Adult Vaccine 2013 final

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adult vaccine updates according to last ACIP 2013

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Adult Vaccine 2013 final

  1. 1. Ahmed Saad MD. FACP. Assistant Prof Internal Medicine & Infectious Diseases Cairo university
  2. 2. Disclosures  I have no financial conflict or interest with the manufacturer of any product named during this presentation .  I will not discuss vaccines not licensed by the FDA
  3. 3. 2013 Vaccine Updates  Influenza  Hepatitis Vaccine  Pneumococcal  Varicella  Herpes Zoster  T dap  HPV  Meningococcal
  4. 4. Louis Pasteur (1822-1895) A Vision to future of humanity  When dealing with a disease, I never think of finding a remedy for it, but, instead, a means of prevention
  5. 5. Why adult vaccinations? Adult deaths from vaccine preventable diseases = 60,000 From: IOM, Calling the Shots: Immunization Finance Policies and Practices, 200
  6. 6. Why some adults need vaccines?  Some adults incorrectly assume that the vaccines they     received as children will protect them for the rest of their lives. Some adults were never vaccinated as children Newer vaccines were not available when some adults were children Immunity can begin to fade over time As we age, we become more susceptible to serious disease caused by common infections (e.g., flu, pneumococcus)
  7. 7. Burden of Adult Vaccine-Preventable Disease Influenza: 10-20% of US people annually 36,000 deaths (average) Pertussis: 1 million Cervical cancer: 10,000 H Zoster : 1 million Pneumococcal: 2,000-5000 meningitis 40,000 bloodstream infections 150,000-300,000 pneumonia
  8. 8. Incidence rates for invasive PD (IPD) in the Middle East 1. Garcia CR et al. Poster presented at 8th bi-annual International Symposium on Pneumococci and Pneumococcal Diseases (ISPPD8), Iguacu Falls, Brazil (March, 2012).
  9. 9. What makes a conjugate different? Polysaccharide antigens carrier protein Conjugate vaccine + = Presentation B cell T cell B cell Plasma cell T-independent Memory B cell T-dependent Plasma cell The conjugation of a polysaccharide to a carrier protein leads to the interaction with T cells resulting in the release of functional antibodies and production of memory B cells 1,2 1. de Roux A et al. Clin Infect Dis. 2008;46:1015-1023. 2. Pollard AJ et al. Nat Rev Immunol. 2009;9:213-220.
  10. 10. Recommended Adult Immunization Schedule — United States, 2013  Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the recommended adult immunization schedule to ensure that the schedule reflects current recommendations for the licensed vaccines.
  11. 11. From: http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm
  12. 12. Influenza Virus  Family Orthomyxoviridae  Three main types  Type A  Multiple species  Type B  Humans  Type C  Humans and swine
  13. 13. Influenza updates  For the (Live Attenuated Influenza Vaccine) LAIV, beginning with 2013–14 season, only the quadrivalent formulation will be available and trivalent formulation will stop.  It contains 2 influenza A (H3N2) and (H1N1), plus 2 influenza B vaccine virus strains  Also the name inactivate influenza vaccine( IIV ) replaced the name trivalent inactivated vaccine ( TIV)
  14. 14. Influenza updates  Annual vaccination against influenza is recommended for all persons aged 6 months or older.  Healthy persons , non pregnant (2-49 y) with no high-risk medical conditions can receive (LAIV) or IIV.  Health care personnel, immunocompromised and pregnant should receive IIV rather than LAIV.
  15. 15. clinical form of pneumococcal disease Invasive Non-invasive * Acute otitis media ** including empyema 1. WHO. Acute Respiratory Infections (Update September 2009). 2. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine Preventable Diseases. The Pink Book. 11th Edition. May 2009.
  16. 16. ACIP risk groups for pneumococcal infection  (ACIP) recommends vaccination of:  All adults aged 65 years on over • The US Advisory Committeeand Immunization Practise (ACIP) recommends vaccination of: − All adults aged 65 years and with the following underlying medical conditions: Adults 19-64 years over − Adults aged 19-64 years with the following underlying medical conditions: 1- Immunocompetent persons  Chronic heart disease  Chronic lung disease Diabetes mellitus  Cerebrospinal fluid leaks  Cochlear implant  Chronic liver disease   Cigarette smoking 3-Immunocompromised persons  Congenital or acquired (HIV)     2- Functional or anatomic asplenia Sickle cell disease  Splenectomy  congenital or acquired asplenia   immunodeficiet C R F & Nephrotic Leukaemias & Lymphomas Generalised malignancy Diseases treated with immunosuppression( steroids >1 m or Biologics Solid organ transplantation 1. Centers for Disease Control and Prevention. MMWR. Prevention of Pneumococcal Disease. ACIP Recommendations 2010;59:1102–1106. 29
  17. 17. Pneumococcal Vaccine Adults aged 19 years or older with underlying medical conditions should receive a single dose of PCV13 followed 8 weeks later by a dose of PPSV23
  18. 18. Prevenar 13 (PCV13): 1 4 3 6B 5 9V 6A 14 7F 18C 19A 19F 23F Using CRM197 , the same carrier protein as Prevenar 1,2, with more than 20 years of experience in vaccines 3 1.Prevenar EPAR. 2. Prevenar 13 Summary of Product Characteristics March 2012. 3. Centers for Disease Control and Prevention. Update: Haemophilus influenzae type b vaccine. MMWR. 1989;38:14. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001330.html. Accessed May 24, 2011.
  19. 19. SHINGLES(HERPES ZOSTER)
  20. 20. Effect Of Herpes Zoster Vaccine
  21. 21. Herpes Zoster / Shingles  Live attenuated VZV in amount 14 times greater in minimum potency than varicella vaccine ,to elicit a significant increase in the CMI to VZV among older adults  Since 2006, the ACIP/CDC recommends to vaccinate all people > 60 y regardless of history of shingles.  CDC has recommendation and both Zoster & Pneumococcal vaccines can be administered at the same visit if indicated.
  22. 22. Herpes zoster vaccination  Only single dose.  Also persons with chronic medical conditions Can be vaccinated
  23. 23. H zoster use in immunocompromised
  24. 24. H ZOSTER for immunocompromised  Retrospective study of 463,541 with age >60 y with 1 of the following autoimmune diseases: rheumatoid arthritis, psoriasis, psoriatic arthritis, ankylosing spondylitis, or inflammatory bowel disease.  19,000 of received zoster vaccine, of them 633 patients exposed to biologics (551 anti TNF) .  Incidence of HZ within 42 days post vaccination and follow up period of 2 years.
  25. 25. Demographic Data
  26. 26. immunosuppressive Treatment
  27. 27. H ZOSTER for immunocompromised  None of these patients on biologics developed varicella or HZ in 42 days  Decrease incidence of H zoster by 39 % in vaccinated group in 2 years  ACIP recommended that persons > 60 to receive zoster vaccine with or without immunocomromised conditions .
  28. 28. Natural History of HPV Infection and Potential Progression to Cervical Cancer 0–1 Year 0–5 Years Continuing Infection Initial HPV Infection 1–20 Years CIN 2/3 Invasive Cervical Cancer CIN 1 Cleared HPV Infection (~80%) 1. Pinto AP, Crum CP. Clin Obstet Gynecol. 2000;43:352–362. cervical intraepithelial neoplasia (CIN).
  29. 29. Recurrent Respiratory Papillomatosis
  30. 30. Human Papilloma virus VaccineRecommendations Age & Dose  Routine immunization of females at 11-12 years  Vaccination of females up to age 26  3 Dose 0, 1, 6 months
  31. 31. Meningococcal vaccination  Meningococcal vaccine should be administered to persons with the following indications: 1-Medical: A 2-dose series of meningococcal conjugate vaccine (8 w apart ) is recommended for adults with anatomic or functional asplenia, or persistent complement component deficiencies. 2-Adults with HIV infection : to receive a routine 2-doses The 2 doses should be administered at 0 and 2 months
  32. 32. Meningococcal vaccination  Administer a single dose to 1- Microbiologists routinely exposed to N meningitidis 2- Military recruits, 3- Those who travel to or live in countries in which meningococcal disease is hyperendemic or epidemic.  Revaccination with MCV4 every 5 years is recommended for adults who remain at increased risk for
  33. 33. Tetanus, Diphtheria & Pertussis (Tdap), cont  Adults are recognized as a reservoir of transmission of Pertussis to a susceptible infants at greatest risk of complications  Updated schedule for Tdap adults 19-64 y to receive a one dose of Tdap followed Td booster every 10 years  Pregnant women:  Tdap during 3rd trimester of every pregnancy
  34. 34. T dap
  35. 35. Varicella vaccination  All adults without evidence of immunity to varicella should receive 2 doses (1 month apart )  Evidence of immunity to varicella in adults includes any of the following: 1- Documentation of 2 doses of varicella vaccine at least 4 weeks apart 2-History of varicella diagnosed by healthcare provider
  36. 36. Hepatitis A vaccination  Vaccinate any person seeking protection from hepatitis A virus (HAV) or persons with any of the following — Persons with chronic liver disease or who is receiveing clotting factor concentrates. — Persons who use injection or non injection illicit drugs. — Persons traveling to or working in countries that have high endemicity of hepatitis A
  37. 37. Hepatitis A vaccination  2 doses at 0 and 6 months (Havrix )  Or Twinrix (Hepatitis A+B)0-1-6  Or Twinrix a 4-dose schedule (days 0, 7, and 21 ) followed by a booster dose a 12 month .
  38. 38. Hemodialysis and Hepatitis B Vaccination For hemodialysis or immunocompromised 2 doses of 20 μg/mL (Engerix-B) administered simultaneously on a 4-dose schedule( 0, 1, 2, and 6 months)
  39. 39. Rubella component  Women of childbearing age rubella immunity should be checked . If no immunity, and not pregnant should be vaccinated.  Pregnant women with no immunity should receive MMR vaccine upon completion or termination of pregnancy and before discharge from the hospital
  40. 40. Conclusion  Our immunocompromised patients should vaccinated with Influenza , Pneumococcal , H Zoster ,Tdap , Hepatitis , Human Papilloma virus

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