Transcript Document 7477159

ADULT IMMUNIZATION
“What Family Physicians Need to Know”
Dr. Marie Andrades
Senior Instructor
Family Medicine
ADULT IMMUNIZATION
Under emphasized and under appreciated
Under utilized
Important preventive strategy to decrease
morbidity and mortality
ADULT IMMUNIZATION
Recommendation
ROUTINE
Tetanus and Diptheria ( Td )
Pneumococcal ( Age >65 )
Influenza ( Age >50 )
Hepatitis B
MISSED CHILDHOOD VACCINES
Mumps, Measles and Rubella ( MMR )
Varicella
ADULT IMMUNIZATION
Other vaccines when indicated
Hepatitis A vaccine
Polio
BCG
Meningococcal
Typhoid
Rabies
Yellow fever
Anthrax
Plague
Hib
ADULT IMMUNIZATION
In Special Cases
Pregnancy
Lactation
Health care workers
Animal handlers
HIV positive patients
Immunocompromised states
ADULT IMMUNIZATION
General Guidelines
Administration of multiple vaccines
Immunoglobulins combined with
Toxoids
Inactivated vaccines
Polysaccharide vaccines
Live virus vaccines
ADULT IMMUNIZATION
Assessment
History of previous immunization
Hypersensitivity reactions to vaccine or
their component
Specific allergies
Acute febrile illness
Contraindications to live vaccine
ADULT IMMUNIZATION
Hepatitis B Vaccine
Case Study
Correct
A 22 year old patient comes to the clinic
for advice. He has missed his last dose
of Hepatitis B vaccination which was
due 4 months back.
Should he repeat the series?
ADULT IMMUNIZATION
Hepatitis B Vaccine
Recombinant DNA vaccine
Dose. 1 ml I/M in deltoid at 0, 1 and 6
months
Booster dosing and serological testing
High risk group: Test for AntiHBs 1-4
months after completion of series
Poor responders: AntiHBs 10-100mIU/ml
Non responders: Anti HBs < 10mIU/ml
ADULT IMMUNIZATION
Hepatitis B
High Risk Group
Health care professionals
Homosexuals
Family member or sexual partner of chronic
hepatitis B carrier
Prostitutes
Drug abusers
Patient frequently receiving blood or its products
Patients with chronic renal failure
Travelers
ADULT IMMUNIZATION
Hepatitis B
Decreased Immunological Response
If given in the gluteus
muscle (needle length
important)
Smokers
Elderly
Immunodeficient
Obese
Chronic renal failure
ADULT IMMUNIZATION
Hepatitis B
Adverse Effects
Pain
Rash
Fever > 37.7 C
Influenza like syndrome
Arthritis, arthralgia, myalgia
ADULT IMMUNIZATION
Case Study
• Correct
A final year medical student presents
with a history of needle stick injury a
few hours ago while giving an injection
to a patient.
The patient’s Hep B status is not known.
What advise would you give to this
student who is not vaccinated?
ADULT IMMUNIZATION
Hepatitis B
Percutaneous Exposure
Source
Unvaccinated Vaccinated
ADULT IMMUNIZATION
Hepatitis B
Percutaneous Exposure
Source
Unvaccinated Vaccinated
HBs Ag+
HBIG 0.06ml/kg Test for Anti HBs
Begin HB vaccine If inadequate
HBIG + Vaccine
series
series
ADULT IMMUNIZATION
Hepatitis B
Percutaneous Exposure
Source
Unvaccinated
HBs Ag+
HBIG 0.06ml/kg Test for Anti HBs
If inadequate
Begin HB vaccine
HBIG + Vaccine
series
series
Unknown Begin HB vaccine
series
source
Vaccinated
Nothing required
ADULT IMMUNIZATION
Tetanus Diphtheria (Td) Vaccine
Toxoids
Dose: 0.5 ml I/M at 0, 1 and 6-12 months
Seroconversion 100%
Booster 10 yearly
ADULT IMMUNIZATION
Tetanus Diphtheria (Td) Vaccine
Adverse Effects
Persistent nodule
Pain, redness swelling
Headache, lethargy, malaise, myalgia
Urticaria, anaphylaxis
ADULT IMMUNIZATION
Case Study
• Correct
A 30 year old is brought to the clinic after
a road traffic accident in which he has
sustained laceration of his leg. On
questioning he says that he has received
all his childhood immunizations.
How would you manage this patient?
ADULT IMMUNIZATION
Tetanus prophylaxis in
wound management
TT
Immunization
Clean
Minor Wound
T.T
Large
Dirty Wounds
TIG
T.T Tetanus Toxoid
TIG Tetanus Immunoglobulin
T.T
TIG
ADULT IMMUNIZATION
Tetanus prophylaxis in
wound management
TT
Immunization
Clean
Minor Wound
T.T
None,
incomplete,
Unknown
Begin
Pre Exp
Series
Large
Dirty Wounds
TIG
T.T
TIG
No
Yes
Yes
T.T Tetanus Toxoid
TIG Tetanus Immunoglobulin
ADULT IMMUNIZATION
Tetanus prophylaxis in
wound management
TT
Immunization
None,
incomplete,
Unknown
Last booster
>5 years
Clean
Minor Wound
Large
Dirty Wounds
T.T
Begin
Pre Exp
Series
TIG
T.T
TIG
No
Yes
Yes
Booster
No
Yes
Yes
T.T Tetanus Toxoid
TIG Tetanus Immunoglobulin
ADULT IMMUNIZATION
Tetanus prophylaxis in
wound management
TT
Immunization
None,
incomplete,
Unknown
Last booster
>5 years
Complete
Last booster
within 5 years
Clean
Minor Wound
Large
Dirty Wounds
T.T
Begin
Pre Exp
Series
TIG
T.T
TIG
No
Yes
Yes
Booster
No
Yes
Yes
No
No
No
No
ADULT IMMUNIZATION
Mumps, Measles & Rubella
Vaccine
Live attenuated vaccine
Dosage: 0.5 ml subcutaneous
Seroconversion 95%
Lifelong immunity
ADULT IMMUNIZATION
Mumps, Measles & Rubella Vaccine
Adverse Effects
Fever
Rash
Arthralgia
Lymphadenopathy
ADULT IMMUNIZATION
Case Study
Correct
A 32 year old lady, 8 weeks
pregnant presents with a history of
recent exposure to German Measles.
On inquiring she reveals that she was
immunized with MMR after the birth
of her first child.
What would you advise this
patient?
ADULT IMMUNIZATION
Rubella Exposure
All pregnant women with suspected
rubella or exposure to rubella must be
investigated serologically irrespective
of a history of rubella immunization,
clinical rubella or previous positive
rubella antibody result
ADULT IMMUNIZATION
Case Study
What immunization would you
recommendfor a 55 year old patient
with congestive cardiac failure and
no previous immunization?
Correct
ADULT IMMUNIZATION
Influenza Vaccine
Inactivated trivalent vaccine
Dosage: 0.5 ml I/M yearly usually October
Efficacy: 70-90% in healthy subjects <65
In elderly, prevents disease in 30-40% and
death in 80%
ADULT IMMUNIZATION
Influenza Vaccine
Indications
Healthy adults > 50
Residents of nursing
homes
Chronic respiratory,
heart and renal
disease
Immunosuppressed
including diabetics
Health care workers
Travelers
ADULT IMMUNIZATION
Pneumococcal Vaccine
Polyvalent vaccine
Dosage: 0.5 ml I/M
Single booster after 5 years
Efficacy: Prevents disease in 70% of
immunized adults
ADULT IMMUNIZATION
Pneumococcal Vaccine
Indications
Healthy adults >65
Comorbids
Asplenia or splenic dysfunction
Chronic heart, lung or liver disease
Chronic renal disease including
nephrotic syndrome
Immunosuppressed states including DM
and HIV positive individuals
ADULT IMMUNIZATION
Typhoid Vaccine
Monovalent whole cell Typhoid vaccine
2 doses 4-6 weeks apart
Booster 3 yearly
Typhoid Vi polysaccharide antigen vaccine
Single dose
Booster 3 yearly
Live attenuated oral Typhoid vaccine
4 doses, 1 capsule on alternate days
Booster 3 yearly
ADULT IMMUNIZATION
Typhoid Vaccine
Adverse Effects
Whole cell vaccine
Pain, swelling, redness, malaise,
fever, headache
Vi polysaccharide vaccine
Mild local and systemic symptoms
Oral vaccine
nausea, vomiting, abdominal
cramps, diarrhea, urticaria
ADULT IMMUNIZATION
Varicella Vaccine
Live attenuated vaccine
Dosage: 0.5 ml s/c. 2 doses 4-6 weeks apart
Seroconversion in 97%
Indications
Health care workers
Workers at day care centers
Non pregnant women
ADULT IMMUNIZATION
Post Exposure Varicella Zoster
Immunoglobulin
Immunosuppressed
Neonates whose mother develops chicken
pox 7 days before to 28 days after
delivery
Pregnant women with significant exposure
to chicken pox or herpes zoster
Dosage: 1000mcg (4 vials) within 10 days
of exposure
ADULT IMMUNIZATION
Conclusion
Vaccination is an important tool in disease
prevention
Adult immunization should be given
priority
Vaccination needs based on occupation,
lifestyle, and health condition should be
considered