immunization update ( د/ أشرف الأباصيري)

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Information about immunization update ( د/ أشرف الأباصيري)
Education

Published on February 24, 2009

Author: ashrafalabasiry

Source: authorstream.com

Slide 1: Dr.Ashraf Sobhy Al-Abasiry.MBBCh.MSc Internist,Primary Care Department Saad Specialist hospital Email: ashrafalabasiry@yahoo.com By IMMUNIZATION UPDATE Immunization : Immunization ? Immunization is among the most successful , cost-effective and safest tool of modern public health interventions. ? Immunization programs have led to eradication of smallpox, elimination of measles and poliomyelitis in regions of the world, and substantial reductions in the morbidity and mortality attributed to diphtheria, tetanus, and pertussis. MMWR May 12, 2006 / 55(18);511-515 Immunization : Immunization ? Immunization saves the lives of approximately 3 million people each year, all over the world. ? Immunization is the foundation of the public health system--without it, other health programs would fail. ? Being immunized is much safer than risking infection and disease. Comparison of 20th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases : Comparison of 20th Century Annual Morbidity and Current Morbidity: Vaccine-Preventable Diseases †Source: JAMA. 2007;298(18):2155-2163 † † Source: CDC. MMWR August 22, 2008/57(33);901,903-913. (Final data) * 22 type b and 180 unknown (< 5 years of age) Immunization : Immunization Immunization providers can help to ensure the safety and efficacy of vaccines through proper: vVaccine storage and administration. v Timing and spacing of vaccine doses. v Observation of contraindications and precautions. v Management of vaccine side effects. v Reporting of suspected side effects to VAERS. The Provider’s Role Immunization : Immunization ?SAFE = No Harm from the vaccine? No vaccine is 100% safe ? SAFE = No Harm from the disease? No vaccine is 100% effective What is Safe? WHO Estimates of Vaccine-Preventable Deaths, 2002 : WHO Estimates of Vaccine-Preventable Deaths, 2002 In 2002, among diseases for which vaccines are universally recommended WHO estimates that Vaccine-Preventable Deaths: MMWR May 12, 2006 / 55(18);511-515 Global Immunization Vision and Strategy for 2006--2015 : Global Immunization Vision and Strategy for 2006--2015 In 2005, WHO and UNICEF worked with partners to create a Global Immunization Vision and Strategy (GIVS) for 2006--2015 GIVS articulates the WHO and UNICEF visions for global immunization in 2015 and is composed of four strategic areas Childhood Immunization : Childhood Immunization A worthwhile investment Slide 14: . INFANRIX HEXA VACCINE PREVENAR Catch-up Immunization Schedule for persons Aged 7 Through 18 Yearsunited states 2009 : Catch-up Immunization Schedule for persons Aged 7 Through 18 Yearsunited states 2009 Tdap Td Vaccines aren't just for kids : Vaccines aren't just for kids ? Far too many adults become ill, are disabled, and die each year from diseases that could easily have been prevented by vaccines. ? At least 45,000 adults in the United States die of complications of influenza, pneumococcal infections, and Hepatitis B each year. ? Thus everyone from young adults to senior citizens can benefit from immunizations. Adults Immunization Schedule : Adults Immunization Schedule The ( ACIP) of the Department of Health and Human Services through the U.S. ( CDC) made the following recommendations about annual vaccines needed by all adults: ?Vaccines needed for all adults. ? Varicella (chickenpox) vaccine. ? Hepatitis B vaccines (adults at risk). ? Measles-Mumps-Rubella (MMR) vaccine ? Tetanus-Diphtheria-pertussis vaccine. Adults Immunization Schedule : Adults Immunization Schedule ?Vaccines needed for those aged 50 years and older: influenza vaccine (for the flu). ?Vaccines needed for those aged 60 years and older: Zoster vaccine (for Herpes Zoster). ?Vaccines needed for those aged 65 years and older: Pneumococcal vaccine. ?Vaccines needed for all health-care workers: influenza vaccine . Annual updates are made each year by the CDC. New or Revised Vaccine Since August 2006 : New or Revised Vaccine Since August 2006 ?New Human papilloma virus Zoster ? Revised TdaP. Hepatitis B. Hepatitis A. Varicella. Meningococcal. Influenza (TIV and LAIV). HPV vaccine ( GARDASIL) : HPV vaccine ( GARDASIL) ? The Food and Drug Administration (FDA) licensed the first vaccine ( GARDASIL) On June 8, 2006. ? The vaccine should be given as a series of three injections over a six-month period 0-2-6 ? Routine vaccination of females 11-12 years of age with three doses of quadrivalent HPV vaccine. ? The vaccination series can be started as young as 9 years of age at the clinician’s discretion. Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org HPV vaccine ( GARDASIL) : HPV vaccine ( GARDASIL) ? Vaccination is recommended for females 13 through 26 years of age not previously vaccinated. ? Vaccine should be administered before onset of sexual activity, if possible. ? Vaccine will have no effect on existing disease or infection. ? Not recommended for pregnant women. ? HPV vaccine is not approved for women older than 26 years or males. MMWR 2007;56(No. RR-2) Harald zur Hausen Herpes Zoster Vaccine (Zostavax) : Herpes Zoster Vaccine (Zostavax) v It was approved by FDA in may 2006. v Contains live attenuated varicella virus in an amount that is approximately 14 times greater than that in regular varicella vaccine v Approved for persons 60 years and older. v Administered by the subcutaneous route. ACIP Recommendations* for Zoster Vaccine* : ACIP Recommendations* for Zoster Vaccine* v Single dose of zoster vaccine for adults 60 years of age and older whether or not they report a prior episode of shingles. v Persons with a chronic medical condition may be vaccinated unless a contraindication or precaution exists for their condition. Provisional recommendations, October 2006 Tdap Vaccines : Tdap Vaccines ? Boostrix Licensed May 2005 Approved for persons 10 through 18 years of age. ? Adacel Licensed June 2005 Approved for persons 11 through 64 years of age. ? Tdap preferred to Td to provide protection against pertussis. Approved only for a single booster dose in persons who have received a full series of pediatric DTaP or DTP. Special emphasis on adults with close contact with infants (e.g., childcare and healthcare personnel, and parents). General Principles for Use of Tdap and Td Among Adults : General Principles for Use of Tdap and Td Among Adults ? All adolescents and adults should have documentation of having received a series of DTaP, DTP, DT, or Td (dT). ? Persons without documentation should receive or complete a series of 3 doses. ? Preferred schedule: single dose of Tdap Td at least 4 weeks after the Tdap dose. second dose of Td at least 6 months after the prior Td dose. MMWR 2006;55(RR-17 Hepatitis B Vaccine : Hepatitis B Vaccine Reminder ?At the present time, booster doses are not recommended routinely for people with normal immune systems. ?The series does not need to be restarted if the series is interrupted. ?The minimum recommended dosing intervals are 4 weeks between the first and second doses and 8 weeks between the second and third doses. The minimum interval between the first and third doses is 16 weeks. Immunization Action Coalition www.immunize.org Hepatitis A Vaccine : Hepatitis A Vaccine ?The first hepatitis A vaccine (HAVRIX®), became available in 1995. ? Hepatitis A vaccine is very effective. ? It appears that all adults, adolescents, and children become immune to HAV infection after getting two doses. ? After one dose, at least 94 out of 100 people become immune for the short term. Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org New Recommendations for Hepatitis A Postexposure Prophylaxis : New Recommendations for Hepatitis A Postexposure Prophylaxis ? Healthy persons 12 months through 40 years single antigen hepatitis A vaccine at the age-appropriate dose is preferred. ? Persons older than 40 years IG is preferred vaccine can be used if IG cannot be obtained. ? Children younger than 12 months, immunocompromised persons, persons who have had chronic liver disease diagnosed, and persons for whom vaccine is contraindicated IG should be used. MMWR 2007;56 (No. 41):1080-4 Hepatitis A Vaccine for International Travel : Hepatitis A Vaccine for International Travel ? One dose of single-antigen hepatitis A vaccine administered at any time before departure can provide adequate protection for most healthy persons. ? Consider vaccine and IG for older adults, immunocompromised persons, and persons with chronic liver disease or other chronic medical conditions planning to depart* in less than 2 weeks. *to an area of intermediate or high risk of hepatitis A Twinrix “Accelerated” Schedule : Twinrix “Accelerated” Schedule ? In April 2007, approval was received for an alternate 4-dose schedule for Twinrix. ? Doses at 0, 7, 21-30 days and a booster dose at 12 months. ? Approved only for persons 18 years and older. MMWR: October 12, 2007 / 56(40);1057 Varicella Vaccine : Varicella Vaccine ? Routine vaccination at 12 to 15 months of age ? Routine second dose at 4 to 6 years of age ? Two doses recommended for all persons older than 4 to 6 years who do not have evidence of varicella immunity. ? Second dose recommended for persons of ANY age who have only received one dose. Source: MMWR 2007;56(RR-4) Varicella Vaccination of Healthcare Workers : Varicella Vaccination of Healthcare Workers v Recommended for all healthcare personnel without evidence of immunity. v Prevaccination serologic screening probably cost-effective. v Postvaccination testing not necessary or recommended. Source: MMWR 1997;46(RR-18) Meningococcal vaccine : Meningococcal vaccine v Meningococcal polysaccharide vaccine or “MPSV” was licensed in 1981 for persons ages 2 years and older. ? It protects against A, C, Y, and W-135. subtypes v Meningococcal conjugate vaccine or “MCV” (Menactra) was licensed in 2005 for use in persons 11-55 years of age. ? It also protects against the A, C, Y and W-135 subtypes. ? MCV is expected to give better, longer-lasting immunity Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 Meningococcal vaccine : Meningococcal vaccine Vaccination is recommended for people at increased risk of meningococcal disease; this includes: ?College freshmen living in dormitories. ? Individuals who have a damaged or missing spleen. ? Persons with terminal complement component deficiency (an immune system disorder). Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 Meningococcal vaccine : Meningococcal vaccine ? Persons working with meningococcus bacteria in laboratories. ? Travelers to certain countries in sub-Saharan Africa as well to other countries for which meningococcal vaccine is recommended. ? military recruits. ? Anyone who might have been exposed to meningitis during an outbreak. Influenza Vaccine : Influenza Vaccine There are two types of influenza vaccine. ? The most common influenza vaccine is made from inactivated (killed) viruses.(TIV). ? In June 2003, a live influenza vaccine (LAIV) was licensed. It contains live viruses that have been weakened (attenuated). The live attenuated vaccine is sprayed into the nose. Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org Timing of Influenza Vaccination : Timing of Influenza Vaccination ? Influenza activity can occur as early as October. ? In more than 60% of seasons the peak was in February or later. ? Immunization providers should begin offering vaccine soon after it becomes available and if possible by October. Source: MMWR 2007;56 (RR-6) 2008-2009 InfluenzaVaccine Recommendations : 2008-2009 InfluenzaVaccine Recommendations ?Annual vaccination with inactivated vaccine is recommended for the following groups: (1) - Everyone age 50 years or older. (2) - Children aged 6 months up to their 18th birthday (3) - Residents of long-term care facilities, nursing homes, and other chronic-care facilities. (4) - All persons, including school-age children, who want to reduce the risk of becoming ill with influenza or of transmitting influenza to others Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org 2008-2009 InfluenzaVaccine Recommendations : 2008-2009 InfluenzaVaccine Recommendations (5)- People of any age with certain chronic medical conditions or weakened immune system (6)- Children and adolescents age 6 months-18 years on long-term aspirin treatment (who could develop Reye’s syndrome if they catch influenza). (7)- Women who will be pregnant during the influenza season. Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org 2008-2009 InfluenzaVaccine Recommendations : 2008-2009 InfluenzaVaccine Recommendations (8)- People who live with or care for those at high risk for complications from flu, including: Health care workers. Household contacts of persons at high risk for complications from the flu. Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated). . The live nasal spray vaccine may only be used in healthy, non pregnant persons age 2 through 49 years. Children age 6 months through 8 years should receive two doses of influenza vaccine the first time they receive this vaccine. Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org Vaccines to Consider for the Pregnant Woman : Vaccines to Consider for the Pregnant Woman 1-Trivalent (Inactivated) Influenza Vaccine (TIV). women who will be pregnant during the influenza season should be vaccinated due to increased risk for influenza-related complications Vaccination can occur in any trimester. 2-Hepatitis B Vaccine (Hep B). The vaccine contains noninfectious hepatitis B surface antigen (HBsAg) particles and should cause no risk to the fetus Neither pregnancy nor lactation should be considered a contraindication to vaccination. Alliance for Immunization in Michigan 2007 AIM Kit – Adult Immunization Section Vaccines to Consider for the Pregnant Woman : Vaccines to Consider for the Pregnant Woman 3- (Td) and (Tdap) Vaccine. ACIP recommends Td when tetanus and diphtheria protection is required during pregnancy. When Td or Tdap is given during pregnancy, the 2nd or 3rd trimester is preferred. Pregnancy is not a contraindication for use of Tdap. 4- Pneumococcal Polysaccharide Vaccine (PPV23). PPV23 is recommended for pregnant women with a high-risk condition. Alliance for Immunization in Michigan 2007 AIM Kit – Adult Immunization Section Vaccines to Consider for the Pregnant Woman : Vaccines to Consider for the Pregnant Woman 5-Hepatitis A Vaccine (Hep A). The safety of hep A vaccination during pregnancy has not been determined. However, because it is an inactivated vaccine, theoretical risk to the fetus is low. The risk associated with vaccination should be weighed against the risk of HAV infection.(1) 6-Meningococcal vaccine . Studies of vaccination with MPSV during pregnancy have not documented adverse effects among either pregnant women or newborns. No data are available on the safety of MCV during pregnancy. Pregnancy is not considered to be a contraindication to either MPSV or MCV.(2) (2)Immunization Action Coalition • St. Paul, MN 55104 • (651) 647-9009 (1)Alliance for Immunization in Michigan 2007 AIM Kit – Adult Immunization Section Vaccines to Avoid During Pregnancy : Vaccines to Avoid During Pregnancy 1- Live, Attenuated Influenza Vaccine (LAIV). 2- Human Papillomavirus Vaccine (HPV4). 3- Measles, Mumps, Rubella (MMR). women should avoid becoming pregnant for 4 weeks after vaccination with measles or mumps vaccines, or MMR or other rubella-containing vaccines 4- Varicella (VAR) and Herpes Zoster (Zostavax) Non-pregnant women who are vaccinated should avoid becoming pregnant for 4 weeks following varicella vaccination. Alliance for Immunization in Michigan 2007 AIM Kit – Adult Immunization Section Slide 47: http://www.authorstream.com/Presentation-Search/Tag/Ashrafalabasiry

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