2/20/2019. The need for adult vaccinations. Update on Adult Immunizations. The Need for Adult Vaccinations. Objectives:

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1 The need for adult vaccinations Update on Adult Immunizations Objectives: Recall the latest recommendations on adult vaccinations Detail the importance of adult vaccinations I m not a kid.. Why are you asking me to take a shot today? Immunizations are not just for children Protection from some childhood vaccines can wear off over time As you age, you are more at risk of vaccine preventable diseases Adults need immunizations to help them from getting AND spreading serious disease that can result in poor health, missed work and medical bills. Didn t know you were going to be reviewing Pathology today did you!! The Need for Adult Vaccinations To understand how vaccines work you need to revisit how the body fights illness. When viruses and bacteria attack the body they multiply and cause and infection. The immune system uses several tools to fight infections. The white blood cells are the cells fighting the infection. 1

2 There are several types of white cells that fight infection. These include macrophages, B- lymphocytes and T-lymphocytes Macrophages are large phagocytic cells found in tissue or in the blood stream. They engulf and digest cellular debris, microbes, foreign substances and anything that does not belong in the body In addition they present antigens to T-cells and initiate inflammation by releasing molecules known as cytokines that activate other cells. The vast majority of infections are cleared by macrophages however sometimes the body has to call out its special ops force. B-cells and T- cells. They are known as our adaptive immunity. B-cells and T-cells are lymphocytes. They are both formed in bone marrow. B-cells mature there whereas T-cells travel to the thymus gland and mature there. Both types of cells remember foreign invaders after their first encounter with them and fight them the next time the next time they enter the body. B-cells fight bacteria and viruses by making Y- shaped proteins called antibodies (which are specific to each pathogen and are able to lock onto the surface of invading cells and mark it for destruction by other immune cells). There are two types of T-cells: helper T-cells and killer T-cells. Helper T-cells stimulate B-cells to make antibodies, while killer T-cells directly kill cells that have already been infected by a foreign invader. It is this cellular memory that is the foundation of how vaccines work. By using a small, harmless amount of protein from a disease, we are able to create this cellular memory allowing the immune system to recognize that protein if the pathogen were to invade the body. The body tends to keep keep a few memory T-cells which are able to go into action quickly if it encounters a pathogen. When a person is vaccinated the process is initiated, and takes a few weeks to develop the memory T-cells and B-cells that will function as the special ops force in the future. 2

3 Now when giving vaccines, the imitation infection can cause minor symptoms such as fever. These symptoms are NORMAL!!! Also, it can take several weeks for the body to produce the T-cells and B-cells after vaccination. So it is possible that if a person were infected with a real disease just prior to or just after vaccination, they could still get the disease. This is important to remind patients of. Just because you got the vaccine, there is not a guarantee that you will not have some sort of symptoms. The Need for Adult Vaccines Scientist have formulated different means of preparing vaccines. These means are based on information about the infections the vaccines will prevent, such as how the germs infect cells and how the immune system responds to it. Other practical considerations, such as region of the world the where the vaccine would be used are also important because the strain of the virus and some environmental conditions, may differ across the globe. Today there are five main types of vaccines that are given commonly in the United States. Live-attenuated vaccines- These vaccines contain a version of the living virus or bacteria that has been weakened so that it does not cause disease when introduced to a healthy immune system. Examples include MMR, Varicella and nasal flu vaccine. Inactivated vaccines- Made by inactivating or killing the germ during the production process. Because the germ is inactivated, the immune response may not be as robust as with live vaccines. Often multiple doses are necessary to build up and/or maintain immunity. Inactivated Polio is an example. 3

4 Toxoid vaccines- prevent diseases caused by bacteria that produce toxins. In the production process the toxins are so weakened that they cannot cause illness. Weakened toxins are called toxoids. The immune system then learn how to fight of the natural toxins. DtaP vaccine is an example as it contains diphtheria and tetanus toxoids. Subunit vaccines- include only parts of the virus or bacteria (subunits) instead of the entire germ. Because the vaccines contain on the essential antigens, side effects are less common. ap (acellular pertussis) in DTaP is an example. Conjugate Vaccines- fight a different type of bacteria. These bacteria have antigens with an outer coat called polysaccharides. This coat acts to disguise the antigen making it hard for immature immune systems to recognize. Conjugate vaccines are effective for these type of bacteria because they connect (conjugate) the polysaccharides to antigens that the immune system responds to very well. An example of this with would be Haemophilus Influena B (HiB) vaccine. Vaccines may require more than one dose for several reasons: 1. The first dose does not provide as much immunity as possible. Ex: HiB 2. For some vaccines the immunity begins to wear off. At that point a booster is needed. Ex: Tdap 3. Some vaccines need multiple doses are needed because the virus changes from season to season. Ex: Influenza vaccine. The Need for Adult Vaccination 4

5 Recommended Adult Vaccines Recommended Adult Vaccines As recommended by the CDC: Every adult needs a seasonal flu vaccine Due to a recent uptick in whooping cough every adult should get the Tdap vaccine once if they did not receive as an adolescent and then a Td booster shot every 10 yrs. Adults 19-26: 1. HPV vaccine in women up to age HPV in men up to HPV in men that have sex with men up to 26 ** FDA recently approved vaccine in women up to 45yrs of age. CDC has not ruled on this as of yet but it is being considered. The evidence suggest the same effectiveness in men in this age range also. Adults 50 and over: 1. Shingles vaccine- 1out 3 people infected with varicella will develop shingles in their lifetime. 2. Pneumococcal vaccines- recommended for adults 65 and older and adults younger than 65 with certain chronic health conditions such as diabetes, sickle cell anemia, heart disease, stroke, HIV, Liver disease, Lung disease including Asthma and COPD, renal disease and weakened immune systems. Recommended Vaccines Recommended Vaccines Pregnant Women- Tdap Vaccine b/w weeks 27 and 36 of gestation. Should get with each pregnancy. The flu vaccine is still safe during pregnancy Healthcare Workers- Hepatitis B (if you don t have documented evidence of completed vaccine series or an up to date titer). Get 3 dose series (Now, 1 month later, 5 months after 2 nd dose). MMR if born 1957 or after and do not have up to date vaccine records or and up to date titer. Get 2 doses four weeks apart. Varicella if no evidence of previous infection or titer. Get 2 doses four weeks apart. Meningitis vaccine- If routinely exposed due specialty a one time dose is recommended. International Travelers- Make sure up to date with all recommended adult vaccines and then visit either consult CDC Travel Health site, refer to local Health Dept, or to an Infectious Disease/Travel Med physician. Get recommended vaccines at least 4-6 weeks prior to trip. 5

6 In conclusion, it important to remind adults that they can be just as susceptible to disease and young children. Vaccines help promote the activated immune system (B-cells and T-cells) to help prevent serious infection. Immunity is not instantaneous. So be proactive in setting the expectation of patients (particularly when it comes to the seasonal flu vaccine). Be aware that there are special populations that may need different immunizations. Do not be afraid to go to CDC website or call the local health department if you are not sure. 6

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