PH 172 Course Slides: Introduction to Immunizations - UC San Diego - PDF

***WELCOME*** **to** **Immunizations and Public Health** **PH 172** (section A00)  **Class 01** **Introduction to Course** **History and Perspectives on Immunizations** 07 Jan 2025 **Introduction** **Margaret Ryan, MD, MPH** Occupational and Preventive Medicine physi...

***WELCOME*** **to** **Immunizations and Public Health** **PH 172** (section A00)  **Class 01** **Introduction to Course** **History and Perspectives on Immunizations** 07 Jan 2025 **Introduction** **Margaret Ryan, MD, MPH** Occupational and Preventive Medicine physician Clinical Professor (part time) Herbert Wertheim School of Public Health, UC San Diego Captain, Medical Corps, US Navy (retired) Medical Director of Defense Health Agency Pacific Region Immunization Program at Naval Medical Center San Diego Please read syllabus and all information posted on Canvas Please contact Dr. Ryan any time with questions or concerns m1ryan\@ucsd.edu 858-342-5786 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#4 **Course Objectives** Upon completion of this course, students should be able to: Understand how public health principles -- including justice, equity, diversity, and inclusion \-- apply to historic events, and future efforts in supporting immunizations; Identify the principles of immunology that apply to vaccine preventable diseases and the foundational science on these topics; Describe immunization recommendations and policy, including the roles of FDA, VRBAC, CDC, ACIP in the United States, and the counterpart advisory organizations internationally; \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#5 **Course Objectives** \[continued\] Describe immunization practice, including clinical challenges in addressing adverse events following immunization (AEFIs), risk communication, and clinical management of vaccinations; Apply understanding of immunization resources to effectively communicate public health information about a specific vaccine preventable disease; Demonstrate understanding of resources within the scientific literature and other public health sources to maintain expertise in the continually evolving immunization field. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#6 **Public Health Values** Because we are public health people, we value justice, equity, diversity, and inclusion. We listen to, respect, and appreciate all voices. Because we are public health people, we are committed to service, compassion, and kindness. We begin interactions by assuming the best in each other and the people we serve. Because we are public health people, we strive to make our learning environments safe spaces -- both physically and emotionally.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#7 **Public Health Values and Immunizations** Immunization topics -- sometimes more than other public health topics -- may incite passionate views. All of our public health values apply!  22 Dec 2023 -- Washington Post reporter Lauren Weber described vaccine related political divisions in many states and the vaccine-opposed platform of Robert F Kennedy (nominee for US Secretary of Health and Human Services) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#8 **Course Materials** **See Canvas for syllabus, slides, and assignments** **See Canvas for all required reading** **Slides and other course-specific material should [not] be publicly posted without permission from Dr. Ryan** ▪ Info on immunizations can become outdated quickly ▪ Info may be viewed out of context or used for other agendas ▪ Info may be protected as UCSD intellectual property \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#9 **Course Materials** **CDC Pink Book** [https://www.cdc.gov/pinkbook/hcp/ table-of-contents/index.html] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#10 **Course Materials** **CDC Yellow Book** **Other Resources** **CDC webpages (many)** [https://wwwnc.cdc.gov/travel/yellowbook/ 2024/table-of-contents ] [https://www.cdc.gov/vaccines/index.html ] **Academic Immunization Experts online** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#11 **Course Logistics**  **Class Engagement\*** Reflections on class material (16 submissions, up to 5 points each) **Homework** Brief assignments on Canvas (4 assignments, up to 20 points each) **Exam \#1** In-class assessment of didactic material from classes 1-9 (80 points) **Exam \#2** Take-home assessment using class resources (80 points) **Group project** Presentation on one vaccine-preventable disease (80 points) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#12 **Course Logistics** **\*Class Engagement** In-class attendance is considered important to engagement in the course and support of the class community. Therefore, in-class attendance is incentivized by reflection points. Reflections on classes attended in-person are worth up to 5 points each, and reflections on classes not attended in-person are worth up to 2 points each. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#13 **Course Logistics** **Academic Integrity and Generative Artificial Intelligence (GenAI)** ∙ Academic integrity is critical to the learning and practice of public health ∙ Just as public health professionals may access GenAI tools, public health students may access GenAI tools in this course. GenAI tools should be used to enhance, but not replace, mastery of the material. ∙ Students should view GenAI responses with caution, since some GenAI responses may be incorrect and/or perpetuate bias. ∙ If GenAI tools are used for a written assignment, the student must cite the tool (e.g., ChatGPT) and describe how it was used. Copy-pasting a response that was GenAI-generated is not permitted since this will not demonstrate the student's understanding of the material. ∙ UC San Diego Academic Integrity policy and guidelines apply [https://academicintegrity.ucsd.edu/excel-integrity/gen-ai/ ] [http://senate.ucsd.edu/Operating-Procedures/Senate-Manual/Appendices/2] \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#14 **Course Philosophy** Upper division courses are more like graduate school courses, focused on learning rather than points Collaboration is encouraged Enjoyment of the topics is anticipated  http://www.publichealthnewswire.org/?p=8456 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#15 **Class Schedule** +-----------------------+-----------------------+-----------------------+ | **Day/ Date** | **Class** | **Topic** | | | | | | **Tue/ 07 Jan 2025** | 1 | **Introduction to | | | | course: History and | | | | perspectives on | | | | immunizations** | +=======================+=======================+=======================+ | **Thu/ 09 Jan 2025** | 2 | **Overview of | | | | vaccine-preventable | | | | infections** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 14 Jan 2025** | 3 | **Immunology basics | | | | and vaccination** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 16 Jan 2025** | 4 | **Adverse events | | | | following | | | | immunization** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 21 Jan 2025** | 5 | **Vaccine production | | | | and the role of FDA** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 23 Jan 2025** | 6 | **Vaccine | | | | recommendations and | | | | role of CDC** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 28 Jan 2025** | 7 | **Ethical and equity | | | | challenges in | | | | immunization policy** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 30 Jan 2025** | 8 | **Vaccine hesitancy | | | | and risk | | | | communication** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 04 Feb 2025** | 9 | **Vaccinations in | | | | clinical practice** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 06 Feb 2025** | 10 | **Review of topics** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 11 Feb 2025** | 11 | **Exam \#1 (in | | | | class)** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 13 Feb 2025** | 12 | **Important vaccine | | | | stories: Smallpox** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 18 Feb 2025** | 13 | **Important vaccine | | | | stories: Polio** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 20 Feb 2025** | 14 | **Important vaccine | | | | stories: Influenza** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 25 Feb 2025** | 15 | **Important vaccine | | | | stories: COVID-19** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 27 Feb 2025** | 16 | **Student vaccine | | | | presentations: Groups | | | | 1, 2, 3** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 04 Mar 2025** | 17 | **Student vaccine | | | | presentations: Groups | | | | 4, 5, 6** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 06 Mar 2025** | 18 | **Student vaccine | | | | presentations: Groups | | | | 7, 8, 9** | +-----------------------+-----------------------+-----------------------+ | **Tue/ 11 Mar 2025** | 19 | **Student vaccine | | | | presentations: Groups | | | | 10, 11, 12** | +-----------------------+-----------------------+-----------------------+ | **Thu/ 13 Mar 2025** | 20 | **Perspectives on the | | Final Exam week | | future of | | | | immunizations and | | | | course wrap-up Exam | | | | \#2 (take home) due | | | | Thu 21 Mar 2025** | +-----------------------+-----------------------+-----------------------+ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#16 **Class \#1 Objectives** Participants will be able to: Know definitions related to the study of immunizations Appreciate some historically important contributions to the field of immunizations Identify important legislation and the basic roles of FDA and CDC/ACIP in immunization care in the US Explain factors that make immunization a special topic, and apply understanding these factors to addressing immunization-related public health challenges \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#17 **Definitions** **[Immunity]** is the ability of the human body (or other organism) to recognize and eliminate microbial \[infection\] threats **[Immunization]** is an action taken to induce immunity **Passive immunization** is the provision of short-term protection from another source; a "gift of antibodies" \[examples: maternal antibodies to pertussis, human rabies immune globulin, monoclonal antibodies to respiratory syncytial virus (RSV)\] **Active immunization** is the induction of long-term protection by challenge with infection or infection-related antigens to prompt the creation of antibodies and an immune response **[Vaccines]** are active immunization products \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#18 **Definitions** On an individual level, immunizations reduce **[morbidity]** (illness) and **[mortality]** (death) from infectious pathogens. On a population level, immunizations reduce **[incidence]** of infections, to control, eliminate, or even eradicate an infectious threat. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#19 **Definitions** *WHO and CDC define specific parameters for control, elimination, or eradiation of vaccine-preventable infections. In general:* **[Control]:** reduction in incidence to a locally acceptable level; continued intervention measures are required. Example: Hepatitis A in the US **[Elimination]:** reduction to zero incidence, or no sustained transmission when pathogen is reintroduced, in a defined geographic area; continued intervention measures are required. Example: Polio in the US **[Eradication]:** permanent reduction to zero of the worldwide incidence of infection; intervention measures no longer needed. Example: Smallpox **[Extinction]**: the specific infectious agent no longer exists in nature or in the laboratory. Example: none \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#20 *Stretch Break* Image from ooapn.org **Important Milestones in Immunization History** 400 BCE: Centuries before human understanding of the microbial cause of infectious disease, **Hippocrates** described human-to-human transmission of mumps, and resistance of patients to subsequent mumps illness 1100s CE: Several cultures in Asia and Africa began the practice of deliberate inoculation with the fluid of smallpox (variola) lesions in an effort to produce mild illness and induce protection from subsequent smallpox disease. This practice was later called '**variolation**' https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407399/ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#22 **Important Milestones in Immunization History** 1796: Edward Jenner (following the work of others) in England demonstrated that deliberate infection with cowpox (vaccinia) resulted in protection from subsequent smallpox (variola) The practice was later called '**vaccination**' and the term was extended to the prevention of non-smallpox diseases. Depiction of Edward Jenner  'vaccinating' James Phipps. Jenner later repeatedly exposed Phipps to smallpox, and the child remained well. http://inmedblogs.us/nicholascomninellis/wp-content/uploads/sites/2/2014/10/jenner \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ small-pox-vaccine-poster-e1412797092290.jpg PH 172, Ryan Slide \#23 **Important Milestones in Immunization History** 1885: Louis Pasteur in Paris, France, demonstrated that weakened or killed **rabies** virus (spinal fluid of infected rabbits, treated with formaldehyde) could be used as a vaccine to prevent rabies in dogs -- and in humans after rabies exposure. Louis Pasteur and Joseph Meister,  the first child treated with post exposure rabies vaccine. The child's severe bites from a rabid dog would have been inevitably fatal in 1885, and even today, without vaccination. https://www.cdc.gov/mmwr/preview/mmwrhtml/00000572.htm \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#24 **Important Milestones in Immunization History** 1894: Dr. Anna Wessels Williams (New York, USA) helped develop **diphtheria antitoxin** (antibody serum drawn from horses). Diphtheria antitoxin provides passive immunity to treat diphtheria.  https://en.wikipedia.org/wiki/Balto **Balto** the sled dog famously helped deliver diphtheria antitoxin from Anchorage to https://cfmedicine.nlm.nih.gov/physicians/biography\_331.html Nome, Alaska in 1925 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#25 **Important Milestones in Immunization History** 1902-1906: Following incidents of contaminated smallpox vaccine (caused 9 children's deaths in NJ) and contaminated diphtheria antitoxin (caused 13 children's deaths in MO), the US enacted the Biologics Control Act and the Pure Food and Drug Act. This was the origin of the US **Food and Drug Administration** (FDA) and its responsibility to license the safe manufacture of immunization products. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#26 **Important Milestones in Immunization History** World War I era: Vaccines were developed to prevent tetanus, pertussis, typhoid, yellow fever, and **influenza**  https://weather.com/health/cold-flu/news/2019-12-23-a-brief-history-of-the-flu-vaccine Warehouse converted to hospital during 1918 influenza pandemic \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#27 **Important Milestones in Immunization History** 1946: US Communicable Disease Center (**CDC**, later the Centers for Disease Control and Prevention) was created and charged with prevention of malaria and other infections in the US 1952: Worst polio epidemic in US history; \>21,000 paralytic cases 1955: First **polio vaccine** developed by Jonas Salk, using formalin-inactivated poliovirus (IPV). Immediately licensed by FDA, IPV vaccine was responsible for dramatic decrease in polio cases \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#28 **Important Milestones in Immunization History** 1955: One of the manufacturers of IPV vaccine, Cutter Laboratories, failed in inactivate poliovirus appropriately. After vaccine administration, 200 children developed paralytic polio and 10 died. The "Cutter incident" highlighted failures of FDA, and strengthened subsequent regulations on vaccine manufacturing. Paul Offit, MD, is Director  of the Vaccine Education Center and professor of pediatrics at Children\'s Hospital of Philadelphia \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#29 **Important Milestones in Immunization History** 1960s: Measles, mumps, and rubella vaccines were developed 1967: World Health Organization launched the coordinated global smallpox eradication program, administering live-vaccinia vaccine (similar to Jenner's original cowpox vaccine) 1980: Smallpox was declared globally eradicated **Eradication of smallpox is** **considered one of the greatest** **achievements in public health!** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#30 **Important Milestones in Immunization History** 1980s: Public concerns about rare vaccine-related adverse events increased as the childhood vaccine schedule expanded 1986: **National Childhood Vaccine Injury Act** established the Vaccine Adverse Event Reporting System (**VAERS**), directed pre vaccination counseling (Vaccine Information Statements, **VIS**s), and specified how vaccinations must be documented 1988: **National Vaccine Injury Compensation Program** (NVICP) was established to provide compensation for adverse events following immunization (**AEFI**s). NVICP is a federal insurance system, alternative to civil litigation, that protects vaccine availability \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#31 **Important Milestones in Immunization History** 1990s: Vaccines preventing Haemophilus influenzae type b (Hib) and pneumococcal infections were added to the routine infant vaccine schedule; \>99% reduction in infant **meningitis** corresponded to reduced disability and death... and changed pediatric practice Lumbar puncture, once a routine part of infant fever evaluations, is now rarely done, since bacterial meningitis is so rare https://link.springer.com/chapter/10.1007/978-1-4939-2507-0\_123 1993: **Vaccines for Children (VFC) Program** was established to improve vaccine equity and access. All vaccines recommended by CDC's Advisory Committee on Immunization Practices (CDC/ACIP) are covered under this program. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#32 **Important Milestones in Immunization History** 1998: CDC/ACIP recommended live oral **rotavirus vaccine** for infants 1999: CDC/ACIP voted to withdraw their recommendation for rotavirus vaccine after investigating 112 VAERS reports of intussusception (bowel obstruction/telescoping) in infants within the first two weeks after vaccination. Although the absolute number of cases was small, the rate of Intussusception was much higher than expected, confirming a 'safety signal' Zhou W, Pool V, Iskander JK, et al.  Surveillance for safety after immunization: Vaccine Adverse Event Reporting System (VAERS)\-- 1991-2001 *MMWR* 2003;52(1):1-24 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#33 **Important Milestones in Immunization History** 2004-present: **Vaccines in pregnancy** In 2004, CDC/ACIP recommended influenza vaccine in pregnancy to protect the pregnant person, fetus and newborn (via maternal passive antibody transfer) from influenza. This recommendation countered prior conventional obstetric practice In 2012, CDC/ACIP recommended pertussis-containing vaccine (Tdap) in every pregnancy to protect newborns from 'whooping cough' Uptake of recommended vaccines in pregnancy is currently near 50%, but disparities in protection persist https://www.cdc.gov/fluvaxview/coverage-by-season/pregnant-april-2024.html \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#34 **Important Milestones in Immunization History** 2009-2010: **Influenza A/H1N1 pandemic** In Apr 2009, a small number of unusual influenza (flu) cases were identified in San Diego; strain was atypical zoonotic (swine) virus. Many severe cases were subsequently identified globally and a pandemic was declared in Jun 2009 Although seasonal flu vaccine composition for fall 2009 was already set, manufacturers and public health leaders collaborated to create a pandemic-specific vaccine by Sep 2009. CDC/ACIP recommended all persons get both seasonal and pandemic-specific vaccines  Pandemic toll in US (60 million cases; 12,000 deaths) was greatly reduced by the special vaccine effort \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ https://www.reuters.com/article/idUSN01495964 PH 172, Ryan Slide \#35 **Important Milestones in Immunization History** 2020-2023: **COVID-19 pandemic** Nov 2019: cases of pneumonia from Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2); Coronavirus Disease-2019 (COVID-19) pandemic declared on 13 Mar 2020 High transmissibility and very high case-fatality rate of the original strain prompted global collaborations on vaccine development mRNA-based vaccines became available in Dec 2020; vaccine products and recommendations evolved over next 3 years COVID-19 vaccines prevented estimated 18 million hospitalizations and 3 million deaths in US... story is ongoing https://www.commonwealthfund.org/blog/2022/two-years-covid-vaccines-prevented-millions-deaths-hospitalizations \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#36 **Important Milestones in Immunization History** In 2024, CDC evaluated impact of US Vaccines for Children program at its 30 year anniversary *See full report on Canvas* In 2024, WHO estimated that global childhood vaccine programs had prevented more that 150 million deaths over the past 50 years Shattock AJ, Johnson HC, Sim SY, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization. *Lancet*. 2024;403(10441):2307-16 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#37 *Stretch Break* Image from ooapn.org **Immunization** **as a Special Topic in Public Health** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#39 **Immunization as a Special Topic in Public Health** **1. Immunizations are important!** Vaccines have saved more lives than any other medical intervention in the modern era Vaccines have prevented more morbidity and disability than any other medical intervention in the modern era Vaccines are vital to protecting children and other vulnerable populations  World Immunization Week 2018 image https://ifa.ngo \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#40 **Immunization as a Special Topic in Public Health** **2. Immunization science is complex** Human understanding of immunology has evolved dramatically in recent decades, and much remains to be discovered "Vaccinology" is a rigorous and challenging academic field Despite complexity, no single healthcare specialty is devoted to immunization care; Allergy/Immunology, Infectious Disease, Pediatrics, Preventive Medicine, and others all have roles Hébert-Dufresne L, Allard A, Young JG, Dubé LJ. Global efficiency of local immunization on complex networks. *Sci Rep*. 2013;3:2171 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#41 **Immunization as a Special Topic in Public Health** **3. Immunization products are numerous and complex** More than 75 vaccine products are currently FDA-licensed or authorized in the US  Products may include dozens of *excipients* as adjuvants, preservatives or stabilizers Products require *special handling*; very sensitive to temperature and sometimes light Products often require special preparation Products all have different requirements for dosing and administration Richardson T. Guidelines for Storage and Temperature Monitoring of Refrigerated Vaccines, 2017. www.nist.gov. \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#42 **Immunization as a Special Topic in Public Health** **4. Immunization recommendations are continually evolving** US standards of care are updated multiple times each year by CDC and its Advisory Committee of Immunization Practices (CDC/ACIP) US standard schedules for childhood and adult vaccines, and seasonal influenza vaccine, are updated at least annually Pandemics compel rapidly changing vaccine guidance \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#43 **Immunization as a Special Topic in Public Health** **5. Immunization recipients have valid concerns** It is difficult to appreciate *prevention* of a disease that has never been experienced Healthy people have little tolerance for interventions that cause pain or adverse reactions, even if adverse reactions are very rare Parents and caregivers have natural concerns about interventions that affect children  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#44 **Class \#1 Objectives Revisited** Participants will be able to: Know definitions related to the study of immunizations Appreciate some historically important contributions to the field of immunizations Identify important legislation and the basic roles of FDA and CDC/ACIP in immunization care in the US Explain factors that make immunization a special topic, and apply understanding these factors to addressing immunization-related public health challenges \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#45 ***Knowledge Check*** **Edward Jenner has an important place in the history of immunizations because he...** **A. Successfully used cowpox to prevent smallpox in 1796 B. Delivered diphtheria antitoxin to Nome, Alaska in 1925 C. Developed the first polio vaccine in 1955** **D. Identified the 'safety signal' of intussusception after rotavirus vaccine in 1999** ***Knowledge Check***  **Edward Jenner has an important place in the history of immunizations because he...** **A. Successfully used cowpox to prevent smallpox in 1796 B. Delivered diphtheria antitoxin to Nome, Alaska in 1925 C. Developed the first polio vaccine in 1955** **D. Identified the 'safety signal' of intussusception after rotavirus vaccine in 1999** ***Knowledge Check*** **The 1986 National Childhood Vaccine Injury Act...** **A. Established the Vaccine Adverse Event Reporting System (VAERS)** **B. Directed pre-vaccination counseling (Vaccine Information Statements, VISs)** **C. Specified how vaccinations must be documented D. All of the above** ***Knowledge Check*** **The 1986 National Childhood Vaccine Injury Act...** **A. Established the Vaccine Adverse Event Reporting System (VAERS)** **B. Directed pre-vaccination counseling (Vaccine Information Statements, VISs)** **C. Specified how vaccinations must be documented D. All of the above** ***Knowledge Check*** **Which of the following statements about immunizations is TRUE?** **A. All vaccines are administered by intramuscular injection B. Vaccines are never recommended in pregnancy** **C. Vaccine recommendations are updated several times each year in the US** **D. Smallpox vaccine is currently part of the routine childhood vaccine schedule** ***Knowledge Check*** **Which of the following statements about immunizations is TRUE?** **A. All vaccines are administered by intramuscular injection B. Vaccines are never recommended in pregnancy** **C. Vaccine recommendations are updated several times each year in the US** **D. Smallpox vaccine is currently part of the routine childhood vaccine schedule** See Canvas for Homework \#1 Share a 'lived experience' personal memory of vaccination. Due before Class 04 on Thu 16 Jan 2025 (5:00pm) *Dr Ryan receiving her 1^st^ COVID-19 vaccine dose, Dec 2020* **Vaccine-Preventable Infections** **PH 172 -- Immunizations and Public Health** **Class 02** **09 Jan 2025** Margaret Ryan, MD, MPH (FIDSA) 1 **Class 02 Objectives** Participants will be able to: 1\. Know correct terminology related to vaccine preventable infections 2\. Describe infection-specific goals of immunization 3\. Appreciate some priorities for current and future infection-specific immunizations 4\. Apply an understanding infections to frame the value of immunization in reducing impacts on human health \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#2 **Brief review of infection-related terminology** Pathogens (microbial agents, microbes, germs, bugs) Bacteria: microscopic organisms, usually sphere or rod-shaped, with DNA within cellular machinery; bacteria live, feed and replicate within a host or other environment Viruses: tiny (100-times smaller than most bacteria) spheres of DNA or RNA in a protein or lipoprotein coat; rely on host cells for replication Bacteria (Streptococcus pneumoniae microscopic image in respiratory secretion)  Virus (influenza electron microscopic depiction)) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#3 **Brief review of infection-related terminology** Pathogens (microbial agents, microbes, germs, bugs) Parasites: organisms with defined nuclei, may be single-celled or multicellular; may live, feed, and replicate within a host or other hospitable environment Fungi: diverse group of eukaryocytes with complex internal structures; many fungi live, feed, and replicate in warm moist environments Parasite (Plasmodium falciparum, microscopic image of blood)  Fungi (Candida species, microscopic image of skin specimen) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#4 **Brief review of infection-related terminology** Host: person (or animal) infected by a pathogen Vector: organism that carries a pathogen without being harmed, and transmits pathogen to others (e.g., mosquitoes are vectors of malaria) Zoonotic infections: pathogens that can cause illness in humans and other animal species (e.g., rabies virus) *Zoonotic diseases. Image Credit: magic pictures/Shutterstock.com* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#5 **Brief review of infection-related terminology** Antimicrobial agents: Medications; like antibiotics, anti-virals, and anti-fungals Disinfectants for hands or surfaces Immunizations: Vaccines induce *active* immune protection from a pathogen Immune globulins provide *passive* immune protection  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#6 **How should we name pathogens?** Lyme Disease  first identified in cluster of arthritis cases in Lyme, CT in 1975 Legionnaires Disease  first identified in pneumonia outbreak at American Legion convention in 1976 *Elizabethkingia* pneumonia-causing bacteria, named to honor microbiology pioneer in 2005 Dr Elizabeth King CDC Microbiologist 1912-1966 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#7 **How should we name pathogens?** **WHO Best Practices on naming new pathogens (published in 2015)** Names may describe microscopic appearance, clinical presentation, or year discovered Names should NOT be based on: ▪ geographic locations (e.g., Hantavirus) ▪ cultural or occupational terms (e.g., Butchers warts) ▪ animals (e.g., swine flu) ▪ people's names (e.g., Chagas disease) *See Canvas for reading on naming pathogens.* *See Canvas for reading on vaccine names and abbreviations.* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#8 **Among thousands of pathogens that cause human**^a^ **infections, only 32**^b^ **are vaccine-preventable**^c^ ^a^ Non-human vaccine-preventable infections are not described here ^b^ Some pathogens have multiple types that are vaccine-preventable ^c^ Pathogens described here have current US FDA-approved vaccines. Non-US vaccines are available for a small number of other pathogens \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#9 **Vaccine-Preventable Infections: Bacterial** Anthrax *Bacillus anthacis*  Cholera *Vibrio cholerae* Diphtheria *Corynebacterium diphtheriae* Hib *Haemophilus influenzae* type b NFID image of diphtheria Meningococci *Neisseria meningitides* (groups A, C, W135, Y, B) Pertussis *Bordetella pertussis* Pneumococci *Streptococcus pneumoniae* (up to 23 types) Tetanus *Clostridium tetani* Tuberculosis *Mycobacteria tuberculosis* Typhoid *Salmonella typhi* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#10 **Vaccine-Preventable Infections: Viral** Adenovirus (types 4 and 7) Ebola virus Chikungunya virus Dengue (types 1, 2, 3, and 4) Hepatitis A Hepatitis B CalTech image Human Papillomavirus (HPV, types 6, 11, 16, 18, 31, 33, 45, 52, 58) Influenza (specific seasonal types of A/H1N1, A/H3N2, and B virus) Japanese Encephalitis virus Measles Mpox (previously called monkeypox) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#11 **Vaccine-Preventable Infections: Viral** Mumps Polio (types 1, 2, 3) Rabies Rotavirus (up to 5 strains of G species) RSV (Respiratory Syncytial Virus) Rubella SARS-CoV-2 (several variants) Smallpox Tick-Borne Encephalitis virus Varicella zoster virus (causing chickenpox or shingles) Yellow Fever virus CalTech image \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#12 **Infections Treated or Prevented by Passive Immunization Products** *\[Vaccines also available\]* Anthrax Diphtheria Hepatitis B Rabies RSV SARS-CoV-2 Smallpox Tetanus Varicella *\[No vaccines available\]* Botulism Cytomegalovirus (CMV) Scorpion and snake venom \[Envenomations are not infections, but shown as examples of other uses of specific immune globulins\] Non-specific human Immune globulin (IG) products can also prevent Hepatitis A, Measles, and Rubella in vulnerable patients \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#13 **Infection-Specific Goals of Immunization** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#14 **Goals of Immunization:** ***Providing lifelong protection from infection*** Although lifelong protection from any infection (mild or severe) could be considered the goal of all vaccines, many vaccines are not capable of reaching this goal Best examples of vaccines that provide long-term protection from infection include: **Hepatitis A, Hepatitis B, Measles, Mumps, Polio, Rubella, Smallpox, Varicella,** and **Yellow Fever** Notice that no bacterial vaccines meet these goals Vaccines that provide excellent long-term  protection from infection have the potential to eliminate (or even eradicate) infections in human populations \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#15 **Goals of Immunization:** ***Providing short-term protection from infection*** ***during a vulnerable period of life*** All vaccine recommendations consider the most vulnerable groups (by age, location, occupation, or other factors) and best timing to prevent disease. Examples of vaccines providing only short-term protection in vulnerable periods include: Infant vaccinations to prevent **diphtheria, Hib, pertussis,** **pneumococci,** or **rotavirus** infections Travel vaccinations to prevent **cholera** or **typhoid** infections \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ www.sandiegocounty.gov/content/sdc/hhsa/programs/phs/immunization\_branch/travelvaccines.html PH 172, Ryan Slide \#16 **Goals of Immunization:** ***Reducing severity of infection*** These vaccines ideally prevent all infections, however such protection is not long-lasting or experienced by all people The value of these vaccines may be better defined by their ability to prevent serious illness, hospitalization, or death Prominent examples: **influenza** and **SARS-CoV-2** vaccines \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#17 **Goals of Immunization:** ***Preventing infection in other people*** Any vaccine that prevents an infection that is human-to-human transmissible has the potential to protect other people On a population-level, indirect protection of vulnerable people is called 'herd immunity' or 'community immunity' Only a few vaccine recommendations specifically focus on protecting people other than the vaccine recipient ▪ Maternal **pertussis** and **RSV** vaccines provide passive immunization to infants ▪ Adolescent/adult **pertussis** vaccines reduce risk of pertussis exposure in infants www.abc.net.au/news/image/57376-3x2-940x627.jpg ▪ Pre-pregnancy rubella vaccine prevents maternal rubella infection and therefore ***congenital* rubella** in the fetus \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#18 **Goals of Immunization:** ***Preventing late consequences of infection*** Vaccines that prevent infection will also prevent disabling consequences of infection. *\[In the pre-vaccine era, Hib infections were the most common cause of permanent hearing loss in children. Up to 20% of infants who survived Hib meningitis had hearing loss.\]* Special case: Varicella vaccine (Varivax®) prevents infection with the virus that causes chickenpox. People who were never infected with this virus have no risk of developing **shingles** Shingles is a painful reactivation of dormant varicella zoster virus, many years after chickenpox. Risk of shingles increases after age 50, so another vaccine (Shingrix®) is currently recommended for older adults.  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#19 **Goals of Immunization:** ***Preventing infection-related cancer*** A small number of human infections increase risk of (or cause) cancer. Two of these infections are vaccine-preventable: **Hepatitis B virus** may cause acute infection with recovery... or chronic infection of the liver, with higher risk of liver cancer. *\[Risk of chronic Hepatitis B depends on age at infection. People with chronic Hepatitis B infection have 20%-40% lifetime risk of liver cancer.\]* **Human papillomavirus (HPV)** infections increase risk of cervical cancer, as well as other genital, anal, and oral cancers. *\[Approximately 10% of women with HPV develop pre-cancerous changes in cervical cells. HPV is considered to 'cause' cervical cancer because \>90% of cancer cases have evidence of HPV infection.\]* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#20 ***Stretch Break***  \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#21 **Infection-Specific Goals of Future Immunizations** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#22 **Goals of Future Immunizations:** **Tuberculosis (TB)** Global burden of TB is enormous; one-third of world affected; \>1 million deaths each year; TB burden in US is much lower Bacillus Calmette-Guerin (BCG vaccine) is a live-attenuated bacterial product, originally developed in 1920s ▪ BCG vaccine primarily prevents severe disease in young children, rather than preventing all TB infections ▪ BCG vaccine is a high-risk vaccine; percutaneous administration results in local reactions and scarring; risk of fatal disseminated BCG infection may be as high as 1 per million ▪ Although BCG vaccine is licensed by FDA, it has rare specific recommendations for use in the United States More safe and effective TB vaccines are under development \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#23 **Goals of Future Immunizations:** **Malaria** Malaria is caused by microbial parasites (plasmodium), spread to humans through mosquito vectors Image from WWII-era Malaria causes cycles of fever and gastrointestinal malaria prevention poster by Theodore Geisel symptoms; liver and neurological complications may occur Global burden is very high; \>220,000,000 cases and \>400,000 deaths estimated each year; burden in US is low WHO approved 1^st^ malaria vaccine in 2021 and 2^nd^ in 2023; vaccines are recommended for infants in high-risk countries; multiple doses reduce hospitalizations by 30%; no malaria vaccines are US FDA-approved More effective malaria vaccines are under development \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#24 **Goals of Future Immunizations:** **Human Immunodeficiency Virus (HIV)** HIV was identified in 1981, and remains the longest ongoing pandemic in modern history Originally, immunodeficiency-related infections were nearly 100% fatal; antiviral treatments dramatically reduced case fatality, but antivirals are expensive and not equitably available More than 1 million new HIV infections occur each year HIV vaccines are being intensively pursued as a priority for global public health... \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#25 **Examples of Two Different Vaccine-Preventable** **Infections with Military Significance:** **Anthrax** **Adenovirus** \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#26 **Anthrax** *Bacillus anthracis* is a hardy spore-forming bacteria Common pathogen in livestock, can also infect humans Cutaneous anthrax responds well to antibiotic treatment Inhalational anthrax causes toxin-mediated lung disease with 50-90% case-fatality rate Anthrax has potential to be used as a bioweapon 2021 movie featuring anthrax In 1979, accidental release of anthrax spores from bioweapons plant in Sverdlovsk, Russia; sickened 94 people and killed 68 In 2001, bioterrorists distributed anthrax in  US postal system; sickened 22 people and killed 5 \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#27 **Anthrax Vaccine** Livestock vaccine originally developed by Pasteur in 1881 Inactivated human vaccine FDA-licensed in US in 1970; requires multiple intramuscular doses and annual boosters Originally recommended only for certain lab workers; in 1998, anthrax vaccination was directed for military members who might respond to a bioterror attack Vaccine effectiveness estimated as \>90%  Serious adverse events following immunization (AEFIs) are very rare Despite strong effectiveness and safety profiles, anthrax vaccine has been the subject of some substantial concerns \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ PH 172, Ryan Slide \#28