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IMMUNIZATION (1)

IMMUNIZATION (1). “ Discuss the population health benefits of immunization programs ” Probability of contracting communicable disease depends on probability that contacts are already immune, are carriers or have the disease

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IMMUNIZATION (1)

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  1. IMMUNIZATION (1) • “Discuss the population health benefits of immunization programs” • Probability of contracting communicable disease depends on probability that contacts are already immune, are carriers or have the disease • If sufficient proportion of population is immune, then disease will not spread (herd immunity) • Prevention is usually cheaper and more effective than treatment (if treatment even exists) • Possibility of eradicating some diseases • Implications for school attendance (Ontario) • Mandatory choice vs. mandatory immunization • Exclusion from school for non-immunized children during outbreak

  2. Standard immunizationsAge 0-17 • Diphtheria • Tetanus • Pertussis • Polio • H. influenzae B • Mumps • Measles • Rubella • Hepatitis B • Chickenpox (varicella) • Pneumococcus • Meningococcus • Influenza • HPV Taken from: Canadian Immunization Guide, 2010

  3. Need to add HPV: Females age 9-13, 3 doses

  4. Pneumococcal vaccines (1) 1,200 cases in Ontario, 2009; pneumonia and meningitis; 4% case fatality rate Prevnar 13 • 13 valent pneumococcal conjugate vaccine to protect under age 6 years • Replaced Prevnar (7 valent) due to emergence of 3, 7F and 19A as frequently reported serotypes • 19A is becoming resistant to first line antibiotics • Conjugated with diphtheria toxoid but does not protect against diphtheria • Introduced fall 2010 • Routine doses at 2, 4, 12 months of age • 4 doses at 2, 4, 6 and 15 months if chronic disease • At 12 months, child receives Prevnar 13, Meningococcal C conjugate and MMR vaccines

  5. Pneumococcal vaccines (2) Pneumococcal polysaccharide 23 valent vaccine • Anyone age 2 or older with chronic conditions • moderate-severe respiratory, cardiac, cirrhosis, renal, diabetes, asplenia, sickle-cell, CSF leak, immune deficiency, cochlear implant recipients • U.S. adding any asthma and cigarette smoking • Booster dose 3-5 years later • Age 65 years or older—everyone • Residents of nursing homes and chronic care facilities—everyone • 50-80% effectiveness among the immunocompetent

  6. Meningococcal vaccines • Meningococcal C Conjugate Vaccine • Give one dose at 12 months • May be offered in Grade 7 or age 14-16 for those unimmunized • Meningococcal ACYW-134 Quadrivalent Conjugate Vaccine • 2-55 years • asplenic, complement, properdin or factor D deficiency, or cochlear implant recipient • Meningococcal ACYW-135 Quadrivalent Polysaccharide Vaccine • Over 55 years for same indications as (2)

  7. Human Papilloma Vaccine (HPV) (1) • Garadsil • Protects against 4 strains of HPV • Types 16 and 18 (linked to 70% of cervical cancer and 80% of anal cancer) • Types 6 and 11 (linked to 90% of anogenital warts) • Females age 9-45 • Cervical, vulvar and vaginal cancer and precursor lesions • Cervical adenocarcinoma in situ • Genital warts • Males age 9-26 • Anogenital warts and general HPV infection • Males and females age 9-26 • Anal cancer and anal intraepithelial neoplasia

  8. Human Papilloma Vaccine (HPV) (2) • Ceravix • Protects against 2 strains of HPV • Types 16 and 18 (linked to 70% of cervical cancer and 80% of anal cancer) • Females age 10-25 • CIN Type 1, 2 and 3 • Cervical adenocarcinoma in situ • If goal is to protect only against type 16/18, can use either vaccine

  9. Human Papilloma Vaccine (HPV) (3) • Need three doses • Give at times 0, 2 and 6 months • Best to give prior to sexual activity • 40% of women become infected with HPV within 16 months after initiation of sexual activity • Ontario • Provided free to grade 8 girls in school • Can still be given • once sexually active, • with previous pap abnormalities • have had a previous HPV infection • Routine vaccination of boys would be useful

  10. IMMUNIZATION (2) • “State that a lapse in immunization schedule does not require re-instituting the initial series, merely giving it at the next visit” • You can give a dose too early; you cannot give a dose too late

  11. IMMUNIZATION (3) • “Communicate to patients and parents about vaccine benefits and risks” • Obtain an immunization history on all children • Late immunization is still very effective • Immigrants require special attention • Depends on availability of good records; countries have different immunization coverage • When in doubt, start the series again; • Canadian Immunization Guidegives more detailed information

  12. IMMUNIZATION (4) • Travel • Update regular immunizations • High risk exposure consider additional immunizations • BCG, cholera, hepatitis A, typhoid, rabies • Meningococcal quadrivalent vaccine • meningitis belt and Hajj • Influenza if the right season • Follow legal requirements • Yellow fever (strict) • Cholera • some countries may require; • medical exemption letter can be provided

  13. IMMUNIZATION (5) • “List possible complications of immunization” • Seizures • secondary to fever • Introduction of acellular pertussis reduced febrile seizures dramatically and was much more protective • Anaphylaxis • Need to differentiate from fainting • Neurological damage • Often a major worry of parents • BUT: rarely associated • Casual rather than causal relationship • no good evidence for MMR causing autism

  14. IMMUNIZATION (6) • “Discuss misconceptions about immunization contraindications” • Following are not contraindications: • Mild/moderate local reactions to previous dose • Mild acute illness with or without fever • Taking antibiotics • Allergy to penicillin, duck, molds, pollens • Positive Mantoux TB skin test • Breast feeding • Asplenia • Prior febrile seizure reaction (consider prophylactic acetaminophen)

  15. IMMUNIZATION (7) • “Discuss immunization of immuno-compromised children (e.g., asplenia, chronic diseases or seizures)” • Asplenia (surgical or congenital/functional) • No contraindication to any vaccine • Particularly need protection against encapsulated bacteria to which these individuals are highly susceptible. • Streptococcus pneumoniae, Haemophilus influenzae B, Neisseria meningitidis (A,C,Y, W135), • Immunosuppression • Avoid live vaccines • Follow regular immunization schedule • High dose steroids can mute immune response • Congenital immunodeficiency • Read the Canadian Immunization Guide!

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