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Six weeks later, Jenner injected the boy with fluid from a smallpox sore, but the boy remained free of smallpox
A preparation of proteins, polysaccharides, or nucleic acids of pathogens that are delivered to the immune system as single entities, as part of complex particles, or by liveattenuated agents or vectors, to induce specific responses that inactivate, destroy, or suppress the pathogen
Public Health
Vaccines are crucial to maitaining public health: Vaccines are safe, cost-effective, and efficient way to prevent sickness and death from infectious diseases Vaccines has lead to some of the greatest public health triumphs ever, including the eradication of naturally occurring smalpox from the globe and the near eradication of polio
Variola virus
Which causes smallpox, was once the scourge of the world This virus passes from person to person trough the air : fever, severe aches and pains, scarring sores that cover the body, blindness, and, often,death In the 18th century, variola killed every 7th child born in Rusia and every 10th in Sweden and France
WHO:1950/50million killed people 1967/10-15 million killed people 1977: the last case of naturally occurring smallpox was in Somalia
Diphteria
1900, USA: diphteria killed more than cancer did Corynebacterium diphteriae : upper airway infection with a grayish, thick membrane that grows in the throat and obstructs breathing, fever, hoarseness, and coughing Deaths not only by blocked airways but from the paralyzing toxin secreted by the bacterium, which can cause heart or other organs to fail
Infectious poliovirus
USA, till 1954: polio crippled 13,000 to 20,000 people every year 1954, before the first polio vaccine: 18,000 cases of paralizing polio in USA Just 3 year later: 2,500/yr 2006, WHO: 2,000 cases worldwide
Statistica in Romania
1957-1961 cazuri
decese 889
Poliomielita 1531
Difterie
Tetanos Pertussis Rujeola
3982
4224 448.882 513.547
319
1843 663 860
9
144 10.413 23.976
1
65 22 25
99,7
96,5 97,6 95,3
99,6
99,7 96,6 97,1
Vaccinations or immunizations (hard core of primary profilaxy) are, generally speaking, interchangeable terms ( active immunisation!)
Active immunization 2
Vaccination is administration of any vaccine (inactivated or killed whole organisms or a part from an organism), toxoid (inactivated toxin), or of a specific recombinant product in order to produce an immune response similarly to those from naturally infection.
To become immune
Once the immune system is trained to resist a disease, the person are said to be immune to it Is provided by vaccines and are an easier and less risky way to become immune
Herd immunity
Vaccines protect not only yourself but also others around you Similarly, when other people are vaccinated, they are less likely to give the disease to you So, vaccines protect not only individuals, but entire communities
Community immunity
If a critical number of people within a community are vaccinated against a particular ilness, the entire group becomes less likely to get the disease. This protection is called community immunity, or herd immunity
Community immunity: if enough people in a community are vaccinated against a particular ilness, the entire group becomes less likely to get the disease, even those who are not vaccinated
x x
Passive immunity
Immunity transferred from one person to another: - antibodies passed from mothers before birth or through breastfeeding protect the babies against some diseases - purified blood serum which contains the antibodies produced after someone suffered from an ilness in the past
Passive immunization II
Involves also the administration of preformed antibody in the form of intramuscular immunoglobulin, intravenous immunoglobulin, or concentrated monoclonal antibodies (Palivizumab for RSV) Indications: after high-risk exposure to individuals not immunized against the disease in question; high-risk of severe complications (children born to women who are chronic carriers of hepatitis B surface antigen); PID ( replacement IVIG)
Types of vaccines Live, Attenuated Vaccines Inactivated Vaccines Subunit Vaccines Toxoid Vaccines Conjugate Vaccines DNA Vaccines
Recombinant
Vector Vaccines
This image shows the live microbes antigens, membrane, and genetic material
Downsides
The organisms used in live, attenuated vaccines can change or mutate ( is the nature of living things to change!), and could revert to a virulent forme and cause disease Persons with damaged or weakened immune systems (PID, HIV, chemotherapy) Need to be refrigerated to stay potent(the shipping overseas and stored by health care workers in developing countries that lack widespread refrigeration)
Live, attenuated
Are relatively easy to create for certain viruses (contain a small number of genes): -measles, rubella,polio (Sabin vaccine),mumps chickenpox,yellow fever Are more difficult to create for bacteria (have thousands of genes, much harder to control): vaccine against Vibrio cholerae
V. bacteriene inactivate : DTPa sau DTPw, HI tip b, meningococic (A,C,Y,W135), cholera, plague Vaccinuri virale inactivate: Flu, VPI(Salk vaccine), hepatita B, hepatita A, rabies,Japanese encephalitis.
Inactivated vaccines
Inactivated vaccines contain microbes that have been inactivated with chemicals, heat, or radiation. The microbes antigens, membrane, and genetic material are still present.
Subunit vaccines
The imagine depicts antigens that have been separated from the rest of the microbe for use in a subunit vaccine
Subunit Vaccines
SUV are vaccines produced by recombinant technology They are called Recombinant Subunit Vaccines : - vaccine against hepatitis B virus Scientists inserted hepatitis B genes that code for important antigens into common bakers yeast The yeast then produced the antigens, they are collected and purified for use in the vaccine
Toxoid Vaccines
Harmless toxoid molecules (artists representation) are used in toxoid vaccines to immunize and protect people against harmful toxins secreted by some microbes
Toxoid Vaccines
The immune system produces antibodies that lock onto and block the toxin Exemples of toxoid vaccines: - Vaccine against diphteria - Vaccine against tetanus
V. Conjugate Vaccines
Are used against bacteria which possessed an outer coating of sugar called polysaccharides Polysaccharide coating disguise a bacteriums antigens so that the immature immune systems of infants and younger children cant recognize or respond to them Scientists link antigens or toxoid from a microbe that an infants immune system can recognize, to the polysaccharides. The linkage helps the immature immune system react to polysaccharide coating and defend against the disease-causing bacterium
Conjugate vaccines
Conjugate vaccines link antigens or toxoids to the polysaccharid or sugar molecule that certain bacteria use as a protective coating,thereby allowing the immune system to recognize and attack thes disguised bacteria. A conjugate vaccine contains the molecules shown in the foreground. The bacterium, part of which is shown in the upper left background, is not part of the vaccine. In fact, this kind of vaccine is a subunit vaccine
DNA Vaccines II
When the genes for a mirobes antigens are introduced into the body, some cells will take up that DNA The DNA then instructs those cells to make the antigen molecules The cells secrete the antigens and display them on their surfaces
DNA Vaccines
In other words, the bodys own cells become vaccine-making factories, creating the antigens necessary to stimulate the immune system DNA vaccines are relatively easy and inexpensive to design and produce
DNA Vaccines
DNA vaccines use a microbes genetic material, in particular, the genes that code for important antigens. The DNA in these vaccines is a circular form known as a plasmid
Comentarii In maternitate
Simultan Simultan Simultan
12 luni
4 ani 7 ani (cls.I) 9 ani (cls. a III-a) 14 ani (cls. a IV-a)
Simultan
Anthrax, Bacterial meningitis, Chickenpox, Diphteria,Haemophilus influenzae type b,Hepatitis A, Hepatitis B, Cervical cancer(HPV),Influenza, Japanese encephalitis,Measles, Mumps, Pertussis, Pneumococcal pneumonia, Polio, Rotavirus diarrhea, Rabies, Rubella, Smallpox, Shingles, Tetanus, Tuberculosis, Typhoid,Yellow fever
Contraindications
For children with intact immune system there are few absolute contraindications to receiving the first dose of any vaccine ! Inactivated or subcomponent vaccines pose no additional risk to patients with immune deficiency disorders, but some patients may not be protected from the target disease
Contraindications
Immediate Hypersensitivity Reactions ( Anaphylaxis or angioedema after a previous dose of vaccine is usually a contraindication for the subsequent doses of the same vaccine) -Vaccines produced in the chick embryo tissue cultures do not contain detectable amounts of egg proteins -Some of hypersensitivity reactions are caused by components added to vaccines( the gel stabilizer in measles vaccine) - The mild allergic reactions are not a contraindication to receive the subsequent doses, but may require special investigations and a consult with an allergist or vaccine safety specialist
Encephalopathy or Encephalitis
Both of them, within a few days after DTP vaccine administration is a contraindication to receipt of the subsequent doses A febrile seizure after any vaccine is not a contraindication to receipt a subsequent doses of vaccine were other vaccines that might induce fever Children who have had encephalitis or encephalopathy of unknown cause unrelated to immunization can safely receive all recommended vaccines if neurologic condition is stable Children with progressive neurologic disorders should defer the DTaP vaccine until the condition is stable
Some patients can safely receive live vaccines: - Patients successfully treated for cancer can be usually be immunized with both live and inactivated vaccines after completion of chemotherapy, but specific waiting times are recommended - Mild immune deficiency disorders, such a subclass IgG deficiency disorders, are not associated with adverse events following vaccination - Patients with disorders of white blood cell functions (CGD), can receive all inactivated varicella and live viral vaccines
Other contraindications
Severe ilnesses ( infectious diseases, TBC evolutiva, chronic nephropaty, chronic liver diseases, severe cardiovascular diseases) Cachexy
Pregnancy,live vaccines are prohibited in the first 3 months because they may be teratogenic.
Children with mild upper respiratory infections or gastroenteritis can receive routine immunizations as there is no evidence of any increased risk from vaccinationof children with these infections
Low-grade fever-less than 39C-is not a contraindication to immunization ! ( Although, is more prudent to wait for a few days to be immunized if uncertainty exists regarding the cause of the concurent ilness) ---------------------------------------------------------
Neal A.Halsey. Immunization. Oskis Pediatrics Principle &Practice, 2006:118-134
Meningococcal Vaccine : 1. A plain polysaccharide vaccine against Neisseria meningitides types A,C, Y, and W135 in children 2 or more years of age, recommended for children at increased risk of disease including those with asplenia or complement deficiency. It is not administered routinely to children because the risk of disease is relatively low 2. A polysaccharide-protein conjugate vaccine containing types A, C, Y, and W135 (2005) for all children 11-12 years of age, for previously unvaccinated 15-16 yr old, college freshman living in dorms, and others at high risk of disease
Vaccine strategies
Some vaccines come in combinations: DTP, MMR Combination vaccines reduce visit to the doctor, saving time and money and sparing children extra needlestick
Safety Issues
Many parents are concerned that multiple vaccines may weaken or overwhelm an infants immune system or that certain vaccines may cause autism, multiple sclerosis, or diabet
Combination vaccines
May they overwhelm or weaken childs immune system ? The immune system contains billion of circulating B and T cells capable of responding to millions of different antigens at once Because the body constantly replenishes these cells, a healthy immune system cannot be used up or weakened by a vaccine According to one published estimation, infants could easily handle 10,000 vaccines at once !
Further reading
http://www.cdc.gov/vaccines/schedules/ http://www.cdc.gov/vaccines/vpdvac/vpd-vac-basics.htm http://www.cdc.gov/vaccines//vpdvac/vaccines-list.htm
type b (Hib) Human Papillomavirus (HPV) Influenza (Flu) Japanese encephalitis (JE)
Haemophilus influenzae
Lyme disease Lyme disease vaccine no longer available in the United States. Measles Meningococcal Monkeypox There is NO monkeypox vaccine. The smallpox vaccine is used for this disease. Mumps Pertussis