Vaccination

VACCINATION

JO Y A N N E C . N IC O D E M U S , M D

Principles of Vaccination 

Immunity Ability of the human body to tolerate the presence of material indigenous to the body (self), and to eliminate foreign (nonself) material  Protection from infectious disease  Usually indicated by the presence of an antibody  Very specific to a single organism 

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Antigen vs. antibody  Antigen  Live

or inactivated substances capable of producing an immune response

 Antibodies  Protein

molecules produced in response to an immune response by B lymphocytes to eliminate an antigen

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Immune response… 1.Cells called macrophages gobble up the invading virus and sound the alarm by showing pieces of invader to T-cells & B-cells 2.B cells produce defensive molecules called antibodies that “stick” to the virus. 

Immune response… 3.To overcome the virus, B cells turn into “plasma cells factories” that produce antibodies. Cytotic T cells eliminate cells infected with virus. Helper T cells direct the action with chemical signals. 

Passive immunity vs. active immunity  Passive

Immunity

 Protection

by products produced by an animal or human and transferred to another human, usually by injection  This protection wanes with time, usually within a few weeks or months 

Passive immunity vs. active immunity  Active

Immunity

 Protection

that is produced by the person’s own immune system  Usually permanent 

Passive immunity  Transfer

of antibody produced by one human or other animal to another  Temporary protection  Most common form is by transplacental transfer A

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full term infant may have the same antibodies as the mother

Sources of passive immunity  Almost

all blood or blood products

 Intravenous

immune globulin and plasma products vs washed or reconstituted red blood cells

 Homologous

pooled human antibody (immune globulin)  Produced

by combining (pooling) IgG antibody fraction from different donors  Used primarily for post-exposure prophylaxis for Hepatitis A and measles

Sources of passive immunity  Homologous

human hyperimmune

globulin  Antibody

products that contain high titers of specific antibodies  Made from the donated plasma of humans with high levels of the antibody of interest  Since main source is from humans  may contain lesser amounts of antibodies  Used for post-exposure prophylaxis (Hepatitis B, rabies, tetanus, varicella)

Sources of passive immunity  Heterologous

hyperimmune serum

(antitoxins)  Produced

in animals usually horses  Contains antibodies against only one antigen 

Active immunity  Stimulation

of the immune system to produce antigen-specific humoral (antibodies) and cellular immunity  Usually lasts for many years (as compared to passive immunity) often for a lifetime 

Achieving Active Immunity… 1.Exposure and recovery from infectious disease  “Immunologic

memory”

Memory B cells continue to circulate in the blood and reside in the bone marrow following exposure of the immune system to an antigen  Upon re-exposure to the antigen, the memory cells replicate and produce antibodies rapidly to establish protection 

Achieving Active Immunity… 2.Vaccination  Vaccines

interact with the immune system and produce an immune response similar to that produced by natural infection

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Also produce immunologic memory similar to that acquired by having a natural disease

Factors that Influence Immune Response to Vaccination Presence of maternal antibodies  Nature and dose of the antigen  Route of administration  Presence of adjuvants 

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Aluminumcontaining materials to improve

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Host factors Age  Nutritional factors  Genetics  Coexisting disease 

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Classification of Vaccines 1. Live attenuated 2. Inactivated Vaccines  Produced by modifying  Composed of either a disease-producing whole viruses or (“wild”) virus or bacteria or their bacterium in the fractions laboratory  Produced by growing the  Resulting vaccine bacterium or virus in organism retains the culture media, then ability to replicate inactivating it with and produce heat and/or chemicals immunity, but usually (usually formalin) does not cause illness Whole-cell vaccines  Must replicate in the  Fractional vaccines vaccinated person in  Organism further order to produce an treated to purify only those immune response components to be  included in the vaccine (e.g.

GENERAL RULE

The more similar a vaccine is to the disease-causing form of the organism, the better the immune response to the vaccine.

examples  

Live attenuated Viral          

Measles Mumps Rubella Vaccinia Varicella Zoster Yellow fever Rotavirus Influenza intranasal Oral polio

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Bacterial  

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BCG Oral typhoid

examples  

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Inactivated Vaccines Whole-cell Inactivated Vaccines Viral    

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Pertussis Typhoid Cholera Plague

Fractional Inactivated Vaccines Subunit  

Polio Hepatitis A Rabies Influenza

Bacterial 

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Hepatitis B Influenza Acellular pertussis Human papillomavirus Lyme disease

Toxoid 

Diphtheria

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Tetanus

RECOMMENDED ADULT IMMUNIZATION SCHEDULE

RECOMMENDED ADULT IMMUNIZATION SCHEDULE – special population

RECOMMENDED CHILDHOOD IMMUNIZATION SCHEDULE

RECOMMENDED ADOLESCENT IMMUNIZATION SCHEDULE

Pre Immunization Checklist 1. Have had a vaccine containing live viruses (e.g., measles, mumps, rubella, oral polio) 2. Are unwell on day of immunization 3. Have had previous reaction to any vaccine 4. Have had reaction to any vaccine components 5. Are taking steroids of any sort 6. Have had immunoglobulin or a blood transfusion in the last 3 months

7. Have a disease or are having treatment which causes low immunity (radiotherapy, chemotherapy, etc) 8. Live with someone who has a disease or is having treatment which causes low immunity 9. Have a condition of the CNS which is still being investigated 10.Live with someone who is not immunized 11.Are pregnant

Adult Immunization PSMID RECOMMENDATION FOR ALL ADULTS

Tetanus booster every 10 years  Rubella  Varicella- 2 doses one month apart  Hepatitis B – after screening 

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Elderly

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Influenza annually  Pneumonia every 5 years 

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HEALTH 

INDIRECT CONTACT WITH BLOOD OR BODY SUBSTANCES ( exposed to infections spread by droplet; catering staff and ward clerks)

CATEGORY C 

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DIRECT CONTACT WITH BLOOD O BODY SUBSTANCES( health practitioners, health care students, emergency personnel, central supply staff responsible for decontamination, mortuary technician, maintenance engineers who service equipment)

CATEGORY B 

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WORKERS

CATEGORY A 

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CARE

LABORATORY STAFF

CATEGORY D 

MINIMAL PATIENT CONTACT (clerical admin staff )

HEPATITIS B essential for all categories A-C  Post serological testing maybe done 3 months after vaccination. Those who are still negative should be offered another round.  PERSISTENT NON RESPONDERS should receive HBIg within 48 hours of parenteral exposure to Hepa B  Booster doses not needed since primary course offers life long protection 

Hepatitis A  Higher

risk for

 nursing

staff  Those in contact with patients in  pediatric

ward  Infectious disease ward  Emergency rooms  Intensive care units 

INFLUENZA 

Offer annually to Category A health care workers

POST IMMUNIZATION REACTION  

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Let the patient remain in the clinic 15-30 minutes after vaccination. Mild temperature (< 39) may occur DPT, Hep B, HiB soon after and in MMR even 6-11 days after. If temperature goes up higher than 38’C may give Paracetamol. Drowsiness may follow DPT Nausea, feeling unwell and joint pain may complicate HepB vaccination MMR may cause faint rash (not infectious), runny nose, cough, puffy eyes 6-11 days after but will not last longer than 48 hours. Swelling of the salivary gland may occur 3 weeks after immunization

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