1 / 94

Vaccines and the Diseases They Prevent

Vaccines and the Diseases They Prevent. Immunization update Joni Reynolds, RNC, MSN. Disclosure. I have no relevant financial interests in any commercial interests or company mentioned in this presentation. Overview. Vaccine Terminology Childhood and Adolescent Vaccines Grace Periods

shanta
Télécharger la présentation

Vaccines and the Diseases They Prevent

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Vaccines and the Diseases They Prevent Immunization update Joni Reynolds, RNC, MSN

  2. Disclosure • I have no relevant financial interests in any commercial interests or company mentioned in this presentation.

  3. Overview • Vaccine Terminology • Childhood and Adolescent Vaccines • Grace Periods • Contraindications • VIS • Conversations with Parents • Documentation • Storage and Handling

  4. What Is a Vaccine ? • A vaccine is the deliberate stimulation of adaptive immunity. Vaccines: • Work by mimicking what happens during natural infection without causing illness. • Use altered versions of viruses or bacteria to trigger an immune response. • Are the most effective means of controlling infectious diseases. • Not only protect those who get them, but they also help keep diseases at bay in the community; this is called herd immunity.

  5. How do Infections Work? • During natural infection: • The immune system recognizes a pathogen as foreign and makes an immune response to it. When a pathogen causes an immune response, it is known as an antigen. • Unfortunately, while the immune response is gaining strength, the person is likely to be ill as the struggle between the pathogen and the immune response is decided. • One part of the immune response creates antibodies; this is known as the antibody-mediated or humoral immune response. • Antibodies are specific to antigens and have the ability to remember them, so that if the same (or a very similar) antigen tries to infect the person again, the immune response will be stronger and faster thereby protecting the person from infection—and illness.

  6. How Do Vaccines Work ? With a vaccine: • The immune system recognizes the vaccine as foreign and makes an immune response to it. The vaccine serves as an antigen in that it causes the immune system to respond to it. • One part of the immune response creates antibodies; this is known as the antibody-mediated or humoral immune response. • Antibodies are specific to the vaccine and have the ability to remember it, so that if the vaccine or a very similar antigen is seen again, the immune response will be stronger and faster thereby protecting the person from infection. • The main difference between a vaccine and natural infection is that the person does not become ill while the immune system is responding to the vaccine.

  7. Vaccine Terminology • Live, attenuated • MMR, VAR (Varicella), MMRV, • LAIV (Flumist) • RV1 (Rotarix), RV5 (RotaTeq) • Inactivated • Acellular pertussis, diphtheria, tetanus (DTaP, Tdap) hepatitis A, hepatitis B, Hib, influenza, IPV, meningococcal conjugate (Menactra), meningococcal polysaccharide (Menomune), pneumococcal conjugate (Prevnar), pneumococcal polysaccharide (Pneumovax), Human Papilloma Virus (HPV),

  8. Childhood Immunization Schedule • 2011 Schedule • Updated annually in January • Use for age birth through 18 years • Birth to age 6 years • Age 7-18 years ACIPAdvisory Committee on Immunization Practices

  9. 2011 Changes • Guidance added for the Hep B vaccine schedule for children who did not receive a birth dose • Use of 13-valent pneumococcal conjugate vaccine • Seasonal influenza vaccine for all children • Use of Tdap vaccine for children aged 7-10 years of age

  10. 2011 Changes • Footnotes for use of HPV vaccine have been condensed • Routine 2-dose schedule of quadrivalent meningococcal conjugate vaccine (MCV4) And • Booster dose of MCV4 have been added • Guidance for use of Haemophilusinfluenzaetype b (Hib) in persons 5 years+

  11. Infants and Children 0 Through 6 Years of Age – Vaccines • Hepatitis B • Rotavirus • Diphtheria, Tetanus and Pertussis • Haemophilus influenzae type b • Pneumococcus • Polio • Influenza • Measles, Mumps and Rubella • Varicella • Hepatitis A

  12. Hepatitis B Vaccine • Given IM • Birth • 1-2 months • 6-12 months • No booster doses recommended • Do NOT re-start series if interrupted • Administration of 4 doses to infants is acceptable when combination vaccines containing HepB are administered after the birth dose.

  13. Hepatitis B Vaccine Reminders • Minimum Interval Schedule  4 weeks between doses 1 and 2  8 weeks between doses 2 and 3  16 weeks between doses 1 and 3 (- 4 days) •  Minimum age for dose 3 is now 24 weeks, and the 4 day grace period applies •  Remember, adolescents and high risk adults need the vaccine too!

  14. A Comment on Minimum Intervals: When to Calculate Days-vs-Weeks-vs-Months • Customarily, if the dosing interval is 4 months or more, it is common to use calendar months (e.g., 6 months from October 1 is April 1). • If the interval is less than 4 months, it is common to convert months into days or weeks (e.g., 1 month = 4 weeks = 28 days).

  15. RV (Rotarix®) 2 dose schedule Max age 1st dose 20 wks Max age any dose 24 wks RV5 (Rotateq®) 3 dose schedule Max age 1st dose 12 wks Max age any dose 32 wks Rotarix® (RV1) and Rotateq® (RV5) Two Very Different Products • Confusing, complicated, challenging! • No data on schedules that include receiving both RV1 and RV5 • ACIP worked >1 year to develop and have approved recommendations for the use of interchanging these products

  16. Recommendations for Routine Rotavirus Vaccination *Off-label. See MMWR 2009;58(RR-2)

  17. Recommendations for Routine Rotavirus Vaccination • Safety and Efficacy demonstrated for both products in prelicensure clinical trials • 85%-98% effective against severe rotavirus disease • 74%-87% effective against rotavirus disease of any severity through approx first rotavirus season • Contraindication: life-threatening allergy to latex, do NOT use Rotarix®, use RotaTeq® instead

  18. Recommendations for Routine Rotavirus Vaccination • Infants receiving dose 1 inadvertantly after 15 wks 0 days or later should complete series according to schedule and by 8 mos 0 days age. • Infants with hx of rotavirus GE disease should still start or complete vaccination series according to age and interval recommendations.

  19. Recommendations for Routine Rotavirus Vaccination • Complete rotavirus vaccine series with same product whenever possible • Do not defer vaccination if product used for prior doses is not known or is unavailable • Continue series with product in stock • If any dose in series was RV5, or the brand used for any prior dose in the series is unknown, a total of 3 rotavirus vaccines must be used to complete the series

  20. DTaP VaccineDiphtheria, Tetanus, acellular Pertussis • Given IM • 2 months • 4 months • 6 months • 12-18 months • 4-6 years • Minimum 6 months between doses 3 and 4. • 4th dose may be given as early as 12 mos (must have 6 mos interval from dose 3.) • Record Review: if dose #4 was given at least 4 months after dose #3, it does not need to be repeated. • This interval should not be used for scheduling vaccine appointments.

  21. DTaP Reminders • Same DTaP preferred throughout series but can be interchanged • Give DTaP simultaneously with other vaccines •  No DTaP after the age of 6 • Tdap booster

  22. Tdap VaccineTetanus, diphtheria, acellular pertussis • Given IM • Recommended at age10-12 years* • Tdap 1x • Additional Td every 10 yrs • Persons 10-18 years that have not received Tdap should get 1 dose • Tdapused as booster; however, a shorter interval may be used when pertussis immunity is needed.

  23. Hib Vaccine • Given IM • 2 months • 4 months • 6 months • 12-15 months • 3-4 dose series depending on brand of vaccine used • All Hib vaccines are interchangeable • Children 15-59 months with no prior doses need only one dose

  24. Pneumococcal Conjugate Vaccine (Prevnar 13) • PCV13 recommended for routine administration as 4-dose series for infants at: • 2 months • 4 months • 6 months and • 12-15 months • Catch-up recommended for children <24 months, using fewer doses depending on age of 1st dose. • Total doses for a complete series depends on the age at time of visit • Minimum intervals: for primary series = 4 weeks • for booster dose • = 8 weeks

  25. Recommendations for Pneumococcal Conjugate Vaccine • Children 24 months through 59 months: • Healthy children who have not completed any PCV13 schedule, give 1 dose • Those with underlying medical conditions* and have received 3 prior doses, give 1 dose • Those with underlying medical conditions and have received <3 prior doses, give 2 doses at least 8 weeks apart • The minimum interval between all doses PCV7 for all children 24-59 months is 8 weeks. *immunocompromising conditions, selected chronic illnesses, sickle cell disease, functional and anatomic asplenia, HIV

  26. Given IM or SQ Routinely for all adults >65 years age Persons >2 years with: chronic illness, anatomic or functional asplenia, immunocompromised, HIV infection, environments or settings with increased risk, cochlear implant Adults 19-64 years who smoke or have asthma should receive a single dose of PPV23 Should not be administered simultaneously with PCV13; must be given 8 weeks apart A second dose of PPV23 is recommended 5 years after the first PPV23 for persons >2 years who are immuno-compromised, have sickle cell disease, or functional or anatomic asplenia Pneumococcal Polysaccharide Vaccine (PPV23)

  27. Pneumococcal Polysaccharide Vaccine (PPV23) • Revised recommendation in use of PPV23 for American Indian and Alaskan Natives • 24-59 months age – use of PPV23 after PCV7 or PCV13 not recommended, unless in special circumstances, PH authorities may recommend in those living in areas of high risk for the disease. • Routine use not recommended in those <65 yrs. • Unless they have underlying medical conditions; • May be recommended for those 50-64 living in areas of high risk for the disease.

  28. Polio Vaccine • Given IM or SQ • 2 months • 4 months • 6-18 months and • 4-6 years • 3 doses with one after age 4 = complete series • Schedule that includes both OPV & IPV MUST be four doses

  29. Minimum age: 2 yrs for Meningococcal Conjugate Vaccine (MCV4) Menanctra® MCV = children 2-10 yrs in certain high-risk groups Administer routinely at age 11-12 years, or at age 13-18 if not previously vaccinated Given IM Administer to previously unvaccinated college freshman living in a dormitory. Revaccinate with MCV if person received MPSV >3 years previously and remain at increased risk for meningococcal disease Meningococcal Conjugate

  30. Influenza Vaccine • Given IM • Administer annually to all children ages 6 months to 18 years • 6 months-8 years 1-2* dose(s) • 9 years one single dose • Healthy, non-pregnant persons 2-49 years may receive either TIV or LAIV • Dosage for children 6-35 mos receiving TIV = 0.25 ml; those >3 years = 0.5 ml • *Children <9 years receiving influenza vaccine for first time or were vaccinated first time last year but only received 1 dose should receive 2 doses at least 4 weeks apart

  31. Influenza LAIV • Given to children 2 years of age on up, through age 49 years • Same intervals as TIV, same annual recommendations • Screen for history of wheezing

  32. MMR Vaccine • 2 doses given SQ • Dose 1 at  12 months • Dose 2 at 4-6 years • Second dose must be at least 4 weeks after first dose • Second dose may be given before 4 years provided at least 28 days have elapsed since dose 1 • Assure that all children and adolescents receive 2 doses

  33. Varicella Vaccine • 2 doses given SQ • Dose 1 at >12 months • Dose 2 at 4-6 years • Second dose may be given before 4 years provided at least 3 months have elapsed since dose 1 • Recommended for all children & adolescents without evidence of immunity to chickenpox disease • Children 12 mos through 12 years – 3 month minimum interval between doses • If 2nd dose administered at least 28 days after dose 1 it can be accepted as valid • For persons >13 years the minimum interval between doses is 28 days. • If not given on same day as MMR, wait 4 weeks

  34. Hepatitis A Vaccine • Given IM • Children 12-23 months • Two doses at least 6 mos apart • Children not fully vaccinated by age 2 yrs can be vaccinated at subsequent visits • Also recommended for children older than age 1 year who live in areas where vaccination programs target older children or who are at increased risk for infection • Not licensed for use in children under 1 year

  35. Children and Teens 7 Through 18 Years of Age – Vaccines • Tetanus, diphtheria and pertussis • Human papillomavirus (HPV) • Meningococcus • Influenza

  36. Tdap Booster • Required in Colorado for entry to Middle and High Schools • Remember: • ACIP recommendations for Tdap for adolescents, parents of newborns, HCW, Child Care providers, grandparents.

  37. Human Papillomaviruses • More than 120 virus types • Approximately 40 are spread through sexual contact infecting the oral, anal or genital areas of both men and women • HPV infections are very common • Estimated 6.2 million new HPV infections occur annually • Prevalence among adolescent girls is as high as 64% • 75% of new infections occur among persons 15-24 years of age • By 50 years of age, 70-80% of women will have acquired genital HPV infection • Most cause minimal or no symptoms and are cleared completely by the immune system within a few weeks or months

  38. Human Papillomaviruses • Types 16 and 18 • Known as “high-risk” HPV types • Can cause abnormal pap tests and cervical cancer • Together, cause 70% of cervical cancer in US • In men and women – thought to cause 85% of anal cancers, 50% of other anogenital cancers, 20% of cancers of throat and mouth, 10% of cancers of larynx and esophagus • Types 6 and 11 • Responsible for more than 90% of genital warts (can be spread from mother to infant and during delivery)

  39. HPV Vaccine • First vaccine licensed in 2006 • HPV4 (Merck) (types 6, 11, 16 and 18) • HPV2 (GSK) types 16 and 18) • Routine recommendation • 11-12 year old adolescents • Catch-up recommended for females 13-26 yrs • Contraindicated for pregnant women, moderate illness, severe allergy to vaccine component • Efficacy • 100% in preventing cervical pre-cancers (for vaccine types) • 100% effective in preventing vulvar and vaginal pre-cancers and genital warts (for vaccine types) • Higher antibody titers in young girls than older women vaccinated

  40. HPV2 (bivalent) (16,18) HPV4 (quadrivalent) (6, 11, 16, 18) 3 dose series Give second dose 2 months after the 1st and the 3rd dose 6 months after the 1st dose (at least 24 wks) Given IM Routine 11 – 12 years Licensed ages 9 – 26 years HPV 4 can be given to males 70% of cervical cancer (16,18) Pap testing HPV Vaccine

  41. Meningococcal Vaccine • First dose at age 11-12 years • Booster dose given 5 years later (16-18) • Advocate for dose given prior to college entry • Note high-risk activities and risk of illness

  42. Adolescents and Teens May Need to “Catch-up” on Certain Vaccines • Hepatitis A • Hepatitis B • Poliovirus • Measles, Mumps and Rubella • Varicella

  43. Additional Vaccine Information • Combination Vaccines • Intervals and Grace Periods • True Contraindications • VIS • Conversations With Parents • Documentation • Storage and Handling

  44. Combination Vaccines • Kinrix™ - DTAP + IPV • Pentacel® - DTaP + IPV + Hib • Pediarix™ - DTaP + Hep B + IPV

  45. Kinrix™ • GSK Product; Licensed 6/24/08 • DTAP + IPV • Approved only for: • 5th DTaP dose AND 4th IPV dose, IN… • Children 4-6 years of age, WHO… • Received Pediarix™ or Infanrix® for doses 1-3 and Infanrix ® for dose 4 of the DTaP series. CDC Imm Update 2008 Webcast

  46. Kinrix™ • Limited immunogenicity and safety data on the interchangeability of DTaP brands • Whenever feasible, the same manufacturer’s DTaP vaccine should be used throughout the DTaP series. • Vaccination should not be deferred if the previous DTaP brand doses are not known or available CDC Imm Update 2008 Webcast

  47. Kinrix™ • Off label use is not recommended • Administering Kinrix™ for any dose other than the 5th DTaP and the 4th IPV in the series is considered a vaccine administration error • If inadvertently administered as an earlier dose in the series, do not repeat dose; count dose as valid if minimum age and intervals since last doses are met. CDC Imm Update 2008 Webcast

More Related