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Adolescent Immunization

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					                            IAP VISION 2007
                            IAP VISION 2007
                                        ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                                                                    Adolescent
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                                                                  IMMUNIZATION



                                                                                Adolescent Friendly School Initiative
                            IAP VISION 2007



                                                     INTRODUCTION
                                                What is Immunization?

                                          - Administration of all or part of micro
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                            organism or modified product.
                                          - Resulting in protection against the
                                            disease.




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007



                                        Importance of adolescent immunization



                                           Prevention and control of disease is important for
                                            their healthy growth.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                           They must be provided with the opportunity of
                                            healthy growth and development.
                                           Routine immunization also provides a chance of a
                                            health visit
                                           Gives further chance for preventive services and
                                            health counseling.


                                        Adolescent Friendly School Initiative
                            IAP VISION 2007



                                        Why adolescents should be immunized?



                                         • Success of Immunization Program has resulted in the
                                           decrease in incidence of the vaccine preventable
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                           diseases.
                                         • But unimmunized adolescents have become more
                                           susceptible.
                                         • TT is the only vaccine included in the National
                                           Immunization Schedule in India.




                                         Adolescent Friendly School Initiative
                            IAP VISION 2007


                 Why Adolescent Immunization is important?



                                              –    To boost immunity that is decreasing
                                              –    Efforts to decrease disease
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                              –    To have specific Protection
                                              –    To provide recent vaccines available for
                                                   immunization




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007



                                                      Current Status



                                                     • Scenario in West
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                     • Indian Scenario




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        Adolescent Friendly School Initiative
                                                    http://www.cdc.gov/nip. Accessed May, 26th 2007
                            IAP VISION 2007
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                          IAP COI Recommendations…




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                               IAP adolescent immunization
                                                        schedule

                                        TT              Booster at 10 and 16 years
                                        Rubella         As part of MMR vaccine or (Monovalent) 1 dose to
                                                        girls at 12-13 years of age, if not given earlier
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        MMR             1 dose at 12-13 years of age. (if not given earlier)
                                        Hepatitis B     3 Doses (0, 1 and 6 m) if not given earlier
                                        Typhoid         TA, Vi or Oral typhoid vaccine every 3 years
                                        Varicella*      1 dose upto 12-13 years, and 2 doses after 13 years
                                                        of age. (if not given earlier)
                                        Hepatitis A*    2 doses (0 and 6 months) if not given earlier



                                        Adolescent Friendly School Initiative
                            IAP VISION 2007




                                                           Td Vaccine
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                               Td vaccine has become available,
                                               should this vaccine be preferred
                                                           over TT?



                                        Adolescent Friendly School Initiative
                            IAP VISION 2007



                                                  Diphtheria in India

                                            • Diphtheria - Down but not out
                                                    S K Kabra AIIMS Indian Ped. 2000 July
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                                            • Patch remains
                                                    Nandy et al Indian Pedicatrics 2001



                                            • Diphtheria – Certainly not out
                                                    Poddar B. Indian Pediatrics 2000



                                        Adolescent Friendly School Initiative
                            IAP VISION 2007
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007


                                        Is it feasible to incorporate Td in
                                        Immunization Schedule?
                                        • At 10 & 16yr instead of TT - Reasonable
                                        • Cost is little higher (Rs. 5.50 for TT and Rs. 6.10 for Td)
                                        • Diphtheria toxoid one of the safest vaccines.
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                                        • Td is not much more reactogenic than TT.
                                        • In some parts of world Td is preferred in place of TT -
                                          in pregnancy & adults
                                        • In India Td should be preferred over TT


                                         Adolescent Friendly School Initiative
                            IAP VISION 2007




                                                         dTap vaccine
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                            dTap vaccine is also available, should this
                                                  vaccine be preferred over dT?




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007


                                        Pertussis in adolescents




                                         There is a need to vaccinate all adolescents &
                                                     adults against pertussis.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                            Recommended by ;
                                              international consensus group on pertussis &
                                                        global pertussis initiative.




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007


                                                         Tdap vaccine

                                        • Tdap instead of Td is recommended by many
                                          authorities to prevent pertussis in adolescents and
                                          adults
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                                        • The major benefit is protection of infants and children
                                          from pertussis
                                        • Cost is major obstacle – 50 times
                                        • Being used in Canada, Not yet licensed in USA




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Rubella


                                        • Aim is to;
                                            – prevent congenital rubella syndrome (CRS), and
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                                            – not to prevent rubella infection per se, as it is usually
                                              benign and inconsequential.




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Rubella


                                                  Haphazard use of rubella vaccine
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                                                            in young children
                                        may shift the epidemiology of rubella to the right with
                                                            more clinical cases
                                                   occurring in young adults leading to
                                                      increase in cases of CRS.




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        MMR


                                        • Recommended to all adolescents (sp. Girls) – irrespective
                                          of previous immunization status – no upper age limit.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        • Many states are likely to include MMR in UIP.




                                         Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Mumps


                                        • There is no difference in efficacy or safety among
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                                          available different strains.
                                        • Aseptic Meningitis following vaccination is mild, without
                                          any sequel or mortality.
                                        • No association with either autism or Crohn’s dis.
                                          (URABE V/S L.Z.)




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007


                                        Hepatitis B

                                        • WHO has recommended universal Hepatitis B vaccination.
                                        • In 2002 GOI also initiated incorporation of HB vaccine as universal
                                          vaccine – in a phased manner.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        • For previously unvaccinated adolescents 0,1 & 6 mo. is a preferred
                                          schedule.
                                        • No booster.




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007
 Hepatitis B Immunogloulin (HBIG)


                                        • HBIG provides immediate passive immunity
                                        • Indications;
                                           – individuals with recent exposure to hepatitis B virus
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                           – prevention of mother to child transmission and
                                           – following sexual exposure like in rape cases.
                                        • Dose:
                                           – Adults: 1000-2000 IU;
                                           – Children:- 32-48 IU/kg body wt.




                                         Adolescent Friendly School Initiative
                            IAP VISION 2007


                                                               Typhoid

                                            Peak in school age children (5-19 yrs)
                                            • Endemic areas – peak incidence – school children.
                                               33m cases & 5 lac deaths
                                            • 3 populations are at particularly high risk
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                               a. Children in endemic areas
                                               b. Travelers to endemic areas
                                               c. Clinical microbiology technicians
                                            Vi capsular polysaccharide vaccine
                                            • Typhoid: in endemic areas every 3 yearly.



                                        Adolescent Friendly School Initiative
                            IAP VISION 2007


                                        Varicella


                                        • The IAP COI opines that varicella vaccine is not
                                          recommended for universal immunization in India at
                                          present.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        • It may be offered to children from high socio-economic
                                          strata of society after explaining the pros and cons to
                                          the parents on a one-to-one “named child” basis.




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Varicella – IAP COI

                                        • It is indicated for ;
                                           – In children with chronic lung/heart disease,
                                           – Humoral immunodeficiencies,
                                           – HIV infection (but with C4 counts above 15% of the
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                                             age related norms),
                                           – Leukemia (but in remission and off chemotherapy for
                                             at least 3-6 months) and those on long term
                                             salicylates/high dose long term oral steroids.
                                           – In household contacts of immuno-compromised.
                                           – In children attending crèches and day care centers.

                                         Adolescent Friendly School Initiative
                            IAP VISION 2007



                                           Varicella Schedule

                                        • One dose below 13 year and two doses after that 4 wk
                                          apart.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        • For post-exposure – within 72 hrs of exposure.
                                        • Ensure that adolescent girl is not pregnant and she
                                          should not conceive for 4 wk after vaccination




                                         Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Hepatitis A


                                        • The IAP COI opines that HA vaccine is not
                                          recommended for universal immunization in India at
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                                          present.
                                        • It may be offered to children after explaining the parents
                                          on a one-to one “named child” basis. .
                                        • Post exposure – to contacts – with in 10 days.
                                        • Two doses at 6 mo interval from 2 yr onwards



                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Indications in Adolescents;

                                        • Who have not had viral hepatitis in past, especially those
                                          who are leaving home for further studies.
                                        • In all sero negative patients with chronic liver disease
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                                        • Family contacts of patients with chronic liver disease.
                                        • In children attending crèches and day care centers and
                                        • In travelers from abroad visiting endemic areas.




                                         Adolescent Friendly School Initiative
                            IAP VISION 2007

                                                Proposed immunization
                                                      schedule
                                        BCG                    All adolescent without a scar
                                         Diphtheria,           -Tdap booster dose in previously
                                        Pertussis,             immunized
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                                        Tetanus                -Three doses of Tdap in previously
                                                               unimmunized or partially unimmunized
                                        MMR                    -Single booster dose in all the
                                                               adolescent
                                                               -Two doses at 4 weeks in previously
                                                               unimmunized
                                        Hepatitis b            Full course in previously unimmunized
                                                               child
                                        Adolescent Friendly School Initiative
                            IAP VISION 2007




                                              Newer and Future Vaccines
                                                   for Adolescent
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007



                                                     Further Vaccines
                                                                 ?         ?          ?
                                        Present                                                 2010 - 2020 ?
                                                                RSV        otitis media
               Hib                              pneumo
                                                                                                                  HIV?
                                               conjugate     mening A, C
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                                               grpB Strep
                                                              conjugate
               acP
               acP
                                               rotavirus                                                          hep C?
                                                                             H. Pylori
                                                              mening B
 DTacP-IPV/Hib                                                             HPV                          malaria
                                                              Herpes
                                                                                    EBV
 DTacP-HB/Hib                                                            dengue
                                                              hep E                              new TB

                                             DTacP-IPV-HB/Hib          ETEC-cholera         Shigella

                                        Adolescent Friendly School Initiative                          (adapted from EPI)
                            IAP VISION 2007

                                        Vaccines under discussion

                                             •   Meningococcal                  •EB V
                                             •   Influenza                      •Parvovirus,
                                                                                •Para I
                                             •   HPV
                                                                                •E Coli
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                             •   e IPV–                         •Adeno
                                             •   Salk Vero cell IPV [v IPV]
                                                                                •Malaria
                                             •   JE                             •Dengue
                                                                                •Hepatitis E
                                             •   CMV                            •Cholera
                                             •   Herpes                         •Shigella
                                                                                •Campylobacter
                                             •   HIV                            •Schistosomiasis


                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Vaccination in special Situations

                                        •    Rabies – Pre/post exposure
                                        •    Meningococcal vaccine
                                        •    Pneumococcal
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        •    Influenza




                                            Adolescent Friendly School Initiative
                            IAP VISION 2007


                                         Influenza vaccine -1

                                             There are 2 influenza viruses, types A and B.
                                             • Type A :subtypes based on two surface antigens
                                             Hemagglutinin (H) and Neuraminidase (N). eg H1N1
                                             • Influenza type B is not categorized into subtypes.
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                             There are two vaccines available,
                                             • The inactivated killed Vaccine &
                                             • Live attenuated influenza vaccine (LAIV)
                                             Both vaccines includes Two type A strains (e.g. H3N2
                                               and H1N1) & One type B strain


                                        Centers for Disease Control and Prevention. Prevention and control of influenza: Recommendations of the Advisory
                                           Adolescent Friendly School Initiative
                                        Committee on Immunization Practices (ACIP). MMWR 2005;54 (RR08):1-40
                            IAP VISION 2007

                                        Human Papilloma Virus (HPV)



                                         • HPV is now implicated as a causative agent > 99% of
                                         cervical cancer cases. Also pharyngeal and ano-genital
                                         cancers .
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                         • Lifetime risk among sexually active men & women - 50%.
                                         • Most common sexually transmitted infection in the USA
                                         • Genital infections occur via G-G; O-G; H-G and AG
                                         contact
                                         • The vast majority of infections go unrecognized


                                         Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent
                                        Patients A Clinical Guide School Initiative
                                        Adolescent Friendlyfor Pediatricians,Vol. 19, No. 1 November 2006
                            IAP VISION 2007

                                        HPV Vaccines available


                                        Quadrivalent HPV vaccine FDA licensed Gardasil, Merck
                                        Bivalent vaccine, Cervarix,GSK Biologicals soon

                                        Both vaccines protect against HPV types 16 and 18.
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                                        In clinical phase 2 and 3 trials, both vaccines were found to be
                                        safe and effective in females.

                                        Quadrivalent vaccine is found to be 100% efficacious against
                                        high-grade dysplasia, the predecessor to cervical cancer.


                                         Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent
                                        Patients A Clinical Guide School Initiative
                                        Adolescent Friendlyfor Pediatricians,Vol. 19, No. 1 November 2006
                            IAP VISION 2007

                                        HPV vaccine schedule


                                        Studies show a rapid rise in ano-genital HPV infections by –
                                        15 yrs age hence ensure immunization completed prior to it.
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                                        11-12 yrs endorsed by the Society for Adolescent Medicine
                                        (SAM), 9-10 yrs left to the discretion of the care provider.

                                        3 doses of HPV given at 0, 2 and 6 months in the Deltoid.


                                         Both have stable antibody levels and continued efficacy -
                                                        5 years post vaccination.
                 Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent Patients A Clinical Guide for
                                        Adolescent Friendly School Initiative
                 Pediatricians,Vol. 19, No. 1 November 2006
                            IAP VISION 2007

                                        ? ? Parental reaction

                                        Major Worry :
                                        Stigma related to the sexual transmission of HPV.
                                        Vaccine will increase sexual activity among teens.
                                        Vaccine will not gain widespread acceptance
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                                        Studies show
                                        Parents decisions based on severity of disease, efficacy and
                                        safety of the vaccine; the mode of transmission is less
                                        important to them.
                                        Once educated about HPV, provided with accurate
                                        information in a calm and reassuring way majority of
                                        parents have positive response .
                                        Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
                                           Adolescent Friendly School Initiative
                                        Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431
                            IAP VISION 2007

                                        How to introduce the topic of HPV vaccine ?


                                          Visit of 10-12 yrs
                                          •Open the conversation with parents and adolescents
                                          about preventive strategy for all adolescent risk-taking
                                          behaviors
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                                          •Clarify their values about a whole range of subjects (eg,
                                          sexuality, drinking)
                                          •Be sensitive to parental anxieties and possible discomfort
                                          with discussing these subjects.
                                          •Then talk of HPV as preventive vaccine for cancer and
                                          STD


                                        Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent Patients A Clinical Guide
                                         Adolescent Friendly School Initiative
                                        for Pediatricians,Vol. 19, No. 1 November 2006
                            IAP VISION 2007

                                        My child is too young to get HPV.
                                        Why can’t we wait ?



                                        •You could wait. But…Two important reasons to do this now :
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                                            •The immune response appears to be better in younger
                                            girls.
                                            •It takes 6 months to be fully immunized and the vaccine
                                            has to be given before any risk of exposure.
                                        •It makes sense to provide it before any possible exposure
                                        might occur.”


                                        Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
                                         Adolescent Friendly School Initiative
                                        Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431
                            IAP VISION 2007

                                            Can HPV vaccine be given to boys ?




                                           •At present it is only licensed for girls.
                                           •The FDA wants more data about boys before they
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                                           approve it.
                                           •Males are a potential target for the vaccine for protection
                                           against warts, penile or anal cancer & as a vector for
                                           transmission to females.




                                        Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
                                           Adolescent Friendly School Initiative
                                        Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431
                            IAP VISION 2007

                                        Don’t you think it will encourage my
                                        daughter to having early and risky sex?

                                        “Does telling young people to wear bicycle helmets or seatbelts
                                        encourage anyone to bicycle or drive recklessly”?
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                                        Your child may never be at risk for HPV infection, or may not be at risk
                                        for many years, but we are recommending that all girls get this before
                                        anyone is at risk of infection.

                                        It is very effective at this age and vaccinating now eliminates the worry
                                        about risk into adulthood.




                                        Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
                                         Adolescent Friendly School Initiative
                                        Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431
                            IAP VISION 2007


                 Pneumococcal vaccine
                                        Risk of serious Pneumococcal disease is relatively low,
                                          not recommended for routine use .

                                        Recommended in; anatomic or functional asplenia (also
                                          sickle cell ),nephritic syndrome, CSF leak,
                                          immunosuppression
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                                        Revaccination : >5 yrs after the 1st dose, highest risk for
                                          serious Pneumococcal infection and rapid waning of
                                          antibodies, Spleenic dysfunction, Sickle cell disease,
                                          HIV infection, Hodgkin’s disease, Lymphoma, Multiple
                                          myeloma, Chronic renal failure, Nephritic syndrome,
                                          undergoing organ transplantation and receiving
                                          chemotherapy

                                        Adolescent Friendly School Initiative
                            IAP VISION 2007


                                            Strategies to increase adolescent immunisation
                                                      Increasing Demand

                                        •   Establish a platform for adolescent immunization
                                        •   Provider and professional recommendation
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                                        •   School based immunization requirements
                                        •   State based immunization laws
                                        •   Education and awareness programs




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Key messages



                                        • Pediatricians need to update periodically about new
                                          recommendations
                                        • Students going abroad will come for advise and
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                                          certificates
                                           – Newer vaccines
                                           – New recommendations for Booster doses
                                           – Preventive /prophylactic vaccines




                                         Adolescent Friendly School Initiative
                            IAP VISION 2007




                                        Example of Chicken POX coverage
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                                                    in Schools




                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        CHICKENPOX:
                                        IT’S MORE SERIOUS THAN YOU THINK
                                        WHAT IT IS ????

                                        •      It is an infectious disease caused by the varicella-
                                               zoster virus.
                                        •      It results in a blister-like rash, itching, tiredness and
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                               fever.
                                        •      The rash appears first on the trunk and face, but can
                                               spread over the entire body causing between 250 to 500
                                               itchy blisters.
                                        •      Most cases of chickenpox occur in persons less than 15
                                               years old.
                                        •      Can cause at least 5-6 days of school loss.
                                        •      Prior to the use of varicella vaccine, the disease had
                                               annual cycles, peaking in the spring of each year.
                                            Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        CHICKENPOX:
                                        What are the serious complications
                                        from chickenpox?


                                        •      Bacterial infections which can involve many sites of the
                                               body including the skin, tissues under the skin, bone,
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                                               lungs (pneumonia), joints and the blood.

                                        •      Due to the virus infection directly – include viral
                                               pneumonia, bleeding problems and infection of the brain
                                               (encephalitis).

                                        •      It may lead to Herpes Zoster later in life – vaccine
                                               protects from this as well

                                            Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Do children prefer vaccination over
                                        having chickenpox ?
                                        • In a recent study,
                                           – 7 out of 10 children preferred a shot over natural
                                             disease.
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                                           – 7 out of 10 children considered chickenpox to be
                                             worse than many other common childhood ailments,
                                             including colds, earaches, sore throat, and fever.
                                           – The study also found that 3 out of 4 parents are
                                             unaware that death is a potential complication of
                                             chickenpox.



                                         Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        Who should be vaccinated?

                                        •       All children between 12 and 18 months of age should
                                                have one dose of chickenpox vaccine.
                                        •       Children who have had chickenpox do not need the
                                                vaccine.
                                        •       Children between 19 months – 13 year should get a
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                                                single dose.
                                        •       People 13 and older should get two doses - 4 to 8
                                                weeks apart.
                                        •       For more information on who should be vaccinated
                                                visit the following site: (ACIP)
                                                http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr48
                                                06a1.htm

                                            Adolescent Friendly School Initiative
                            IAP VISION 2007

                                        I don't think I have had chickenpox, but I
                                        am not sure. Is there a blood test
                                        available to determine whether or not I
                                        have had the disease?

                                        •       Yes, a blood test is available to check
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                                                immunity.
                                        •       If it is not available, it is still safe to
                                                receive the vaccine even if you have
                                                previously had chickenpox.

                                            Adolescent Friendly School Initiative
                            IAP VISION 2007

                 My child was vaccinated 2-3 years ago and
                 he/she developed a mild case of chickenpox
                 this year. Why did this happen?

                                        •    After vaccination, some persons (about 1 person in 10)
                                             do not develop enough protection to completely
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                             prevent them from developing chickenpox.

                                        •    Hence, they may develop a mild case of disease with
                                             less than 50 spots or bumps.

                                        •    This form of chickenpox is also called breakthrough
                                             disease.


                                        Adolescent Friendly School Initiative
                            IAP VISION 2007

                 Chickenpox in children is usually not serious.
                 Why not let children get the disease?


                                        •       It is never possible to predict who will
                                                have a mild case of chickenpox and who
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                will have a serious or even deadly case
                                                of disease. Now that there is a safe and
                                                effective vaccine available, it is not worth
                                                taking this chance.


                                            Adolescent Friendly School Initiative
                            IAP VISION 2007

                                                               Varicella (Chickenpox)
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                        Chickenpox vesicle behind the            Chickenpox on the palate. Notice
                                        ear. Notice the translucent              the glistening, water-drop
                                        quality of the vesicle on the            characteristic of the chickenpox
                                        skin, the classic "dew drop on a         vesicle on the palate.
                                        rose petal" appearance.
                                        Adolescent Friendly School Initiative
                            IAP VISION 2007
                            IAP VISION 2007
                                        ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                                                        Adequate immunization is one of the most
ADOLESCENT FRIENDLY SCHOOL INITIATIVE




                                                                                        important preventive health services that
                                                                                           can be provided for an adolescent.



                                                                                                                        THANKS
                                                                                Adolescent Friendly School Initiative