Immunization and Vaccine Preventable Diseases
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Transcript of Immunization and Vaccine Preventable Diseases
Immunization and
Vaccine Preventable Diseases
Department of Child Health, Medical School, Padjadjaran University
Learning ObjectivesAt the end of the presentation , students will be able to:1. Describe the difference between active and passive
immunity
2. List some group of vaccine-preventable diseases
3. List group of live attenuated and inactivated vaccines
4. For each vaccine-preventable disease, identify those for whom routine immunization is recommended
5. For each vaccine-preventable disease, describe the characteristics of the vaccine used to prevent the disease
INTRODUCTION
WHO & UNICEF: preventable infectious diseases cause two-thirds of child deaths worldwide
Without vaccines : epidemics of many preventable diseases could return
increased - and unnecessary - illness, disability, and death among children
INTRODUCTION
Immunization saves the lives of approximately 3 million people each year, all over the world
Immunization is among the safest of modern medical interventions
Immunization is one of the most cost-effective health interventions
IMMUNIZATION GOAL IMMEDIATE GOAL: PREVENTION
OF DISEASE IN INDIVIDUAL OR GROUPS
ULTIMATE GOAL: ERADICATION
PRINCIPELS OF VACCINATION
Protection produced by the person's own immune system
Usually permanent
Protection transferred from another person or animal
Temporary protection that wanes with time
Active Immunity
Passive Immunity
Vaccination Active immunity produced by vaccine
Immunity and immunologic memory similar to natural infection but without risk of disease
IMMUN RESPONSPrimary Antigen Contanct
Secundary AntigenContact
Primerrespons
Secundarrespons
VACCINE-PREVENTABLE DISEASES
AnthraxCervical CancerDiphtheriaHepatitis AHepatitis BHaemophilus influenzae type b (Hib) Human Papillomavirus (HPV)H1N1 Flu (((Swine Influenza (Seasonal Flu)
Japanese Encephalitis (JE) Lyme DiseaseMeaslesMeningococcalMumpsPertussis (Whooping Cough)
PneumococcalPoliomyelitis (Polio)
Rabies RotavirusRubella (German Measles)Shingles (Herpes Zoster)SmallpoxTetanus (Lockjaw)TuberculosisTyphoid FeverVaricella (Chickenpox)Yellow Fever
VACCINE-PREVENTABLE DISEASES
Most common and serious vaccine-preventable diseases (WHO) :
- tuberculosis - diphtheria, pertussis, tetanus - poliomyelitis - measles, mumps, rubella - Haemophilus influenzae type b (Hib) - yellow fever
Other common vaccine-preventable diseases : influenza and pneumococcal pneumonia
EXPANDED PROGRAM IMMUNIZATION (EPI) TARGET DISEASES
TARGET DISEASESDiseases covered by Traditional EPI
Tuberculosis, Diphtheria; Tetanus: Pertussis; Polio; MeaslesMNT = Maternal and Neonatal Tetanus
EPI + YF Tuberculosis, Diphtheria; Tetanus (MNT); Pertussis; Polio; Measles; Yellow Fever
EPI + diseasesto be prevented by relatively new Vaccines
Tuberculosis, Diphtheria; Tetanus (MNT); Pertussis; Polio; MeaslesHepatitis B; Haemophilus influenzae type b (Hib)
EPI + diseases to be prevented by vaccines in the pipeline
All above plus: Rotavirus acute diarrhoea; Pneumococcal lower respiratory infections; Human papilloma virus (for cervical cancer); Meningitis A, etc.
VACCINE PREVENTABLE DISEASES
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1950 1960 1970 1980 1990 2000
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Tetanus—United States, 1947-2006
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Diphtheria - United States, 1940-2006
EPIDEMIOLOGY
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Inactivated vaccine
Live oral vaccine
Last indigenous case
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1950 1960 1970 1980 1990 2000
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Poliomyelitis—United States, 1950-2006
Measles – United States,1950 - 2006
Live oral vaccine
Vaccine licensed
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Hepatitis A - United States, 1966-2006
VaccineLicensed
Year
VaccineLicensed
Bacteria Vaccine Virus Vaccine
Live attenuated
• BCG
• Diphtheria
• Tetanus • Pertussis • Cholera
• Meningo• Pneumo • Hib • Typhim Vi
• Measles • Mums• Rubella • Varicella
• OPV• Yellow Fever
• Influenza
• Hepatitis B • Hepatitis A
• IPV• Rabies
Inactivated
CLASSIFICATION OF VACCINE
THE MAJOR CONSTITUENTS OF VACCINES Active immunizing antigen
- Tetanus or diphtheria toxoid, acellular pertussis component, varicella, etc. Conjugating agents
- Carrier proteins of proven immunologic potential (eg, tetanus toxoid, nontoxic variant of diphtheria toxin) Suspending fluid
- Sterile water, Saline solution, etc Presevatives, stabilizers, and antimicrobial
agents- Thiomersal, Neomycin, Streptomycin sulfate, etc
Adjuvants : - Alumunium salt
Contraindications and Precautions
• severe allergic reaction to a vaccine component or following a prior dose
• encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination (applies only to pertussis-containing vaccines)
Permanent contraindications to vaccination:
Contraindications and Precautions
ConditionAllergy to componentEncephalopathyPregnancyImmunosuppressionSevere illnessRecent blood product
LiveC---CCP
P**
InactivatedCC
V*VPV
C=contraindication P=precaution V=vaccinate if indicated*except HPV and Tdap. **MMR and varicella-containing (except zoster vaccine), and rotavirus vaccines only
Invalid Contraindications to Vaccination Mild illness Antimicrobial therapy Disease exposure or convalescence Pregnant or immunosuppressed person in the
household Breastfeeding Preterm birth Allergy to products not present in vaccine or allergy
that is not anaphylactic Family history of adverse events Tuberculin skin testing Multiple vaccines
Screening Questions Is the child (or are you) sick today? Does the child have an allergy to any medications,
food, or any vaccine? Has the child had a serious reaction to a vaccine in
the past? Has the child had a seizure, brain or nerve problem? Has the child had a health problem with asthma, lung
disease, heart disease, kidney disease, metabolic disease, such as diabetes, or a blood disorder?
RECCOMENDED IMMUNIZATION SCHEDULE
UNITED STATES 2007 AND 2010 INDONESIAN MINISTRY OF HEALTH INDONESIAN PEDIATRICS ASSOCIATION (IPS)
= IKATAN DOKTER ANAK INDONESIA (IDAI)
Guidelines for Spacing of Live and Inactivated AntigensAntigen Combination
Recommended minimum Interval Between Dose
> 2 inactivated None; can be administtered simultaneously or at any interval between dose
Inactivated and live None; can be administtered stimultaneously or at any interval between dose
> 2 live 28-day minimum interval if not administered at the same visit
EXPANDED PROGRAM IMMUNIZATIONVACCINE DOSE ROUTEBCG 0,05 ml Intra
dermal
Hep B 0,5 ml Intra muscular
DTP 0,5 ml Intra muscular
Polio 1-2 gtt Per oral
Measles 0,5 ml Sub cutan
NON-EXPANDED PROGRAM IMMUNIZATION
Prevention: Measles, Mumps and Rubella AAP recommended at 12-15 months of age;Second dose at 4-6 years of age IDAI recommended as booster at 15 month and 6 years of age Dose: 0.5 ml subcutan
1.MMR (Measles, Mumps, Rubella)
Two conjugate vaccines licensed for use in infants PRP-T ActHIB, TriHIBit PRP-OMP PedvaxHIB, ComvaxRecommended at 2, 4, and 6 month; booster at 12 – 15 month of ageDose: 0.5 ml, intramuscular
2. Hib (Haemophilus influenzae tipe b)
There are 2 type- Polisacharida vaccine (injection)- Capsular vi Polisakharida vaccine (oral)Recommended at 2 year of age and the booster every 3 year
3. Typhoid Fever
4. Hepatitis A- Schedule: > 2 year (2 dose, interval 6
month)- Dose: 720 U
5. Varicella
AAP recommended at 12-15 months of age;Second dose at 4-6 years of age IDAI recommended at 5-12 years of age Dose: 0,5 ml subcutan6. Pnemococcal (PCV7)Major clinical syndromes include pneumonia, bacteremia, and meningitisDoses at 2, 4, 6, months of age, booster dose at 12-15 months of age.Dose: 0.5 ml intramuscular
7. Influenza< 8 years of age: 2 dose (interval min
4 week)
Dose: 0.25 ml (6-35 months of age) 0.5 ml (> 3years of age)
Booster: anually
LAPSED IMMUNIZATIONS A lapse in the immunization schedule does not
require reinstitution of the entire series or addition of doses to the series.
UNKNOWN OR UNCERTAIN IMMUNIZATION STATUS
□ Many children do not have adequate documentation□ In general, when in doubt: recommended immunization should be initiated without delay on a schedule commensurate with the person’s current age.