Thursday, May 13, 2010

ACIP 2010 Immunisation for 0-18yrs

The Advisory Committee on Immunization Practices (ACIP) annually publishes an immunization schedule for persons aged 0 through 18 years that summarizes recommendations for currently licensed vaccines for children aged 18 years and younger and includes recommendations in effect as of December 15, 2009.
Changes to the previous schedule[1] include the following:

The statement concerning use of combination vaccines in the introductory paragraph has been changed to reflect the revised ACIP recommendation on this issue.

The last dose in the inactivated poliovirus vaccine series is now recommended to be administered on or after the fourth birthday and at least 6 months after the previous dose. In addition, if 4 doses are administered before age 4 years, an additional (fifth) dose should be administered at age 4 through 6 years.

The hepatitis A footnote has been revised to allow vaccination of children older than 23 months for whom immunity against hepatitis A is desired.

Revaccination with meningococcal conjugate vaccine is now recommended for children who remain at increased risk for meningococcal disease after 3 years (if the first dose was administered at age 2 through 6 years), or after 5 years (if the first dose was administered at age 7 years or older)

Footnotes for human papillomavirus (HPV) vaccine have been modified to include
1) the availability of and recommendations for bivalent HPV vaccine, and
2) a permissive recommendation for administration of quadrivalent HPV vaccine to males aged 9 through 18 years to reduce the likelihood of acquiring genital warts.

The National Childhood Vaccine Injury Act requires that health-care providers provide parents or patients with copies of Vaccine Information Statements before administering each dose of the vaccines listed in the schedules.

Additional information is available from state health departments and from CDC at

Detailed recommendations for using vaccines are available from ACIP statements (available at and the 2009 Red Book.[6] Guidance regarding the Vaccine Adverse Event Reporting System form is available at or by telephone, 800-822-7967.

Friday, May 7, 2010

Deterrence/Prevention of Chickenpox (Varicella)

The American Academy of Pediatrics (AAP) recommends excluding affected children from school until the sixth day of rash.
This may not prevent spread of varicella because the child is infective before the rash appears.


Varicella vaccine consists of live attenuated Oka strain varicella virus. The vaccine is safe and highly immunogenic. It was approved for use in the United States in 1995 and has greatly reduced the incidence and mortality due to varicella.

The vaccine has been found to have protective efficacy of 71-100% against varicella. However, protection against moderate and severe varicella is much higher (95-100%).

Babies are born with protective maternal antibodies to varicella. The half-life of these antibodies is about 6 weeks, and most children have very low levels beyond age 5 months.

However, the varicella vaccine is recommended after age 1 year. A single dose provides protection to approximately 85% of recipients. Vaccine-conferred immunity to varicella wanes over time, making more vaccine recipients susceptible to the disease. The Advisory Committee on Immunization Practices (ACIP) and the AAP now recommend 2 doses of this vaccine for all children.

After the first dose at age 12-15 months, the second dose should be administered at age 4-6 years. All persons who have received one dose of the vaccine at any time in the past should be offered a second dose.
Two doses of the varicella vaccine provide 98% protection against varicella, and 100%protection against severe disease. These children also have a lower incidence of breakthrough varicella.

Breakthrough disease involves varicella that occurs after 42 days of immunization. When it occurs, it is usually mild disease but can spread to other susceptible individuals. These children usually have less than 50 skin lesions, and fever is low and quickly subsides. Headache, sore throat, malaise, and anorexia are less frequent.

Some studies have found that breakthrough disease is more common if the vaccine was given prior to age 14 months, within 28 days after the measles-mumps-rubella (MMR) vaccine, and if the child was on oral steroid therapy. Duration between vaccination and exposure has also been found to be significant.Other studies have not found such associations.

Research study protocols allow varicella vaccine administration to patients with leukemia while they are in remission. Seroconversion is good among children with leukemia.

Postexposure prophylaxis, if provided within 36-72 hours of contact, can prevent or attenuate disease in the exposed individual.This property allows the use of the vaccine to control outbreaks by vaccinating susceptible children.
Outbreaks do occur, even with high levels of vaccination.
Vaccinated children develop milder disease but are infectious. Outbreaks can be controlled by offering catch-up vaccination to unimmunized children and adolescents in the area.

Varicella Author: Parang N Mehta, MD

Adolescents, Young Adults Lack Knowledge of Acetaminophen's Toxicity

From Medscape Medical News
Brian Hoyle

May 7, 2010 (Vancouver, British Columbia) — A study of more than 250 teenagers and young adults by researchers at the University of Rochester, in New York, has found that more than 60% do not know what acetaminophen is, even though a third are users of acetaminophen-containing over-the-counter (OTC) pain-relieving products. Nearly 25% misuse the medications, researchers announced here at the Pediatric Academic Societies 2010 Annual Meeting.

"Acetaminophen toxicity is a big deal, but we know a lot more [about its effects] in adults than we do in adolescents. The adolescent age group is what is new about this work," said study presenter Laura Shone, DrPH, MSW, associate professor of pediatrics and clinical nursing, Department of Pediatrics, University of Rochester Medical Center, in an interview with Medscape Pediatrics.

The problem is huge, Dr. Shone said. Published studies have documented that overdoses of acetaminophen are the cause of more acute liver failure in the United States than viral hepatitis. Furthermore, one half to two thirds of these overdoses are unintentional and result from taking excessive doses of OTC medication.

At the heart of this problem is a lack of awareness about medications being consumed (health literacy). Agencies such as the National Academy of Sciences (NAS) have weighed in on the issue. Estimates are that up to half of American adults have problems with health literacy, which, according to a 2004 NAS report, is "the ability to find, understand, and use health information to communicate and make health decisions and function successfully as a patient."

The situation for adolescents is far less clear, particularly concerning the understanding of OTC medications and label instructions for their use, explained Dr. Shone.

"Health literacy in regard to OTC meds is truly lacking in the adolescent age group, because the medication managers prior to these years were the adults in the home. Now, there is capability and access without knowledge, in combination with teenage behavior and thoughts — a combination of [the attitude that] nothing is going to hurt me, impulsive thinking, and risk-taking behaviors — that are all in play," Germaine Defendi, MD, associate clinical professor, Department of Paediatrics, Olive View/UCLA Medical Center, Los Angeles, told Medscape Pediatrics.

In the study, conducted in 2008 and 2009, 266 youth (age range, 16 to 23 years; mean age, 18.6 ± 2 years; 56% female) from Monroe County, New York, were anonymously recruited, passively during visits to clinics or more actively during health information sessions at schools and elsewhere. The health literacy of the participants was determined using the Rapid Estimate of Adult Literacy (REALM) or REALM-Teen surveys. Limited health literacy was a REALM score of 60 or below, or a REALM-Teen score of 62 or below.

Of the 266 participants, 96 (36%) had limited health literacy and 170 (64%) had adequate health literacy.

A survey solicited information about knowledge of acetaminophen as the active ingredient in OTC pain relief medications, the ability to identify acetaminophen-containing OTC products, and the ability to identify the one-time and daily dosage limits of acetaminophen.

Fully 63% of the participants had no knowledge of acetaminophen, even though 33% of them had used an acetaminophen-containing OTC product within the previous month. The majority displayed limited health literacy.

Multivariate analysis pegged inadequate health literacy as the main reason for taking too few or too many pills per dose, for incorrect frequency of use, and for incorrect maximum daily dose. Even 77% of those identified as health literate did not know the maximum daily dose of acetaminophen.

"I truly think that this is a worthwhile study addressing the lack of knowledge in teens about OTC medication. Kids know that there are things that they can easily purchase OTC that are medicines. But a true understanding of the medications and what they are used for and what they do is lacking," Dr. Germaine told Medscape Pediatrics.

Dr. Shone and the other study authors suggest that providers of OTC drugs have "a critical role" to play in conveying information in a way that is meaningful and relevant to adults and adolescents alike.

"Label information . . . is not as simple as it may seem. Providers can help prepare adolescents to safely self-administer," Dr. Shone told Medscape Pediatrics.

The study was funded by the National Institute for Child Health and Human Development and the Centers for Disease Control and Prevention, Office of the Director. The authors have disclosed no relevant financial relationships.

Pediatric Academic Societies (PAS) 2010 Annual Meeting: Poster session 1476.250. Presented May 1, 2010.

my note: for adolescents/adults - do not take more than 4 gram of panadol (add all sources - including combination flu-fever tabs) per day.