VACCINES IMMUNISATION IN ADULTS Prof. Dr. A. Çağrı BÜKE Yeditepe University Medical Faculty Department of Infectious Diseases

Principles of Immunization Ç. BÜKE VACCINES Principles of Immunization A number of factors are important when administering vaccines to healthy adults These include; The type of immunization to be used Safety The responsibilities of the individual giving the vaccination Proper storage

Type of Immunization Active Immunization; Ç. BÜKE VACCINES Type of Immunization Active Immunization; The goal of active immunization of a vaccine or toxoid is to stimulate the host to produce a primary immune response (usually by inducing B-cell proliferation, antibody response, and T-cell sensitization) Vaccines used for active immunization are derived from Whole killed bacteria, live attenuated bacteria or viruses, or antigenic subunits of organisms Toxoids

Type of Immunization Passive Immunization; Ç. BÜKE VACCINES Type of Immunization Passive Immunization; Passive immunization involves administration of antibodies Passive immunization offers short-term protection to people who have been or will be exposed to a specific pathogen It is typically used by immunocompromised patients who are unable to produce an effective immune response with active immunization

Classification of vaccines Ç. BÜKE VACCINES Classification of vaccines Live attenuated; MMR, BCG, Varicella, Rota, OPV Inactive; Influenza, Hepatitis A, IPV Subünits Toksoid; TDB Polisaccaride; S.pneumoniae 23V PSV Konjugated; H.influenzae tipb, S.pneumoniae 13V, N.meningitidis Recombinant; Hepatit B, HPV

Type of Immunization Administration Ç. BÜKE VACCINES Type of Immunization Administration Most adult vaccines are administered intramuscularly or subcutaneously, usually in or over the deltoid muscle. Deltoid intramuscular injections should be given with a 1 to 1.5 inch needle to achieve at least 5 mm of muscle penetration Most widely used vaccines can be administered simultaneously at different sites without compromising efficacy

Type of Immunization Administration Ç. BÜKE VACCINES Type of Immunization Administration Live virus vaccines should either be administered on the same day Subsequent immunization with live virus vaccines should be delayed one month to avoid the theoretical concern that the immune response to one or both might be impaired Immune globulins should not be administered along with live virus vaccines because the passively administered antibodies can interfere with the vaccine response

Type of Immunization Safety Ç. BÜKE VACCINES Type of Immunization Safety Most vaccines are safe to administer, causing only minor side effects Many vaccines and toxoids cause side effects such as; fever, local reactions at the site of injection These adverse reactions can be caused by the immunogenic moiety in the vaccine or by trace amounts of antibiotics, preservatives, stabilizers, and residual animal proteins These side effects are not considered true contraindications to vaccination

Type of Immunization Safety Ç. BÜKE VACCINES Type of Immunization Safety True contraindications to vaccination are rare and include; Severe hypersensitivity reactions, such as anaphylaxis and severe neurologic complications Administration of live virus vaccines to immunocompromised patients is also contraindicated Vaccination should be avoided only if true contraindications are present

Vaccine specific reportable events Ç. BÜKE VACCINES Vaccine specific reportable events Tetanus – Brachial neuritis within 28 days Pertussis – Encephalopathy or encephalitis within seven days Measles, mumps, and/or rubella – Encephalopathy or encephalitis within 15 days Rubella – Chronic arthritis within six weeks Measles – Thrombocytopenic purpura within 7 to 30 days Oral polio – Paralytic polio or vaccine-strain polio within 30 days to six months

Immunization in adults: By age Ç. BÜKE VACCINES Immunization in adults: By age You should get this vaccine if you did not get it when you were a child Recomended Flu vaccine every year You should get a Td booster every 10 years May be recomended Women should get a Tdap vaccine during every pregnancy 1 dose of PCV13 and at least 1 dose of PPSV23 are needed depending on the age and health condition

Immunization in adults: By doses Ç. BÜKE VACCINES Immunization in adults: By doses

Immunization in adults: By health condition Ç. BÜKE VACCINES Immunization in adults: By health condition You should get this vaccine if you did not get it when you were a child Recomended Flu vaccine every year You should get a Td booster every 10 years May be recomended Women should get a Tdap vaccine during every pregnancy 1 dose of PCV13 and at least 1 dose of PPSV23 are needed depending on the age and health condition

Influenza vaccination Ç. BÜKE VACCINES Influenza vaccination All persons aged 6 months or older who do not have a contraindication should receive annual influenza vaccination with an age-appropriate formulation of inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV) Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate IIV or RIV Pregnant women and women who might become pregnant in the upcoming influenza season should receive IIV.

Tetanus, diphtheria, and acellular pertussis vaccination Ç. BÜKE VACCINES Tetanus, diphtheria, and acellular pertussis vaccination Adults with an unknown or incomplete history of a 3-dose primary series with tetanus and diphtheria toxoid-containing vaccines should complete the primary series that includes 1 dose of Tdap. Unvaccinated adults should receive the first 2 doses at least 4 weeks apart and the third dose 6–12 months after the second dose Pregnant women should receive 1 dose of Tdap during each pregnancy, preferably during the early part of gestational weeks 27–36, regardless of prior history of receiving Tdap

Tetanus prophylaxis in wound management Ç. BÜKE VACCINES Tetanus prophylaxis in wound management

Pneumococcal vaccination Ç. BÜKE VACCINES Pneumococcal vaccination Adults who are immunocompetent and aged 65 years or older should receive 13-valent pneumococcal conjugate vaccine (PCV13) followed by 23-valent pneumococcal polysaccharide vaccine (PPSV23) at least 1 year after PCV13 Adults are recommended to receive 1 dose of PCV13 and 1, 2, or 3 doses of PPSV23 depending on indication When both PCV13 and PPSV23 are indicated, PCV13 should be administered first PCV13 and PPSV23 should not be administered during the same visit

Pneumococcal vaccination Ç. BÜKE VACCINES Pneumococcal vaccination Adults aged 19 through 64 years with chronic heart disease, chronic lung disease, chronic liver disease, alcoholism, diabetes mellitus, who smoke cigarettes, Adults aged 19 years or older with cerebrospinal fluid leak or cochlear implant and with anatomical or functional asplenia Should receive they should receive PCV13 and another dose of PPSV23 at least 1 year after PCV13 and at least 5 years after the most recent dose of PPSV23

Human papillomavirus vaccination Ç. BÜKE VACCINES Human papillomavirus vaccination Adult females through age 26 years and adult males through age 21 years who have not received any human papillomavirus (HPV) vaccine should receive a 3-dose series of HPV vaccine at 0, 1–2, and 6 months. Males aged 22 through 26 years may be vaccinated with a 3-dose series of HPV vaccine at 0, 1–2, and 6 months.

Thank you for your attention Ç. BÜKE Antibiotics Thank you for your attention