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

0

100

200

300

400

500

600

700

1950 1960 1970 1980 1990 2000

Cas

es

Tetanus—United States, 1947-2006

Year

02000400060008000

100001200014000160001800020000

1940 1950 1960 1970 1980 1990 2000

Cas

es

Diphtheria - United States, 1940-2006

EPIDEMIOLOGY

0

5000

10000

15000

20000

25000

1950 1956 1962 1968 1974 1980 1986 1992 1998 2004

Cas

es

Inactivated vaccine

Live oral vaccine

Last indigenous case

0100200300400500600700800900

1950 1960 1970 1980 1990 2000

Cas

es (t

hous

ands

)

Poliomyelitis—United States, 1950-2006

Measles – United States,1950 - 2006

Live oral vaccine

Vaccine licensed

0

10000

20000

30000

40000

50000

60000

70000

1966 1970 1975 1980 1985 1990 1995 2000 2005

Cas

es

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.