ADULT IMMUNIZATION
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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.

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ADULT IMMUNIZATION

“What Family Physicians Need to Know”

Dr. Marie Andrades

Senior Instructor

Family Medicine


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ADULT IMMUNIZATION

Under emphasized and under appreciated

Under utilized

Important preventive strategy to decrease morbidity and mortality


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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


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ADULT IMMUNIZATION

Other vaccines when indicated

Rabies

Yellow fever

Anthrax

Plague

Hib

Hepatitis A vaccine

Polio

BCG

Meningococcal

Typhoid


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In Special Cases

Pregnancy

Lactation

Health care workers

Animal handlers

HIV positive patients

Immunocompromised states


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General Guidelines

Administration of multiple vaccines

Immunoglobulins combined with

Toxoids

Inactivated vaccines

Polysaccharide vaccines

Live virus vaccines


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Assessment

History of previous immunization

Hypersensitivity reactions to vaccine or their component

Specific allergies

Acute febrile illness

Contraindications to live vaccine


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Hepatitis B VaccineCase 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?


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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


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Hepatitis BHigh 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


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Hepatitis BDecreased Immunological Response

If given in the gluteus muscle (needle length important)

Immunodeficient

Chronic renal failure

Smokers

Elderly

Obese


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Hepatitis BAdverse Effects

Pain

Rash

Fever > 37.7 C

Influenza like syndrome

Arthritis, arthralgia, myalgia


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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?


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Hepatitis BPercutaneous Exposure

Source

Unvaccinated

Vaccinated


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Hepatitis BPercutaneous Exposure

Source

Unvaccinated

Vaccinated

HBIG 0.06ml/kg

Test for Anti

HBs

If inadequate

HBs

Ag+

Begin HB vaccine

HBIG + Vaccine

series

series


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ADULT IMMUNIZATION

Hepatitis BPercutaneous Exposure

Source

Unvaccinated

Vaccinated

HBIG 0.06ml/kg

Test for Anti

HBs

If inadequate

HBs

Ag+

Begin HB vaccine

HBIG + Vaccine

series

series

Begin HB vaccine

Unknown

Nothing required

series

source


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Tetanus Diphtheria (Td) Vaccine

Toxoids

Dose: 0.5 ml I/M at 0, 1 and 6-12 months

Seroconversion 100%

Booster 10 yearly


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Tetanus Diphtheria (Td) VaccineAdverse Effects

Persistent nodule

Pain, redness swelling

Headache, lethargy, malaise, myalgia

Urticaria, anaphylaxis


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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?


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ADULT IMMUNIZATION

Tetanus prophylaxis in wound management

T.T Tetanus Toxoid

TIG Tetanus Immunoglobulin


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Tetanus prophylaxis in wound management

TT

Clean

Large

Immunization

Minor Wound

Dirty Wounds

T.T

TIG

T.T

TIG

Begin

None,

Pre

Exp

No

Yes

Yes

incomplete,

Series

Unknown

T.T Tetanus Toxoid

TIG Tetanus Immunoglobulin


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Tetanus prophylaxis in wound management

T.T Tetanus Toxoid

TIG Tetanus Immunoglobulin


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Tetanus prophylaxis in wound management

T.T Tetanus Toxoid

TIG Tetanus Immunoglobulin


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Mumps, Measles & Rubella Vaccine

Live attenuated vaccine

Dosage: 0.5 ml subcutaneous

Seroconversion 95%

Lifelong immunity


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Mumps, Measles & Rubella VaccineAdverse Effects

Fever

Rash

Arthralgia

Lymphadenopathy


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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?


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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


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Case Study

What immunization would you recommendfor a 55 year old patient with congestive cardiac failure and no previous immunization?

Correct


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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%


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Influenza Vaccine Indications

Healthy adults > 50

Residents of nursing homes

Chronic respiratory, heart and renal disease

Immunosuppressed including diabetics

Health care workers

Travelers


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Pneumococcal Vaccine

Polyvalent vaccine

Dosage: 0.5 ml I/M

Single booster after 5 years

Efficacy: Prevents disease in 70% of immunized adults


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Pneumococcal Vaccine Indications

Healthy adults >65

Asplenia or splenic dysfunction

Chronic heart, lung or liver disease

Chronic renal disease including nephrotic syndrome

Immunosuppressed states including DM and HIV positive individuals

Comorbids


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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 daysBooster 3 yearly


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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


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Varicella Vaccine

Live attenuated vaccine

Dosage: 0.5 ml s/c. 2 doses 4-6 weeks apart

Seroconversion in 97%

Health care workers

Workers at day care centers

Non pregnant women

Indications


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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


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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


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