Adolescent Immunization                Dr. Raju R Sahetya                 M.D., D.G.O., D.F.P., F.C.P.S., F.I.C.O.G.,     ...
Positions                               Honorary         Hinduja Healthcare – Surgical Hospital, Khar, Mumbai             ...
RRS
What is Immunization?      -   Administration of all or part of micro          organism or modified product.      -   Resu...
   Prevention and control of disease is important          for their healthy growth.         Routine immunization also p...
   Immunization Program has resulted in the decrease      in incidence of the vaccine preventable diseases.     Unimmuni...
◦   To boost immunity that is decreasing      ◦   Efforts to decrease disease      ◦   To have specific Protection      ◦ ...
RRS
   Scenario in West         Indian ScenarioRRS
RRS
RRS
TT             Booster at 10 and 16 years      Rubella        As part of MMR vaccine or (Monovalent) 1 dose to            ...
BCG            All adolescent without a scar   Diphtheria,   -Tdap booster dose in previously  Pertussis,     immunized  T...
Td vaccine has become available, should            this vaccine be preferred over TT?RRS
In 2007, India contributed 6081 (86.66%) of      the 7017 diphtheria cases reported globallyRRS
RRS
dTap vaccine is also available, should this            vaccine be preferred over dT?RRS
India Contributed >        43%(70k) of Globally      reported Pertussis cases          (161 k) in 2007RRS
RRS
There is a need to vaccinate all adolescents &                  adults against pertussis.                       Recommende...
   Tdap instead of Td is recommended by many          authorities to prevent pertussis in adolescents and          adults...
   Aim is to;          ◦ prevent congenital rubella syndrome (CRS)          ◦ Not just to prevent rubella infection per s...
Haphazard use of rubella vaccine                    in young children      may shift the epidemiology of rubella to the   ...
• Rubella during pregnancy: up to        80% chance of baby born with        CRS      • Growth retardation, eye        pro...
GLOBAL EXPERIENCE               &      WAY FORWARD IN INDIARRS
VZV transmitted from pregnant       woman to fetus during        1st trimester. Can cause:       stillbirth       aborti...
RRS
100 HPV Types Have Been Identified1              30 HPV Types are Transmitted by Genital skin to                          ...
   500,000 women diagnosed per year1     270,000 deaths per year1  ◦ >1 million new cases of cervical cancer each year, ...
   Every year 134000 Indian women are diagnosed          with Cervical cancer and around 72000 die from          the dise...
* Global total HPV-attributable cancers in 2002                                               Attributable to HPV         ...
Cervical canal          Mature         squamous           layer          Squamous            layer         Parabasal      ...
Progression*Time                               Months                                                   Years  Normal     ...
   HPV infections are very common and up to 80% of women will    acquire an HPV infection in their lifetime5–7   The ris...
Natural HPV infection induces a weak immuneresponse1-4                 No inflammation, no danger signals                 ...
Vaccination induces higher antibodies in the blood and site of infection                         • Vaccine induces higher ...
Quadrivalent HPV vaccine FDA licensed Gardasil, Merck      Bivalent vaccine, Cervarix,GSK Biologicals      Both vaccines p...
Studies show a rapid rise in ano-genital HPV infections by –      15 yrs age hence ensure immunization completed prior to ...
Major Worry :  Stigma related to the sexual transmission of HPV.  Vaccine will increase sexual activity among teens.  Vacc...
Visit of 10-12 yrs•Open the conversation with parents and adolescents aboutpreventive strategy for all adolescent risk-tak...
•You could wait. But…Two important reasons to do this now :         •The immune response appears to be better in younger  ...
Can HPV vaccine be given to boys ?      •At present it is only licensed for girls.      •The FDA wants more data about boy...
“Does telling young people to wear bicycle helmets or      seatbelts encourage anyone to bicycle or drive      recklessly”...
RRS
RRS
    Pediatricians & Gynaecologists need to update      periodically about new recommendations     Students going abroad ...
Adolescent Immunization         Adequate immunization      is one of the most important       preventive health services  ...
THANKS      Dr. Raju SahetyaRRS
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Adolescent immunization final

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Adolescent immunization final by Dr Raju R Sahetya

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  • Approved on 10 Sept 2010GSK BIO .
  • Adolescent immunization final

    1. 1. Adolescent Immunization Dr. Raju R Sahetya M.D., D.G.O., D.F.P., F.C.P.S., F.I.C.O.G., OBSTETRICIAN & GYNAECOLOGIST Infertility & Laparoscopic Surgeon Pushpaa Hospital Lokhandwala Complex, Andheri (w), Mumbai, India www.pushpaahospital.com drrajusahetya@gmail.comRRS
    2. 2. Positions Honorary Hinduja Healthcare – Surgical Hospital, Khar, Mumbai Visiting Hospitals BSES * Mumbadevi * Hiranandani Vice President Indian Society for Prenatal Diagnosis & Fetal Therapy (ISPAT) Member Excecutive Council Mumbai Obstetrics & Gynaecology Society (MOGS) Association of Fellow Gynaecologist (AFG) Assciation of Medical Consultant (AMC) Current Position Held MOGS – PNDT & Academic Cell, FOGSI – Sexual Medicine Committee Editorial Board – ISPAT Int. Journal of Prenatal Diagnosis & AFG Times Rotarian Past President Rotary Club of Bombay AirportRRS
    3. 3. RRS
    4. 4. What is Immunization? - Administration of all or part of micro organism or modified product. - Resulting in protection against the disease.RRS
    5. 5.  Prevention and control of disease is important for their healthy growth.  Routine immunization also provides a chance of a health visit  Gives further chance for preventive services and health counseling.RRS
    6. 6.  Immunization Program has resulted in the decrease in incidence of the vaccine preventable diseases.  Unimmunized adolescents are more susceptible.  TT was the only vaccine included in the National Immunization Schedule in India - 2004.RRS
    7. 7. ◦ To boost immunity that is decreasing ◦ Efforts to decrease disease ◦ To have specific Protection ◦ To provide recent vaccines available for immunizationRRS
    8. 8. RRS
    9. 9.  Scenario in West  Indian ScenarioRRS
    10. 10. RRS
    11. 11. RRS
    12. 12. TT Booster at 10 and 16 years Rubella As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13 years of age, if not given earlier MMR 1 dose at 12-13 years of age. (if not given earlier) Hepatitis B 3 Doses (0, 1 and 6 m) if not given earlier Typhoid TA, Vi or Oral typhoid vaccine every 3 years Varicella* 1 dose upto 12-13 years, and 2 doses after 13 years of age. (if not given earlier) Hepatitis A* 2 doses (0 and 6 months) if not given earlierRRS
    13. 13. BCG All adolescent without a scar Diphtheria, -Tdap booster dose in previously Pertussis, immunized Tetanus -Three doses of Tdap in previously unimmunized or partially unimmunized MMR -Single booster dose in all the adolescent -Two doses at 4 weeks in previously unimmunized Hepatitis b Full course in previously unimmunized AdolescentsRRS
    14. 14. Td vaccine has become available, should this vaccine be preferred over TT?RRS
    15. 15. In 2007, India contributed 6081 (86.66%) of the 7017 diphtheria cases reported globallyRRS
    16. 16. RRS
    17. 17. dTap vaccine is also available, should this vaccine be preferred over dT?RRS
    18. 18. India Contributed > 43%(70k) of Globally reported Pertussis cases (161 k) in 2007RRS
    19. 19. RRS
    20. 20. There is a need to vaccinate all adolescents & adults against pertussis. Recommended by ; international consensus group on pertussis & global pertussis initiative.RRS
    21. 21.  Tdap instead of Td is recommended by many authorities to prevent pertussis in adolescents and adults  The major benefit is protection of infants, children and Adolescents from pertussis  Cost is major obstacle – 50 times  Being used in Canada, Not yet licensed in USARRS
    22. 22.  Aim is to; ◦ prevent congenital rubella syndrome (CRS) ◦ Not just to prevent rubella infection per se, as it is usually benign and inconsequential.RRS
    23. 23. Haphazard use of rubella vaccine in young children may shift the epidemiology of rubella to the right with more clinical cases occurring in young adults leading to increase in cases of CRS.RRS
    24. 24. • Rubella during pregnancy: up to 80% chance of baby born with CRS • Growth retardation, eye problems, deafness, heart defects, mental retardation • Many other organs and body systems can be affected • Onset of signs, symptoms and abnormalities may be delayed Thrombocytopenia in a baby born with CRSRRS
    25. 25. GLOBAL EXPERIENCE & WAY FORWARD IN INDIARRS
    26. 26. VZV transmitted from pregnant woman to fetus during 1st trimester. Can cause:  stillbirth  abortion  pre-maturity  malformations  low birth weight  herpes zoster may develop in early childhoodRRS
    27. 27. RRS
    28. 28. 100 HPV Types Have Been Identified1 30 HPV Types are Transmitted by Genital skin to skin Contact 15 HPV Types are Oncogenic In India 4 HPV Types: HPV 16, 18, 31 and 45 are responsible for >90% Squamous Cell Carcinoma2 >95% Adenocarcinoma2RRS
    29. 29.  500,000 women diagnosed per year1  270,000 deaths per year1 ◦ >1 million new cases of cervical cancer each year, 20502  1 out of 4 women who die due to Cervical Cancer in the world is an Indian3RRS
    30. 30.  Every year 134000 Indian women are diagnosed with Cervical cancer and around 72000 die from the disease  Cervical cancer ranks No. 1 among cancers in Indian women, that’s even more than Breast CancerRRS
    31. 31. * Global total HPV-attributable cancers in 2002 Attributable to HPV Site Total cancers % Cases Cervix 492,800 100 492,800 Vulva, vagina 40,000 40* 16,000 Anus 15,900 90* 14,300 Oropharynx 9,600 12* 1,100 Mouth 98,400 3* 2,900 Total 527,100RRS
    32. 32. Cervical canal Mature squamous layer Squamous layer Parabasal cells Basal (stem) cells Basement membrane Normal Infected epithelium epitheliumRRS
    33. 33. Progression*Time Months Years Normal HPV infection CIN1 CIN2 CIN3 Invasive epithelium koilocytosis carcinoma Low-grade squamous intraepithelial High-grade squamous intraepithelial lesion (ASCUS/LSIL) lesion (HSIL) RegressionRRS
    34. 34.  HPV infections are very common and up to 80% of women will acquire an HPV infection in their lifetime5–7 The risk of oncogenic HPV infection is high even after first intercourse and continues throughout a woman’s sexually active lifetime2–4 Although new infections decrease with age, risk of their persistence infection increases with age8 The cumulative risk of acquiring cervical HPV infection in women with only one sexual partner is 46% (3 years after first sexual encounter)1RRS
    35. 35. Natural HPV infection induces a weak immuneresponse1-4 No inflammation, no danger signals Local immunosuppression No viremiaRRS
    36. 36. Vaccination induces higher antibodies in the blood and site of infection • Vaccine induces higher antibody levels in the blood which means higher antibody levels at the site of infection4 • These Antibodies neutralize the virus & prevent entry into cells5,6RRS
    37. 37. Quadrivalent HPV vaccine FDA licensed Gardasil, Merck Bivalent vaccine, Cervarix,GSK Biologicals Both vaccines protect against HPV types 16 and 18. In clinical phase 2 and 3 trials, both vaccines were found to be safe and effective in females. Quadrivalent vaccine is found to be 100% efficacious against high-grade dysplasia, the predecessor to cervical cancer and genital warts.RRS
    38. 38. Studies show a rapid rise in ano-genital HPV infections by – 15 yrs age hence ensure immunization completed prior to it. 11-12 yrs endorsed by the Society for Adolescent Medicine (SAM), 9-10 yrs left to the discretion of the care provider. 3 doses of HPV given at 0, 1 and 6 months in the Deltoid. Both have stable antibody levels and continued efficacy - 5 years post vaccination.RRS
    39. 39. Major Worry : Stigma related to the sexual transmission of HPV. Vaccine will increase sexual activity among teens. Vaccine will not gain widespread acceptance Studies show Parents decisions based on severity of disease, efficacy and safety of the vaccine; the mode of transmission is less important to them. Once educated about HPV, provided with accurate information in a calm and reassuring way, majority of parents have positive response .RRS
    40. 40. Visit of 10-12 yrs•Open the conversation with parents and adolescents aboutpreventive strategy for all adolescent risk-taking behaviors•Clarify their values about a whole range of subjects• (eg, sexuality, drinking, smoking)•Be sensitive to parental anxieties and possible discomfort withdiscussing these subjects.•Talk of HPV as preventive vaccine for cancer and STDRRS
    41. 41. •You could wait. But…Two important reasons to do this now : •The immune response appears to be better in younger girls. •It takes 6 months to be fully immunized and the vaccine has to be given before any risk of exposure. •It makes sense to provide it before any possible exposure might occur.”RRS
    42. 42. Can HPV vaccine be given to boys ? •At present it is only licensed for girls. •The FDA wants more data about boys before they approve it. •Males are a potential target for the vaccine for protection against warts, penile or anal cancer & as a vector for transmission to females.RRS
    43. 43. “Does telling young people to wear bicycle helmets or seatbelts encourage anyone to bicycle or drive recklessly”? Your child may never be at risk for HPV infection, or may not be at risk for many years, but we are recommending that all girls get this before anyone is at risk of infection. It is very effective at this age and vaccinating now eliminates the worry about risk into adulthood.RRS
    44. 44. RRS
    45. 45. RRS
    46. 46.  Pediatricians & Gynaecologists need to update periodically about new recommendations  Students going abroad will come for advise and certificates ◦ Newer vaccines ◦ New recommendations for Booster doses ◦ Preventive / prophylactic vaccinesRRS
    47. 47. Adolescent Immunization Adequate immunization is one of the most important preventive health services that can be provided for an adolescent.RRS
    48. 48. THANKS Dr. Raju SahetyaRRS

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