administrative principles of vaccination prof. dr. ahmet arvas i.u. cerrahpasa medical faculty,...
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Administrative Principles of Vaccination
Prof. Dr. AHMET ARVASI.U. Cerrahpasa Medical Faculty, Department of Pediatrics
Vaccine preventable diseases
infant mortality in world-2010
Lancet 2012;380:2095-125
child mortality-2010 (1-4 y)
Lancet 2012;380:2095-125
Vaccine preventable deaths in world-2008
Measles 118.000Hib inf. 199.000Pertussis 195.000Tetanus 2.000N. Tetanus 59.000Yellow fever 30.000Diphteria 4.000Rotavirus inf. 453.000Pneumococcal dis. 476.000Hepatitis B inf. 10.000
1.5 million of deaths among children under 5 years are due todiseases that could have been prevented by routine vaccination
Measles: 2011:111; 2012:101 cases
Active vaccination
Protection produced by vaccine
Usually permanent
Immunity and immunologic memory similar to natural infection but without risk of disease
Classification of vaccines
Live attenuated bacterial viral
Inactivated whole: viruses, bacteria fractional: protein based (toxoid, subunit) polysaccharide-based (pure, conjugate)
Live Attenuated Vaccines
• Attenuated (weakened) form of the "wild" virus or bacterium
• Must replicate to be effective• Immune response similar to natural infection• Usually produce immunity with one dose(except those administrated orally)
*except those administered orally
Inactivated Vaccines
• Cannot replicate• Generally not as effective as live vaccines• Less interference from circulating antibody
than live vaccines• Generally require 3-5 doses• Immune response mostly humoral• Antibody titer may diminish with time
General RulesInactivated vaccines are generally not affected by circulating antibody to the antigen
Live attenuated vaccines may be affected by circulating antibody to the antigen
Polysaccharide Vaccines
• pneumococcal• meningococcal• Salmonella Typhi (Vi)
• Haemophilus influenzae type b• Pneumococcal (PCV-7, PCV-10, PCV13)• Meningococcal (MenC, MCV4)
Pure polysaccharide
Conjugate polysaccharide
2012Immunization Schedule-Turkeybirth 1
month2
months
4months
6months m m
First school grade (6
yrs)
Eighth school grade (13-14
yrs)
PCV
MMR
OPV
B
B
B
vP
DaPT/IPV +HepA II Varicella ı
Immunization coverage rate in Turkey (%)
Source: Turhish Health Ministry Public Health Institute
Immunization schedule (unvaccinated children: > 1 year)
12-59 mos(1-5 yrs) 6-13 yrs >14 yrs
at first time DaPT/IPV/Hib,HepB,ppd
DaPT/IPV, HepB, KKK Td, OPV, HepB, KKK
>2 days KKK, ppd: BCG - -
2 months DaPT/IPV/Hib orDaPT/IPV,HepB,OPV
DaPT/IPV, HepB, KKK,OPV
Td, OPA, HepB, KKK
8 months DaPT/IPV,HepB,OPV DaPT/IPV, HepB, OPV Td, HepB
All vaccines can be administered at the same visit as all other vaccines
Combination
two live injected or intranasal influenza vaccine
all other
Minimum Interval
4 weeks
None
Spacing of Vaccine Combinations Not Given Simultaneously
Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine. It is not necessary to restart the series or add doses because of an extended interval between doses
Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection
Vaccine doses should not be administered at intervals less than the minimum intervals or earlier than the minimum age
*after the series has been completed
Time limits for using vaccines after reconstitution
MMR≤ 8 hrs
BCG ≤ 4-8 hrs protect from ligth
Varicella ≤ 30 min
Types of administration errors
wrong vaccine or wrong diluent
wronge dosage
expired vaccine
wrong route/site/needle size
wrong time
wrong patient
Correct route, site, needle size
Vaccine Adverse Reactions
• Local– pain, swelling, redness at
site of injection– common with inactivated
vaccines– usually mild and self-limited
Vaccine Adverse Reactions
• Systemic– fever, malaise, headache– nonspecific– may be unrelated to vaccine
Vaccine Adverse Reactions
• Allergic– due to vaccine or vaccine
component– rare– risk minimized by screening
Contraindication
• A condition in a recipient that greatly increases the chance of a serious adverse reaction
Precaution
• A condition in a recipient that might increase the chance or severity of an adverse reaction, or
• Might compromise the ability of the vaccine to produce immunity
Contraindications
• severe allergic reaction to a vaccine component or following a prior dose
(anaphylactic reaction: all vaccines)
• Encephalopathy/encephalitis not due to another identifiable cause occurring within 7 days of pertussis vaccination
• Severe combined immunodeficiency (live vaccines)
Permanent contraindications to vaccination:
Immunosuppression• Disease– congenital immunodeficiency– leukemia or lymphoma– generalized malignancy
• Chemotherapy– alkylating agents– antimetabolites– radiation
Immunosuppression• Corticosteroids– 20 mg or more per day
of prednisone*– 2 mg/kg or more per day of prednisone*– NOT aerosols, alternate day, short courses,
topical
*for 14 days or longer
Vaccination of household contacts of immunosuppressed persons
• Healthy household contacts of immunosuppressed persons should receive MMR and varicella vaccines and annual influenza vaccination
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
Vaccination during acute illness
• No evidence that acute illness reduces vaccine efficacy or increases vaccine adverse reactions
• Vaccines should be delayed until the illness has improved
• Mild illness, such as otitis media or an upper respiratory infection, is NOT a contraindication to vaccination
A healthcare encounter in which a person is eligible to receive vaccination but is not vaccinated completely
Missed opportunity
Reasons for missed opportunities
• Lack of simultaneous administration• Unaware child needs additional vaccines• Invalid contraindications• Inappropriate clinic policies
Vaccine Adverse Event Reporting System (VAERS)
National reporting system
Vaccine Adverse Event Reporting System (VAERS)
• Detects–new or rare events– increases in rates of known side effects–patient risk factors
• Additional studies required to confirm VAERS signals
• Not all reports of adverse events are causally related to vaccine
Adverse Event Classification
• Vaccine-induced: Due to the intrinsic characteristic of the vaccine preparation and the individual response of the vaccinee. These events would not have occurred without vaccination (e.g., vaccine-associated paralytic poliomyelitis after oral polio vaccine).
• Vaccine-potentiated: The event would have occurred anyway, but was precipitated by the vaccination (e.g., first febrile seizure in a predisposed child).
• Programmatic error: Due to technical errors in vaccine storage, preparation, handling, or administration.
• Coincidental: The reported event was not caused by vaccination but happened by chance occurrence or due to underlying illness.
Vaccine-associated paralytic polio (VAPP): overall incidence of once case of VAPP: per2.4 million doses of OPV
Rotavirus vaccine/ increased risk of intussusception: no evidence for a causal link (coins.)
MMR-V: additional 4.3 febrile seizures per 10.000 MMR-V doses compared to MMR andV administered separately
MCV4/ Guillain-Barre Syndrome: no evidence for a causal link (coincidental)
Hep B V/ Guillain-Barre Syndrome, transverse myelitis: no evidence for a causal link
MMR/ autism, inflammatory bowel diseases: no evidence for a causal link (coinc.)
Thimerosal (mercury containing preservative)-containing vaccines/ autism, inflammatory bowel diseases, ADHD : no evidence for a causal link (coincidental)
Vaccines/ ITP: vaccine potentiated