Pneumococcal and Influenza vaccine guideline - Comment
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All the things u need to know regarding influenza and pneumococcal vaccination. What's covered in the presentation slides: 1. Important Vaccines in Chronic Lung Diseases Dr. Tanveer kamal Fahim Phase B Resident , Pulmonology NIDCH 2. Vaccine • A biological preparation that provides active acquired immunity towards a specific disease, protecting from that disease • Made from weakened or killed forms of microbe, its toxins, or one of its surface proteins • Usually administered through needle injections, but can also be administered by mouth or sprayed into the nose 3. •Edward Jenner , English physician and scientist •The father of immunology •Pioneer of smallpox vaccine, the world's first vaccine •“His work saved more lives than the work of any other human” 4. Immunity • Innate Immunity • Adaptive / Acquired Immunity 5. Benefits of Adult Vaccination in Chronic Lung Diseases • Reduces the number of exacerbations of the disease (COPD , Asthma ) • Reduce hospital admissions • Prevents complications that are more likely to occur in COPD and Asthma patients due to pneumonia and flu • Reduces morbidity and mortality 6. - 7. Influenza Vaccine 8. Influenza, commonly known as the flu, is an infectious disease caused by influenza virus RNA virus , enveloped , Orthomyxovirus 4 serotype – Influenza viruses A,B,C D Spread by inhalation 9. •Influenza virus contains seven or eight pieces of segmented RNA •Influenza A genome contains 11 genes on 8 pieces of RNA, encoding for 11 proteins : Hemaglutinin (HA), Neuroaminidase (NA), Nucleoprotein (NP), M1 (matrix 1 protein), m2 , NS (non-structural protein 1), NS2 , PA, PB1 ,PB1-F2 and PB2 •HA mediates binding of the virus to target cells •NA causes release of progeny virus from infected cells 10. • Influenza A viruses are classified into subtypes based on different HA and NA ( H5N1 – bird flue) • Changes in the antigencity ( mutation ) of HA & NA proteins causes devastating worldwide endemics & production of vaccines difficult • Antigenic shift : Major change based on reassortment of segment • Antigenic drift : Minor change based on mutation of genome 11. •Each year a new flu vaccine is made to protect against three or four viruses that may cause disease in the upcoming flu season •Even when the vaccine doesn’t exactly match the viruses, it may still provide some protection •Influenza vaccine does not cause flu •It’s possible to get sick with flu even if someone have been vaccinated 12. How does the vaccine works ? By producing Antibodies Antibodies develop in the body about 2 weeks after vaccination 13. Why Vaccination is needed every year ?? Immune response declines over time Flu viruses are constantly changing (Antigenic shift and drift ) 14. Who Should Get Vaccinated? • Annual influenza vaccination is recommended for all persons aged ≥6 months who do not have contraindications 15. Who Should Get Vaccinated? High-risk groups and their contacts/caregivers : • Children aged 6 - 59 months & Adults aged ≥50 years • Persons with chronic pulmonary (including asthma), cardiovascular (excluding isolated hypertension), renal, hepatic, neurologic, hematologic, or metabolic disorders (including diabetes mellitus) • Persons who are immunocompromised due to any cause, including medications or HIV infection • Women who are or will be pregnant during the influenza season • Residents of nursing homes and other long-term care facilities • Extremely obese (BMI ≥40 for adults) 16. Caregivers and contacts of those at risk: • Health care personnel, working in health-care settings who have potential for exposure to patients and/or to infectious materials • Household contacts and caregivers of children less than 5 years and adults aged ≥50 years • Household contacts and caregivers of persons with medical conditions • 17. Types of Vaccine Available • IIV = Inactivated Influenza Vaccine , administered intramuscularly (IM) • IIV3 = Trivalent Inactivated Influenza Vaccine • IIV4 = Quadrivalent Inactivated Influenza Vaccine • RIV4 = Quadrivalent Recombinant Influenza Vaccine, administered intramuscularly (IM) ( Not for age less than 18 yrs ) • LAIV4 = Quadrivalent Live Attenuated Influenza Vaccine, administered intranasally ( 2 to 50 years of age ) 18. Influenza Vaccine Composition For 2019-20 :• Hemagglutinin (HA) derived from influenza viruses antigenically similar to those recommended by FDA. • Trivalent (three-component) vaccines will contain: • A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated) • A/Kansas/14/2017 (H3N2)-like virus (updated) • B/Colorado/06/2017-like (Victoria lineage) virus • Quadrivalent (four-component) vaccines will contain the same three HA antigens as trivalent vaccines, plus a B/Phuket/3073/2013–like virus (Yamagata lineage) 19. Administration of Influenza Vaccine with Other Vaccines • Inactivated , Recombinant and Live Attenuated vaccine Influenza Vaccine may be administered concurrently or sequentially with other vaccines at separate anatomic sites • In case of Live Attenuated vaccine If not given simultaneously, ≥4 weeks should pass between administration of LAIV4 and another live vaccine 20. Pregnant Women •All women who are pregnant or who might be pregnant during the influenza season should receive influenza vaccine. • An age-appropriate IIV or RIV4 may be used • LAIV4 should not be used during pregnancy •Influenza vaccine can be administered at any time during pregnancy 21. Risks of a vaccine reaction Very common • Headache • Muscle pain • Malaise , unusual weakness • Injection site reactions : pain , redness, swelling , itchiness Common • Joint pain , Increased sweating • Injection site reactions: bruising , itchiness , Shivering , fever , malaise, unusual tiredness or weakness Uncommon • Swelling of the glands in the neck, armpit or groin • dizziness • Nausea , diarrhoea • Flu-like syndrome Rare • Paraesthesia , hypoesthesia , numbness • brachial radiculitis , neuralgia 22. Contraindications • A previous severe allergic reaction to flu vaccine • Egg allergy of any severity can receive influenza vaccine • Children aged 2 through 4 years who have asthma(LAIV4) • Immunocompromised due to any cause (medications or by HIV infection) (LAIV4) • Close contacts and caregivers of severely immunosuppressed persons(LAIV4) • Pregnancy(LAIV4) • Receipt of influenza antiviral medication within previous 48 hours(LAIV4) 23. Precautions: •Moderate or severe acute illness with or without fever •Guillain–Barré syndrome within 6 weeks following a previous dose of influenza vaccine 24. Efficacy of Vaccine - Influenza vaccine has been shown to reduce the risk of flu and flu related complications by 40 to 60 % 25. Pneumococcal Vaccines 26. Streptococcus pneumoniae •lancet-shaped , gram-positive diplococci •More than 90 known serotypes •Common inhabitants of the airway •Spread by respiratory droplets 27. Disease caused by Streptococci Pneumoniae • Community-acquired pneumonia (CAP) • Meningitis • Bacteremia • Otitis media The best way to prevent pneumococcal disease is to vaccinate •Sinusitis •Septic arthritis •Osteomyelitis •Peritonitis •Endocarditis 28. Types of Vaccines •Pneumococcal Conjugated Vaccine (PCV13 or Prevnar 13 ) •Pneumococcal Polysaccharide Vaccine (PPSV23 or Pneumovax23®) 29. Pneumococcal Conjugate vaccine (PCV13 or Prevnar 13®) • Purified capsular polysaccharide of 13 serotypes of Streptococcus pneumoniae (1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 19A, 19F, 18C, and 23F) conjugated to a nontoxic variant of diphtheria toxin known as CRM197 • The Diptheria carrier protein makes the vaccine more immunogenic 30. •Protects against both systemic and mucosal infection and prevents nasopharyngeal colonization, thus reducing transmission in the community •Conjugated vaccine protects 75 in 100 adults 65 years or older against invasive pneumococcal disease 31. Pneumococcal Polysaccharide Vaccine (PPSV23 or Pneumovax 23®) • Purified preparations of pneumococcal capsular polysaccharide • Immune response usually occurs within 2 to 3 weeks after vaccination • Older adults with chronic illnesses or immunodeficiency may have reduced effectiveness • 60% to 70% effective in preventing invasive disease 32. •Anyone who is moderately or severely ill should wait until recovery before getting the vaccine •Patient with mild illness can be vaccinated •Children below 2 years should not receive PPSV • Elevated antibody levels persist for at least 5 years in healthy adults 33. Pneumococcal Conjugated vaccine Pneumococcal Polysaccharide Vaccine Can be used for all ages, including infants and children under 2 years of age Can only be used for children above2 years or older and adults. Protection lasts longer »Protection is shorter Generate long term memory cells allowing rapid boosting of immunity with booster doses up to many years later Do not generate long term memory cells No Boost effect Repeat polysaccharide vaccine doses generate less circulating antibodies than previous doses. No published pregnancy recommendations Women should be vaccinated before becoming pregnant but there is no evidence that PPSV is harmful Stimulates T Cell Immunity Do not (poorly ) Induces Mucosal Immunity Do not Effect on nasopharyngeal carriage Do not Hypo responsiveness - No Hypo responsiveness - yes Herd Immunity No more expensive less costly 34. Whom to vaccinate •All children younger than 2 years of age •All adults 65 years or older •In certain circumstances other children and adults 35. Indication of Pneumococcal vaccination in Children above 6 years and Adults • Sickle cell disease or other hemoglobinopathies • Congenital or acquired asplenia • Immunodeficiency , Immunosuppressive drugs, Including radiation,chemotherapy & prolong steroid • HIV infection • Leukemia or lymphoma , Hodgkin’s disease • Generalized malignancy , Multiple myeloma • CSF leaks , Cochlear implant • Organ transplantation • Alcoholism , Smoker • Chronic liver disease • Chronic renal failure or nephrotic syndrome • Chronic lung disease • Diabetes mellitus 36. High Risk People 37. Pneumococcal vaccine timing for adults 65 years or older 38. Pneumococcal vaccine timing for adults 65 years or older 39. Pneumococcal vaccine timing for adults with certain medical conditions 40. Pneumococcal vaccine timing for adults with certain medical conditions 41. • Who have already received 1 or more doses of PPSV23, or those with unclear documentation of the type of pneumococcal vaccine received: Administer 1 dose of PCV13 at least 1 year after the most recent pneumococcal vaccine dose. • Administer a second dose of PPSV23 at least 8 weeks after PCV13 and at least 5 years after the previous dose of PPSV23 • Administer 1 final dose of PPSV23 at 65 years or older in all patients. This dose should be given at least 5 years after the most recent dose of PPSV23. 42. Contraindications and Precautions • H/O severe allergic reaction (e.g., anaphylaxis) after a previous dose • Severe allergy to any component of this vaccine or any diphtheria toxoid-containing vaccine ( in case of PCV 13) Vaccination may be done if benefits outweigh the risks : A person who has a moderate or severe acute illness with or without fever 43. ADVERSE REACTIONS • Pain at the injection site (>50%) • Fatigue • Headache • Muscle pain • Joint pain • Decreased appetite • Injection site redness , swelling • Limitation of arm movement • Vomiting • Fever , chills • Rash 44. Why should PCV13 be given before 23PPV? Why are both PCV13 and 23PPV recommended for those with a high risk group people ? • Immunisation with a pneumococcal polysaccharide vaccine (23PPV) can decrease an individual’s immune response to subsequent pneumococcal immunisations • Giving Prevenar 13 eight weeks before Pneumovax23 allows the individual to maximise their response to the pneumococcal conjugate vaccine (PCV13) • The immune response to Prevenar 13 is better and expected to last longer • Administration of Pneumovax23 (23PPV) 8 weeks after Prevenar 13 (PCV13) is recommended to broaden protection against an additional 11 pneumococcal serotypes 45. Some physicians order PPSV23 every 5 years for their patients. Is this correct? • No • Only certain high-risk people who were vaccinated when younger than age 65 years will need a second dose 5 years later • At age 65 years, all adults (including people vaccinated when younger) will need to be vaccinated 46. Scenario : A 24-year-old man sees his doctor for a routine office visit. He has asthma and has not received any pneumococcal vaccines in the past. How he should be vaccinated ??? 47. Answer: 1 dose of PPSV23 now, at age 24 1 dose of PCV13 at age 65 A second dose of PPSV23 at least 1 year after PCV13 is given Asthma, as a chronic lung disease, is an indication for pneumococcal vaccination. A dose of PCV13 would only be recommended for a 19–64 year old with asthma who is being treated with immunosuppressive drugs such as long-term systemic corticosteroids. The 24-year-old man in this scenario has an indication to receive a single dose of PPSV23 now. A dose of PCV13 would be given at age 65 years or older followed by a dose of PPSV23 one year later 48. • Qstn : How many doses of PPSV23 can an adult get in a lifetime? Answer : CDC recommends 3 doses • Qstn : How many doses of PCV13 can an adult get in a lifetime ?? Answer : CDC recommends 1 dose in lifetime • Qstn : Can I administer PPSV23 and PCV13 at the same visit? Answer : No, never give PPSV23 and PCV13 together • Qstn : Can I give other vaccines at the same time I give either PCV13 or PPSV23 to a patient? Answer : Yes 49. • Both Influenza and pneumococcal Vaccines are very safe to administer • We , the respiratory physicians should encourage our patients taking both vaccines to improve their quality of life and thus preventing morbidity and mortality |
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| Posted by : peter88 | Post date : 2019-11-08 16:20 | ||
| Category : Health & Medicine | Views : 519 | ||
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