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Vaccines and Vaccination
Dr Alex DodooPhD, MPSGH, MRPharmSAg. Director, Centre for Tropical Clinical
Pharmacology & TherapeuticsUGMS, Accra
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Overview
Vaccine preventable diseases
Vaccines Available
Expanded Programme on Immunization
Schedule of Immunization for Ghana
Current Global Trends on Immunization
Global Advisory Committee on Vaccine
Safety
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Vaccine preventable diseases
The goal of a vaccine is to make a person immune toviruses or bacteria
Immune SystemBodys defences against virusesand bacteria
Antibodies
Lymphocytes (B-lymphocytes and T-lymphocytes andMemory Cells)
Immunity and immune memory
From natural infection
From vaccination
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Types of Vaccines
Type of Vaccine Examples
Killed, intact bacteria Typhoid vaccine
Killed, intact virus Inactivated polio vaccine, Hep A
virusKilled, disrupted virus Influenza vaccine
Live, weakened or attenuated
vaccine
Oral polio vaccine, MMR, Chicken
pox
Purified bacterial proteins Acellular pertusis vaccine
Purified bacterial polysaccharide Hib vaccine, Pneumococal vaccine
Purified viral protein Hep B vaccine
Inactivated bacterial toxin Diphtheria and tetanus toxoids
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E P I
Expanded Programme on Immunization
National Programme
Seeks to achieve maximum coverage forchildhood immunization
Part of the Ministry of Health and Ghana
Health ServiceImmunization free to all children in Ghana
National Immunization Schedule
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National Immunization Schedule
EPI/GHS/MOH
Disease/Vaccine Age For
Immunization
Tuberculosis (TB)Polio
BCG, OPV0
At Birth
Diphtheria, Pertussis (Whooping Cough), Tetanus,
Hepatitis B, Haemophilus influenzae type B
(HiB)PolioDPT1-Hep B1+Hib1 (Five in one)
OPV1
Six Weeks
Five in One 2
OPV 2
10 weeks
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National Immunization Schedule
EPI/GHS/MOH
Disease/Vaccine Age For
Immunization
Diphtheria, Pertussis (Whooping Cough), Tetanus,
Hepatitis B, Haemophilus influenzae type B
(HiB)PolioDPT3-Hep B3+Hib3 (Five in one)
OPV3
14 weeks
Measles, Yellow Fever 9 months
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Anti-immunisation lobby
IMMUNISATION SAFETY
IS AN EMERGING ISSUE
Regulations are changing
Vaccination campaign
Mishandling rumoursInternet
Evolution of programme
Unsafe injection
Inadequatemonitoring
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If we have no fear of vaccines, but
have fear of disease, we vaccinate our
children
If we have no fear of vaccines, but no
fear disease either, there is inertia
But if we have no fear of disease, but
fear of vaccines, we refuseimmunization
Source: LW Sullivan, President Morehouse School of Medicine, Georgia US.
At US National Immunization Conference, Atlanta, Georgia, July 1998
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Target diseases disappearing
Difficult to prepare for crisesNew communications: television and
Internet
Bad news more exciting than good news
Very technical subject with difficult concepts
to explain
A communicationschallenge
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Risk whendisease isvirtually
absent
Risk
during anepidemic
Concepts difficult even
for professionals e.g.
temporal vs.causal
association,relative risk,
risk assessment
A communicationschallenge
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Parents seek litigation
Is the service for the benefit of individual or
society?Compulsory or opt-out?
Mass campaigns vs. right to choose
Compensation
Legal aspects
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ADVERSE EVENTS
Anti-vaccine lobby reduced coveragewith pertussis vaccine
Number of cases and deaths rose for
some years afterwardsConclusion: misinformation hurts
immunization programmes and children
Does it matter?
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0
100
200
300
400
500
I
1940 1950 1970 1980 1990
Vaccine
uptake
DTP introduced
81%
31%
93%
Year
Active AVM
Source: Gangarosa. Lancet 351, 1998
1960
INCIDENCE OF PERTUSSIS IN COUNTRIES AFFECTED BY
ACTIVE ANTI-VACCINE MOVEMENTS (United Kingdom)
RISKS OF MEASLES INFECTION
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RISKS OF MEASLES INFECTION
VS. RISKS OF MEASLES VACCINE
Otitis 7-9% 0
Pneumonia 1-6% 0
Diarrhoea 6% 0Post-infectiousencephalomyelitis
0.5/1000 1/million
SSPE 1/100 000 0
Anaphylaxis 0 1/100 000 million
Thrombocytopenia Poorly quantified 1/30 000
Death 0.1-1/1000 (up to 5-15%) 0Duclos P, Brian J. Ward
Measles infection Measles vaccine
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RISK-BENEFIT OF VACCINES
The complications and accidentsmust be
looked upon as the price we pay for the
protection these agents confer upon us. Thereis no insurance without a premium. Our
business is to provide greater and more
comprehensive insurance and to diminish thesize of the premium
Wilson (1967) Wilson GS, The Hazards of immunisation,Athlone Press, London 1967
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Wait to draw vaccines into syringes until immediatelyprior to administration
Never mix vaccines in the same syringe unless they are
specifically approved for mixingRecord vaccine and administration information, including
lot numbers and injection sites, in the patient's record
If errors in vaccine storage and administration occur, take
corrective action immediately to prevent them fromhappening again and notify public health authorities
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Contraindication to vaccination
Many conditions are often inappropriately regarded as contraindications tovaccination. In most cases,the following arenot contraindications:
Mild acute illness (e.g., diarrhea and minor upper-respiratory tractillnesses, including otitis media) with or without low grade fever
Mild to moderate local reactions and/or low grade or moderate feverfollowing a prior dose of the vaccine
Current antimicrobial therapy
Convalescent phase of illness
Recent exposure to an infectious disease
Premature birth
Breastfeeding
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?
Children with compromised immune system, asoccurs with cancer patients
A person has had a severe allergic reaction to a
vaccine
A person with a mild, common illness, such as a coldwith a low-grade fever, does not have to wait to bevaccinated.
Follow any guidelines given by the EPI especially incases of infections including HIV/AIDS
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The providers of vaccines can do a number of things to helpmake vaccines as safe and effective as possible
providing patients or parents/guardians with informationabout vaccines and immunization is very important.
Before administeringeach dose of certain vaccines,provide sufficient information to either the adult vaccineeor to the childs parent/legal guardian in a language theycan understand
discuss the benefits and risks associated with specific
vaccines and what to do and who to contact in case ofadverse events
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Most people experience no side effects, or only mild ones,following immunization.
Mild side effects may include soreness, swelling, or redness at
the injection site or mild fever. Severe side effects, such as severe allergic reactions,
following vaccination are extremely rare.
However, any provider who administers vaccines should haveprocedures in place for the emergency care of a person who
experiences an anaphylactic reaction.
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What to do in case of adverse events
Manage appropriately as per hospital or
institutional guidelines/protocols
Fill an Adverse Events FollowingImmunization (AEFI) form
Send form to EPI or to National Centre for
Pharmacovigilance, Food and Drugs Board
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Adjuvants and Safety
Complex, evolving and neglectedsafety area
Review of current, new & novel adjuvants
GACVS: WHO role in facilitating dialoguescientists-academe/industry and regulators
Need consistent regulatory approach
(Tech Report Series)
Need for collation A/Es with adjuvants
WHO
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Adjuvants contd
Need for short and long-term safety data for
adjuvants, including effect on immune
system
Need for validated animal models for
adjuvant safety testing
Need to evaluate adjuvant safety both alone
and combined with antigen(s)
Need for pharmacokinetics of antigens with
with adjuvants WER 2004;79:269-272
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Way Forward:GACVS
A/E vaccine allegations ongoing need for more
reviewsMore consultation with industry,national govts
and drug regulators
Conclusions by GACVS open for scrutiny
GACVS work with and give more support to drugregulatory authorities and to WHOImmunizations, Vaccines and Biologicals
Folb et al American Journal of Public Health.2004; 94: 1926-31.
WHO
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WHO IVB, GACVS and National Govt
Bringing serious safety issues from nationalperspective to attention of WHO IVB important forshaping selection of topics for GACVS review
GACVS welcomes opportunities to share outcomesfrom reviews more widely
IVB and GACVS : Vaccine Safety Net Projecteffort made to assess systematically quality of
vaccine safety websites WER 2005;80: 3-7(http://www.who.int/vaccine_safety/en/)
IVB, GAVCS welcome opportunity for morecollaborative work on serious vaccine safety issues
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