“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

ROUTINE Tetanus and Diptheria ( Td ) Pneumococcal ( Age >65 ) Influenza ( Age >50 ) Hepatitis B MISSED CHILDHOOD VACCINES Mumps, Measles and Rubella ( MMR ) Varicella ADULT IMMUNIZATION Recommendation

Hepatitis A vaccine Polio BCG Meningococcal Typhoid Rabies Yellow fever Anthrax Plague Hib ADULT IMMUNIZATION Other vaccines when indicated

Pregnancy Lactation Health care workers Animal handlers HIV positive patients Immunocompromised states ADULT IMMUNIZATION In Special Cases

Administration of multiple vaccines Immunoglobulins combined with Toxoids Inactivated vaccines Polysaccharide vaccines Live virus vaccines ADULT IMMUNIZATION General Guidelines

History of previous immunization Hypersensitivity reactions to vaccine or their component Specific allergies Acute febrile illness Contraindications to live vaccine Assessment ADULT IMMUNIZATION

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 Case Study

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 mIU/ml Non responders: Anti HBs < 10mIU/ml ADULT IMMUNIZATION Hepatitis B Vaccine

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 High Risk Group

If given in the gluteus muscle (needle length important) Immunodeficient Chronic renal failure Smokers Elderly Obese ADULT IMMUNIZATION Hepatitis B Decreased Immunological Response

Pain Rash Fever > 37.7 C Influenza like syndrome Arthritis, arthralgia, myalgia ADULT IMMUNIZATION Hepatitis B Adverse Effects

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 Case Study

Source UnvaccinatedVaccinated ADULT IMMUNIZATION Hepatitis B Percutaneous Exposure

SourceUnvaccinatedVaccinated HBsAg+ HBIG 0.06ml/kg Begin HB vaccine series Test for AntiHBs If inadequate HBIG + Vaccine series ADULT IMMUNIZATION Hepatitis B Percutaneous Exposure

SourceUnvaccinatedVaccinated HBsAg+ HBIG 0.06ml/kg Begin HB vaccine series Test for AntiHBs If inadequate HBIG + Vaccine series Unknown source Begin HB vaccine series Nothing required ADULT IMMUNIZATION Hepatitis B Percutaneous Exposure

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

Persistent nodule Pain, redness swelling Headache, lethargy, malaise, myalgia Urticaria, anaphylaxis ADULT IMMUNIZATION Tetanus Diphtheria (Td) Vaccine Adverse Effects

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 Case Study

ADULT IMMUNIZATION Tetanus prophylaxis in wound management T.T Tetanus Toxoid TIG Tetanus Immunoglobulin

TT Immunization Clean Minor Wound Large Dirty Wounds T.TTIGT.TTIG None, incomplete, Unknown Begin PreExp Series NoYes ADULT IMMUNIZATION Tetanus prophylaxis in wound management T.T Tetanus Toxoid TIG Tetanus Immunoglobulin

ADULT IMMUNIZATION Tetanus prophylaxis in wound management T.T Tetanus Toxoid TIG Tetanus Immunoglobulin

ADULT IMMUNIZATION Tetanus prophylaxis in wound management T.T Tetanus Toxoid TIG Tetanus Immunoglobulin

Live attenuated vaccine Dosage: 0.5 ml subcutaneous Seroconversion 95% Lifelong immunity ADULT IMMUNIZATION Mumps, Measles & Rubella Vaccine

Fever Rash Arthralgia Lymphadenopathy ADULT IMMUNIZATION Mumps, Measles & Rubella Vaccine Adverse Effects

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 Case Study

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 Rubella Exposure

What immunization would you recommendfor a 55 year old patient with congestive cardiac failure and no previous immunization? Correct ADULT IMMUNIZATION Case Study

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

Healthy adults > 50 Residents of nursing homes Chronic respiratory, heart and renal disease Immunosuppressed including diabetics Health care workers Travelers ADULT IMMUNIZATION Influenza Vaccine Indications

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

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 ADULT IMMUNIZATION Pneumococcal Vaccine Indications Comorbids

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

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 Typhoid Vaccine Adverse Effects

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 ADULT IMMUNIZATION Varicella Vaccine Indications

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 Post Exposure Varicella Zoster Immunoglobulin

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 ADULT IMMUNIZATION Conclusion