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

2. Principles of Immunization
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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

3. Type of Immunization Active Immunization;
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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

4. Type of Immunization Passive Immunization;
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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

5. Classification of vaccines
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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

6. Type of Immunization Administration
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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

7. Type of Immunization Administration
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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

8. Type of Immunization Safety
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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

9. Type of Immunization Safety
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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

10. Vaccine specific reportable events
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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

11. Immunization in adults: By age
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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

12. Immunization in adults: By doses
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Immunization in adults: By doses

13. Immunization in adults: By health condition
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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

14. Influenza vaccination
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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.

15. Tetanus, diphtheria, and acellular pertussis vaccination
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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

16. Tetanus prophylaxis in wound management
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Tetanus prophylaxis in wound management

17. Pneumococcal vaccination
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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

18. Pneumococcal vaccination
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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

19. Human papillomavirus vaccination
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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.

20. Thank you for your attention
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Thank you for your attention