Traveler, School Adolescent and Maternal Immunization PDF

FAMILY MEDICINE Community -4 0 traveler, sChool adolesCent and maternal immunization  Vaccination in general.....

FAMILY MEDICINE Community -4 0 traveler, sChool adolesCent and maternal immunization  Vaccination in general..  Vaccination is highly effective method of certain infectious diseases.  Vaccines are generally very safe, and serious adverse reactions are uncommon. Travel-related vaccination School Adolescent Routine vaccines for review Vaccines recommended for Vaccines demanded by Maternal Immunization Immunization before travelling certain destinations certain countries 1. MMR vaccine 1. Hepatitis A vaccine 1. Covid-19 vaccine 1. Meningeococcal vaccine 1. Meningeococcal vaccine 2. Yellow fever 2. Influenza vaccine 2. Varicella vaccine 2. Yellow fever vaccine 2. Influenza vaccine (Inactivated) vaccine 3. DPT vaccine 3. Rabies vaccine 3. HPV vaccine 3. Hepatitis A vaccine 4. Haemophilus influenza 4. Meningococcal 3. Meningococcal 4. Tetanus, diphtheria & 4. Hepatitis B vaccine type b vaccine vaccine vaccine pertussis (Tdap) vaccine 5. Japanese encephalitis 5. Influenza vaccine 5. Dengue vaccine 5. Tetanus & adult diphtheria (Td) vaccine 6. Tuberculosis 6. Polio (adult booster dose) 4. Polio vaccine 7. Hepatitis B vaccine 7. Typhoid fever vaccine 6. Tetanus, diphtheria & 8. Polio vaccine 8. Cholera vaccine acellular pertussis vaccine Dr. Ziad Mahana 34  FAMILY MEDICINE Community -4 I  Vaccination For travelers offers the possibility of avoiding some infectious diseases that may be encountered while they are away from home.  These vaccines are part of most national childhood immunization programs.  Pre-travel consultation is a good opportunity for health care providers to review the vaccination status for infants, children, adolescents & adults. MCQ  MMR VACCINE  VARICELLA VACCINE  DPT VACCINE NATURE Live Attenuated vaccine. Live Attenuated vaccine. All licensed vaccines are conjugated For children For primary or booster vaccination No of Mode of No of Mode of Appropriately formulated combined DPT Dose Dose Doses administration Doses administration vaccines or booster tetanus & diphtheria Single Single (Td) vaccines should be used according to 0.5 ml S.C. 0.5 ml S.C. national recommendations. DOSE dose dose For Adolescents & adult Individuals ≥ 7 years of age No of Doses Dose & Schedule Should receive combinations with reduced diphtheria toxoid content. 2 doses 0.5 ml, 4-8 week apart PROTECTIVE 95% 70-90% for unknown period --- VALUE and may be lifelong (so a booster dose is recommended)  It is compulsory in Egypt. APPLICATION ---  International travelers to endemic areas ▪ International travelers to endemic areas  In many countries, MMR vaccine is  In some countries, varicella vaccine is  In most countries, DPT vaccine is routinely administered in childhood. routinely administered in childhood. routinely administered in childhood. NB FOR Unvaccinated travelers Unvaccinated travelers Travellers who missed vaccination TRAVELERS Should be offered vaccine according May be offered vaccination according to Should be offered vaccine according national recommendations. national recommendations. national recommendations. Dr. Ziad Mahana 35  FAMILY MEDICINE Community -4  HAEMOPHILUS INFLUENZA TYPE B “HIB“ VACCINE  INFLUENZA VACCINES  TB VACCINE  Seasonal influenza vaccines..  Include prevailing strains of influenza A and B NATURE All licensed vaccines are conjugated  Which are either inactivated or live attenuated --- INACTIVATED LIVE ATTENUATED MODE OF --- Injected Delivered via nasal spray --- ADMINISTRATION  Children aged > 6 months.  People with high risk Healthy, non-pregnant APPLICATION --- medical conditions. individuals aged 2-49 ---  Pregnant women. years  Older people.  In many countries, Haemophilus influenza type b vaccine is routinely administered in childhood. BCG vaccination is of NB FOR Before travelling during the influenza season Unvaccinated travelers < 5 years of age very limited value TRAVELERS Travelers should be offered vaccination according to for most travelers. Should be offered vaccine according national recommendations. national recommendations Dr. Ziad Mahana 36  FAMILY MEDICINE Community -4  POLIO VACCINE  HEPATITIS B VACCINE (HBV) SABINE (OPV) SALK (IPV) : Oral Poliovirus Vaccine : Inactivated Poliovirus Vaccine Live attenuated Inactivated NATURE The active ingredient of hepatitis B vaccine HBsAg (Prepared from the 3 types of the virus I, II,III) MODE OF IM, in the deltoid region. Orally administered IM or SC injection ADMINISTRATION The primary series of vaccination The primary series No of Doses Nature Schedule 3 doses of OPV + 1 dose of IPV 1 dose Monovalent vaccine At birth In countries at high risk of importation & spread of poliovirus Monovalent Followed by At intervals of an OPV dose at birth (zero dose) “WHO recommendation” or combined 2 or 3 doses 1 to several months hepatitis B vaccine DOSE ONLY In countries with For older children or adults Immunization coverage > 90% No of Doses Nature Schedule & a low risk of wild poliovirus importation. Monovalent Routine vaccination with IPV alone At appropriate 3 doses or conveniently combined intervals WHO no longer recommends an OPV-only vaccination hepatitis A & B vaccine schedule. PROTECTIVE 95% for 5-7 years. --- VALUE  It is compulsory in Egypt.  It is compulsory in Egypt.  Pre-exposure vaccination to high risk groups:  International travelers to endemic areas. APPLICATION  International travelers to endemic areas.  Contact of cases.  Health care workers. Dr. Ziad Mahana 37  FAMILY MEDICINE Community -4  HEPATITIS B VACCINE (HBV)  POLIO VACCINE For unvaccinated travelers Travelers TO polio infected areas “if there is insufficient time to complete Before travelling to areas with active poliovirus transmission, the standard vaccination schedule” people from polio free countries should ensure that they have No of Doses Schedule completed age-appropriate polio vaccination series. 3 dose 0, 7, 21 days Who completed an OPV or IPV Who haven’t received any polio Followed by series > 12 months previously vaccine previously 12 months after the 1st dose 4th dose Should be given another Should complete a primary booster dose schedule of polio vaccination of polio vaccine before departure NB FOR Hepatitis B vaccination is universally recommended. TRAVELERS Travelers FROM infected areas Dose Schedule Within 4 weeks to 12 months of travel  Why? Additional dose  To boost intestinal mucosal immunity of OPV or IPV  To reduce the risk of poliovirus shedding which could → reintroduction of polio virus into a polio free area. Dr. Ziad Mahana 38  FAMILY MEDICINE Community -4  These vaccines are recommended to provide protection against diseases endemic to the country of origin or of destination.  They are intended to: 1. Protect travelers. 2. Prevent disease spread within and between countries. MCQ  HEPATITIS A VACCINE  YELLOW FEVER VACCINE  RABIES VACCINE Inactivated vaccine NATURE Inactivated vaccine Live attenuated vaccine Prepared from virus grown on human diploid cells SERIES 2 doses 1 doses 3-dose series SCHEDULE 1 month apart --- 0, 7 and 21 (or 28) days DOSE DOSE 1 ml each 0.5 ml 1 ml MODE I.M. injection S.C. injection IM, in deltoid (in thigh in children).  Immunity after 2-3  Protective Value: 99%. weeks of the first dose  Start 7-10 days after immunization. Rabies vaccination is:  Persist 30-35 years. IMMUNITY  Licensed for use in persons of all ages.  Single dose of yellow fever vaccine  Safe for use in pregnant women. provides life-long immunity to the disease  Often quite expensive. making boosters unnecessary  Required for travelers to certain countries.  Required for travelers to certain countries.  International travelers to  All travelers to areas subject to endemic & APPLICATION  Recommended for all travelers to areas subject endemic areas. epidemic disease e.g., to endemic and epidemic disease.  44 countries in Africa & South America.  Travelers who are visiting locations with: Hepatitis A vaccine is  High animal rates of rabies. Yellow fever vaccine is  & Inadequate access to rabies ttt. NB FOR the most common vaccine the most successful & most widely used TRAVELERS preventable illness for  Travelers who plan on visiting rabies- endemic vaccine for international travelers international travelers locations for extended periods of time (longer than 1 month). Dr. Ziad Mahana 39  FAMILY MEDICINE Community -4  MENINGOCOCCAL VACCINE  JAPANESE ENCEPHALITIS VACCINE Quadrivalent vaccine containing group A, C, Y, and W 135 Inactivated vero Live attenuated Live recombinant NATURE Capsular polysaccharides (killed vaccine) cell-derived vaccines vaccine vaccine 2 doses Single dose Single dose at 4 week intervals PRIMARY Single dose, 0.5 ml, S.C injection For individuals For individuals For individuals DOSE ≥ 6 m of age ≥ 8 m of age ≥ 9 m of age 1-2 years 12-24 months No need for BOOSTER after primary later for those booster dose immunization < 18 years of age  For two destinations: Travelers with extensive outdoor exposure For whom?  The Hajj, the pilgrims to Mecca in Saudi Arabia. (such as camping) APPLICATIONS  The meningitis belt of Sub-Saharan Africa. When? During the transmission season  For all travelers to areas within the meningitis belt if their travel Particularly in endemic countries or areas will extend within a month of the December to June window. Where? where farming involves irrigation by flooding For all travelers aged 2 month and older including those over 55 Quadrivalent conjugated vaccine is the only vaccine available for them NB FOR  If the traveler remain at risk: Boosters are required every 5 yrs TRAVELLERS  Adolescents & preadolescents already vaccinated: will not need additional boosters for travel. Vaccination against B meningococcus is not needed for travel. Dr. Ziad Mahana 40  FAMILY MEDICINE Community -4  POLIO (ADULT BOOSTER DOSE)  All travelers to countries with polio Should have completed the standard series.  Adults whose polio vaccinations took place the remote past Should have a single, lifetime polio booster. NB FOR TRAVELLERS  Long term (more than 4 weeks) travelers May be required to show proof of to certain high-risk countries vaccination within 1 year for entry & exit.  TYPHOID FEVER VACCINE The newer generation typhoid conjugate The oral The injectable unconjugated Vi capsular TYPES vaccine Ty21a vaccine Polysaccharide (ViPS) vaccine Based on a live attenuated NATURE Conjugate --- strain of S. typhi MODE I.M. Enteric coated capsules I.M. or S.C. 3 or 4 capsules DOSE Single dose Single dose (one capsule every other day). DOSE ▪ In infants & children: from 6 months of age. TARGET AGE Used in people aged ≥ 6 years To people aged ≥ 2 years. ▪ In adults: ≤ 45 years. REVACCINATION --- Recommended after 1-7 years. After 3 years (to maintain protection)  For travelers to:  Destinations where the risk of typhoid fever is high.. APPLICATIONS  Especially to those staying in endemic areas like India, China, Nepal, Indonesia & Pakistan, for more than 1 month and / or  Locations in which antibiotic resistant strains of S. typhi are prevalent. For previously vaccinated travelers from non-endemic to endemic areas  A booster dose is recommended.. NB FOR TRAVELLERS  After 1-7 years for the Ty21a vaccine. Ty21a has been used primarily to protect travelers.  After 3 years for the ViPS vaccine. Dr. Ziad Mahana 41  FAMILY MEDICINE Community -4  CHOLERA VACCINE Koll’s vaccine Oral cholera vaccine Dukoral vaccine Shanchol vaccine TYPES V. cholera O1 V. cholera O1 & O139 --- Among all age groups In children < 5 years of age Given in 150 ml of safe water --- NATURE Heat killed phenol preserved whole cell vaccine Whole-cell killed vaccines PRIMARY SERIES NO OF DOSES 2 doses (4 weeks apart) 2 doses (Between 7 days & 6 weeks apart) DOSE 0.5 ml and 1 ml --- DOSE MODE S.C injection --- BOOSTER Booster dose 6 months in continuous exposure ---  Protective Value: 50%.  Protective value: > 50%  Start 6 days after: PROTECTIVE VALUE  2nd dose of 1ry immunization or a booster dose.  Lasts for 6 months.  Lasts for 2 years.  All travelers coming from or going to endemic places. APPLICATIONS  During epidemics. ---  Oral cholera vaccine is: NB ---  WHO-prequalified & licensed in over 60 countries.  Safe and effective  Some countries require proof of vaccination for travelers wishing to enter or exit the country.  It includes:  Polio vaccine.  Yellow fever vaccine (For travellers going to & coming from countries or areas at risk of yellow fever).  Meningococcal vaccine.  Covid-19 vaccine (There are several types of covid-19 vaccines) Dr. Ziad Mahana 42  FAMILY MEDICINE Community -4 COVID-19 VACCINE  SII/COVISHIELD &  Janssen/Ad26.COV 2.S  Sinopharm COVID-19 TYPES  Pfizer/BioNTech Comirnaty vaccine vaccine AstraZeneca/AZD1222 vaccines developed by Johnson & Johnson vaccine NATURE Messenger RNA vaccine Viral vector vaccine Viral vector vaccine Inactivated vaccine N OF O PRIMARY SERIES DOSES 2 doses, 3 weeks apart 2 doses, 4 - 12 weeks apart Single dose 2 doses, 3 - 4 weeks apart DOSE 0.3 mL (30 mcg) 0.5 ml 0.5 ml 0.5 ml MODE IM IM IM IM  Booster dose 1: DOSE  Single booster dose:  Single booster dose:  At least 5 months after dose 2  At least 2 months  4 – 6 months after BOOSTER  Booster dose 2: --- after completion of completion of DOSE  At least 4 months after primary vaccination primary vaccination booster dose 1 series series For persons aged ≥50 yr.  Efficacy of Pfizer/BioNTech  Efficacy AstraZeneca vaccine:  Efficacy of 2 doses,  Efficacy of 2 doses, vaccine: 95% against 72% against symptomatic 2 months apart: 94% 21 days apart: 79% symptomatic SARS-CoV-2 SARS-CoV-2.  Efficacy of the single dose  Against symptomatic infection. As shown by the primary analysis of PROTECTIVE data irrespective of inter-dose interval vaccine: 72%. SARS-CoV-2 infection. from trial participants who received 2 VALUE standard doses with an interval  Start 14 or more days varying from about 4 to 12 weeks. after 2nd dose.  Vaccine efficacy tended to be According to A large multi- higher when the interval country Phase 3 trial has shown that between doses was longer.  Vaccine is safe & effective for all individuals aged 5 and above. Adults & all international travelers APPLICATIONS  Now, All international travelers aged 18 years and above must take at least 2 doses of covid-19 vaccine. Dr. Ziad Mahana 43  FAMILY MEDICINE Community -4 II  Meningeococcal vaccine  Tetanus, diphtheria & Quadrivalent vaccine containing  Influenza vaccine  Human papillomas virus vaccine  Dengue vaccine pertussis group A,C, Y, and W 135 (Tdap) vaccine Inactivated NATURE Capsular polysaccharides or live attenuated --- --- --- influenza vaccine  Routinely HPV vaccination: APPLICATION (AGE)  For children at age 11-12 years 9-16 years living in (can start at 9 years). At age 11-12 dengue-endemic --- ---  Catch up HPV vaccination: years areas (e.g., South For all persons through age 18 years Asia & Africa) If not adequately vaccinated.  According to age at initial immunization: Age at initial Dose series immunization 2 dose series 3 dose series 2 doses series at age  Annual vaccination: 9-14 years DOSE at 0, 6-12 m. 1 dose of Tdap administered at 11-12 years; 16 years. only 1 dose 15 years or 3 dose series 0, 6, 12 months older at 0, 1-2 m, 6 m.  If vaccination schedule is interrupted, Series doesn’t need to be restarted. Dr. Ziad Mahana 44  FAMILY MEDICINE Community -4 III  Meningeococcal vaccine  Hepatitis A  Hepatitis B Quadrivalent vaccine containing  Inactivated influenza vaccine vaccine vaccine group A,C, Y, & W 135 Inactivated NATURE Capsular polysaccharides Inactivated Inactivated (as it is safe to administer during any trimester) NO OF 2 doses, 3 doses Single dose DOSES (1 month apart) (0, 1 m & 6 m) DOSE --- DOSE 0.5 ml 1 ml each 1 ml each MODE S.C injection IM IM In pregnant women In pregnant women In pregnant women Can be received if they are at Influenza vaccination is especially important.. Recommended prior to travel APPLICATIO ed risk of meningococcal disease  Because pregnant women who contract N influenza are at greater risk of: 1. Maternal morbidity & mortality 2. Fetal morbidity. Dr. Ziad Mahana 45  FAMILY MEDICINE Community -4  Tetanus and adult diphtheria (Td) vaccine  Tetanus, diphtheria & acellular pertussis vaccine In pregnant women In Pregnant women  Administer at least 2 doses of Td before delivery:  Should administer: a dose of Tdap during each pregnancy irrespective of the patient’s prior history of receiving Tdap. Dose Time  Time: Tdap vaccine is recommended during every 1 dose st As soon as possible Pregnancy pregnancy, between 27 & 36 weeks gestation. DOSE IN During PREGNANCY 2nd dose At least 4 weeks after 1st dose For women not previously vaccinated with Tdap 3rd dose 6 months-1year after 2nd dose Delivery If Tdap isn’t administered during pregnancy After 4th dose 1-5 years after 3rd dose Tdap should be administered immediately postpartum. 5th dose 1-10 years after 4th dose  A full course of immunization against Tetanus with 3 doses of Tetanus toxoid: confers immunity for 10 years. IMMUNITY ---  So, pregnant women require a booster dose of Td vaccine every 10 years. Dr. Ziad Mahana 46  FAMILY MEDICINE Community -4 As regard Hepatitis B vaccine, what is the dose schedule in unvaccinated adult travelers? A. 0, 1, 2 days. B. 2, 4, 6 days. 1 D C. 0, 6, 12 days. D. 0, 7, 21 days. E. 0, 1, 6 days. Which type of vaccine is MMR? A. Live attenuated vaccine. B. Killed vaccine. 2 A C. Toxoid vaccine. D. Subunit vaccine. E. Messenger RNA vaccine. Yellow fever vaccination starts protection after how many days of injection? A. 5 days. B. 10 days. 3 B C. 15 days. D. 20 days. E. 30 days. Dr. Ziad Mahana 47