Three Vaccines You Can't Live Without!

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Contact me with any questions or comments: chilla@chillagoncz.com

This is a presentation about the benefits and risks, history, and other helpful information about pneumococcal vaccine, seasonal influenza vaccine, and H1N1 vaccine. It was presented to patients at Holy Cross Hospital in November 2009.

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  • Hello and thank you for coming today. My name is Chilla Goncz, I’m a fourth year pharmacy student at Nova Southeastern University, and right next to me is Jennifer Holser, a fourth year pharmacy student at Palm Beach Atlantic University. As many of you are aware, Thanksgiving is coming up next week. Many people say that they are thankful for their health during Thanksgiving, and when we talk about health, people generally think of things like diet, exercise, going to the doctor when you’re sick, but what about preventing being sick in the first place, by using things such as vaccines, which brings me to our subject today, “Three Vaccines You Can’t Live Without!”.
  • Have you ever wondered, well what exactly is a vaccine and how does it work? Would you like to know a little more about pneumococcal diseases, the flu, and H1N1? Who gets sick the most often with these illnesses and who should be targeted with vaccines? What are the benefits and risks of these vaccines? Well, you are about to find out the answers to those very questions. But first, a foundation…
  • So many times we hear the word “germs”. Especially with children, “don’t put that in your mouth, it has germs”, “if you go to school sick, you will give everybody your germs”, but let’s take it up a notch and talk about, what exactly are germs?
  • “germs” are harmful microscopic organisms that can cause disease or illness- we are talking about a multitude of bacteria, viruses, and other agents that are invisible to the naked eye. For the purposes of this presentation, we are going to call them by their scientific term, which is “pathogens”. Only microscopic organisms that cause disease or illness are called pathogens, so this term does not include any of the beneficial bacteria that we get from yogurt and other foods. Vaccines target these pathogens. Which brings me to….
  • Vaccines. Most of you know that they are helpful, but what exactly is a vaccine? Well, the American Heritage Dictionary defines it as a preparation of a weakened or killed pathogen, or a portion of the pathogen’s structure (such as a piece of a bacterial capsule) that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection. So, contrary to popular belief, you can’t get a severe disease or illness from a vaccine that is meant to prevent it.Also, did you know that the vaccine got it’s name from cows? Vaccinus is Latin for “from cows”. Cows are the origin of the first vaccine for humans. Now, we are going to go a little more in-depth…
  • Vaccines work by introducing a small amount or piece of a pathogen (usually a bacteria or virus) to your immune system, which then has the opportunity to stealthily figure out strategies to defeat the invader. This way, when your immune system possibly encounters the pathogen in larger quantities in the future, it will remember its strategy on killing that pathogen in the most effective and efficient manner possible. As a result, you do not end up getting sick because the pathogen is wiped out before it has a chance to truly do any real damage.
  • There are many different types of vaccines on the market, these include:Live, attenuated vaccines, which is essentially a weakened version of a live pathogen and is the closest thing to a natural infection. Inactivated vaccines kill the pathogen with chemicals, heat, or radiation. They are safer because the dead microbes can’t mutate back to their disease-causing state.Subunit vaccines only include the antigens that best stimulate the immune system.Toxoid vaccines are used for bacteria that secrete harmful toxins or chemicals that cause the illness. The toxin is “detoxified”and Conjugate, which link antigens or toxoids from a microbe to a polysaccharide. This is especially useful to the immature immune systems of infants, and a safer alternative for them than the other types of vaccinations.Although almost everyone can get most vaccines, each vaccine has a different set of people that it targets, usually based on things like age, gender, and health conditions. These are called its “indications”.
  • So, rather than having to naturally get sick, suffer, hopefully survive the infection, and then end up with naturally acquired immunity, you can get artificially acquired immunity with vaccines. This way you can become immune to a particular pathogen in a simpler, less risky fashion. Vaccines not only protect you, but the community as well. The more people get vaccinated, the less likely it is that the people that they live with, work with, and interact with will get the pathogen that they are vaccinated against. Did you know that since 1900, the number of Measles, Diptheria, Smallpox, Rubella and Polio cases has decreased by 99-100% because of vaccines! Mumps and Tetanus have also decreased by approximately 96%!So as you can see, there is truth to the old saying “an ounce of prevention is worth a pound of cure”. I will tell you more about that later, but you should be aware of the fact that preventing the illnesses associated with the pathogens that these vaccines protect you against is actually much costlier than getting the vaccine itself.
  • Bringing a drug to the market is no small task. It takes an average of 12 years, $500 million to $2 billion, and a 100,000 page-long application for a drug to go from a laboratory to a pharmacy shelf. Even after a drug is approved to be distributed by pharmacies after three phases of testing in humans, post-marketing surveillance Phase 4 testing is continued as long as a drug is on the market to make sure that it remains as safe and effective as long as humans receive it.
  • One way for the FDA to perform this post-marketing surveillance specifically for vaccine safety is through VAERS reports via the Vaccine Adverse Event Reporting System. This website is set up so that anybody- healthcare professionals, vaccine manufacturers, vaccine recipients, and others can report a bad reaction to a vaccine. The CDC and FDA follow up on these reports to ensure the safety of all vaccines administered in the U.S.
  • So, the first vaccine we are going to talk about today is pneumococcal vaccine.
  • Pneumococcal vaccine protects against bacteria called streptococcus pneumoniae. Did you know that there are 90 different types? Each of these types can cause very severe illnesses, such as…
  • Meningitis, pneumonia, and ear infections. Bacteremia can result from a pneumococcal infection. When you have bacteremia, this means that the bacteria are no longer isolated in one part or region of your body, but have reached your bloodstream and are able to spread throughout your body via your blood vessels. This occurs in 1 out of every 3 to 4 patients that develop pneumococcal pneumonia. It happens most frequently in children, however, adults are susceptible as well. 1 out of 5 cases of bacteremia are fatal, however in the elderly, this jumps to 2 out of 3.Bacteremia can lead to meningitis, which is the most fatal complication of a pneumococcal infection. The meninges cover and protect the brain and spinal cord. Meningitis can result in neurological damage and/or learning disabilities.Pneumonia is the most common pneumococcal disease. You may start to feel ill and weak within 3 days and develop a fever, chills, chest pain, cough, shortness of breath, difficulty breathing and a fast heartbeat. It is fatal in 5-7% of patients, even more so in the elderly.Acute otitis media, or ear infection, is frequently caused by S. pneumoniae as well. 1 out of every 2-4 ear infections in children are caused by these bacteria. Ear infections can result in hearing impairment.
  • Like I mentioned before, there are approximately 90 different subtypes of pneumococcus bacteria. The adult vaccine (Pneumovax) protects against 23 different subtypes that cause 90% of infections, while the children’s vaccine (Prevnar) protects against 7 different subtypes. Both types of pneumococcal vaccine are created using inactivated bacteria. The bacteria are killed and the polysaccharide molecules that make up their capsule are extracted and made into a vaccine.
  • Now, does anybody know who this is on this slide? It is Alexander the Great. Did you know that he died from pneumonia?A safe and effective pneumococcal vaccine was first developed in the 1940s, however, that was approximately when penicillin emerged as well, and the reluctance of physicians to use the vaccine resulted in lack of promotion and it being withdrawn from the market. The first pneumococcal vaccine was released in 1978 and it only protected against 14 subtypes of pneumococcal bacteria. In 1983, an improved version was released that protects against 23 subtypes. In the 1990s, pneumococcal bacteria started to develop resistance to antibiotics, which led to an increase in interest in the pneumococcal vaccine. More recently, in 2000, the children’s version was released. So, these vaccines are quite new when you look at the grand scheme of things and consider that people have been getting ill from pneumococcal diseases for probably hundreds of years.
  • Many people can get this type of vaccine. Who can get the Pneumococcal Polysaccharide Vaccine-23 (PPSV23)? Adults ≥ 65People ages 2-64 who: - Have long-term health complications (heart disease, lung disease, sickle cell disease, DM, etc.)- Have a disease or condition that lowers the body’s resistance to infection (leukemia, kidney failure, organ transplant, etc.)- Are taking a drug or treatment that lowers the body’s resistance to infection (long-term steroids, cancer drugs, radiation, etc.)(get ahead of time if expect immunocompromised state)… takes 2 weeks to kick in.People 19 through 64 who have asthma or smoke cigarettesSo, what about Prevnar (PPSV7), the children’s version? Those who get it include:All infants 2 months of age and older, as well as children < 5 years of age
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  • The second vaccine we are going to talk about today is the seasonal influenza vaccine.
  • Each seasonal influenza vaccine contains three types of influenza: an A strain (H3N2), a regular seasonal A virus (H1N1), and a B virus. Of the 3 types of Influenza (A, B, & C), we are especially concerned with influenza A because it is the most common, the most virulent, and causes the most severe disease. The viruses in the vaccine change annually based on international surveillance and scientists’ educated estimations regarding which strains are most likely to circulate in the upcoming flu season. CDC scientists determining the composition of the 2007-08 flu shot had to sort through 1,161 influenza viruses collected by U.S. labs and an FDA committee was consulted to choose which three strains of influenza to cover to best protect the population. Because the flu vaccine mutates every year, it is difficult to predict which strain will end up being the dominant strain each flu season. However, if you get a seasonal flu shot but end up catching a different strain of the flu that was not one of the three contained in your shot, you will end up with a milder illness than if you had not received the flu shot. This is because your body has a cross-reactive response to the various strains of influenza out there.
  • Influenza A strains are specially identified by their type of Hemagglutinin and Neuraminidase antigens. So, this is where we get things like “H3N2” and “H1N1”. If you look closely at this picture, you can see that Hemagglutinin is here in yellow on the virus and Neuraminidase is in red. Hemagglutinin allows the virus to attach to your cells and Neuraminidase allows the virus to escape from your cells upon replication.
  • Now, why we we have to get a new flu shot every year? Scientists have to target new strains for the seasonal influenza vaccine annually because the influenza virus mutates frequently. Kind of like the Teenage Mutant Ninja Turtles.
  • One strain of influenza can easily combine with another, even across species, leading to recombinant strains of influenza. So, a strain of swine influenza can combine with avian influenza to make a new version of the influenza virus. Occasionally a strain that is virulent will combine with a strain that is highly contagious and create a very powerful version of the flu, such as the novel H1N1 influenza virus.
  • Seasonal influenza often results in high fever, headache, extreme tiredness, dry cough, sore throat, runny or stuffy nose, muscle aches and stomach problems. In the worst case scenario, it can result in pneumonia, worsening of congestive heart failure, worsening of chronic obstructive pulmonary disease, also known as COPD, and other health conditions.When did we start trying to do something about this? Well, from the 1930s through the 1950s, researchers worked on developing an effective influenza vaccine. It was first tested on laboratory animals and then in humans. In 1943 and 1945 a monovalent vaccine was released and found to be effective, but lack of activity in 1947 led researchers to realize that the virus is able to mutate and a new flu vaccine must be created annually in order to effectively protect the population from influenza. A polyvalent vaccine was released in 1959 and has been the most successful solution to date.
  • There are two versions: inactivated and live attenuated. Both are grown and harvested in chicken eggs. The virus is killed in formaldehyde, purified, and packaged in a vial or syringe to make the inactivated vaccine, and the live attenuated virus is packaged in a nasal sprayer. The government actually has worked together with vaccine manufacturer Sanofi Pasteur to manage flocks of chicken specifically set aside to lay eggs for vaccines. These chickens are completely housed and monitored by veterinarians. There are even contingency flocks set aside in case the primary flock comes down with avian influenza or other issues arise.
  • Almost everybody should consider getting this vaccine! It is indicated for a vast majority of the population, including:Children aged 6 months up to their 19th birthdayPregnant womenPeople 50 years of age and olderPeople of any age with certain chronic medical conditionsPeople who live in nursing homes and other long-term care facilitiesPeople who live with or care for those at high risk for complications from flu, including:Health care workersHousehold contacts of persons at high risk for complications from the fluHousehold contacts and out of home caregivers of children < 5 years of age with particular emphasis on vaccinating contacts of children < 6 months of age (these children are too young to be vaccinated & are at higher risk of flu-related complications)
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  • The third vaccine we are going to talk about today is the seasonal influenza vaccine.
  • As I mentioned earlier, certain strains of the influenza virus can combine with each other to form a more powerful version of the flu. This particular version of the flu is two parts swine, one part avian, and one part human, so you can say it’s a bit of a viral “mutt”.
  • This subtype of influenza is actually not new. It has reared its ugly head before as Spanish flu and Russian flu, and was responsible for the Fort Dix outbreak of flu. Each of these occurrences had a high fatality rate.
  • So how does the novel H1N1 influenza compare to seasonal influenza? Mild signs and symptoms are generally the same, however, H1N1 tends to cause more vomiting and diarrhea. H1N1 tends to also hit those under 25 harder than the elderly, unlike seasonal flu. At this time, there are relatively less cases and deaths reported in those 65 and older, which is quite different from the seasonal flu. Pregnant women and those with certain underlying medical conditions are at a higher risk of medical complications with the novel H1N1 influenza strain.
  • The novel H1N1 vaccine is made just like the seasonal flu vaccine and comes in the same formulations!There are two formulations of the H1N1 monovalent vaccine. One is an intramuscular shot of inactivated H1N1 vaccine, the other is an inhaled live attenuated vaccine. The main difference is that the novel H1N1 vaccine targets only one strain of the influenza virus, whereas the seasonal flu shot targets three strains.
  • Who should get the novel H1N1 vaccine? The indications include:pregnant womenpeople who live with or care for children younger than 6 months of agehealthcare and emergency medical services personnelpersons between the ages of 6 months and 24 years oldpeople ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems
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