4.2 Medicine_Adult Immunization (Other Vaccines)_2014A

August 2, 2012

Other Vaccines

(not Dr. Solante discussed but in PPT)

OTHER VACCINES     

Hepatitis A Vaccine Meningococcal Vaccine HPV or Human Papilloma Vaccine Herpes Zoster Vaccine Cholera Vaccine

o people with chronic liver disease (because of the risk of fulminant hepatitis)

SCHEDULE [HARRISON’S]  2 doses (either 0 and 6-12 mos or 0 and 6-18 mos.  IF COMBINED Hep A and Hep B vaccine: administer 3 doses (0, 1, and 6 mos) (Harrison)

HEPATITIS A VACCINE ETIOLOGY  Hepatitis A Virus  Hepatotrophic Picornavirus  Inactivated by boiling for 1 min, contact with formaldehyde and chlorine or by UV irradiation. (Harrison)

THE DISEASE  incubation period: 28 days (2-6 wks)  flu-like symptoms and anorexia, 2/3 clinically icteric  acute illness lasts from 1-3 wks, prolonged convalescence  chronic hepatitis does not follow the acute illness  Hep A virus replication is limited to the liver but the virus is present in liver, bile, stools and blood during late incubation period and acute preicteric phase. [Harrison’s]  Despite persistence of virus in liver, viral shedding in feces, viremia and infectivity diminish rapidly once jaundice becomes apparent. (Harrison)

TRANSMISSION  fecal-oral route: contaminated food or water, close contact  worldwide distribution  This agent is transmitted almost exclusively by fecal-oral route. Person to person spread of this is enhanced by poor personal hygiene and overcrowding, large outbreaks have been traced to contaminated food, water, milk, berries and strawberries. (Harrison)  It is also more symptomatic in adults thus as frequency of HAV infection declines likelihood of clinically apparent or severe HAV illnesses (Harrison)

INDICATIONS (ROUTINE)  In areas of high prevalence of hepatitis A (e.g. Asia), susceptible individuals at risk of exposure: o travelers o Armed forces o persons for whom hepatitis A is an occupational hazard o homosexuals o abusers of injectable drugs o persons with multiple sex partners o contact of infected persons o people who work with hepatitis A virus in research settings o people who work with infected nonhuman primates o recipients of clotting factors concentrates (J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

HEPATITIS A IMMUNOGLOBULIN INDICATIONS:

1. Healthcare care personnel who are not immune and

exposed to feces of infected persons during outbreaks . 2. In the case of travel within 4 weeks of vaccine administration, a dose of immune globulin may be given alone or in addition to hepatitis A vaccine at a different site, for optimal protection.

* IG should be administered by IM injection into the deltoid or gluteal muscle

MENINGOCOCCAL VACCINE (polysaccharide) ETIOLOGY  Neisseria meningitides  13 serogroups; all invasive disease is caused by one of 5 serogroups :A,B,C,Y,W-135 (Phils A,C,Y, W-135)  Gram (-) aerobic diplococci with polysaccharide capsule (a major virulence factor which imparts antiphagocytic, antibactericidal, antiadherent properties enhancing survival during invasion into bloodstream and promoting transmission and spread) (Harrison)

THE DISEASE  incubation period: 1-10 days 1 of 7

 chills, malaise, prostration and rash that may be urticarial,maculopapular or petechial  CASE-fatality rate 9-12% all age group in fulminant cases, purpura, DIC, shock, coma and death  Meningococci colonizing URT are internalized by nonciliated mucosal cells and traverse the submucosa from which the make their way to bloodstream with which they survive host defenses.  It may then either slowly multiply and seed local sites such as meninges or pericardium OR rapidly multiply and develop into meningococcemia. (Harrison)

 Live attenuated vaccine, SUBCUTANEOUS (SQ)  TYPES: a. Quadrivalent o contains types 6,11,16,18 L1 capsid protein virus-like particles o prevention of vulvar, cervical, and vaginal cancers including genital warts b. Bivalent HPV o contains types 16 and 18 L1 capsid protein

TRANSMISSION  person to person through droplets of respiratory tract secretions *Minimum interval between 1 and 2 is 4 weeks, 2 and 3 is 12 weeks HPVs selectively infect epithelium of skin and mucous membranes. They may be asymptomatic, produce warts or be associated with a variety of benign and malignant neoplasias. (Harrison)

EPIDEMIOLOGY  disease occur more often in children < 5 y.o.  peak attack rate 3-5 mos age grp  children older than 5 and young adults have the highest attack rates during epidemics.

INDICATIONS ROUTINE:  Not recommended for routine use in the general public SPECIAL SITUATIONS:  Recommended for children 2 years and older  in high-risk gps: o functional or anatomic asplenia o with terminal component or properdin deficiencies o HIV infection o Microbiologist routinely exposed o travel to or reside where infection is hyperendemic o for control of outbreaks caused by vaccine-preventable serogps o people who wish to decrease their risk of meningococcal infection may elect to receive the vaccine

ETIOLOGIC AGENT  double stranded DNA virus, categorized according to their epidemiologic association with cervical cancer  low risk types (non-oncogenic) types 6 and 11  high risk types, 16,18,31,33,35,39,45,51,52,56,58,59,68,69,  73,82 (99.7%) causes low to high grade cervical abnormalities that are precursors to CA and anogenital CAs.  type 16 causes 50% of cervical CA, while both 16 and 18, 70% of cervical CA.

 Other indications: first year college students living in dorms, military recruits. (Harrison)

CONTRAINDICATIONS  Serious allergic reaction to vaccine component (thimerosal or phenol ) or previous dose  Moderate or severe acute illness  Breastfeeding, immunosuppression and pregnancy are not contraindications

EPIDEMIOLOGY WORLWIDE:  worldwide, humans are the only reservoir  risk of acquisition is 50% during one’s lifetime, and more than 80% of sexually active women will have been infected by age 50  globally, 300 M asymptomatic infections, 30 M low-grade cervical lesions, 30 M warts, 10 M precancerous lesions, and 0.4932 M cervical cancer in 2002 (WHO) PHILIPPINES:  Cervical CA incidence 1980-200522/100,000, 56% die within 5 years  2/3 are diagnosed in the advanced stage and types 16, 18, and 45 are the most frequently isolated types

INDICATIONS ROUTINE:  adolescent males and females 10 years to 19 years old CATHCH UP VACCINATION:

HUMAN PAPILLOMA VACCINE (J-group) K.A, KIMPOY and MAGSIE

Edited by: Constantino

2 of 7

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Quadrivalent HPV vaccine for women 19-45 years  Bivalent HPV for women 19-55 years  Both vaccines do not require prior screening before administration of the vaccine. Routine screening should be continued even after vaccination as there are other types of HPV that can cause cervical cancer VACCINE CAN BE ADMINISTERED TO:  equivocal or abnormal Pap smear  immunosuppression  positive HPV DNA test  breastfeeding  genital warts 

 

It is recommended for all women aged 60 y/o regardless of prior zoster infection (J-group) K.A, KIMPOY and MAGSIE

Neither taking varicella history of serology for immunity are needed prior to administration of vaccine  Dosing and administration o Subcutaneous administration in upper arm (0.65 ml dose) - one time single shot o Lyophilized zoster vaccine stored frozen, at 5｡F (-15｡C) o Should be given within 30 minutes of reconstitution to maintain potency  Side Effects o Redness, soreness, swelling or itching at injection site o Headache  Assess pregnant women for evidence of varicella o

immunity. Women who do not have evidence of immunity should receive dose 2 of varicella vaccine upon completion or termination of pregnancy and before discharge from healthcare facility. Dose 2 must be administered4-8wks after. [Harrison’s]

CONTRAINDICATIONS  Contraindicated if previous anaphylactic reaction to any component of the zoster vaccine (e.g., gelatin, neomycin)  Contraindicated in immunocompromised condition; HIV infection with