Vaccine3 polio


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  • Increased risk of VAPP in immunodeficient children and persons >18 years of age.
  • Vaccine3 polio

    1. 1. <ul><li>Vaccine 2 </li></ul>D-r Mitova MU-Sofia
    2. 2. Poliomyelitis <ul><li>First described by Michael Underwood in 1789 </li></ul><ul><li>First outbreak described in U.S. in 1843 </li></ul><ul><li>21,000 paralytic cases reported in the U. S. in 1952 </li></ul><ul><li>Global eradication in near future </li></ul>
    3. 3. Poliovirus <ul><li>Enterovirus (RNA) </li></ul><ul><li>Three serotypes: 1, 2, 3 </li></ul><ul><li>Minimal heterotypic immunity between serotypes </li></ul><ul><li>Rapidly inactivated by heat, formaldehyde, chlorine, ultraviolet light </li></ul>
    4. 4. Poliomyelitis Pathogenesis <ul><li>Entry into mouth </li></ul><ul><li>Replication in pharynx, GI tract, local lymphatics </li></ul><ul><li>Hematologic spread to lymphatics and central nervous system </li></ul><ul><li>Viral spread along nerve fibers </li></ul><ul><li>Destruction of motor neurons </li></ul>
    5. 5. <ul><li>Outcomes of poliovirus infection </li></ul>
    6. 7. Poliovirus Epidemiology <ul><li>Reservoir Human </li></ul><ul><li>Transmission Fecal-oral Oral-oral possible </li></ul><ul><li>Communicability 7-10 days before onset Virus present in stool 3-6 weeks </li></ul>
    7. 8. Poliovirus Vaccine <ul><li>1955 Inactivated vaccine </li></ul><ul><li>1961 Types 1 and 2 monovalent OPV </li></ul><ul><li>1962 Type 3 monovalent OPV </li></ul><ul><li>1963 Trivalent OPV </li></ul><ul><li>1987 Enhanced-potency IPV (IPV) </li></ul>
    8. 9. Inactivated Polio Vaccine <ul><li>Contains 3 serotypes of vaccine virus </li></ul><ul><li>Grown on monkey kidney (Vero) cells </li></ul><ul><li>Inactivated with formaldehyde </li></ul><ul><li>Contains 2-phenoxyethanol, neomycin, streptomycin, polymyxin B </li></ul>
    9. 10. Oral Polio Vaccine <ul><li>Contains 3 serotypes of vaccine virus </li></ul><ul><li>Grown on monkey kidney (Vero) cells </li></ul><ul><li>Contains neomycin and streptomycin </li></ul><ul><li>Shed in stool for up to 6 weeks following vaccination </li></ul>
    10. 11. Inactivated Polio Vaccine <ul><li>Highly effective in producing immunity to poliovirus </li></ul><ul><li>>90% immune after 2 doses </li></ul><ul><li>>99% immune after 3 doses </li></ul><ul><li>Duration of immunity not known with certainty </li></ul>
    11. 12. Oral Polio Vaccine <ul><li>Highly effective in producing immunity to poliovirus </li></ul><ul><li>50% immune after 1 dose </li></ul><ul><li>>95% immune after 3 doses </li></ul><ul><li>Immunity probably lifelong </li></ul>
    12. 13. Polio Vaccination Recommendations, 1996-1999 <ul><li>Increased use of IPV (sequential IPV- OPV schedule) recommended in 1996 </li></ul><ul><li>Intended to reduce the risk of vaccine- associated paralytic polio (VAPP) </li></ul><ul><li>Continued risk of VAPP for contacts of OPV recipients </li></ul>
    13. 14. Polio Vaccination Recommendations <ul><li>Exclusive use of IPV recommended in 2000 </li></ul><ul><li>OPV no longer routinely available in the United States </li></ul><ul><li>VAPP eliminated </li></ul>
    14. 15. Polio Vaccination Schedule Vaccine OPV OPV OPV OPV OPV Age 2 months 3 months 4 months 16months 6 years Minimum Interval --- 4 wks 4 wks
    15. 16. <ul><li>Polio Vaccination Schedule </li></ul>Vaccine IPV IPV IPV IPV Age 2 months 4 months 6-18 months 4-6 years Minimum Interval --- 4 wks 4 wks 4 wks
    16. 17. Schedules that Include Both IPV and OPV <ul><li>Only IPV is available in the United States </li></ul><ul><li>Schedule begun with OPV should be completed with IPV </li></ul><ul><li>Any combination of 4 doses of IPV and OPV by 5 years constitutes a complete series </li></ul>
    17. 18. Polio Vaccination of Adults <ul><li>Routine vaccination of U.S. residents > 18 years of age not necessary or recommended </li></ul><ul><li>May consider vaccination of travelers to polio-endemic countries and selected laboratory workers </li></ul>
    18. 19. Polio Vaccination of Unvaccinated Adults <ul><li>IPV </li></ul><ul><li>Use standard IPV schedule if possible (0, 1-2 months, 6-12 months) </li></ul><ul><li>May separate doses by 4 weeks if accelerated schedule needed </li></ul>
    19. 20. Polio Vaccination of Previously Vaccinated Adults <ul><li>Previously complete series </li></ul><ul><ul><li>administer one dose of IPV </li></ul></ul><ul><li>Incomplete series </li></ul><ul><ul><li>administer remaining doses in series </li></ul></ul><ul><ul><li>no need to restart series </li></ul></ul>
    20. 21. Polio Vaccine Adverse Reactions <ul><li>Rare local reactions (IPV) </li></ul><ul><li>No serious reactions to IPV have been documented </li></ul><ul><li>Paralytic poliomyelitis (OPV) </li></ul>
    21. 22. Vaccine-Associated Paralytic Polio <ul><li>Increased risk in persons > 18 years </li></ul><ul><li>Increased risk in persons with immunodeficiency </li></ul><ul><li>No procedure available for identifying persons at risk of paralytic disease </li></ul><ul><li>5-10 cases per year with exclusive use of OPV </li></ul><ul><li>Most cases in healthy children and their household contacts </li></ul>
    22. 23. Vaccine-Associated Paralytic Polio (VAPP) 1980-1998 <ul><li>Healthy recipients of OPV 41% </li></ul><ul><li>Healthy contacts of OPV recipients 31% </li></ul><ul><li>Community acquired 5% </li></ul><ul><li>Immunodeficient 24% </li></ul>
    23. 24. Polio Vaccine Contraindications and Precautions <ul><li>Severe allergic reaction to a vaccine component or following a prior dose of vaccine </li></ul><ul><li>Moderate or severe acute illness </li></ul>
    24. 25. Polio Eradication <ul><li>Western Hemisphere certified polio free in 1994 </li></ul><ul><li>Last isolate of type 2 poliovirus in India in October 1999 </li></ul><ul><li>Global eradication goal by 2010 </li></ul>
    25. 27. <ul><li>At the start of 2010, 9 countries in west and central Africa are considered to have active outbreaks of polio (i.e. cases within the last six months): Burkina Faso, Chad, Guinea, Liberia, Mali, Mauritania, Nigeria, Senegal and Sierra Leone. </li></ul><ul><li>October 04, 2011 </li></ul><ul><li>Cases of polio have been reported in China, the country’s first cases in more than 10 years. All cases were reported in Xinjiang Uygur autonomous region. Genetic sequencing has shown that the poliovirus isolated from these cases most closely resembles wild poliovirus type 1 found in Pakistan during the second half of 2010. </li></ul>
    26. 28. Distribution of laboratory-confirmed wild poliovirus type 1 cases (N = 476) European Region, 2010 (458 in Tajikistan, 14 in Russia, three in Turkmenistan, and one in Kazakhstan)
    27. 29. Rubella <ul><li>From Latin meaning &quot;little red&quot; </li></ul><ul><li>Discovered in 18th century - thought to be variant of measles </li></ul><ul><li>First described as distinct clinical entity in German literature </li></ul><ul><li>Congenital rubella syndrome described by Gregg in 1941 </li></ul>
    28. 30. Rubella Virus <ul><li>Togavirus </li></ul><ul><li>RNA virus </li></ul><ul><li>One antigenic type </li></ul><ul><li>Rapidly inactivated by chemical agents, low pH, heat and ultraviolet light </li></ul>
    29. 31. Rubella Pathogenesis <ul><li>Respiratory transmission of virus </li></ul><ul><li>Replication in nasopharynx and regional lymph nodes </li></ul><ul><li>Viremia 5-7 days after exposure with spread to tissues </li></ul><ul><li>Placenta and fetus infected during viremia </li></ul>
    30. 32. Rubella Clinical Features <ul><li>Incubation period 14 days (range 12-23 days) </li></ul><ul><li>Prodrome of low grade fever </li></ul><ul><li>Lymphadenopathy in second week </li></ul><ul><li>Maculopapular rash 14-17 days after exposure </li></ul>
    31. 34. Rubella Complications Arthralgia or arthritis children adult female Thrombocytopenic purpura Encephalitis Neuritis Orchitis rare up to 70% 1/3000 cases 1/6,000 cases rare rare
    32. 35. Congenital Rubella Syndrome <ul><li>Infection may affect all organs </li></ul><ul><li>May lead to fetal death or premature delivery </li></ul><ul><li>Severity of damage to fetus depends on gestational age </li></ul><ul><li>Up to 85% of infants affected if infected during first trimester </li></ul>
    33. 36. Congenital Rubella Syndrome <ul><li>Deafness </li></ul><ul><li>Cataracts </li></ul><ul><li>Heart defects </li></ul><ul><li>Microcephaly </li></ul><ul><li>Mental retardation </li></ul><ul><li>Bone alterations </li></ul><ul><li>Liver and spleen damage </li></ul>
    34. 37. Rubella Laboratory Diagnosis <ul><li>Isolation of rubella virus from clinical specimen (e.g., nasopharynx, urine) </li></ul><ul><li>Significant rise in rubella IgG by any standard serologic assay (e.g., enzyme immunoassay) </li></ul><ul><li>Positive serologic test for rubella IgM antibody </li></ul>
    35. 38. Rubella Epidemiology <ul><li>Reservoir Human </li></ul><ul><li>Transmission Respiratory Subclinical cases may </li></ul><ul><li>transmit </li></ul><ul><li>Temporal pattern Peak in late winter and spring </li></ul><ul><li>Communicability 7 days before to 5-7 days </li></ul><ul><li>after rash onset Infants with CRS may shed </li></ul><ul><li>virus for a year or more </li></ul>
    36. 39. Measles <ul><li>Highly contagious viral illness </li></ul><ul><li>First described in 7th century </li></ul><ul><li>Near universal infection of childhood in prevaccination era </li></ul><ul><li>Frequent and often fatal in developing areas </li></ul>
    37. 40. Measles Virus <ul><li>Paramyxovirus (RNA) </li></ul><ul><li>Hemagglutinin important surface antigen </li></ul><ul><li>One antigenic type </li></ul><ul><li>Rapidly inactivated by heat and light </li></ul>
    38. 41. Measles Pathogenesis <ul><li>Respiratory transmission of virus </li></ul><ul><li>Replication in nasopharynx and regional lymph nodes </li></ul><ul><li>Primary viremia 2-3 days after exposure </li></ul><ul><li>Secondary viremia 5-7 days after exposure with spread to tissues </li></ul>
    39. 42. Measles Clinical Features <ul><li>Incubation period 10-12 days </li></ul><ul><li>Stepwise increase in fever to 103 ° F or higher </li></ul><ul><li>Cough, coryza, conjunctivitis </li></ul><ul><li>Koplik spots </li></ul>Prodrome
    40. 43. Measles Clinical Features <ul><li>2-4 days after prodrome, 14 days after exposure </li></ul><ul><li>Maculopapular, becomes confluent </li></ul><ul><li>Begins on face and head </li></ul><ul><li>Persists 5-6 days </li></ul><ul><li>Fades in order of appearance </li></ul>Rash
    41. 46. Condition Diarrhea Otitis media Pneumonia Encephalitis Hospitalization Death Percent reported 8 7 6 0.1 18 0.2 Measles Complications Based on 1985-1992 surveillance data
    42. 47. Measles Laboratory Diagnosis <ul><li>Isolation of measles virus from a clinical specimen (e.g., nasopharynx, urine) </li></ul><ul><li>Significant rise in measles IgG by any standard serologic assay (e.g., EIA, HA) </li></ul><ul><li>Positive serologic test for measles IgM antibody </li></ul>
    43. 48. Measles Epidemiology <ul><li>Reservoir Human </li></ul><ul><li>Transmission Respiratory Airborne </li></ul><ul><li>Temporal pattern Peak in late winter – spring </li></ul><ul><li>Communicability 4 days before to 4 days after rash onset </li></ul>
    44. 49. Mumps <ul><li>Acute viral illness </li></ul><ul><li>Parotitis and orchitis described by Hippocrates in 5th century BCE </li></ul><ul><li>Viral etiology described by Johnson and Goodpasture in 1934 </li></ul><ul><li>Frequent cause of outbreaks among military personnel in prevaccine era </li></ul>
    45. 50. Mumps Virus <ul><li>Paramyxovirus </li></ul><ul><li>RNA virus </li></ul><ul><li>One antigenic type </li></ul><ul><li>Rapidly inactivated by chemical agents, heat and ultraviolet light </li></ul>
    46. 51. Mumps Pathogenesis <ul><li>Respiratory transmission of virus </li></ul><ul><li>Replication in nasopharynx and regional lymph nodes </li></ul><ul><li>Viremia 12-25 days after exposure with spread to tissues </li></ul><ul><li>Multiple tissues infected during viremia </li></ul>
    47. 52. Mumps Clinical Features <ul><li>Incubation period 14-18 days </li></ul><ul><li>Nonspecific prodrome of low-grade fever, headache, malaise, myalgia </li></ul><ul><li>Parotitis in 30%-40% </li></ul><ul><li>Up to 20% of infections asymptomatic </li></ul><ul><li>May present as lower respiratory illness, particularly in preschool-aged children </li></ul>
    48. 54. Mumps Complications CNS involvement Orchitis Pancreatitis Deafness Death 15% of clinical cases 20%-50% in post- pubertal males 2%-5% 1/20,000 1-3/10,000
    49. 55. Mumps Laboratory Diagnosis <ul><li>Isolation of mumps virus </li></ul><ul><li>Serologic testing </li></ul><ul><ul><li>positive IgM antibody </li></ul></ul><ul><ul><li>significant increase in IgG antibody between acute and convalescent specimens </li></ul></ul>
    50. 56. Mumps Epidemiology <ul><li>Reservoir Human </li></ul><ul><li>Transmission Respiratory drop nuclei Subclinical infections may transmit </li></ul><ul><li>Temporal pattern Peak in late winter – spring </li></ul><ul><li>Communicability Three days before to four days after onset of active disease </li></ul>
    51. 57. Measles Mumps Rubella Vaccine <ul><li>12 months is the recommended and minimum age </li></ul><ul><li>MMR given before 12 months should not be counted as a valid dose </li></ul><ul><li>Revaccinate at >12 months of age </li></ul>
    52. 58. MMR Indications <ul><li>All infants >12 months of age </li></ul><ul><li>Susceptible adolescents and adults without documented evidence of rubella immunity </li></ul><ul><li>Emphasis on non-pregnant women of childbearing age, particularly those born outside the U.S. </li></ul>
    53. 59. Second Dose Recommendation <ul><li>First dose of MMR at 12-15 months </li></ul><ul><li>Second dose of MMR at 4-6 years </li></ul><ul><li>Second dose may be given any time >4 weeks after the first dose </li></ul>
    54. 60. MMR Adverse Reactions <ul><li>Fever 5%-15% </li></ul><ul><li>Rash 5% </li></ul><ul><li>Joint symptoms 25% </li></ul><ul><li>Thrombocytopenia <1/30,000 doses </li></ul><ul><li>Parotitis rare </li></ul><ul><li>Deafness rare </li></ul><ul><li>Encephalopathy <1/1,000,000 doses </li></ul>
    55. 61. <ul><li>Severe allergic reaction to vaccine component or following prior dose </li></ul><ul><li>Pregnancy </li></ul><ul><li>Immunosuppression </li></ul><ul><li>Moderate or severe acute illness </li></ul><ul><li>Recent blood product </li></ul>MMR Vaccine Contraindications and Precautions
    56. 62. MMR Vaccine and Autism <ul><li>“ The evidence favors a rejection of a causal relationship at the population level between MMR vaccine and autism spectrum disorders (ASD).” </li></ul><ul><li>- Institute of Medicine, April 2001 </li></ul>
    57. 63. Measles and Mumps Vaccines and Egg Allergy <ul><li>Measles and mumps viruses grown in chick embryo fibroblast culture </li></ul><ul><li>Studies have demonstrated safety of MMR in egg allergic children </li></ul><ul><li>Vaccinate without testing </li></ul>
    58. 64. Measles Vaccine and HIV Infection <ul><li>MMR recommended for persons with asymptomatic and mildly symptomatic HIV infection </li></ul><ul><li>NOT recommended for those with evidence of severe immuno- suppression </li></ul><ul><li>Prevaccination HIV testing not recommended </li></ul>
    59. 65. PPD and Measles Vaccine <ul><li>Apply PPD at same visit as MMR </li></ul><ul><li>Delay PPD >4 weeks if MMR given first </li></ul><ul><li>Apply PPD first—give MMR when skin test read </li></ul>