American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington

Pneumococcal vaccine for seniors

• The AdvisoryCommitteevoted 13-2to recommend that adults ≥65 years of age who havenotreceived pneumococcal vaccineor Immunization update whose previousvaccination historyisunknown shouldreceivea doseof pneumococcal13-valent conjugatevaccine(Prevnar 13; Pfizer) first, followed bypneumococcal polysaccharide Liz Clark, D.O., MPH & TM vaccine (Pneumovax 23; Merck & Co.). It is also FACOPM recommended that those who have received the one or more doses of the pneumococcal polysaccharidevaccinealso receivethe pneumococcal 13-valent conjugate vaccine.

Shingles vaccine Influenza

herpes zoster vaccine is effective in protecting • The U.S.-licensed influenza vaccines for the 2014– 2015 seasonwill containthesamevaccinevirus older adults against shingles, even if they later strainsasthoseinthe 2013–2014 vaccine. undergo chemotherapy, according to new Trivalent influenzavaccines will contain research. The findings were published online in hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an the journal Clinical Infectious Diseases. A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like (Yamagatalineage) virus. Quadrivalent influenzavaccineswill contain theseantigens plus a B/Brisbane/60/2008-like (Victoria lineage) virus.

Seniors/Flu FLU recommendations

high-dose, trivalent, inactivated influenza • The updatedrecommendations for children ages vaccine (IIV3-HD) is associated with improved 6 months–8yearsstatethattwodosesof influenza vaccine, given ≥4 weeks apart, should protection for seniors against laboratory- be administered duringtheir first season of confirmed influenza infection compared with vaccination orif previousvaccination historyis standard-dose trivalent, inactivated influenza unknown to optimize immune response. Only vaccine (IIV3-SD), according to a study published one dose is required for children ages 6 months– in the August 14 issue of the New England 8 years who previously received ≥1 dose of a Journal of Medicine. 2013–2014 influenza vaccine due to the unchanged strainsin the2014–2015 vaccines.

F-1 American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington

Flu flu

• While studies have shown similar efficacy in • For individuals who report prior reactions to egg involving such symptoms as angioedema, respiratory LAIV and IIVs for adults, research has indicated distress, lightheadedness, or recurrent emesis, or who that LAIV is superior in efficacy in younger required epinephrine or another emergency medical intervention, the ACIP now advises that they may children compared to IIVs. The ACIP receive IIVs if trivalent recombinant hemagglutinin recommends the use of LAIV, when available, [rHA] influenza vaccine (RIV3) is not available or if the recipient is not within the indicated RIV3 age range. IIV for healthy children ages 2–8 years of age who can be administered by a physician with experience in have no contraindications or precautions. the recognition and management of severe allergic conditions. The patient should be observed for at least 30 minutes after vaccination for any reactions.

All Pregnant Women Should Get Novel Dengue Vaccine Safe, Efficacious Influenza Vaccine, ACOG Says in Study • Pregnant women should receive influenza • Vaccination could reduce the incidence of vaccination,accordingto an updatedopinion of the Committee on ObstetricPractice and symptomatic infection and hospital admission Immunization Expert Work Group of the and has the potential to provide an important American College of Obstetricians and public health benefit," the authors write. Gynecologists (ACOG), publishedin the September issue of Obstetrics & Gynecology. The committee emphasizes thatobstetrician- gynecologists, other healthcare providers, healthcareorganizations,and publichealth officials should work to improve the rate of influenza vaccinationamongpregnant women.

August14, 2014 Long Term Study Shows Sustained HPV Results in HPV Vaccine • Persistent infection with HPV has been clearly • A long-termfollow-up studyshowsthesustained established as the necessary cause of the overwhelming majority of cervical cancer cases. At efficacy, immunogenicity,and safetyof least 40 different HPV types are known to infect the GlaxoSmithKline's human papillomavirus (HPV) genital mucosa, of which approximately 15 are vaccine Cervarix. Women vaccinated with the associated with cervical cancer. Among these types, HPV-16/18 AS04-adjuvantedvaccine were HPV-16 and HPV-18 are the most common and followed for more than 9 years, and vaccine responsible for approximately 70% of cervical cancers. efficacy (VE) against incidentinfectionwas 100%. Both HPV-16 and HPV-18 are included in the two Thisis the longestfollow-upreportforalicensed licensed HPV vaccines (GSK's Cervarix and Merck's HPV vaccine. Gardasil), which are now widely available and used.

F-2 American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington

HPV July 01, 2014 Childhood Vaccines Safe, Not Linked to • Despitea slightincreasein thenumbergirls and Autism, Says New Study boys ages 13–17 receiving a human • The MMR vaccineisnotassociatedwithautismbutisassociated papillomavirus (HPV) vaccine since 2012, withfebrileseizures. approximately one third of parents of girls and • LAIC andTIV formsofinfluenzavaccinesare associatedwithmild over half of parents of boys reported that their gastrointestinal events. child'sclinician had failed to recommended the • TIV influenzavaccineis associated with febrile seizures. HPV vaccination duringofficevisits.These results • The hepatitisAvaccine isnotassociatedwithlongorshort-term adverse events. from the 2013 NationalImmunization Survey- • A moderate but consistent strength of evidence linked the MMR Teen (NIS-Teen) were published in theCDC's vaccine and thrombocytopenicpurpurain children and the varicella Morbidity and Mortality Weekly Report (MMWR). vaccine and thrombocytopenicpurpurain children ages 11–17. • No vaccines studied wereassociated with childhood-onset leukemia.

Meningococcal Vaccine HIV and Meningococcal vaccine Recommendations Updated • According to thereport,in theabsenceof contraindications, an age-appropriate meningococcal • HIV-infected children should be given a two- conjugate vaccine is preferred to the meningococcal dose primary series with a single booster polysaccharidevaccine. Adolescents should beroutinely immunizedat age11 or12 years andgivenaboosterat age dose; children >2 years at risk of 16 with quadrivalent conjugated meningococcal vaccine; meningococcal disease should have a primary thosewho receivetheir first doseat 13–15 yearsshould receive aboosterat age16–18 years.A boosteris not series that includes two doses of quadrivalent necessary for those who receive their first dose ≥16 years. For individuals at increased risk of invasivemeningococcal meningococcal conjugate vaccine. Children at disease, a two-doseprimary series should beadministered persistent risk of meningococcal disease to thoseaged 2–55 years,and afour-doseprimary series should beadministered to children aged 2–18 months. should be given regular boosters.

Vaccination vaccination

• Among the results reported, vaccination coverage • However,coverage forthe followingvaccinationsdonotmeetthe Healthy People2020 goals passedthe90% national Healthy People 2020 • InformationfromIndustry goal for: • 4 or more doses of diphtheria, tetanus, and pertussis vaccine (DTaP, • 1 or more doses of measles, mumps, and rubella 83.1%); vaccine (MMR, 91.9%); • 4 or more dosesof pneumococcal conjugatevaccine (PCV,82.0%); • thefullseriesof Haemophilus influenza type b vaccine (Hib, 82.0%); • 3 or moredoses of hepatitisBvaccine (HepB, • 2 or moredosesofhepatitisAvaccine(HepA,54.7%); 90.8%); • rotavirus vaccine (72.6%); and • 3 or more doses of poliovirus vaccine (92.7%); • HepB birthdose (74.2%). and • Goalsfor those were 90%,exceptforHepA(85%),rotavirusvaccine (80%), and HepBbirth dose (85%). Notably, only rotavirus vaccine • 1 or more doses of varicella vaccine (91.2%). coverage increased from 2012 to 2013.

F-3 American Osteopathic College of Occupational and Preventive Medicine 2014 Annual Meeting, Seattle, Washington

vaccination Vaccination

• Other variationsfor2013 included: • In 2013, 10 states had coverage levels at or • black children had lowercoveragethan white above 95% for MMR, but 17 states had MMR children for DTaP, Hib, PCV, rotavirus, and the combined series; coverage below the goal of 90%. MMR • American Indian/Alaska Native children had coverage ranged from 86% in Colorado, Ohio, bettercoveragethan whitechildren forMMR, and West Virginia to 96.3% in New Hampshire. varicella, and HepB; DTaP coverage ranged from 74.3% in Arkansas • Asian children had bettercoveragethan white children for HepA; and to 93.3% in Massachusetts. HepA coverage • black and Hispanicchildren had bettercoverage ranged from 33.6% in Wyoming to 72.1% in thanwhitechildrenforHepB birthdose. Connecticut.

references

• www.cdc.gov • Vaccination Coverage High Overall, but Varies by State Medscape Medical News, 2014-08- 28 • Protect the Next Generation: Recommend the HPV Vaccine CDC Expert Commentary, 2014-08-18

F-4 If you are this age, 2014 Recommended Immunizations for Adults by Age Talk to your healthcare professional about these vaccines: 19-21 years 22-26 years 27-49 years Influenza (Flu)1 Get a flu vaccine every year

2 Get a Tdap vaccine once, then a Td booster vaccine every 10 years

3 2 doses

3,4 3 doses

3,4 3 doses

5 1 dose

3 1 or 2 doses

7 1 dose

Pneumococcal (PPSV23)7 1 or 2 doses

3 2 doses

Hepatitis B3 3 doses

Haemophilus influenzae type b (Hib) 1 or 3 doses

Boxes this color show that Boxes this color show when the No recommendation the vaccine is recommended vaccine is recommended for for all adults who have not adults with certain risks related been vaccinated, unless your to their health, job or lifestyle healthcare professional tells that put them at higher risk for you that you cannot safely serious diseases. Talk to your receive the vaccine or that you healthcare professional to see if do not need it. you are at higher risk.

FOOTNOTES: 1. Influenza vaccine: There are several flu vaccines available—talk to your healthcare professional about which flu vaccine is right for you. 2. Td/Tdap vaccine: Pregnant women are recommended to get Tdap vaccine with each pregnancy in the third trimester to increase protection for infants who are too young for vaccination, but at highest risk for severe illness and death from pertussis (whooping cough). People who have not had Tdap vaccine since age 11 should get a dose of Tdap followed by Td booster doses every 10 years. 3. Varicella, HPV, MMR, Hepatitis A, Hepatitis B vaccine: These vaccines are needed for adults who didn’t get these vaccines when they were children. 4. HPV vaccine: There are two HPV vaccines, but only one, HPV (Gardasil®), should be given to men. Gay men or men who have sex with men who are 22 through 26 years old should get HPV vaccine if they haven’t already started or completed the series. 5. Zoster vaccine: You should get the zoster vaccine even if you’ve had shingles before. 6. MMR vaccine: If you were born in 1957 or after, and don’t have a record of being vaccinated or having had these infections, talk to your healthcare professional about how many doses you may need. 7. Pneumococcal vaccine: There are two different types of pneumococcal vaccines: PCV13 and PPSV23. Talk with your healthcare professional to find out if one or both pneumococcal vaccines are recommended for you.

If you are traveling outside of the United States, you may need additional vaccines. Ask your healthcareF-5 professional which vaccines you may need. For more information, call toll free 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/vaccines

3 doses 50-59 years 1 dose 60-64 years 65+ years

MeningococcalMeasles, mumps, rubella (MMR) HPV VaccineTetanus, for Women diphtheria,Varicella pertussisPneumococcal (Chickenpox) (Td/Tdap)1 or HPV(PCV13) more Vaccine dosesZoster for Men (Shingles)

Hepatitis A 2014 Recommended Immunizations for Adults by Medical Condition If you have this health condition, Weakened HIV Infection immune system (not human CD4 CD4 Pregnancy immuno­ count is less count is Talk to your healthcare professional deficiency virus than 200 or about these vaccines: [HIV]) 200 greater Influenza (Flu)1 Get a flu vaccine every year

1 dose Tdap 2 each pregnancy Get Tdap vaccine once, then a Td booster every 10 years 3 SHOULD NOT GET VACCINE 3,4 3 doses through age 26 years 3,4 3 doses through age 26 years 3 doses through age 21 years 5 SHOULD NOT GET VACCINE 3,6 SHOULD NOT GET VACCINE 7 1 dose 7 1 or 2 doses

3 2 doses 3 3 doses

type b (Hib) post-HSCT recipients only 1 or 3 doses 1 or 3 doses

Boxes this color show that Boxes this color show when Boxes this color indicate the No recommendation the vaccine is recommended the vaccine is recommended adult should NOT get this for all adults who have not for adults with certain risks vaccine. been vaccinated, unless your related to their health, job healthcare professional tells or lifestyle that put them at you that you cannot safely higher risk for serious diseases. receive the vaccine or that you Talk to your healthcare do not need it. professional to see if you are at higher risk. FOOTNOTES: 1. Influenza vaccine: There are several flu vaccines available—talk to your healthcare professional about which flu vaccine is right for you. 2. Td/Tdap vaccine: Pregnant women are recommended to get Tdap vaccine with each pregnancy in the third trimester to increase protection for infants who are too young for vaccination but at highest risk for severe illness and death from pertussis (whooping cough). People who have not had Tdap vaccine since age 11 should get a dose of Tdap followed by Td booster doses every 10 years. 3. Varicella, HPV, MMR, Hepatitis A, Hepatitis B vaccine: These vaccines are needed for adults who didn’t get these vaccines when they were children. 4. HPV vaccine: There are two HPV vaccines, but only one, HPV (Gardasil®), should be given to men. Gay men or men who have sex with men who are 22 through 26 years old should get HPV vaccine if they haven’t already started or completed the series. 5. Zoster vaccine: You should get the zoster vaccine even if you’ve had shingles before. 6. MMR vaccine: If you were born in 1957 or after, and don’t have a record of being vaccinated or having had these infections, talk to your healthcare professional about how many doses you may need. 7. Pneumococcal vaccine: There are two different types of pneumococcal vaccines: PCV13 and PPSV23. Talk with your healthcare professional to find out if one or both pneumococcal vaccines are recommended for you. If you are traveling outside of the United States, you may need additional vaccines. Ask your healthcare F-6professional which vaccines you may need. For more information, call toll free 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/vaccines Last updated February 1, 2014 • CS245563-A

313 dosesordoses more 1 dosesor more doses 1 dose 121 ordoses dose 2 doses for1 or2 those doses2 doses 60 years and older Asplenia (if you Heart disease, Kidney disease do not have chronic lung Diabetes Hepatitis HaemophilusB influenzae HPVPneumococcal VaccineZosterMeasles, for (Shingles)Meningococcal Women Hepatitis(PCV13) mumps,HPV Arubella Vaccine Tetanus, (MMR) forVaricellaPneumococcal diphtheria,Men (Chickenpox) pertussis (PPSV23) 1 or more doses Chronic Liver (Td/Tdap) or poor kidney a spleen or it disease, (Type 1 and Disease function does not work chronic Type 2) well) alcoholism At 1 month of age, HepB (1-2 months), At 2 months of age, HepB (1-2 months), DTaP,2014 PCV, Hib, Polio, Recommended Immunizations for Children from Birth Through 6 Years Old and RV At 4 months of age, DTaP, PCV, Hib, Polio, and RV At 6 months of age, HepB (6-18 months), DTaP, PCV, Hib, Polio (6-18 months), RV, and Influenza 1 2 4 6 12 15 18 19–23 (yearly, 6 months through 18 2–3 4–6 years)* Birth month months months months months months months months years years At 12 months of age, MMR (12-15 HepB † HepB HepB months), PCV (12-15 months) , Hib (12-15 months), Varicella (12-15 months), HepA (12-23 RV RV RV months)§, and Influenza (yearly, 6 months through 18 years)* DTaP DTaP DTaP DTaP At 4-6 years, DTaP, IPV, MMR, DTaP Varicella, and Influenza (yearly, 6 months through 18 years)* Hib Hib Hib Hib Is your family PCV PCV PCV PCV growing? To protect your new baby and

yourself against whooping IPV IPV IPV IPV cough, get a Tdap vaccine * in the third trimester Influenza (Yearly) of each pregnancy. Talk to your doctor for more MMR MMR details. Varicella Varicella Shaded boxes indicate the vaccine can be given during HepA§ shown age range.

NOTE: If your child misses a shot, FOOTNOTES: * Two doses given at least four weeks apart are recommended for children aged 6 months through 8 years See back page you don’t need to start over, of age who are getting a flu vaccine for the first time and for some other children in this age group. for more just go back to your child’s information on § Two doses of HepA vaccine are needed for lasting protection. The first dose of HepA vaccine should be doctor for the next shot. given between 12 months and 23 months of age. The second dose should be given 6 to 18 months later. vaccine­ Talk with your child’s doctor HepA vaccination may be given to any child 12 months and older to protect against HepA. Children and preventable if you have questions adolescents who did not receive the HepA vaccine and are at high-risk, should be vaccinated against HepA. about vaccines. diseases and the I f your child has any medical conditions that put him at risk for infection or is traveling outside the vaccines that United States, talk to your child’s doctor about additional vaccines that he may need. prevent them.

For more information, call toll free 1-800-CDC-INFO (1-800-232-4636)

http://www.cdc.gov/vaccines F-7

or visit Vaccine-Preventable Diseases and the Vaccines that Prevent Them Disease Vaccine Disease spread by Disease symptoms Disease complications Infected blisters, bleeding disorders, encephalitis (brain Varicella vaccine protects against chickenpox. Air, direct contact Rash, tiredness, headache, fever Chickenpox swelling), pneumonia (infection in the lungs) Sore throat, mild fever, weakness, swollen Swelling of the heart muscle, heart failure, coma, DTaP* vaccine protects against diphtheria. Air, direct contact Diphtheria glands in neck paralysis, death Meningitis (infection of the covering around the brain and spinal cord), intellectual disability, epiglottitis (life­ Hib vaccine protects against Haemophilus May be no symptoms unless bacteria Hib Air, direct contact threatening infection that can block the windpipe and influenzae type b. enter the blood lead to serious breathing problems), pneumonia (infec­ tion in the lungs), death May be no symptoms, fever, stomach pain, Direct contact, contaminated Liver failure, arthralgia (joint pain), kidney, pancreatic, HepA vaccine protects against hepatitis A. loss of appetite, fatigue, vomiting, jaundice Hepatitis A food or water and blood disorders (yellowing of skin and eyes), dark urine May be no symptoms, fever, headache, Contact with blood or HepB vaccine protects against hepatitis B. weakness, vomiting, jaundice (yellowing of Chronic liver infection, liver failure, liver cancer Hepatitis B body fluids skin and eyes), joint pain Fever, muscle pain, sore throat, cough, Flu vaccine protects against influenza. Air, direct contact Pneumonia (infection in the lungs) Flu extreme fatigue Encephalitis (brain swelling), pneumonia (infection in MMR** vaccine protects against measles. Air, direct contact Rash, fever, cough, runny nose, pinkeye Measles the lungs), death Meningitis (infection of the covering around the brain Swollen salivary glands (under the jaw), fever, MMR**vaccine protects against mumps. Air, direct contact and spinal cord) , encephalitis (brain swelling), inflam­ Mumps headache, tiredness, muscle pain mation of testicles or ovaries, deafness DTaP* vaccine protects against pertussis Severe cough, runny nose, apnea (a pause in Air, direct contact Pneumonia (infection in the lungs), death Pertussis (whooping cough). breathing in infants) Air, direct contact, through May be no symptoms, sore throat, fever, IPV vaccine protects against polio. Paralysis, death Polio the mouth nausea, headache May be no symptoms, pneumonia (infection Bacteremia (blood infection), meningitis (infection of PCV vaccine protects against pneumococcus. Air, direct contact Pneumococcal in the lungs) the covering around the brain and spinal cord), death Rotavirus RV vaccine protects against rotavirus. Through the mouth Diarrhea, fever, vomiting Severe diarrhea, dehydration Children infected with rubella virus sometimes Very serious in pregnant women—can lead to miscar­ MMR** vaccine protects against rubella. Air, direct contact Rubella have a rash, fever, swollen lymph nodes riage, stillbirth, premature delivery, birth defects Stiffness in neck and abdominal muscles, DTaP* vaccine protects against tetanus. Exposure through cuts in skin Broken bones, breathing difficulty, death Tetanus difficulty swallowing, muscle spasms, fever

* DTaP combines protection against diphtheria, tetanus, and pertussis. ** MMR combines protection against measles, mumps, and rubella. Last updated January 2014 • CS245366-A ­ F-8 2014 Recommended Immunizations for Children from 7 Through 18 Years Old

7–10 YEARS 11-12 YEARS 13-18 YEARS

Tdap 1 Tetanus, Diphtheria, Pertussis (Tdap) Vaccine Tdap Human Papillomavirus (HPV) Vaccine (3 Doses)2 HPV MCV4 Meningococcal Conjugate Vaccine (MCV4) Dose 13 MCV4 Dose 13 Booster at age 16 years

Influenza (Yearly)4 Pneumococcal Vaccine5 Hepatitis A (HepA) Vaccine Series6 Hepatitis B (HepB) Vaccine Series Inactivated Polio Vaccine (IPV) Series Measles, Mumps, Rubella (MMR) Vaccine Series Varicella Vaccine Series

These shaded boxes indicate when the vaccine is These shaded boxes indicate the These shaded boxes indicate the vaccine is recommended for children with certain health recommended for all children unless your doctor tells vaccine should be given if a child is conditions that put them at high risk for serious diseases. Note that healthy children can get the you that your child cannot safely receive the vaccine. catching-up on missed vaccines. HepA series6. See vaccine-specific recommendations at www.cdc.gov/vaccines/pubs/ACIP-list.htm.

FOOTNOTES 1 Tdap vaccine is combination vaccine that is recommended at age 11 or 12 to protect against tetanus, diphtheria and pertussis. If your child has not received any or all of the DTaP vaccine series, or if you don’t know if your child has received these shots, your child needs a single dose of Tdap when they are 7 -10 years old. Talk to your child’s health care provider to find out if they need additional catch-up vaccines. 2 All 11 or 12 year olds – both girls and boys – should receive 3 doses of HPV vaccine to protect against HPV-related disease. Either HPV vaccine (Cervarix® or Gardasil®) can be given to girls and young women; only one HPV vaccine (Gardasil®) can be given to boys and young men. 3 Meningococcal conjugate vaccine (MCV) is recommended at age 11 or 12. A booster shot is recommended at age 16. Teens who received MCV for the first time at age 13 through 15 years will need a one-time booster dose between the ages of 16 and 18 years. If your teenager missed getting the vaccine altogether, ask their health care provider about getting it now, especially if your teenager is about to move into a college dorm or military barracks. 4 Everyone 6 months of age and older—including preteens and teens—should get a flu vaccine every year. Children under the age of 9 years may require more than one dose. Talk to your child’s health care provider to find out if they need more than one dose. 5 Pneumococcal Conjugate Vaccine (PCV13) and Pneumococcal Polysaccharide Vaccine (PPSV23) are recommended for some children 6 through 18 years old with certain medical conditions that place them at high risk. Talk to your healthcare provider about pneumococcal vaccines and what factors may place your child at high risk for pneumococcal disease. 6 Hepatitis A vaccination is recommended for older children with certain medical conditions that place them at high risk. HepA vaccine is licensed, safe, and effective for all children of all ages. Even if your child is not at high risk, you may decide you want your child protected against HepA. Talk to your healthcare provider about HepA vaccine and what factors may place your child at high risk for HepA. For more information, call toll free 1-800-CDC-INFO (1-800-232-4636) or visit http://www.cdc.gov/vaccines/teensF-9 Vaccine-Preventable Diseases and the Vaccines that Prevent Them

Diphtheria (Can be prevented by Tdap vaccine) droplets of an infected person. Measles is so contagious that just cord), bacteremia and sepsis (blood stream infection). Sinus and Diphtheria is a very contagious bacterial disease that affects the being in the same room after a person who has measles has already ear infections are usually mild and are much more common than respiratory system, including the lungs. Diphtheria bacteria can be left can result in infection. Symptoms usually include a rash, fever, the more severe forms of pneumococcal disease. However, in passed from person to person by direct contact with droplets from cough, and red, watery eyes. Fever can persist, rash can last for up some cases pneumococcal disease can be fatal or result in long- an infected person’s cough or sneeze. When people are infected, to a week, and coughing can last about 10 days. Measles can also term problems, like brain damage, hearing loss and limb loss. the diptheria bacteria produce a toxin (poison) in the body that cause pneumonia, seizures, brain damage, or death. Pneumococcal disease spreads when people cough or sneeze. can cause weakness, sore throat, low-grade fever, and swollen Many people have the bacteria in their nose or throat at one time glands in the neck. Effects from this toxin can also lead to swell­ Meningococcal Disease (Can be prevented by MCV vaccine) or another without being ill—this is known as being a carrier. ing of the heart muscle and, in some cases, heart failure. In severe Meningococcal disease is caused by bacteria and is a leading cases, the illness can cause coma, paralysis, and even death. cause of bacterial meningitis (infection around the brain and Polio (Can be prevented by IPV vaccine) spinal cord) in children. The bacteria are spread through the Polio is caused by a virus that lives in an infected person’s throat Hepatitis A (Can be prevented by HepA vaccine) exchange of nose and throat droplets, such as when coughing, and intestines. It spreads through contact with the feces (stool) Hepatitis A is an infection in the liver caused by hepatitis A virus. The sneezing or k issing. Symptoms include nausea, vomiting, of an infected person and through droplets from a sneeze or virus is spread primarily person-to-person through the fecal-oral sensitivity to light, confusion and sleepiness. Meningococcal cough. Symptoms typically include sudden fever, sore throat, route. In other words, the virus is taken in by mouth from contact disease also causes blood infections. About one of ever y headache, muscle weakness, and pain. In about 1% of cases, with objects, food, or drinks contaminated by the feces (stool) of an ten people who get the disease dies from it. Sur vivors of polio can cause paralysis. Among those who are paralyzed, up to infected person. Symptoms include fever, tiredness, loss of appetite, meningococcal disease may lose their arms or legs, become 5% of children may die because they become unable to breathe. nausea, abdominal discomfort, dark urine, and jaundice (yellowing deaf, have problems with their nervous systems, become devel­ of the skin and eyes). An infected person may have no symptoms, opmentally disabled, or suffer seizures or strokes. Rubella (German Measles) (Can be prevented by MMR vaccine) may have mild illness for a week or two, or may have severe illness Rubella is caused by a virus that is spread through coughing and for several months that requires hospitalization. In the U.S., about Mumps (Can be prevented by MMR vaccine) sneezing. In children rubella usually causes a mild illness with 100 people a year die from hepatitis A. Mumps is an infectious disease caused by the mumps virus, fever, swollen glands, and a rash that lasts about 3 days. Rubella which is spread in the air by a cough or sneeze from an infected rarely causes serious illness or complications in children, but can Hepatitis B (Can be prevented by HepB vaccine) person. A child can also get infected with mumps by coming be very serious to a baby in the womb. If a pregnant woman is Hepatitis B is an infection of the liver caused by hepatits B virus. in contact with a contaminated object, like a toy. The mumps infected, the result to the baby can be devastating, including The virus spreads through exchange of blood or other body fluids, virus causes fever, headaches, painful swelling of the salivary miscarriage, serious heart defects, mental retardation and loss of for example, from sharing personal items, such as razors or during glands under the jaw, fever, muscle aches, tiredness, and loss of hearing and eye sight. sex. Hepatitis B causes a flu-like illness with loss of appetite, nausea, appetite. Severe complications for children who get mumps are vomiting, rashes, joint pain, and jaundice. The virus stays in the liver uncommon, but can include meningitis (infection of the cover­ Tetanus (Lockjaw) (Can be prevented by Tdap vaccine) of some people for the rest of their lives and can result in severe liver ing of the brain and spinal cord), encephalitis (inflammation of Tetanus is caused by bacteria found in soil. The bacteria enters diseases, including fatal cancer. the brain), permanent hearing loss, or swelling of the testes, the body through a wound, such as a deep cut. When people are which rarely can lead to sterility in men. infected, the bacteria produce a toxin (poison) in the body that Human Papillomavirus (Can be prevented by HPV vaccine) causes serious, painful spasms and stiffness of all muscles in the Human papillomavirus is a common virus. HPV is most common Pertussis (Whooping Cough) (Can be prevented by Tdap vaccine) body. This can lead to “locking” of the jaw so a person cannot in people in their teens and early 20s. It is the major cause of Pertussis is caused by bacteria spread through direct contact open his or her mouth, swallow, or breathe. Complete recovery cervical cancer in women and genital warts in women and men. with respiratory droplets when an infected person coughs or from tetanus can take months. Three of ten people who get The strains of HPV that cause cervical cancer and genital warts sneezes. In the beginning, symptoms of pertussis are similar to tetanus die from the disease. are spread during sex. the common cold, including runny nose, sneezing, and cough. After 1-2 weeks, pertussis can cause spells of violent coughing Varicella (Chickenpox) (Can be prevented by varicella vaccine) Influenza (Can be prevented by annual flu vaccine) and choking, making it hard to breathe, drink, or eat. This cough Chickenpox is caused by the varicella zoster virus. Chickenpox Influenza is a highly contagious viral infection of the nose, throat, and can last for weeks. Pertussis is most serious for babies, who can is very contagious and spreads very easily from infected people. lungs. The virus spreads easily through droplets when an infected get pneumonia, have seizures, become brain damaged, or even The virus can spread from either a cough, sneeze. It can also person coughs or sneezes and can cause mild to severe illness. Typical die. About two-thirds of children under 1 year of age who get spread from the blisters on the skin, either by touching them or symptoms include a sudden high fever, chills, a dry cough, headache, pertussis must be hospitalized. by breathing in these viral particles. Typical symptoms of chick­ runny nose, sore throat, and muscle and joint pain. Extreme fatigue enpox include an itchy rash with blisters, tiredness, headache can last from several days to weeks. Influenza may lead to hospitalization Pneumococcal Disease and fever. Chickenpox is usually mild, but it can lead to severe or even death, even among previously healthy children. (Can be prevented by Pneumococcal vaccine) skin infections, pneumonia, encephalitis (brain swelling), or even Pneumonia is an infection of the lungs that can be caused by the death. Measles (Can be prevented by MMR vaccine) bacteria called pneumococcus. This bacteria can cause other Measles is one of the most contagious viral diseases. Measles types of infections too, such as ear infections, sinus infections, virus is spread by direct contact with the airborne respiratory meningitis (infection of the covering around the brain and spinal

I f you have any questions about your child ’s vaccines, talk to your healthcare provider. Last updated on 03/28/2014 • CS246905-A F-10