Overview of Immunizations for People Who Work in Labs

Transcription

1 Overview of Immunizations for People Who Work in Labs CLMA/ASCLMS Spring Meeting Little Rock, AR April 5, 2019 Jennifer Dillaha, MD Medical Director, Immunizations Medical Advisor, Health Literacy Arkansas Department of Health

2 Objectives 1. Review current CDC vaccination recommendations for adults. 2. Review current CDC vaccination recommendations for health care personnel, with focus on laboratory workers. 3. Discuss special considerations related to Hepatitis B vaccination.

3 CDC Adult Immunization Schedule 2019 Adult (19 Years and Older) Immunization Schedule: PDF for Download: Immunization of Health-Care Personnel: Recommendations of the Advisory Committee on Immunization Practices (ACIP) Summary of HCP Vaccination Recommendations

4 Influenza Vaccination Recommended for all adults without a contraindication Life-threatening allergic reaction History of Guillain-Barre syndrome within 6 weeks of a prior dose Inactivated Influenza Vaccine (IIV) Recombinant Influenza Vaccine (RIV) Live Attenuated Influenza Vaccine (LAIV) Quadrivalent vs Trivalent Effectiveness

5 Influenza Vaccination for HCP All health care personnel should receive annual vaccination against influenza. LAIV may be given only to non-pregnant healthy HCP age 49 years and younger. IIV or RIV is preferred over LAIV for HCP who in in close contact with severely immunocompromised patients (e.g., stem cell transplant recipients) when they require protective isolation.

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7 Routine Tdap Vaccination Tetanus, Diphtheria, Pertussis For adults who previous did not receive Tdap at or after age 11 years: 1 dose Tdap, then Td booster every 10 years For pregnant women: 1 dose Tdap during each pregnancy

8 Tdap Vaccination for HCP All HCP who have not or are unsure if they have preciously received a dose of Tdap should receive a dose as soon as feasible without regard to the interval since the previous dose of Td. Pregnant HCP should be revaccinated during each pregnancy. All HCP should then receive Td boosters every 10 years thereafter.

9 Pertussis (Whooping Cough) An acute infectious disease caused by Bordetella pertussis, which is a small gram-negative bacterium Human disease transmitted via respiratory droplets Primarily a toxin-mediated disease, as bacteria adhere to respiratory epithelial cells and produce toxins that paralyze the cilia and cause inflammation Immunity following infection does not appear to be permanent

10 Disease Course of Pertussis Adults may be asymptomatic, yet still transmit disease (especially young children) Actual burden in adults aged 65 and older is likely 100 times greater than reported Secondary attack rate 80% among susceptible household contacts Adults may have classic pertussis Catarrhal stage: similar to common cold, 1-2 weeks Paroxysmal stage: 15 per 24 hours, 1-6 weeks Convalescent stage: gradual recovery, many months

11 Complications of Pertussis Secondary bacterial pneumonia is most common Neurologic complications, such as seizures and encephalopathy due to hypoxia and/or toxins Pressure effects: Pneumothorax, epistaxis, subdural hematomas, hernias, and rectal prolapse Difficulty sleeping, urinary incontinence, rib fracture

12 Varicella (Chickenpox) Vaccination 2 dose-series of varicella vaccine is recommended for all adults with no evidence of immunity Evidence of immunity: U.S.-born before 1980 (except pregnant women and HCP) Documentation of 2 doses of varicella-containing vaccine at least 4 weeks apart Diagnosis or verification of history of varicella or herpes zoster by a health care provider Laboratory evidence of immunity or disease Contraindicated for pregnant women and persons who are immunocompromised

13 Varicella Vaccination for HCP It is recommended that all HCP be immune to varicella. 2 dose-series of varicella vaccine is recommended for all HCP with no evidence of immunity Evidence of immunity: Documentation of 2 doses of varicella-containing vaccine at least 4 weeks apart Diagnosis or verification of history of varicella or herpes zoster by a health care provider Laboratory evidence of immunity or disease

14 ACIP Recommendations for Herpes Zoster Vaccines Recombinant Zoster Vaccine (RZV) Zoster Vaccine Live (ZVL) 1. RZV is recommended for immunocompetent adults aged 50 years and older. 2. RZV is recommended for immunocompetent adults previously vaccinated with ZVL. 3. RZV is preferred over ZVL.

15 Zoster Vaccine Recombinant (RZV) Shingrix was qpproved by FDA October 20, 2017 Subunit vaccine Recombinant glycoprotein E Novel adjuvant (AS01 B ) 2 doses administered IM 2-6 months apart Recommended by the Advisory Committee on Immunization Practices for use in immunocompetent adults aged 50 years and older RZV in adults would wane to zero 19 years after vaccination

16 Herpes Zoster (Shingles) Reactivation of latent Varicella Zoster Virus in sensory ganglia due to decline of cellular immunity 1 million cases in U.S. each year: $5 billion 1 in every 3 persons, mostly in persons aged 50 and older 1 in every 2 persons aged 85 and older Occurs in persons who are healthy as well as those with chronic diseases Recurrence rate of 6.4 percent

17 Presentation Begins with neuropathic pain, followed by unilateral dermatomal rash Initially maculopapular on an erythematous base Evolves into a vesicular-pustular appears After 7 to 10 days begins to crust over and heals within 2 to 4 weeks Limited to single dermatome or adjacent dermatomes Systemic symptoms: fever, fatigue, headache, malaise, photophobia

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19 Zoster Ophthalmicus

20 Complications Postherpetic neuralgia Significant pain after rash has healed 20% may have pain for a year or longer 50% of person over 85 Burning, sharp, or jabbing feeling Deep and aching Discomfort with the slightest touch (allodynia) Debilitating: physical, psychological, functional, social May be refractory

21 Complications Secondary bacterial infection Staphylococcal or Streptococcal Septicemia Residual neurologic deficits Vision loss Hearing loss Balance problems Vasculopathy leading to stroke or MI

22 MMR Vaccination 1 dose of MMR vaccine is recommended for adults with no evidence of immunity Evidence of immunity: U.S.-born before 1957 (except HCP) Documentation of 1 dose of MMR vaccine Laboratory confirmation of immunity or disease College students, international travelers, close contacts of immunocompromised persons: 2 doses Contraindicated for pregnant women and persons who are immunocompromised

23 MMR Vaccination for HCP 2 dose-series of MMR vaccine is recommended for HCP with no evidence of immunity Evidence of immunity for HCP born in 1957 or later: Documentation of 2 doses of MMR vaccine after first birthday and at least 4 weeks apart Laboratory confirmation of immunity or disease Evidence of immunity for HCP born before 1957: Consider 2 dose-series of MMR vaccine for unvaccinated HCP without laboratory evidence of disease or immunity measles or mumps, or 1 does MMR vaccine for rubella. HCP with 2 documented doses of MMR vaccine are not recommended to be serologically tested for immunity

24 Meningococcal Vaccination MenACWY vaccine Health Conditions Anatomical or functional asplenia HIV infection Persistent complement deficiency Eculizumab use First-year college student who live in residential housing if not previously vaccinate at age 16 and military recruits Travel to countries with hyperendemic or epidemic disease Microbiologists routinely exposed to Neisseria meningitidis

25 Meningococcal Vaccination MenB vaccine Health Conditions Anatomical or functional asplenia Persistent complement deficiency Eculizumab use Microbiologists routinely exposed to Neisseria meningitidis

26 Meningococcal Vaccination MenACWY vaccine 1 dose for Microbiologists Revaccinate every 5 years if risk remains Men B vaccine 2-dose series MenB-4C (Bexsero) at least 1 month apart 3-dose series MenB-FHbp (Trumenba) at 0, 1-2, 6 months (is dose 2 was administered at least 6 month after dose 1, dose 3 is not needed) MenB-4C and MenB-FHbp are not interchangeable, so all doses in the series must be the same product

27 Hepatitis A Vaccination Recommended for adults not at risk but want protection Special situations: Chronic liver disease Clotting factor disorders Men who have sex with men Injection or non-injection drug use Homelessness Travel in countries with endemic hepatitis A Close personal contact with international adoptee Persons who work with hepatitis A virus in research laboratory or nonhuman primates with hepatitis A virus infection

28 Hepatitis A Vaccination 2-dose series HepA vaccine 6 months apart 3-dose series of combined HepA-HepB vaccine at 0, 1, and 6 months

29 Hepatitis B Vaccination Recommended for adults not at risk but want protection Special situations: Hepatitis C virus infection Chronic liver disease HIV infection Sexual exposure risk Current or recent injection drug use Percutaneous or mucosal risk of exposure to blood Incarcerated persons Travel in countries with endemic hepatitis

30 Hepatitis B Vaccination for HCP Recommended for unvaccinated HCP and/or those who cannot document previous vaccination 2-dose series of Heplisav-B at 0 and 1 month, or 3-dose series of HepB vaccine at 0, 1, and 6 months

31 Hepatitis B Vaccination for HCP HCP that perform tasks that may involve exposure to blood or body fluids should be tested for hepb surface antibody (anti-hbs) 1-2 months after series completed to document immunity If anti-hbs is positive, the HCP is immune. If anti-hbs is negative, a single dose of HepB vaccine should be administered and anti-hbs testing repeated. If anti-hbs is still negative, the Hep B vaccine series should be completed and anti-hbs tested repeated.

32 Hepatitis B Vaccination for HCP A person whose anti-hbs remains negative after 2 complete series is considered a non-responder No additional doses of HepB vaccine are recommended Non-responders should be considered susceptible to Hepatitis B virus Counsel regarding precautions Obtain HBIG prophylaxis for known or probable parenteral exposure Testing for HBsAg is recommended Reassignment may be required depending on governing organization

33 Questions?

34 Jennifer Dillaha, MD Medical Director for Immunizations Medical Advisor for Health Literacy Arkansas Department of Health 4815 W. Markham Street, Slot 48 Little Rock, AR Office: