WOMEN AND IMMUNISATION PROMOTING ADOLESCENT / ADULT WOMEN IMMUNIZATION DR....Lifecare Centre
WHO Immunisation programs are amongst the most cost-beneficial health interventions
WHO COMMISSIONED GLOBAL REVIEW PUBLISHED IN 1993 MISSED OPPORTUNITIES
to vaccinate an estimated 30% of children and women
Adult Vaccination_Dr Animesh Jain IMA KSB 16 March 2022Animesh Jain
This slideset was a part of a webinar talk by Dr Animesh Jain in a programme hosted by IMA Karnataka State Academic Subcommittee on 16th March 2022. This brief presentation was an attempt to sensitize the audience regarding adult vaccination.
WOMEN AND IMMUNISATION PROMOTING ADOLESCENT / ADULT WOMEN IMMUNIZATION DR....Lifecare Centre
WHO Immunisation programs are amongst the most cost-beneficial health interventions
WHO COMMISSIONED GLOBAL REVIEW PUBLISHED IN 1993 MISSED OPPORTUNITIES
to vaccinate an estimated 30% of children and women
Adult Vaccination_Dr Animesh Jain IMA KSB 16 March 2022Animesh Jain
This slideset was a part of a webinar talk by Dr Animesh Jain in a programme hosted by IMA Karnataka State Academic Subcommittee on 16th March 2022. This brief presentation was an attempt to sensitize the audience regarding adult vaccination.
adult vaccination, types of vaccine, forms of vaccine, active immunity, passive immunity, schedule of vaccination, CDC, contraindications, cost of vaccines
Healthy Mothers Healthy Babies
2014 Annual Meeting & Conference
October 7th, 2014
Presented by: Carol E. Hayes, CNM, MN, MPH
American College of Nurse Midwives representative to CDC Advisory Committee on Immunization Practice (ACIP)
adult vaccination, types of vaccine, forms of vaccine, active immunity, passive immunity, schedule of vaccination, CDC, contraindications, cost of vaccines
Healthy Mothers Healthy Babies
2014 Annual Meeting & Conference
October 7th, 2014
Presented by: Carol E. Hayes, CNM, MN, MPH
American College of Nurse Midwives representative to CDC Advisory Committee on Immunization Practice (ACIP)
Immunization dashboards aim to improve quality and use of reported data for concrete programmatic action to address the challenges in strengthening UIP.
Know More: http://www.itsu.org.in/immunization-dashboard
The Immunization Technical Support Unit facilitates routine immunization programme, strengthening and monitoring regular health concerns of the nation.
David Haselwood | How vaccines prevent diseasesDavid Haselwood
David Haselwood - Vaccines provide immunity that protects you from disease without the risk of the infection. It contains a small amount of the germs or parts of the germs that cause disease. The germs in vaccines are either killed or weakened so they can't make you sick. Therefore, vaccination plays an important role in one’s health. #DavidHaselwood
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Immunization for INDIAN Adolescents Dr. Jyoti Agarwal Dr. Sharda Jain Dr. J...Lifecare Centre
Vaccinations are among the greatest public health achievements of the 20th century
First recorded in 1890-95
Imminization is the action of making a person immune to infection, typically by inoculation
Immunization prevents disability & death from infectious diseases
It also helps control the spread of infections within communities
The Newer Concepts In Endometriosis Management : Dr Sharda JainLifecare Centre
The Newer Concepts In
Endometriosis Management
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DELEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
The Newer Concepts forReduced Surgery to preserve fertility in Endometrios...Lifecare Centre
The Newer Concepts forReduced Surgery to preserve fertility in Endometriosis
ENDOMETRIOSIS IS ENIGMA
DIAGNOSTIC DILEMMA
DEBILITATING DISEASE QOL
PROGRESSIVE DISEASE
RECURRENCE IS BIG PROBLEM
NO FINAL VERDICT ON CAUSE
NO PERMANENT CURE
The exact prevalence of endometriosis is unknown, but estimates 10% in the general female population in India but up to 50% in infertile women
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
Strategies for Improving Success Rates in ART PARTLifecare Centre
Strategies for Improving Success Rates in ART
Part - 2
Strategies for Improving Success Rates in ART
Tailoring Controlled Ovarian Stimulation
Strategies for Luteal Phase in ART cycles
Endometrial Receptivity Array
How to optimize success rates in ART? : Dr Sharda JainLifecare Centre
How to optimize success rates in ART? : Dr Sharda Jain
How to improve success rates in ART?
The big debate कार्य में आनंद
Evolution of In-vitro Fertilization (IVF)
Factors Influencing IVF Success Ist Part
Strategies for Improving Success Rates in ART Second Part
Innovations & Breakthroughs in IVF Part Three
OPEN DEBATE
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda JainLifecare Centre
SOCIALEGG FREEZING : Dr Poorva Bhargav and Dr Sharda Jain
Introduction
Social egg freezing (oocyte cryopreservation for non-medical reasons) has evolved as a proactive option for women looking to extend their reproductive possibilities past their peak childbearing years
It is the process of saving or protecting eggs, or reproductive tissues so that a person can use them to have biological children in future
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.
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Hot Selling Organic intermediates
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
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
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
6. What is IMMUNIZATION?
• Immunization refers to the artificial
induction of immunity. It can be by
Active Immunization: the use of live
attenuated infectious agents or inactivated
toxins, or antigens obtained by genetic
recombination OR
Passive Immunization: temporary
immunity obtained by the administration
of immunoglobulins or antitoxins.
6Source : Dictionary of Public Health, J Kishore - 2007
7. WHY ADULT
IMMUNIZATION?
•“Disease-free young and older adults can remain
active, healthy participants in society / contribute a lot
in NATION building and more fully generating money..
• Researchers strongly feel… this create a Win- win
situation for all individuals in the society.
• Health costs for curing will be contained, and
economic productivity will go up.
8. WHY NO ONE IS TALKING ABOUT
ADULT IMMUNIZATION ?
In INDIA, there is often lack of resources, political will and
awareness on immunization and the impact on health
among DOCTORS & POLICY MAKERS, it takes years to
build system & evolve.
•As we have seen with childhood vaccinations access. …
raising awareness and understanding of how vaccines can
improve health and economies has taken so long. Still we
are far away from 100% immunisation Goal
It takes decades for new public health interventions
to reach those most in need
9. • Adult immunizations have:
• Lack of clear vaccination recommendations
among national and global bodies except USA
• Complex vaccination schedules
• Inadequate physician and patient knowledge
• Patients have limited awareness of the benefits
of vaccinations for themselves and their families
WHY NO ONE IS TALKING ABOUT
ADULT IMMUNIZATION ?
10. ADULT IMMUNIZATION SHOULD BE A
MAJOR POLICY PRIORITY FOR
POLICYMAKERS AND OTHER
STAKEHOLDERS IN INDIA
This is also how childhood immunizations
were developed, and the model & motivation
behind success should be brought to
innovations in adult vaccines too
Now is the time to create similar levels of attention
on the critical value of adolescent & adult
vaccines as is done western countries
11. WHY ADULT VACCINATION ?
• Immunity wanes over time
• As we age, we become more susceptible to serious
diseases caused by common infections, such as
shingles, flu & pneumonia. This results in otherwise
preventable morbidity & mortality.
• Considerable vaccine – preventable morbidity
* Excess Hospitalization
* Diminished quality of life (Post – herpetic neuralgia)
* Missed work
* Medical Complications
14. ACIP Adult Immunization Schedule- Medical/Occupational and Behavior-Based
Recommendations (USA)
9/29/2016 14
Pregn
ancy
Immunoco
mpromisin
g
conditions
excluding
HIV
HIV &
CD4
Count
<200
cell/
µl
>200
cell/
µl
Men
having
sex
with
men
(MSM)
Heart
disease,
chronic
lung
diseases,
chronic
alcoholic
Aspleni
a
includi
ng
elective
Splenec
tomy
Chro
nic
liver
dise
ases
Diabete
Kidney
failure,
ESRD,
on
hemodi
lysis
Health
-Care
perso
nnel
15. 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 with Td,
then booster with Td every 10 years
Td booster
every 10 yrs
Human Pappiloma 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
ACIP Adult Immunization Schedule, Age-Based Recommendations, INDIA
Recommended if some risk factor is present
All persons who meet the age criteria
No recommendation
16. Adult Immunization based on medical and other indications (INDIA)
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 Td every 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
Contraindication
17. ADULT Immunization
recommended in India
Tdap MMR
Influenza Pneumococcal
Hepatitis B Hepatitis A
Varicella HPV (cervical cancer)
Meningococcal Herpes Zoster
20. HUMAN PAPILLOMA VIRUS
infection is the most common
sexually transmitted infection. It is
transmitted early in adolescence
when sexual oro pharyngeal cancer.
The high risk subtypes of HPV are
responsible for these cancers.
22. India ~1,22,844
Total world ~ 5,27,624
India ~23% of new
Cervical Cancer cases in world
India ~ 67,477
Total world ~ 2,65,653
India ~23%
Rest of World - 77%
India ~25% of deaths
due to Cervical Cancer in world
Rest of World - 73%
India - 27%
2013
Cervical Cancer Disease Burden INDIA
Incidence Mortality
India ~25%
Rest of World - 75%
2. Bruni L, Barrionuevo-Rosas L, Serrano B, Brotons M, Cosano R, Muñoz J, Bosch FX, de Sanjosé S, Castellsagué X. ICO Information Centre on HPV and
Cancer (HPV Information Centre). Human Papillomavirus and Related Diseases in India. Summary Report 2014-01-31. [Accessed on 11th Feb 14]
23. HPV 16
HPV 18
HPV 6
HPV 11
Cancer causing Types
High risk group-16,18,
31,33,45,52,58
Non-cancer causing types
Low risk group- 6,11.
• >75% of Cervical Cancer5,6
• >50% of Vaginal & Vulvar Cancer5
90% of Anogenital warts5
HPV is a necessary cause of cervical cancer – 99.7%4
HPV
1.Schiffman M, Castle PE. Arch Pathol Lab Med. 2003;127:930–934. 2. Wiley DJ, Douglas J, Beutner K, et al. Clin Infect Dis. 2002;35(suppl 2):S210–S224. 3. Muñoz N, Bosch FX, Castellsagué X, et al. Int J
Cancer. 2004;111:278–285. Reprinted from J Virol. 1994;68:4503–4505 with permission from the American Society for Microbiology Journals Department. 4. Walboomers JM, Jacobs MV, Manos MM, et al. J
Pathol. 1999;189:12–19. 5. X. Castellsagué, S. de Sanjose, T. Aguado, K. S. Louie, L. Bruni, J.Muñoz, M. Diaz, K. Irwin, M. Gacic, O. Beauvais, G. Albero, E. Ferrer, S. Byrne,F. X. Bosch. HPV and Cervical
Cancer in the World. 2007 Report. WHO/ICO Information Centre on HPV and Cervical Cancer (HPV Information Centre). Available at: www.who.int/hpvcentre6. Bhatla N et al.Vaccine (2008;26; 2811-17
HUMAN PAPILLOMAVIRUS (HPV)
Need for multivalent HPV vaccine for broader HPV protection
24. RATIONALE FOR VACCINATION
Natural Infection – Weak AB response
Vaccination - High AB Response
Higher AB level at
cervical epithelium
prevents HPV infection
25. 3 HPV Vaccine
available in the World
Gardasil 0 2 6 (MSD)
Cevarix 0 1 6 (GSK)
Nano valent vaccine (MSD)
(3 doses in six months)
Target Population 9 to 45 years
27. TARGET POPULATION - HPV
• HPV vaccination can also be given with the
following special situations: abnormal
Papanicolau (Pap) smear,
• History of genital warts,
• Breastfeeding
• Immunocompromised.
Papsmear and HPV infection status
is not a prerequisite for HPV vaccination.
28. 9vHPV VACCINATION
The most recent recommendation in the USA considers
that adolescents of both sexes should be vaccinated at
the age of 11-12 years with 9vHPV vaccination .
However , bivalent or quadrivalent vaccine may be used
for females, but boys can have only quadrivalent vaccine
or 9vHPV vaccination .
In Europe and many countries including
India, HPV vaccine is only
recommended for girls.
30. TARGET POPULATION - TDAP
• Pregnant women with no previous
tetanus immunization or unknown
tetanus immunization history
should receive three doses of Td
vaccine to be given on month apart,
starting the second trimester. The
third dose can be given postpartum
as Tdap.
31. TDaP
• Pregnant women whose last
Td/ Tdap vaccination was more
than ten years ago should receive Td
booster in the second or third
trimester of pregnancy.
32. DOSE REGIMEN OF TDAP
• The primary tetanus immunization series
consists of 3 Td injections given
intramuscularly. The first two doses are given
one month apart, and the third dose is given 6-
12 months after the second dose. The third
dose may be given as Tdap.
• Tdap dose is 0.5 mL administered IM,
preferably into the deltoid muscle.
33. CONTRAINDICATION - TDAP
• Severe allergic reaction
(e.g. anaphylaxis) after a previous
dose or to a vaccine component.
34. PRECAUTION - TDAP
• History of hypersensitivity reactions
following a previous dose of TT-
containing vaccine – defer
vaccination until at least 10 years
have lapsed since the last TT-
containing vaccine.
35. ADVERSE EVENTS - TDAP
• Pain
• Redness or swelling
• Fever
• Headache or tiredness
38. TARGET POPULATION – INFLUENZA VIRUS
• All pregnant and breastfeeding women
should receive the inactivated flu vaccine
• Individuals belonging to the following risk
groups
– All children aged 6 months to 18 years
– All persons aged ≥ 50 years
– Other persons at risk for medical complications
from influenza
– All healthcare professionals
39. DOSING REGIMEN – INFLUENZA VIRUS
• Infants, children and adolescents aged 6
months to 18 years.
• Women ≥ 19 years: given
intramuscularly, every year, as soon as
the newest/current WHO-recommended
vaccine strains become available.
41. PRECAUTIONS – INFLUENZA VIRUS
• Guillaine Barre Syndrome within 6
weeks of previous dose of influenza
vaccine
• Moderate or severe acute illness with
or without fever.
42. Available Preparations –
Influenza Virus
Vaccine Formulation
Inactivated Split-Influenza
Virus Vaccine
0.5 mL prefilled
syringe
Inactivated Influenza Virus
Vaccine
0.25 mL and 0.5 mL
prefilled syringe
44. TARGET POPULATION - MMR
• All non-pregnant women of
childbearing age must be offered
measles, mumps and rubella (MMR)
vaccination if not had vaccination in
childhood.
45. TARGET POPULATION - MMR
• Upon completion or termination of
pregnancy, women who do not have
serologic evidence of rubella immunity
or documentation of rubella vaccination
should be vaccinated with MMR before
discharge from the hospital or birthing
centre.
46. TARGET POPULATION - MMR
• Routine prenatal serologic testing
for rubella on all pregnant women
to test rubella immunity should be
done.
47. DOSE REGIMEN - MMR
• 0.5 mL, administered subcutaneously, 1-
2 doses.
• Second dose of MMR vaccine,
administered 4 weeks after the first dose
is recommended for adults
48. CONTRAINDICATIONS - MMR
• Severe allergic reaction after a
previous dose of the vaccine.
• Pregnancy
• Severely immunocompromised
patients
49. PRECAUTIONS - MMR
• Women administered the
MMR vaccine should be
advised not to get pregnant
during the next 4 weeks post-
vaccine.
50. PRECAUTIONS - MMR
• History of thrombocytopenia or
thrombocytopenic purpura
• Need for tuberculin skin testing
• Moderate or severe acute illness
with or without fever
51. AVAILABLE PREPARATION - MMR
Vaccine Formulation
Measles, Mumps, Rubella Virus
Vaccine, live-attenuated
0.5 mL
53. TARGET POPULATION - VARICELLA
• Persons aged >13 years
• School-aged children,
• college students, and students in other post-
secondary educational institutions
• Other healthy adults
54. POSTPARTUM VACCINATION - VARICELLA
• Women who do not have evidence of
varicella immunity should receive the first
dose of vaccine before discharge from the
health-care facility. The second dose should
be administered 4-8 weeks later.
• Women should be counselled to avoid
conception 1 month after each dose of
varicella vaccine.
55. DOSE REGIMEN - VARICELLA
• Eligible recipients should receive two
0.5 mL doses of single-antigen
varicella vaccine administered
subcutaneously, 4-8 weeks apart. If
>8 weeks elapsed after the first
dose, the second dose may be
administered without restarting the
schedule.
56. CONTRAINDICATIONS - VARICELLA
• Persons with history of anaphylactic
reaction to any component of the vaccine,
to neomycin.
• Persons with malignant condition
• Family history of congenital or hereditary
immunodeficiency
58. PRECAUTIONS - VARICELLA
• Vaccination of persons who have acute severe
illness, including untreated, active
tuberculosis, should be postponed until
recovery.
• Varicella vaccines should not be administered
for the same intervals as measles vaccine, after
administration of blood, plasma or
immunoglobulin.
59. AVAILABLE PREPARATION - VARICELLA
Vaccine Formulation
Varicella Virus Vaccine, live-
attenuated, freeze-dried with
separate diluent, to be
reconstituted right before
administration
0.5 mL
61. TARGET POPULATION - HEPATITIS A
• Women, 18 years old and above, who have
close contact with persons with hepatitis A,
must be vaccinated.
• Women travelling to or working in countries
with high or intermediate prevalence of
hepatitis A should be vaccinated.
62. TARGET POPULATION - HEPATITIS A
• Women who use street drugs are
candidates for vaccination.
• Women with chronic liver disease
(including hepatitis B and C) should
receive hepatitis A vaccination.
63. TARGET POPULATION - HEPATITIS A
• Women previously treated with clotting
factor concentrates should avail of
hepatitis A vaccination.
• Women with occupational risk including
laboratory staff should be vaccinated.
64. POST-EXPOSURE PROPHYLAXIS -
HEPATITIS A
• For susceptible healthy women up to age 40
years, single-antigen hepatitis A vaccine should
be administered as soon as possible after
exposure.
• Beyond 40 years, immune globulin (Ig) is
preferred. Vaccine can be used if Ig cannot be
obtained.
65. DOSE REGIMEN - HEPATITIS A
• Hepatitis A vaccine should be
administered by intramuscular route
for 2 doses, 6-12 months apart, for
lasting protection.
66. CONTRAINDICATIONS/PRECAUTIO
NS /ADVERSE EVENTS -
HEPATITIS A
• Severe or life-threatening allergic reaction to a
previous dose of hepatitis A vaccine is an
absolute contraindication.
• Severe or life-threatening allergic reaction to
any vaccine component contraindicates the
administration of hepatitis A vaccine.
67. CONTRAINDICATIONS/PRECAUTIONS
/ADVERSE EVENTS - HEPATITIS A
• Moderate or severe ilnnes at the time of
vaccination may defer the scheduled
administration.
• Safety of the hepatitis A vaccine for pregnant
women has not been determined.
68. CONTRAINDICATIONS/PRECAUTIO
NS /ADVERSE EVENTS -
HEPATITIS A
• The most commonly reported adverse
reaction following hepatitis A
vaccination is local reaction at the site
of injection.
69. AVAILABLE PREPARATIONS -
HEPATITIS A
Vaccine Formulation
Inactivated hepatitis A vaccine 1 ml/vial
Combined inactivated
hepatitis A and B vaccine
1 mL prefilled
syringe
71. TARGET POPULATION - HEPATITIS B
• Women 18 years old and above who belong to
the high risk groups:
– Healthcare and public safety and security workers
who may have exposure to blood in the workplace
– Persons in training for allied health professions
– Hemodialysis patients and those receiving blood
and blood products including transplant
candidates
72. TARGET POPULATION - HEPATITIS B
• Women 18 years old and above who
belong to the high risk groups:
–Patients in early course of chronic liver
diseases
–Sexually transmitted disease (STD) clinic
clients
–Multiple sexual partners or prior STD
–Inmates of correctional facilities
73. TARGET POPULATION - HEPATITIS B
• Women 18 years old and above who belong to
the high risk groups:
– Clients and staff of institutions for development
disability.
– Travellers to high endemicity areas
– Overseas foreign workers
– Injection drug users
– Household contacts and sexual partners of
hepatitis B virus carriers
74. TARGET POPULATION - HEPATITIS B
• Hepatitis B vaccine may be administered to a
pregnant woman who is otherwise eligible for
it.
• All HBsAg-negative pregnant women seeking
STD treatment who have not been previously
vaccinated should receive hepatitis B
vaccination.
75. DOSE REGIMEN - HEPATITIS B
• Hepatitis B vaccine is administered
intramuscularly in 3 doses at 0, 1, 6-12 months.
• The accelerated schedule should be
given in 4 doses at 0, 1, 2, 12 months.
• The rapid schedule should be given in
4 doses at 0, 7, 21 days and 12 months.
76. CONTRAINDICATIONS/
PRECAUTIONS/ADVERSE EVENTS -
HEPATITIS B
• A severe allergic reaction to vaccine
component or to a prior dose of hepatitis B
vaccine is a contraindication to further doses of
the vaccine.
• Persons with moderate or severe acute illness
should not be vaccinated until their condition
improves.
80. HERPES ZOSTER (SHINGLES)
• Shingles is caused by a
reawakening of the chickenpox
virus
• Symptoms – rash usually along
nerve pathways
• Very painful and debilitating
• 20-30 % people can expect to
get shingles in their lifetime
81. VACCINES
• Zostavax - lyophilized preparation of the Oka strain of
live, attenuated varicella zoster virus (VZV).
SCHEDULE
• Single 0.65 ml dose subcutaneously in the upper arm.
• Each 0.65 ml dose contains a minimum of 19,400
plaque-forming units [PFU].
• The vaccine must be used within 30 minutes after
reconstitution.
Herpes Zoster
82. RECOMMENDATIONS
• Recommended for persons > 60 years.
• High risk for developing recurrent herpes
zoster, such as
– Patients with chronic medical conditions (CKD,
diabetes mellitus, rheumatoid arthritis, and
chronic pulmonary disease);
– Persons who are likely to have severe
immunosuppression in near future.
HERPES ZOSTER
84. PNEUMOCOCCAL Vaccination
VACCINES
• The pneumococcal polysaccharide
vaccine (PPV), contains 25 μg each of purified
capsular polysaccharide from 23 serotypes of
Streptococcus pneumoniae.
SCHEDULE
– A single standard dose (0.5 ml) is
administered by the intramuscular or
subcutaneous route.
– This vaccine can be co-administered with
live vaccines such as the influenza vaccine.
85. • Adults who are 65yrs of age or older.
HIGH RISK PEOPLE
• Anatomic asplenia
• Sickle cell disease
• Immunocompromised
persons including HIV
• Leukemia, Lymphoma
• Hodgkin’s disease
• Multiple myeloma
• Generalized malignancy
• Chronic renal failure
• Nephrotic syndrome
• Chemotherapy &
corticosteroids)
• Organ or bone marrow
transplant.
• Pregnant women with
high-risk conditions
PNEUMOCOCCAL Vaccination
86. • One-time revaccination is
recommended 5yrs later for people
with
–Rapid antibody loss
(e.g., renal disease)
–People >65yrs of age if the 1st dose
was given prior to age 65 and > 5yrs
have elapsed since previous dose.
PNEUMOCOCCAL Vaccination
88. 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.
89. Schedule
• A single dose of 0.5 ml SC in deltoid region.
• In children between 3 months and 2 years of
age, two doses at an interval of 3 months are
indicated.
Meningococcal Vaccination
90. Recommendations
• The meningococcal vaccine can be used in
selected populations in certain situations,
such as
–During an outbreak (HCW, Lab. worker,
Close contacts )
–During inter-epidemic period
–To travelers, pilgrims(Quadrivalent),
people attending fairs and
festivals(bivalent 10-14 days prior).
Meningococcal Vaccination
91. • Mass vaccination may be considered depending on
the age-specific attack rate, geographical
distribution of cases, and the availability of vaccine.
• During the inter-epidemic period, to personnel
living in dormitories; military recruits; jail inmates;
immunocompromised individuals.
• Adults with anatomic or functional asplenia, or
terminal complement component deficiencies.
Meningococcal Vaccination
92. RECOMMENDED VACCINES FOR
HEALTHCARE WORKERS
• Healthcare workers should maintain an
immunization history for:
• Hepatitis B
• Influenza *
• MMR
• Varicella (chickenpox)
• Tetanus, diphtheria, pertussis
• Meningococcal**
* Receive annually
** For specific healthcare personnel
93. RECOMMENDED VACCINES FOR
TRAVELERS TO INDIA
CDC recommends the vaccines according
to duration of stay in India.
• Tetanus-Diphtheria
• Hepatitis A
• Yellow Fever
• Polio
• Japanese Encephalitis
• Rabies
• Typhoid
• Hepatitis B
• Tuberculosis
• Meningitis
< 1 month
1- 5 month
> 6 month
94. TAKE HOME MESSAGE
Adult women are an important group of
any country & their health care is utmost
important. Our social scenario prevent
them to access a health care facility on
their own …it is for us as gynaecologists,
Paediatricians, general practitioners to
see that they are cared & needed
vaccination are given in time
95. REMEMBER..ADULT Immunization
recommended in India for WOMEN
Tdap MMR
Influenza Pneumococcal
Hepatitis B Hepatitis A
Varicella HPV (cervical cancer)
Meningococcal Herpes Zoster
96. ADDRESS
11 Gagan Vihar, Near
Karkari Morh Flyover,
Delhi - 51
CONTACT US
9650588339
011-22414049
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