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Administrative Principles of Vaccination Prof. Dr. AHMET ARVAS I.U. Cerrahpasa Medical Faculty, Department of Pediatrics.

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Presentation on theme: "Administrative Principles of Vaccination Prof. Dr. AHMET ARVAS I.U. Cerrahpasa Medical Faculty, Department of Pediatrics."— Presentation transcript:

1 Administrative Principles of Vaccination Prof. Dr. AHMET ARVAS I.U. Cerrahpasa Medical Faculty, Department of Pediatrics

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3 Vaccine preventable diseases

4 infant mortality in world-2010 Lancet 2012;380:

5 child mortality-2010 (1-4 y) Lancet 2012;380:

6 Vaccine preventable deaths in world-2008 Measles Hib inf Pertussis Tetanus N. Tetanus Yellow fever Diphteria Rotavirus inf Pneumococcal dis Hepatitis B inf million of deaths among children under 5 years are due to diseases that could have been prevented by routine vaccination

7 Measles: 2011:111; 2012:101 cases

8 Active vaccination  Protection produced by vaccine  Usually permanent  Immunity and immunologic memory similar to natural infection but without risk of disease

9 Classification of vaccines Live attenuated  bacterial  viral Inactivated  whole: viruses, bacteria  fractional: protein based (toxoid, subunit) polysaccharide-based (pure, conjugate)

10 Live Attenuated Vaccines Attenuated (weakened) form of the "wild" virus or bacterium Must replicate to be effective Immune response similar to natural infection Usually produce immunity with one dose (except those administrated orally) *except those administered orally

11 Inactivated Vaccines Cannot replicate Generally not as effective as live vaccines Less interference from circulating antibody than live vaccines Generally require 3-5 doses Immune response mostly humoral Antibody titer may diminish with time

12 General Rules  Inactivated vaccines are generally not affected by circulating antibody to the antigen  Live attenuated vaccines may be affected by circulating antibody to the antigen

13 Polysaccharide Vaccines pneumococcal meningococcal Salmonella Typhi (Vi) Haemophilus influenzae type b Pneumococcal (PCV-7, PCV-10, PCV13) Meningococcal (MenC, MCV4) Pure polysaccharide Conjugate polysaccharide

14 2012 Immunization Schedule-Turkey birth 1 month 2 months 4 months 6 months m m First school grade (6 yrs) Eighth school grade (13-14 yrs) PCV MMR OPV B B B vP DaPT/IPV + HepA II Varicella ı

15 Immunization coverage rate in Turkey (%) Source: Turhish Health Ministry Public Health Institute

16 Immunization schedule (unvaccinated children: > 1 year) mos(1-5 yrs) 6-13 yrs >14 yrs at first timeDaPT/IPV/Hib,HepB, ppd DaPT/IPV, HepB, KKKTd, OPV, HepB, KKK >2 daysKKK, ppd: BCG monthsDaPT/IPV/Hib or DaPT/IPV,HepB,OPV DaPT/IPV, HepB, KKK, OPV Td, OPA, HepB, KKK 8 monthsDaPT/IPV,HepB,OPV Td, HepB

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22  All vaccines can be administered at the same visit as all other vaccines

23 Combination two live injected or intranasal influenza vaccine all other Minimum Interval 4 weeks None Spacing of Vaccine Combinations Not Given Simultaneously

24  Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine. It is not necessary to restart the series or add doses because of an extended interval between doses  Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection  Vaccine doses should not be administered at intervals less than the minimum intervals or earlier than the minimum age *after the series has been completed

25 Time limits for using vaccines after reconstitution MMR≤ 8 hrs BCG ≤ 4-8 hrs protect from ligth Varicella ≤ 30 min

26 Types of administration errors  wrong vaccine or wrong diluent  wronge dosage  expired vaccine  wrong route/site/needle size  wrong time  wrong patient

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29 Correct route, site, needle size

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31 Vaccine Adverse Reactions Local – pain, swelling, redness at site of injection – common with inactivated vaccines – usually mild and self-limited

32 Vaccine Adverse Reactions Systemic – fever, malaise, headache – nonspecific – may be unrelated to vaccine

33 Vaccine Adverse Reactions Allergic – due to vaccine or vaccine component – rare – risk minimized by screening

34 Contraindication A condition in a recipient that greatly increases the chance of a serious adverse reaction

35 Precaution A condition in a recipient that might increase the chance or severity of an adverse reaction, or Might compromise the ability of the vaccine to produce immunity

36 Contraindications severe allergic reaction to a vaccine component or following a prior dose (anaphylactic reaction: all vaccines) Encephalopathy/encephalitis not due to another identifiable cause occurring within 7 days of pertussis vaccination Severe combined immunodeficiency (live vaccines) Permanent contraindications to vaccination:

37 Immunosuppression Disease – congenital immunodeficiency – leukemia or lymphoma – generalized malignancy Chemotherapy – alkylating agents – antimetabolites – radiation

38 Immunosuppression Corticosteroids – 20 mg or more per day of prednisone* – 2 mg/kg or more per day of prednisone* – NOT aerosols, alternate day, short courses, topical * for 14 days or longer

39 Vaccination of household contacts of immunosuppressed persons Healthy household contacts of immunosuppressed persons should receive MMR and varicella vaccines and annual influenza vaccination

40 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

41 Vaccination during acute illness No evidence that acute illness reduces vaccine efficacy or increases vaccine adverse reactions Vaccines should be delayed until the illness has improved Mild illness, such as otitis media or an upper respiratory infection, is NOT a contraindication to vaccination

42 A healthcare encounter in which a person is eligible to receive vaccination but is not vaccinated completely Missed opportunity

43 Reasons for missed opportunities Lack of simultaneous administration Unaware child needs additional vaccines Invalid contraindications Inappropriate clinic policies

44 Vaccine Adverse Event Reporting System (VAERS) National reporting system

45 Vaccine Adverse Event Reporting System (VAERS) Detects – new or rare events – increases in rates of known side effects – patient risk factors Additional studies required to confirm VAERS signals Not all reports of adverse events are causally related to vaccine

46 Adverse Event Classification Vaccine-induced: Due to the intrinsic characteristic of the vaccine preparation and the individual response of the vaccinee. These events would not have occurred without vaccination (e.g., vaccine- associated paralytic poliomyelitis after oral polio vaccine). Vaccine-potentiated: The event would have occurred anyway, but was precipitated by the vaccination (e.g., first febrile seizure in a predisposed child). Programmatic error: Due to technical errors in vaccine storage, preparation, handling, or administration. Coincidental: The reported event was not caused by vaccination but happened by chance occurrence or due to underlying illness.

47 Vaccine-associated paralytic polio (VAPP): overall incidence of once case of VAPP: per 2.4 million doses of OPV Rotavirus vaccine/ increased risk of intussusception: no evidence for a causal link (coins.) MMR-V: additional 4.3 febrile seizures per MMR-V doses compared to MMR and V administered separately MCV4/ Guillain-Barre Syndrome: no evidence for a causal link (coincidental) Hep B V/ Guillain-Barre Syndrome, transverse myelitis: no evidence for a causal link MMR/ autism, inflammatory bowel diseases: no evidence for a causal link (coinc.) Thimerosal (mercury containing preservative)-containing vaccines/ autism, inflammatory bowel diseases, ADHD : no evidence for a causal link (coincidental) Vaccines/ ITP: vaccine potentiated


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