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VACCINE-PREVENTION

VACCINE-PREVENTION. VACCINES USED UNDER THE NATIONAL IMMUNIZATION PROGRAMME. VACCINE = antigenic product obtained from a specific pathogenic agent or one very close related to it, which can induce, in a receptive person, an immune response that protect against the pathogenic agent.

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VACCINE-PREVENTION

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  1. VACCINE-PREVENTION VACCINES USED UNDER THE NATIONAL IMMUNIZATION PROGRAMME

  2. VACCINE = antigenic product obtained from a specific pathogenic agent or one very close related to it, which can induce, in a receptive person, an immune response that protect against the pathogenic agent. RECEPTIVES = people who interact with a source of pathogenic agent and did not have an effective specific or non-specific resistance. ANATOXIN (TOXOID) = bacterial exotoxin partially detoxified, but which keeps it immunogenicity

  3. OBSERVATIONS • 5 classes of Ig: IgM, IgG, IgA, IgD, IgE • Normal serum (non-immune serum)– Ig without Ab activity • Maternal Ig – cross the placenta (IIIrdtrim.) → at birth, in n.b. circulation – especially maternal IgG – ensure the n.b. protection in the first 6-9 months, if the mother has a protective level of Ab and just against the Ag with which the mother interacts

  4. OBSERVATIONS • foetus – very low level of IgM (10th week) and IgG (12th week of intrauterine life) • after birth – level of IgM grows quickly, IgG production - start since 4th week of extrauterine life • cellular immunity = able from birth → BCG

  5. IMMUNE RESPONSE • Primary immune response (PIR): - after the first contact with an Ag - latency period = 10-15 days - IgM • Secondary immune response (SIR): - after the secondary contact, repeated with the same Ag - initiate by the very low doses - IgG • PIR/SIR – appear after natural or artificial active immunization

  6. IMMUNE RESPONSE • humoral: - Ab→ Ly B - primary vaccination → immune response → level of Ab decreases in short time under the protecting limit - secondary vaccination → repeated administration of Ag at an appropriate intervals → increases the level of Ab, extends the synthesis duration = keeping the immunologic memory • cellular: - Ly T - a single administration / at long distances in time → immunologic memory for the entire life (theoretically)

  7. VACCINE-PREVENTION = the operation of giving the necessary doses of Ag to the persons or groups receptive to a pathogenic agent, in order to give them protection

  8. VACCINE-PREVENTION Objective: specific protection→ knowing the factors conditioning the immune response : • age • immune deficiencies • genetic factors • vaccination scheme • vaccination indications • vaccination contraindications • the necessary technical conditions

  9. MINIMAL OPTIMAL AGE FOR VACCINATION • Stages of immune system maturation: a. Cellular immunity – efficient from birth → BCG b. Local intestinal immunity (IgA) – efficient till 6-8 weeks of life → substituted after that by VPOT c. Humoral immunity (circulating Ab) – efficient before the age of 2-3 months → DTP

  10. MINIMAL OPTIMAL AGE FOR VACCINATION 2. Protection - inherited from mother (protective level of Ab) – efficient till 6-9 months → measles vaccine (live attenuated vaccine) = after 9 months 3. Epidemiological context – according to the incidence and severity of transmissible diseases in the area, available vaccines, economic resources

  11. IMMUNE DEFICIENCIES → reduces the IR • GENETIC FACTORS : - strong IR, good quality - IR with unprotected levels - IR humoral – weak; cellular - strong • SCHEDULE VACCINE : - specify the population groups - methods and routes of administration - number and size of doses - the interval between doses and the interval between different vaccines

  12. INDICATIONS • Vaccines administrated under the National Immunization Program - according to age group: BCG, IPV, DTPa, MMR, HepB, Hib, pneumococcal vaccine (PCV) 2. Vaccines administrated in special epidemiological situations – for risk groups: HepA vaccine, influenza vaccine, rabies vaccine, leptospirosis, HPV vaccine, meningococcal vaccine; chickenpox vaccine (varicella); rotavirus vaccine; yellow fever vaccine

  13. Whooping cough —pertussis — is a highly contagious respiratory tract infection. Although it initially resembles an ordinary cold, whooping cough may eventually turn more serious, particularly in infants. The best way to prevent it is through vaccinations. The childhood vaccine is called DTaP. The whooping cough booster vaccine for adolescents and adults is called Tdap. Both DTaP and Tdap protect against whooping cough, tetanus, and diphtheria. Polio is an infectious disease caused by a virus that lives in the throat and intestinal tract. It is most often spread through person-to-person contact with the stool of an infected person and may also be spread through oral/nasal secretions. Polio used to be very common in the United States and caused severe illness in thousands of people each year before polio vaccine was introduced in 1955. Most people infected with the polio virus have no symptoms; however, for the less than 1% who develop paralysis it may result in permanent disability and even death.

  14. INDICATIONS 3. Vaccines administered in relation with certain diseases - anatomic / functional asplenia: pneumococcal vaccine, influenza vaccine, Hib vaccine, meningococcal vaccine - hemodialysis, recipients of transplants: Hib vaccine, influenza vaccine, pneumococcal vaccine - chronic alcoholism

  15. GENERAL CONTRAINDICATIONS • TEMPORARY– must be recovered • fever due to mild infection • incubation period of some infectious diseases • infectious disease in progress and in convalescence • recent administration of standard Ig → after 4-6 weeks • immunosuppressive therapy with corticosteroids → high doses, extended scheme - pregnancy - diabetes mellitus - active TB - prematurity - IIIrd degree dystrophy

  16. GENERAL CONTRAINDICATIONS • DEFINITIVE: - progressive neurological disorders - organic diseases - decompensated - immunodeficiency status (including HIV positive persons) - major allergy to egg proteins - skin diseases

  17. SIDE EFFECTS /ADVERSEEVENTS • Side Effects After Vaccination (SEAV) = medical incidents occurring after vaccination, which are considered to be due to its • SEAV produced by vaccines with live attenuated agents→ of infectious nature andwith late onset • SEAV produced by vaccines with killed / inactivated agents → immediate / early onset and are based on hypersensitivity mechanisms

  18. SIDE EFFECTS /ADVERSEEVENTS 1. Local side effects after vaccination : • Early (the first 3 days) ~ localised pain, redness, swelling at injection site(vaccines with killed / inactivated agents). • Late (3-12 weeks) ~ suppurated lesions (TB vaccine) 2. Febrile episodes: • Early (the first 1-3 days) → anatoxin, pertussisvaccine, influenza vaccine, Hep B vaccine. • Late (5-15 days) → vaccines with live attenuated virus (measles vaccine, yellow fever vaccine).

  19. SIDE EFFECTS /ADVERSEEVENTS 3. Seizures(hyperthermic to young children) → pertussis vaccine, measles vaccine. 4. Exanthema • Allergic (early) - vaccines with inactivated agents • Infectious (late) – measles vaccine 5. Arthralgia (adults) - rubella vaccine, Hep B vaccine .

  20. SIDE EFFECTS /ADVERSEEVENTS Severe side effects: • shock, persistent seizures, encephalopathy ~ after pertussis vaccine ; • ~ paralysis after poliomyelitis vaccine – live attenuated virus (returning to initial neuro virulence); • generalized tuberculosis ~ after TB vaccine administered to a person with congenital immunodeficiency, undetectable at birth.

  21. VACCINES USED UNDER THE NATIONAL IMMUNIZATION PROGRAM • Morbidity structure - Morbidity trend for transmissible diseases ROMANIANNATIONAL IMMUNIZATION PROGRAM - Vaccination against- tuberculosis (BCG) - Vaccination against- poliomyelitis (IPV) - Vaccination against- viral hepatitis B (HepB) - Vaccination against- diphtheria-tetanus- pertussis (DTPa, dT) - Vaccination against- measles-mumps-rubella (MMR) - Vaccination against- Hemophilusinfluenzaeb infection (Hib) - Pneumococcal conjugate vaccine (PCV)

  22. Schedule in use (2014-2015)

  23. Tuberculosis Vaccination (BCG)

  24. INDICATIONS - 4-7 days from birth (Wbirth> 2500 g) - until 3 months (babies not vaccinated in the maternity hospital) - at 6 months – reading of postvaccinal scar (those without a scar or with a scar Ø < 3 mm – are receiving a vaccine dose without a previous tuberculin test)

  25. ADMINISTRATION TECHNIQUE - lyophilized product - powder non-adhering to the walls of the ampoule – 1 vial = 20 mg bacterial mass - open the ampoule after protection with a sheet of cellophane that comes with the vaccine - for reconstitution : Sauton medium (2ml sol/ampoule) - Injection site: deltoid muscle of the left arm - dose: 0,1 ml vaccine - route of administration: strictly intradermal - correct vaccination: papule with Ø = 5-6 mm which disappears in 30 minutes

  26. CONTRAINDICATIONS • persons with positive tuberculin skin test • HIV infection • underweight newborns (Wbirth< 2500 g) • malignancies • treatment with corticosteroids • acute dermatological diseases • pregnancy • convalescents after infectious diseases

  27. ADVERSE EVENTS • persistent ulcerations(over 3 months) • abscess at the inoculation site • locoregional lymph nodes • inflammatory nodules • osteitis, osteomyelitis • disseminated BCG infection– Mycobacterium bovis strain

  28. Poliomyelitis vaccination

  29. INDICATIONS - first-vaccination (primary immunisation): at the age of 2, 4, 6 months (IPV) - Ist revaccination: at 12 months (6 months from first-vaccination) (IPV) - IInd revaccination: at 6 years (IPV) - IIIrd revaccination: at 9 years (IPV)

  30. ADMINISTRATION TECHNIQUE - IPV (injectable poliomyelitis vaccine) prepared from inactivated agent - i.m. administration - dose: 0,5 ml

  31. ADMINISTRATION TECHNIQUE For small babies Infants < 12 months of age

  32. ADMINISTRATION TECHNIQUE Children > 3 years: deltoid muscle

  33. CONTRAINDICATIONS • infectious diseases during the acute period and in convalescence • contact with sick persons (rubella, measles, chicken pox, mumps) • immunosuppressive treatments • Ig administration less than six weeks before • administration of other vaccines with less than 30 days before • convalescents after infectious diseases • allergic reaction to neomycin, streptomycin or polymyxin B

  34. ADVERSE EVENTS • local: pain, redness, swelling • medium fever

  35. Hepatitis B vaccination

  36. INDICATIONS - IstDose : in the first 24h from birth (maximum 7 days) - IInd Dose: at 2 months - IIIrd Dose: at 6 months

  37. INDICATIONS • active medical staff • familial / sexual contacts • intravenous drug users • hemodialysis, haemophilia, recipients of blood and derivatives, candidates for organ transplants • population in areas where VHB is hyperendemic • institutionalized persons

  38. PARTICULAR CASES • Newborns from mothers with positive HBsAg: - specific Ig against-HBV (HBIg) + - concurrent vaccination(in other anatomic site) in the first 12h after birth - with one of the schemes: 0, 1, 2 months or 0, 1, 6 months 2. Accidental exposure: - before exposure: vaccination (scheme 0,1,6 months) ± IVth dose after 1 year and Vth dose after 5 years (for high risk sectors) - post exposure - dermal exposure or percutaneous: - person with complete vaccination scheme→ check the level of Ab → protective level (> 10mUI/ml) → not require additional doses - unvaccinated person or with an incomplete vaccination scheme → HBIg + vaccination (Ist dose) → level of Ab – the vaccination is stopped or we continue with the quick scheme

  39. ADMINISTRATION TECHNIQUE • Slightly opaque white suspension • Administration: deep i.m. - before 3 years age (infant and toddler): at the thigh level, at the union of upper 1/3 with the inferior 2/3 - in older children and adults: deltoid muscle • Dose: - infant and toddler = 0,5 ml suspension /10 µg HBsAg - older children and adults = 1 ml suspension /20 µg HBsAg - immunosuppressed adults= 2 ml suspension /40 µg HBsAg

  40. CONTRAINDICATIONS • Subjects with high sensibility to one of the vaccine components (yeast or others) • Subjects with sensibility at previous administration

  41. ADVERSE REACTIONS • Most frequently – local: - pain - rash - induration 2. Rarely – transitory: - subfebrility, fatigue, headache, vertigo, malaise - abdominal pain, nausea, vomiting - pruritus, urticaria - arthralgia

  42. Vaccination against –diphtheria-tetanus-pertussis (DTPa, dT)Infanrix hexa = DTPa-hepB-IPV-Hib - GlaxoSmithKlineInfanrix -IPV= DTPa-IPV – GlaxoSmithKlineInfanrix Penta = DTPa-hepB-IPV – GlaxoSmithKlineAdacel – Sanofi Pasteur = dTpaAdacel Polio – Sanofi Pasteur = dTpa-IPV

  43. INDICATIONS - Thefirst vaccination: 3 doses at age 2, 4, 6 months – with DTPa product (tetra-vaccine DTPa-IPV or penta-vaccine DTPa-IPV-Hib) - Ist Revaccination : 12 months (at 6 months from the first vaccination) with DTPa-IPV or DTPa-IPV-Hib - IInd Revaccination : 4 years with DTPa - IIIrd Revaccination : 6 years with DTPa-IPV - IVrd Revaccination : 14 years with dT - Vth Revaccination : 24 years with dT - After 24 years age: revaccination at every 10 years with dT

  44. ADMINISTRATION TECHNIQUE • Milky white liquid • Administration - deep intramuscular injection: - infants and young children: at the union of superior 1/3 with the inferior 2/3, 2-3 cm lateral to the midline - children after 3 years of age and adults: the deltoid muscle • Dose: 0.5 ml

  45. CONTRAINDICATIONS • Temporary: - recent Ig administration • incubation period of infectious diseases • immunosuppressive treatments • Definitive: • kidney diseases, decompensated cardiovascular diseases • autoimmune diseases, hematological diseases • cancers • Related to pertussis: • fever (> 40,5˚C), persistent crying(> 3 hours), seizure syndrome (within 3 days after vaccination) occurred after a previous vaccination • onset of encephalopathy within 7 days after a previous dose of DTP

  46. SIDE EFFECTS /ADVERSE EVENTS • Local: - pain - swelling - induration at the injection site 2. General: febrile reaction for 1-2 days 3. Neurological: - Guillain-Barré syndrome, brachial neuritis(correlated with – ATPA) - encephalopathy, episodes of hypotonia-areflexia , persistent crying (correlated with pertussis component)

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