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: 1.Describe the difference between active and passive immunity 2.List some group of vaccine-preventable diseases 3.List group of live attenuated and inactivated vaccines 4.For each vaccine-preventable disease, identify those for whom routine immunization is recommended 5.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. IMMUNIZATION GOAL  IMMEDIATE GOAL: PREVENTION OF DISEASE IN INDIVIDUAL OR GROUPS  ULTIMATE GOAL: ERADICATION

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

9. VACCINE-PREVENTABLE DISEASES Anthrax Cervical Cancer Diphtheria Hepatitis A Hepatitis B Haemophilus influenzae type b (Hib) Human Papillomavirus (HPV) H1N1 FluH1N1 Flu (((Swine Influenza (Seasonal Flu) Influenza (Seasonal Flu) Japanese Encephalitis (JE) Lyme Disease Measles Meningococcal Mumps Pertussis (Whooping Cough) Pneumococcal Poliomyelitis (Polio) Rabies Rotavirus Rubella (German Measles) Shingles (Herpes Zoster) Smallpox Tetanus (Lockjaw) Tuberculosis Typhoid Fever Varicella (Chickenpox) Yellow Fever

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

11. EXPANDED PROGRAM IMMUNIZATION (EPI) TARGET DISEASES TARGET DISEASES Diseases covered by Traditional EPI Tuberculosis, Diphtheria; Tetanus: Pertussis; Polio; Measles MNT = Maternal and Neonatal Tetanus EPI + YFTuberculosis, Diphtheria; Tetanus (MNT); Pertussis; Polio; Measles; Yellow Fever EPI + diseases to be prevented by relatively new Vaccines Tuberculosis, Diphtheria; Tetanus (MNT); Pertussis; Polio; Measles Hepatitis B; Haemophilus influenzae type b (Hib) EPI + diseases to be prevented by vaccines in the pipeline All above plus: Rotavirus acute diarrhoea; Pneumococcal lower respiratory infections; Human papilloma virus (for cervical cancer); Meningitis A, etc.

12. VACCINE PREVENTABLE DISEASES

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

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

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

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

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 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) Permanent contraindications to vaccination:

21. Contraindications and Precautions Condition Allergy to component Encephalopathy Pregnancy Immunosuppression Severe illness Recent blood product Live C --- C P P** Inactivated C V* V P V 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 Antigen Combination Recommended minimum Interval Between Dose > 2 inactivatedNone; can be administtered simultaneously or at any interval between dose Inactivated and liveNone; can be administtered stimultaneously or at any interval between dose > 2 live28-day minimum interval if not administered at the same visit

31. EXPANDED PROGRAM IMMUNIZATION VACCINEDOSEROUTE BCG0,05 mlIntra dermal Hep B0,5 mlIntra muscular DTP0,5 mlIntra muscular Polio1-2 gttPer oral Measles0,5 mlSub cutan

32. NON-EXPANDED PROGRAM IMMUNIZATION 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 1. MMR (Measles, Mumps, Rubella)

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

34. There are 2 type - Polisacharida vaccine (injection) - Capsular vi Polisakharida vaccine (oral) Recommended at 2 year of age and the booster every 3 year 3. Typhoid Fever 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.