Oral polio vaccine risks and consequences

Oral polio vaccine risks and consequences

1. Adolescent Friendly School Initiative
IAP VISION 2007
ADOLESCENT FRIENDLY SCHOOL INITIATIVE
IAP VISION 2007
Adolescent Friendly School Initiative
ADOLESCENT FRIENDLY SCHOOL INITIATIVE
Adolescent
IMMUNIZATION

2. Adolescent Friendly School Initiative
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INTRODUCTION
-Administration of all or part of micro
organism or modified product.
-Resulting in protection against the
disease.
What isImmunization?

3. Adolescent Friendly School Initiative
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Importance of adolescent immunization
Preventionandcontrolofdiseaseisimportantfor
theirhealthygrowth.
Theymustbeprovidedwiththeopportunityof
healthygrowthanddevelopment.
Routineimmunizationalsoprovidesachanceofa
healthvisit
Givesfurtherchanceforpreventiveservicesand
healthcounseling.

4. Adolescent Friendly School Initiative
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Why adolescents should be immunized?
•SuccessofImmunizationProgramhasresultedinthe
decreaseinincidenceofthevaccinepreventable
diseases.
•Butunimmunizedadolescentshavebecomemore
susceptible.
•TTistheonlyvaccineincludedintheNational
ImmunizationScheduleinIndia.

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–To boost immunity that is decreasing
–Efforts to decrease disease
–To have specific Protection
–To provide recent vaccines available for
immunization
Why Adolescent Immunization is important?

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7. Adolescent Friendly School Initiative
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Current Status
•Scenario in West
•Indian Scenario

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http://www.cdc.gov/nip. Accessed May, 26th 2007

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IAP COI Recommendations…

10. Adolescent Friendly School Initiative
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IAP adolescent immunization
schedule
TT Boosterat10and16years
Rubella AspartofMMRvaccineor(Monovalent)1doseto
girlsat12-13yearsofage,ifnotgivenearlier
MMR 1doseat12-13yearsofage.(ifnotgivenearlier)
HepatitisB 3Doses(0,1and6m)ifnotgivenearlier
Typhoid TA,ViorOraltyphoidvaccineevery3years
Varicella* 1doseupto12-13years,and2dosesafter13years
ofage.(ifnotgivenearlier)
HepatitisA* 2doses(0and6months)ifnotgivenearlier

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Td Vaccine
Td vaccine has become available,
should this vaccine be preferred
over TT?

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Diphtheria in India
•Diphtheria -Down but not out
S K Kabra AIIMS Indian Ped. 2000 July
•Patch remains
Nandy et al Indian Pedicatrics 2001
•Diphtheria –Certainly not out
Poddar B. Indian Pediatrics 2000

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Is it feasible to incorporate Td in
Immunization Schedule?
•At 10 & 16yr instead of TT -Reasonable
•Cost is little higher (Rs. 5.50 for TT and Rs. 6.10 for Td)
•Diphtheria toxoid one of the safest vaccines.
•Td is not much more reactogenic than TT.
•In some parts of world Td is preferred in place of TT -
in pregnancy & adults
•In India Td should be preferred over TT

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dTap vaccine
dTap vaccine is also available, should this
vaccine be preferred over dT?

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Pertussis in adolescents
There is a need to vaccinate all adolescents &
adults against pertussis.
Recommended by ;
international consensus group on pertussis &
global pertussis initiative.

17. Adolescent Friendly School Initiative
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Tdap vaccine
•Tdap instead of Td is recommended by many
authorities to prevent pertussis in adolescents and
adults
•The major benefit is protection of infants and children
from pertussis
•Cost is major obstacle –50 times
•Being used in Canada, Not yet licensed in USA

18. Adolescent Friendly School Initiative
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Rubella
•Aim is to;
–prevent congenital rubella syndrome (CRS),and
–not to prevent rubella infection per se, as it is usually
benign and inconsequential.

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Rubella
Haphazard use of rubella vaccine
in young children
may shift the epidemiology of rubella to the right with
more clinical cases
occurring in young adults leading to
increase in cases of CRS.

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MMR
•Recommended to all adolescents (sp. Girls) –irrespective
of previous immunization status –no upper age limit.
•Many states are likely to include MMR in UIP.

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Mumps
•There is no difference in efficacy or safety among
available different strains.
•Aseptic Meningitis following vaccination is mild, without
any sequel or mortality.
•No association with either autism or Crohn’s dis.
(URABE V/S L.Z.)

22. Adolescent Friendly School Initiative
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Hepatitis B
•WHO has recommended universal Hepatitis B vaccination.
•In 2002 GOI also initiated incorporation of HB vaccine as universal
vaccine –in a phased manner.
•For previously unvaccinated adolescents 0,1 & 6 mo. is a preferred
schedule.
•No booster.

23. Adolescent Friendly School Initiative
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Hepatitis B Immunogloulin (HBIG)
•HBIG provides immediate passive immunity
•Indications;
–individuals with recent exposure to hepatitis B virus
–prevention of mother to child transmission and
–following sexual exposure like in rape cases.
•Dose:
–Adults: 1000-2000 IU;
–Children:-32-48 IU/kg body wt.

24. Adolescent Friendly School Initiative
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Typhoid
Peak in school age children (5-19 yrs)
•Endemic areas –peak incidence –school children.
33m cases & 5 lac deaths
•3 populations are at particularly high risk
a. Children in endemic areas
b. Travelers to endemic areas
c. Clinical microbiology technicians
Vi capsular polysaccharide vaccine
•Typhoid: in endemic areas every 3 yearly.

25. Adolescent Friendly School Initiative
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Varicella
•The IAP COI opinesthat varicella vaccine is not
recommendedfor universal immunization in India at
present.
•It may be offered to children from high socio-economic
strata of society after explaining the pros and cons to
the parents on a one-to-one “named child” basis.

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Varicella –IAP COI
•It is indicated for ;
–In children with chronic lung/heart disease,
–Humoral immunodeficiencies,
–HIV infection (but with C4 counts above 15% of the
age related norms),
–Leukemia (but in remission and off chemotherapy for
at least 3-6 months) and those on long term
salicylates/high dose long term oral steroids.
–In household contacts of immuno-compromised.
–In children attending crèches and day care centers.

27. Adolescent Friendly School Initiative
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Varicella Schedule
•One dose below 13 year and two doses after that 4 wk
apart.
•For post-exposure –within 72 hrs of exposure.
•Ensure that adolescent girl is not pregnant and she
should not conceive for 4 wk after vaccination

28. Adolescent Friendly School Initiative
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Hepatitis A
•The IAP COI opines that HA vaccine is not
recommended for universal immunization in India at
present.
•It may be offered to children after explaining the parents
on a one-to one “named child” basis. .
•Post exposure –to contacts –with in 10 days.
•Two doses at 6 mo interval from 2 yr onwards

29. Adolescent Friendly School Initiative
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Indications in Adolescents;
•Who have not had viral hepatitis in past, especially those
who are leaving home for further studies.
•In all sero negative patients with chronic liver disease
•Family contacts of patients with chronic liver disease.
•In children attending crèches and day care centers and
•In travelers from abroad visiting endemic areas.

30. Adolescent Friendly School Initiative
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Proposed immunization
schedule
BCG Alladolescentwithoutascar
Diphtheria,
Pertussis,
Tetanus
-Tdapboosterdoseinpreviously
immunized
-ThreedosesofTdapinpreviously
unimmunizedorpartiallyunimmunized
MMR -Singleboosterdoseinallthe
adolescent
-Twodosesat4weeksinpreviously
unimmunized
Hepatitisb Fullcourseinpreviouslyunimmunized
child

31. Adolescent Friendly School Initiative
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ADOLESCENT FRIENDLY SCHOOL INITIATIVE
Newer and Future Vaccines
for Adolescent

32. Adolescent Friendly School Initiative
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ADOLESCENT FRIENDLY SCHOOL INITIATIVE
Hib
acP
DTacP-IPV/Hib
DTacP-HB/Hib
DTacP-IPV-HB/Hib
pneumo
conjugate
rotavirus
RSV
mening A, C
conjugate
mening B
hep E
dengue
Herpes
ETEC-cholera
otitis media
grpB Strep
H. Pylori
HPV
EBV
Shigella
new TB
malaria
HIV?
hep C?
(adapted from EPI)
Further Vaccines
Present 2010 -2020 ?
? ? ?
acP

33. Adolescent Friendly School Initiative
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ADOLESCENT FRIENDLY SCHOOL INITIATIVE
Vaccines under discussion
•Meningococcal
•Influenza
•HPV
•e IPV–
•Salk Vero cell IPV [v IPV]
•JE
•CMV
•Herpes
•HIV
•EB V
•Parvovirus,
•Para I
•E Coli
•Adeno
•Malaria
•Dengue
•Hepatitis E
•Cholera
•Shigella
•Campylobacter
•Schistosomiasis

34. Adolescent Friendly School Initiative
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Vaccination in special Situations
•Rabies –Pre/post exposure
•Meningococcal vaccine
•Pneumococcal
•Influenza

35. Adolescent Friendly School Initiative
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Influenza vaccine -1
There are 2 influenza viruses, types A and B.
•Type A :subtypes based on two surface antigens
Hemagglutinin (H) and Neuraminidase (N). eg H1N1
•Influenza type B is not categorized into subtypes.
There are two vaccines available,
•The inactivated killed Vaccine &
•Live attenuated influenza vaccine (LAIV)
Both vaccines includes Two type A strains (e.g. H3N2
and H1N1) & One type B strain
Centers for Disease Control and Prevention. Prevention and control of influenza: Recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR 2005;54 (RR08):1-40

36. Adolescent Friendly School Initiative
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Human Papilloma Virus(HPV)
•HPV is now implicated as a causative agent > 99% of
cervical cancer cases. Also pharyngeal and ano-genital
cancers .
•Lifetime risk among sexually active men & women -50%.
•Most common sexually transmitted infection in the USA
•Genital infections occur via G-G; O-G; H-G and AG
contact
•The vast majority of infections go unrecognized
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent
Patients A Clinical Guide for Pediatricians,Vol. 19, No. 1 November 2006

37. Adolescent Friendly School Initiative
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HPV Vaccines available
Quadrivalent HPV vaccine FDA licensed Gardasil, Merck
Bivalent vaccine, Cervarix,GSK Biologicals soon
Both vaccines protect against HPV types 16 and 18.
In clinical phase 2 and 3 trials, both vaccines were found to be
safe and effective in females.
Quadrivalent vaccine is found to be 100% efficacious against
high-grade dysplasia, the predecessor to cervical cancer.
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent
Patients A Clinical Guide for Pediatricians,Vol. 19, No. 1 November 2006

38. Adolescent Friendly School Initiative
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ADOLESCENT FRIENDLY SCHOOL INITIATIVE
HPV vaccine schedule
Studies show a rapid rise in ano-genital HPV infections by –
15 yrs age hence ensure immunization completed prior to it.
11-12 yrs endorsed by the Society for Adolescent Medicine
(SAM), 9-10 yrs left to the discretion of the care provider.
3 doses of HPV given at 0, 2 and 6 months in the Deltoid.
Both have stable antibody levels and continued efficacy -
5 years post vaccination.
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent Patients A Clinical Guide for
Pediatricians,Vol. 19, No. 1 November 2006

39. Adolescent Friendly School Initiative
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? ? Parental reaction
Major Worry :
Stigma related to the sexual transmission of HPV.
Vaccine will increase sexual activity among teens.
Vaccine will not gain widespread acceptance
Studies show
Parents decisions based on severity of disease, efficacy and
safety of the vaccine; the mode of transmission is less
important to them.
Once educated about HPV, provided with accurate
information in a calm and reassuring way majority of
parents have positive response .
Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431

40. Adolescent Friendly School Initiative
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How to introduce the topic of HPV vaccine ?
Visit of 10-12 yrs
•Open the conversation with parents and adolescents
about preventive strategy for all adolescent risk-taking
behaviors
•Clarify their values about a whole range of subjects (eg,
sexuality, drinking)
•Be sensitive to parental anxieties and possible discomfort
with discussing these subjects.
•Then talk of HPV as preventive vaccine for cancer and
STD
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent Patients A Clinical Guide
for Pediatricians,Vol. 19, No. 1 November 2006

41. Adolescent Friendly School Initiative
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My child is too young to get HPV.
Why can’t we wait ?
•You could wait. But…Two important reasons to do this now :
•The immune response appears to be better in younger
girls.
•It takes 6 months to be fully immunized and the vaccine
has to be given before any risk of exposure.
•It makes sense to provide it before any possible exposure
might occur.”
Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431

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•At present it is only licensed for girls.
•The FDA wants more data about boys before they
approve it.
•Males are a potential target for the vaccine for protection
against warts, penile or anal cancer & as a vector for
transmission to females.
Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431
Can HPV vaccine be given to boys ?

43. Adolescent Friendly School Initiative
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ADOLESCENT FRIENDLY SCHOOL INITIATIVE
Don’t you think it will encourage my
daughter to having early and risky sex?
“Does telling young people to wear bicycle helmets or seatbelts
encourage anyone to bicycle or drive recklessly”?
Your child may never be at risk for HPV infection, or may not be at risk
for many years, but we are recommending that all girls get this before
anyone is at risk of infection.
It is very effective at this age and vaccinating now eliminates the worry
about risk into adulthood.
Diekema DS and the American Academy of Pediatrics Committee on Bioethics.
Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431

44. Adolescent Friendly School Initiative
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Pneumococcal vaccine
Risk of serious Pneumococcal disease is relatively low,
not recommended for routine use .
Recommended in; anatomic or functional asplenia (also
sickle cell ),nephritic syndrome, CSF leak,
immunosuppression
Revaccination :>5 yrs after the 1
st
dose,highest risk for
serious Pneumococcal infection and rapid waning of
antibodies, Spleenic dysfunction, Sickle cell disease,
HIV infection, Hodgkin’s disease, Lymphoma, Multiple
myeloma, Chronic renal failure, Nephritic syndrome,
undergoing organ transplantation and receiving
chemotherapy

45. Adolescent Friendly School Initiative
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•Establish a platform for adolescent immunization
•Provider and professional recommendation
•School based immunization requirements
•Statebasedimmunizationlaws
•Educationandawarenessprograms
Strategies to increase adolescent immunisation
Increasing Demand

46. Adolescent Friendly School Initiative
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Key messages
•Pediatricians need to update periodically about new
recommendations
•Students going abroad will come for advise and
certificates
–Newer vaccines
–New recommendations for Booster doses
–Preventive /prophylactic vaccines

47. Adolescent Friendly School Initiative
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Example of Chicken POX coverage
in Schools

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•It is an infectious disease caused by the varicella-
zoster virus.
•It results in a blister-like rash, itching, tiredness and
fever.
•The rash appears first on the trunk and face, but can
spread over the entire body causing between 250 to 500
itchy blisters.
•Most cases of chickenpox occur in persons less than 15
years old.
•Can cause at least 5-6 days of school loss.
•Prior to the use of varicella vaccine, the disease had
annual cycles, peaking in the spring of each year.
CHICKENPOX:
IT’S MORE SERIOUS THAN YOU THINK
WHAT IT IS ????

49. Adolescent Friendly School Initiative
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CHICKENPOX:
What are the serious complications
from chickenpox?
•Bacterial infections which can involve many sites of the
body including theskin, tissues under the skin, bone,
lungs (pneumonia), joints and the blood.
•Due to the virus infection directly –include viral
pneumonia, bleeding problems and infection of the brain
(encephalitis).
•It may lead to Herpes Zoster later in life –vaccine
protects from this as well

50. Adolescent Friendly School Initiative
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Do children prefer vaccination over
having chickenpox ?
•In a recent study,
–7 out of 10 children preferred a shot over natural
disease.
–7 out of 10 children considered chickenpox to be
worse than many other common childhood ailments,
including colds, earaches, sore throat, and fever.
–The study also found that 3 out of 4 parents are
unaware that death is a potential complication of
chickenpox.

51. Adolescent Friendly School Initiative
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Who should be vaccinated?
•All children between 12 and 18 months of age should
have one dose of chickenpox vaccine.
•Children who have had chickenpox do not need the
vaccine.
•Children between 19 months –13 year should get a
single dose.
•People 13 and older should get two doses -4 to 8
weeks apart.
•For more information on who should be vaccinated
visit the following site: (ACIP)
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr48
06a1.htm

52. Adolescent Friendly School Initiative
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I don't think I have had chickenpox, but I
am not sure. Is there a blood test
available to determine whether or not I
have had the disease?
•Yes, a blood test is available to check
immunity.
•If it is not available, it is still safe to
receive the vaccine even if you have
previously had chickenpox.

53. Adolescent Friendly School Initiative
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My child was vaccinated 2-3 years ago and
he/she developed a mild case of chickenpox
this year. Why did this happen?
•After vaccination, some persons (about 1 person in 10)
do not develop enough protection to completely
prevent them from developing chickenpox.
•Hence, they may develop a mild case of disease with
less than 50 spots or bumps.
•This form of chickenpox is also called breakthrough
disease.

54. Adolescent Friendly School Initiative
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Chickenpox in children is usually not serious.
Why not let children get the disease?
•It is never possible to predict who will
have a mild case of chickenpox and who
will have a serious or even deadly case
of disease. Now that there is a safe and
effective vaccine available, it is not worth
taking this chance.

55. Adolescent Friendly School Initiative
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Varicella (Chickenpox)
Chickenpox vesicle behind the
ear. Notice the translucent
quality of the vesicle on the
skin, the classic "dew drop on a
rose petal" appearance.
Chickenpox on the palate. Notice
the glistening, water-drop
characteristic of the chickenpox
vesicle on the palate.

56. Adolescent Friendly School Initiative
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ADOLESCENT FRIENDLY SCHOOL INITIATIVE
THANKS
ADOLESCENT FRIENDLY SCHOOL INITIATIVE
IAP VISION 2007
Adequate immunization is one of the most
important preventive health services that
can be provided for an adolescent.