New Online Tool Manages Childrenâ

Tag : Tool For Children

A new downloadable software tool will help pediatricians, parentsand other healthcare professionals determine how to adjust complexchildhood immunization schedules when one or more vaccine dosesaren’t received at the proper time.
Children commonly miss recommended times to receive vaccines. Areport issued last month by the Centers for Disease Control andPrevention (CDC) found an alarming 28 percent of toddlers have notbeen vaccinated according to U.S. guidelines. Another recent survey found that only nine percent ofchildren received all of their vaccinations at the recommendedtimes and that only half received all recommended doses by theirsecond birthday.
Once a child falls behind in the vaccination schedule, healthcareprofessionals are left to figure out when it’s appropriate togive any missed vaccines and any future vaccines. They typicallyhave to construct a unique, personalized catch-up schedule for eachchild – often while the child sits in the treatment room.
Researchers at the Georgia Institute of Technology are taking theguesswork out of developing individualized catch-up vaccinationschedules. A new online tool allows parents and pediatricians toensure that the missed vaccines and future vaccines areadministered without violating guidelines regarding vaccines anddoses.
“Physicians have been telling us for years that they needed acomputerized program to tell them when to give vaccines after achild misses scheduled immunizations,” said Larry Pickering,executive secretary of the Advisory Committee on ImmunizationPractices (ACIP) of the CDC and a collaborator on the project.“Now this tool is available for healthcare professionals andparents to use and they are excited to use it.”
The program removes the challenging task of simultaneouslyconsidering complex rules, guidelines and discretionaryconsiderations when creating a catch-up schedule. A physician orcaregiver simply inputs a child’s date of birth and previousimmunization dates, and the program displays a personalizedschedule of the recommended dates to administer all futurevaccines.
The tool removes the numerical and computational aspects ofconstructing a catch-up schedule by hand and provides two options:administer the vaccines as soon as possible or administer thevaccines when recommended.
“Sometimes a physician sees a child that he or she knows willnot return for all follow-up visits. In this case, the toolprovides the physician flexibility in administering as manyvaccines as possible while the child is in the office rather thanwaiting,” said Pickering .
It is important that children are protected against diseases bygetting vaccinated. Since vaccines contain weakened viruses orparts of organisms that cause disease, the body’s immunesystem reacts to the vaccine the same as it would if it were beinginvaded by the disease, but without getting sick.
The body makes antibodies and stimulating cells that destroydisease-causing germs. If the immunized person is ever exposed tothe real disease, the antibodies are there for protection.Sometimes additional doses of a vaccine have to be administered toboost immunity.
The vaccines included in the scheduler are those required betweenbirth and six years of age: Hepatitis B, rotavirus,diphtheria/tetanus/pertussis, haemophilus influenzae type b,pneumococcal, inactivated poliovirus, measles/mumps/rubella,varicella, hepatitis A and meningococcal. Influenza is contained inthe recommended schedule, but is not included in the scheduler.Each infant requires approximately 27 vaccine doses administeredbefore two years of age for protection from 15 vaccine-preventablediseases.
A beta version of the tool was demonstrated at the AAP NationalConference and Exhibition last October and presented to theCommittee on Infectious Diseases as well as several pediatricclinics in Atlanta , including Children’s Healthcare of Atlanta.
The scheduler follows the guidelines developed and revised eachyear by ACIP in collaboration with the AAP and the American Academy of Family Physicians. These guidelines include the feasiblenumber, timing and spacing of doses of each vaccine based on thechild’s age, the number of doses and the age at which eachdose was administered.
In addition, each dose of each vaccine has a minimum, maximum andrecommended age for administration, and there are minimum andrecommended gaps between doses. These gaps as well as futureadministrations of a particular vaccine may vary depending on thecurrent age of the child and the age at which previous doses wereadministered.
If a child requires more than one live vaccine to be administered,there are two options: administer all live vaccines on the same dayor wait 28 days between live vaccine shots. There also may bediscretionary considerations such as limiting the number ofsimultaneous administrations a child receives or the number ofvisits required to complete the series for all vaccines.
To solve the complicated problem of developing a personalizedcatch-up vaccination schedule in just seconds, the researchers useda technique called dynamic programming. Dynamic programming meanssolving an optimization problem by efficiently sorting partialresults.
For example, if two partial schedules are created for a child andthey both administer the same number of doses, but one scheduleadministers them earlier than the other, then the partial schedulethat administers the vaccines later is eliminated because a betteroption is already available.
The key to dynamic programming is to prove that one partialschedule is better than another without having to determine theentire schedule and without having to try every possible schedule.
“The benefit of dynamic programming is that it eliminatessolutions or partial solutions that are not promising – thosethat won’t lead to the optimal solution,” saidKeskinocak.
In providing such a tool, the researchers hope to improve theeffectiveness of childhood vaccination programs by improving timelyvaccination rates.