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Chapter 1 Index
A. General Information
about the well child examination B. Nutrition Issues
C. Sleep Issues
D. Dental Issues
E. Anticipatory Guidance
F. Screening Tests
G. Immunizations
--Screening Tests and
Immunization Schedule
--Influenza - Dx and Prevention |
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Varicella Vaccine – 2002
Ann Arvin: Ped Annals: June 97; Cont Peds May 97; Redbook 2000
Introduction: Until the advent of the live attenuated
vaccine, there were 3-4 million cases of varicella in children each year
with 10,000 hospitalizations and up to 100 deaths per year. Data from July
MMWR: 1999: Immunization rates by 3 years of age:
DtaP X 3: 95.9%; Polio X 3: 89.6%; HIB X 3: 91.5%; MMR X 1: 91.5%; Hep B
X 3: 88%; Varicella X 1: 59.4%. Varicella now required in the state of
Georgia for school.
Age at which given: 12-18 mos of age or 13 years of age
given 4-8 weeks apart.
Side Effects of Vaccine:
- Fever in 14% of children in the
first 42 days.
- Cutaneous varicella in 4-5 %
about 5-26 days after shot: median #: 5 lesions.
- Rare: URI, headache, fatigue,
cough, myalgia, pneumonia, encephalitis, hepatitis, Stevens-Johnson,
death.
- Herpes Zoster: 2.6 per 100,000
vaccinees vs 68 per 100,000 after natural exposure.
- Reduction in invasive
streptococcal disease: probably the most important reason to give it: Peds
2000; 150:e60: 15% of invasive streptococcal infections are associated
with varicella; 4% fatality: this prevented by vaccine.
- Redbook 2000: if give vaccine
after 72 hours of exposure to varicella, markedly reduced incidence of
infection (4% vs. expected 70-90%).
Long-term Effectiveness of the Varicella Vaccine:
- Some say prevents 80% of infection but 100% of serious infections
- After 4 years, 99.5% persistence of VZV IgG Antibodies in children
- After 7 years, there is a 95% protection rate in vaccines. Incidence
of breakthrough infection rates: 0.3% to 0.9% per year in children. In
adolescents, the incidence is slightly higher: 4.1%. Modified: 10-100
lesions in these children vs. natural infection with average of 250-500
lesions.
- Should give it to children who have been exposed in the previous 2-3
days. No question now that decreases the incidence of varicella vaccine.
Contraindications of the Vaccine:
- Somewhat controversial: now may
give it to immunosuppressed as long as not too immunosuppressed: e.g: if
CD count greater than 25% of normal, give vaccine.
- Pregnancy: must check pregnancy
test prior to giving in teenaged girls.
- Steroids 2 mg/kg for 14 days of
prednisone: do not give.
- Do not give within 5 months of
receiving VZIG, IVIG and blood.
- Household contacts with
immunosuppression: OK to give to the child, but if child then breaks out
with rash, give VZIG to the family contact.
- Salicylate use: no information
on Reye Syndrome after varicella, but insert states that child should not
receive vaccine if received salicylates within 6 weeks.
Other immunosuppression: leukemia, lymphoma, and immunodeficiency.
Updated 10/2000; Reviewed 10/01
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