Childhood vaccinations

The worldwide market is approximately 3.0 bHHon in sales, with the pediatric portion accounting for about 35%. Basic, required childhood vaccines (DTP, poHo, measles /MMR, BCG, and TT) account for 3640 x 10 doses of this global market. In the United States doses distributed in the pediatric sector have risen from around 45 x 10 in 1982, covering basic, childhood vaccines, to around 75 x 10 in 1993 due primarily to the addition of vaccines for Haemophilus disease, hepatitis B, and a second dose of MMR to the recommended childhood series (144). The majority of vaccines for the U.S. market are... 

H. influenzae type b conjugate vaccine is a recommended routine childhood vaccine given at 2,4, 6, and 12 to 15 months of age. Adolescents and adults with functional or anatomic asplenia should also receive a booster dose of H. influenzae type b vaccine. The currently available vaccines are labeled for pediatric use, but can be used in adults when vaccination is indicated. There are several H. influenzae type b vaccines on... 

Vaccines are a cost-effective means for disease prevention. It is estimated that for every dollar spent on routine childhood vaccines there will be a savings of 0.90 to 24.00 in direct medical expense. The rates of vaccination for children are well over 90%. This has been attributed to the requirements for proof of vaccination by states for enrollment into day care centers and school. Additionally, children (less than or equal to 18 years of age) may receive routine vaccinations free of charge through state health departments or other assistance programs, such as the national Vaccines for Children program. 

This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December 1,2006, for children aged 0-6 years. Additional information is available at http //www.cdc.gov/nip/recs/child-schedule.htm. Any dose not administered at the recommended age should be administered at any subsequent visit, when indicated and feasible. Additional vaccines may be licensed and recommended during the year. Licensed combination vaccines may be used whenever any components of the combination are indicated and other components of the vaodne are... 

In response to the National Childhood Vaccine Injury Act of 1988, which required health workers to report vaccine adverse events, the CDC and the FDA collaborated in 1990 to implement the Vaccine Adverse Event Reporting System (VAERS) to monitor the safety of vaccines in both sectors. Health care professionals and parent or other caretakers are encouraged to report all clinically significant vaccine adverse events. Narrative diagnostic reports are reviewed and assigned standard codes using Coding Symbols for a Thesaurus of Adverse Reaction Terms. The source of the vaccines (public versus private provider) is recorded on the form. 

The Childhood Vaccine Act requires vaccine makers to provide patient information, gives FDA authority to recall biologies, and authorizes civil penalties. 

In response to continued concerns about vaccine safety, the National Childhood Vaccine Injury (NCVI) Act of 1986 established a no-fault compensation process for people injured by them. The NCVI also mandated that the Institute of Medicine (lOM) reviews scientific evidence of vaccine-related ADRs in children. In 1996, the Department of Health and Human Services (HHS) made changes to the NCVI, which lessened its usefulness. In response to the problems this generated, the Vaccine Injured Children s Compensation Act of 2001 was introduced in Congress.This bill, however, also has its problems, and in April 2001, the bill was referred to the House subcommittee on health, where it still... 

The National Childhood Vaccine Injury Act of 1986, Section 2125, Public Health Service Act as codified at 42 U.S.C. 300aa (SuppL), 1987. 

Common childhood vaccines include the three-in-one measles, mumps and rubella and the diphtheria vaccine. Infectious mononucleosis, also knov/n as glandular fever, is caused by the Epstein-Barr virus and no vaccine is available. 

How do childhood vaccinations help prevent serious diseases ... 

Judged in terms of the relationship of benefit to cost, vaccines are among the most socially valuable public health investments (U.S. Centers for Disease Control and Prevention [CDC] 1999 Stratton, Durch, and Lawrence 2000)d In spite of some recent successes, such as increases in immunization rates in the United States (CDC 2002a, b, 2003), substantial structural and financial problems remain. In particular, the United States has recently experienced unprecedented shortages in 8 of the 11 routine childhood vaccines (Georges et al. 2003). Flu vaccine shortages were experienced in 2000-2002 and 2004 (Cohen 2002 Enserink 2004 Institute of Medicine 2004). 

The third policy, the Vaccine Injury Compensation Fund, introduced a government-run, no-fault product liability system that reduced the mean and variance of product liability costs associated with four childhood vaccines polio, diphtheria-tetanus, measles-mumps-rubella, and pertussis. 

Davis, M. M., J. L. Zimmerman, J. R. C. Wheeler, and G. L. Freed. 2002. Childhood Vaccine Purchase Costs in the Public Sector Past Trends, Future Expectations. American Journal of Public Health 92(12) 1982-1987. 

Giffin, R., K. Stratton, and R. Chalk. 2004. Childhood Vaccine Finance and Safety Issues. Health Affairs 23(5) 98-lll. 

Luman, E. T., L. E. Barker, K. M. Shaw, et al. 2005. Timeliness of Childhood Vaccinations in the United States Days Undervaccinated and Number of Vaccines Delayed. Journal of the American Medical Association 293(10) 1204-1211. 

A 4-year-old boy has signihcantly reduced levels of IgA, IgM, IgD and IgE in his blood. Testing demonstrates that he did not develop the appropriate antibody titer following standard childhood vaccinations. The most probable cause of these dehciencies is... 

D. The boy has significantly reduced serum antibody levels and a reduced ability to mount an antibody response to childhood vaccinations. The most probably cause is a primary immunodeficiency disease affecting humoral immunity. 

Another important component of most vaccine formulations is a suitable preservative. The three most commonly used preservatives in available vaccines are phenol, 2-phenoxyethanol, and ethyl mercurithiosalicylate (thimerosal). Thimerosal, in particular, is used in multidose vials as an antimicrobial preservative. Concerns about the presence of mercury in thimerosal (25 pg/dose) has led to FDA stopping the use of this preservative in all vaccines by an amendment to the FDA Modernization Act of 1997. By 2001, thimerosal was removed from most childhood vaccines as a precautionary measure. The sources of all of the preservatives for vaccines are the same suppliers that supply preservatives for the parenteral dosage forms (J. T. Baker, Aldrich, Spectrum, etc. from U.S.A.). Table 2 lists some of the preservative concentrations in common vaccines. 

Congress passes the National Childhood Vaccine Injury Act, requiring patient information on vaccines and reporting of adverse events after vaccination. 

Sue has been on staff at Professional Pharmacy for 6 months. She is beginning to feel comfortable with the employees, customers, and flow of the business. The immunization program that she helped institute while a student has continued to grow, now offering vaccinations year round for influenza, diphtheria, and tetanus, in addition to miscellaneous travel and childhood vaccinations. 

This schedule indicates the recommended ages for routine administration of currently licensed childhood vaccines, as of December I, 2006, for children aged 7-18 years, Additional information is available at http //www.cdc.gov/nip/recs/child-schedule.htm. 

Mvula M, Ryder R, Manzila T, et al. Respotrse to childhood vaccination in African children with HIV irrfection. In Abstracts, IV International Conference on AIDS, Stockholm, Sweden, 12-16 June 1988. 

The amounts of thiomersal in the UK schedule of childhood vaccination are lower than in the USA. No specific action has been recommended in the vaccination program. European and American regulatory authorities have recommended that vaccine manufacturers should phase out their use of thiomersal whenever possible as a precaution (SEDA-25, 278). 

Ball LK, Ball R, Pratt RD. An assessment of thimerosal use in childhood vaccines. Pediatrics 2001 107(5) 1147-54. 

Stratton KR, Howe CJ, Johnson Jr. RB Jr, editors. Adverse Events Associated with Childhood Vaccines. Washington, DC National Academy of Sciences, 1994. 

In the USA, the National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program as a federal no-fault compensation system for individuals who may have been injured by specific vaccines. This compensation program relies on a Vaccine Injury Table that lists the vaccines that are covered by the program, as well as injuries, disabilities, illnesses, and conditions (including death) for which compensation may be awarded. To better reflect current scientific knowledge about vaccine injuries, the Vaccine Injury Table was revised in 1995 and has been subsequently further modified. The latest modification, which became effective on December 1, 2004, is shown in Table 7. This revision took into account a review of the literature on specific adverse consequences of pertussis and rubella vaccines performed and published by the lOM (SED-12, 817) (SED-12, 825). In addition to the seven vaccines (diphtheria, pertussis, tetanus, measles, mumps, rubella, and poliomyelitis) included in the first Vaccine Injury Table, the 1997 revision includes hepatitis B, Hemophilus influenzae type b, and Varicella vaccines, as well as any future licensed vaccine recommended by the Advisory Committee on Immunization Practices (ACIP) for routine administration to children (38). 

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