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Immunization in Adults,
Geriatrics and
Paediatrics
Dr. Milan. C. Patel.
DNB (Family Medicine).
Inlaks and Budhrani Hospita...
What is immunization?
 Immunization is the administration of antigenic
material to stimulate an individual’s immune syste...
History of Vaccination
 429 BC : Greek historian Thycudides noticed that people
who survive smallpox do not get reinfecte...
Edward Jenner
Jenner vaccinated baby with the lymph from a cowpox infected dairymaid. He also used lymph from sores on cow...
EDWARD JENNER
Discovered the small pox vaccine in its
modern form and proved to the scientific
committee that it worked.
History of Vaccination
 1890: Emil von Behring discovers the basis of DT vaccine
 1920s: Vaccines become widely availabl...
Louis Pasteur
Discovered the rabies vaccine
Vaccine Preventable Diseases
 Tuberculosis
 Diptheria
 Pertussis
 Tetanus
 Poliomyelitis
 Measles
 Mumps
 Rubella
...
Recommended Adult Immunization
Schedule by vaccine and age group
 Influenza vaccine
 One dose annually for all adults, 0...
Is an intranasally administered vaccine
0.1 ml in each nostril
Trivalent Inactivated Influenza Vaccine
Tdap/Td Vaccine
 All adults not (I) earlier
 Contacts of infants
 Health care personnel
 Post exposure
 Minor wound:1...
Varicella Vaccine
 2 doses of varicella 4 weeks
apart, 0.5 ml sc
 Special consideration for
 Teachers and child care
em...
Human Papilloma Virus Vaccine
 Quadrivalent ( Gardasil) or Bivalent ( Cervarix) vaccine
 For females , at age 11-12 yrs ...
Quadrivalent HPV Vaccine
Contains types 6,11,16,18.
Bivalent HPV Vaccine
Contains types 16 and 18
Herpes Zoster vaccine
 Single dose 0.65 ml sc for adults more than 60 years of
age.
 For persons with chronic medical co...
Zoster Vaccine
Live virus vaccine recently launched for adults > 60 years
MMR Vaccine
 Measles and Mumps component: two doses of MMR vaccine
are recommended, the second dose administered a
minimu...
MMR Vaccine
 Rubella component: for women of childbearing age,
regardless of birth year, rubella immunity should be
deter...
Pneumococcal polysaccharide Vaccine
All adults more
than 65
Chronic medical
conditions
• Asthma, CAD
• CLD,CRF,DM
• Asplen...
Revaccination with PPSV
 0.5 ml im/sc; 1-2 doses may be required.
 One dose of PPSV is recommended after 5 years for
per...
PNEUMOCOCCAL
VACCINE
Pneumovac 23
contains 23 serotypes
7 valent and 13 valent
Prevnar is also
available
Meningococcal Vaccine
2 doses at 0 and 2
months
Persons with
anatomic and
functional
asplenia
Persistent
complement
defici...
Meningococcal Vaccine
Single dose for microbiologists,
military recruits, students living in
dormitories and travellers to...
Hepatitis A Vaccine
MSM and injection
drug users
Persons working
in laboratories
Persons with CLD
Travellers to
endemic re...
Hepatitis A Vaccine
 It should be administered in a 2 dose schedule at either 0
and 6-12 months or or 0 and 6-18 months.
...
Hepatitis B vaccine
3 doses at 0,1 and 6 months
Sexually active persons not in a
long term monogamous
relationship
Persons...
Administering Vaccine to Adults:
Dose and route
Vaccine Dose Route
Hep A <=18 yrs: 0.5 ml
>=19 yrs: 1 ml
im
Hep B <=19 yrs...
Administering vaccines to Adults:
Dose and Route
Vaccine Dose Route
MMR 0.5 ml sc
MPSV 0.5 ml sc
MCV 0.5 ml im
PCV 0.5 ml ...
National immunization schedule for
infants
vaccine When to give dose route site
BCG At birth or
asap till 1 yr
of age
0.1 ...
National immunization schedule for
children
vaccine When to give Dose route site
DPT booster 16-24 mths 0.5 ml im AL mid t...
National Immunization schedule for
pregnant women
vaccine When to give dose route site
TT-1 Early in
pregnancy
0.5 ml im U...
IAP Immunization Schedule.
Age (completed wks/mo/y) Vaccine
Birth BCG
OPV 0
Hep B-1
6 weeks DTwP-1
IPV – 1
Hib -1
Rotaviru...
IAP Immunization Schedule
Age ( completed wks/mo/y) Vaccines
6 months OPV-1, Hep –B 3
9 months OPV-2, MMR-1
9-12 months Ty...
IAP Immunization Schedule
Age (completed wks/mo/y) Vaccines
16 -18 months DTwP-B1, IPV-B1,Hib-B1
18mths – 2yrs Hep-A 2, Ty...
IAP recommended vaccines for high-risk
children
 Influenza vaccine
 Meningococcal vaccine
 Japanese Encephalitis vaccin...
High Risk Category of Children
 Immunodeficiency
 Chronic medical
conditions , DM
 Long term
immunosuppressive
therapy ...
Dos and Don’ts during immunization
sessions
Dos Don’ts
It is safe and effective to give BCG,
DPT,OPV and measles vaccines ...
Dos and Don’ts during vaccine handling
and administration
Dos Don’ts
Screen for contraindications Do not use unsterile syr...
Vaccine Vial Monitor
Do not use if the central square is equal to or darker than the surrounding circle.
Angles for inserting injections
1) Intramuscular injections are given at an
angle of 90 degrees
2) Subcutaneous injections...
Vaccination in pregnancy
 Live virus vaccines are contraindicated in pregnancy
 Most live virus vaccines, including vari...
Immunosuppression
 In patients with compromised immune function, enhanced
replication of vaccine viruses is possible and ...
Contraindications and precautions for
commonly used vaccines in adults
Vaccine Contraindication Precaution
All vaccines Se...
Contraindications and Precautions
Vaccine Contraindication Precaution
Tdap History of
encephalopathy eg: coma
or prolonged...
Contraindications and Precautions
Vaccine Contraindication Precaution
HPV History of immediate
hypersensitivity to yeast
(...
Contraindications and Precautions
Vaccine Contraindication Precaution
Varicella 1) Pregnancy
2) Known severe
immunodeficie...
Contraindications and Precautions
Vaccine Contraindication Precaution
Influenza, live,
attenuated
1)Hypersensitivity to eg...
Contraindications and Precautions
Vaccine Contraindication Precaution
PPSV none none
Hepatitis A none pregnancy
Hepatitis ...
“
”
The quest for vaccines for
diseases like HIV still continues
“
”
SCIENCE HOPES A VACCINE FOR
EVERY DISEASE.
Thank You.
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Immunization in adults, geriatrics and paediatrics.

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Immunization in adults, geriatrics and paediatrics

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Immunization in adults, geriatrics and paediatrics.

  1. 1. Immunization in Adults, Geriatrics and Paediatrics Dr. Milan. C. Patel. DNB (Family Medicine). Inlaks and Budhrani Hospital, Pune.
  2. 2. What is immunization?  Immunization is the administration of antigenic material to stimulate an individual’s immune system to develop adaptive immunity to a pathogen.  Active immunity develops as a result of infection or by specific immunization and is usually associated with presence of antibodies.  Passive immunity develops when antibodies produced in a human or animal body are transferred to another to induce protection against disease.
  3. 3. History of Vaccination  429 BC : Greek historian Thycudides noticed that people who survive smallpox do not get reinfected.  900 AD : Chinese discovered variolation  1700s : Variolation spreads around the world  1796 : Edward Jenner discovered vaccination in its modern form and proved to the scientific community that it worked.
  4. 4. Edward Jenner Jenner vaccinated baby with the lymph from a cowpox infected dairymaid. He also used lymph from sores on cow teats – found it equally effective
  5. 5. EDWARD JENNER Discovered the small pox vaccine in its modern form and proved to the scientific committee that it worked.
  6. 6. History of Vaccination  1890: Emil von Behring discovers the basis of DT vaccine  1920s: Vaccines become widely available.  1955: Polio vaccination begins.  1956: WHO fights to eradicate smallpox.  1980: Smallpox eradicated from the world.  2008: Professsor Harald zur Hausen awarded Nobel Prize for discovery of HPV Vaccine.  2013: Rotavirus vaccine and shingles vaccine introduced.
  7. 7. Louis Pasteur Discovered the rabies vaccine
  8. 8. Vaccine Preventable Diseases  Tuberculosis  Diptheria  Pertussis  Tetanus  Poliomyelitis  Measles  Mumps  Rubella  Typhoid  Haemophilus influenza B  Hepatitis A  Hepatitis B  Influenza (H1N1)  Varicella  Zoster  Pneumococcal disease  Meningococcal disease  Rotavirus and HPV infection
  9. 9. Recommended Adult Immunization Schedule by vaccine and age group  Influenza vaccine  One dose annually for all adults, 0.5 ml im or id.  Healthy and non-pregnant adults can receive live vaccine.  Others should receive the inactivated vaccine.  For adults aged 65 years and older there is also a high dose influenza vaccine.  Special consideration for people with chronic diseases, immunosuppression with high risk of influenza, pregnancy and people > 65 yrs of age.
  10. 10. Is an intranasally administered vaccine 0.1 ml in each nostril
  11. 11. Trivalent Inactivated Influenza Vaccine
  12. 12. Tdap/Td Vaccine  All adults not (I) earlier  Contacts of infants  Health care personnel  Post exposure  Minor wound:1TT booster if last > 10 yrs ago  Major wound:1TT booster if last dose>5 yrs ago  Primary : 3 doses, 0,1, 6- 12 months, 0.5 ml im  Contacts: single dose 2 wks before contact  Booster : every 10 yrs  Tdap for 19-64 yrs age group and Td for > 65 yrs of age.
  13. 13. Varicella Vaccine  2 doses of varicella 4 weeks apart, 0.5 ml sc  Special consideration for  Teachers and child care employees  Health care staff  Adults and adolescents in contact with children  Contacts of persons with ICS  Non pregnant women of child bearing age  International travellers  C/I in pregnancy, ICS, HIV infection with CD4 count < 200.  Post exposure administration: within 3 days of exposure to varicella rash , can be given upto 5 days of exposure to rash
  14. 14. Human Papilloma Virus Vaccine  Quadrivalent ( Gardasil) or Bivalent ( Cervarix) vaccine  For females , at age 11-12 yrs and catch up vaccination between 13-26 years.  For males, routine vaccination at age 11-12 yrs and for those between 13-21 yrs. MSM may benefit by prevention of condyloma and anal cancer.  3 doses to be given. Second dose 1-2 mths after the first dose, third dose 6 months after the first dose.
  15. 15. Quadrivalent HPV Vaccine Contains types 6,11,16,18.
  16. 16. Bivalent HPV Vaccine Contains types 16 and 18
  17. 17. Herpes Zoster vaccine  Single dose 0.65 ml sc for adults more than 60 years of age.  For persons with chronic medical conditions.  Contraindicated in pregnancy, immunocomprimising conditions and HIV.
  18. 18. Zoster Vaccine Live virus vaccine recently launched for adults > 60 years
  19. 19. MMR Vaccine  Measles and Mumps component: two doses of MMR vaccine are recommended, the second dose administered a minimum of 28 days after the first dose for adults  Who have been recently exposed to measles or mumps or are in an outbreak setting  Are students in postsecondary educational institutions  Work in a health care facility  Those who plan to travel internationally
  20. 20. MMR Vaccine  Rubella component: for women of childbearing age, regardless of birth year, rubella immunity should be determined. If there is no evidence of immunity, women who are not pregnant should be vaccinated. Pregnant women who do not have evidence of immunity should receive MMR vaccine upon termination of pregnancy and before discharge from the health care facility.
  21. 21. Pneumococcal polysaccharide Vaccine All adults more than 65 Chronic medical conditions • Asthma, CAD • CLD,CRF,DM • Asplenia • Elective splenectomy Other conditions • Residents of nursing homes • Chronic smokers
  22. 22. Revaccination with PPSV  0.5 ml im/sc; 1-2 doses may be required.  One dose of PPSV is recommended after 5 years for persons aged 19 through 64 years with chronic renal failure, nephrotic syndrome, asplenia and immune compromising conditions,  For persons aged 65 years or older, one time revaccination is recommended if they were vaccinated 5 or more years previously and were aged less than 65 years at the time of primary vaccination.
  23. 23. PNEUMOCOCCAL VACCINE Pneumovac 23 contains 23 serotypes 7 valent and 13 valent Prevnar is also available
  24. 24. Meningococcal Vaccine 2 doses at 0 and 2 months Persons with anatomic and functional asplenia Persistent complement deficiencies People with HIV 0.5 ml sc
  25. 25. Meningococcal Vaccine Single dose for microbiologists, military recruits, students living in dormitories and travellers to endemic regions Conjugate vaccine (MCV 4 ) for adults less than 55 years Revaccination recommended every 5 years Polysaccharide vaccine for adults more than 55 years Vaccination must for travellers to Hajj
  26. 26. Hepatitis A Vaccine MSM and injection drug users Persons working in laboratories Persons with CLD Travellers to endemic regions Unvaccinated persons who anticipate close personal contact
  27. 27. Hepatitis A Vaccine  It should be administered in a 2 dose schedule at either 0 and 6-12 months or or 0 and 6-18 months.  If the combined hepatitis A and B vaccine ( Twinrix) is used, administer 3 doses at 0, 1 and 6 months. Alternatively, a 4 dose schedule may be used, administered on days 0,7, 21-30, followed by a booster dose at 12 months
  28. 28. Hepatitis B vaccine 3 doses at 0,1 and 6 months Sexually active persons not in a long term monogamous relationship Persons with ESRD,CLD, HIV Contacts of chronic HBV infection MSM, IDU, persons with STD International travellers
  29. 29. Administering Vaccine to Adults: Dose and route Vaccine Dose Route Hep A <=18 yrs: 0.5 ml >=19 yrs: 1 ml im Hep B <=19 yrs: 0.5 ml >=20 yrs: 1 ml im Hep A+B ( Twinrix) >=18 yrs: 1 ml im HPV 0.5 ml im Influenza, live 0.1 ml in each nostril Intranasal spray Influenza,inactivated 0.5 ml im Fluzone 0.1 ml id
  30. 30. Administering vaccines to Adults: Dose and Route Vaccine Dose Route MMR 0.5 ml sc MPSV 0.5 ml sc MCV 0.5 ml im PCV 0.5 ml im PPSV 0.5 ml im / sc Tdap 0.5 ml im Varicella 0.5 ml sc Zoster 0.65 ml sc
  31. 31. National immunization schedule for infants vaccine When to give dose route site BCG At birth or asap till 1 yr of age 0.1 ml ( 0.05 ml until I mth of age) id (L) Upper arm Hep - B At birth or asap within 24 hours 0.5 ml im Anterolateral side of mid thigh OPV 0 At birth or asap within first 15 days 2 drops oral oral OPV 1,2 & 3 6,10,14 wks 2 drops Oral oral DPT 1,2 & 3 6,10,14 wks 0.5 ml im AL mid thigh Hep B 1,2,3 6,10,14 wks 0.5 ml im AL mid thigh measles 9 completed 0.5 ml sc (R ) upper arm
  32. 32. National immunization schedule for children vaccine When to give Dose route site DPT booster 16-24 mths 0.5 ml im AL mid thigh OPV booster 16-24 mths 2 drops Oral oral Measles ( 2nd) 16-24 mths 0.5 ml sc R upper arm JE** 16-24 mths 0.5 ml sc L upper arm Vit A ( 2nd -9th dose ) 16 mths with DPT/OPV booster. Then 1 dose every 6 months upto 5yrs of age. 2 lac IU oral oral DPT booster 5-6 years 0.5 ml im Upper arm TT 10 yrs & 16 yrs 0.5 ml im Upper arm
  33. 33. National Immunization schedule for pregnant women vaccine When to give dose route site TT-1 Early in pregnancy 0.5 ml im Upper arm TT-2 4 weeks after TT-1 0.5 ml im Upper arm TT-booster If taken 2 TT doses in a pregnancy within last 3 yrs. Give before 36 wks. give TT to a woman in labour if she has not got TT before. 0.5 ml im Upper arm
  34. 34. IAP Immunization Schedule. Age (completed wks/mo/y) Vaccine Birth BCG OPV 0 Hep B-1 6 weeks DTwP-1 IPV – 1 Hib -1 Rotavirus -1 PCV-1 Hep B-2 10 weeks 2ND dose of DTwP, IPV,Hib,Rotavirus,PCV 14 weeks 3RD dose of DTwp,IPV, Hib,Rotavirus,PCV
  35. 35. IAP Immunization Schedule Age ( completed wks/mo/y) Vaccines 6 months OPV-1, Hep –B 3 9 months OPV-2, MMR-1 9-12 months Typhoid conjugate vaccine 12 months Hep-A 1 15 months MMR-2, Varicella-1, PCV Booster
  36. 36. IAP Immunization Schedule Age (completed wks/mo/y) Vaccines 16 -18 months DTwP-B1, IPV-B1,Hib-B1 18mths – 2yrs Hep-A 2, Typhoid booster 4 – 6 years DTwP-B 2, Varicella 2, Typhoid booster, OPV 3 10-12 years Tdap/Td, HPV.
  37. 37. IAP recommended vaccines for high-risk children  Influenza vaccine  Meningococcal vaccine  Japanese Encephalitis vaccine  Cholera vaccine  Rabies vaccine  Yellow fever vaccine  PPSV 23
  38. 38. High Risk Category of Children  Immunodeficiency  Chronic medical conditions , DM  Long term immunosuppressive therapy or RT  CSF leaks, cochlear implants, malignancies  Functional or anatomic asplenia  During outbreaks  Having pets in home  Who are at higher threat of being bitten by dogs such as hostellers, risk of stray dogs while going outdoor
  39. 39. Dos and Don’ts during immunization sessions Dos Don’ts It is safe and effective to give BCG, DPT,OPV and measles vaccines at the same time to a child who has completed 9 months and never been vaccinated Do not withhold the vaccine in case of illness such as cold, cough, diarrhoea or fever. Give BCG to infants less than 1 year of age Never give BCG to children above 1 year of age If a child is brought late for a dose , pick up where the schedule was left
  40. 40. Dos and Don’ts during vaccine handling and administration Dos Don’ts Screen for contraindications Do not use unsterile syringe Check label of the vial and expiry date Do not touch any part of needle Lightly shake the vial of T-series vaccine before drawing the dose Do not recap the needle Use a new syringe for each injection and a new disposable syringe for each reconstitution Do not leave the needle inside the vial Never inject in the buttock. Use correct diluent Never use vaccine with VVM in unusable stage Inject using correct site and route Never massage the vaccination site Allow dose to self dispense instead of massaging Never use reconstituted measles and BCG vaccine after 4 hours and JE after 2 hours
  41. 41. Vaccine Vial Monitor Do not use if the central square is equal to or darker than the surrounding circle.
  42. 42. Angles for inserting injections 1) Intramuscular injections are given at an angle of 90 degrees 2) Subcutaneous injections are given at an angle of 45 degrees 3) Intravenous injections are given at an angle of 25 degrees 4) Intradermal injections are given at an angle of 10-15 degrees
  43. 43. Vaccination in pregnancy  Live virus vaccines are contraindicated in pregnancy  Most live virus vaccines, including varicella vaccine, are not secreted in breast milk; therefore, breast feeding is not a contraindication for live virus or other vaccines.  Pregnancy is not a C/I for inactivated vaccines but most are avoided in pregnancy as relevant safety data are limited.  Trivalent inactivated influenza vaccine may be given in influenza season.
  44. 44. Immunosuppression  In patients with compromised immune function, enhanced replication of vaccine viruses is possible and could lead to disseminated infection with the vaccine virus. Hence live viruses are C/I in immunocompromised conditions.  HIV, hematologic or generalized malignancy and therapy with immunosuppressive agents including high dose glucocorticoids are immune compromising conditions.
  45. 45. Contraindications and precautions for commonly used vaccines in adults Vaccine Contraindication Precaution All vaccines Severe allergic reaction Moderate to severe acute illness with or without fever Td -- GBS within 6 weeks of a previous dose of TT containing vaccine History of arthus type hypersensitivity reaction after a previous dose of TT containing vaccine. Defer vaccination until atleast 10 years have elapsed since the last dose.
  46. 46. Contraindications and Precautions Vaccine Contraindication Precaution Tdap History of encephalopathy eg: coma or prolonged seizures not attributable to another identifiable cause within 7 days of administration of DTaP or Tdap ie : with pertussis component 1) GBS within 6 weeks after a previous dose of TT-containing vaccine 2) Unstable neurologic conditions 3) History of Arthus type hypersensitivity reactions; defer vaccination until at least 10 years have elapsed since the last dose. 4) Pregnancy.
  47. 47. Contraindications and Precautions Vaccine Contraindication Precaution HPV History of immediate hypersensitivity to yeast ( for Gardasil) Pregnancy MMR 1) History of immediate hypersensitivity reaction to gelatin or neomycin 2) Pregnancy 3) Known severe immunodeficiency Recent ( within 11 mths) receipt of antibody containing blood product.
  48. 48. Contraindications and Precautions Vaccine Contraindication Precaution Varicella 1) Pregnancy 2) Known severe immunodeficiency 3) History of immediate hypersensitivity reaction to gelatin or neomycin Recent (within 11 mths) receipt of antibody containing blood products. Influenza, injectable, trivalent History of immediate hypersensitivity reaction to eggs 1) GBS within 6 weeks of previous dose. 2) Pregnancy is not a C/I Recommended for women who will be pregnant during influenza season.
  49. 49. Contraindications and Precautions Vaccine Contraindication Precaution Influenza, live, attenuated 1)Hypersensitivity to eggs 2)Age > 50 yrs 3)Pregnancy 4)Immunosuppression 5)Chronic medical conditions 6)Close contact with severely immunosuppressed persons who require a protected environment, such as isolation in a bone marrow transplant unit. History of GBS within 6 weeks of a previous influenza vaccine dose.
  50. 50. Contraindications and Precautions Vaccine Contraindication Precaution PPSV none none Hepatitis A none pregnancy Hepatitis B Hypersensitivity to yeast Meningococcal conjugate 1) Age > 55 years 2) History of severe allergic reaction to latex or to DT containing vaccine History of GBS Meningococcal polysaccharide History of severe allergic reaction to latex Zoster 1) Age < 60 years & ICS 2) Pregnancy 3) Hypersensitivity to gelatin or neomycin.
  51. 51. “ ” The quest for vaccines for diseases like HIV still continues
  52. 52. “ ” SCIENCE HOPES A VACCINE FOR EVERY DISEASE.
  53. 53. Thank You.

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