Recommended Immunizations

Varicella (Chicken Pox)

(Source: www.familydoctor.org)

Chickenpox is a disease that can be very easily spread from person to person. It is most common in children. Most cases occur in people who are under 15 years old.

Chickenpox is usually a mild illness, but it can cause problems such as brain swelling, pneumonia and skin infections. Some children get sicker than others. Chickenpox may be a very serious illness in infants and adults.

Because chickenpox is so contagious, a child with chickenpox shouldn't go to school or day care until all the sores have dried or crusted. Many parents miss work during the time their child has chickenpox. Because of the lost time from work, chickenpox can be a significant cost to parents of children who get the illness.

What is the varicella vaccine?

The varicella vaccine is a shot that can prevent chickenpox. It is called varicella because the varicella virus causes chickenpox. Up to 90% of people who receive the vaccine will not get chickenpox. People who get chickenpox after having the vaccine have a milder form of the disease.

Who should be vaccinated against chickenpox?

The chickenpox vaccine is not required like some other vaccines. However, it is generally safe and will save your child from suffering with a preventable illness. Talk to your doctor if you have questions about the vaccine. It's given to children from 12 to 18 months of age.

The following people should probably receive the varicella vaccine if they have never had chickenpox:

  • Older children, adolescents and adults
  • Healthcare or day care workers
  • Teachers
  • College students
  • Military personnel
  • Inmates and staff of correctional institutions
  • Women of childbearing age who are not pregnant (women should avoid pregnancy for 1 month following the vaccine)
  • Anyone traveling to other countries outside the United States

Who should not receive the varicella vaccine?

The following people should not receive the varicella vaccine:

  • Anyone with a serious illness
  • Pregnant women
  • Anyone who has had a serious allergic reaction to the varicella vaccine in the past
  • Anyone who is allergic to gelatin (Tell your doctor. There is a gelatin-free varicella vaccine.)
  • Anyone who is allergic to neomycin, an antibiotic often found in creams and ointments
  • Anyone who has an immune system disease, such as HIV
  • Anyone who is receiving high doses of steroids, such as prednisone
  • Anyone who is receiving treatment for cancer with x-rays, drugs or chemotherapy
  • Anyone who has received blood products during the past 5 months, such as a blood transfusion

Talk to your doctor if you have any questions about whether you should receive the varicella vaccine.

Are there any side effects from the varicella vaccine?

The most common side effects are pain, redness or swelling at the injection site. Severe reactions are rare. If your child seems to be having any side effects or reaction to the vaccine, call your doctor right away.

Hepatitis A

(Source: http://www.nlm.nih.gov/medlineplus/hepatitisa.html)

Hepatitis A, also called: HAV, is one type of hepatitis - a liver disease - caused by the hepatitis A virus (HAV). The disease is spread primarily through food or water contaminated by stool from an infected person. You can get HAV from

  • Eating food prepared by someone with HAV who did not wash their hands after using the bathroom
  • Having anal/oral sex with someone with HAV
  • Not washing your hands after changing a diaper
  • Drinking contaminated water

HAV can cause swelling of the liver, but it rarely causes lasting damage. You may feel as if you have the flu, or you may have no symptoms at all. It usually gets better on its own after several weeks.

The hepatitis A vaccine can prevent HAV. Healthy habits also make a difference. Wash your hands thoroughly before preparing food, after using the toilet or after changing a diaper. International travelers should be careful about drinking tap water. (Source: National Institute of Diabetes and Digestive and Kidney Diseases)

HPV- Human Papillomavirus/ Gardasil Vaccine

(Source: http://www.cdc.gov/hpv/)

What is the HPV vaccine?

The vaccine, Gardasil, is the first vaccine developed to prevent cervical cancer, precancerous genital lesions, and genital warts due to HPV.

Who should get the HPV vaccine?

CDC recommends the HPV vaccine for all 11 and 12 year old girls. The recommendation allows for vaccination to begin at age nine. Vaccination also is recommended for females aged 13 through 26 years who have not been previously vaccinated or who have not completed the full series of shots.

Are there other HPV vaccines in development?

Another HPV vaccine (being developed by GlaxoSmithKline) is in the final stages of clinical testing, but it is not yet licensed. This vaccine would protect against the two types of HPV that cause most cervical cancers.

How and when is the vaccine delivered?

The vaccine is given in a series of three injections over a six-month period. The second and third doses should be given at two and six months (respectively) after the first dose. HPV vaccine may be given at the same time as other vaccines.

Is the HPV vaccine effective?

This vaccine is highly effective in preventing four types of HPV in young women who have not been previously exposed to HPV. This vaccine targets HPV types that cause up to 70% of all cervical cancers and about 90% of genital warts. The vaccine will not treat existing HPV infections or their complications.

Is the HPV vaccine safe?

The FDA has licensed the vaccine as safe and effective. This vaccine has been tested in thousands of females (9 to 26 years of age) around the world. These studies have shown no serious side effects. The most common side effect is brief soreness at the injection site. CDC, working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.

Does the vaccine contain thimerosal or mercury?

No, there is no thimerosal or mercury in the vaccine.

How long does vaccine protection last? Will a booster shot be needed?

The length of vaccine protection (immunity) is usually not known when a vaccine is first introduced. So far, studies have found that vaccinated persons are protected for five years. More research is being done to find out how long protection will last, and if a booster dose of vaccine will be needed.

Will girls/women be protected against HPV and related diseases, even if they don’t get all three doses?

It is not yet known how much protection girls/women would get from receiving only one or two doses of the vaccine. For this reason, it is very important that girls/women get all three doses of the vaccine..

If a woman turns 27 years of age after the first dose of HPV was administered but before the third doses is administered, should the series be completed?

Yes, the series should be completed using the recommended intervals between doses, even if this means that the series is completed after a woman turns 27 years of age.

Does the vaccine protect against cervical cancer?

Yes, HPV vaccine is the first vaccine developed to prevent cervical cancer. This new vaccine is highly effective in preventing HPV infection, the major cause of cervical cancer in women. The vaccine protects against four types of HPV, including two that cause about 70% of cervical cancer.

How common is cervical cancer?

The American Cancer Society estimates that in 2007, over 11,000 women will be diagnosed with cervical cancer and approximately 3,600 women will die from this disease.

Will the girls/women who have been vaccinated still need cervical cancer screening?

Yes, they will still need to see their healthcare provider for cervical cancer screening. There are three reasons why women will still need regular cervical cancer screening. First, the vaccine will NOT provide protection against all types of HPV that cause cervical cancer, so women will still be at risk for some cancers. Second, some women may not get all required doses of the vaccine (or they may not get them at the right times), so they may not get the vaccine’s full benefits. Third, women may also not get the vaccine’s full benefits if they have already acquired a vaccine HPV type.

Why is the vaccine only recommended for girls/women ages 9 through 26?

The vaccine has been extensively tested in 9 through 26 year-old females so information is only available about vaccine safety and protection for girls/women of this age group. However, studies on the vaccine are now being done in boys/men, as well as in women older than 26 years of age. The FDA will consider licensing the vaccine for these other groups when there is research to show that it is safe and effective in these groups.

Why is HPV vaccine recommended for girls 11 to 12 years of age?

It is important for girls to get HPV vaccine before they become sexually active. The vaccine is most effective for girls/women who get vaccinated before their first sexual contact. It does not work as well for those who were exposed to the virus before getting the vaccine. However, most women will still benefit from getting the vaccine because they will be protected against other virus types contained in the vaccine.

Should pregnant women be vaccinated?

The vaccine is not recommended for pregnant women. There has only been limited information about vaccine safety among pregnant women and their unborn babies. So far, studies suggest that the vaccine has not caused health problems during pregnancy, nor has it caused health problems for the child. But more research is still needed. For now, pregnant women should wait to complete their pregnancy before getting the vaccine. If a women finds out she is pregnant after she has started getting the vaccine series, she should wait until after her pregnancy is completed to finish the three-dose series.

What about vaccinating males?

We do not yet know if the vaccine is effective in boys or men. Studies are now being done to find out if the vaccine works to prevent HPV infection and disease in males. When more information is available, this vaccine may be licensed and recommended for boys/men as well.

Will my child be required to get the vaccine before she enters school?

There are no federal laws requiring the immunization of children. All school and daycare entry laws are state laws and vary from state to state. Therefore, you should check with your state health department of Board of Education to find out what vaccines your child will need to enter school or daycare.

Each year the CDC publishes childhood and adolescent immunization schedules that provide recommended timelines for immunization of children and adolescents. The annual childhood and adolescent immunization schedules are a joint effort of the CDC, the American Academy of Pediatrics (AAP), and the American Academy of Family Physicians (AAFP). While these organizations have no regulatory authority over the immunization of children, the recommendations of the CDC, AAP, and AAFP are considered standards of medical practice and most physicians follow the recommendations.

How much will the HPV vaccine cost?

The retail price of the vaccine is $120 per dose ($360 for full series).

Will the vaccine be covered by insurance plans?

Most insurance plans and managed care plans cover recommended vaccines. However, there may be a lag-time after a vaccine is recommended, before it is available and covered by health plans. While some insurance companies may cover the vaccine, others may not.

How can I get the vaccine if I don’t have insurance?

The Vaccines for Children (VFC) program helps families of children who may not otherwise have access to vaccines by providing free vaccines to doctors who serve them. The VFC program provides free vaccines to children and adolescents younger than 19 years of age, who are either Medicaid-eligible, American Indian, or Alaska Native or uninsured. There are over 45,000 sites that provide VFC vaccines, including hospital, private, and public clinics. The VFC Program also allows children and adolescents to get VFC vaccines through Federally Qualified Health Centers or Rural Health Centers, if their private health insurance does not cover vaccinations. For more information about the VFC, visit http://www.cdc.gov/vaccines/programs/vfc/index.html.

Some states also provide free or low-cost vaccines at public health department clinics to people without health insurance coverage for vaccines.

What is HPV?

HPV (human papillomavirus) is a virus that is common in the United States and around the world and can cause cancer and genital warts. HPV is spread through sexual contact. There are about 40 types of genital HPV. HPV is the major cause cervical cancer in women and is also associated with several other types of cancer in both men and women.

How common is HPV?

HPV is the most common sexually transmitted infection in the United States. At least 50 percent of sexually active people will get HPV at some time in their lives. Every year in the U.S., about 6.2 million people get HPV. HPV is most common in young women and men who are in their late teens and early 20s.

Is HPV the same thing as HIV or herpes?

No, HPV is not the same as HIV or herpes virus (herpes simplex virus or HSV). While these are all viruses that can be sexually transmitted— HIV and HSV do not cause the same symptoms or health problems as HPV.

Can HPV be treated?

There is no cure for HPV. But there are treatments for the health problems that HPV can cause, such as genital warts, cervical cell changes, and cancers caused by HPV.

 

TB Screening

WHAT IS TB?


(Source: http://www.lung.org/lung-disease/tuberculosis/)

Tuberculosis (often called TB) is an infectious disease that usually attacks the lungs, but can attack almost any part of the body. Tuberculosis is spread from person to person through the air.

When people with TB in their lungs or throat cough, laugh, sneeze, sing, or even talk, the germs that cause TB may be spread into the air. If another person breathes in these germs there is a chance that they will become infected with tuberculosis. Repeated contact is usually required for infection.

It is important to understand that there is a difference between being infected with TB and having TB disease. Someone who is infected with TB has the TB germs, or bacteria, in their body. The body's defenses are protecting them from the germs and they are not sick. This is referred to as latent TBI.

Someone with TB disease is sick and can spread the disease to other people. A person with TB disease needs to see a doctor as soon as possible. This is referred to as active TBII.

It is not easy to become infected with tuberculosis. Usually a person has to be close to someone with TB disease for a long period of time. TB is usually spread between family members, close friends, and people who work or live together. TB is spread most easily in closed spaces over a long period of time. However, transmission in an airplane, although rare, has been documented.

Even if someone becomes infected with tuberculosis, that does not mean they will get TB disease. Most people who become infected do not develop TB disease because their body's defenses protect them. Most active cases of TB disease result from activating old infection in people with impaired immune systems.

Experts believe that about 10 million Americans are infected with TB germs. Only about 10 percent of these people will develop TB disease in their lifetime. The other 90 percent will never get sick from the TB germs or be able to spread them to other people.1

TB is an increasing and major world wide problem, especially in Africa where the spread has been facilitated by AIDS. It is estimated that nearly 1 billion people will become newly infected, over 150 million will become sick, and 36 million will die worldwide between now and 2020 -- if control is not further strengthened. Each year there are more than 9 million cases and close to 2 million deaths attributed to TB; 100,000 of those 2 million deaths occur among children.2


WHO GETS IT?


Anyone can get TB. However, some groups are at higher risk to get active TB disease. The groups that are at high risk include:

  • People with HIV infection (the AIDS virus)
  • People in close contact with those known to be infectious with TB
  • People with medical conditions that make the body less able to protect itself from disease (for example: diabetes, the dust disease silicosis, or people undergoing treatment with drugs that can suppress the immune system, such as long-term use of corticosteroids)
  • Foreign-born people from countries with high TB rates
  • Some racial or ethnic minorities
  • People who work in or are residents of long-term care facilities (nursing homes, prisons, some hospitals)
  • Health care workers and others such as prison guards
  • People who are malnourished
  • Alcoholics, IV drug users and people who are homeless

WHAT ARE THE SYMPTOMS OF TB?

A person with TB infection will have no symptoms. A person with TB disease may have any, all or none of the following symptoms:

  • A cough that will not go away
  • Feeling tired all the time
  • Weight loss
  • Loss of appetite
  • Fever
  • Coughing up blood
  • Night sweats

These symptoms can also occur with other diseases so it is important to see a doctor and to let the doctor determine if you have TB.

It is also important to remember that a person with TB disease may feel perfectly healthy or may only have a cough from time to time. If you think you have been exposed to TB, get a TB skin test.

HOW DOES TB DISEASE DEVELOP?

There are two possible ways a person can become sick with TB disease:

The first applies to a person who may have been infected with TB for years and has been perfectly healthy. The time may come when this person suffers a change in health. The cause of this change in health may be another disease like AIDS or diabetes. Or it may be drug or alcohol abuse or a lack of health care because of homelessness.

Whatever the cause, when the body's ability to protect itself is compromised, TB infection can become active TB disease. In this way, a person may become sick with TB disease months or even years after they first breathed in the TB germs.

The other way TB disease develops happens much more quickly. Sometimes when a person first breathes in the TB germs the body is unable to protect itself against the disease. The germs then develop into active TB disease within weeks.

WHAT IS THE TB SKIN TEST?

The TB skin test is a way to find out if a person has TB infection. Although there is more than one TB skin test, the preferred method of testing is to use the Mantoux test.3

For this test, a small amount of testing material is placed just below the top layers of skin, usually on the arm. Two to three days later a health care worker checks the arm to see if a bump has developed and measures the size of the bump. The significance of the size of the bump is determined in conjunction with risk factors for TB.

Once the doctor knows that a person has TB infection he or she will want to determine if the person has TB disease. This is done by using several other tests including a chest X-ray and a test of a person's mucus (the material that is sometimes coughed up from the lungs).

Q: Should you get a skin test each year to check on TB?

A: Only if you are at high risk for getting or transmitting TB or your jobs request it.

The advice for most people is to get a tuberculin test if you have symptoms or if you are living in close contact or have otherwise been in close contact with someone who recently came down with activeTB disease. (Some people get skin tests because of their jobs, in a school or hospital, for example, to make sure they have not contracted TB and will not infect others if they have TB).

If you fall into one or more of the high-risk categories for TB noted earlier, for example, if you are HIV-positive, never had a skin test before, or there is no record of the last result, you should be tested.

If you're not sure, ask your doctor. TB can be prevented, even if you are at risk.

WHAT IS THE TREATMENT FOR TB?

Treatment for TB depends on whether a person has active TB disease or only TB infection.4

A person who has become infected with TB, but does not have active TB disease, may be given preventive therapy. Preventive therapy aims to kill germs that are not doing any damage right now, but could so do.

If a doctor decides a person should receive preventive therapy, the usual prescription is a daily dose of isoniazid (also called "INH"); an inexpensive TB medicine. The person takes INH for nine months (up to a year for some patients), with periodic checkups to make sure the medicine is being taken as prescribed.

 

What if the person has active TB disease?

Then treatment is needed.

Years ago a patient with TB disease was placed in a special hospital for months, maybe even years, and would often have surgery. Today, TB can be treated with very effective drugs.

Often the patient will only have to stay a short time in the hospital and can then continue taking medication at home. Sometimes the patient will not have to stay in the hospital at all. After a few weeks a person can probably even return to normal activities and not have to worry about infecting others.

The patient usually gets a combination of several drugs (most frequently INH plus two to three others including rifampin, pyrazinamide and ethambutol). The patient will probably begin to feel better only a few weeks after starting to take the drugs.

It is very important, however, that the patient continue to take the medicine correctly for the full length of treatment. If the medicine is taken incorrectly or stopped the patient may become sick again and will be able to infect others with TB. As a result, public health authorities recommend Directly Observed Therapy (DOT), in which a health care worker insures that the patient takes his/her medicine.

 

If the medicine is taken incorrectly and the patient becomes sick with TB a second time, the TB may be harder to treat because it has become drug resistant. This means that the TB germs in the body are unaffected by some drugs used to treat TB.

Multi-drug resistant TB is very dangerous, so patients should be sure that they take all of their medicine correctly.

Regular checkups are needed to see how treatment is progressing. Sometimes the drugs used to treat TB can cause side effects. It is important both for people undergoing preventive therapy and people being treated for TB disease to immediately let a doctor know if they begin having any unusual symptoms.

WHAT IS MULTI-DRUG RESISTANT TB?

Multi-drug resistant tuberculosis (called MDR-TB for short) is a very dangerous form of tuberculosis. Some TB germs become resistant to the effects of some TB drugs. This happens when TB disease is not properly treated.

These resistant germs can then cause TB disease. The TB disease they cause is much harder to treat because the drugs do not kill the germs. MDR-TB can be spread to others, just like regular TB.

It is important that patients with TB disease follow their doctor's instructions for taking their TB medicine so that they will not develop MDR-TB.

CAN A TB PATIENT INFECT OTHERS?

Yes, if they have TB disease and it is not being treated. Once treatment begins, a patient ordinarily quickly becomes noninfectious; that is, they cannot spread the disease to others.

There is little danger from the TB patient who is being treated, is taking his or her medication continuously, and is responding well. The drugs usually make the patient noninfectious within weeks.

TB is spread by germs in the air, germs put there by coughing or sneezing. Handling a patient's bed sheets, books, furniture, or eating utensils does not spread infection.

Brief exposure to a source of TB rarely infects a person. It's day-after-day close contact that usually does it.

TB: WHAT YOU SHOULD DO

Find out if you're infected.

Certain people such as those infected with HIV or health care workers should be tested regularly. You should be tested if there's any chance you have been infected, recently or many years ago.

If the test is negative:

A negative reaction usually means that you are not infected and no treatment is needed. However, if you have TB symptoms your doctor must continue to look for the cause. Sometimes, when a person has only recently been infected, or when his or her immune system isn't working properly, the test may be falsely negative.

If the test is positive:

A significant reaction usually means that you have been infected with the TB germ. It does not necessarily mean that you have TB disease. Cooperate with the doctor when he or she recommends a chest X ray and possibly other tests.

If the doctor recommends treatment to prevent sickness, follow the recommendations. If medicine is prescribed, be sure to take it as directed.

If you don't need treatment, do what the doctor tells you to do about follow-up. The doctor may simply say to return for another checkup if you get into a special risk situation for TB sickness or develop symptoms.

If you are sick with TB disease, follow the doctor's recommendations for treatment.

If you're a health worker:

Your local American Lung Association can provide you with more comprehensive information developed for health professionals on the diagnosis, treatment and control of TB.

Footnote:

  1. Definition of latent disease: Inactive disease. Person does not have symptoms.
  2. Definition of active disease: Bacteria is active. Person has symptoms of TB and is infectious.

Sources

  1. Centers for Disease Control and Prevention. Status of the Tuberculosis Epidemic in the U.S. July 1999.
  2. World Health Organization. Global TB Control Report, 2003.
  3. American Thoracic Society and Centers for Disease Control and Prevention. Targeted Tuberculin Testing and Treatment of Latent Tuberculosis Infection. American Journal of Respiratory and Critical Care Medicine. Vol. 161(4), April 2000.
  4. American Thoracic Society, Centers for Disease Control and Prevention and Infectious Disease Society of America. Treatment of Tuberculosis. Morbidity and Mortality Weekly Report Vol. 52 (RR-11), 2003.