Adult immunisation.pptx

Immunization in adults
vaccines

1. Adult immunization By Dr. Sshrutkirti gupta Consultant Microbiologist KEM MUMBAI

2. Tetanus pertussis & diphtheria Human Papillomavirus Influenza Varicella Zoster MMR Pneumococcus Meningococcus Hepatitis A Hepatitis B JAPANESE B ENCEPHALITIS SWINE FLU

3. Vaccine- Definition A vaccine is any preparation intended to produce immunity to a disease by stimulating the production of antibodies. Suspensions of killed or live attenuated microorganisms, or products or derivatives of microorganisms.

4. Tetanus pertussis & diphtheria Burden of pertussis : 1 to 3 million cases annually, increases in adult. Morbidity: 13,278 cases reported in 2008 U.S Ages 15 and older – 4,145 cases Ages 25 and older – 2,760 cases Objective: Protection from pertussis Reduce reservoir of Bordetella pertussis in adult.

5. Tdap Vaccines Recommendation Adults with incomplete history of primary immunization or who have not received primary immunization. Adult with pri . Immunization should get booster every 10 yrs wt Tdap or Td. In pregnant women 2 nd &3 rd trimester. Wound management in adult or adolescent. Health care worker contact wt infants &children.

6. VACCINE ( Killed vaccine-adsorbed tetanus toxoid ) 1 . Adacel : 5 pertussis antigen 2.Boostrix: 3 pertussis antigen 3 doses : single dose of Tdap Td at least 4 weeks after the1st dose 3rd dose of Td at least 6 months after the Td dose. 0.5 ml ,IM Advice 92% protection rate Contraindication Anaphylaxis to component to vaccine like thiomersal . History with unstable neurologic condition. Encephalopathy within 7 days of administration of a pertussis vaccine that is not attributable to another identifiable cause.

7. Human Papillomavirus Burden : 6 million cases annually, 3 out of 4 younger female in US More than 100 types More than 60 cutaneous types- skin warts 40 mucosal types(16, 18,6,11) HPV16, 18 – Cervical cancer 70% Low or high grade cervical abnormalities 30- 50% Head and neck cancers 10% HPV 6, 11 - Low grade cervical abnormalities 10% Genital warts 90% Resp.papillomatosis 90%

8. Target population : Female 9 to 26 yrs Males 9 to 26 yrs HPV vaccine HPV4 ( Gardasil ) Contains types 16 and 18 (high risk) and types 6 and 11 (low risk) HPV2 ( Cervarix ) Contains types 16 and 18 (high risk) 3Doses advised : 0 ,2,6,( Gardasil )& 0,1,6,( Cervarix ) Males – HPV4 Females –HPV2 as well as HPV4 0.5 ml IM rout Not recommended during pregnancy

9. Influenza BURDEN: 10-20% of US population affected annually 200,000 hospitalizations 36,000 deaths (average) INDIA- May2003 influ.A (H3N2) outbreak in Murshidabad (West Bengal).211 cases wt Res. Illness. Recommendation: Adults aged 50 years or older. Pregnant women during the influenza season. Chronic diseases:( Pulmonary including asthma, heart diseas,Renal ,Hepatic, diabetic). Immunosuppressed persons. Those with any condition that can compromise respiratory function.

10. VACCINE Two forms are available 1 . Inactivated influenza vaccine TIV(H3N2, H1N1, B) s/c route o.5 ml 70%-90% effective among healthy persons <65 years of age 30%-40% effective among persons 65 years and older. 2 . Live attenuated influenza vaccine persons 2 through 49 years of age who are healthy and not pregnant. Nasal spray ,Immunity lasts for 1yrs . Booster require on annual basis.

11. Contraindications : severe allergic reaction to eggs or vaccine component. For LAIV only: pregnancy . Underlying medical conditions Immunosuppression History of Guillain-Barre ´ syndrome within 6 weeks following a previous dose of influenza vaccine

12. Varicella (chicken pox) Burden of varicella : in US 3,000 deaths annually. 5.4 cases/1,000 person-years for all ages. 11.7/1,000 person-years for 65 years and older. Recommendation: All adults who never had chicken pox or vaccinated. Special consideration- Teachers of young children Military personnel. International travelers.  

13. Varicella Vaccine Live vaccine Varilrix & okavax Both contain attenuated live VZV( oka strain) Schedule - 2 doses separated by at least 4 weeks Efficacy 70%-90% against varicella disease. 95%-100% against severe diseas . Varicella zoster immuneglobulin ( VZIg ) post exposure prophylaxis within 72 hrs 125U/10 kg of body wt. up to 625 U max.

14. Contraindication: Pregnancy Immunocompromised pt .like leukemia, lymphoma, malignant neoplasm affecting bone marrow or lymphatic system. Precautions : persons who have received blood or bl. Products in the past 1 yr. Adverse reaction: Injections site complaints - 20% Rash - 4% - 6%. Temperature 102°F or higher - 10% - 15% Two or more vaccines can be introduced on the same time but should be at diff. locations

15. Reactivation of a latent varicella zoster virus infection in the form of painful skin rash. Can occur years or decades after illness with chickenpox More common in older people, people with weak immune system, healthy children& young adult SHINGLES (HERPES ZOSTER )

16. Burden : About 1 million cases annually, 1in3 Americans will get shingels in their life time. Recommendation: All adult after 60 yrs of age & older. People who had previous infections. VACCINE Live attenuated vaccine. Subcutaneous route,0.65 ml in deltoid region. No booster required. Contraindicated in immuno compromised persons.

17. Measles-Mumps-Rubella Measles Each year about 450 people died, 48,000 were hospitalized, 7,000 had seizures, &about 1,000 permanent brain damage or deafness. Mumps Is rarely fatal, causes a bilateral parotitis or occasionally orchitis . Rubella ”German measles” mild disease including fever & rash. In pregnancy-congenital rubella syndrome. Target population : All adult, all women of childbearing age, college student healthcare workers and travelers to endemic areas.

18. MMR VACCINE: Live attenuated strain is use. 1.Edmonston Zagrab for measles 2.L- zagreb for Mumps 3.Potkins RA 2713 for rubella Dose efficacy varies from 80% (mumps) to 95% (measles & rubella) Duration of immunity probably lifelong 2 doses at least 1month apart, 0.5 ml S.C route Contra indication : Receipt of blood products or immune globulin within the preceding 3 to 12 months, Pregnancy allergy to vaccine component (neomycin or gelatin), immune compromised person.

19. Pnemococcus Burden: Among older adults is substantial (50 cases/100,000) More than 40,000 invasive infections annually More than 4,500 deaths Target population : Adults 65 years of age and older. Adults of any age with who have chronic illness. CVS disease ,pulmonary disease, diabetes, alcoholism, cirrhosis,CSF leak. Functional or anatomic asplenia or in elective spleenectomy. Other high risk state

20. VACCINE Pneumococcal polysaccharide vaccine PPV Purified capsular polysaccharide antigen from 23 types of pneumococcus 88% of pneumococcal disease Schedule 1 dose 60% to 70% efficacy. Immunity at least 6 years Revaccination in high risk ( 5 years after the 1st dose) Pneumococcal conjugate vaccine PCV13 is used in younger individuals Contraindications: Anaphylactic reaction to the vaccine or its components.

21. Meningococcal diseases 1400 to 2800 infected annually in US. 1 in 10 people die & up to 2 in 20 survivors will have permanent disabilities( deafness, brain damage.) Target population: Adolescents ,college student live in a dormitory Military personnel Those with anatomic or functional asplenia Complement component deficiency &HIV infection. Travelers to a country with an outbreak of meningococcal disease.

22. Vaccine: Two types of vaccine 1.Polysaccharide vaccines : Bivalent (A+C) & Quadrivalent (A,C,Y,W135) vaccine advised age >55 years MPSV is administered as a single 0.5-mL dose 2. Conjugate vaccines.(MCV 4 ) Covalent linkage of polysaccharide to a carrier protein (diphtheria/tetanus toxoid ), which converts the polysaccharide to antigen which enhances Ab formation. Preferred in 2 to 55 yrs Revaccination for after 5 yrs

23. Hepatitis A 13,000 total cases in 2007 annually in US. Target population: Men who have sex with men. Recipients of clotting factor concentrates. Drugs user. Persons with chronic liver disease. Individuals traveling to or working in countries where HAV is endemic. Vaccine: Inactivated single antigen vaccine(HAV) e.g., Havrix ® (GlaxoSmithKline) Vaqta ® (Merck & Co); Combination vaccine e.g., Twinrix ®

24. Doses : 2 dose -0,6-18 M apart 1 to 18 yrs- 0.5 ml IM More than 19yrs- 1 ml IM Combination (HAV+HBV) 1ml IM – 3 doses 0,1,6. 80-90% efficacy Immunity begins 2-4 weeks after injection. Post-exposure prophylaxis Healthy person 1-40yrs HAV vaccine is preferred over anti-HAV immunoglobulin coz of long term protection, equivalent efficacy of vaccine. anti-HAV immunoglobulin (0.02 ml/kg, intramuscularly) as soon as possible, within two weeks

25. Hepatitis B Estimated 25,000 total cases in 2007 Most of the deaths with HBV infection are due to hepatocellular carcinoma. Target population: Persons with end-stage renal disease. Persons wt. sexually transmitted infection (STI) HIV Chronic liver disease Healthcare workers exposed to blood or body fluids Sexually active individuals. IV drug users Men who have sex with men

26. Vaccine(HBV) RECOMBINANT DNA VACCINE Derived from cultures of yeast cloned with HBsAg s gene Series of 3 doses at 0,1 and 6 months. 0.5 ml IM injection. 90% protection rate. When antibody levels decline to less than 10 mIU / mL , a booster dose is recommended. Contraindications: Severe allergic reaction such as anaphylaxis after a previous vaccine dose or hypersensitivity to yeast.

27. JAPANESE B ENCEPHALITIS 3 TYPES OF VACCINE Mouse brain derived purified and inactivated vaccine Cell culture derived inactivated JE vaccine Cell culture derived live attenuated vaccine SA-14-14-2 for 1-15 yrs 2 doses 28 days apart Booster after one year and than every 3 years

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