This document discusses adult immunization and vaccination. It covers the basics of immunity and the immune system. It describes the different types of vaccines including live, inactivated, conjugate, and combination vaccines. It discusses the various routes of administration including oral, intranasal, subcutaneous, intramuscular, and intradermal. Recommendations are provided for various adult vaccines including Tdap, MMR, varicella, HPV, hepatitis A and B, pneumococcal, influenza, and meningococcal vaccines. A table outlines the recommended vaccines for different adult age groups.
A vaccine is a biological agent that provides active acquired immunity to a particular disease. A vaccine usually contains an agent that resembles a disease-causing microorganism. It is often made from killed or weakened forms of the microbe, its toxins or one of its surface proteins. Body's immune system is stimulated to recognize the agent as a threat and destroy it, and any of these microorganisms that it later encounters.
A vaccine is a biological agent that provides active acquired immunity to a particular disease. A vaccine usually contains an agent that resembles a disease-causing microorganism. It is often made from killed or weakened forms of the microbe, its toxins or one of its surface proteins. Body's immune system is stimulated to recognize the agent as a threat and destroy it, and any of these microorganisms that it later encounters.
Vaccines are tiny fragments of the disease-causing organism or the blueprints for making the tiny fragments. They contain other ingredients to keep the vaccine safe and effective.
Vaccines are tiny fragments of the disease-causing organism or the blueprints for making the tiny fragments. They contain other ingredients to keep the vaccine safe and effective.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
2. • Immunity refers to protection against infections.
• Immune system is the collection of cells and molecules that
are responsible for defending us against the countless
pathogenic microbes in our environment.
• Deficiencies in immune defenses result in an increased
susceptibility to infections, which can be life-threatening if the
deficits are not corrected
3. Defense against microbes consists of two types
of reactions.
• epithelial barriers of the skin
• gastrointestinal tract
• respiratory tract, which prevent
microbe entry (and have to be
breached for a microbe to
establish infection)
• phagocytic leukocytes
(neutrophils and macrophages)
• a specialized cell type called
the natural killer (NK) cell
• circulating plasma proteins, the
most important of which are the
proteins of the complement
system
Innate
immunity
(also called
natural, or
native,
immunity)
major
components
are
4. • Normally silent and responds (or
"adapts") to the presence of
infectious microbes by becoming
active, expanding, and generating
potent mechanisms for neutralizing
and eliminating the microbes.
• The components of the adaptive
immune system are lymphocytes
and their products
• There are two types of adaptive
immune responses humoral
immunity, mediated by soluble
antibody proteins that are
produced by B lymphocytes (also
called B cells), and cell-mediated
(or cellular) immunity, mediated
by T lymphocytes (also called T
cells)
Adaptive
immunity
(also called
acquired,
or specific,
immunity).
5.
6.
7.
8. • Immunization: a procedure designed to increase
concentrations of antibodies and/or effector T-cells which are
reactive against infection (or cancer).
• Immunization procedure called vaccination and the
immunizing agent called vaccine
9. Discovery of Vaccination
• Discovered in 1796 by Dr.
Edward Jenner
• Tested empirical knowledge:
mild cattle disease cowpox
protects against deadly
human disease smallpox
• scratching liquid from
cowpox sores into the boy's
skin -> full protection
against smallpox
10. Immunization
• When performed before exposure to an infectious agent (or
soon after exposure in certain cases), it is called
immunoprophylaxis,
– intended to prevent the infection.
• When performed during an active infection (or existing
cancer), it is called immunotherapy, intending to cure the
infection (or cancer)
11. • Two mechanisms by which immunization can be achieved
• Passive immunization:
– Transfer of active humoral immunity in the form of ready-
made antibodies, from one individual to another. ..
– Protective Abs --> non immune recipient
– No immunological memory
• Active immunization:
– Give host a foreign organism/protein in non-infectious
form
– Induction of adaptive immune response, with protection
and memory.
12. METHODS OF ADMINISTRATION
• Oral (PO) Route - Rotavirus vaccines
(RV1/Rotarix, RV5/RotaTeq) and oral
typhoid vaccines that are administered by the
oral route.
• Oral vaccines should generally be
administered prior to administering injections
or performing other procedures that might
cause discomfort.
• Administer the liquid slowly down one side
of the inside of the cheek (between the cheek
and gum) toward the back of the infant’s
mouth.
• Care should be taken not to go far enough
back to initiate the gag reflex. Never
administer or spray (squirt) the vaccine
directly into the throat
13. INTRANASAL ROUTE
• The live attenuated
influenza vaccine (LAIV,
FluMist) is currently the
only vaccine administered
by the nasal route.
• The vaccine dose (0.2 mL)
is inside a special sprayer
device
14. SUBCUTANEOUS ROUTE
• Subcutaneous injections are administered
into the fatty tissue found below the
dermis and above muscle tissue.
• -Site - The recommended subcutaneous
sites for vaccine administration are the
thigh (for infants younger than 12
months of age) and the upper outer
triceps of the arm (for persons 12
months of age and older). If necessary,
the upper outer triceps area can be
used to administer subcutaneous
injections to infants.
15. INTRAMUSCULAR ROUTE
• Intramuscular injections are
administered into muscle tissue
below the dermis and subcutaneous
tissue.
• There are only two routinely
recommended IM sites for
administration of vaccines, the
vastus lateralis muscle (anterolateral
thigh) and the deltoid muscle (upper
arm). Injection at these sites reduces
the chance of involving neural or
vascular structures. The site depends
on the age of the individual and the
degree of muscle development.
16. INTRADERMAL ROUTE
• Site - The site of
administration is the deltoid
region of the upper arm. The
patient should be seated
with the arm bent at the
elbow and the hand on the
hip to ensure that the site of
administration is prominent.
17. Live vaccines
• attenuated strains which replicate in host
• attenuation means the virus or bacterium has been weakened to
reduce virulence so it cannot cause disease in healthy people
• act like natural infection
• live vaccines are the closest to actual infection and therefore
elicit good, strong, long-lasting immune responses
18. Live vaccines
• Advantages
• Single dose often sufficient
to induce long-lasting
immunity
• Strong immune response
evoked
• Local and systemic
immunity produced
• Disadvantages
• Potential to revert to
virulence
• Contraindicated in
immunosuppressed patients
• Interference by viruses or
vaccines and passive
antibody
• Poor stability
• Potential for contamination
19. Inactivated vaccines
Either:
• suspensions of whole intact killed organisms
– e.g. whole cell pertussis, influenza, rabies, HepA
• acellular and sub-unit vaccines
– contain one or a few components of organism important in
protection
– e.g. acellular pertussis vaccine contains between 2-5
components of the whole cell pertussis bacteria
– e.g. diphtheria toxoid
– e.g. Hib polysaccharide
20. Immunisation Department, Centre for
Infections
Inactivated vaccines
• Advantages
• Stable
• Constituents clearly defined
• Unable to cause the
infection
• Disadvantages
• Need several doses
• Local reactions common
• Adjuvant needed
– keeps vaccine at
injection site
– activates antigen
presenting cells
• Shorter lasting immunity
21. Conjugation
• Some bacteria (e.g. Haemophilus influenzae type b, Neisseria
meningitidis, Streptococcus pneumoniae) have an outer coating
of sugar molecules (called polysaccharides)
• Polysaccharide coatings make it difficult for a baby or young
child’s immature immune system to see and respond to the
bacterium inside
• Polysaccharide vaccines are poorly immunogenic in children
under 2 years old and do not stimulate long term
immunological memory
• Conjugate vaccines have enabled us to effectively protect
children against Hib, and pneumococcal diseases
22. Carrier
protein
Polysaccharide linked to
carrier protein
Conjugate vaccine
Bacteria
Polysaccharide
(sugar) coating
Conjugation
Conjugation is the process of attaching (linking) the polysaccharide antigen to a
protein carrier (e.g. diphtheria or tetanus) that the infant’s immune system already
recognises in order to provoke an immune response
23. Combination Vaccines
• Many vaccines are combined to make it easier to give several
vaccines at one time
• Combination vaccines reduce both number of clinic visits and
number of injections needed
• Before combination vaccines are licensed, studies are carried
out to ensure that:
• the immune response to any of the combined antigens is just
as good as the response to the individual vaccines
• the rates of adverse reactions are the same as they would be if
the vaccines were administered separately
24. Immunisation Department, Centre for
Infections
Vaccine composition
• In addition to the antigen, vaccines may contain some or all of
• the following components:
Component Purpose Example
Adjuvants enhance the immune response to a
vaccine
aluminium salts
Preservatives prevent bacterial or fungal contamination
of vaccine
thiomersal
Additives stabilise vaccines from adverse
conditions such as freeze-drying or heat,
thereby maintaining a vaccine’s potency
gelatine
Residuals from
manufacturing
process
Inactivating agents
Antibiotics - prevent bacterial
contamination during manufacturing
process
Egg proteins- some vaccine viruses are
grown in chick embryo cells
Yeast proteins
formaldehyde
neomycin, streptomycin,
polymyxin B
influenza, yellow fever
HepB vaccine
25. Adult Immunization recommended in
india
• Tdap MMR
• Influenza Pneumococcal
• Hepatitis B Hepatitis A
• Varicella HPV (cervical cancer)
• Meningococcal Herpes Zoster
26. Diphtheria, Tetanus, Pertussis
Vaccines
• Two Tdap Vaccines are available for use in those
who are more than 10 years of age.
-Efficacy of Tdap vaccine - 92%
Recommendations
- for all adults who have not received Tdap or for
whom vaccine status is not known
6/23/2017 2
6
27. Measles, Mumps And Rubella
Vaccines
• In India the measles, mumps, rubella (MMR) live
attenuated vaccine is manufactured using the
following strains:
• The measles and the rubella components are
produced using human diploid cells while the
mumps component is produced from chick
embryo.
• The MMR vaccine should be administered
subcutaneously into the upper arm.
2
7
28. Indications
• Adolesents and adults
• Women of childbearing age who is not
pregnant
FREQUENCY
• Two doses at interval of 4 weeks
• Subcutaneously in upper arm
29. Varicella (Chickenpox)
Vaccines
• Two Live attenuated VZV (Oka strain)
vaccines for varicella virus are
currently available in India.
Schedule
- Interval between 2 doses should be4–
8wks.
29
30. 30
Recommendations
• All susceptible adults and adolescents should
be vaccinated.(18-49yrs)
• It is especially important to susceptible
persons
– Health care workers
– Family contacts of immunocompromised persons
– High risk of exposure (e.g., teachers, day care
employees, military personnel, and international
travelers).
31. Human Papilloma Virus
• Papilloma virus infection is precursor to cervical
cancer
– Types 16, 18 account for 70% of cervical
cancers
Vaccines
• Two types HPV vaccines are available.
– a quadrivalent vaccine containing HPV virus L1
protein like particles of HPV 6,11,16, and 18
– is a bivalent vaccine containing L1 VLPs of
HPV 16,18.
31
32. 14
Recommendations
• The vaccine has to be delivered prior to
exposure to the HPV virus. Therefore, the
immunization must precede the sexual debut.
• Age for initiation for vaccination to be 10 - 12
years.
• Catch-up vaccination can be advised up to the
age of 26 years for Gardasil vaccine and 45
years for Cervarix vaccine.
33. • Schedule
– BHPV – 0,1,6 months
– QHPV – 0,2,6 months
For male HPV 4 is recommanded
34. Hepatitis B
Vaccines
• For immunocompetent adults, 1ml (20 μg)of
recombinant vaccine is administered at 0, 1, and 6
months as an intramuscular.
• Protection (anti-HBs antibody titer of 10mIU/ml or
higher) after recombinant vaccine
– After first dose - 20% to 30%
– After second dose - 75% to 80%
– After third doses - 90% to 95%
Recommendations
• All unvaccinated adult risk for HBV infection and
• All adults seeking protection from HBV infection
including post-exposure prophylaxis.
34
35. 0
• Booster doses of HBV vaccine are not
indicated in persons with normal immune
status .
• For CKD patients, the need for booster
doses should be assessed by annual anti-
HBs antibody titre testing.
• A booster dose should be administered
when anti-HBs levels decline to less than 1
mIU/ml & <100 mIU/ml in patients on
dialysis.
.
35
37. Hepatitis A
s,
• Vaccines
• Inactivated-single antigen (HAV antigen) vaccine
• Schedule
• Two doses of 1ml at 6 month interval.
• Immune status for hepatitis A should be
checked
37
38. Pneumococcal Infection
Vaccines
Two types
• The pneumococcal polysaccharide vaccine
(PPV23), contains 25 μg each of purified
capsular polysaccharide from 23
serotypes of Streptococcus pneumoniae.
• Pneumococcal conjugate vaccine (PCV 13)
– This vaccine can be co-administeredwith live
vaccines such as the influenza vaccine.
38
39. 39
Schedule
–A single standard dose (0.5 ml) is
administered by the intramuscular or
subcutaneous route.
–Revaccination: 0.5ml IM or SC at least
after 5 years of 1st dose in case of High
risk people.
40. Influenza
Vaccines
– Trivalent inactivated influenza vaccine (TIV) and
– Live attenuated influenza vaccine (LAIV)
• The TIV contains
– A/17/California/2009/38(H1N1),
– A/Brisbane/ 10/2007 (H3N2), and
– B/Brisbane/60/2008 strains.
• Live attenuated influenza vaccine (LAIV) –
Nasovac contains
– A/17/California/2009/38 like strain
• Schedule
– The TIV - annual, single dose of 0.5 ml IM.
– The LAIV – 0.5 ml intranasal (spray 0.25 ml per
nostril)
40
41. Meningococcal Meningitis
Vaccines
• Types
– Polysaccharide vaccines
• Bivalent (A&C)
• Quadrivalent (A,C,Y & W135)
– Conjugate vaccines.
• The vaccine does not induce herd immunity
and has no effect on nasopharyngeal
carriage.
• Containing 50 μg of polysaccharide per dose.
• After reconstitution use within 8-12 hours.
41
42. Schedule
• A single dose of 0.5 ml SC in deltoid region.
• Used in selected population
• Age 2- 3 yrs
• Congenital deficiencs in complement
components
• Travellers to hajj
• Lab persons
42
43. OTHER VACCINES
YELLOW FEVER
• Yellow fever caused by virus belonging to
family called flaviviridae.
• Yellow fever vaccine is live attenuated vaccine
• Single s.c dose of 0.5ml given and
seroconversion is >95%.
• Protection stats from 10th day and last till
10yrs.
44. RABIES
• Two regime available
- intramuscular
- intradermal
•Cholera vaccine
oral cholera – WC, WC-rBS, CVD-103HgR
injectable – not used now
• Typhoid
Vi polysaccharide vaccine
ty21a vaccine
• Tuberculosis
- BCG vaccine currently available
45. Vaccine / Age group 19-26 yrs 27-49 yrs 50-59 yrs 60-64 yrs > 65 yrs
Tetanus, Diptheria, Pertussis (Tdap)
Substitude one time dose of Tdap withTd, then
booster with Tdevery 10 years
Td
booster
every 10
yrs
Human Papiloma Vaccine 3 doses
Varicella 2 doses
Zoster 1 dose
Measles, Mumps, Rubella 1 or 2 doses 1 dose
Influenza 1 dose annually
Pnemococcal (Polysaccharide) 1 or 2 doses 1 dose
Hepatitis A 2 doses
Hepatitis B 3 doses
Meninngicoccal 1 or more doses
Recommended if some risk factor is present
All persons who meet the age criteria
6N/2o3/2r0e1c7ommendation 27
ACIP Adult Immunization Schedule, Age-Based Recommendations,
INDIA
46. 28
Indications
Pregnancy
Immunoco
mpromise d
conditions
(Excluding
HIV)
HIV infection
with CD4 count
Diabetes,
heart
disease,
chronic
lung disease
Asplenia
(excluding
elective
splenectomy
)
Chronic
liver
disease
Kidney failure,
end stage renal
disease, on
hemodialysi s
Health
care
professi
onals
Vaccine <200
cells/ µl
>200
cells/ µl
Tetanus, Diptheria,
Pertussis (Tdap)
Td
Substitute one time dose of Tdap with Td, then booster with Tdevery 10 years
Human Pappiloma
Vaccine
3 doses for females through age 26 years
Varicella Contraindication 2 doses
Zoster Contraindication 1 dose
Measles, Mumps, Rubella Contraindication 1 or 2 doses
Influenza
1 dose TIV annually 1 dose TIV
or LAIV
Pnemococcal
(Polysaccharide)
1 or 2 doses
Hepatitis A
2 doses
Hepatitis B
3 doses
Meninngicoccal
1 or more doses
Recommended if some risk factor is present
All persons who meet the age criteria
6C/2o3/n2t0r1a7indication
Adult Immunization based on medical and other indications (INDIA)
47. Contraindications and Precautions
Vaccine Contraindication Precautions
All vaccines
(live and
inactivated)
•A confirmed anaphylactic reaction
to a previous dose of the vaccine or
to a component of the vaccine
•If individual acutely unwell on day of
vaccination, postpone until recovered
•Pregnancy
DTP •As above •If evidence of evolving neurological
abnormality or current neurological
deterioration, including poorly
controlled epilepsy, immunisation
should be deferred until condition
stabilised
Influenza •As above and additionally:
•Individuals with confirmed
anaphylactic hypersensitivity to egg
products
•Where possible, thiomersal free
influenza vaccines recommended for
pregnant women and infants
Live vaccines
(MMR,
varicella)
•As above and additionally:
•Immunocompromising treatment or
condition
•Pregnancy
•If ITP following previous MMR vaccine,
perform antibody test
•If confirmed anaphylactic reaction to
egg, seek further advice with view to
immunisation under controlled
conditions
48. Adult Immunization Challenges
• Inadequate funding for vaccines
and
administration in public programs
• Lack of knowledge – both patients
and providers
• Poor public health and private
infrastructure for vaccine delivery.
• Lack of availability of vaccine.
• High cost of vaccine.