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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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Principles of Vaccination
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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Principles of Vaccination
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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Principles of Vaccination
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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Principles of Vaccination
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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Live Attenuated Vaccines
Severe reactions possible
Interference from circulatingantibody
Fragile must be stored andhandled carefully
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Live Attenuated Vaccines
Viral measles, mumps,rubella, varicella/zoster,yellow fever, rotavirus,
intranasal influenza,rotavirus, vaccinia
Bacterial BCG, oral typhoid
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Inactivated Vaccines
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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Inactivated Vaccines
Viral polio, hepatitis A,rabies, influenza*
Bacterial pertussis*, typhoid*cholera*, plague*
Whole-cell vaccines
*not available in the United States
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Inactivated Vaccines
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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Vaccine Adverse Reactions
Local
pain, swelling, redness atsite of injection
common with inactivatedvaccines
usually mild and self-limited
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Vaccine Adverse Reactions
Systemic
fever, malaise, headache
nonspecific
may be unrelated to vaccine
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Vaccine Adverse Reactions
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
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