What's all the Fuss with Vaccinations?

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Dr. Maynard reviews the importance of vaccination for the health and safety of children, and adults alike. (originally presented 8.15.12)

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What's all the Fuss with Vaccinations?

  1. 1. What’s all the fuss with vaccinations? Presented by Dr. Roy Maynard August 15, 2012
  2. 2. Objectives• Understand the role of antigenic drift and shift in influenza• Recognize differences in influenza vaccinations• Describe mechanism of action of anti-influenza drugs• Identify American Academy of Pediatrics Recommendations for influenza vaccination for the 2012-2013 season 2 of 39
  3. 3. Definition• Edward Jenner 1796 used cowpox (variola vaccinia) to inoculate• Individuals inoculated with cowpox were protected against smallpox• The term “vaccine” derived from this historical perspective 3 of 39
  4. 4. Definition• A vaccine is a biological preparation that improves immunity to a particular disease• Flu shot: split-virus vaccine, trivalent since 1945• Nasal spray: LAIV (live attenuated influenza virus) since 2003 4 of 39
  5. 5. Dr. Edward Jennerhttp://www.ourcivilisation.com/smartboard/shop/jennere/about.htm Accessed 8/14/12 5 of 39
  6. 6. SmallpoxBangledesh (1973) USA (1912) http://en.wikipedia.org/wiki/Smallpox Accessed 8/14/12 6 of 39
  7. 7. Smallpox• Mortality 30 in severe form• Mortality 40-50% for children less than one year of age• 18th century killed 400,000 people/year in Europe• 300-500 million deaths during the 20th century 7 of 39
  8. 8. Smallpox• Last case reported in 1973• Immunization programs for smallpox discontinued• Smallpox has been eradicated• Success story for global immunization to eradicate a devastating disease 8 of 39
  9. 9. Types of Vaccines• Killed: influenza, cholera, polio, hepatitis A, bubonic plague, rabies• Attenuated: measles, rubella, mumps, yellow fever, typhoid, BCG• Subunit: surface proteins or particles only, hepatitis B, influenza, HPV• Conjugate: polysaccharides poorly immunogenic, link to protein get better response, HIB vaccine 9 of 39
  10. 10. Types of Vaccines• Valences: polyvalent like PCV 7, now PCV 13• Toxoid: toxic compound is inactivated but used in the vaccine, tetanus, diptheria• Passive immunization: synagis• Experimental: DNA vaccines, cancer vaccines 10 of 39
  11. 11. Influenzahttp://www.nytimes.com/2006/12/26/health/26cons.html?_r=1 Accessed 8/14/12 11 of 39
  12. 12. Transmission• Droplet transmission from coughing or sneezing• Nasal secretions• Incubation period is 1-5 days 12 of 39
  13. 13. Presentation• Starts with rhinitis, pharyngitis and cough• High fever• Chills• Muscle aches• Headache 13 of 39
  14. 14. Anatomy of Influenza Virus www.environment.ucla.edu/CTR/research/Inf-Diseases/avian_influenza.html Accessed 8/14/12 14 of 39
  15. 15. Anatomy of Influenza Virus• Orthomyxovirus single stranded RNA virus, 8 pieces• Surface antigens – Hemagglutin (HA) – determines extent of infection by binding to host cells (H1-H17) – Neuraminadase (NA) – breaks down glycoprotein link so new virus can be released from host cell, target of Tamiflu (N1-N9) 15 of 39
  16. 16. Anatomy of Influenza Virus http://www.abc.net.au/health/library/stories/2004/07/08/1831345.htm Accessed 8/14/12 16 of 39
  17. 17. Influenza Virus• Influenza A, B and C• A is highly mutagenic, antigenic shift• A causes more severe disease• Seasonal flu in winter• Pandemic influenza occurs when new A virus appears and population has no immunity 17 of 39
  18. 18. Viral Replicationhttps://dokuwiki.noctrl.edu/doku.php?id=bio:440:rabies Accessed 8/14/12 18 of 39
  19. 19. Antigenic Drifthttp://en.wikipedia.org/wiki/File:Antigenic_drift_vs_shift.png Accessed 8/14/12 19 of 39
  20. 20. 3 Horses of the Apocalypse http://jspivey.wikispaces.com/file/view/bird_flu_2.JPG/34372223/bird_flu_2.JPG Accessed 8/14/12 20 of 39
  21. 21. Antigenic Shifthttp://en.wikipedia.org/wiki/Antigenic_shift Accessed 8/14/12 21 of 39
  22. 22. Complications• Bacterial pneumonia and other bacterial infections• Viral pneumonia• Croup, bronchiolitis in children• Encephalitis• Myocarditis• Reye’s Syndrome 22 of 39
  23. 23. Influenza Deaths• 3,000 to 49,000 deaths/year; average is 23,000 deaths/year• Healthy people get the flu• HEALTHY PEOPLE DIE FROM THE FLU (secondary bacterial pneumonia)• 2009 H1N1 pandemic USA 12,500 deaths• 2009 H1N1 pandemic USA 90% of hospitalizations and deaths in people <65 years of age 23 of 39
  24. 24. Influenza Associated Pediatric Deaths• 46 deaths in 2005-2006• 282 deaths in 2009-2010 (H1N1 pandemic)• 26 confirmed deaths in 2011-2012 by CDC – 50% had no known risk factor except age 24 of 39
  25. 25. Treatment• Tamiflu oseltamivir (Tamiflu), zanamivir, amantadine, rimantadine (treat early or for chemoprophylaxis) – Active against neuraminadase – Resistance prevalent• F16 antibody – active against all A viruses, active against HA 25 of 39
  26. 26. Influenza Shothttp://bulldogblog.csufresno.edu/articles/wp-content/uploads/2009/09/flu-shot-cartoon.jpg Accessed 8/14/12 26 of 39
  27. 27. Side Effects of Flu Shot• Serious side effects are very rare• Inactivated virus – YOU CANNOT GET INFLUENZA FROM THE VACCINE• Mild reaction, lasts 24-48 hours, soreness, redness or swelling where the shot was given (20%), fever, aches, headache, fatigue, hoarseness, red or itchy eyes (1%) 27 of 39
  28. 28. Side Effects of Flu Shot• Moderate reactions: febrile seizures in children receiving flu shot and PCV13, more of a problem in children with a history of febrile seizures• Severe problems: life-threatening allergic reactions, Guillain-Barre Syndrome 28 of 39
  29. 29. Egg Allergyhttp://www.ifpma.org/resources/influenza-vaccines/influenza-vaccines/vaccine-manufacture-virus-harvesting.html Accessed 8/14/12 29 of 39
  30. 30. Egg Allergy• Skin testing no longer necessary• Use lowest ovalbumin-containing vaccine• Get immunization in office where emergency equipment is available – First approach: get 1/10th dose, wait 30 minutes, get remainder and wait 30 minutes – Second approach: get full dose, wait 30 minutes 30 of 39
  31. 31. LAIVhttp://flushotsideeffect.com/ Accessed 8/14/12 31 of 39
  32. 32. Side Effects of LAIV• Runny nose• Headache• Vomiting• Muscle aches• Fever not common in adults• Viral shedding up to 7 days 32 of 39
  33. 33. Influenza Vaccine Effectiveness• 60% across the board• 90% effective in young people, 30-40% effective in >65 years of age – Different strains chosen for the vaccine – Immune system of the individual – Intranasal live virus vaccine available – Shots are inactivated virus – Safe but not always effective• Flu shot and Flu mist comparable 33 of 39
  34. 34. Influenza Vaccine Effectiveness • 25 deaths prevented per 100,000 people vaccinated • 1 death prevented for every 4,000 vaccinated • Protects against hospitalization and death for those vaccinated even if they get clinical disease 34 of 39
  35. 35. American Academy of Pediatrics (AAP)Recommendations for 2012-2013 Flu Season • Recommend influenza vaccination for all people including children and adolescents over 6 months of age 35 of 39
  36. 36. American Academy of Pediatrics (AAP)Recommendations for 2012-2013 Flu Season• Special Efforts – Children >6 months with chronic disease (asthma, diabetes, prematurity, BPD, immunosuppression, neurological disorders) – Out-of-home providers of high risk children <5 years of age and especially <6 months of age – All health care personnel – Women who are pregnant, planning to be pregnant, who have recently delivered or are breast feeding 36 of 39
  37. 37. Conclusions• Influenza is a potentially fatal disease• Generally affects the very young and the very old• Pandemics are associated with influenza A after antigenic shift and affects a population with no immunity• Pandemics affect all ages in a population• Scientific data supports protective effect of flu vaccine• Generally safe, not always effective 37 of 39
  38. 38. Get Immunized• Protect yourself• Protect your family• Protect your co-workers• Protect your patients 38 of 39
  39. 39. Q&AQuestions?Thank you for attending! 39 of 39

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