Vaccine Cdc

8/8/2019 Vaccine Cdc

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Principles of Vaccination

Epidemiology and Prevention of Vaccine-

Preventable Diseases

National Center for Immunization andRespiratory Diseases

Centers for Disease Control and Prevention

Revised April 2009


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Self vs. nonself

Protection from infectious disease

Usually indicated by the presenceof antibody

Very specific to a single organismAll vaccines can be administered at

the same visit as all other

vaccines

Immunity


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principals

Increasing the interval betweendoses of a multidose vaccinedoes not diminish the

effectiveness of the vaccine*

Decreasing the interval betweendoses of a multidose vaccinemay interfere with antibodyresponse and protection


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Protection produced by the person'sown immune system

Usually permanent

Protection transferred from another

person or animal Temporary protection that wanes

with time

Active Immunity

Passive Immunity


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A live or inactivated substance(e.g., protein, polysaccharide)capable of producing an immuneresponse

Protein molecules (immuno-globulin) produced by Blymphocytes to help eliminate anantigen

Antigen

Antibody


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Passive Immunity

Transfer of antibody produced byone human or other animal toanother

Temporary protection

Transplacental most importantsource in infancy


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Sources of Passive Immunity

Almost all blood or bloodproducts

Homologous pooled humanantibody (immune globulin)

Homologous humanhyperimmune globulin

Heterologous hyperimmuneserum (antitoxin)


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Monoclonal Antibody

Derived from a single type, orclone, of antibody-producing cells(B cells)

Antibody is specific to a singleantigen or closely related group ofantigens

Used for diagnosis and therapy ofcertain cancers and autoimmuneand infectious diseases


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Vaccination

Active immunity produced byvaccine

Immunity and immunologicmemory similar to naturalinfection but without risk of

disease


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Classification of Vaccines

Live attenuated

viral

bacterial

Inactivated


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Inactivated Vaccines

viruses bacteria

protein-based toxoid subunit

polysaccharide-based pure conjugate

Whole

Fractional


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General Rule

The more similar a vaccine is tothe disease-causing form of the

organism, the better the

immune response to thevaccine


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Live Attenuated Vaccines

Attenuated (weakened) form ofthe "wild" virus or bacterium

Must replicate to be effective

Immune response similar tonatural infection

Usually produce immunity withone dose*

*except those administered orally


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Severe reactions possible

Interference from circulatingantibody

Fragile must be stored andhandled carefully


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Viral measles, mumps,rubella, varicella/zoster,yellow fever, rotavirus,

intranasal influenza,rotavirus, vaccinia

Bacterial BCG, oral typhoid


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Cannot replicate

Generally not as effective as livevaccines

Less interference from circulatingantibody than live vaccines

Generally require 3-5 doses

Immune response mostly humoral Antibody titer may diminish with time


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Viral polio, hepatitis A,rabies, influenza*

Bacterial pertussis*, typhoid*cholera*, plague*

Whole-cell vaccines

*not available in the United States


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Subunit hepatitis B, influenza,acellular pertussis,

human papillomavirus,anthrax

Toxoid diphtheria, tetanus

Fractional vaccines


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Pure Polysaccharide Vaccines

Not consistently immunogenic inchildren younger than 2 years ofage

No booster response

Antibody with less functionalactivity

Immunogenicity improved byconjugation


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Polysaccharide Vaccines

pneumococcal

meningococcal

Salmonella Typhi (Vi)

Haemophilus influenzae type b

pneumococcal

meningococcal

Pure polysaccharide

Conjugate polysaccharide


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Vaccine Adverse Reactions

Adverse reaction

extraneous effect caused byvaccine

side effect

Adverse event

anyevent following vaccination

may be true adverse reaction

may be only coincidental


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Local

pain, swelling, redness atsite of injection

common with inactivatedvaccines

usually mild and self-limited


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Systemic

fever, malaise, headache

nonspecific

may be unrelated to vaccine


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Allergic

due to vaccine or vaccinecomponent

rare

risk minimized by screening


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Contraindication

A condition in a recipient thatgreatly increases the chance of aserious adverse reaction


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Precaution

A condition in a recipient thatmight increase the chance orseverity of an adverse reaction,

or

Might compromise the ability of

the vaccine to produce immunity


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Permanent contraindications tovaccination:

severe allergic reaction to avaccine component or followinga prior dose

encephalopathy not due toanother identifiable cause

occurring within 7 days ofPertusis vaccination


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Immunosuppressant

Disease

congenital immunodeficiency

leukemia or lymphoma

generalized malignancy

Chemotherapy

alkylating agents

antimetabolites

radiation


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Immunosuppression

Live vaccines should not beadministered to severelyimmunosuppressed persons

Inactivated vaccines are safe touse in immunosuppressedpersons but the response to the

vaccine may be decreased


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Invalid Contraindicationsto Vaccination

Mild illness

Antimicrobial therapy

Disease exposure or convalescence

Pregnant or immunosuppressed person in

the household Breastfeeding

Preterm birth

Allergy to products not present in vaccine or

allergy that is not anaphylactic Family history of adverse events

Tuberculin skin testing

Multiple vaccines


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Vaccine Adverse EventReporting System (VAERS)

Detects

new or rare events

increases in rates of known side

effectspatient risk factors

Additional studies required to

confirm VAERS

signals Not all reports of adverse events are

causally related to vaccine


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Adverse Event Classification

Vaccine-induced

Vaccine-potentiated

Programmatic error

Coincidental


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Strategies for High Immunization Levels

Recordkeeping

Recommendations andreinforcement

Reminder and recall to patients Reminder and recall to providers

Reduction of missed

opportunities Reduction of barriers to

immunization


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Records

Must be available at the timeof the visit

Must be easy to read

Must be accurate

reflect current patient

populationreflect all vaccines given


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Recommendations andReinforcement

Recommend the vaccine

powerful motivator

patients likely to followrecommendation of the provider

Reinforce the need to return

verbal

written

link to calendar event


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Missed Opportunity

A healthcare encounter in which a

person is eligible to receive

vaccination but is not vaccinated

completely


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Reasons forMissedOpportunities

Lack of simultaneousadministration

Unaware child needs additionalvaccines

Invalid contraindications

Inappropriate clinic policies Reimbursement deficiencies


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The Providers Role

Immunization providers can help toensure the safety and efficacy ofvaccines through proper:

vaccine storage and administration

timing and spacing of vaccinedoses

observation of contraindicationsand precautions


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Reduction to Barriersto Immunization

Physical barriers

waiting time

distance

Psychological barriers

unpleasant experience

safety concerns


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CDC Vaccines and

ImmunizationContact Information

Telephone 800.CDC.INFO

Email [email protected]

Website www.cdc.gov/vaccines

Vaccine Cdc

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