Conflict Disclosure Information
|
|
- Julius Merritt
- 5 years ago
- Views:
Transcription
1 Conflict Disclosure Information Speaker: Ethan Rubinstein, M.D., L.Lb. Professor & Head Section of Infectious Diseases University of Manitoba, Faculty of Medicine Title of the event : The Changing Landscape of Adult Immunization FINANCIAL DISCLOSURE Grants/Research Support: CIHR, NIH, Trius Speaking Engagements/Honoraria: Pfizer, Astellas, Theravance, Merck Consulting Fees: Trius, Merck, Bayer, Pfizer, Astellas, Theravance, Optimer, BiondVax, Atox Bio, Canadian Copper Board, BiondVax, Other:
2 Disclosure I had full editorial control over the content of this presentation and wish to advise that it may contain content that is not consistent with the approved Canadian Product Monographs.
3 Adult Vaccinations What s new? What s needed? Zoster Vaccine Conjugated Pneumococcal Vaccine New Influenza Vaccines Pertusis Anti smoking vaccine Staphylococcal Vaccine Military Vaccines
4 Shingles: A Painful Vesicular Eruption in a Dermatomal Distribution
5 Annual Incidence of Herpes Zoster by Age Decile per 1000 Manitobans 2003/ Incidence per Age (years) By age 85 yrs, 25% will experience an episode of HZ
6 Studies demonstrating that exposure to chickenpox reduces risk of HZ Hope Simpson (1965); Solomon (1998), Terada (1998) Pediatricians exposed to CP have reduced rates of HZ Gershon (1996) Rate HZ lower in vaccinated children with household exposure to chickenpox Thomas (2002) Case control study demonstrated protection against HZ by exposure to children and to varicella (with dose response relationship) Brisson (2002) Exposure to varicella in adult cohort protected against HZ
7 Brisson et al Vaccine 2002;20:2500 Living with children: 0.75 (0.63, 0.89)
8 HZ Causes Three Problems Acute pain until the HZ rash heals, approximately 4 weeks In HZ ophthalmicus, ocular damage including vision impairment and facial scarring Post herpetic neuralgia (PHN) The most common problem A therapeutic challenge
9 Treatments for Established PHN are not Uniformly Efficacious Amitrytiline 1 Gabapentin 2 Topical Capsaicin 3 Lidocaine 4 Transcutaneous nerve stimulation 5 1. Watson et al. J Neurol 1982; 32: Rowbotham et al. JAMA 1998; 280: Watson et al. Pain 1988; 33: Rowbotham et al. Pain 1989; 9: Bates et al. Anaesthesia 1980; 35:817
10 Comparison of Pain Scores for Acute Pain Conditions Various Conditions More Pain Chronic Pain Conditions Abdominal hysterectomy Acute headache Zoster Labor pain Postsurgical pain Mucositis Angioplasty sheath removal Less Pain Fibromyalgia Postherpetic neuralgia Atypical facial pain Musculoskeletal pain Arthritis Osteoarthritis Rheumatoid arthritis Chronic cancer pain Adapted from Surgical Clinics of North America, Vol 79, Katz J, Melzack R, Measurement of pain, pp Copyright 1999, with permission from Elsevier.
11 Antiviral Drugs May Reduce the Probability of PHN But Their Efficacy is Limited Acyclovir, famciclovir & valacyclovir Must be initiated less than 72 H after rash onset Cochrane Systematic Review: Acyclovir not effective Efficacy of famciclovir & valacyclovir not yet established Li et al. Cochrane Systematic Review 2009
12 Research Question To determine whether vaccination with a live attenuated VZV vaccine would decrease the incidence, severity, or both of HZ and PHN, in adults 60 years of age or older. PHN = pain > grade 3/10 persisting > 90 days after the rash began Oxman M et al. N Engl J Med 2005; 352:2271
13 Study Design Randomized 1:1 Zoster Vaccine or placebo Double blind, placebo controlled, multicenter trial 22 U.S. sites Study Timeline: Nov 1998 to April 2004 Enrolled 38,546 subjects 60 years of age Age stratified (60 to 69 years, 70 years) Oxman M et al. N Engl J Med 2005; 352:2271
14 Study Population All eligible subjects had a history of varicella or had resided in the U.S. for at least 30 years. Immunocompromised persons were excluded All subjects provided written consent Oxman M et al. N Engl J Med 2005; 352:2271
15 Intervention Vaccine type: Live attenuated OKA/MERCK VZV vaccine (Zoster Vaccine) Administration: Subcutaneous injection The minimal potency of the Zoster Vaccine was at least 14 times greater than the Varicella live attenuated Oka/Merck VZV vaccine. Oxman M et al. N Engl J Med 2005; 352:2271
16 Cumulative Incidence of HZ (%) Results Vaccine Efficacy: HZ incidence 6 VE =51% Placebo (n=642) HZ 5 p< Zoster Vaccine (n=315) Years of follow-up Oxman M et al. N Engl J Med 2005; 352:2271
17 Results Vaccine Efficacy: PHN Incidence Cumulative Incidence of PHN (%) VE PHN =67% p<0.001 Placebo (n=80) 0.2 Zoster vaccine (n=27) Years of follow-up Oxman M et al. N Engl J Med 2005; 352:2271
18 The Shingles Prevention Study Results Vaccine Efficacy: PHN Incidence by Age Efficacy Incidence of PHN (95% CI) * 66.5% ( ) 79.2) 65.7% ( ) Vaccine Placebo 66.8% ( ) 0.0 All Subjects yr 70 yr *P <0.001 Adapted from Oxman M et al. N Engl J Med 2005; 352:2271
19 HZ Vaccine Local Side Effects Vaccine Placebo Pain or tenderness 35% 9% Redness 36% 7% Swelling 26% 5% Oxman et al. N Engl J Med 2005; 352:2271
20 Conclusions The HZ vaccine reduced the incidence of HZ by 51% The incidence of PHN was reduced by 67%
21 Effect was similar in those < 69 and those > 70 years old Well tolerated Recommended for prevention of HZ and its sequelae in U.S. adults > 60 years of age NACI guideline awaited
22 Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease Hung Fu Tseng, PhD, MPH, Ning Smith, PhD, Hung Fu Tseng, PhD, MPH, Ning Smith, PhD, Rafael Harpaz, MD, MPH, Stephanie R. Bialek, MD, MPH, Lina S. Rafael Harpaz, Sy, MPH, MD, MPH, Steven Stephanie J. Jacobsen, R. Bialek, MD, PhD MD, MPH, Lina S. Sy, MPH, Steven J. Jacobsen, MD, PhD JAMA 2011;305(2): JAMA 2011;305(2):
23 Results Kaplan Meier estimates of the cumulative risk of HZ by HZ vaccination status HZ vaccine was associated with a 55% reduction in incidence of HZ Tseng HF et al. JAMA 2011;305(2):
24 Results Hazard ratio of HZ in study cohorts according to age, sex, race and chronic conditions/diseases In contrast to the SPS, the lower HZ risk associated with the vaccine was retained across all age strata The lower HZ risk associated with the vaccine did not vary with the presence of chronic diseases Tseng HF et al. JAMA 2011;305(2):
25 Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease Conclusion: Conclusion: Among Among immunocompetent immunocompetent community dwelling community dwelling adults adults aged aged years years or or older, older, receipt receipt of of the the HZ HZ vaccine vaccine was was associated associated with with a a lower lower incidence incidence of of HZ HZ (reduction (reduction of of 55%). 55%). The The HZ HZ risk risk was was reduced reduced regardless regardless of of age, age, race, race, and and presence presence of of chronic chronic diseases. diseases. The The results results support support recommendations recommendations to to offer offer HZ HZ vaccine vaccine to to all all eligible eligible patients patients of of all all ages ages including including the the oldest oldest population. population. Tseng HF et al. JAMA 2011;305(2):
26 Pneumococcal Invasive Disease Conjugated pneumoccoal Vaccine
27 Efficacy, Immunogenicity, Safety and Tolerability of Zoster Vaccine in Subjects 50 to 59 Years of Age Schmader et al IDSA October, 2010
28 Disposition of Subjects All Randomized Subjects Subjects in Population (N=22,439) Subjects Vaccinated (N=22,396) Not Vaccinated (N=43) Zoster vaccine n (%) Randomized 11,186 (99.8) Completed 10,550 (94.1) Discontinued 661 (5.9) Adverse Event 19 (0.2) Lost to Follow-Up 353 (3.1) Subject Withdrawal 263 (2.3) Other Reasons 26 (0.2) Placebo n (%) Randomized 11,210 (99.8) Completed 10, ) Discontinued 673 (6.0) Adverse Event 29 (0.3) Lost to Follow-Up 375 (3.3) Subject Withdrawal 255 (2.3) Other Reasons 14 (0.1) Schmader et al, IDSA Octobre, 201
29 Statistical Analysis of Incidence of HZ ITT Population Vaccine Efficacy (95% CI) (0.541*, 0.806) Estimated Incidence Rate of HZ (Per 1000 Person-Years) n=30 n=99 ZOSTAVAX Placebo *A lower bound of >25% indicates that the success criterion was met Schmader et al, IDSA Octobre, 2010
30 VZV gpelisa Antibody Responses Week 6 Postvaccination Random Subcohort Population Estimated GMT Ratio 2.3; p<0.001 Estimated GMT n=1124 n=1125 ZOSTAVAX Placebo Schmader et al, IDSA Octobre, 201
31 Invasive Pneumococcal disease in Canada and Anti pneumococcal immunization
32 The burden of pneumococcal disease in the Canadian population 2001 estimates before the significant use of the conjugated vaccine cases of pneumococcal infections Meningitis : 226 cases Bacteremia : 3773 cases Pneumonia : Acute otitis media : Total cost : 193 million Morrow A et al. Can J Infect Dis Med Microbiol 2007; 18(2):
33 Pneumonia is the most common presentation of PD among adults aged 65 years IPD Clinical Presentation: Source of Pneumococcal Isolates in Calgary, by Age Groups, Kellner JD, Vanderkooi OG, MacDonald J, Church DL, Tyrrell GJ, Scheifele DW. Changing epidemiology of invasive pneumococcal disease in Canada, : update from the Calgary-area Streptococcus pneumoniae research (CASPER) study. Clin Infect Dis. 2009;49(2):
34 In adults aged 65 years, CAP is costly CAP patients (n=60; mean age 70 years) Total societal cost (medical cost plus private cost) within 30 days of hospital admission was $8,970 per patient Average hospital stay was 11 days Medical costs included emergency room visit, hospital stay, and physician fees Private costs (which are not commonly covered or sometimes not covered by health plans) included lost wages, travel and communications costs, child care expense, ambulance fees, prescriptions, and supplies Jacobs P, Marrie TJ, Calder P. Private costs of patients hospitalized with community-acquired pneumonia. Can Respir J. 2005;12(4):
35 Pneumonia causing change in employment status at time of study enrollment Percentage N=236 Marrie TJ, Beecroft MD, Herman-Gnjidic Z. Resolution of symptoms in patients with community-acquired pneumonia treated on an ambulatory bases. Journal of Infection 2004;49:
36 Factors Predicting Mortality in Invasive Pneumococcal Disease in Adults : Alberta Study Marrie T et al. Medicine (Baltimore) 2011 May;90(3): patients with IPD 14.1% (163) died within 30 days. 62.6% of the deaths occurred within 5 days of admission. Factors independently associated with increased 30 day mortality: cancer within 5 years Diabetes cirrhosis. treatment with a single antibiotic.
37 Invasive pneumococcal disease and cancer in Canada Adults 18 and over Lung Cancer Multiple myeloma Rate 11 / per year / per year / per year 69% of cases were caused by serotypes in the 23 valent pneumococcal polysaccharide vaccine. 53 % of cases were caused by serotypes in 13 valent pneumococcal (investigational at the time of the study). Wong A et al. Epidemiol Infect 2010;138(12):
38 Pneumococcal meningitis : the most dreaded complication. Rare but severe consequences. Not to be missed. In adults up to age 60 : S. pneumoniae was responsible for 60 percent of cases. In adults age 60 and above : 70 percent of cases were due to S. pneumoniae.. Meningitis represents 4% of IPD
39 Current vaccine environment There are currently three available pneumococcal vaccines for adults in Canada: Pneumococcal polysaccharide vaccines (PPV) Pneumo 23 and Pneumovax 23, containing 25 μg of capsular polysaccharide from each of 23 pneumococcal serotypes: 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F and 33F Pneumococcal conjugate vaccine (PCV) Prevnar 13, composed of the purified polysaccharides of the capsular antigens of 13 pneumococcal serotypes: 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F 50
40 NACI recommendations for high-risk adults Current recommendations are that PPV23 should be given to persons at high risk of IPD: 1 Individuals with a history of chronic lung disease (including smoking) Heart failure Chronic renal failure (including nephrotic syndrome) Chronic liver disease (including alcohol dependence and cirrhosis) Diabetes Asplenia/sickle cell disease Congenital or acquired immune deficiency Chronic cerebrospinal fluid leak Residents of long-term care facilities All those 65 years of age or older Recently, homelessness and injection drug abuse were added as indications National Advisory Committee on Immunization (NACI). Canadian Immunization Guide, 7 th ed. Ottawa: Public Health Agency of Canada, 2006: Public Health Agency of Canada. National Advisory Committee on Immunization: Statement on the Recommended Use of Pneumococcal 23-Valent Polysaccharide Vaccine in Homeless Persons and Injection Drug Users. CCDR 2008;34:
41 Polysaccharide pneumococcal vaccine Meta analysis of 22 clinical trials ( participants) Pneumococcal polysaccharide vaccine : Decrease the risk of Invasive pneumococcal disease (OR = 0.26, 95% CI : ) No effect on all cause pneumonia and no reduction in all cause mortality (OR =0.87, 95% CI : ) Moberley SA et al. Cochrane Database Syst Rev (1): CD000422
42 PPV23 re-vaccination NACI guidelines do not recommend routinely re-vaccinating all adults who receive the polysaccharide vaccine as the data supporting re-vaccination is sparse. 1 The duration of protection has been estimated between 3 and 5 years 2 Thus, re-vaccination should be considered for those of any age at highest risk of invasive infection 1 If re-vaccination is carried out, it should be performed 5 years after the first dose 1 1. National Advisory Committee on Immunization (NACI). Canadian Immunization Guide, 7 th ed. Ottawa: Public Health Agency of Canada, 2006: Shapiro ED, Berg AT, Austrian R, et al: The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991; 325:
43 The debate surrounding the efficacy of adult pneumococcal polysaccharide vaccination Meta-analysis #1 findings* PPV23 efficacy seen in randomized controlled trials (RCTs), however, vaccine efficacy amongst the subgroup of adults with chronic disease appears poor in comparison to that of otherwise healthy adults, in developed or low income countries Protective efficacy for IPD demonstrated in non-rcts Inconclusive efficacy against all cause pneumonia No evidence of protective efficacy against all-cause mortality Note: high level of statistical heterogeneity was present No protective efficacy against pneumonia related mortality Note: high level of statistical heterogeneity was present * Cochrane review published in 2009 assessed the effectiveness of PPV in preventing disease or death in adults. Twenty-two studies were included. Fifteen were RCTs involving 48,656 participants and seven were non-rcts involving 62,294 participants. Moberly S, Holden J, Tatham DP, Andrews RM. Vaccines for preventing pneumococcal infection in adults. Cochrane Database of Systematic Reviews 2009, Issue 1. 54
44 Incidence of invasive pneumococcal disease in Calgary, by serotype grouping, for persons aged 65 years, For 2007 vs , there was a 29% change in the incidence for all serotypes (p=0.11 ), a 92% change for 7-valent pneumococcal conjugate vaccine (PCV7) serotypes (P <0.001), and a +64% change for non-pcv7 serotypes (P=0.04).
45 Incidence of invasive pneumococcal disease in Calgary, (before the introduction of 7 valent pneumococcal conjugate vaccine [PCV7]) versus (after the introduction of PCV7), Kellner et al. C I D 2009;49: No Incidence per , PCV7 serotypes Non-PCV7 serotypes Difference between and years years >85 years * PCV7 serotypes change (%) Non- PCV7 serotypes change (%) +183*
46 Effect of PCV vaccination of children on IPD in adults Active Bacterial Core Surveillance=Active population and laboratory based system Conducted in 8 centres in 8 states (CA,GA,MD,MIN,NY,OR,TN, CT) Population surveillance ~19 months Period pre PCV , post PCV Pilishvili T et al. CID 2010;201:32
47 Changes in incidence of pneumococcal disease pre and post vaccine Incidence Rate Diff Per 10 5 Change % (95%CI) y All types (-25 to-9) Vaccine types (-90 to-83) 19A (202 to 551 Non-Vaccine types (25 to 84) >65 y All types (-42 to-32) Vaccine types (-94 to-89) 19A (84 to 223 non-vaccine types (9 to 38)
48 Change in IPD rates pre vs post PCV 7 vaccination in children adults ages y All sero-types Vaccine types Other -types n % * * * 1 0 Bacter * * Bacter.pneu * * * Meningitis * * Mortality * * *
49 Change in IPD rates pre vs post PCV 7 vaccination in children adults>65 y All sero-types Vaccine types Other -types n % * * * Primary Bacteremia Bacteremic.pneumonia * * * * * Meningitis * Mortality * * Pilishvili T et al. C I D 2010;201:32
50 Cases per
51
52
53 Percentage of Penicillin* Non Susceptible S. pneumoniae in Canada: % intermediate resistance % high-level resistance *Non-meningitis, IV breakpoints used Canadian Bacterial Surveillance Network, Jun 2010
54 Polysaccharide vaccines activate B cells but do not induce immunological memory in infants 1,2 Polysaccharide B cell Cross linking Surface antibody Activated B cell T-cell independent pathway Weak and short-lasting IgM immune response No affinity maturation and antibody class switching to IgG Lack of booster effect on revaccination Limited impact on pneumococcal nasopharyngeal carriage IgM 1. Pollard AJ, et al. Nature Reviews Immunology. 2009;9(3): Overturf GD, et al. Pediatrics. 2000;106;
55 Conjugate vaccines induce a strong immune response and immunological memory in infants by activating B and T cells 1,2 The combination of polysaccharide protein antigen-conjugate is captured by B cells and other antigenpresenting cells (APC) APC present these antigens to T-helper 2 (Th2) cells Activation of Th2 cells helps B cells to differentiate into memory B cells and plasma cells Antibody class switching Polysaccharide-protein antigen conjugate (covalently linked) Peptide processing Dendritic cell polysaccharide protein T cell Memory B cells T cell B cell Differentiation Plasma cells 1. Ada G. N Engl J Med. 2001;345: Pollard AJ, et al. Nature Reviews Immunology. 2009;9(3): IgG antibodies
56 PCV13 vs PPSV23 in Subjects Year Old Who Are Naive to PPSV23 13vPnC (n=417) PPSV23 (n=414) vPnC (n=403) } Blood draw- 1 month after the dose
57
58
59 Sequential Dosing With PCV13 in Subjects 70 years Old Pre-immunized with PPSV23 Subjects were immunized with 1 dose of PPSV23 5 yrs prior to study inclusion 13vPnC (n=463) PPSV23 (n=473) } 1 year interval between sequential doses 13vPnC (n=391) 13vPnC (n=404) } Blood draw- 1 month after the dose
60
61
62
Expanded Use of PCV13 & PPV23
Expanded Use of PCV13 & PPV23 Dr. Jim Kellner Professor & Head Department of Pediatrics University of Calgary & Calgary Zone, Alberta Health Services Jim.Kellner@ahs.ca Objectives Explain the differences
More informationVaccines for Primary Care Pneumococcal, Shingles, Pertussis
Vaccines for Primary Care Pneumococcal, Shingles, Pertussis Devang Patel, M.D. Assistant Professor Chief of Service, MICU ID Service University of Maryland School of Medicine Pneumococcal Vaccine Pneumococcal
More informationLes 2 articles qui peuvent changer votre pratique sur: Vaccination et biothérapies
Les 2 articles qui peuvent changer votre pratique sur: Vaccination et biothérapies VZV Epidemiology and Pathogenesis 98% adults Respiratory spread 1,000,000/year and increasing CMI continuously boosted
More informationACIP Recommendations for Pneumococcal 13-valent Conjugate and 23-valent Polysaccharide Vaccine Use among Adults
ACIP Recommendations for Pneumococcal 13-valent Conjugate and 23-valent Polysaccharide Vaccine Use among Adults National Center for Immunization & Respiratory Diseases Respiratory Diseases Branch ACIP
More informationZoster Vaccine for Older Adults
BC Centre for Disease Control IMMUNIZATION FORUM 29 Zoster Vaccine for Older Adults Michael N. Oxman, M.D. Professor of Medicine and Pathology University of California, San Diego VASDHS Staff Physician
More informationUpdate on Adult Immunization Strategies: Understanding the Current Recommendations
Update on Adult Immunization Strategies: Understanding the Current Recommendations EDWARD A. DOMINGUEZ, MD, FACP, FIDSA Medical Director, Organ Transplant Infectious Diseases Methodist Dallas Medical Center,
More informationUpdate on Adult Immunization Strategies: Understanding the Current Recommendations
Sunday CME Breakfast Update on Adult Immunization Strategies: Understanding the Current Recommendations Edward Dominguez, MD Medical Director, Organ Transplant Infectious Diseases Methodist Dallas Medical
More informationHot Topics Adult Infectious Diseases 2018 Wayne Ghesquiere MD FRCPC
Hot Topics Adult Infectious Diseases 2018 Wayne Ghesquiere MD FRCPC Infectious Diseases Consultant Island Health Authority Clinical Assistant Prof of Med, UBC Victoria Faculty/Presenter Disclosure Wayne
More informationDr Stewart Reid. General Practitioner Ropata Medical Centre Wellington
Dr Stewart Reid General Practitioner Ropata Medical Centre Wellington 7:15-8:10 Medicines New Zealand Breakfast Session Adult Vaccination The Poor Cousin Adult Vaccination The poor cousin Stewart Reid
More informationJon Temte, MD/PhD Chair Wisconsin Council on Immunization Practices Professor of Family Medicine and Community Health
Jon Temte, MD/PhD Chair Wisconsin Council on Immunization Practices Professor of Family Medicine and Community Health University of Wisconsin School of Medicine and Public Health Grand Rounds September
More informationRecommendations for Using Pneumococcal Vaccines among Adults
Recommendations for Using Pneumococcal Vaccines among Adults AI Collaborative Webinar July 2017 Tamara Pilishvili Respiratory Diseases Branch, CDC National Center for Immunization & Respiratory Diseases
More informationPneumococcal vaccines. Safety & Efficacy. Prof. Rajesh Kumar, MD PGIMER School of Public Health Chandigarh
Pneumococcal vaccines Safety & Efficacy Prof. Rajesh Kumar, MD PGIMER School of Public Health Chandigarh Disclosure Slide X X I DO NOT have any significant or other financial relationships with industry
More informationCall-to-Action: Recognizing the Burden of Vaccine- Preventable Diseases
Call-to-Action: Recognizing the Burden of Vaccine- Preventable Diseases Burden of Vaccine-Preventable Diseases Each Year 200,000 hospitalizations due to influenza As many as 36,000 deaths 29,100 cases
More informationSubunit adjuvanted zoster vaccine: why the fuss?
Subunit adjuvanted zoster vaccine: why the fuss? Soren Gantt, MD PhD MPH Pediatric Infectious Diseases Vaccine Evaluation Center BC Children s Hospital University of British Columbia Disclosures Research
More information11/17/2013 THE WHO, WHAT, WHEN, AND WHY OF ADULT VACCINATIONS. Pneumococcal Vaccines for Adults (PPV) Pneumococcal Vaccines
THE WHO, WHAT, WHEN, AND WHY OF ADULT VACCINATIONS CAROL A. KAUFFMAN, MD VA ANN ARBOR HEALTHCARE SYSTEM UNIVERSITY OF MICHIGAN Will discuss: bacterial vaccines made of toxoids or polysaccharide capsular
More informationACTIVITY DESCRIPTION Target Audience Learning Objectives
ACTIVITY DESCRIPTION Target Audience This activity is designed as a comprehensive approach to address the practice needs of primary care providers, including primary care physicians, doctors of osteopathy,
More informationACTIVITY DESCRIPTION Target Audience Learning Objectives
ACTIVITY DESCRIPTION Target Audience This activity is designed as a comprehensive approach to address the practice needs of primary care providers, including primary care physicians, doctors of osteopathy,
More informationRecommendations for Using Pneumococcal Vaccines among Adults
Recommendations for Using Pneumococcal Vaccines among Adults AI Collaborative Webinar February 2016 Tamara Pilishvili Respiratory Diseases Branch, CDC National Center for Immunization & Respiratory Diseases
More informationPneumococcal Vaccines. What s right for your clients?
Pneumococcal Vaccines What s right for your clients? Vaccines Available - Pneumovax 23 A pneumococcal polysaccharide vaccine that includes 23 purified capsular polysaccharide antigens Vaccines Available
More informationPrevention of pneumococcal disease in Canadian adults Old and New. Allison McGeer, MSc, MD, FRCPC Mount Sinai Hospital University of Toronto
Prevention of pneumococcal disease in Canadian adults Old and New Allison McGeer, MSc, MD, FRCPC Mount Sinai Hospital University of Toronto Objectives Review epidemiology of pneumococcal disease in adults
More informationPneumococcal vaccines
Pneumococcal vaccines Marco Aurélio Sáfadi, MD, PhD FCM da Santa Casa de São Paulo Challenges in establishing the baseline burden of disease, before implementing a vaccination program S. pneumoniae disease
More informationPneumoccocal vaccines in the elderly (conjugated vs polysaccharides)
Aging and Immunity II Campus Novartis, Siena April 24, 2012 Pneumoccocal vaccines in the elderly (conjugated vs polysaccharides) Paolo Bonanni Department of Public Health University of Florence, Italy
More informationVaccination against shingles for adults aged 70 and 79 years of age Q&A s for healthcare professionals
Vaccination against shingles for adults aged 70 and 79 years of age Q&A s for healthcare professionals Background In 2010, the Joint Committee on Vaccination and Immunisation (JCVI) 1 were asked by the
More informationHerpes zoster vaccine in Korea
Review article CLINICAL EXPERIMENTAL VACCINE RESEARCH Herpes zoster vaccine in Korea Clin Exp Vaccine Res 2013;2:92-96 pissn 2287-3651 eissn 2287-366X Won Suk Choi Division of Infectious Diseases, Department
More informationHERPES ZOSTER VACCINATION
HERPES ZOSTER VACCINATION Herpes Zoster (shingles) is a reactivation of the varicella zoster infection in some-one who has previously had varicella(chicken pox) disease Painful, unilateral, self-limiting
More informationStreptococcus pneumoniae CDC
Streptococcus pneumoniae CDC Pneumococcal Disease Infection caused by the bacteria, Streptococcus pneumoniae» otitis media 20 million office visits (28-55% Strep)» pneumonia 175,000 cases annually» meningitis
More informationPneumococcal vaccination in UK: an update. Dr Richard Pebody Immunisation Department Health Protection Agency Centre for Infections
Pneumococcal vaccination in UK: an update Dr Richard Pebody Immunisation Department Health Protection Agency Centre for Infections Leading infectious causes of mortality, 2000 WHO estimates 3.5 Deaths
More informationBackground Rationale for resource
Background The Joint Committee on Vaccination and Immunisation 1 reviewed all the available medical, epidemiological and economic evidence as well as vaccine safety and efficacy relevant to offering a
More informationPneumococcal Disease and Pneumococcal Vaccines
Pneumococcal Disease and Epidemiology and Prevention of - Preventable Diseases Note to presenters: Images of vaccine-preventable diseases are available from the Immunization Action Coalition website at
More informationNQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE
Last Updated: Version 4.4 NQF-ENDORSED VOLUNTARY CONSENSUS STANDARDS FOR HOSPITAL CARE Measure Set: Immunization Set Measure ID#: Measure Information Form Collected For: CMS Voluntary Only The Joint Commission
More informationACTIVITY DESCRIPTION. Reminder
1 ACTIVITY DESCRIPTION Target Audience This activity is designed as a comprehensive approach to address the practice needs of primary care providers, including primary care physicians, doctors of osteopathy,
More informationCost effectiveness analysis of the new pneumococcal conjugate vaccine (Synflorix TM ) compared to Prevnar
CPHA 2009 Cost effectiveness analysis of the new pneumococcal conjugate vaccine (Synflorix TM ) compared to Prevnar Ismaila AS 1,2, Pereira JA 1, Robson RC 1, Rawson NS 1, Simpson SD 1, Standaert BA 3
More informationPNEUMONIA : PROMISE FULFILLED? Regina Berba MD FPSMID
PNEUMONIA : PROMISE FULFILLED? Regina Berba MD FPSMID Objectives of Lecture Know the quality of current evidence based guidelines on immunization Appreciate the performance of pneumonia vaccines in terns
More informationShingles Prevention. Dr. JS Reid March 2014
Shingles Prevention Dr. JS Reid March 2014 1 Conflict of interest In the past I have received support for vaccine work, clinical trials, presentation of papers and conference attendance from NZ Ministry
More informationRxVaccinate. Support. Objectives. Disclosures 7/8/2013. Pneumococcal Immunization Update
RxVaccinate Pneumococcal Immunization Update Stephan L. Foster, Pharm.D., FAPhA, FNAP Professor and Vice-Chair College of Pharmacy University of Tennessee Health Science Center, Memphis, TN Liaison Member,
More informationThis continuing education activity is co-sponsored by USF Health and by CME Outfitters, LLC.
This continuing education activity is co-sponsored by USF Health and by CME Outfitters, LLC. USF Health and CME Outfitters, LLC, gratefully acknowledge an educational grant from Pfizer Inc. in support
More informationBackground Rationale for resource
Slide 1 Background The Joint Committee on Vaccination and Immunisation 1 reviewed all the available medical, epidemiological and economic evidence as well as vaccine safety and efficacy relevant to offering
More informationIncidence per 100,000
Streptococcus pneumoniae Surveillance Report 2005 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Department of Human Services Updated: March 2007 Background
More informationTo view past issues, go to: The New 13-Valent Pneumococcal Conjugate Vaccine (PCV13)
From the Texas Department of State Health Services Immunization Branch The goal of the Vaccine Advisory is to disseminate, in a timely manner, practical information related to vaccines, vaccine-preventable
More informationVaccine Preventable Diseases Among Adults
Vaccine Preventable Diseases Among Adults Stephanie Borchardt, MPH, PhD Wisconsin Immunization Program Division of Public Health Wisconsin Department of Health Services November 17, 2016 At a Glance Burden
More informationACTIVITY DESCRIPTION
ACTIVITY DESCRIPTION FACULTY DISCLOSURES Burden of Vaccine-Preventable Diseases Each Year 226,000 hospitalizations due to influenza As many as 49,000 deaths 32,000 cases of invasive pneumococcal disease
More informationSplenectomy Vaccine Protocol PIDPIC
Splenectomy Vaccine Protocol PIDPIC 6.24.14 Rationale Spleen clears encapsulated bacteria and infected erythrocytes Serves as one of the largest lymphoid tissues where B cells are educated against encapsulated
More informationVaccinations for Adults
Case: Vaccinations for Adults Lisa Winston, MD University of California, San Francisco San Francisco General Hospital A 30-year old healthy woman comes for a routine visit. She is recently married and
More informationSeries of 2 doses, 6-12 months apart. One dose is 720 Elu/0.5ml (GSK) or 25 u/0.5 ml (Merck)
UTAH PREVENTIVE CARE RECOMMENDATIONS Adult - Ages 19 and Above IMMUNIZATIONS CONTENTS: General Instructions Hepatitis A Hepatitis B Human Papilloma Virus Influenza Meningococcal A, C, Y, W (MCV4) Meningococcal
More informationHaemophilus influenzae
Haemophilus influenzae type b Severe bacterial infection, particularly among infants During late 19th century believed to cause influenza Immunology and microbiology clarified in 1930s Haemophilus influenzae
More informationPneumococcal Vaccine Effectiveness. Steven Black, MD Center for Global Health Cincinnati Children s s Hospital Cincinnati, Ohio USA
Pneumococcal Vaccine Effectiveness Steven Black, MD Center for Global Health Cincinnati Children s s Hospital Cincinnati, Ohio USA Overview Possible effectiveness outcomes for pneumococcal vaccines Pre-licensure
More informationZostavax vaccine: now fully subsidised
Dermatology Infections Older person s health Virology Zostavax vaccine: now fully subsidised Zostavax is a herpes zoster (shingles) vaccine that will become fully subsidised from 1 April, 2018 for people
More informationImmunization across the age span: What s new and/or improved?
Immunization across the age span: What s new and/or improved? PICNet 2018 Educational Conference March 9 2018 Monika Naus MD MHSc FRCPC FACPM BC Centre for Disease Control School of Population and Public
More informationBenefits of the pneumococcal immunisation programme in children in the United Kingdom
Benefits of the pneumococcal immunisation programme in children in the United Kingdom 2006-2014 Professor Mary P E Slack mpeslack@gmail.com March 2015 Disclosure of interest The presenter has received
More informationZOSTAVAX Zoster Virus Vaccine Live (Oka/Merck) Refrigerator stable
PRODUCT INFORMATION ZOSTAVAX Zoster Virus Vaccine Live (Oka/Merck) Refrigerator stable DESCRIPTION ZOSTAVAX is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella - zoster virus
More informationKenneth McCall, BSPharm, PharmD Associate Professor UNE
Kenneth McCall, BSPharm, PharmD Associate Professor UNE Objectives Discuss the gap between current rates and Healthy People 2020 goals for vaccinations. Categorize each of the CDC recommended flu vaccines
More informationShingles. A Guide to Understanding Herpes Zoster. By Sarah Weis, PharmD Candidate 2012
Shingles A Guide to Understanding Herpes Zoster Information Every Elder Should Know By Sarah Weis, PharmD Candidate 2012 Herpes zoster, also known as shingles, effects up to 1 million people every year
More informationAdult Vaccine Update. NB Internal Medicine Update, April 22 nd, 2016 Dan Smyth, MD, FRCPC, DTMH
Adult Vaccine Update NB Internal Medicine Update, April 22 nd, 2016 Dan Smyth, MD, FRCPC, DTMH Summary points: Canadian adults > 18 should be regularly assessed to ensure recommended vaccinations are up
More information2/16/2015 IMMUNIZATION UPDATE Kelly Ridgway, RPh February 21, Today s Overview NEW RECOMMENDATIONS
IMMUNIZATION UPDATE 2015 Kelly Ridgway, RPh February 21, 2015 Today s Overview 1 2 3 4 5 6 Pneumococcal Vaccine Recommendations Meningococcal Vaccine Recommendations HPV Vaccine Recommendations Patient
More informationSCIENTIFIC DISCUSSION. London, Product name: Zostavax Procedure No. EMEA/H/C/000674/II/0003
SCIENTIFIC DISCUSSION London, 21.06.2007 Product name: Zostavax Procedure No. EMEA/H/C/000674/II/0003 SCIENTIFIC DISCUSSION 3.1. Introduction ZOSTAVAX is a live attenuated vaccine containing Varicella-zoster
More informationReport of Typing & Antimicrobial Susceptibilities of Isolates Causing Invasive Pneumococcal Disease in Ireland,
Report of Typing & Antimicrobial Susceptibilities of Isolates Causing Invasive Pneumococcal Disease in Ireland, 2011-2013 1. Background Streptococcus pneumoniae is a major cause of life-threatening infections
More informationSession 1 Introduction to Vaccines and Basic Concepts
Module 8 Evaluating Immunological Correlates of Protection Session 1 Introduction to Vaccines and Basic Concepts Ivan S.F. Chan, Ph.D. Merck Research Laboratories 1 The Ten Greatest Public Health Achievements
More information2013 Adult Immunization Update. David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle
2013 Adult Immunization Update David H. Spach, MD Professor of Medicine Division of Infectious Diseases University of Washington, Seattle Adult Immunization Update Pertussis Vaccine Influenza Vaccine Zoster
More informationZOSTAVAX. CLINICAL TRIALS Evaluation of Clinical Efficacy Afforded by ZOSTAVAX
PRODUCT INFORMATION Zoster Virus Vaccine Live (Oka/Merck) Refrigerator stable DESCRIPTION is a lyophilized preparation of the Oka/Merck strain of live, attenuated varicella- zoster virus (VZV). The virus
More informationUse of 13-valent Pneumococcal Conjugate Vaccine and 23-valent Polysaccharide Vaccine in Adults with Immunocompromising Conditions
Use of 13-valent Pneumococcal Conjugate Vaccine and 23-valent Polysaccharide Vaccine in Adults with Immunocompromising Conditions Tamara Pilishvili, MPH Respiratory Diseases Branch National Center for
More informationPneumococcal Vaccine Introductions Dr. Carsten Mantel WHO/FCH/IVB/EPI
Pneumococcal Vaccine Introductions 2012 Dr. Carsten Mantel WHO/FCH/IVB/EPI Pneumonia is leading cause of death in children < 5 yrs * Pneumococcus and Hib are the two leading causes of life-threatening
More informationUpdate on Immunizations H. Keipp Talbot, M.D., M.P.H.
Update on Immunizations H. Keipp Talbot, M.D., M.P.H. Vanderbilt University Medical Center 1 DISCLOSURES Financial Relationships with Relevant Commercial Interests Receive research funding from Sanofi
More informationPNEUMOVAX 23 pneumococcal vaccine, polyvalent solution for injection
PRODUCT INFORMATION PNEUMOVAX 23 pneumococcal vaccine, polyvalent solution for injection NAME OF THE MEDICINE PNEUMOVAX 23 (pneumococcal vaccine, polyvalent) DESCRIPTION PNEUMOVAX 23 (Pneumococcal Vaccine
More informationUNIVERSITY OF CALGARY. (IPD) in Adults with Underlying Comorbidities. Jason Lee Cabaj A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
UNIVERSITY OF CALGARY The Influence of Childhood Conjugate Vaccine Introduction on Invasive Pneumococcal Disease (IPD) in Adults with Underlying Comorbidities by Jason Lee Cabaj A THESIS SUBMITTED TO THE
More informationDisclosures. I have no financial interests in immunizations discussed here. I may discuss off-label use of licensed vaccines
2/28/18 Disclosures I have no financial interests in immunizations discussed here I may discuss off-label use of licensed vaccines Herpes Zoster (HZ) and Postherpetic Neuralgia (PHN) epidemiology, United
More informationImmunizations to Reduce Disease H. Keipp Talbot, M.D., M.P.H.
Immunizations to Reduce Disease H. Keipp Talbot, M.D., M.P.H. Vanderbilt University School of Medicine 1 DISCLOSURES Financial Relationships with Relevant Commercial Interests Receive research funding
More informationThe Role of the Pharmacist in Pneumococcal Vaccination
The Role of the Pharmacist in Pneumococcal Vaccination The Role of the Pharmacist in Pneumococcal Vaccination Miranda Wilhelm, PharmD Clinical Associate Professor Department of Pharmacy Practice Southern
More informationOREGON HEALTH AUTHORITY IMMUNIZATION PROTOCOL FOR PHARMACISTS LIVE ZOSTER VACCINE
OREGON HEALTH AUTHORITY IMMUNIZATION PROTOCOL FOR PHARMACISTS LIVE ZOSTER VACCINE Revisions as of /4/10 Zostavax should not be given concomitantly with Pneumovax 3 due to reduced immune response to Zostavax.
More informationAged 70 or 78? There s a vaccine to help protect you from the pain of shingles
Aged 70 or 78? There s a vaccine to help protect you from the pain of shingles This leaflet describes shingles and the benefits of the vaccination and who is eligible for the vaccine this year. There is
More informationPotential Health and Economic Impact of new Pneumococcal Vaccines Against Acute Otitis Media in Canada
CPHA 2010 Potential Health and Economic Impact of new Pneumococcal Vaccines Against Acute Otitis Media in Canada Afisi S. Ismaila a,b, Jennifer A. Pereira c, Reid C. Robson a, Gerhart Knerer d a Medical
More informationUNIVERSITY OF CALGARY. Pneumococcal Vaccination of the Elderly During Visits to Acute Care Providers: Who Are Vaccinated? David Mark Arthur Sabapathy
UNIVERSITY OF CALGARY Pneumococcal Vaccination of the Elderly During Visits to Acute Care Providers: Who Are Vaccinated? by David Mark Arthur Sabapathy A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES
More informationVaccines for preventing pneumococcal infection in adults (Review)
Vaccines for preventing pneumococcal infection in adults (Review) Moberley S, Holden J, Tatham DP, Andrews RM This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration
More informationPneumococcal 13-valent Conjugate Vaccine Biological Page
Pneumococcal 13-valent Conjugate Vaccine Biological Page Section 7: Biological Product Information Standard #: 07.291 Created by: Province-wide Immunization Program Standards and Quality Approved by: Province-wide
More informationVaccination Against Zoster Remains Effective in Older Adults Who Later Undergo Chemotherapy
MAJOR ARTICLE Vaccination Against Zoster Remains Effective in Older Adults Who Later Undergo Chemotherapy 5 Hung Fu Tseng, 1 Sara Tartof, 1 Rafael Harpaz, 2 Yi Luo, 1 Lina S. Sy, 1 Rulin C. Hetcher, 1
More informationBacterial diseases caused by Streptoccus pneumoniae in children
Bacterial diseases caused by Streptoccus pneumoniae in children Bactermia 85% Bacterial pneumonia 66% Bacterial meningitis 50% Otitis media 40% Paranasal sinusitis 40% 0% 10% 20% 30% 40% 50% 60% 70% 80%
More information9/12/2018. Pneumococcal Disease and Pneumococcal Vaccines. Streptococcus pneumoniae. Pneumococcal Disease. Adult Track. Gram-positive bacteria
Centers for Disease Control and Prevention National Center for Immunization and Respiratory Diseases Pneumococcal Disease and Pneumococcal Vaccines Adult Track Chapter 17 Photographs and images included
More informationMulti-drug Resistant Serotype 19A Pneumococci in Toronto
TML Lab Rounds January 17, 2008 Multi-drug Resistant Serotype 19A Pneumococci in Toronto The Role of the Microbiology Lab Susan M. Poutanen, MD, MPH, FRCPC Microbiologist/ID Consultant, TML/MSH Assistant
More informationShingles: What s New to Know
This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (NE QIN-QIO), the Medicare Quality Improvement Organization for New England, under contract with
More informationSUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICAL PRODUCT 2. QUALITATIVE AND QUANTITATIVE COMPOSITION
Registration No.: 1C 10/54 (NBC) Importer / Manufacturer: MSD (Thailand) Ltd. / Merck Sharp & Dohme Corp., West Point, Pennsylvania 19486, USA SUMMARY OF PRODUCT CHARACTERISTICS 1. NAME OF THE MEDICAL
More informationBackground Rationale for resource Note: Shingles is also known as herpes zoster. For the purpose of this resource the
Slide 1 Background The Joint Committee on Vaccination and Immunisation 1 reviewed all the available medical, epidemiological and economic evidence as well as vaccine safety and efficacy relevant to offering
More informationKeeping up with immunizations for adults
MEDICAL GRAND ROUNDS CME CREDIT EDUCATIONAL OBJECTIVE: Readers will vaccinate their patients according to guidelines from the US Centers for Disease Control and Prevention CRAIG NIELSEN, MD Associate Professor,
More informationWould a combined PCV10+PCV13 immunization schedule be a cost-effective option for Canadian children?
Would a combined PCV10+PCV13 immunization schedule be a cost-effective option for Canadian children? Philippe De Wals Department of Social and Preventive Medicine, Laval University Quebec University Hospital
More informationUPDATE ON IMMUNIZATION GUIDELINES AND PRACTICES
DISCLOSURES UPDATE ON IMMUNIZATION GUIDELINES AND PRACTICES Nothing to disclose Kylie Mueller, Pharm.D., BCPS Clinical Specialist, Infectious Diseases Spartanburg Regional Medical Center LEARNING OBJECTIVES
More informationIncreasing Zostavax Awareness and Uptake at Optimus Health Care. Background of Need
1 SEARCH Project Abstract Student: Colleen Linari, RN Preceptor: Luis Rojas, APRN July 2012 Increasing Zostavax Awareness and Uptake at Optimus Health Care Background of Need Herpes zoster (HZ) or shingles
More informationChapter 16 Pneumococcal Infection. Pneumococcal Infection. August 2015
Chapter 16 16 PPV introduced for at risk 1996 PCV7 introduced for at risk 2002 and as routine 2008 PCV13 replaced PCV7 in 2010 NOTIFIABLE In some circumstances, advice in these guidelines may differ from
More informationImmunization of Adults in High Risk Populations. Carol A. Kurbis MD, CCFP, FRCPC WRHA Medical Officer of Health
Immunization of Adults in High Risk Populations Carol A. Kurbis MD, CCFP, FRCPC WRHA Medical Officer of Health OBJECTIVES To review recommendations for immunization in adult populations, with a focus on
More informationSurveillance of invasive pneumococcal infection in Belgium
Surveillance of invasive pneumococcal infection in Belgium National Reference Laboratory Start in 198 Laboratory Microbiology UH Leuven (prof. J. Vandepitte) Capsular type determination Antibiotic susceptibility
More informationImpact of pneumococcal conjugate vaccine: US experience Stephanie Schrag Centers for Disease Control and Prevention Atlanta, GA
Impact of pneumococcal conjugate vaccine: US experience Stephanie Schrag Centers for Disease Control and Prevention Atlanta, GA San Jose, Costa Rica, August 2007 Pneumococcal Conjugate Vaccine Introduction
More informationU.S. Adult Vaccine Program Update: The Evolving Landscape. Laura P. Hurley, MD, MPH
U.S. Adult Vaccine Program Update: The Evolving Landscape Laura P. Hurley, MD, MPH Denver Health Objectives Discuss current status of adult vaccination in U.S. Review how the ACA might affect the adult
More informationSupplementary Materials. Determining the optimal vaccination schedule for herpes zoster: a cost-effectiveness analysis.
Supplementary Materials Determining the optimal vaccination schedule for herpes zoster: a cost-effectiveness analysis. Phuc Le, PhD, MPH and Michael B. Rothberg, MD, MPH. Long term efficacy of the live
More informationAged 70 or 78? There s now a vaccine to help protect you against shingles
Aged 70 or 78? There s now a vaccine to help protect you against shingles This leaflet describes shingles and the benefits of the vaccination. The new shingles vaccine is being phased in over the next
More informationVaccines and Adults: Our Collective Challenge Webinar
Vaccines and Adults: Our Collective Challenge Webinar Questions 1. What documentation would a pediatrician need to immunize adult parents to avoid some risk since they are non-patients of the practice
More informationSusan J. Rehm, MD, FACP, FIDSA Department of Infectious Disease Cleveland Clinic Cleveland, OH
Improving Adult Vaccination Practices Preventing Pneumococcal Disease in Your High-Risk and Older Patients Susan J. Rehm, MD, FACP, FIDSA Department of Infectious Disease Cleveland Clinic Cleveland, OH
More informationWhat are the new active vaccine recommendations in the Canadian Immunization Guide?
154 CCDR 17 April 2014 Volume 40-8 https://doi.org/10.14745/ccdr.v40i08a03 1 What are the new active vaccine recommendations in the Canadian Immunization Guide? Warshawsky B 1 and Gemmill I 2 on behalf
More informationAdult Immunization Rates
Adult Immunization Rates California Immunization Coalition Summit May 5, 2014 Eileen Yamada, MD, MPH California Department of Public Health Immunization Branch Adult Immunization Rates California Data
More informationVaccinations for Adult and Adolescent Women
Vaccinations for Adult and Adolescent Women Eliseo J. Pérez-Stable, MD Professor of Medicine DGIM, Department of Medicine University of California, San Francisco July 3, 2013 Declaration of full disclosure:
More informationINTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND BIO-SCIENCE
Amar PP,, 2014; Volume 3(3): 123-127 INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND BIO-SCIENCE A REVIEW ON HERPES ZOSTER AMAR PP 1, AJINKYA C 2, TOHID NB 2, ROHIDAS P 2, AVINASH C 2 1. Assistant
More information4/7/13. Vaccinations for Adults and Adolescents. Effect of Full Use of Adult Immunizations. General Vaccine Information
Vaccinations for Adults and Adolescents Nicholas A. Daniels, MD MPH Department of Medicine Professor of Clinical Medicine Declaration of full disclosure: No conflict of interest 2 Effect of Full Use of
More informationHERPES ZOSTER, COMMONLY
ORIGINAL CONTRIBUTION Herpes Zoster Vaccine in Older Adults and the Risk of Subsequent Herpes Zoster Disease Hung Fu Tseng, PhD, MPH Ning Smith, PhD Rafael Harpaz, MD, MPH Stephanie R. Bialek, MD, MPH
More information