Routine Vaccines Lesson - 8 PDF

AZERBAIJAN MEDICAL UNIVERSITY FAMILY MEDICINE DEPARTMENT Routine Vaccines Ph.D. Dr. Aygun Guliyeva  Routine vaccination  Routine vaccination is among the most significant of all medical advances and is a cornerstone for...

AZERBAIJAN MEDICAL UNIVERSITY FAMILY MEDICINE DEPARTMENT Routine Vaccines Ph.D. Dr. Aygun Guliyeva  Routine vaccination  Routine vaccination is among the most significant of all medical advances and is a cornerstone for all preventive medical goals. Although many vaccine- preventable diseases (VPD) such as Haemophilus influenzae type b (Hib) infection are now rarely encountered, others such as pertussis persist despite widespread vaccination. Despite demonstrated vaccine effectiveness, concerns about vaccine efficacy, safety, and duration of protection continue to interfere with universal acceptance of some vaccines, and misinformation abounds. Important facets of vaccination include the patient's age and underlying medical conditions, disease burden, vaccine efficacy and adverse reactions, and official recommendations.  HEPATITIS B VACCINE  Five hepatitis B vaccines (HepB) are available in the United States: Engerix-B or Recombivax HB, both monovalent vaccines given at birth and in a three- dose series at times 0, 1-2, and 6 months; Pediarix. a pentavalent vaccine given at age 2, 4, and 6 months (maximum age 6 years); Heplisav-B, given at time 0 and 1 month and at a minimum age of 18 years; and Twinrix, a bivalent vaccine given at time 0, l, and 6 months and at a minimum age of 18 years. All children should be immunized against HBV. Adults with diabetes mellitus or other specific conditions like hepatitis C or travel or workplace risk (healthcare workers) should also be vaccinated.  Rationale for Routine Hepatitis B Vaccination  Hepatitis B surface antigen (HBsAg) has been found in impetigo, in saliva on toothbrush holders of persons chronically infected with HBV, and on used blood sugar testing stylets. Infants and children can transmit HBV.  Efficacy for HepB is high. After the third dose of HepB, >95% of children seroconvert. Immunosuppression and prematurity with low birth weight are associated with lower rates of seroconversion, so HepB vaccination should be delayed in preterm infants weighing < 2 kg until 1 month of age or hospital discharge, whichever is first, unless the mother is HBsAg-positive or has unknown HBsAg status, in which case HepB should be given within 12 hours of birth.  Recommendations  The comprehensive US HBV vaccination policy includes the following: (1) routine vaccination of infants starting with monovalent HepB within 24 hours of birth, with dose 2 given at age 1-2 months and dose 3 at age 6-12 months; (2) catch-up immunization of adolescents not previously or fully vaccinated; and (3) immunization of unvaccinated adults age 19-59 years with diabetes mellitus (type 1 and type 2) as soon as possible after a diagnosis of diabetes is confinned. Routine postvaccination testing is not indicated except for hepatitis B surface antibody (anti-HBs) and HBsAg testing at age 9-18 months for infants born to HBsAg-positive mothers and anti-HBs for healthcare workers. An adequate anti-HBs response is a titer of ≥10 mIU/mL. Postvaccination anti- HBs levels diminish over time, so low or absent serum antibody levels do not accurately predict susceptibility to HBV. Immunologic memory and the long incubation period of HBV infection enable most immunized persons to mount a protective anamnestic immune response. However, renal failure on dialysis necessitates higher antigen-content vaccines to maintain antibody level of ≥10 mIU/mL, measured annually.  HEPATITIS A VACCINE  All infants should receive two doses of hepatitis A vaccine (HepA), given at ages 12-15 and 18-21 months. Side effects include localized swelling and redness. Anyone wanting to be protected from hepatitis A virus should be given HepA at time 0 and 6 months. Hepatitis A is not a benign disease  PERTUSSIS VACCINE  Waning immunity after childhood pertussis vaccination, partial vaccine-induced protection, and alterations in pertussis surface proteins are apparent reasons for disease perpetuation. Most pertussis-related hospitalizations and deaths occur in infants too young to be fully vaccinated. Infants age