Call Girls Navi Mumbai Just Call 9907093804 Top Class Call Girl Service Avail...
ygyuyhgjiuhiuhuihnjkhiuhkjnhkihiohkhliholihoi
1. Haemophilus influenzae type b
• Severe bacterial infection,
particularly among infants
• During late 19th century believed to
cause influenza
• Immunology and microbiology
clarified in 1930s
2. Haemophilus influenzae
• Aerobic gram-negative bacteria
• Polysaccharide capsule
• Six different serotypes (a-f) of
polysaccharide capsule
• 95% of invasive disease caused
by type b
3. Haemophilus influenzae type b
Pathogenesis
• Organism colonizes nasopharynx
• In some persons organism invades
bloodstream and cause infection at
distant site
• Antecedent upper respiratory tract
infection may be a contributing
factor
5. Haemophilus influenzae type b
Meningitis
• Accounted for approximately
50%-65% of cases in the
prevaccine era
• Hearing impairment or neurologic
sequelae in 15%-30%
• Case-fatality rate 2%-5% despite of
effective antimicrobial therapy
6. Haemophilus influenzae type b
Medical Management
• Hospitalization required
• Treatment with an effective 3rd
generation cephalosporin, or
chloramphenicol plus ampicillin
• Ampicillin-resistant strains now
common throughout the United
States
7. Haemophilus influenzae type b
Epidemiology
• Reservoir Human
Asymptomatic carriers
• Transmission Respiratory droplets
• Temporal pattern Peaks in Sept-Dec
and March-May
• Communicability Generally limited but
higher in some
circumstances
8. 0
5
10
15
20
25
1990 1992 1994 1996 1998 2000 2002 2004
Incidence
Incidence*of Invasive Hib
Disease, 1990-2004
*Rate per 100,000 children <5 years of age
Year
10. Haemophilus influenzae type b—
United States, 1996-2000
• Incidence has fallen 99% since
prevaccine era
• 341 confirmed Hib cases reported
during 1996-2000 (average of 68
cases per year)
• Most recent cases in unvaccinated
or incompletely vaccinated
children
11. Haemophilus influenzae type b
Risk Factors for Invasive Disease
• Exposure factors
–household crowding
–large household size
–child care attendance
–low socioeconomic status
–low parental education
–school-aged siblings
• Host factors
–race/ethnicity
–chronic disease
13. Haemophilus influenzae type b
Conjugate Vaccines
• 3 conjugate vaccines licensed for
use in infants as young as 6 weeks
of age
• All utilize different carrier proteins
• 2 combination vaccines available
that contain Hib vaccine
15. Vaccine 2 mo 4 mo 6 mo 12-18 mo
HbOC x x x x
PRP-T x x x x
PRP-OMP x x x
Haemophilus influenzae type b Vaccine
Routine Schedule
16. Haemophilus influenzae type b
Vaccine Interchangeability
• All conjugate Hib vaccines
interchangeable for primary series
and booster dose
• 3 dose primary series if more than
one brand of vaccine used
17. Haemophilus influenzae type b
Vaccine
Use in Older Children and Adults
• Generally not recommended for
persons older than 59 months of
age
• Consider for high-risk persons:
asplenia, immunodeficiency, HIV
infection, HSCT
• One pediatric dose of any
conjugate vaccine
18. • Swelling, redness, or pain in
5%-30% of recipients
• Systemic reactions infrequent
• Serious adverse reactions rare
Haemophilus influenzae type b
Vaccine
Adverse Reactions
19. Haemophilus influenzae type b
Vaccine
Contraindications and Precautions
• Severe allergic reaction to vaccine
component or following a prior
dose
• Moderate or severe acute illness
• Age less than 6 weeks
20. Pneumococcal Disease
• S. pneumoniae first isolated by
Pasteur in 1881
• Confused with other causes of
pneumonia until discovery of Gram
stain in 1884
• More than 80 serotypes described
by 1940
• First U.S. vaccine in 1977
21. Streptococcus pneumoniae
• Gram-positive bacteria
• 90 known serotypes
• Polysaccharide capsule
important virulence factor
• Type-specific antibody is
protective
24. Pneumococcal Pneumonia
• Estimated 175,000 hospitalizations per
year in the United States
• Up to 36% of adult community-acquired
pneumonia and 50% of hospital-
acquired pneumonia
• Common bacterial complication of
influenza and measles
25. Pneumococcal Bacteremia
• More than 50,000 cases per year in
the United States
• Rates higher among elderly and
very young infants
• Case-fatality rate ~20%; up to 60%
among the elderly
26. Pneumococcal Meningitis
• Estimated 3,000 - 6,000 cases per
year in the United States
• Case-fatality rate ~30%, up to 80%
in the elderly
• Neurologic sequelae common
among survivors
27. Pneumococcal Disease in Children
• Bacteremia without known site of
infection most common clinical
presentation
• S. pneumoniae leading cause of
bacterial meningitis among children
younger than 5 years of age
• Highest rate of meningitis among
children younger than 1 year of age
• Common cause of acute otitis media
28. Bacteremia 13,000
Meningitis 700
Death 200
Otitis media 5,000,000
Syndrome Cases
Burden of Pneumococcal
Disease in Children*
*Prior to routine use of pneumococcal conjugate vaccine
29. Pneumococcal Disease
Epidemiology
• Reservoir Human carriers
• Transmission Respiratory
• Temporal pattern Winter and early spring
• Communicability Unknown
Probably as long as
organism in respiratory
secretions
30. Invasive Pneumococcal Disease
Incidence by Age Group—1998
0
50
100
150
200
250
<1 1 2 3 4 5-17 18-34 35-49 50-64 65+
Age Group (Yrs)
Rate*
*Rate per 100,000 population
Source: Active Bacterial Core surveillance/EIP Network
31. Children at Increased Risk of
Invasive Pneumococcal Disease
• Functional or anatomic asplenia, especially
sickle cell disease
• HIV infection
• Recipient of cochlear implant
• Out-of-home group child care
• African American children
• Alaska Native and American Indian children
who live in Alaska, Arizona, or New Mexico
• Navaho children who live in Colorado and
Utah
32. Pneumococcal Disease
Outbreaks
• Outbreaks not common
• Generally occur in crowded
environments (jails, nursing
homes)
• Persons with invasive disease
often have underlying illness
• May have high fatality rate
34. Pneumococcal
Polysaccharide Vaccine
• Purified capsular polysaccharide
antigen from 23 types of
pneumococcus
• Account for 88% of bacteremic
pneumococcal disease
• Cross-react with types causing
additional 8% of disease
35. Pneumococcal Conjugate
Vaccine
• Pneumococcal polysaccharide
conjugated to nontoxic
diphtheria toxin (7 serotypes)
• Vaccine serotypes account for
86% of bacteremia and 83% of
meningitis among children
younger than 6 years of age
36. Pneumococcal
Polysaccharide Vaccine
• Purified pneumococcal
polysaccharide (23 types)
• Not effective in children younger
than 2 years
• 60%-70% against invasive disease
• Less effective in preventing
pneumococcal pneumonia
37. Pneumococcal Conjugate
Vaccine
• Highly immunogenic in infants and
young children, including those with
high-risk medical conditions
• 97% effective against invasive
disease caused by vaccine serotypes
• 73% effective against pneumonia
• 7% reduction in all episodes of acute
otitis media
38. Pneumococcal Polysaccharide
Vaccine Recommendations
• Adults 65 years of age or older
• Persons 2 years or older with
–chronic illness
–anatomic or functional asplenia
–immunocompromised (disease,
chemotherapy, steroids)
–HIV infection
–environments or settings with
increased risk
MMWR 1997;46(RR-8):1-24
40. Pneumococcal Conjugate
Vaccine Recommendations
• Doses at 2, 4, 6, months of age,
booster dose at 12-15 months of
age
• Unvaccinated children >7
months of age require fewer
doses
MMWR 2000;49(RR-9):1-35
41. Pneumococcal Conjugate
Vaccine
• Children aged 24-59 months at
high risk and previously
vaccinated with PPV23 should
receive 2 doses of PCV7
• Children at high risk who
previously received PCV7 should
receive PPV23 at age 2 years of
age
MMWR 2000;49(RR-9):1-35
42. Pneumococcal Polysaccharide
Vaccine Revaccination
• Routine revaccination of
immunocompetent persons is not
recommended
• Revaccination recommended for
persons age >2 years at highest
risk of serious pneumococcal
infection
• Single revaccination dose >5
years after first dose
MMWR 1997;46(RR-8):1-24
43. Pneumococcal Polysaccharide Vaccine
Candidates for Revaccination
• Persons >2 years of age with:
–functional or anatomic asplenia
–immunosuppression
–transplant
–chronic renal failure
–nephrotic syndrome
• Persons vaccinated at <65 years of
age
MMWR 1997;46(RR-8):1-24
45. Pneumococcal Vaccines
Contraindications and Precautions
• Severe allergic reaction to vaccine
component or following prior dose
of vaccine
• Moderate or severe acute illness
46. Pneumococcal Polysaccharide Vaccine
Missed Opportunities
• >65% of patients with severe
pneumococcal disease had been
hospitalized within preceding 3-5
years yet few had received vaccine
• May be administered
simultaneously with influenza
vaccine
