VACCINE PREVENTABLE DISEASES (PART 1) Flashcards
ADULT VACCINES
Herpes zoster (shingles)
Pneumococcal-polysaccharide-23
Seasonal Influenza
Td/Tdap: Td every 10 years; at least 1 dose of acellular
pertussis as an adult (Tdap)
COVID Vaccination
VARICELLA
- Varicella zoster virus
- Primary infection: chicken pox
- Reactivated infection: herpes zoster (shingles)
- Transmission: airborne (respiratory droplets) and virus shed from skin lesions
- Highly contagious (primary infection)
You are contagious as long as those blebs are filled with fluid, so once the the blebs dry up and crust over. You’re not considered contagious anymore - Clinical illness:
- usually mild disease; causes itchy rash, fever, headache, aches and pains
- Complications
- pneumonia, bacteremia, severe skin infections, and death
- Natural infection results in lifelong immunity
VARICELLA VACCINE
- Varicella vaccine available in Canada in 1999; routine immunization program in Alberta in 2001
- 80% reduction in hospitalizations
- Effectiveness: > 98% following 2 doses
- Preparations available:
- Live attenuated univalent varicella (VARIVAX®III, VARILRIX®)
- Live attenuated measles, mumps, rubella, and varicella (PRIORIX TETRA®, ProQuad™)
- Recommendations for use:
- Healthy children (12 months to < 13 years of age):
- 2 doses of varicella-containing vaccine (1st dose at 12 to 15 months, 2nd dose at 18 months of age or any time thereafter but no later than around school entry)
- Healthy adults:
- < 50 years of age – 2 doses of univalent varicella if do not meet the definition of varicella immunity
Give if adults if they havent had confirmed case of varicella - Susceptible women of childbearing age are a priority (cannot give during pregnancy)
- > 50 years of age – if known to be serologically susceptible, should receive 2 doses of univalent varicella vaccine
Dermatomes
it usually will express on a dermatone. So what happens with chicken pox is when you get it. Some of the virus decides to hide in one of your root gangly of your nerves and the spine. And then, some time later.
very often, when you have something that’s weakened your immune system. So you’ve gotten sick, You’ve gotten cancer. You’ve gotten older and your immune system when it’s spiked up after it reaches some magic line, this virus can re-express itself.
Travel down that nerve, and then it literally expresses on the base of the nerve. And this is why we get these tight little groupings, because it’s just along the one dermatome eg. T4 dermatome
HERPES ZOSTER VACCINES
Vaccine type Live attenuated Inactivated;
zostavax vs shingrix
dose and route
recommended use
efficacy
storage
ZOSTER VACCINES
advantges
disadvantage
Advantages (Shingrix®)
*Much more effective than a liveattenuated vaccine
*adjuvant increases immune
response leading to longerlasting and greater
immunogenicity
high level of efficacy up to ~7
years of follow up
*Not a live vaccine
*increased data in
immunocompromised
individuals
*89-91% efficacy in preventing PHN
(compared to ~67% with LZV)
t immuno compromise individuals can get the shot. We just have to make sure they’re aware that the shot may not be as effective for them as somebody who is immunocomp
Disadvantages (Shingrix®)
*Requires 2 doses
*Expensive $$$ & not publicly
funded
*Injection site (pain, redness,
swelling) and other reactions
(myalgia, fatigue, fever)
–Reactions occur more
often in people 50-69
years (versus 70 years
and older)
NACI STATEMENT ZOSTER VACCINATION
*RZV should be offered to individuals ≥50 years of age
without contraindications (including those who have
previously been vaccinated with LZV)
*Re-immunization with 2 doses of RZV may be
considered at least one year after LZV
*RZV should be offered to individuals ≥50 years of age
without contraindications who have had a previous
episode of herpes zoster
*RZV (not LZV) may be considered for
immunocompromised adults < 50 years of age on a
case-by-case basis.
with the inactivated vaccine. There’s not the concern about timeline, because we’re just giving you a big dose of antigen, so you can get it relatively closely after having a shingles attack. They usually say to wait about 4 or 5 months.
ZOSTER VACCINE REVIEW
* Should Shingrix® be given to people who have already received
Zostavax®?
* What is the minimum interval between two doses of Shingrix®?
* If a patient does not come back to receive their 2nd dose of Shingrix®
between 2 and 6 months, do I need to restart the series?
* Before administering Shingrix® is it necessary to ask if the person has
ever had chickenpox or shingles?
* Should people who haven’t had chickenpox be vaccinated with the zoster
vaccine?
* Can someone who has experienced an episode of shingles be vaccinated
with the zoster vaccine?
* Is Shingrix® publicly covered?
Yes
2 months is the guideline. You can go down to 4 weeks if reason. Longer interval is preferred (6 months)
We never restart the series, especially on inactivated vaccines. We just give the next dose in the series, and continue where we left off
Yes, you can ask them. It’s not necessarily relevant, older than 50 assume they had it
We assume that if you’re at the right age range, get the vaccine that you’ve been exposed unless we go into a blood test to confirm whether you’ve been exposed or not. That’s the only way to know the blood test is about $300 to public health. I would rather just vaccinate someone than send them for blood work.
Yes, They say that from a live case of shingles that you’re probably protected for between 5 and 10 years, but we assume that the vaccine will actually probably be more effective than that.
Not publicly covered
PNEUMOCOCCAL
- Streptococcus pneumoniae ( > 90 strains or serotypes)
- Transmission: close, direct contact, respiratory droplets
- Local infections: otitis media, sinusitis, bronchitis, pneumonia
- Invasive pneumococcal disease (IPD):
- meningitis, bacteremia, endocarditis, septic arthritis, osteomyelitis,
peritonitis - IPD is most common in very young, elderly, and groups at high risk due to
underlying conditions - Many people are asymptomatic carriers
- Antibiotic resistance increasing
PNEUMOCOCCAL VACCINE
- Polysaccharide vaccine approved in 1983; conjugate vaccine approved in 2001 (added to routine childhood immunizations in 2005)
- Efficacy:
- Pneumococcal conjugate – in children < 5 years, 86% to 97% effective against IPD serotypes in the vaccine
- Pneu-P-23 - > 80% effective again IPD among healthy young adults, and 50%-80% effective in elderly and high-risk groups (efficacy decreased in certain groups at high risk of pneumococcal infection, e.g., kidney failure, impaired immune response)
- Preparations available:
- Pneumococcal conjugate (SYNFLORIX®, 10 valent; Vaxneuvane, 15 valent; Prevnar®13, 13 valent; Prevnar®20, 20 valent)
- 0.5 mL IM
- Pneumococcal polysaccharide 23-valent vaccine (PNEUMOVAX®23)
- 0.5 mL IM or SC **Prevnar 20 and Vaxneuvance have not been
assessed by NACI at this time and do not have any official recommendations
the polysaccharide vaccine it can either be done in the muscle or under the skin.
PNEUMOCOCCAL VACCINE COMPOSITION
- PCV 13, 15 and 20 use CRM197 (Diphtheria toxoid) as a carrier Protein
- 2 extra strains in PCV 1accountts for ~15% of IPD cases
- 7 extra strains in PCV 20 account for ~27% of IPD cases
PPSV23 covers strain 2 and 17F
And the others actually cover a strain of 6, a. The Pps V. 23 doesn’t cover.
If you get PCV 20 and PPSV23 you could cover 24 strains
It actually uses crm 197 which is a really fancy term. What they’ve taken is, they taken diphtheria toxoid,. They’ve deactivated, and that’s what they use as their conjugate. they mount all the Polysaccharides onto that, because it gives a good immune response.
No protection to diptheria, completely deactivated toxoid
PNEUMOCOCCAL VACCINE
* Recommendations for Use:
- Infants (2 months to < 12 months)
- Pneu-C-13 routine immunization (3 or 4 dose schedule)
- Children at high risk of IPD due to underlying medical condition should receive 4 dose
schedule of Pneu-C-13 and 1 dose of Pneu-P-23 at 24 months of age
The polysaccharide vaccine was poorly immunogenic in children less than 2 years of age, and protective immunity was found to wane significantly 3 years after vaccination.
So the conjugate Vaccine, if you do it prior to Polysaccharide, you wait 8 weeks to do Polysaccharide. If you do Polysaccharide first, then you have to wait a full year before you do the conjugate vaccine.
PNEUMOCOCCAL
VACCINE NACI
RECOMMENDATIONS
FOR ADULTS
Adults 65 years of age or older,
regardless of risk factors or previous
pneumococcal vaccination
Pneu-P-23 1 dose
Adults 18 – 65 years at high risk of IPD
due to underlying medical condition
(chronic heart, kidney, liver, lung
disease; diabetes mellitus)
Pneu-P-23 1 dose +
1 booster dose of Pneu-P-23
vaccine at least 5 years
later for people at highest
risk of IPD
Adults 18-65 years who are residents of
long term care facilities, smokers,
persons with alcoholism, homeless
Pneu-P-23 1 dose
Adults with immunocompromising
condition
Pneu-C-13;
Pneu-P-23
1 dose of Pneu-C-13
1 dose of Pneu-P-23 at
least 8 weeks after Pneu-C13
1 booster dose of Pneu-P23 at least 5 years later
1 dose of conjugate, 8 wks later polysaccharide 23, 5 yrs later booster polysaccharide - never more than 2 polysac
IF PNEUMOCOCCAL
CONJUGATE IS A
BETTER VACCINE,
SHOULD ALL ADULTS 65
YEARS OF AGE AND
OLDER RECEIVE IT?\
NACI PNEUMOCOCCAL
RECOMMENDATIONS
- Immunization with Pneu-C-13 vaccine, in addition to Pneu-P-23
vaccine, may be considered for immunocompetent individuals (≥65
years) on an individual basis (should not be publicly funded for
individuals without additional risk factors) - Real-world effectiveness of Pneu-C-13 in preventing pneumonia (and
IPD) has been seen in studies - Pneu-P-23 may or may not prevent community-acquired pneumonia,
however, may be as effective as Pneu-C-13 in preventing IPD - The incidence of pneumococcal disease in older adults caused by
serotypes in Pneu-C-13 is low as a result of widespread childhood
vaccination (overall expected benefit for most persons would be
low) - Pneumococcal vaccination coverage goals by 2025 (national): 80%
- There’s actually been numerous studies that show, unfortunately, with polysaccharide vaccines that if we do too many doses, you get what’s called this hypo responsiveness. So where most vaccines we do do, and we get a booster fact and dose, and we get a booster effect and dose, and we get a booster effect.
- If we give them too many doses, they actually start to get less protection. And it’s because of this apoptosis. Theoretically, of those beta cells that are producing the antibodies. They seem to just die off.
there’s a reason we only do 2 doses maximally of these polysaccharide vaccines, because if they start to have too many, the vaccine is not as effective.
INFLUENZA
- RNA virus (Orthymyxoviridae family)
- Transmission: primarily by droplets spread through coughing or
sneezing; direct or indirect contact with respiratory secretions - Respiratory illness – mild to severe; can result in hospitalization or
death - Young children, older adults and people with chronic conditions
are at higher risk of complications - 2 main types of influenza virus that cause seasonal epidemics: A and
B - Influenza A classified into different strains or subtypes based on
proteins or antigens on the virus surface E.g., H1N1, H3N2 - Influenza B is classified into two antigenically distinct lineagesYamagata and Victoria
