When it comes to the health of toddlers, you wish nothing but for a healthy child. One of the biggest controversies in this generation within toddlers is whether we should immunize our children. Immunizations or vaccinations not only protect adults from infectious disease but also children “by introducing a vaccine into the body that triggers an immune response” (Immunize Immunization Canada, 2018). As toddlers are still developing, so are their immune systems. According to Allison Kempe, vaccinations are recognized as one of the greatest public health achievements of the 20th century. Since vaccines have been developed, it has been linked to a decline in major childhood infectious disease by 98% (Kempe, 2103). Although there has been a decline, there is only 44.3% of children between the ages of 19 to 35 months who have received all the recommended vaccines. Many studies have gone underway to determine why fewer parents are immunizing their children. One reason many parents may not like the idea of immunizing their children is because the sense of uncertainty. Parents do not completely feel confident in immunizing their children as they believe that it actually puts them in more risk of being exposed to infectious diseases. With this mindset, parents do believe that they only way they can protect their children is to carefully supervise their social contracts with other children whose parents have the same beliefs.
To truly understand how immunizations affect toddlers, this scholarly paper will explore four of the most often recommended vaccines including HepA, HepB, Influenza and IPV in toddlers.
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Hepatitis A
Hepatitis A (HAV) infection can occur worldwide. HAV is a non-enveloped virus that belongs to the Heparnavirus genus of the Picornaviridae family. It is a virus that is stable at low pH and moderate temperature but is inactivated by high temperature, chlorine, and formalin. Characteristics such as these can be helpful in determining preventative measures (Quiros-Tejeir, 2018). Despite the availability of the Hepatitis A vaccination, it is one of the most commonly reported “vaccine-preventable disease in the United States” (Quiros-Tejeira, 2018). It can be spread through the fecal-oral route which can be transmitted through contaminated water or food. In most situations, it can come from children, themselves, who have not yet been toilet-trained. The spread of the virus can come anywhere within a community, restaurants, schools, etc. Outbreaks of the virus is often recognized when toddlers are presented with signs and symptoms, which includes jaundice. Oftentimes it is, however, difficult to determine whether or not they have contracted the virus as they will be asymptomatic or in other words, show no symptoms of the virus.
Hepatitis B
Hepatitis B (HBV) infection can be acute or chronic. The infection is spread through blood when the blood containing the virus enters into a healthy person’s body. For example, an infected mother can pass it on to her baby. There are three possible ways the virus can be transmitted from the mother to the baby, which includes transplacental transmission of HBV in utero, natal transmission during delivery or postnatal transmission during care or breast milk (Hou, 2005). Chronic HBV occurs in more than 90% of infants that are infected perinatal; however, among the children who are exposed to the virus before the age of 5 years, 25-50% develop chronic HBV (Komatsu, 2017). Pregnant women who are infected with the virus have a high viral load, due to this it puts the mother at a higher risk in transmitting the virus to the child (Komatsu, 2017). For children younger than 1 year who acquire the HBV infection perinatally become 90% at risk for the infection due to the developing immune system (Hou, 2005). According to author Jinlin Hou in the journal article Epidemiology and Prevention of Hepatitis B Virus Infection, he states that 15-40% reports of HBV infected patients would develop cirrhosis, liver failure or hepatocellular carcinoma (HCC). For those who are newly or chronically infected with the Hepatitis B virus can be asymptomatic and not know. This is considered as a “silent epidemic” as people can be unknowingly be spreading the virus to others.
Influenza
There are two types of Influenza: Influenza A and Influenza B. Subtypes based on antigenic differences further categorize these two influenza viruses. Influenza A is categorized into subtypes based on the characterization of two surface antigens, hemagglutinin and neuraminidase. The influenza virus is always mutating resulting in an antigenic change meaning that people are exposed to new types of the virus each year. It is often passed from child to child through sneezing or coughing. The virus can live on surfaces such as toys, doorknobs, and tablets for a short period of time. Toddlers are often exposed to this virus because once they are in contact with the infected surface they will place objects in their mouth, nose or even rub their eyes. Influenza is a respiratory disease in which it can affect the whole body. Symptoms that toddlers can experience include fever, sore throat, and nausea/vomiting. It is very important to know the difference between a cold and the flu virus because symptoms are similar to one another. The cold is usually mild and will often go away after a few days. The flu on the other hand can cause severe symptoms and lead to illness including pneumonia and possible death.
Polio
Poliomyelitis (polio) is a contagious disease caused by a virus. There are three types of the virus: abortive poliomyelitis (the mildest form), non-paralytic poliomyelitis (symptoms are more severe) and paralytic poliomyelitis (the most severe, may results in permanent paralysis of certain muscle groups including breathing muscles and leg muscles). Similar to the transmission of hepatitis A, polio is also spread through contact with infected feces. This is often due to toddlers not washing their hands. It can also be spread through a toddlers cough and sneeze.
Physical Health Issues
Hepatitis A
Children who are exposed to the infection are typically associated with general symptoms including fever, malaise, and diarrhea. The incubation period is fifteen to fifty days. During the prodromal period, aminotransferase is usually elevated causing the toddler to experience jaundice, along with chloria (bilirubin in the urine) and mild hematomegaly (Quiros-Tejeira, 2018). Approximately 30% of symptomatic children are less than six years old who present with jaundice. Typically, jaundice will occur for less than two weeks and the conjugated bilirubin and aminotransferase levels will return to normal ranges between two to three months. Prevention of this virus can occur by improving sanitary conditions by following sanitary practices. Hand washing is the most effective preventative measure in the transmission of the virus as HAV can survive up to four hours on the fingertips (Quiros-Tejeira, 2018). In addition to preventative measures, the Hepatitis A vaccine was added to the recommended childhood and adolescent immunization schedule. The Hepatitis A vaccination is administered in a two-dose schedule and it is recommended for all children who reach the age of one year (Quiros-Tejeira, 2018). It is important to understand that toddlers who are exposed to the virus cannot return to school or daycare until one week after the toddler was exposed, prophylaxis program (immune-globulin) has been completed, or the heath department has agreed it is safe for the toddler and the community.
Hepatitis B
According to the author Haruki Komatsu in the article Pediatric Hepatitis B Treatment, he states that children who are exposed to HBV before the age of five years, 25-50% of these toddlers will develop chronic HBV infection. Komatsu later explains that, “Horizontal transmission” through family members with chronic HBV occur more likely in early infancy and childhood. Chronic HBV infection is determined by age the person has been exposed to, gender, transmission route, and genotype/environmental factors (Komatsu, 2017). It is classified into four phases: (I) immune-tolerant phase; (II) immune-reactive phase; (III) low replicative phase; and (IV) reactivation phase.
The immune-tolerant phase is characterized by the presence of HBeAg, a high level of serum HBV DNA, and slightly elevated ALT levels (Komastu, 2017). A liver biopsy will be done and will show normal histology or minimal histological changes. In this phase antiviral treatment is ineffective and not recommended.
The immune-reactive phase is characterized by high fluctuating or gradually decreasing serum HBV DNA levels, the presence of HBeAG and persistent or intermittent ALT elevation (Komatsu, 2017). In a liver histology, it will show active necroinflammation as the immune system begins to attack the infected hepatocyte. If active necroinflammation occurs during the HBeAg seroconversion, it is linked to the cause of liver injury, cirrhosis and HCC.
The low-reactive phase or also known as the “inactive carrier state” is a phase that includes flare-ups, and is characterized by the absence of HBeAg, the presence of anti-HBe, persistently normal ALT levels and low serum HBV DNA levels. A liver histology will show minimal inflammation and minimal fibrosis. In this phase, complications occur in toddlers include HCC and present with cirrhosis.
The last phase, reactivation phase or also known as the “HBeAg-negative/anti-HB-positive chronic hepatitis B.” It is usually characterized by the presence of anti-HB, elevated or fluctuating ALT levels and detectable serum HBV DNA (Komatsu, 2017). In a liver biopsy moderate to sever necroinflammation with changing amounts of fibrosis will occur.
Treatment of toddlers with chronic HBV infection includes antiviral treatment. The aim of the antiviral treatment is to prevent the progression of liver disease (Komatsu, 2017). Cirrhosis is a risk factor for HCC and is present in toddlers who are HBV positive because of this reason children with cirrhosis need to be treated immediately. If toddlers present with advanced cirrhosis a liver transplant is needed. However, in order to select the best treatment for the toddlers who have chronic HBV, providers evaluate ALT levels, HBeAg status, serum HBV DNA levels and liver histology.
Influenza
Toddlers who present with the flu virus will usually experience sudden fever, chills, and shakes (Paediatric Child Health, 485-487). Signs and symptoms of the flu virus in toddlers are similar to adults; however, there are differences that are important to observe including toddlers who present with temperatures over 39.5C may experience febrile seizures. In toddlers, it is important to teach parents that the flu is a cause to croup (an infection of the throat and vocal cords), pneumonia, and bronchiolitis. It is more severe in children under 2 years of age and in toddlers who have chronic conditions.
Polio
Clinical manifestations of the poliovirus are classified according to the severity of the symptoms (Mehndiratta, 2014). About 95% of exposed patients are asymptomatic and the incubation period ranges from 2 to 35 days. In this period the virus is in the stage of shedding through the toddlers stool. One form of the poliovirus includes abortive poliomyelitis, which presents in a mild viremic form accounting for 4% to 8% of the infection. In some toddler’s gastroenteritis, influenza-like illness and respiratory tract infections occur but typically subside within one week. Clinical cases, about 1% of toddlers will display signs and symptoms of aseptic meningitis. Toddlers who test positive for meningitis due to polio will experience severe muscle spasms of the neck, back, and lower limbs. The most severe form of polio is paralytic polio, in which less than 1% of toddlers will experience excruciating pain of the back and lower limbs. Toddlers will experience a period of prodromal followed by a period of 7-10 days of not experiencing signs and symptoms of the virus. One important teaching for parents in recognizing the hallmark sign of the poliovirus, which include flaccid paralysis with loss of deep tendon reflexes (Mehndiratta, 2014).
Modern medicine has impacted the management of polio. Exercise is the major key factor in assisting with paralyzed muscles. Toddlers will go through various sessions of intense physiotherapy in rehabilitation and recovery. But the essential protection for toddlers based on the study of the poliovirus is the polio vaccine.
PICO Question
In order to improve immunity in our toddlers, how does exposing them in little bits of the virus compared to being exposed to the disease in a bigger portion affect the toddler’s health.
Physical Growth, Development Level, & Family Safety
According to the author of the journal article Evidence-Based Options to Improve Routine Immunization , Joseph Mathew states that routine immunization is a cornerstone of public health believing that it has saved an estimated 2-3 million lives annually. However, the toddler immunization coverage remains low in the U.S. After reviewing observation studies about immunizations the real lesson we have to teach parents is not whether reminders help keep track of toddler immunization schedules but assist parents with understanding the benefits of getting their toddlers immunized. The scheduled vaccinations “help protect infants and young children from 14 diseases that can be very deadly” (Messonniar, 2017). The diseases are not commonly reported in the U.S.; however, it does exist around the world. Benefits of vaccines “reduce the risk of the virus by working with the body’s natural defenses to help it safely develop immunity to the disease (Messonniar, 2017). Although it has not been fully understood, sometimes toddlers will not be completely protected due to the decrease of efficacy overtime but it does aid in lessoning the chances of everyone’s chance of being exposed to the disease. Messonniar explained that even with toddlers who are not 100% immunized and catches the disease the toddler with usually experience milder symptoms that if they were not immunized at all.
Two QSEN nursing safety issues that are relevant to pediatrics are safety and patient-centered care (Competencies, 2018). For this reason toddlers are prone to receiving and spreading germs through various ways especially in toddlers who are likely to use their hands to wipe their noses or rub their eyes so the virus goes from one object to another. This is important to understand because if everyone is informed in proper preventative measures, everyone in the household including the healthcare professionals involved in care are involved with the process of reaching the goal, which, is a healthy toddler, thus safety and patient-centered care is essential.
Nursing Concepts & Diagnoses
For the purpose of this academic paper, two nursing diagnosis to emphasis the importance of immunizations include risk for infection related to incomplete immunization series or no history of immunizations and knowledge deficit related to insufficient information about immunizations.
The goal for the risk for infection in toddlers is for the toddler to become adequately protected from disease-preventable illness. In doing so, the priority intervention is to review the child’s immunization record for needed vaccines and identity which vaccines can be provided at the same time. For this reason healthcare providers can assess which immunizations have been missed. Therefore, the concept health promotion from the book Concepts for Nursing Practice by Jean Giddens best describes the role of a nurse in the “focus on improvement of health and prevention of disease” and supports people in increasing their control over and improve their health (Giddens, p. 422).
Together with risk for infection, knowledge deficit comes into the concept of immunizations in toddlers because parents are who would need to provide consent whether their toddlers should receive the vaccinations. The most important intervention is educating the parents about the need for specific vaccines and the risk if not given when information has been given and parents do authorize vaccinations the pediatricians should obtain consent before vaccinations are administered. In addition, as health care providers, we need to explain side effects that should be reported to the doctors. That is to say patient education is the perfect concept to demonstrate a “purposeful process whereby patient is learning health-related information to support healthy lifestyle or behavior changes” (Giddeons, 414).
Conclusion
In today’s world parents have not seen first-hand the devastating consequences vaccine-preventable diseases can do to a toddler, a family, or to the community. The most important thing we want as parents is to protect our children from any harm presented in front of them. By keeping our toddlers health and decrease their chances of outbreaks, immunizations can help early childhood development in keeping a safe environment for our toddlers and the communities children. Ultimately, it is the parents’ decisions in protecting not only their children but everyone else. It is up to us, the community, to make the change and inform others about the benefits of vaccinating our toddlers.
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