INFECTIOUS DISEASES - PART 1 pptx

RED BOOK: 2006 REPORT OF THE COMMITTEE ON INFECTIOUS DISEASES - 27th Ed. Author: Committee on Infectious Diseases American Academy of Pediatrics Larry K. Pickering, MD, FAAP, Editor Carol J. Baker, MD, FAAP, Associate Editor Sarah S. Long, MD, FAAP, Associate Editor Julia A. McMillan, MD, FAAP, Associate Editor American Academy of Pediatrics 141 Northwest Point Blvd Elk Grove Village, IL 60007-1098 Preface The Committee on Infectious Diseases of the American Academy of Pediatrics (AAP) is dedicated to providing practitioners with the most current and accurate information available. Because the practice of pediatric infectious diseases is changing rapidly and because of the emergence of new infectious diseases and immunizations, the ability to obtain information quickly is paramount. Although the Red Book is updated every 3 years, practitioners who care for children should visit periodically the AAP Web site (www.aap.org) and the Red Book Online Web site (www.aapredbook.org), where interim updates will be provided. The Committee on Infectious Diseases relies on information and advice from many experts as evidenced by the lengthy list of contributors. We especially are indebted to the many contributors from other AAP committees, the Centers for Disease Control and Prevention, the Food and Drug Administration, the National Institutes of Health, the Canadian Paediatric Society, the World Health Organization, and many other organizations that have made this edition possible. In addition, many suggestions made by individual AAP members to improve the presentation of information on specific issues have been taken into account under the able leadership of Larry K. Pickering, MD, editor, and associate editors Carol J. Baker, MD, Sarah S. Long, MD, and Julia A. McMillan, MD. We also are indebted to Edgar O. Ledbetter, MD, who spent many hours gathering the slide materials that are part of the electronic versions of the Red Book and provided other invaluable assistance with this edition. As noted in previous editions of the Red Book, some omissions and errors are inevitable in a book of this type. We hope that AAP members will continue to assist the committee actively by suggesting specific ways to improve the quality of future editions. Keith R. Powell, MD, FAAP Chairperson, Committee on Infectious Diseases Introduction The Committee on Infectious Diseases (COID) of the American Academy of Pediatrics (AAP) is responsible for developing and revising guidelines of the AAP for control of infectious diseases in children. At intervals of approximately 3 years, the committee issues the Red Book: Report of the Committee on Infectious Diseases, which contains a composite summary of current AAP recommendations concerning infectious diseases in and immunizations for infants, children, and adolescents. These recommendations represent a consensus of opinions developed by members of the committee in conjunction with liaison representatives from the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), the National Institutes of Health, the National Vaccine Program Office, the Canadian Paediatric Society, Red Book consultants, and numerous collaborators. This edition is based on information available as of January 2006. Unanswered scientific questions, the complexity of medical practice, the explosion of new information, and inevitable differences of opinion among experts result in inherent limitations of the Red Book. In the context of these limitations, the committee endeavors to provide current, relevant, and defensible recommendations for prevention and management of infectious diseases in infants, children, and adolescents. In some cases, other committees and experts may differ in their interpretation of data and resulting recommendations. In some instances, no single recommendation can be made because several options for management are equally acceptable. In making recommendations in the Red Book, the committee acknowledges these differences in viewpoints by use of the phrases "most experts recommend " and "some experts recommend " Both phrases indicate valid recommendations, but the first signifies more support among experts, and the second, less support. Hence "some experts recommend " indicates a minority view that is based on data and/or experience and is sufficiently valid to warrant consideration. Inevitably in clinical practice, questions arise that cannot be answered on the basis of currently available data. In such cases, the committee attempts to provide guidelines and information that, in conjunction with clinical judgment, will facilitate well-reasoned decisions. We appreciate the questions, different perspectives, and alternative recommendations that we have received, and encourage any suggestions or correspondence that will improve future editions of the Red Book. Through this process, the committee seeks to provide a practical and authoritative guide for physicians and other health care professionals in their care of infants, children, and adolescents. To aid physicians and other health care professionals in assimilating current changes in the recommendations in the Red Book, a list of major changes has been compiled (see Summary of Major Changes, p xxix). However, this listing does not include many changes of lesser importance, and health care professionals should consult individual chapters and sections of the book for current guidelines. In addition, new information inevitably begins to outdate some recommendations in the Red Book, and necessitates that health care professionals remain informed of new developments and resulting changes in recommendations. Between editions, the AAP publishes new recommendations from the committee in Pediatrics, in AAP News, and on the Red Book Online Web site (www.aapredbook.org). In this edition, we have provided Web site addresses throughout the text to enable early access to new information. For the most up-to-date list of important Red Book errata, please visit the Red Book Online Web site at www.aapredbook.org. The list of errata is available in standard HTML format and as an easy-to-navigate and easy-to-print PDF file and is freely accessible to all visitors to the site. On Red Book Online, you can sign up for e-mail alerts to be notified automatically when new errata have been announced. When using antimicrobial agents, physicians should review the package inserts (product labels) prepared by manufacturers, particularly for information concerning contraindications and adverse reactions. No attempt has been made in the Red Book to provide this information, because it is readily available in the Physicians' Desk Reference, online (www.pdr.net), and in package inserts (product labels). As in previous editions, recommended dosage schedules for antimicrobial agents are given (see Section 4, Antimicrobial Agents and Related Therapy). Recommendations in the Red Book for drug dosages may differ from those of the manufacturer in the package insert. Physicians also should be familiar with information in the package insert for vaccines and immune globulins as well as recommendations of other committees (see Sources of Vaccine Information, This book could not have been prepared without the dedicated professional competence of Edgar O. Ledbetter, MD, who served as the Red Book reviewer appointed by the AAP Board of Directors, who led the charge in gathering and organizing the new slide materials for the electronic part of the Red Book, and who provided valuable suggestions and support. The AAP staff has been outstanding in its committed work and contributions, particularly Martha Cook and Alison Siwek, managers, who served as the administrative directors for the committee and coordinated the preparation of the Red Book; Jennifer Pane, senior medical copy editor; Darlene Mattefs, department assistant; Barbara Drelicharz, division assistant; and Mark Ruthman and Mark Grimes, Department of Marketing, who make the Red Book Online and other Red Book products possible. Special thanks are given to Stephanie Renna, assistant to the editor, for her work, patience, and support. Marc Fischer, MD, and Douglas Pratt, MD, of the CDC and FDA, respectively, devoted a great deal of time and effort in providing input from their organizations. I am especially indebted to the associate editors Carol J. Baker, MD, Sarah S. Long, MD, and Julia A. McMillan, MD, for their expertise, tireless work, good humor, and immense contributions in their editorial and committee work. Georges Peter, MD, and Margaret Rennels, MD, continue to provide constant support and advice. Members of the committee contributed countless hours and deserve appropriate recognition for their patience, dedication, revisions, and reviews. As a committee, we particularly appreciate the guidance and dedication of the current committee chairperson, Keith R. Powell, MD, whose knowledge, dedication, insight, and leadership are reflected in the quality and productivity of the committee's work. The patience, tolerance, and support of Mimi are beyond words. These individuals are only a few of the many contributors whose professional work and commitment have been essential in the committee's preparation of the Red Book. Section 1. Active and Passive Immunization Active Immunization Introduction Active immunization involves administration of all or part of a microorganism or a modified product of that microorganism (eg, a toxoid, a purified antigen, or an antigen produced by genetic engineering) to evoke an immunologic response that mimics that of natural infection but that usually presents little or no risk to the recipient. Immunization can result in antitoxin, antiadherence, anti-invasive, or neutralizing activity or other types of protective humoral or cellular responses in the recipient. Some immunizing agents provide nearly complete lifelong protection against disease, some provide partial protection, and some must be readministered at regular intervals to maintain protection. The effectiveness of a vaccine is assessed by evidence of protection against the natural disease. Induction of antibodies commonly is an indirect measure of protection (eg, antitoxin against Clostridium tetani or neutralizing antibody against measles virus), but for some conditions (eg, pertussis), the immunologic response that correlates with protection is poorly understood, and serum antibody concentration does not always predict protection. Vaccines incorporating an intact infectious agent may be live-attenuated (weakened) or killed (inactivated). Vaccines licensed for immunization in the United States are listed in Table 1.3 The US Food and Drug Administration (FDA) maintains and updates a Web site listing vaccines licensed for immunization in the United States (www.fda.gov/cber/vaccine/licvacc.htm). Many viral vaccines contain live-attenuated virus. Although active infection (with viral replication) ensues after administration of these vaccines, usually little or no adverse host reaction occurs. The vaccines for some viruses and most bacteria are inactivated (killed) components, subunit (purified components) preparations, or inactivated toxins or are conjugated chemically to immunobiologically active proteins (eg, tetanus toxoid, nontoxic variant of mutant diphtheria toxin, or meningococcal outer membrane protein complex). Viruses and bacteria in inactivated, subunit, and conjugate vaccine preparations are not capable of replicating in the host; therefore, these vaccines must contain a sufficient antigenic mass to stimulate a desired response. Maintenance of long-lasting immunity with inactivated viral or bacterial vaccines may require periodic administration of booster doses. Inactivated vaccines may not elicit the range of immunologic response provided by live-attenuated agents. For example, an injected inactivated viral vaccine may evoke sufficient serum antibody or cell-mediated immunity but evoke only minimal local antibody in the form of secretory immunoglobulin (Ig) A. Thus, mucosal protection after administration of inactivated vaccines generally is inferior to mucosal immunity induced by live vaccines. Although systemic infection is prevented or ameliorated by the presence of serum and cellular factors, local infection or colonization with the agent can occur. However, viruses and bacteria in inactivated vaccines cannot replicate in or be excreted by the vaccine recipient as infectious agents and, thereby, cannot adversely affect immunosuppressed vaccinees or contacts of vaccinees. Recommendations for dose, vaccine storage and handling, route and technique of administration, and immunization schedules should be followed for predictable, effective immunization (see disease-specific chapters in Section 3). Adherence to recommended guidelines is critical to the success of immunization practices. Immunizing Antigens Physicians should be familiar with the major constituents of the products they use. The major constituents, including cell line derivation or animal derivatives as relevant, are listed in the package inserts. If a vaccine is produced by different manufacturers, differences may exist in the active and/or inert ingredients and the relative amounts contained in the various products. The major constituents of vaccines include the following: Active immunizing antigens. Some vaccines consist of a single antigen that is a highly defined constituent (eg, tetanus or diphtheria toxoid). In other vaccines, antigens that provoke protective immune responses vary substantially in chemical composition and number (eg, acellular pertussis components, Haemophilus influenzae type b, and pneumococcal and meningococcal products). Vaccines containing live-attenuated viruses (measles-mumps-rubella [MMR], measles-mumps-rubella-varicella [MMRV], varicella, oral poliovirus [OPV], live-attenuated influenza vaccine, oral rotavirus vaccine), killed viruses or portions of virus (eg, enhanced inactivated poliovirus [IPV], hepatitis A, and inactivated influenza vaccines), and viral proteins incorporated into a vaccine through recombinant technology (eg, hepatitis B vaccine) produce both humoral and cellular-mediated responses to ensure long-term protection. Conjugating agents. Carrier proteins of proven immunologic potential (eg, tetanus toxoid, nontoxic variant of diphtheria toxin, meningococcal outer membrane protein complex), when chemically combined to less immunogenic polysaccharide antigens (eg, H influenzae type b, meningococcal and pneumococcal polysaccharides), enhance the type and magnitude of immune responses in people with immature immune systems, particularly children younger than 2 years of age. Suspending fluid. The suspending fluid commonly is as simple as sterile water for injection or saline solution, but it may be a complex tissue-culture fluid. This fluid may contain proteins or other constituents derived from the medium and biological system in which the vaccine is produced (eg, egg antigens, gelatin, or cell culture-derived antigens). Preservatives, stabilizers, and antimicrobial agents. Trace amounts of thimerosal (less than 0.5 ug/0.25 mL of vaccine), other chemicals, and certain antimicrobial agents (such as neomycin or streptomycin sulfate) may be included in some vaccines and immune globulin preparations to prevent bacterial growth or to stabilize an antigen. Allergic reactions may occur if the recipient is sensitive to one or more of these additives. Whenever feasible, these reactions should be anticipated by screening the potential vaccinee for known severe allergy to specific vaccine components. Standardized forms are available to assist clinicians in screening for allergies and other potential contraindications to immunization (www.immunize.org/catg.d/p4060scr.pdf). Adjuvants. An aluminum salt commonly is used in varying amounts to increase immunogenicity and to prolong the stimulatory effect, particularly for vaccines containing inactivated microorganisms or their products (eg, hepatitis B and diphtheria and tetanus toxoids). Vaccine Handling and Storage Vaccines should be stored at recommended temperatures. Inattention to vaccine storage conditions can contribute to vaccine failure. Exposure of inactivated vaccines to freezing temperature (0.0C [32.0F] or colder) is the most common storage error. Live-virus vaccines, including MMR, MMRV, varicella, yellow fever, live-attenuated influenza, and OPV vaccines, are sensitive to increased temperature (heat sensitive). Inactivated vaccines may tolerate limited exposure to elevated temperatures but are damaged rapidly by freezing (cold sensitive). Examples of cold-sensitive vaccines include diphtheria and tetanus toxoids and acellular pertussis (DTaP and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap]) vaccines, IPV vaccine, H influenzae type b (Hib) vaccine, pneumococcal polysaccharide and conjugate vaccines, hepatitis A and hepatitis B vaccines, inactivated influenza vaccine, and meningococcal polysaccharide and conjugate vaccines. Some products may show physical evidence of altered integrity, and others may retain their normal appearance despite a loss of potency. Physical appearance is not an appropriate basis for determining vaccine acceptability. Therefore, all personnel responsible for handling vaccines in an office or clinic setting should be familiar with standard procedures designed to minimize risk of vaccine failure. Recommended storage conditions for commonly used vaccines are listed in Table 1.4 (p 13); new vaccines and new formulations of currently available products may have storage requirements different from those listed. In addition, storage recommendations may be revised by the manufacturer. Revisions require approval by the FDA. Recommendations for handling and storage of selected biologicals are summarized in several areas, including the package insert for each product; in a publication titled Vaccine Management, available from the Centers for Disease Control and Prevention (CDC)*; and in a Web-based toolkit available at www2a.cdc.gov/nip/isd/shtoolkit/splash.html. The most current information about recommended vaccine storage conditions and handling instructions can be obtained directly from manufacturers; their telephone numbers are listed in product labels (package inserts) and in the Physicians' Desk Reference, which is published yearly. The following guidelines are suggested as part of a quality control system for safe handling and storage of vaccines in an office or clinic setting. * Centers for Disease Control and Prevention. Vaccine Management: Recommendations for Handling and Storage of Selected Biologicals. Atlanta, GA: US Department of Health and Human Services, Public Health Service; 2005 PERSONNEL Designate one person as the vaccine coordinator, and assign responsibility for ensuring that vaccines and other biological agents and products are handled and stored in a careful, safe, recommended, and documentable manner. Assign a backup person to assume these responsibilities during times of illness or vacation. Inform all people who will be handling vaccines about specific storage requirements and stability limitations of the products they will encounter (see Table 1.4, p 13). The details of proper storage conditions should be posted on or near each refrigerator or freezer used for vaccine storage or should be readily available to staff. Receptionists, mail clerks, and other staff members who may receive shipments also should be educated. EQUIPMENT Ensure that refrigerators and freezers in which vaccines are to be stored are working properly and are capable of meeting storage requirements. Do not connect refrigerators or freezers to an outlet with a ground-flow circuit interrupter or one activated by a wall switch. Use plug guards and warning signs to prevent accidental dislodging of the wall plug. Post "Do not unplug" warning signs on circuit breakers. Equip each refrigerator and freezer compartment with a certified thermometer located at the center of the storage compartment. A certified thermometer has been individually tested against a reference standard, such as the National Institute of Standards and Technology or ASTM International. These thermometers are sold with an individually numbered certificate documenting this testing. A calibrated, constant-recording thermometer with graphical readings or a thermometer that indicates upper and lower extremes of temperature during an observation period ("minimum-maximum" thermometer) will provide more information as to whether vaccines have been exposed to potentially harmful temperatures than single-reading thermometers. Placement of vaccine cold-chain monitor cards* in refrigerators and freezers can serve to detect potentially harmful increases in temperature but should not be a substitute for use of certified thermometers. Maintain a logbook in which temperature readings are recorded at the beginning and end of the clinic day and in which the date, time, and duration of any mechanical malfunctions or power outages are noted. The current temperature log should be posted on the door to remind staff to monitor and record temperatures. Previous logs should be stored for a minimum of 3 years. Place all opened vials of vaccine in a refrigerator tray. To avoid mishaps, do not store other pharmaceutical products in the same tray. Store unopened vials in the original packaging. This facilitates inventory management and rotation of vaccine by expiration date and also protects MMR and MMRV vaccines from light. Equip refrigerators with several bottles of chilled water and freezers with several ice trays or ice packs to fill empty space, which will help to minimize temperature fluctuations during brief electrical or mechanical failures. * Available from 3M Pharmaceuticals. PROCEDURES Acceptance of vaccine on receipt of shipment: Ensure that the expiration date of the delivered product has not passed. Examine the merchandise and its shipping container for any evidence of damage during transport. Consider whether the interval between shipment from the supplier and arrival of the product at its destination is excessive (more than 48 hours) and whether the product has been exposed to excessive heat or cold that might alter its integrity. Review vaccine time and temperature indicators, both chemical and electronic, if included in the vaccine shipment. Do not accept the shipment if reasonable suspicion exists that the delivered product may have been damaged by environmental insult or improper handling during transport. Contact the vaccine supplier or manufacturer when unusual circumstances raise questions about the stability of a delivered vaccine. Store suspect vaccine under proper conditions and label it "Do not use" until the viability has been determined. Refrigerator and freezer inspection: Measure the temperature of the central part of the storage compartment twice a day, and record this temperature on a temperature log. If a minimum- maximum thermometer is available, record extremes in temperature fluctuation and reset to baseline. The refrigerator temperature should be maintained between 2C and 8C (35F and 46F) with a target temperature of 40F, and the freezer temperature should be -15C (5F) or colder. Train staff to respond immediately to temperature recordings outside the recommended range and to document response and outcome. Inspect the unit weekly for outdated vaccine and either dispose of or return expired products appropriately. Routine procedures: Store vaccines according to temperatures recommended in the package insert. Rotate vaccine supplies so that the shortest-dated vaccines are in front to reduce wastage because of expiration. Promptly remove expired (outdated) vaccines from the refrigerator or freezer and dispose of them appropriately or return to manufacturer to avoid accidental use. Keep opened vials of vaccine in a tray so that they are readily identifiable. Store unopened vials in the original packaging. Indicate on the label of each vaccine vial the date and time the vaccine was reconstituted or first opened. Avoid reconstituting multiple doses of vaccine or drawing up multiple doses of vaccine in multiple syringes before immediate use. Predrawing vaccine increases the possibility of medication errors and causes uncertainty of vaccine stability. When feasible, use prefilled unit-dose syringes to prevent contamination of multidose vials and errors in labeling syringes. Discard reconstituted live-virus and other vaccines if not used within the interval specified in the package insert. Examples of discard times include varicella vaccine after 30 minutes and MMR vaccine after 8 hours. All reconstituted vaccines should be refrigerated during the interval in which they may be used. Always store vaccines in the refrigerator or freezer as indicated, including throughout the office day. Do not open more than 1 vial of a specific vaccine at a time. Store vaccine only in the central storage area of the refrigerator, not on the door shelf or in peripheral areas, where temperature fluctuations are greater. Do not keep food or drink in refrigerators in which vaccine is stored; this will limit frequent opening of the unit that leads to thermal instability. Do not store radioactive materials in the same refrigerator in which vaccines are stored. Discuss with all clinic or office personnel any violation of protocol for handling vaccines or any accidental storage problem (eg, electrical failure), and contact vaccine suppliers for information about disposition of the affected vaccine. Develop a written plan for emergency storage of vaccine in the event of a catastrophic occurrence. Office personnel should have a written and easily accessible procedure that outlines vaccine packing and transport. Vaccines that have been exposed to temperatures outside the recommended storage range may be ineffective. Vaccines should be packed in an appropriate insulated storage box and moved to a location where the appropriate storage temperatures can be maintained. Office personnel need to be aware of alternate storage sites and trained in the correct techniques to store and transport vaccines to avoid warming vaccines that need to be refrigerated or frozen and to avoid freezing vaccines that should be refrigerated (see Table 1.4, p 13). After a power outage or mechanical failure, do not assume that vaccine exposed to temperature outside the recommended range is unusable. Contact the vaccine manufacturer for guidance before discarding vaccine. Other resources on vaccine storage and handling are available, including a video from the CDC National Immunization Program, "How to Protect Your Vaccine Supply," (available at http://video.cdc.gov/asxgen/nip/isdvacstorage/VacStorage.wmv). Additional materials are available at www.cdc.gov/nip/menus/vaccines.htm#Storage. Vaccine Administration GENERAL INSTRUCTIONS FOR VACCINE ADMINISTRATION Personnel administering vaccines should take appropriate precautions to minimize risk of spread of disease to or from patients. Hand hygiene should be used before and after each new patient contact. Gloves are not required when administering vaccines unless the health care professional has open hand lesions or will come into contact with potentially infectious body fluids. Syringes and needles must be sterile and preferably disposable. To prevent inadvertent needlesticks or reuse, a needle should not be recapped after use, and disposable needles and syringes should be discarded promptly in puncture-proof, labeled containers. Changing needles between drawing a vaccine into a syringe and injecting it into the child is not necessary. Different vaccines should not be mixed in the same syringe unless specifically licensed and labeled for such use. Occupational Safety and Health Administration recommendations for use of gloves and needle devices are available, which are aimed at decreasing transmission of infectious agents by exposure to body fluids (www.osha.gov/pls/oshaweb). Because of the rare possibility of a severe allergic reaction to a vaccine component, people administering vaccines or other biological products should be prepared to recognize and treat allergic reactions, including anaphylaxis (see Hypersensitivity Reactions to Vaccine Constituents, p 46). Facilities and personnel should be available for treating immediate allergic reactions. This recommendation does not preclude administration of vaccines in school- based or other nonclinic settings. When possible, patients should be observed for an allergic reaction and syncope for 15 to 20 minutes after receiving immunization(s). Syncope may occur after immunization, particularly in adolescents and young adults. Personnel should be aware of presyncopal manifestations and take appropriate measures to prevent injuries if weakness, dizziness, or loss of consciousness occurs. The relatively rapid onset of syncope in most cases suggests that having vaccine recipients sit or lie down for 15 minutes after immunization could avert many syncopal episodes and secondary injuries. If syncope develops, patients should be observed until they are asymptomatic. SITE AND ROUTE OF IMMUNIZATION (ACTIVE AND PASSIVE) Oral vaccines. Breastfeeding does not interfere with successful immunization with OPV or rotavirus vaccine. Vomiting within 10 minutes of receiving an oral dose is an indication for repeating the dose of OPV but not rotavirus vaccine. If the second dose of OPV vaccine is not retained, neither dose should be counted, and the vaccine should be readministered. Intranasal Vaccine. Live-attenuated influenza vaccine is the only vaccine licensed for intranasal administration. This vaccine is licensed for healthy people 5 through 49 years of age. With the recipient in the upright position, approximately 0.25 mL (ie, half of the total sprayer contents) is sprayed into one nostril. An attached dose-divider clip is removed from the sprayer to administer the second half of the dose into the other nostril. If the recipient sneezes after administration, the dose should not be repeated. The vaccine can be administered during minor illnesses. However, if clinical judgment [...]... are in Appendix I: Parklawn Building 5600 Fishers Lane Room 11 C-26 Rockville, MD 20857 Telephone: 80 0-3 3 8-2 382 Web site: www.hrsa.gov/osp/vicp People wishing to file a claim for a vaccine injury should telephone or write to the following: United States Court of Federal Claims 717 Madison Place, NW Washington, DC 2000 5 -1 011 Telephone: 20 2-2 1 9-9 657 PRECAUTIONS AND CONTRAINDICATIONS Precautions and contraindications... resulting from the disease A suggested protocol is SC administration of the following successive doses of vaccine at 1 5- to 20minute intervals: 0.05 mL of a 1: 10 dilution 0.05 mL of full-strength vaccine 0 .10 mL of full-strength vaccine 0 .15 mL of full-strength vaccine 0.20 mL of full-strength vaccine Scratch, prick, or puncture tests with other allergens have resulted in fatalities in highly allergic... American Academy of Pediatrics, Committee on Infectious Diseases Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) Pediatrics 19 99 ;10 3 :10 6 4 -1 077 (Reaffirmed 2002) a For example, Pediarix (DTaP-IVP-hepatitis B) is licensed for the first... of Pediatrics, Committee on Infectious Diseases Combination vaccines for childhood immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP) Pediatrics 19 99 ;10 3 :10 6 4 -1 077 (Reaffirmed 2002) An increasing number of new vaccines to prevent childhood diseases have been or will be... of Vaccine-Preventable Diseases Most vaccine-preventable diseases are reportable throughout the United States (see Appendix IX, p 870) Public health officials depend on health care professionals to report promptly to state or local health departments suspected cases of vaccine-preventable disease These reports are transmitted weekly to the CDC and are used to detect outbreaks, monitor disease-control... not listed in Appendix IV, also should be reported to the VAERS Vaccine failures (disease in an immunized person who received 1 dose or more of vaccine) and vaccine administration errors also may be reported Forms (see Fig 1. 2, p 43) can be obtained from the VAERS at 1- 8 0 0-8 2 2-7 967 and can be mailed or faxed Reports also can be obtained and submitted electronically through a secure Web site (http://vaers.hhs.gov)... infection has been reported (see Varicella-Zoster Infections, p 711 ) Immunosuppression of a household contact is not a contraindication to administration of any routinely recommended live-virus vaccines, including MMR, MMRV, varicella, and rotavirus; inactivated influenza vaccines, when available, are preferred to live-attenuated influenza vaccine Recent exposure to an infectious disease Breastfeeding the... vaccine during a measles outbreak, in which case the vaccine may be administered before 12 months of age However, if a measles-containing vaccine is administered before 12 months of age, the dose is not counted and the child should be reimmunized at 12 to 15 months of age with MMR or MMRV vaccine (see Measles, p 4 41) The second consideration involves administering a dose a few days earlier than the minimum... vaccine constituents are (1) allergic reactions to egg-related antigens; (2) mercury sensitivity in some recipients of mercury-containing IG and vaccines (see Thimerosal Content of Some Vaccines and Immune Globulin Preparations, p 48); (3) antimicrobial-induced allergic reactions; and (4) hypersensitivity to other vaccine components, including gelatin, yeast protein, and the infectious agent itself Allergic... on the vaccine As immunizations successfully eliminate their target vaccine-preventable diseases, vaccine safety issues have increased in relative prominence, increasing the need for immunization providers to communicate the risks and benefits of immunizations to a population whose first-hand experience with vaccine-preventable diseases is increasingly rare Risks of immunization may vary from trivial . products). Vaccines containing live-attenuated viruses (measles-mumps-rubella [MMR], measles-mumps-rubella-varicella [MMRV], varicella, oral poliovirus [OPV], live-attenuated influenza vaccine,. American Academy of Family Physicians (AAFP). Pediatrics. 19 99 ;10 3 :10 6 4 -1 077 (Reaffirmed 2002) a For example, Pediarix (DTaP-IVP-hepatitis B) is licensed for the first 3 doses of the DTaP. Editor American Academy of Pediatrics 14 1 Northwest Point Blvd Elk Grove Village, IL 6000 7 -1 098 Preface The Committee on Infectious Diseases of the American Academy of Pediatrics