This document discusses vaccination recommendations for adolescents, preconception, and during pregnancy. It provides guidance on routine vaccinations such as Tdap, HPV, influenza, and meningococcal vaccines for adolescents. It also discusses catch-up vaccinations for hepatitis B, MMR, varicella, hepatitis A, and typhoid. The effectiveness and schedules for 2-dose HPV vaccination in adolescents is reviewed. Preconception vaccination guidance emphasizes determining immune status for rubella, varicella and hepatitis B and vaccinating susceptible women.
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
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
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
HPV Vaccination, Cerviocal Cancer : Do we need it
for Prevention of cervical cancer &
other HPV related diseasesm,
Presentation Outlines
Cervical cancer disease burden
Prevention with HPV vaccination
Vaccination of sexually active women
Opportunity of Postpartum HPV vaccination
Importance of genital warts prevention
Real world effectiveness data
Safety of HPV vaccine
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Cervical Cancer is common worldwide , ranking 3rd among all malignancies for women.
Second leading cause of cancer death.
Most of these cancers stem from infection with the Human Pappiloma Virus (HPV).
Basics To Ca Cx Screening (Eastern Biotech)Pankaj Sohaney
Detecting HPV means better understanding of the risk of cervical cancer was the major focus of Dr. Dinesh Gupta. He spoke on “Opportunistic Screening for Cervical Precancer Lesions” and informed why the combination screening is vital for prevention and detection of cervical cancer. According to Dr. Gupta, combined screening with liquid based cytology and hybrid capture2 HPV DNA test would identify who’s at risk for high-grade disease and cancer and reduce missed disease caused by false-negative Pap Smear. HPV DNA test is the only FDA approved test to detect 13 high risk HPVs associated with virtually all cervical cancer, he added.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.
Symptoms:
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.
In women who have symptoms, the most common signs and symptoms of uterine fibroids include:
Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.
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 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
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
Cervical Cancer is common worldwide , ranking 3rd among all malignancies for women.
Second leading cause of cancer death.
Most of these cancers stem from infection with the Human Pappiloma Virus (HPV).
Basics To Ca Cx Screening (Eastern Biotech)Pankaj Sohaney
Detecting HPV means better understanding of the risk of cervical cancer was the major focus of Dr. Dinesh Gupta. He spoke on “Opportunistic Screening for Cervical Precancer Lesions” and informed why the combination screening is vital for prevention and detection of cervical cancer. According to Dr. Gupta, combined screening with liquid based cytology and hybrid capture2 HPV DNA test would identify who’s at risk for high-grade disease and cancer and reduce missed disease caused by false-negative Pap Smear. HPV DNA test is the only FDA approved test to detect 13 high risk HPVs associated with virtually all cervical cancer, he added.
Say no to cervical cancer-PUBLIC Awareness-Life Care Centre_Dr.Sharda JainLifecare Centre
Cervical Cancer in INDIA
Say no to cervical cancer
Dr.Sharda Jain
Life Care Centre
PUBLIC Awareness_Dr.Sharda Jain
HPV Infection
HPV Vaccination
Cervical Screening
SEE & TREAT Programme tp Prevent Cervical Cancer
Uterine fibroids are noncancerous growths of the uterus that often appear during childbearing years. Also called leiomyomas (lie-o-my-O-muhs) or myomas, uterine fibroids aren't associated with an increased risk of uterine cancer and almost never develop into cancer.
Fibroids range in size from seedlings, undetectable by the human eye, to bulky masses that can distort and enlarge the uterus. You can have a single fibroid or multiple ones. In extreme cases, multiple fibroids can expand the uterus so much that it reaches the rib cage and can add weight.
Symptoms:
Many women who have fibroids don't have any symptoms. In those that do, symptoms can be influenced by the location, size and number of fibroids.
In women who have symptoms, the most common signs and symptoms of uterine fibroids include:
Heavy menstrual bleeding
Menstrual periods lasting more than a week
Pelvic pressure or pain
Frequent urination
Difficulty emptying the bladder
Constipation
Backache or leg pains
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.
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 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
Vaccination of pregnant women and health care workers - Slideset by Professor...WAidid
Professor Lopalco suggests the vaccines to be considered for pregnant women and the ones recommended for health care workers (Influenza, HBV, dTap, MMR-V, meningococcal).
LAIV in India - Should we use it? Sep 2014Gaurav Gupta
LAIV Nasovac S by Serum Institute of India, should it be used in India?
Influenza vaccine, Flu, India, Live, Inactivated, Children, injection, vaccine, asthma
This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.
Vaccination during pregnancy is crucial to protect both the mother and the developing baby. It helps prevent serious complications and ensures a healthier start in life. #VaccinateForTwo 🤰💉
Immunization of children with cancer is a burning topic. Not only concerned parents but also paediatric oncologists have so many questions and queries regarding this matter. This presentation will try to answer those questions with the help of recent and updated guidelines on immunization of both developed and developing countries.
Similar to Vaccination in women from adolescence to menopause (20)
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 Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
4. Vaccination in adolescence
• Vaccination important for adolescents and adults
• 80-85% effective in preventing infectious
diseases
• One third of unimmunised children in world live
in India
• Vaccination coverage – 60-65% in India till 2014
• Mission Indradhanush launched to immunise all
children in 2015 - Target 90% coverage by 2020
• Diphteria and pertusis still endemic in country
5. Adolescence
• Routine Vaccination
• Tdap
• HPV
• Influenza*
• Meningococcal Vaccine*
• Catchup Vaccination
• Hepatitis B
• MMR
• Varicella
• Hepatitis A
• Vaccine in certain
situations
• Pneumococcal
conjugate
• H. Influenza B (Hib)
• Hepatitis A
• Meningococcal
• Pnemococcal
conjugate
ACIP 2017
*Influenza and Meningococcal vaccine to be given in certain
situation according to IAP 2016
6. Vaccination in adolescents IAP
2016
• Routine Vaccination
• Tdap
• HPV
• Vaccine in High risk
children
• Influenza Vaccine
• Meningococcal Vaccine
• Japanese Encephalitis
Vaccine
• Cholera Vaccine
• Rabies Vaccine
• Yellow Fever Vaccine
• Pneumococcal
Polysaccharide vaccine
(PPSV 23)
• High Risk Children
• HIV
• Chronic pulmonary,
renal, hematological,
diabetic
• Immunosuppressive Rx
• Malignancies
• Functional / anatomic
asplenia or hyposplenism
• Children with pets at
home
• Travellers
• Disease outbreak
7. Tetanus Diptheria and acellular
Pertusis (Tdap)
Routine vaccination:
• Administer 1 dose of Tdap vaccine to all adolescents
aged 11 through 12 years.
• Tdap may be administered regardless of the interval
since the last tetanus and diphtheria toxoid–
containing vaccine.
• Administer 1 dose of Tdap vaccine to pregnant
adolescents during each pregnancy (preferably during
the early part of gestational weeks 27 through 36),
regardless of time since prior Td or Tdap vaccination.
8. Tetanus Diptheria and acellular
Pertusis Tdap
Catch–up vaccination:
• Persons aged 7 years or more who are not fully immunized
with DTaP vaccine should receive Tdap vaccine as 1 dose
(preferably the first) in the catch–up series; if additional
doses are needed, use Td vaccine.
• For children 7-10 yrs who receive a dose of Tdap as part of
the catch–up series, an adolescent Tdap vaccine dose at
age 11-12 yrs may be administered.
• Persons aged 11-18 yrs who have not received Tdap vaccine
should receive a dose, followed by tetanus and diphtheria
toxoids (Td) booster doses every 10 years thereafter.
• Inadvertent doses of DTaP vaccine to an adolescent 11-18
yrs, the dose should be counted as the adolescent Tdap
booster.
9. HPV Vaccination
• FOGSI, ACIP, ACOG, RCOG recommends HPV
vaccination in all adolescents for protection
against cancer cervix.
• 9-14 years two dose schedule – 0 and 6 month
• 14 years and above - three dose schedule
10. HPV Vaccine ACIP (2017)
Routine Vaccination
• Administer a 2–dose series of HPV vaccine on a
schedule of 0, 6–12 months to all adolescents aged 11
or 12 years. The vaccination series can start at age 9
years
Catchup vaccination
• Age of initiation of vaccine < 15 years – 2 dose
schedule – 0, 6-12 months
• Age of initiation of vaccine >15 years – 3 dose
schedule -0, 1-2 and 6 months
11. HPV Vaccine ACIP (2017)
2 Dose schedule 3 Dose schedule
Dose Min interval Dose Min Interval
1st & 2nd 5 mth 1st & 2nd 4 wks
2nd & 3rd 12 wks
1st & 3rd 5 mths
If the 2nd dose is administered at a shorter
interval, a 3rd dose should be administered a
min of 12 wks after the 2nd dose and a min
of 5 mths after the1st dose.
If a vaccine dose is administered at a shorter
interval, it should be readministered after another
minimum interval has been met since the most
recent dose
A vaccine dose administered at a shorter interval should be
readministered at the recommended interval.
Special populations:
For children with h/o sexual abuse or assault, administer HPV vaccine beginning
at age 9 yrs.
Immunocompromised persons, including those with HIV should receive a 3–dose
series at 0, 1–2, and 6 months, regardless of age at vaccine initiation
12. HPV Vaccine ACIP 2017
• HPV Vaccine
• Bivalent (Cervarix)– HPV 16 and 18
• Quadrivalent (Gardasil)– HPV 6,11,16 and 18,
• 9-valent (Gardasil9) – HPV types 6,11,16,18, 31, 33,
45, 52, and 58.
• All three vaccines have been approved for
administration in a 3-dose series
• In October 2016 FDA also approved 9vHPV for use
in a 2-dose series for 9-14 yrs
MMWR 2016
13. Rationale of 2 dose schedule -
HPV
• Immunogenicity of 2 dose schedule is non-inferior to
3 dose schedule in age group 9-14 years for 9vHPV,
4vHPV and 2vHPV in various studies
JAMA, 2016, CDC, 2016
• 9vHPV may be used to continue or complete vaccine
schedule of 4vHPV or 2vHPV
• Interrupted schedule- if the schedule is interrupted it
does not need to be restarted. The number of
recommended dose depend on the age of initiation
MMWR, 2017
14. Immunogenicity and HPV infection after one, two,
and three doses of quadrivalent HPV vaccine in
girls in India: a multicentre prospective cohort
study
Unmarried girls aged 10-18 years recd 4HPV from
Sept 1, 2009 to Apr 8, 2010 in 9 centres, 188
clusters, 17,729 girls
• Three doses 0, 60, 180 days –n- 4348 (25%)
• Two doses 0 and 180days-n- 4979 (28%)
• Two doses by default 0 and 60 days- n- 3542 (19%)
• One dose only by default- n-4950 (28%)
Sahnkarnarayan R et al, Lancet, 2016
15. Immunogenicity and HPV infection after one, two,
and three doses of quadrivalent HPV vaccine in
girls in India: a multicentre prospective cohort
study
• Immune response in the two-dose HPV vaccine
group was non-inferior to the three-dose group
(median fluorescence intensity ratio for HPV 16 1·12 [95% CI 1·02–
1·23] and for HPV 18 1·04 [0·92–1·19]) at 7 months, but
was inferior in the two-dose default (0·33 [0·29–0·38]
for HPV 16 and 0·51 [0·43–0·59] for HPV 18) and one-dose
default (0·09 [0·08–0·11] for HPV 16 and 0·12 [0·10–0·14] for HPV
18) groups at 18 months.
Sahnkarnarayan R et al, Lancet, 2016
16. • The geometric mean avidity indices after fewer than
three doses by design or default were non-inferior to
those after three doses of vaccine.
• Fewer than three doses by design and default
induced detectable concentrations of neutralising
antibodies to all four vaccine-targeted HPV types, but
at much lower concentration after one dose.
• The testing of at least two samples from 838
participants showed that there was no persistent HPV
16 or 18 infections in any study group at a median
follow-up of 4·7 years (IQR 4·2–5·1).
18. Influenza – ACIP 2017
• Influenza more severe in <5 years, >65 years,
pregnant women and person with underlying illness
• Administer 1 dose of Inactivated influenza vaccine to
all children more than 9 years
• LAIV is not recommended for influenza 2016-1017
• Both Trivalent IIV3 and quadrivalent IIV4 are
recommennded
• IIV3 – influenza A/california/7/2009(H1N1) like virus,
A/Hongkong/4801/2014(H3N2) and
B/Brisbane/60/2008 like virus, Victoria lineage
• IIV4 – additional influenza B virus strain
B/Phuket/3073/2013 Yamagata lineage
MMWR, 2016
19. Influenza Vaccine Preparation
Vaccine Strains Manufacturer Dose &
Route
Age
Vaxigrip Trivalent Sanofi 15mcg each
HA strain IM
>3 years
Vaxiflue Quadrivalent Zydus 15mcg each
HA strain IM
>3 years
Fluzone Trivalent high
dose
Sanofi 60mcg each
HA strain IM
>65 yrs
Fluzone Quadrivalent Sanofi 9mcg each
HA strain ID
18-64 years
20. Meningococcal Vaccine IAP 2016
• Recommended only for certain high risk group of
children, during outbreaks, and international
travelers to Hajj and sub-Sahara Africa.
• Meningococcal vaccine available in India
• Conjugate vaccines (Quadrivalent MenACWY-D,
Menactra® by Sanofi Pasteur and Monovalent group A,
PsA–TT, MenAfriVac® by Serum Institute of India)
• Polysaccharide vaccines (bi- and quadrivalent)
• Conjugate vaccines have potential for herd protection
and their increased immunogenicity, particularly in
children <2 years of age.
• Quadrivalent conjugate and polysaccharide vaccines
are recommended only for children 2 years and
above. Monovalent group A conjugate vaccine, PsA–TT
can be used in children above 1 year of age.
21. Catch up vaccination Adolescence
– Hepatitis B
• Administer the 3-dose series to those not previously
vaccinated
• Vaccine monovalent Hepatitis B- Recombivax HB
(Merck & Co), Engerix B (GlaxoSmithKline)
• Unvaccinated - 0.5 ml (paediatric dose)
• 0,1-2 month, 6 month
• 0, 1, 4 month
• 0, 2, 4 month
• Engerix 0,1,2,12 month is approved for all ages
• Children 11-15 years – Hep B – 2 dose schedule ( adult
dose Recombivax HB )- (0, 1 month)
22.
23.
24.
25. Measles,Mumps and Rubella
vaccination
• Live attenuated vaccine
• MMR 2 doses 4 weeks apart (Priorix by GSK)
• Adverse reactions rare
• Mild rash
• Fever
• Pain
• Lymphadenitis
• Thrombocytopenia
• Serious allergic reactions very rare
• Avoid Pregnancy for three month
• If pregnancy occurs within 4 weeks of vaccination there is
a very small chance of the fetus being born with CRS and
usually follow and close monitoring with USG is advised
instead of pregnancy termination .
FOGSI 2014
26. Catchup Vaccination - MMR
vaccine
• Ensure that all school-aged children and adolescents have had
at least 2 doses of MMR vaccine (3 doses if the 1st dose is
received before 12 months) ;
• The minimum interval between the 2 doses is 4 weeks.
IAP 2016
• MMR not required if
• Proof of vaccination with live attenuated vaccine
• Proof of exposure to measles, mumps and rubella
• MMR not to be given
• Pregnancy
• h/o life threatening allergic reaction to vaccine, gelatin and
neomycin
• h/o HIV, immunocompromised state, cancer drugs, steroid
treatment, blood disorder, moderate or severe illness,
27. Catchup vaccination – Hepatitis A
• Pre vaccination screening for Hepatitis A
antibody is recommended in children older than
10 years as at this age the estimated sero-
positive rates exceed 50%
• Inactivated HepA vaccine – 0, 6-12 months
• Live attenuated H2-strain Hepatitis A vaccine -
Single dose
28. Catchup Vaccination - Typhoid
• Recommended throughout the adolescent period, i.e.
up to 18 years of age
• Typhoid conjugate vaccines (Vi-PS): single dose
• Typbar-TCV®
• Pedatyph®
• Vi-PS (polysaccharide) vaccines: single dose every 3
years;
• An interval of at least 4 weeks with the MMR vaccine
• Vi conjugate typhoid vaccine should be preferred
over Vi-PS vaccine wherever feasible
• The need and exact timing of the booster doses are
not yet determined
29. Vaccine Dose Type of vaccine Comment
Cholera Two doses 2 weeks Vaxchora –Oral, live
attenuated
Only in highly endemic areas and
traveling to areas where risk of
transmission is very high like Kumbh
mela, etc
Rabies Post-exposure prophylaxis
- 0, 3, 7, 14, and 30 days
Pre- exposure -0, 7 and
28
Human Diploid Cell Vaccine
(HDCV), Purified Chick
Embryo Cell (PCEC) vaccine,
Purified Duck Embryo Vaccine
(PDEV); 0.5 ml for Purified
Vero Cell Vaccine (PVRV).
significant contact with dogs, cats,
cows, buffaloes, sheep, goats, pigs,
donkeys, horses, camels, foxes,
jackals, monkeys, mongoose,
squirrel, bears and others. Domestic
rodent (rat) bites do not require
post exposure prophylaxis in India
Japanese
encephalitis
2 doses 4 weeks apart Inactivated cell culture
derived SA-14-14-2 (JEEV® by
BE India)
Inactivated Vero cell culture-
derived Kolar strain,
821564XY, JE vaccine
(JENVAC® by Bharat Biotech)
Endemic areas or outbreaks only
Varicella 2 doses 4 weeks apart Varivax, live attenuated With no evidence of immunity
Pneumoccal Single dose PPSV 23 Immunocompromised state
Vaccination in certain situations -
Adolescents
33. Preconception - Vaccines
Window of opportunity to vaccinate susceptible
individuals
• MMR
• Varicella
• HPV
• Influenza
• Tdap/Td
• Hepatitis B
34. Preconception counselling – Key
Points
• Determining immune status for Rubella, varicella and
Hepatitis B is an important component of
Preconception counselling
• Unvaccinated women must be vaccinated for MMR,
Varicella, Hepatitis B, and Tdap to prevent perinatal
infection
• Catchup vaccination should be given for HPV prior to
conception
• Women receiving Live viral vaccines should be
advised to avoid pregnancy for 4 weeks to avoid
theoretical risk of live virus reaching fetus
35. Preconception immunization
• Rubella infection in susceptible women in pregnancy
leads to CRS
• First trimester – 85% CRS
• 13-16 weeks – 54% CRS
• Late second trimester – 25%
• Varicella infection in pregnancy
• Increased perinatal and maternal morbidity and mortality
• FVS occurs in 0.9% in first trimester and upto 50% of
newborns get infected and 23% develop congenital
varicella if infection occurs within 1-4 weeks of delivery
36. Preconception or adults -Hepatitis
• Hepatitis B –Monovalent Recombivax HB or Engerix B
• Hepatitis A and B – Twinrix (Glaxo) licenced from
2001, alternate schedule from 2007 in >18 years
• Recombinant Hep B and inactivated Hep A
• Dose schedule – 1ml each dose
• 0, 1, 6 month
• Alternate schedule 0, 7, 21-30 days and 12 months
• For immunocompromised alternate schedule with 2ml
• Efficacy of First three doses of alternate schedule is
as effective as single dose of monovalent Hep A and 2
doses of Hep B – effective for people travelling
38. Immunisation in Pregnancy
• Vaccine preventable diseases significant maternal and
perinatal morbidity and mortality
• Immunogenicity of vaccine affected by maternal
immune response
• Immature immune system of neonates and preterms
vulnerable to infections
• Immunization of mother protects fetus and infant
directly against vaccine preventable diseases
• Limited evidence of safety of vaccines in pregnancy
as pregnant women not included in trials
Safety of immunization during pregnancy – a review of evidence,
Global Advisory Committee on Safety of Vaccine, WHO 2014
39. Considered safe if
otherwise
indicated
Contraindicated
during
pregnancy or safety
not established
Special
recommendations
pertain
Tetanus and
diphtheria
toxoids (Td)
Tdap
Hepatitis B
Influenza
Meningococcal
Rabies
BCG*
Measles*
Mumps*
Rubella*
Varicella*
Anthrax
Hepatitis A
Japanese
encephalitis
Pneumococcal
Polio (IPV)
Typhoid (parenteral
and Ty21a*)
Vaccinia*
Yellow fever*
Immunizations During Pregnancy
*—Live, attenuated vaccine.
BCG = bacille Calmette-Guérin; IPV = inactivated polio virus.
Adapted from Guidelines for vaccinating pregnant women. Recommendations of the Advisory
Committee on Immunization Practices (ACIP). Atlanta, Ga.: Centers for Disease Control and
Prevention, 2002
40.
41.
42. Influenza vaccination in
pregnancy
• Influenza is pandemic in India and worldwide
• Pregnant women are at high risk for influenza
with 3-4 times higher rate of hospitalisation and
4-5 times higher chances of ICU admission
• Perinatal mortality 39/1000, 33% loss of
pregnancy and 33% higher maternal mortality
• Most of influenza is caused by Influenza A
(H1N1), (H3N2) and Influenza B
• Antigenic drift–Seasonal influenza,Influenza A B C
• Antigenic shift – Pandemic, Influenza A
43.
44. Non-adjuvanted inactivated trivalent
seasonal and monovalent pandemic
influenza vaccines
• Inactivated influenza vaccine is safe and have
adequate immune response in pregnancy with
adequate transfer of transplacental antibody transfer
• The excellent and robust safety profile of multiple
inactivated influenza vaccine preparations over many
decades, and the potential complications of influenza
disease during pregnancy, support WHO
recommendations that pregnant women should be
vaccinated.
• Recommended in 2nd and 3rd trimester and protects
baby till 6 months of age
GACVS, WHO 2014
45. Influenza vaccination in
pregnancy
• CDC, RCOG, ACOG and ACIP recommends annual
influenza vaccine to all pregnant mothers
• Influenza vaccine is an essential component in
preconception, prenatal and postnatal care of
women and should be offered to women who are
or will be pregnant in influenza season
ACOG committee Opinion, 2014
• FOGSI recommends Inactivated Influenza Vaccine
from 26 weeks onwards and can be given earlier
in pandemic at least 2 weeks prior to delivery
FOGSI 2014
46. Influenza vaccination in
pregnancy
• Newer Quadrivalent Vaccine (Vaxiflu)available
contains two strains of Influenza A and two
strains of Influenza B (Yamagata and Victoria)
47. Tetanus Toxoid Vaccines
• 59000 neonatal death in 2008 – 92% reduction from 1980
• 34 countries still not eliminated tetanus till 2012
• WHO recommends 2 TT doses in pregnancy 4 weeks apart with
last dose at least 2 weeks before delivery
• VARES database 2005-2010 search found Tdap to be safe in
pregnancy and can be safely recommended in place TT in
Pregnancy
• There are moderate local reaction to Tdap but because of the
potential benefits of maternal pertussis immunization (ACIP) has
recently recommended that pregnant women receive Tdap
boosters during each pregnancy
ACIP 2012
• ACIP, ACOG and FOGSI recommends Tdap in place of second TT in
pregnancy
GACVS, WHO 2014
48. Pertusis vaccination in Pregnancy
• Substantial increase in pertusis in children in
2012
• 41,880 pertusis cases and 14 infant death in 2012
• Maternal antibodies transported across placenta
provides passive immunity to newborn before
he/she can be vaccinated
• Vaccines are well tolerated and immunogenic in
pregnant women and their neonates
• Tdap has been found safe to be used in
pregnancy with no adverse fetal effects
CDC 2012
49.
50. Tdap in third trimester
• Tdap may be administered any time during pregnancy, but
vaccination during the third trimester would provide the
highest concentration of maternal antibodies to be
transferred closer to birth
• After Tdap, a minimum of 2 weeks is required to mount a
maximal immune response to the vaccine antigens.
• Active transport of maternal IgG does not substantially
take place before 30 weeks of gestation
• One study of pregnant women who received Tdap within
the prior 2 years noted that maternal antibodies waned
quickly; even women immunized during the first or second
trimester had low levels of antibodies at term.
• ACIP concluded that pregnant women should be vaccinated
with Tdap during the third trimester to optimize
transplacental transfer of maternal antibodies
MMWR, 2013
51.
52. ACIP update on Tdap in pregnancy
• Antibody levels in in non pregnant adults peak within
first month with substantial decay after 1 year
• Maternal antibodies from women immunized before
pregnancy waned quickly and the concentration of
maternal antibodies was unlikely to be high enough to
provide passive protection to infants
• Because antibody levels wane substantially during the
first year after vaccination, ACIP concluded a single
dose of Tdap at one pregnancy would be insufficient
to provide protection for subsequent pregnancies.
MMWR, 2013
ACIP recommends Tdap in every pregnancy
53. Impact of Tdap in Pregnancy
Annual mean Cases prevented by Tdap
n(range)
Antenatal Tdap Postpartum Tdap
Infant Pertusis cases 906 (595–1,418) 549 (361–860)
Hospitalisation 462 (261–736) 219 (124–349)
Death 9 (4–17) 3 (1–6)
Tdap in pregnancy versus postpartum Tdap
CDC, unpublished data, 2012, MMWR, 2013
54. Live attenuated Vaccines in
Pregnancy
• Live Viral Vaccines has potential to cross
placenta and affect fetus, they are
contraindicated in pregnancies
• Inadvertent exposure in pregnancy raises safety
concerns
55. Safety of Monovalent Rubella and MMR live
attenuated vaccines exposure in pregnancy
• CRS was not seen after inadvertent exposure of vaccine in
pregnancy in a review of more than 680 Rubella susceptible
women conceived within 3 month of vaccination.
ACIP 2006
• In Latin America, 2894 women rubella susceptible who
conceived within 1 month of Rubella or MMR vaccine were
evaluated for Rubella IgM and features of CRS in fetus.
Cord Rubella IgM was positive in 70 women (3.5%) but none
developed CRS.
Vaccines, 2006
• On the basis of these data, a maximum theoretical risk for
CRS of 0.2% was estimated following inadvertent
vaccination with rubella vaccine during pregnancy
• Inadvertent administration of MMR vaccines is not
considered an indication for termination of the pregnancy,
as there is no evidence of harm to the fetus
GACVS, WHO 2014
58. Postnatal Vaccination
FOGSI recommends postnatal vaccinations to all
non immunized postnatal mothers
• MMR
• Hepatitis B
• Varicella
• Influenza
• Tetanus
• HPV
59.
60. Post Natal Vaccination
• Both inactivated and Live Vaccines (except Small
Pox and Yellow Fever) are safe for lactating
mothers
• Three vaccines should be given before discharge
to susceptible mothers to protect themselves
and their baby
• MMR
• Varicella
• Tdap
64. Vaccination in adults and elderly
FOGSI recommends vaccination for women of all
ages
• HPV – licensed upto 45 years
• Tetanus ,diphtheria – TT/dT every 10 years,
women more than 65 years in contact with
infant should be given Tdap instead of TT/dT
• Influenza – annual flu shots throughout life,
live attenuated upto 49 years
65. Influenza vaccination in elderly
>65 years – ACIP 2017
• Annual one dose influenza vaccine prior to
innfluenza season
• Fluzone - high dose IIV3 vaccine -60mcg of each
HA strain, total 180mcg should be recommended
66.
67. ACIP recommendations for HPV
2017
• Age <15 years – 2 doses atleast 5 month apart
• Age >15 years – 3 doses
• Adult female through 26 years who have not received
any vaccination should receive 3 doses- 0,1-2,6
months
• Adult female who received 2 vaccines prior to 15
years are considered adequately vaccinated
• Adult female who initiated vaccination prior to 15
years but received only 1 dose or 2 dose less than 5
months apart should receive 1 dose of HPV
68. Vaccine Dose Comments Guideline
Influenza
Inactivated
CDC, ACOG,
FOGSI
Td 0,4 weeks and
6 month
In unknown or
incomplete
immunization
CDC, ACOG,
FOGSI
Tdap one dose 27-
36 weeks
CDC
Vaccine Recommended for use in Pregnancy
69. Vaccine Dose Comments Guidelines
Hepatitis A
Hepatitis B
PCV 13 No
recommendation
CDC
PPSV23 Safety in first
trimester not
established
CDC
Polio IPV May be given if
increased risk of
exposure
CDC
Vaccine to be given in pregnancy if benefit more than the risk
70. Vaccine Dose Comments Guidelines
Influenza (LAIV) CDC, FOGSI, ACOG
MMR CDC, FOGSI, ACOG
Varicella CDC, FOGSI, ACOG
Zoster CDC, FOGSI, ACOG
HPV
Vaccines not recommended or Contraindicated in Pregnancy