6.1 | Pharmacists in Immunization

Immunity

Body's ability to prevent invasion of pathogens

Immunization

- process

- by which a person becomes protected against a disease through vaccination

Vaccine

- preparation

- to stimulate the body's immune response against diseases

Vaccination

- act

- introducing a vaccine into the body to produce protection from a specific disease

Immunity: Types (2)

1. Active

2. Passive

Active Immunity

exposure to a disease organism triggers the immune system to produce antibodies to that disease

Passive Immunity

a person is given antibodies to a disease rather than producing them through their own immune system

Natural Immunity: Examples (2)

1. Infection

2. Maternal antibodies

Artificial Immunity: Examples (2)

1. Vaccination

2. Monoclonal antibodies

Body's Natural Response [to Antigens]

When a new pathogen or disease enters our body, it introduces a new antigen.

For every new antigen, our body needs to build a specific antibody that can grab onto the antigen and defeat the pathogen.

How do vaccines work?

- tiny weakened non-dangerous fragment of the organism

- includes parts of the antigen

- It's enough that our body can learn to build the specific antibody

The body learns about the antibody

Then if the body encounters that real antigen later, as part of the real organism, it already knows how to defeat it.

Community Immunity

Community vaccination protects the whole community, even those who can't vaccinate.

Philippine Health Situation

Triple Burden of Disease

Triple Burden of Disease (3)

1. Infectious diseases are still common

2. NCDs are on rise

3. Disaster-related health problems increasingly affect the country

Health indicators (3)

1. CDs

2. NCDs

3. third highest disaster-prone country

Health indicators: CDs

13 out of 17 WHO recognized neglected tropical diseases remaining endemic

Health indicators: NCDs

Increasing level

high prevalence of all risk-factors

Health indicators: 3rd highest disaster-prone country

50% of the population: living on less than $2 a day despite a 4% GDP growth annually for the past decade

Factors Contributing to the Rise of Infectious Diseases (5)

1. Malnutrition

2. ↑ Immunocompromised Px

3. ↑ Hospitalizations

4. Emergency situations during disasters

5. Poverty & heavy burden on individuals and the health system

1. Malnutrition

lowers resistance to infections

2. ↑ Immunocompromised Patients

due to NCDs

3. ↑ Hospitalizations

predispose patients to nosocomial infections

nosocomial infections

hospital-acquired infections

4. Emergency situations during disasters: Examples (4)

1. lack of potable water

2. poor sanitation

3. malnutrition

4. increased concentration of the population in evacuation: outbreaks

5. Poverty & heavy burden on individuals and the health system to respond to treatment and needs of the population

highlight the importance of preventive measures

Immunization Program Benefits & Impact on Public Health (8)

1. Prevention of infection & infectious diseases

2. Control of mortality, morbidity, & complications

3. Protection of the unvaccinated

4. Societal & Economic benefits

5. Preventing AMR development

6. Safe travel & mobility

7. Protection vs. Bioterrorism

8. Enhancing equity

1. Prevention of infection & infectious diseases

- against establishment of an infection

- Sterilizing immunity or complete prevention of infection

against establishment of an infection: Example

Hepatitis A vaccine

= 90% protections against symptomatic disease and asymptomatic infections

Sterilizing immunity: Example

HPV

- to completely prevent persistent vaccine-type infection

2. Control of mortality, morbidity, & complications: Administrations (2)

1. Pre-exposure administration

2. Post-exposure administration

Pre-exposure administration

Pre-exposure vaccination with a combination of several antigens successful

Post-exposure administration (4)

1. Rabies

2. Hepatitis A and B

3. Measles

4. Varicella

Groups that are most vulnerable to infections and with the greatest need (3)

1. Pregnant women

2. Cancer patient

3. Immunocompromised

Vaccines can annually prevent almost _ deaths worldwide

Vaccines can annually prevent almost 6 million deaths worldwide

Failure to prevent infections (4)

1. Congenital rubella syndrome

2. Liver cirrhosis

3. Cancer

4. Measles and mumps (may lead to neurological problems)

3. Protection of the unvaccinated

"Herd Protection" of an unimmunized individual

Herd Protection: Mechanisms (2)

1. First Mechanism

2. Second Mechanism

First Mechanism

reducing amount and/or duration of pathogen shedding, thereby retarding transmission

Second Mechanism

- via "contact immunization"

- where vaccine viruses may infect more individuals than those administered vaccine

4. Societal & Economic benefits

Protective effects of vaccines translate into long-term cost savings

6. Safe travel & mobility

MOST COMMON vaccine-preventable diseases among travelers

MOST COMMON vaccine-preventable diseases among travelers (2)

1. Influenza

2. Hepatitis A

Other vaccine-preventable diseases among travelers (8)

1. Rabies

2. Hepatitis B

3. Typhoid

4. Cholera

5. Yellow fever

6. Japanese encephalitis

7. Measles

Protection vs. Bioterrorism

Cessation in the potential use of smallpox virus in bioterrorism

Enhancing equity

"perinatal and early infancy period"

Main Targets of Immunization Programs (2)

1. Disease Eradication

2. Disease Elimination

Challenges

1. With environmental or animal reservoir

2. Misconceptions & anti-vaccination

Environmental reservoir: Example

Tetanus

Animal reservoir: Examples (2)

1. Japanese encephalitis

2. Rabies

Pharmacists in Immunization Programs (2)

1. utilize their practice settings to advocate for immunization

2. increase their responsibilities in the area of Public Health

Pharmacists-Run Immunization Clinics: Purpose (3)

1. to provide an alternative resource for immunization

2. a resource person for immunization information

3. as an entry point for patients to receive immunization through the health system

Considerations in Establishing Pharmacy-Based Immunization Services

Education and Training

Education and Training (2)

1. Curricula

2. continuing education programs and resources

Curricula

incorporate the immunization program as an elective to promote the role of the pharmacist in preventive health

Pharmacy-Based Immunization Advocacy: Guidelines (5)

1. Prevention

2. Partnership

3. Quality

4. Documentation

5. Empowerment

1. Prevention

- by being vaccine advocates

- adopt one of the three levels of involvement in vaccine advocacy

Levels of Involvement in Vaccine Advocacy

Pharmacist as:

1. Educator

2. Facilitator

3. Immunizer

Educator

motivating people to be immunized

Facilitator

hosting others who immunize

2. Partnership

administer immunizations and do so in partnership with their community

3. Quality

achieve and maintain competence to administer immunization

4. Documentation

- document immunizations fully

- report clinically significant events

5. Empowerment

educate patients about immunizations and respect patients' rights