Immunization and Vaccine Preventable Diseases

1. Immunization and Vaccine Preventable Diseases Department of Child Health, Medical School, Padjadjaran University

2. Learning Objectives At the end of the presentation , students will be able to: • Describe the difference between active and passive immunity • List some group of vaccine-preventable diseases • List group of live attenuated and inactivated vaccines • For each vaccine-preventable disease, identify those for whom routine immunization is recommended • For each vaccine-preventable disease, describe the characteristics of the vaccine used to prevent the disease

3. 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

4. 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

5. IMMEDIATE GOAL: PREVENTION OF DISEASE IN INDIVIDUAL OR GROUPS ULTIMATE GOAL: ERADICATION IMMUNIZATION GOAL

6. PRINCIPELS OF VACCINATION Active Immunity • Protection produced by the person's own immune system • Usually permanent • Protection transferred from another person or animal • Temporary protection that wanes with time Passive Immunity

7. Vaccination • Active immunity produced by vaccine • Immunity and immunologic memory similar to natural infection but without risk of disease

8. IMMUN RESPONS Primary Antigen Contanct Secundary Antigen Contact Secundar respons Primer respons

9. VACCINE-PREVENTABLE DISEASES

10. VACCINE-PREVENTABLE DISEASES • Most common and serious vaccine-preventable diseases (WHO) : - tuberculosis - diphtheria, pertussis, tetanus - poliomyelitis - measles, mumps, rubella - Haemophilusinfluenzae type b (Hib) - yellow fever • Other common vaccine-preventable diseases : influenza and pneumococcal pneumonia

11. EXPANDED PROGRAM IMMUNIZATION (EPI) TARGET DISEASES

12. VACCINE PREVENTABLE DISEASES

13. EPIDEMIOLOGY Tetanus—United States, 1947-2006 Diphtheria - United States, 1940-2006 Year

14. Live oral vaccine Last indigenous case Poliomyelitis—United States, 1950-2006 Measles – United States, 1950 - 2006 Inactivated vaccine Vaccine licensed Live oral vaccine

15. Hepatitis A - United States, 1966-2006 Vaccine Licensed Vaccine Licensed Year

16. Bacteria Vaccine Virus Vaccine Live attenuated Inactivated CLASSIFICATION OF VACCINE • Measles • Mums • Rubella • Varicella • BCG • OPV • Yellow • Fever • Influenza • Diphtheria • Tetanus • Pertussis • Cholera • Meningo • Pneumo • Hib • Typhim Vi • IPV • Rabies • Hepatitis B • Hepatitis A

17. 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

20. Contraindications and Precautions Permanent contraindications to vaccination: • 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)

21. Contraindications and Precautions Inactivated C C V* V P V Condition Allergy to component Encephalopathy Pregnancy Immunosuppression Severe illness Recent blood product Live C --- C C P P** C=contraindication P=precaution V=vaccinate if indicated *except HPV and Tdap. **MMR and varicella-containing (except zoster vaccine), and rotavirus vaccines only

22. 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

23. 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?

24. RECCOMENDED IMMUNIZATION SCHEDULE • UNITED STATES 2007 AND 2010 • INDONESIAN MINISTRY OF HEALTH • INDONESIAN PEDIATRICS ASSOCIATION (IPS) = IKATAN DOKTER ANAK INDONESIA (IDAI)

30. Guidelines for Spacing of Live and Inactivated Antigens

31. EXPANDED PROGRAM IMMUNIZATION

32. NON-EXPANDED PROGRAM IMMUNIZATION MMR (Measles, Mumps, Rubella) 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

33. 2. Hib (Haemophilus influenzae tipe b) Two conjugate vaccines licensed for use in infants • PRP-T ActHIB, TriHIBit • PRP-OMP PedvaxHIB, Comvax Recommended at 2, 4, and 6 month; booster at 12 – 15 month of age Dose: 0.5 ml, intramuscular

34. 3. Typhoid Fever There are 2 type - Polisacharida vaccine (injection) - Capsular vi Polisakharida vaccine (oral) Recommended at 2 year of age and the booster every 3 year 4. Hepatitis A - Schedule: > 2 year (2 dose, interval 6 month) - Dose: 720 U

35. 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 subcutan 6. Pnemococcal (PCV7) Major clinical syndromes include pneumonia, bacteremia, and meningitis Doses at 2, 4, 6, months of age, booster dose at 12-15 months of age. Dose: 0.5 ml intramuscular

36. 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

37. 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.

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