Transcript Vaccine Preventable Diseases

Vaccination: A Cornerstone of
Public Health
TH Tulchinsky MD MPH
Braun School of Public Health
BOX 4.3: VACCINES AND PREVENTION
The Greeks had two gods of health. Aesculapius and Hygiea, therapy and
prevention, respectively. Medicine in the twentieth century retains those two
concepts, and vaccination is a powerful means of prevention. What follows is
information on the vaccines that together with sanitation, make modern
society possible, and that if wisely used will continue to bestow on mankind
the gift of prevention, which according to proverb is worth far more than
cure.
Source: Plotkin SA, Mortimer EA. Vaccines. Philadelphia: WB Saunders, 1988
[Introduction].
Vaccination Issues
•
•
•
•
•
•
•
•
•
•
Organization
Reporting “up and down and sideways” (UDS)
Coverage
Herd immunity
Strategies and target groups
Program content
Continuous up-dating
International and “gold standards”
Infectious and chronic diseases
Costs and benefits
Vaccine Preventible Diseases (VPDs)
• World immunization coverage increased from 10% in
1970s to 80 in 1990s, then decreased to 77% in 1995-98
• Smallpox eradication 1982 ?
• Polio eradication 2005?
• Measles
• still kills 1 million per year
• need for a two dose policy
• Cost and priorities
•
•
•
•
•
•
Hepatitis B and A
Hib
MMRx2, DPTx4 - update policies
Varicella
Human papillovirus (HPV) and Cancer of cervix
New vaccines and cocktails
Vaccines: a suspension of live or killed microorganisms
or antigenic portion of those agents presented to a
potential host to induce immunity to prevent the
specific disease cause by that organism.
Preparation of Vaccines
a. Live attenuated organisms which have been passed repeatedly in tissue
culture or chick embryos so that they have lost their capacity to cause
disease, but retained an ability to induce antibody response, such as polio
(Sabin), measles, rubella, mumps, yellow fever, BCG, typhoid and plague.
b. Inactivated or killed organisms which have been killed by heat or chemicals
but retain and ability to induce antibody response. They are generally safe
but less efficacious than live vaccines and require multiple doses; e.g. polio
(Salk), influenza, rabies and Japanese encephalitis.
c. Cellular fractions: usually polysaccharide fraction of the cell wall of a
disease causing organism, such as pneumococcal pneumonia or
meningococcal meningitis
d. Recombinant vaccines: produced by methods in which specific DNA
sequences are inserted by molecular engineering techniques, e.g. DNA
sequences spliced to vaccinia virus grown in cell culture to produces an
effective influenza vaccine, and Hepatitis B vaccine by similar methods.
Passive Immunity “Vaccination”
Toxoids or antisera: are modified toxins made non-toxic to
stimulate formation of an antitoxin, such as those produced to
protect against toxins of tetanus, diphtheria, botulism, gas
gangrene, snake and scorpion venom.
Immune globulin: An antibody containing solution derived from
human blood in the form of pooled plasma, used primarily for
immunity for passive immunization such as for immunocompromised persons e.g. smallpox response groups.
Antitoxin: is an antibody derived from serum of animals after
stimulation with specific antigens and used to provide passive
immunity in humans.
Target Groups
• Newborns - Hep B, DPT, Polio, BCG
• Infants – Hep B, DPT, Polio (IPV, OPV), Hib, Hep A,
MMR
• Pre-schoolers • School age children - dT, MMR
• Adult women - Rubella
• Chronically ill – Influenza, pneumococcal pneumonia
• Travellers – yellow fever, polio, dT
• Adults - dT
• Elderly - Influenza, pneumococcal pneumonia, dT
• Risk groups for bioterrorism – smallpox, anthrax
Table 4.4: Annual Incidence of Vaccine Preventable Infectious Diseases in
Rates per 100,000 Population, Selected Years, United States, 1950-1996
Disease
1950
1960
1970
1980
3.8
0.5
0.2
Pertussis
79.8
8.2
Poliomyelitis
22.0
1.8
Measles
211.0
245.4
Mumps
na
Rubella
Hepatitis A
Diphtheria
Hepatitis B
1985
1990
1996
0
0
0
0
2.1
0.8
1.5
1.8
2.9
0
0
0
0
0
23.2
6.0
1.2
11.2
0.2
na
55.6
3.9
1.3
2.2
0.3
na
na
27.8
1.7
0.3
0.5
0.1
na
na
27.8
12.8
10.0
12.6
11.7
na
na
Source: Health, United States, 1990 and 1998.
4.1
8.4
11.5
8.5
4.0
Diphtheria
0 5 0 1 1 3
3
0
2
5
2
0
1
5
1
0
+ D i
p h t
h e r i
a
i
n c i
d e n c e
p e
5
0
1
9
7
01
9
7
51
9
8
01
9
8
51
9
9
01
9
9
52
0
0
02
0
0
5
Tetanus
0 5 0 1 1 4
0
.
4
.
3
5
0
.
3
.
2
5
0
.
2
.
1
5
0
.
1
.
0
5
+ T e t
a n u s
i
n c i
d e n c e
p e r
0
1
9
7
01
9
7
51
9
8
01
9
8
51
9
9
01
9
9
52
0
0
02
0
0
5
Rubella
0 5 0 1 3 0
0
0
0
9
0
0
8
0
0
7
0
0
6
0
0
5
0
0
4
0
0
3
0
0
2
0
0
1
0
0
+ R u b e l
l
a
8
51
i
n c i
d e n c e
p e r
0
1
9
7
01
9
7
51
9
8
01
9
9
9
01
9
9
52
0
0
02
0
0
5
Congenital Rubella
0 5 0 1 1 7
.
1
4
.
1
2
0
.
1
.
0
8
.
0
6
.
0
4
.
0
2
+ C o n g e n i
t
a l
r u b e l
l
a
i
n c
0
1
9
7
01
9
7
51
9
8
01
9
8
51
9
9
01
9
9
52
0
0
02
0
0
5
Measles
0 5 0 1 1 1
3
5
0
3
0
0
2
5
0
2
0
0
1
5
0
1
0
0
5
0
+ M
e a s l
e s
i
n c i
d e n c e
p e r
0
1
9
7
01
9
7
51
9
8
01
9
8
51
9
9
01
9
9
52
0
0
02
0
0
5
AIDS Infection Rates
0 5 0 3 1 2
3
.
+ C l
i
n i
c a l
l
y
d i
a g n o s e d
5
3
2
.
5
2
1
.
5
1
0
.
5
0
1
9
7
01
9
7
51
9
8
01
9
8
51
9
9
01
9
9
52
0
0
02
0
0
5
A
HIB Incidence Rates
0 4 0 3 1 6
2
.
+ H
a e
m
o p h i
l
i
u s
i
n f
0
02
l
u e
5
2
1
.
5
1
0
.
5
0
1
9
7
01
9
7
51
9
8
01
9
8
51
9
9
01
9
9
52
0
0
0
5
n
Regulation of Vaccines
Inspection of vaccines for safety, purity, potency and standards is part of the
regulatory function.
Vaccines are defined as biologic products and are therefore subject to
regulation by national health authorities.
In US, this comes under the legislative authority of the Public Health Service
Act, as well as the Food, Drug and Cosmetics Act, with applicable
regulations in the Code of Federal Regulations.
Federal agency empowered to carry out this regulatory function is the Center
for Drugs and Biologics of the Federal Food and Drug Administration.
Litigation re side effects of vaccines is costly, led to inflation of costs and
efforts to limit court settlements.
US federal Child Vaccine Injury Act of 1988 requires providers to document
vaccines and report complications or reactions.
Pays benefits to persons injured by vaccines faster and less expensive
procedure than a civil suit for resolving claims in “no-fault system”,
Eradication or Control of VPDs
• Since eradication of smallpox, discussion of possibility of
eradicating other diseases
• Potential candidate diseases emerged; some were abandoned
because of practical difficulties with current technology
• Diseases under discussion for eradication - measles, TB, and
some tropical diseases e.g. malaria and dracunculiasis
• Eradication - no further cases of a disease occur anywhere in
nature; continued control measures may be unnecessary e.g.
smallpox, polio
• Reducing epidemic and endemic VPDs in selected areas or
target groups, may achieve local elimination
• Local elimination is where domestic circulation of a virus is
interrupted with cases occurring from importation only
• Strong, sustained immunization program, adaptation to
changing epidemiologic patterns e.g. age groups, impotation
Vaccine Coverage
Vaccine
No. persons immunized in specified age group
Coverage =
--------------------------------------------- X 100
No. persons in the age group during that year
HIGH RISK GROUPS RECOMMENDED
FOR ANNUAL INFLUENZA
VACCINATION
Adults and children with chronic cardiovascular and respiratory conditions
under medical supervision;
Residents of long-term care facilities, such as nursing homes;
Adults over 65 years of age;
Patients on long term aspirin therapy who are at risk for Reye Syndrome
following influenza infection;
Persons with HIV infection or immuno-suppression;
Medical personnel;
Employees of nursing homes and long term care facilities;
Home care staff and contacts of high-risk individuals
Children.
•
Source: From Cassens B. Preventive Medicine and Public Health, Second Edition.
Malvern PA: Harwal Co., 1992, p. 99.
RISK GROUPS RECOMMENDED FOR
PNEUMOCOCCAL VACCINE
Given once to the following categories of persons at high risk:
1. People over 65 years of age;
2. The chronically ill e.g. with cardiovascular, respiratory,
liver, renal disease or diabetes mellitus;
3. Asplenic patients;
4. Adult immuno-compromised patients, including HIV
positive persons;
5. Children 2 years or older who are chronically ill, or
immuno-compromised;
6. Persons travelling abroad.
•
•
Source: Cassens B. Preventive Medicine and Public Health, Second Edition. Malvern
PA: Harwal Co, 1992, p 95.
CRITERIA FOR ASSESSING ERADICABILITY OF
DISEASES, INTERNATIONAL TASK FORCE FOR
DISEASE ERADICATION (ITFDE)
Scientific Feasibility
a. Epidemiologic vulnerability; lack of non-human reservoir, ease of spread, no
natural immunity, relapse potential;
b. Effective practical intervention available; vaccine or other primary preventive or
curative treatment, or vectoricide that is safe inexpensive, long lasting and easily
used in the field;
c.Demonstrated feasibility of elimination in specific locations, such as an island or
other geographic unit.
1.
2. Political Will/Popular Support
a. Perceived burden of the disease; morbidity, mortality, disability and costs of care in
developed and developing countries;
b. Expected cost of eradication;
c. Synergy of implementation with other programs;
d. Reasons for eradication versus control.
•
Source: Morbidity and Mortality Weekly Review, 1992;41:40-2. A decade after the eradication of smallpox was
achieved,
And International Task Force for Disease Eradication (ITFDE)
WHO 1998 Health Targets of Infectious Disease
Eradication/Control
Eradication of Chaga's disease by 2010;
Eradication of neonatal tetanus by 2010;
Eradication of leprosy by 2010;
Eradication of measles by 2020;
Eradication of trachoma by 2020;
Reversing the current trend of increasing
tuberculosis and HIV/AIDS
Footnotes for Recommended Adult Immunization Schedule
1. Tetanus and diphtheria (Td): A primary series for adults is 3 doses: the first 2
doses given at least 4 weeks apart and the 3rd dose, 6-12 months after the
second. Administer 1 dose if the person had received the primary series and
the last vaccination was 10 years ago or longer. MMWR 1991; 40 (RR-10):
1-21. The ACP Task Force on Adult Immunization supports a second option:
a single Td booster at age 50 years for persons who have completed the full
pediatric series, including the teenage/young adult booster. Guide for Adult
Immunization. 3rd ed. ACP 1994: 20.
2. Influenza vaccination: Medical indications: chronic disorders of the
cardiovascular or pulmonary systems including asthma; chronic metabolic
diseases including diabetes mellitus, renal dysfunction, hemoglobinopathies,
immunosuppression (including immunosuppression caused by medications
or by human immunodeficiency virus [HIV] ), requiring regular medical followup or hospitalization during the preceding year; women who will be in the
second or third trimester of pregnancy during the influenza season.
Occupational indications: health care workers. Other indications: residents of
nursing homes and other long-term care facilities; persons likely to transmit
influenza to persons at high-risk (in-home care givers to persons with
medical indications, household contacts and out-of-home caregivers of
children birth to 23 months of age, or children with asthma or other indicator
conditions for influenza vaccination, household members and care givers of
elderly and adults with high-risk conditions); and anyone who wishes to be
vaccinated. MMWR 2002; 51 (RR-3): 1 -31.
3. Pneumococcal polysaccharide vaccination: Medical indications: chronic
disorders of the pulmonary system (excluding asthma), cardiovascular
diseases, diabetes mellitus, chronic liver diseases including liver disease as
a result of alcohol abuse (e.g., cirrhosis), chronic renal failure or nephrotic
syndrome, functional or anatomic asplenia (e.g., sickle cell disease or
splenectomy), immunosuppressive conditions (e.g., congenital
immunodeficiency, HIV infection, leukemia, lymphoma, multiple myeloma,
Hodgkins disease, generalized malignancy, organ or bone marrow
transplantation), chemotherapy with alkylating agents, anti-metabolites, or
long-term systemic corticosteroids. Geographic/other indications: Alaskan
Natives and certain American Indian populations. Other indications:
residents of nursing homes and other long-term care facilities. MMWR 1997;
47 (RR-8): 1-24.
4. Revaccination with pneumococcal polysaccharide vaccine: one time
revaccination after 5 years for persons with chronic renal failure or nephrotic
syndrome, functional or anatomic asplenia (e.g., sickle cell disease or
splenectomy), immunosuppressive conditions (e.g., congenital
immunodeficiency, HIV infection, leukemia, lymphoma, multiple myeloma,
Hodgkins disease, generalized malignancy, organ or bone marrow
transplantation), chemotherapy with alkylating agents, anti-metabolites, or
long-term systemic corticosteroids. For persons 65 and older, one-time
revaccination if they were vaccinated 5 or more years previously and were
aged less than 65 years at the time of primary vaccination. MMWR 1997; 47
(RR-8): 1-24.
5. Hepatitis B vaccination: Medical indications: hemodialysis patients, patients
who receive clotting-factor concentrates. Occupational indications: healthcare workers and public-safety workers who have exposure to blood in the
workplace, persons in training in schools of medicine, dentistry, nursing,
laboratory technology, and other allied health professions. Behavioral
indications: injecting drug users, persons with more than one sex partner in
the previous 6 months, persons with a recently acquired sexually-transmitted
disease (STD), all clients in STD clinics, men who have sex with men. Other
indications: household contacts and sex partners of persons with chronic
HBV infection, clients and staff of institutions for the developmentally
disabled, international travelers who will be in countries with high or
intermediate prevalence of chronic HBV infection for more than 6 months,
inmates of correctional facilities. MMWR 1991; 40 (RR-13): 1-25.
(www.cdc.gov/travel/diseases/hbv.htm)
6. Hepatitis A vaccination: For the combined HepA-HepB vaccine use 3 doses at
0, 1, 6 months). Medical indications: persons with clotting-factor disorders or
chronic liver disease. Behavioral indications: men who have sex with men, users of
injecting and noninjecting illegal drugs. Occupational indications: persons working
with HAV-infected primates or with HAV in a research laboratory setting. Other
indications: persons traveling to or working in countries that have high or
intermediate endemicity of hepatitis A. MMWR 1999; 48 (RR-12): 1-37.
(www.cdc.gov/travel/diseases/hav.htm)
7. Measles, Mumps, Rubella Vaccination (MMR): Measles component: Adults born
before 1957 may be considered immune to measles. Adults born in or after 1957
should receive at least one dose of MMR unless they have a medical
contraindication, documentation of at least one dose or other acceptable evidence
of immunity. A second dose of MMR is recommended for adults who:
 are recently exposed to measles or in an outbreak setting
 were previously vaccinated with killed measles vaccine
 were vaccinated with an unknown vaccine between 1963 and 1967
 are students in post-secondary educational institutions
 work in health care facilities
 plan to travel internationally
Mumps component: 1 dose of MMR should be adequate for protection.
Rubella component: Give 1 dose of MMR to women whose rubella vaccination
history is unreliable and counsel women to avoid becoming pregnant for 4 weeks
after vaccination. For women of child-bearing age, regardless of birth year,
routinely determine rubella immunity and counsel women regarding congenital
rubella syndrome. Do not vaccinate pregnant women or those planning to become
pregnant in the next 4 weeks. If pregnant and susceptible, vaccinate as early in
postpartum period as possible.
MMWR 1998; 47 (RR-8): 1-57.
8.Varicella vaccination: Recommended for all persons who do not have reliable
clinical history of varicella infection, or serological evidence of varicella zoster virus
(VZV) infection; health-care workers and family contacts of immunocompromised
persons, those who live or work in environments where transmission is likely (e.g.,
teachers of young children, day care employees, and residents and staff members
in institutional settings), persons who live or work in environments where VZV
transmission can occur (e.g., college students, inmates and staff members of
correctional institutions, and military personnel), adolescents and adults living in
households with children, women who are not pregnant but who may become
pregnant in the future, international travelers who are not immune to infection.
Note: Greater than 90% of U.S. born adults are immune to VZV. Do not vaccinate
pregnant women or those planning to become pregnant in the next 4 weeks. If
pregnant and susceptible, vaccinate as early in postpartum period as possible.
MMWR 1996; 45 (RR-11): 1-36,
MMWR 1999; 48 (RR-6): 1-5.
9.Meningococcal vaccine (quadrivalent polysaccharide for serogroups A, C, Y, and
W-135). Consider vaccination for persons with medical indications: adults with
terminal complement component deficiencies, with anatomic or functional asplenia.
Other indications: travelers to countries in which disease is hyperendemic or
epidemic (“meningitis belt” of sub-Saharan Africa, Mecca, Saudi Arabia for Hajj).
Revaccination at 3-5 years may be indicated for persons at high risk for infection
(e.g., persons residing in areas in which disease is epidemic). Counsel college
freshmen, especially those who live in dormitories, regarding meningococcal
disease and the vaccine so that they can make an educated decision about
receiving the vaccination.
MMWR 2000; 49 (RR-7): 1-20.
Note: The AAFP recommends that colleges should take the lead on providing
education on meningococcal infection and vaccination and offer it to those who are
interested. Physicians need not initiate discussion of the meningococcal
quadravalent polysaccharide vaccine as part of routine medical care.
Based on the Recommendations of the Advisory Committee on Immunization Practices, Centers for Disease Control and Prevention
Recommended Adult Immunization Schedule
United States, 2002-2003
and
Recommended Immunizations for Adults with
Medical Conditions
Summary of Recommendations Published by
The Advisory Committee on
Immunization Practices
Department of Health and Human Services
Centers for Disease Control and Prevention
Recommended Adult Immunization Schedule, United States, 2002-2003
For all persons in this
age group
Age
Vaccine
Catch-up on
childhood vaccinations
19-49 years
For persons with
medical / exposure indications
50-64 years
Tetanus, Diphtheria
(Td)*
Recommended Immunizations for Adults with Medical Conditions, United States, 2002-2003
For all persons in
this group
Catch-up on
childhood vaccinations
Vaccine
65 years and older
Medical
Conditions
1 dose booster every 10 years1
TetanusDiphtheria
(Td)*
Pregnancy
1 dose annually for persons
with medical or occupational
indications, or household contacts
of persons with indications 2
Influenza
Pneumococcal
(polysaccharide)
1 annual dose
1 dose for persons with medical or other indications. (1 dose
revaccination for immunosuppressive conditions) 3,4
1 dose for unvaccinated persons 3
1 dose revaccination 4
Hepatitis B*
3 doses (0, 1-2, 4-6 months) for persons with medical, behavioral, occupational, or other indications 5
Hepatitis A
2 doses (0, 6-12 months) for persons with medical, behavioral, occupational, or other indications 6
Measles, Mumps,
Rubella (MMR)*
Varicella*
Meningococcal
(polysaccharide)
1 dose if measles, mumps, or
rubella vaccination history is
unreliable;
2 doses for persons with
occupational, geographic,
or other indications 7
2 doses (0, 4-8 weeks) for persons who are susceptible8
1 dose for persons with medical or other indications 9
Diabetes, heart disease,
chronic pulmonary disease,
chronic liver disease,
including chronic alcoholism
Influenza
For persons with
medical / exposure indications
Pneumo- Hepatitis
coccal
B*
(polysaccharide)
B
E
Renal failure / end stage renal
disease, recipients of
hemodialysis or clotting
factor concentrates
E
Asplenia including elective
splenectomy and
terminal complement
component deficiencies
HIV infection
*Covered by the Vaccine Injury Compensation Program.
A. If pregnancy is at 2nd or 3rd trimester during influenza season.
B. Although chronic liver disease and alcoholism are not indicator
conditions for influenza vaccination, give 1 dose annually if the patient is > 50 years,
has other indications for influenza vaccine, or if the patient requests vaccination.
C. Asthma is an indicator condition for influenza but not for pneumococcal vaccination.
D. For all persons with chronic liver disease.
E. Revaccinate once after 5 years or more have elapsed since initial vaccination.
F. Persons with impaired humoral but not cellular immunity may be vaccinated.
MMWR 1999; 48 (RR-06): 1-5.
For additional information about the vaccines listed above and contraindications for immunization, visit the National Immunization Program Website at http://www.cdc.gov/nip/ or call
the National Immunization Hotline at 800-232-2522 (English) or 800-232-0233 (Spanish).
Approved by the Advisory Committee on Immunization Practices (ACIP), and accepted by the American College of
Obstetricians and Gynecologists (ACOG) and the American Academy of Family Physicians (AAFP)
C
Congenital immunodeficiency,
leukemia, lymphoma,
generalized malignancy,
therapy with alkylating agents,
antimetabolites, radiation
or large amounts
of corticosteroids
See Footnotes for Recommended Adult Immunization Schedule on the back cover.
Report all clinically significant post-vaccination reactions to the Vaccine Adverse Event Reporting System (VAERS). Reporting forms and instructions on filing a VAERS report are
available by calling 1-800-822-7967 or from the VAERS website at http://www.vaers.org.
Measles
Mumps
Rubella
(MMR)*
Varicella*
A
*Covered by the Vaccine Injury Compensation Program. For information on how to file a claim call 1-800-338-2382. Please also visit http://www.hrsa.osp.gov/vicp accessed
February 21, 2002. To file a claim for vaccine injury write: U.S. Court of Federal Claims, 717 Madison Place, N.W., Washington D.C. 20005. (202) 219-9657.
This schedule indicates the recommended age groups for routine administration of currently licensed vaccines for persons 19 years of age and older. Licensed combination vaccines
may be used whenever any components of the combination are indicated and the vaccine’s other components are not contraindicated. Providers should consult the manufacturers'
package inserts for detailed recommendations.
Hepatitis
A
Contraindicated
D
F
G
E, H, I
E, J
K
G. Hemodialysis patients: Use special formulation of vaccine (40 ug/mL) or two 1.0
mL 20 ug doses given at one site. Vaccinate early in the course of renal disease.
Assess antibody titers to hep B surface antigen (anti-HBs) levels annually.
Administer additional doses if anti-HBs levels decline to <10 milliinternational units
(mlU)/ mL.
H. Also administer meningococcal vaccine.
I. Elective splenectomy: vaccinate at least 2 weeks before surgery.
J. Vaccinate as close to diagnosis as possible when CD4 cell counts are highest.
K. Withhold MMR or other measles containing vaccines from HIV-infected persons
with evidence of severe immunosuppression. MMWR 1996; 45: 603-606,
MMWR 1992; 41 (RR-17): 1-19.
Bacterial Diseases
• Control - Elimination as a Public Health Problem
–
–
–
–
–
–
Pertussis
Neonatal tetanus
Congenital syphilis
Trachoma
Tuberculosis
Leprosy
• Eradicable- Regional/Global
– Diphtheria
– Hemophilus influenza b
Viral Diseases
• Control - Elimination as a Public Health Problem
–
–
–
–
–
Hepatitis B
Hepatitis A
Yellow fever
Rabies
Japanese encephalitis
• Eradicable- Regional/Global
–
–
–
–
Poliomyelitis
Measles
Rubella
Mumps
Parasitic Disease
• Control - Elimination as a Public Health
Problem
–
–
–
–
–
Malaria
Chagas disease
Helminthic infestation
Schistosomiasis
Leishmaniasis, visceral
• Eradicable- Regional/Global
– Echinococcus
– Teniasis
Non Infectious Disease
• Control - Elimination as a Public Health Problem
–
–
–
–
–
–
–
–
Lead poisoning
Silicosis
Protein energy malnutrition
Micronutrient malnutrition
Iodine deficiency
Vitamin A deficiency
Folic acid deficiency
Iron deficiency
Source: Goodman RA, Foster KL, Trowbridge FL, Figuero JP. Global Disease
Elimination and Eradication as Public Health Strategies: Proceedings of a
Conference Atlanta, Georgia, USA, 23-25 February 1998. Bulletin of the
World Health Organization. 1998;76 Supplement 2:1-161.
New Vaccines-New Issues
•
•
•
•
•
•
•
Human Papilovirus
HIV
Malaria
Dengue
Salmonella
E coli
Streptococcal
•
•
•
•
•
Lyme disease
Ebola virus
Leishmaniasis
Helicobacter
Many others
HPV Vaccine
•
•
•
•
•
Human Papillovirus
Sexually transmitted disease
High prevalence in uncircumcised men
Cancer of cervix among top Ca’s of women
Screening works but expensive and non-existent
in many countries
• Women’s health issue
• HPV vaccine ready fro use within 3-5 years
H Pylori
H. pylori is among commonest bacterial infections in humans,
and may be be transmitted by water and oral fecal spread.
Genomics may help understanding the pathogenesis of H. pylori
infection and development of new therapies, including H.
pylori–specific antimicrobial agents and vaccines
Enormous progress in studying the virulence factors of H. pylori
and their variation, but not yet used in clinical practice
Px and Rx vaccination have been successful in animal models,
but the translation to human vaccine remains difficult
These developments will be needed to prevent and treat this
infection in areas of the world where there is a high
prevalence of chronic infection
Nobel Prize in Medicine 2005
–
Bioterrorism and Vaccines
• Anthrax
• Smallpox
• Hemorrhagic fevers e.g. Rift Valley Fever
and many others
• Polio
Other National Considerations
•
•
•
•
•
•
•
Eradication of measles – high priority
Control of mumps
Control of rubella and rubella syndrome
Haemophilus influenza B
Hepatitis B and A
Influenza and pneumonia
Adult diphtheria and tetanus
BASIC TERMS IN IMMUNOLOGY OF INFECTIOUS DISEASES
Infectious agent: organism (e.g. virus, rickettsia, bacteria, fungus, protozoa or
helminth) capable of producing infection or an infectious disease.
Infection: the process of entry, development and multiplication of an infectious
agent into the body of a living body (human, animal or plant) resulting in an
inapparent or clinically manifest disease.
Antigen: a substance (e.g. protein, polysaccharide) capable of inducing specific
response mechanisms in the body. An antigen may be introduced into the body by
invasion of an infectious agent, by immunization, inhalation, ingestion or through
the skin, wounds or via transplantation.
Antibody: a protein molecule formed by the body in response to a foreign
substance (an antigen) or acquired by passive transfer. Antibodies bind to the
specific antigen that elicits its production, causing the infective agent to be
susceptible to immune mechanisms protecting against infectious disease.
Immunoglobulins: antibodies which meet different types of antigenic challenges.
They are present in blood or other body fluids, and can cross from a mother to
fetus in utero, providing protection during part of the first year of life. There are 5
major classes and various subclasses are based on molecular weight.
Antisera or antitoxin: are materials prepared in animals for use in passive
immunization against infection or toxins.
Vaccines administered simultaneously: directions for new
combination vaccines based on historical review of the
literature.
Fletcher MA, Fabre P, Debois H, Saliou P.
Combination vaccines needed to fill epidemiologic
niches in EPI with, e.g. a measles-yellow fever, a
measles-Japanese encephalitis or a pertussis-based
paediatric combination rabies vaccine.
Other combinations could broaden protection against
the pathogens responsible for meningitis, pneumonia,
or enteric diseases.
Complex issues such as necessity, feasibility, or
affordability will determine future combination
vaccines
Int J Infect Dis. 2004
Nov;8(6):328-38.
Summary and Conclusion
•
•
•
•
Vaccination is cornerstone of NPH
Children and other groups
Rapidly developing field
First priority in public health after safe water
and food
• National programs must be revised annually