TPA in Stroke: What's All the Fuss?. FERNE Brain Illness and Injury Course.
What's all the Fuss with Vaccinations?
-
Upload
pediatric-home-service -
Category
Health & Medicine
-
view
2.923 -
download
0
description
Transcript of What's all the Fuss with Vaccinations?
What’s all the fuss with vaccinations?
Presented by Dr. Roy Maynard
August 15, 2012
2 of 39
Objectives
• Understand the role of antigenic drift and shift in
influenza
• Recognize differences in influenza vaccinations
• Describe mechanism of action of anti-influenza drugs
• Identify American Academy of Pediatrics
Recommendations for influenza vaccination for the
2012-2013 season
3 of 39
Definition
• Edward Jenner 1796 used cowpox (variola
vaccinia) to inoculate
• Individuals inoculated with cowpox were
protected against smallpox
• The term “vaccine” derived from this historical
perspective
4 of 39
Definition
• A vaccine is a biological preparation that
improves immunity to a particular disease
• Flu shot: split-virus vaccine, trivalent since 1945
• Nasal spray: LAIV (live attenuated influenza
virus) since 2003
5 of 39
Dr. Edward Jenner
http://www.ourcivilisation.com/smartboard/shop/jennere/about.htm Accessed 8/14/12
6 of 39
Smallpox
http://en.wikipedia.org/wiki/Smallpox Accessed 8/14/12
Bangledesh (1973) USA (1912)
7 of 39
Smallpox
• Mortality 30 in severe form
• Mortality 40-50% for children less than one
year of age
• 18th century killed 400,000 people/year in
Europe
• 300-500 million deaths during the 20th century
8 of 39
Smallpox
• Last case reported in 1973
• Immunization programs for smallpox
discontinued
• Smallpox has been eradicated
• Success story for global immunization to
eradicate a devastating disease
9 of 39
Types of Vaccines
• Killed: influenza, cholera, polio, hepatitis A, bubonic plague, rabies
• Attenuated: measles, rubella, mumps, yellow fever, typhoid, BCG
• Subunit: surface proteins or particles only, hepatitis B, influenza, HPV
• Conjugate: polysaccharides poorly immunogenic, link to protein get better response, HIB vaccine
10 of 39
Types of Vaccines
• Valences: polyvalent like PCV 7, now PCV 13
• Toxoid: toxic compound is inactivated but used in the vaccine, tetanus, diptheria
• Passive immunization: synagis
• Experimental: DNA vaccines, cancer vaccines
11 of 39
Influenza
http://www.nytimes.com/2006/12/26/health/26cons.html?_r=1 Accessed 8/14/12
12 of 39
Transmission
• Droplet transmission from coughing or
sneezing
• Nasal secretions
• Incubation period is 1-5 days
13 of 39
Presentation
• Starts with rhinitis, pharyngitis and cough
• High fever
• Chills
• Muscle aches
• Headache
14 of 39
Anatomy of Influenza Virus
www.environment.ucla.edu/CTR/research/Inf-Diseases/avian_influenza.html Accessed 8/14/12
15 of 39
Anatomy of Influenza Virus
• Orthomyxovirus single stranded RNA virus,
8 pieces
• Surface antigens
– Hemagglutin (HA) – determines extent of
infection by binding to host cells (H1-H17)
– Neuraminadase (NA) – breaks down glycoprotein
link so new virus can be released from host cell,
target of Tamiflu (N1-N9)
16 of 39
Anatomy of Influenza Virus
http://www.abc.net.au/health/library/stories/2004/07/08/1831345.htm Accessed 8/14/12
17 of 39
Influenza Virus
• Influenza A, B and C
• A is highly mutagenic, antigenic shift
• A causes more severe disease
• Seasonal flu in winter
• Pandemic influenza occurs when new A virus appears and population has no immunity
18 of 39
Viral Replication
https://dokuwiki.noctrl.edu/doku.php?id=bio:440:rabies Accessed 8/14/12
19 of 39
Antigenic Drift
http://en.wikipedia.org/wiki/File:Antigenic_drift_vs_shift.png Accessed 8/14/12
20 of 39
3 Horses of the Apocalypse
http://jspivey.wikispaces.com/file/view/bird_flu_2.JPG/34372223/bird_flu_2.JPG Accessed 8/14/12
21 of 39
Antigenic Shift
http://en.wikipedia.org/wiki/Antigenic_shift Accessed 8/14/12
22 of 39
Complications
• Bacterial pneumonia and other bacterial infections
• Viral pneumonia
• Croup, bronchiolitis in children
• Encephalitis
• Myocarditis
• Reye’s Syndrome
23 of 39
Influenza Deaths
• 3,000 to 49,000 deaths/year; average is 23,000 deaths/year
• Healthy people get the flu
• HEALTHY PEOPLE DIE FROM THE FLU (secondary bacterial pneumonia)
• 2009 H1N1 pandemic USA 12,500 deaths
• 2009 H1N1 pandemic USA 90% of hospitalizations and deaths in people <65 years of age
24 of 39
Influenza Associated Pediatric Deaths
• 46 deaths in 2005-2006
• 282 deaths in 2009-2010 (H1N1 pandemic)
• 26 confirmed deaths in 2011-2012 by CDC
– 50% had no known risk factor except age
25 of 39
Treatment
• Tamiflu oseltamivir (Tamiflu), zanamivir, amantadine, rimantadine (treat early or for chemoprophylaxis)
– Active against neuraminadase
– Resistance prevalent
• F16 antibody – active against all A viruses, active against HA
26 of 39
Influenza Shot
http://bulldogblog.csufresno.edu/articles/wp-content/uploads/2009/09/flu-shot-cartoon.jpg Accessed 8/14/12
27 of 39
Side Effects of Flu Shot
• Serious side effects are very rare
• Inactivated virus – YOU CANNOT GET INFLUENZA FROM THE VACCINE
• Mild reaction, lasts 24-48 hours, soreness, redness or swelling where the shot was given (20%), fever, aches, headache, fatigue, hoarseness, red or itchy eyes (1%)
28 of 39
Side Effects of Flu Shot
• Moderate reactions: febrile seizures in children receiving flu shot and PCV13, more of a problem in children with a history of febrile seizures
• Severe problems: life-threatening allergic reactions, Guillain-Barre Syndrome
29 of 39
Egg Allergy
http://www.ifpma.org/resources/influenza-vaccines/influenza-vaccines/vaccine-manufacture-virus-harvesting.html Accessed 8/14/12
30 of 39
Egg Allergy
• Skin testing no longer necessary
• Use lowest ovalbumin-containing vaccine
• Get immunization in office where emergency equipment is available
– First approach: get 1/10th dose, wait 30 minutes, get remainder and wait 30 minutes
– Second approach: get full dose, wait 30 minutes
32 of 39
Side Effects of LAIV
• Runny nose
• Headache
• Vomiting
• Muscle aches
• Fever not common in adults
• Viral shedding up to 7 days
33 of 39
Influenza Vaccine Effectiveness
• 60% across the board
• 90% effective in young people, 30-40% effective in >65 years of age
– Different strains chosen for the vaccine
– Immune system of the individual
– Intranasal live virus vaccine available
– Shots are inactivated virus
– Safe but not always effective
• Flu shot and Flu mist comparable
34 of 39
Influenza Vaccine Effectiveness
• 25 deaths prevented per 100,000 people
vaccinated
• 1 death prevented for every 4,000
vaccinated
• Protects against hospitalization and death
for those vaccinated even if they get
clinical disease
35 of 39
American Academy of Pediatrics (AAP)
Recommendations for 2012-2013 Flu Season
• Recommend influenza vaccination for all
people including children and adolescents
over 6 months of age
36 of 39
American Academy of Pediatrics (AAP)
Recommendations for 2012-2013 Flu Season
• Special Efforts
– Children >6 months with chronic disease (asthma,
diabetes, prematurity, BPD, immunosuppression,
neurological disorders)
– Out-of-home providers of high risk children <5 years
of age and especially <6 months of age
– All health care personnel
– Women who are pregnant, planning to be pregnant,
who have recently delivered or are breast feeding
37 of 39
Conclusions
• Influenza is a potentially fatal disease
• Generally affects the very young and the very old
• Pandemics are associated with influenza A after
antigenic shift and affects a population with no
immunity
• Pandemics affect all ages in a population
• Scientific data supports protective effect of flu
vaccine
• Generally safe, not always effective
38 of 39
Get Immunized
• Protect yourself
• Protect your family
• Protect your co-workers
• Protect your patients
39 of 39
Q & A
Questions?
Thank you for attending!