Bexar County Vaccine Update

Transcription

1 Bexar County Vaccine Update Anil T. Mangla., MS., PhD., PHD., FRIPH Assistant Director, San Antonio Metro Health Associate Adjunct Professor University of Texas-School of Public Health Mercer University, School of Medicine Wednesday July 9, Immunizations Provider Conference

2 Ranking and Coverage Before 19 to 36 Months of Age by State, DC and Bexar County, Texas Coverage Rate % Ranking Year SA Rate SA Rank Linear (SA Rate) Rank out of 52, US National and other local not included, U.S. Vaccination Coverage Reported via NIS- 4:3:1:3:3:1 2

3 THE TEN CORE PUBLIC HEALTH FUNCTIONS And the Essential Public Health Services I. Assessment: Monitor health status to identify and solve community health problems (e.g., community health profile, vital statistics, and health status). Diagnose and investigate health problems and health hazards in the community (e.g., epidemiologic surveillance systems, laboratory support). II. Policy Development: Inform, educate, and empower people about health issues (e.g., health promotion and social marketing). Mobilize community partnerships and action to identify and solve health problems (e.g., convening and facilitating community groups to promote health). Develop policies and plans that support individual and community health efforts (e.g., leadership development and health system planning). III. Assurance: Enforce laws and regulations that protect health and ensure safety (e.g., enforcement of sanitary codes to ensure safety of environment). Link people to needed personal health services and ensure the provision of health care when otherwise unavailable (services that increase access to health care). Assure competent public and personal health care workforce (e.g., education and training for all public health care providers). Evaluate effectiveness, accessibility, and quality of personal and population-based health services (e.g., continuous evaluation of public health programs). Research for new insights and innovative solutions to health problems (e.g., links with academic institutions and capacity for epidemiologic and economic analyses). 3

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7 The cost of recommended vaccines from birth to age 18 has risen sharply. $1,255

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9 Genital Human Papillomavirus (HPV) 9

10 Introduction Epidemiology Genital HPV is one of the most common STDs More than 40 HPV types can infect the genital tract 10

11 Introduction Epidemiology HPV types are divided into two groups based on their association with cancer. Low-risk types (nononcogenic) associated with genital warts and mild Pap test abnormalities High-risk types (oncogenic) associated with moderate to severe Pap test abnormalities, cervical dysplasia and cervical cancer, and other cancers Most genital HPV infections are transient, asymptomatic, and have no clinical consequences. 11

12 Incidence in the U.S. Epidemiology Estimated annual incidence of sexuallytransmitted HPV infection is 14.1 million Estimated $1.7 billion spent annually in direct medical costs to treat conditions associated with genital HPV infection 12

13 Prevalence in the U.S. Epidemiology 100% of sexually active men and women acquire genital HPV at some point in their lives. An estimated 79 million females aged years are infected with HPV infection. 13

14 Incidence and Prevalence of Epidemiology HPVassociated Diseases Genital warts Incidence may be as high as 100/100,000. An estimated 1.4 million may be affected at any one time. Cervical cancer Rates of cervical cancer have fallen by approximately 75% since the introduction of Pap screening programs. Incidence is estimated at 8.1/100,

15 Epidemiology Transmission of Genital HPV Predominantly associated with sexual activity Can occur from asymptomatic and subclinical patients Infectivity after treatment of genital warts or cervical cellular abnormalities is unknown Condoms may reduce risk 15

16 Risk Factors for Women Epidemiology Young age Sexual behavior Risk increases with increasing number of recent and lifetime sex partners Sexual behavior of sex partners risk increases for women whose sex partners had multiple sex partners Immune status HPV more likely to be detected in immune-suppressed women 16

17 Risk Factors for Men Epidemiology Risk increases with increasing number of recent and lifetime sex partners Being uncircumcised increases risk 17

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22 Sensitive Slides

23 Genital Warts in a Male Source: CDC/ NCHSTP/ Division of STD Prevention, STD Clinical Slides Source: Cincinnati STD/HIV Prevention Training Center

24 HPV Penile Warts Source: Cincinnati STD/HIV Prevention Training Center

25 Female Genital Warts Source: CDC/NCHSTP/Division of STD, STD Clinical Slides

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28 HPV Warts on the Thigh Source: Cincinnati STD/HIV Prevention Training Center

29 Perianal Warts Source: Cincinnati STD/HIV Prevention Training Center

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31 Bio 360 Bordetella pertussis Jill Angelosanto

32 Outline Bordetella Pertussis microbiology Whooping Cough/Pertussis Vaccine Current problems with B. pertussis

33 Bordetella pertussis Basics Aerobic, Gram negative coccobacillus Alcaligenaceae Family Specific to Humans Colonizes the respiratory tract Whooping Cough (Pertussis) gram_pertussis.html

34 Transmission Very Contagious Transmission occurs via respiratory droplets

35 Virulence Steele, R.W. Pertussis: Is Eradication Achievable. Pediatric Annals. Aug (8):

36 Adhesions Filamentous hemagglutinin Pertactin Fimbriae

37 Toxins Pertussis Toxin Adenylate Cyclase Toxin Tracheal cytotoxin Dermonecrotic toxin Heat-labile toxin

38 Whooping Cough Also known as Pertussis Outbreaks first described in the 16 th Century Major cause of childhood fatality prior to vaccination paaap.org/immunize/ course/slide27.html

39 Clinical Features Incubation period 4-21 days 3 Stages 1 st Stage- Catarrhal Stage 1-2 weeks 2 nd Stage- Paroxysmal Stage 1-6 weeks 3 rd Stage- Covalescent Stage weeks-months

40 Pertussis Infection gsbs.utmb.edu/ microbook/ch031.htm

41 Diagnosis Isolation by culture PCR Direct fluorescent antibody Serological testing

42 Antibiotic therapy Treatment Erythromycin Azithromycin and clarithromycin FILENAME/ /033_lg.jpg

43 Pertussis Vaccine 1st Pertussis vaccine- whole cell Acellular vaccine now used Combination vaccines

44 Increase in Pertussis cases Incidence of disease increasing in countries with high vaccination levels US- Massachusetts Netherlands France Finland

45 Vaccine problems Complications/Safety Multiple administration Waning adolescent and adult immunity Strain Variability

46 Conclusions Reemerging in adult and adolescent populations as worldwide vaccination rates increase High vaccination rates not enough

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48 Thank you Any Questions???