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What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
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What 2012 vaccini
What 2012 vaccini
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What 2012 vaccini
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What 2012 vaccini
What 2012 vaccini
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What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
What 2012 vaccini
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What 2012 vaccini

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  • 1. WHAT YOU SHOULD HAVE READ BUT….2012  VaccinesAttilio BonerUniversity ofVerona, Italy
  • 2. generalità
  • 3. Infant Pertussis Epidemiology and Implications for Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccination Hanson APAM 2011;165:647 • Among 176 confirmed cases of Retrospective infants with pertussis, analysis of reported the median age was 3 months; 80.1% were younger than 6 mo. pertussis cases among infants • 77% were age-appropriately younger than 1 year. vaccinated. • Households were the suspected exposure location for January 1, 2002 - 70.0% of cases. December 31, 2007. • Case households had a median of 3 (range, 1-15) Tdap-eligible persons.
  • 4. Infant Pertussis Epidemiology and Implications for Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis (Tdap) Vaccination Hanson APAM 2011;165:647 • Among 176 confirmed cases of Tdap vaccination Retrospective infants with pertussis, analysis ofeligible of reported the median age was 3 months; household members pertussis cases 80.1% were younger than 6 mo. and close contacts among infants • 77% were age-appropriately younger thanpromoted should be 1 year. vaccinated. as an additional • Households were the suspected means of exposure location for January 1, 2002 - protecting infants 70.0% of cases. Decemberpertussis. from 31, 2007. • Case households had a median of 3 (range, 1-15) Tdap-eligible persons.
  • 5. Spontaneous resolution of diphteria-tetanus vaccine hypersensitivity in a pediatric population Bégin, Allergy 2011;66:1508 Allergy to the Diphteria and tetanus (DT ) vaccine is a clinical challenge considering that the regular immunization schedule includes multiple doses of DT-containing vaccine and that boosters are needed throughout life; Although desensitization is an option in these patients, in our experience, it is seldom performed, either because of lack of access to a specialist or for fear of reactions.
  • 6. Spontaneous resolution of diphteria-tetanus vaccine hypersensitivity in a pediatric population Bégin, Allergy 2011;66:1508 Patients referred to our institution from 1998 to 2009; On re-evaluation, only 3 patients still had 15 patients whose allergy to positive skin test to the DT component had been DT toxoids. confirmed by a positive The remaining patients immediate intradermal skin tolerated vaccination test were contacted and challenges with DT re-evaluated; vaccine, all 3 patients with persistent allergy Initial reactions to vaccine had experienced included 11 systemic reactions generalized reactions. and 4 large local reactions.
  • 7. The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents OLeary, Pediatrics 2012;129;248 WHAT’S KNOWN ON THIS SUBJECT: Studies onvaccine safety are crucial to the ongoing success of our national immunization program. Immune Thrombocytopenic Purpura (ITP) has a known association with MMR in young children, occurring in 1 in 40 000 doses. The risk after other childhood vaccines is unknown.
  • 8. The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents OLeary, Pediatrics 2012;129;248 Data from 5 managed care organizations There were 197 for 2000 to 2009. chart-confirmed ITP 1.8 million children cases out of 1.8 million (6 weeks to 17 years). (0.01%) children in the cohort. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.
  • 9. The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents OLeary, Pediatrics 2012;129;248 Data from 5 managed There was no elevated care organizations for 2000 to 2009. risk of ITP after any vaccine in early 1.8 million children childhood other (6 weeks to 17 years). than MMR in the 12-19-month age group. Incidence rate ratios were calculated comparing the risk of ITP in risk (1 to 42 days after vaccination) and control periods.
  • 10. The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents OLeary, Pediatrics 2012;129;248 There was a significantly Data from 5 managed elevated risk of ITP care organizations after hepatitis A vaccine for 2000 to 2009. at 7 to 17 years of age, 1.8 million children and (6 weeks to 17 years). for varicella vaccine and tetanus-diphtheria- Incidence rate ratios acellular pertussis were calculated comparing vaccine at 11 to 17 the risk of ITP in risk (1 to years of age. 42 days after vaccination) and control periods.
  • 11. The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents OLeary, Pediatrics 2012;129;248 There was a significantly For hepatitismanaged Data from 5 A,varicella, elevated risk of ITP care tetanus-diphtheria- and organizations after hepatitis A vaccine foracellular 2009. 2000 to pertussis vaccines, elevated risks at 7 to 17 years of age, 1.8 million children to two were based on one and vaccine-exposed cases. (6 weeks to 17 years). for varicella vaccine Most cases were acute and tetanus-diphtheria- and mild with no Incidence rate ratios acellular pertussis long-term were calculated comparing vaccine at 11 to 17 the risk sequelae. risk (1 to of ITP in years of age. 42 days after vaccination) and control periods.
  • 12. The Risk of Immune Thrombocytopenic Purpura After Vaccination in Children and Adolescents OLeary, Pediatrics 2012;129;248 CONCLUSIONS: ITP is unlikely after early childhoodvaccines other than MMR. Because of the small number of exposed cases and potential confounding, the possible association of ITP with hepatitis A, varicella, and tetanus-diphtheria-acellular pertussis vaccines in older children requires further investigation.
  • 13. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy Kattan JACI 2011;128:215 The US national Vaccine Adverse Events Reporting System lists 39 anaphylactic reactions to DTaP, DTP, or Tdap vaccines for patients aged 0 to 17 years from 2007-2010. We noted that these vaccines are labeled as being processed in medium containing casamino acids (derived from cow’s milk), raising the concern that residual casein in the vaccines might have triggered these reactions. To investigate this possibility, we tested 8 lots of the vaccines for residual casein.
  • 14. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy Kattan JACI 2011;128:215 Mean casein concentrations in vaccine samples examined
  • 15. Anaphylaxis to diphtheria, tetanus, and pertussis vaccines among children with cow’s milk allergy Kattan JACI 2011;128:215 8 children were obtained by means of chart review. These patients were selected based on reports of anaphylactic reactions to the vaccines and not because of a history of milk allergy. Six of the patients had prior acute allergic reactions to cow’s milk, including severe reactions in 5 patients and reactions to trace exposures in 4 patients. In conclusion, our novel observation raises a concern regarding booster vaccination of children with high levels of milk allergy with Tdap and DTaP.
  • 16. influenza
  • 17. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 The key points for the upcoming 2011–2012 season are:(1) the influenza vaccine composition for the 2011–2012 season isunchanged from the 2010 –2011 season,
  • 18. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 The key points for the upcoming 2011–2012 season are:(1) the influenza vaccine composition for the 2011–2012 season isunchanged from the 2010 –2011 season,(2) annual universal influenza immunization is indicated,
  • 19. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 The key points for the upcoming 2011–2012 season are:(1) the influenza vaccine composition for the 2011–2012 season isunchanged from the 2010 –2011 season,(2) annual universal influenza immunization is indicated,(3) a simplified dosing algorithm for administration of influenza vaccineto children 6 months through 8 years of age has been created,
  • 20. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 The key points for the upcoming 2011–2012 season are:(1) the influenza vaccine composition for the 2011–2012 season isunchanged from the 2010 –2011 season,(2) annual universal influenza immunization is indicated,(3) a simplified dosing algorithm for administration of influenza vaccineto children 6 months through 8 years of age has been created,(4) most children presumed to have egg allergy can safely receive influenza vaccine in the office without need for an allergy consultation,
  • 21. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 The key points for the upcoming 2011–2012 season are: Ù(1) the influenza vaccine composition for the 2011–2012 season isunchanged from the 2010 –2011 season,(2) annual universal influenza immunization is indicated,(3) a simplified dosing algorithm for administration of influenza vaccineto children 6 months through 8 years of age has been created,(4) most children presumed to have egg allergy can safely receive influenza vaccine in the office without need for an allergy consultation,(5) an intradermal trivalent inactivated influenza vaccine has been licensed for the 2011–2012 season for use in people 18 through 64 years of age.
  • 22. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Special efforts should be made to vaccinate people (1): All people 6 months of age and older should receive trivalent seasonal influenza vaccine each year, especially those who are at high risk of influenza complications (eg, children with chronic medical conditions : asthma, diabetes mellitus, immunosuppression, or neurologic disorders). Annual trivalent seasonal influenza vaccine is recommended for household members and out-of home care providers of children and adolescents at high risk of complications of influenza and healthy children younger than 5 years, especially infants younger than 6 months.
  • 23. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Special efforts should be made to vaccinate people (2): As soon as the trivalent seasonal influenza vaccine is available locally, health care personnel (HCP) should be immunized, publicize vaccine availability to parents and caregivers. Any female who is pregnant, considering pregnancy, or breastfeeding during the influenza season.
  • 24. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 The number of trivalent seasonal influenza vaccine doses to be administered thisyear depends on the child’s age at the time of the first administered dose and his or her vaccine history :
  • 25. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 • Infants < 6 months The number of trivalent are too young to be seasonal influenza vaccine immunized doses to be administered this with influenza vaccine.year depends on the child’s age at the time of the first • Children 9 years administered dose and his or of age and older need her vaccine history : only 1 dose.
  • 26. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 • Children 6 mo-8 yrs The number of trivalent should receive seasonal influenza vaccine 2 doses of vaccine doses to be administered this if they did not receiveyear depends on the child’s age any dose of vaccine last at the time of the first season. administered dose and his or her vaccine history : The second dose should be administered at least 4 weeks after the first dose.
  • 27. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 • Children 6 mo-8 yrs The number of trivalent who received at least seasonal influenza vaccine 1 dose of the 2010–2011 doses to be administered this trivalent seasonalyear depends on the child’s age influenza vaccine last at the time of the first season, need only 1 dose administered dose and his or of the 2011–2012 her vaccine history : influenza vaccine this season.
  • 28. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Children Who Should Not Be Vaccinated With TIV (trivalent inactivated influenza vaccine): <6 months; who have a moderate-to-severe febrile illness; who have experienced Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination;
  • 29. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Children Who Should Not Be Vaccinated With LAIV (live attenuated influenza vaccine) (1): <2 years; who have a moderate-to-severe febrile illness; with copious nasal congestion that would impede vaccine delivery; who have experienced Guillain-Barré syndrome within 6 weeks after a previous influenza vaccination;
  • 30. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Children Who Should Not Be Vaccinated With LAIV (live attenuated influenza vaccine) (2):  who have received other live-virus vaccines within the previous 4 weeks; however, other livevirus vaccines can be given on the same day as LAIV;  with asthma, other chronic disorders of the pulmonary or cardiovascular systems, or with a history of recurrent wheezing ;  with chronic medical conditions: metabolic disease, diabetes mellitus, renal dysfunction, hemoglobinopathies.
  • 31. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Children Who Should Not Be Vaccinated With LAIV (live attenuated influenza vaccine) (3):  who have known or suspected immunodeficiency disease or receiving immunosuppressive or immunomodulatory therapies ;  who are receiving aspirin or other salicylates ;  any female who is pregnant or considering pregnancy ;  with any condition that can compromise respiratory function or handling of secretions or can increase the risk for aspiration.
  • 32. Recommendations for prevention and control of influenza in children, 2011-2012 Committee on infectious diseases Pediatrics 2011;128:813 Pediatricians, nurses, and all health care personnel have leadership roles in the prevention of influenza through vaccine use and public education.
  • 33. Randomized Controlled Trial of Dose Response to Influenza Vaccine in Children Aged 6 to 23 Months Skowronski, Pediatrics 2011;128:e276 Reactogenicity in infants (aged 6–11 months) and toddlers (aged 12–23 months). In toddlers, post-immunization 2 full (0.5-mL) or sero-protection rates 2 half (0.25-mL) doses exceeded 85% of 2008–2009 for all 3 vaccine split TIV components (trivalent inactivated without significant influenza vaccine). difference by dose. Full dose: n=124; half-dose: n=128.
  • 34. Randomized Controlled Trial of Dose Response to Influenza Vaccine in Children Aged 6 to 23 Months Skowronski, Pediatrics 2011;128:e276 Reactogenicity in infants (aged 6–11 months) and toddlers In infants, (aged 12–23 months). the full dose induced 2 full (0.5-mL) or higher responses for all 2 half (0.25-mL) doses 3 vaccine components. of 2008–2009 Rates of fever were split TIV not increased (trivalent inactivated among full- versus influenza vaccine). half-dose recipients in either age group. Full dose: n=124; half-dose: n=128.
  • 35. Randomized Controlled Trial of Dose Response to Influenza Vaccine in Children Aged 6 to 23 Months Skowronski, Pediatrics 2011;128:e276 Reactogenicity in infants (aged 6–11 months) and toddlers Administration of In infants, (aged 12–23 months). 2 full TIV doses the full dose induced may improve 2 full (0.5-mL) or higher responses for all immunogenicity 2 half (0.25-mL) doses 3 vaccine components. without increasing of 2008–2009 Rates of fever were reactogenicity split TIV not increased in infants. (trivalent inactivated among full- versus influenza vaccine). half-dose recipients in either age group. Full dose: n=124; half-dose: n=128.
  • 36. Randomized Controlled Trial of Dose Response to Influenza Vaccine in Children Aged 6 to 23 Months Skowronski, Pediatrics 2011;128:e276 Reactogenicity in infants (aged 6–11 months) and toddlers Current In infants, (agedTIV dosing 12–23 months). the full dose induced 2 full (0.5-mL) or for recommendations higher responses for all young children 2 half (0.25-mL) doses 3 vaccine components. warrant of 2008–2009 Rates of fever were additional split TIV not increased evaluation. (trivalent inactivated among full- versus influenza vaccine). half-dose recipients in either age group. Full dose: n=124; half-dose: n=128.
  • 37. Influenza vaccination is associated with reduced severityof community-acquired pneumonia Tessmer ERJ 2011;38:147 Pneumonia is an important cause of influenza-associated morbidity and mortality. Influenza vaccination has been shown to reduce morbidity and mortality during influenza seasons. Protection from severe pneumonia may contribute to the beneficial effect of influenza vaccination. Therefore, we investigated the impact of prior influenza vaccination on disease severity and mortality in patients with community-acquired pneumonia (CAP).
  • 38. Influenza vaccination is associated with reduced severityof community-acquired pneumonia Tessmer ERJ 2011;38:147 During the influenza season in vaccinated subjects OR 1.0 –  Patients were analysed separately as an influenza 0.76 0.53 season (2.368 0.5 – patients) and off-season cohort.  Vaccination status. 0 Severe Procalcitonin pneumonia ≥2.0 ng/ml
  • 39. Influenza vaccination is associated with reduced severityof community-acquired pneumonia Tessmer ERJ 2011;38:147 During the influenza season in vaccinated subjects OR These patients 1.0 –  Patients were a showed analysed separately significantly as an influenza 0.76 better overall 0.53 season and 2.368 0.5 – survival within the off-season cohort. 6-month  Vaccination status. follow-up period. 0 Severe Procalcitonin pneumonia ≥2.0 ng/ml
  • 40. Influenza vaccination is associated with reduced severityof community-acquired pneumonia Tessmer ERJ 2011;38:147 During the influenza season in vaccinated subjects OR 1.0 – Within the  Patients were cohort off-season analysed separately (2,632 patients) as an influenza 0.76 there was no 0.53 season (2.368 0.5 – patients) and influence significant of vaccination off-season cohort. status on CAP  Vaccination status. severity 0 Severe Procalcitonin pneumonia ≥2.0 ng/ml
  • 41. Influenza Coinfection and Outcomes in ChildrenWith Complicated Pneumonia. Williams APAM 2011;165:506 A bacterial pathogen was identified in 1201 cases (35.5%). The most commonly identified 3382 children bacteria were discharged from Staphylococcus aureus hospitals with in children with complicated influenza coinfection pneumonia (22.9% of cases) requiring a and pleural drainage. Streptococcus pneumoniae in children without coinfection (20.0% of cases).
  • 42. Influenza Coinfection and Outcomes in ChildrenWith Complicated Pneumonia. Williams APAM 2011;165:506 Multivariable analysis comparing outcomes between patients with complicated pneumonia with and without influenza
  • 43. Influenza Coinfection and Outcomes in ChildrenWith Complicated Pneumonia. Williams APAM 2011;165:506 Multivariable analysis comparing outcomes between patients with complicated pneumonia with and without influenza Influenza coinfection was associated with higher odds of intensive care unit admission, mechanical ventilation, vasoactive infusions, blood product transfusions, higher costs and a longer hospital stay.
  • 44. Adherence to Expanded Influenza Immunization Recommendations among Primary Care Providers O’Leary, J Pediatr 2012;160:480 % doctors reporting adherence to Advisory Committee on Immunization Practices (ACIP) 100 – A survey July to 90 – October 2009 80 – 70 – 416 pediatricians 60 – 50 – 65% 424 family 40 – medicine physicians 35% 30 – (FMs). 20 – 10 – 0 Pediatricians FMs
  • 45. Adherence to Expanded Influenza Immunization Recommendations among Primary Care Providers O’Leary, J Pediatr 2012;160:480 % of physician reporting routinely vaccinating patients of different age groups during the ‘08-’09 influenza season (pediatrician vs FMs). A survey July to October 2009 416 pediatricians 424 family medicine physicians (FMs).
  • 46. Adherence to Expanded Influenza Immunization Recommendations among Primary Care Providers O’Leary, J Pediatr 2012;160:480 RR for routine vaccination A survey July to 2 – October 2009 416 pediatricians 1 – 1.33 424 family medicine physicians (FMs). 0 Having dedicated influenza vaccination clinics after hours or weekends
  • 47. Adherence to Expanded Influenza Immunization Recommendations among Primary Care Providers O’Leary, J Pediatr 2012;160:4801) The Advisory Committee on Immunization Practices (ACIP) has incrementally expanded the recommendations for influenza vaccination in children.2) For many years, influenza vaccination has been recommended for children aged >6 months with a chronic medical condition.3) In 2002, the ACIP encouraged the vaccination of healthy children aged 6-23 months when feasible.4) The recommendation was again expanded in 2006 to include children aged 24-59 months.5) Most recently, in 2008 the ACIP recommended expanding coverage to all children aged 5-18 yrs.
  • 48. Effectiveness of Pandemic H1N1 Vaccine Against Influenza-Related Hospitalization in Children Gilca Pediatrics 2011;128:e1084Objective:Young children are generally considered immunologically naivewith respect to influenza exposure opportunities; thus,a 2-dose schedule is recommended when a child is firstimmunized with conventional influenza vaccine lacking adjuvant.We estimated the effectiveness of a single pediatric dose ofAS03-adjuvanted vaccine against hospitalization for confirmedpandemic influenza A/H1N1 (pH1N1) infection in children aged 6months to 9 years during the fall 2009 vaccination campaign.
  • 49. Effectiveness of Pandemic H1N1 Vaccine Against Influenza-Related Hospitalization in Children Gilca Pediatrics 2011;128:e1084 1. The overall effectiveness of Case subjects were a single pediatric dose of children hospitalized vaccine administered for pH1N1 infection ≥14 days before illness in the Fall of 2009. onset was 85%. Controls were 2. Overall vaccine non-hospitalized effectiveness for children, matched by age immunization ≥10 days and region of residence. before illness onset was slightly lower at 80% with Vaccination status in similar variation according case subjects and to age. controls.
  • 50. Effectiveness of Pandemic H1N1 Vaccine Against Influenza-Related Hospitalization in Children Gilca Pediatrics 2011;128:e1084 Varying according to age Case subjects were children hospitalized category but with wide and for pH1N1 infection overlapping confidence in the Fall of 2009. intervals: Controls were 1) 92% in 6 –23 month-old non-hospitalized children, matched by age children, and region of residence. 2) 89% in 2– 4 year-olds, Vaccination status in case subjects and controls. 3) 79% in 5–9 year-olds.
  • 51. Effectiveness of Pandemic H1N1 Vaccine Against Influenza-Related Hospitalization in Children Gilca Pediatrics 2011;128:e1084 pH1N1 vaccination coverage in children younger than 10 years in Quebec, positive pH1N1 tests, and number of study cases (children hospitalized for pH1N1) according to CDC week. 77% 60% 27%
  • 52. Children With Asthma Hospitalized With Seasonal or Pandemic Influenza, 2003–2009 Dawood Pediatrics 2011;128:e27 % children hospitalized with 2003–2009 influenza influenza had asthma seasons. 50 – 2009 pandemic. 40 – 44% Surveillance of 5.3 32% 30 – million children aged 17 yrs or younger. 20 – Hospitalization with 10 – laboratory-confirmed influenza and 0 identified those 2003–2009 2009 with asthma. influenza seasons pandemic
  • 53. Children With Asthma Hospitalized With Seasonal or Pandemic Influenza, 2003–2009 Dawood Pediatrics 2011;128:e27 % children hospitalized with 2003–2009 influenza influenza had asthma seasons. Compared with 50 – asthmatic children 2009 pandemic. with seasonal influenza, 40 – 44% Surveillance of 5.3a higher proportion with 32% 30 – million children aged 2009 pandemic H1N1 17 influenza required yrs or younger. 20 – intensive care Hospitalization with (16% vs 22%; 10 – laboratory-confirmed influenzaP=0.01) and 0 identified those 2003–2009 2009 with asthma. influenza seasons pandemic
  • 54. Children With Asthma Hospitalized With Seasonal or Pandemic Influenza, 2003–2009 Dawood Pediatrics 2011;128:e27 % asthmatic children with 2003–2009 influenza diagnoses of asthma exacerbations seasons. 60 – 2009 pandemic. 50 – Surveillance of 5.3 40 – 51% million children aged 17 yrs or younger. 30 – Hospitalization with 20 – 29% laboratory-confirmed 10 – influenza and 0 identified those influenza A influenza B with asthma. (seasonal or pandemic)
  • 55. Guillain-Barré syndrome and H1N1 influenza vaccine in UK children. Verity, Lancet 2011;378:1546Background:• In 1976, the US National Influenza Immunization Programme (against swine influenza) was discontinued because of an increased risk of Guillain-Barré syndrome within 6 weeks of vaccination.• Guillain-Barré syndrome surveillance was therefore imperative for pandemic H1N1 influenza vaccines.
  • 56. Guillain-Barré syndrome and H1N1 influenza vaccine in UK children. Verity, Lancet 2011;378:1546 Children reported with symptoms of Guillain-Barré syndrome September 2009- August 2010. 55 children with Guillain-Barré syndrome.
  • 57. Guillain-Barré syndrome and H1N1 influenza vaccine in UK children. Verity, Lancet 2011;378:1546 49 had evidence of an infection in the prior 3 months: September 2009- • 22 respiratory; August 2010. • 13 gastroenteritis; • 7 H1N1 influenza; 55 children with • 2 seasonal influenza; Guillain-Barré syndrome. • 2 Epstein-Barr virus; • 1 Chickenpox; • 2 unexplained fevers;
  • 58. Guillain-Barré syndrome and H1N1 influenza vaccine in UK children. Verity, Lancet 2011;378:1546 49 had evidence of an infection in the prior 3 months: September 2009- of • 22 respiratory; Of the 55 cases • 13 gastroenteritis; August 2010. Guillain-Barré • 7 H1N1 influenza; 55 children with , Syndrome • 2 seasonal influenza; Guillain-Barré syndrome. • 2 Epstein-Barr virus; 9 had influenza. • 1 Chickenpox; • 2 unexplained fevers;
  • 59. Guillain-Barré syndrome and H1N1 influenza vaccine in UK children. Verity, Lancet 2011;378:1546 49 had evidence of an infection in the Only 1 case with prior 3 months: Septemberor seasonal H1N1 2009- • 22 respiratory; • 13 gastroenteritis; influenza August 2010. vaccines • 7 H1N1 influenza; with an interval 55 children with • 2 seasonal influenza; potentially indicating Guillain-Barré syndrome. • 2 Epstein-Barr virus; a causal relation. • 1 Chickenpox; • 2 unexplained fevers;
  • 60. Guillain-Barré syndrome and H1N1 influenza vaccine in UK children. Verity, Lancet 2011;378:1546 49 had evidence of Given the proven an infection in the effectiveness of prior 3 months: pandemic influenza vaccine SeptemberUK children, used in 2009- • 22 respiratory; the vaccination August 2010. • 13 gastroenteritis; programme might have • 7 H1N1 influenza; 55 children withprotective had an overall • 2 seasonal influenza; Guillain-Barréagainst effect syndrome. • 2 Epstein-Barr virus; Guillain- • 1 Chickenpox; Barré syndrome. • 2 unexplained fevers;
  • 61. meningococco
  • 62. Meningococcal Conjugate Vaccines Policy Update: Booster Dose Recommendations Committee on Infectious Diseases Pediatrics 2011;128:1213The American Academy of Pediatrics approved updated recommendations for the use of quadravalent (serogroups A, C, W-135, and Y)meningococcal conjugate vaccines in adolescents and in people at persistent high risk of meningococcal disease.1. adolescents should be routinely immunized at 11 through 12 years of age and given a booster dose at 16 years of age;
  • 63. Meningococcal Conjugate Vaccines Policy Update: Booster Dose Recommendations Committee on Infectious Diseases Pediatrics 2011;128:1213The American Academy of Pediatrics approved updated recommendations for the use of quadravalent (serogroups A, C, W-135, and Y)meningococcal conjugate vaccines in adolescents and in people at persistent high risk of meningococcal disease.1. adolescents should be routinely immunized at 11 through 12 years of age and given a booster dose at 16 years of age;2. adolescents who received their first dose at age 13 through 15 years should receive a booster at age 16 through 18 years or up to 5 years after their first dose;
  • 64. Meningococcal Conjugate Vaccines Policy Update: Booster Dose Recommendations Committee on Infectious Diseases Pediatrics 2011;128:1213The American Academy of Pediatrics approved updated recommendations for the use of quadravalent (serogroups A, C, W-135, and Y)meningococcal conjugate vaccines in adolescents and in people at persistent high risk of meningococcal disease.1. adolescents should be routinely immunized at 11 through 12 years of age and given a booster dose at 16 years of age;2. adolescents who received their first dose at age 13 through 15 years should receive a booster at age 16 through 18 years or up to 5 years after their first dose;3. adolescents who receive their first dose of meningococcal conjugate vaccine at or after 16 years of age do not need a booster dose;
  • 65. Meningococcal Conjugate Vaccines Policy Update: Booster Dose Recommendations Committee on Infectious Diseases Pediatrics 2011;128:1213The American Academy of Pediatrics approved updated recommendations for the use of quadravalent (serogroups A, C, W-135, and Y)meningococcal conjugate vaccines in adolescents and in people at persistent high risk of meningococcal disease.4. a 2-dose primary series should be administered 2 months apart for those who are at increased risk of invasive meningococcal disease because of persistent complement component deficiency (eg, C5–C9, properdin, factor H, or factor D) (9 months through 54 years of age) or functional or anatomic asplenia (2–54 years of age) and for adolescents with HIV infection;
  • 66. Meningococcal Conjugate Vaccines Policy Update: Booster Dose Recommendations Committee on Infectious Diseases Pediatrics 2011;128:1213The American Academy of Pediatrics approved updated recommendations for the use of quadravalent (serogroups A, C, W-135, and Y)meningococcal conjugate vaccines in adolescents and in people at persistent high risk of meningococcal disease.5. a booster dose should be given 3 years after the primary series if the primary 2-dose series was given from 2 through 6 years of age and every 5 years for persons whose 2-dose primary series or booster dose was given at 7 years of age or older who are at risk of invasive meningococcal disease because of persistent component deficiency (eg, C5–C9, properdin, factor H, or factor D) or functional or anatomic asplenia.
  • 67. morbillo
  • 68. papilloma
  • 69. Adolescent Perceptions of Risk and Need for Safer Sexual Behaviors After First Human Papillomavirus Vaccination. Kowalczyk Mullins T, APAM 2012;166:82 % girls sexually experienced 60 - Girls 13 to 21 yrs (n=339) receiving their first HPV vaccination. 50 – 57.5% 40 – Their mothers (n=235). 30 – 20 – 10 – 0
  • 70. Adolescent Perceptions of Risk and Need for Safer Sexual Behaviors After First Human Papillomavirus Vaccination. Kowalczyk Mullins T, APAM 2012;166:82 % girls sexually experienced 60 - Girls 13 to 21 yrs (n=339) Girls perceived receiving their to be themselves first HPVat less risk for vaccination. 50 – 57.5% HPV than for 40 – Their mothers (n=235). other sexually transmitted 30 – infections after HPV vaccination 20 – (P<0.001) 10 – 0
  • 71. Adolescent Perceptions of Risk and Need for Safer Sexual Behaviors After First Human Papillomavirus Vaccination. Kowalczyk Mullins T, APAM 2012;166:82 % girls sexually experienced 60 - Girls adolescents perceived Few 13 to 21 yrs (n=339) 57.5% less need for safer receiving their first 50 – sexual behaviors after HPV first HPV vaccination. the vaccination. Education about 40 – Their mothers (n=235). HPV vaccines and encouraging communication 30 – between girls and their mothers may 20 – prevent misperceptions among these adolescents 10 – 0
  • 72. pneumococcoThe original 7-valent formulation containsserotypes 4, 6B, 9V, 14, 18C, 19F, and 23F, and results in a 98%probability of protection against these strains, which caused 80%of the pneumococcal disease in infants in the US. In 2010, Pfizer introduced Prevnar 13 which containssix additional strains (i.e., 1, 3, 5, 6A, 19A and 7F), which protectagainst the majority of the remaining pneumococcal infections
  • 73. Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia McKee Pediatr Pulmonol 2011;46:717BackgroundThe frequency of complicatedpneumococcal disease, including necrotizingpneumonia, has increased over the lastdecade.During 2008–2009, we noted an increase inthe number of children whose empyemawas complicated by the development of abronchopleural fistula and air leak.We studied these children to see if therewas an associated cause.
  • 74. Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia McKee Pediatr Pulmonol 2011;46:717 % children with fistula 35 – 33% Retrospective review of 30 – children admitted with a parapneumonic effusion 25 – or empyema from 20 – p<0.0001 2002 to 2007, compared 15 – with 2008 to 2009. 10 – 310 children. 05 – 00 1% 2002-2007 2008-2009
  • 75. Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia McKee Pediatr Pulmonol 2011;46:717 % children with fistula 35 – 33% Retrospective review of Pneumococcal serotype 30 – children admitted with a 3 was identified in parapneumonic effusion 10/16 (63%) children 25 – orwith a bronchopleural empyema from 20 – p<0.0001 2002 to 2007, compared fistula and 1/33 (3%) 15 – withwithout (<0.0001). 2008 to 2009. 10 – 310 children. 05 – 00 1% 2002-2007 2008-2009
  • 76. Increased incidence of bronchopulmonary fistulas complicating pediatric pneumonia McKee Pediatr Pulmonol 2011;46:717 % children with fistula 35 – 33% Retrospective review of Pneumococcal serotype 30 – children admitted with a 3 infection, was not parapneumonic effusion covered by the 25 – or empyema from 20 – p<0.0001 heptavalent 2002 to 2007, compared pneumococcal 15 – with 2008 to 2009. vaccine Prevenar. 10 – 310 children. 05 – 00 1% 2002-2007 2008-2009
  • 77. Immunogenicity and Safety of MMRV and PCV-7 Administered Concomitantly in Healthy Children Leonardi Pediatrics 2011;128:e1387 Immunogenicity and safety The immune responses to all of a combination measles, antigens present in MMRV mump, rubella, and varicella and PCV-7 were similar vaccine (MMRV) (ProQuad) whether administered administered to healthy concomitantly or sequentially. children concomitantly The incidence of local and with a pneumococcal systemic adverse experiences 7-valent conjugate vaccine (AEs) was comparable. (PCV-7) (Prevnar). No vaccine-related serious 1027 healthy 12- AEs were reported. to 15-month-old children.
  • 78. Pneumococcal polysaccharide vaccine at 12 months of age produces functional immune responses Licciardi, JACI 2012;129:794Background: Infections with Streptococcus pneumoniae are a causeof significant child mortality. Pneumococcal glycoconjugate vaccinesare expensive and provide limited serotype coverage.The 23-valent pneumococcal polysaccharide vaccine (Pneumovax)might provide wider serotype coverage but is reported to be weaklyimmunogenic in children less than 2 years of age.We have previously reported that Pneumovax administered tohealthy 12-month-old Fijian infants elicits significant serotype-specific IgG responses.However, the functional capacity of these responses in 12-month-old infants is not known.
  • 79. Pneumococcal polysaccharide vaccine at 12 months of age produces functional immune responses Licciardi, JACI 2012;129:794 Proportion of infants with an opsonisation index (OI) ≥8 to the 8 seroptypes tested Immunization with Pneumovax 23 Functional responses of 12-month-old infants using the opsonophagocytic and antibody avidity assay against 8 serotypes and 23 serotypes, respectively
  • 80. Pneumococcal polysaccharide vaccine at 12 months of age produces functional immune responses Licciardi, JACI 2012;129:794 Proportion of infants with an opsonisation index (OI) ≥8 to the 8 seroptypes tested 71% Immunization with Pneumovax of infants Functional responses of produced strong 12-month-old infants opsonophagocytic using the activity against opsonophagocytic and 4 of 8 antibody avidity assay against 8 serotypes and serotypes 23 serotypes, respectively
  • 81. Pneumococcal polysaccharide vaccine at 12 months of age produces functional immune responses Licciardi, JACI 2012;129:794 Proportion of infants with an avidity index (AI) ≥50% to all vaccine seroptypes after immunization with 23vPPV Immunization with Pneumovax 23 Functional responses of 12-month-old infants using the opsonophagocytic and antibody avidity assay against 8 serotypes and 23 serotypes, respectively
  • 82. Pneumococcal polysaccharide vaccine at 12 months of age produces functional immune responses Licciardi, JACI 2012;129:794 Proportion of infants with an avidity index (AI) ≥50% to all vaccine seroptypes after 30% immunization with 23vPPV Produced Immunization with Pneumovax high-avidity Functional responses of serotype-specific 12-month-old infants IgG antibodies to using the 10 of 23 opsonophagocytic and serotypes antibody avidity assay against 8 serotypes and 2 weeks after 23 serotypes, Pneumovax respectively
  • 83. Pneumococcal polysaccharide vaccine at 12 months of age produces functional immune responses Licciardi, JACI 2012;129:794 Proportion of infants with an avidity index Responses were (AI) ≥50% to all vaccine seroptypes after protective for most immunization with 23vPPV Immunization with serotypes that cause Pneumovax Western disease in Functional responses of Countries. 12-month-old infants to Whereas responses using most of the the opsonophagocytic and epidemiologically antibody avidity assay relevant serotypes against 8developing and for serotypes 23 serotypes, countries respectively low were
  • 84. rotavirus
  • 85. Hospitalizations for Intussusception Before and After theReintroduction of Rotavirus Vaccine in the United States Zickafoose APAM 2012;166:350 Observed and predicted hospital discharges for intussusception for infants before (1997-2006) and after (2009) rotavirus vaccine reintroduction Children < 1 year with a discharge diagnosis of intussusception in the US 4 years prior to vaccine reintroduction (1997, 2000, 2003, and 2006) and 1 year after (2009).
  • 86. Hospitalizations for Intussusception Before and After theReintroduction of Rotavirus Vaccine in the United States Zickafoose APAM 2012;166:350 Observed and predicted hospital discharges for intussusception for infants before (1997-2006) and after (2009) rotavirus vaccine reintroduction The reintroduction Children < 1 year with a of rotavirus vaccine discharge diagnosis of since 2006 has not intussusception in the US resulted in a detectable 4 years prior to vaccine increase in the number reintroduction (1997, of hospital discharges 2000, 2003, and 2006) for intussusception and 1 year after (2009). among US infants.
  • 87. Development of Cystic Periventricular Leukomalacia in Newborn Infants after rotavirus Infection. Verboon-Maciolek, J Pediatr 2012;160:165  5 preterm & 3 term infants who presented with seizures during rotavirus infection within 6 weeks after birth.  6 of these infants developed late-onset cystic periventricular leukomalacia.  4 of the preterm infants had neurodevelopmental delay, and 4 (near) term infants had normal early outcome.
  • 88. Development of Cystic Periventricular Leukomalacia in Newborn Infants after Rotavirus Infection. Verboon-Maciolek, J Pediatr 2012;160:165 cranial UltraSonography (cUS)cUS showing severeperiventricul arechogenicity at4 days (A-B). cUS showing early cystic evolution in the white
  • 89. Development of Cystic Periventricular Leukomalacia in Newborn Infants after Rotavirus Infection. Verboon-Maciolek, J Pediatr 2012;160:165 MRI T2-weighted spin- echo sequence MRI, transverseplane, performed 11 days after systemic rotavirus infection showing extensive cysts throughout theperiventricular anddeep white matter, along with
  • 90. Development of Cystic Periventricular Leukomalacia in Newborn Infants after Rotavirus Infection. Verboon-Maciolek, J Pediatr 2012;160:1651) Our small case series suggests that rotavirus enteritis with neurologic manifestation in newborn infants may be associated with white matter necrosis.2) Thus, it is our practice to perform sequential neuroimaging (cUS and MRI) in newborns with rotavirus infection, especially when apnea and seizures are present.
  • 91. Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children. Cortes, NEJM 2011;365:1108Background:Routine vaccination of U.S. infants with pentavalent rotavirus vaccine(RV5) began in 2006.Objective:We compared the rates of diarrhea associated health care use invaccinated and unvaccinated children in 2007-2009 with thepre-vaccine rates.
  • 92. Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children. Cortes, NEJM 2011;365:1108 % of children who received ≥1 dose of RV5 by December 2008 100 80 MarketScan databases (2001-2009) in USA. 60 73% RV5 coverage and 40 64% diarrhea-associated 20 health care use. 0 8% Children <5 yrs of age. <1 year 1 year 2-4 years Age of children
  • 93. Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children. Cortes, NEJM 2011;365:1108 % Relative Reductions from 2001–2006 in hospitalization rates for diarrhea and specific rotavirus infection 100 MarketScan databases (2001-2009) in USA. 80 RV5 coverage and 60 75% diarrhea-associated 60% 40 health care use. 20 35% Children <5 yrs of age. 25% 0 2007-2008 2008-2009
  • 94. Rotavirus Vaccine and Health Care Utilization for Diarrhea in U.S. Children. Cortes, NEJM 2011;365:1108 % Relative Reductions from 2001–2006 Nationally, in hospitalization rates for diarrhea for the 2007–2009 and specific rotavirus infection 100 MarketScan databases period, there was an (2001-2009) in USA. estimated reduction 80 of 64855 RV5 coverage and 75% 60 hospitalizations diarrhea-associated saving approximately 40 60% health care use. $278 million 20 35% Children <5 yrs of age. in treatment costs. 25% 0 2007-2008 2008-2009
  • 95. Varicella
  • 96. Policy Statement-Prevention of Varicella: Update of Recommendations for Use of Quadrivalent and Monovalent Varicella Vaccines in Children Brady Pediatrics 2011;128:630Two varicella-containing vaccines are licensed: - monovalent varicella vaccine (Varivax ), - quadrivalent measles-mumps-rubella-varicella vaccine (MMRV).After vaccination at 12 through 23 months of age, 7 to 9 febrile seizures occur per 10.000 children who receive the MMRV, and 3 to 4 febrile seizures occur per 10.000 children who receive the measles-mumps-rubella (MMR) and varicella vaccines administered concurrently but at separate sites.No increased risk of febrile seizures is seen among patients 4 to 6 years of age receiving MMRV.
  • 97. Policy Statement-Prevention of Varicella: Update of Recommendations for Use of Quadrivalent and Monovalent Varicella Vaccines in Children Brady Pediatrics 2011;128:630• The American Academy of Pediatrics recommends that either MMR and varicella vaccines separately or the MMRV be used for the first dose of measles, mumps, rubella, and varicella vaccines administered at 12 through 47 months of age.• For the first dose of measles, mumps, rubella, and varicella vaccines administered at ages 48 months and older, and for dose 2 at any age (15 months to 12 years), use of MMRV generally is preferred over separate injections of MMR and varicella vaccines.
  • 98. Il pediatra ha la possibilità di programmare e proporre la strategia preventiva.

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