
ACOG Committee Opinion. Immunization
during pregnancy.Obstet Gynecol. 2003;101:207-12.MEDLINE
3. Centers for Disease Control & Prevention. General Recommendations on
Immunization: Recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR 43 (No. RR-1): 20-21, 1994.
4.
Centers for Disease Control & Prevention. Hepatitis B Virus: A Comprehensive
Strategy for Eliminating Transmission in the United States Through Universal
Childhood Vaccination: Recommendations of the Immunization Practices
Advisory Committee (ACIP). MMWR 40 (No. RR-13): 4, 1991.
5.Breastfeeding and Maternal Medication. Recommendations for Drugs in the
Eleventh WHO Model list of Essential Drugs. pp 23-24
World Health Organization, 2002. 20 Avenue Appia ,1211 Geneva ,Switzerland
6. Centers for
Disease Control & Prevention. Prevention and Control of Influenza:
Recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR 47 (No. RR-6): 6, 1998.
7.
Fiore AE. et al. Prevention and control of influenza.
Recommendations of the Advisory Committee on Immunization Practices (ACIP),
2007.MMWR Recomm Rep. 2007 Jul 13;56(RR-6):1-54. PMID: 17625497
8. Centers for Disease
Control & Prevention. Prevention of Pneumococcal Disease: Recommendations of
the Advisory Committee on Immunization Practices (ACIP). MMWR 46 (No. RR-8):
6, 1997.
9.. Adacel prescribing information. Sanofi Pasteur Inc. January 2009
http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?id=17656
10. Murphy TV, et. al., Advisory Committee on Immunization Practices (ACIP) Centers for Disease Control and Prevention (CDC).Prevention of pertussis, tetanus, and diphtheria among pregnant and postpartum women and their infants recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008 May 30;57(RR-4):1-51. PMID: 18509304
11.
Huong McLean, PhD, MPH;et. al., Congenital Rubella Syndrome Prevent
Transmission from Infants with CRS Manual for the Surveillance of
Vaccine-Preventable DiseasesCenters for Disease Control and Prevention
Available at:
http://www.cdc.gov/vaccines/pubs/surv-manual/chpt15-crs.html
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