PHA 6121 — Pharmacists in Immunization

immunity

body's ability to prevent the invasion of pathogens

vaccine

preparation that is used to stimulate the body's immune response against diseases

immunization

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

vaccination

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

1) active immunity

2) passive immunity

the 2 types of immunity

active immunity

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

passive immunity

is provided when a person is given antibodies to a disease rather than producing them through his or her own immune system

FALSE —

the results from active immunity are —

natural: infection

artificial: vaccination

on the other hand, these are produced from passive immunity —

natural: maternal antibodies

artificial: monoclonal antibodies

T or F:

the results from active immunity are —

natural: maternal antibodies

artificial: monoclonal antibodies

on the other hand, these are produced from passive immunity —

natural: infection

artificial: vaccination

antigen & antibodies

body's natural response

antigen

produced when new pathogen/disease enters the body;

for every new of this, body needs to build specific antibody that can grab onto it & defeat the pathogen

antibodies

for every new antigen, body builds this specific substance for it to grab onto the antigen & defeat the pathogen

vaccine

a tiny weakened non-dangerous fragment of organism & includes parts of antigen so it can learn to defeat the real organism that is to be eliminated

vaccinating

not only protects an individual, but also protects those in the community who are unable to be vaccinated

1) inactivated vaccines

2) live-attenuated vaccines

3) mRNA vaccines

4) subunit vaccines

5) toxoid vaccines

6) viral vector vaccines

6 types of vaccines

live-attenuated vaccines

- type of vaccine that has a weakened (attenuated) form of the pathogen

- typically 1-2 doses can give lifetime protection

- MMR vaccine

- rotavirus

- oral polio vaccine

- BCG vaccine

- yellow fever

- varicella vaccine

6 examples of live-attenuated vaccines

mRNA vaccines

- type of vaccine that creates proteins in order to trigger response

- COVID-19 vaccine (Pfizer, Moderna)

example of mRNA vaccines

subunit vaccines

- type of vaccine that contains killed, antigenic component of pathogen

- require several doses (booster shots)

- Haemophilus influenzae type B (Hib) vaccine

- hepatitis B vaccine

- pneumococcal vaccine

- acellular pertussis vaccine

4 examples of subunit vaccines

toxoid vaccines

- type of vaccine contain toxin made by pathogen

- may require booster shots

- tetanus toxoid

- diptheria toxoid

2 examples of toxoid vaccines

viral vector vaccines

- type of vaccine that has a modified version of a different pathogen as a vector to deliver protection

- the viral vector is a virus that does not cause serious illness (e.g. adenovirus/modified vaccinia Ankara virus)

COVID-19 (Janssen/Johnson & Johnson, AstraZeneca)

example of viral vector vaccines

inactivated vaccines

- type of vaccine that has a killed form of the pathogen

- does not provide immunity as strong as live vaccines

- requires several doses

- whole cell-pertussis

- inactivated polio vaccine

2 examples of inactivated vaccines

1) antigens

2) stabilizers

3) adjuvants

4) antibiotics

5) preservatives

5 components of vaccine

antigents

- a component of vaccine that is derived from disease-causing organisms

stabilizers

- a component of vaccine that maintains the effectiveness by maintaining stability of the product during storage, particularly where the cold chain in unreliable

- e.g.

a) MgCl2 (for OPV)

b) MgSO4 (for measles)

c) lactose-sorbitol and sorbitol-gelatin

d) 2-phenoxy ethanol

adjuvants

- a component of vaccine that stimulates the production of antibodies against the vaccine to make it more effective

- ability to enhance the immune response

- e.g. Aluminum gels/salts

antibiotics

- a component of vaccine that is used during the manufacturing phase to prevent bacterial contamination of the tissue culture cells in which the viruses are grown

- in trace amounts

preservatives

- a component of vaccine that is added to multi-dose vaccines

- e.g.

a) thimerosal (ethyl mercury-containing compound)

b) formaldehyde to inactivate viruses (IPV)

c) to detoxify bacterial toxins (diphtheria and tetanus)

- during production, a purification process removes all formaldehyde in vaccines

1) Infectious Diseases are still common

2) Non-communicable diseases are on rise

3) Disaster-related health problems increasingly affect the country

in the "Philippine Health Situation", what are the triple burden disease?

1) High incidences of all key communicable diseases with 13 out of 17 WHO recognized neglected tropical diseases remaining endemic

2) Increasing level of non-communicable diseases and high prevalence of all risk-factors

3) Being the third highest disaster-prone country in the

world

in the "Philippine Health Situation", what are the 3 health indicators?

50%

in the 3rd health indicator titled: being the third highest disaster-prone country in the world — how many percent of the population is living on less than $2 a day despite a 4% GDP growth annually for the past decade?

1) Prevalence of malnutrition plays a part in lowering resistance to infections

2) Increased number of immunocompromised patients due to NCDs

3) Increased hospitalizations predispose patients to nosocomial infections

4) Emergency situations during disasters like lack of potable water, poor sanitation, malnutrition and increased concentration of the population in evacuation & outbreaks

5) Poverty, heavy burden on individuals, & the health system to respond to treatment needs of the population highlight the importance of preventive measures

in the "Philippine Health Situation", what are the 5 factors that contribute to the rise of infectious diseases?

1) prevention of infection & infectious diseases

2) control of mortality, morbidity, & complications

3) protection of the unvaccinated population

4) societal & economic benefits of immunization

5) preventing development of antibiotic resistance

6) safe travel & mobility

7) protection against bioterrorism

8) enhancing equity

8 immunization program benefits & impact on public health

protecting against establishment of an infection

in the prevention of infection & infectious diseases (under the immunization program benefits & impact on public health), what is the action that has the example of —

Hepatitis A Vaccine: 90% protection against symptomatic disease & asymptomatic infections

sterilizing immunity (complete prevention of infection)

in the prevention of infection & infectious diseases (under the immunization program benefits & impact on public health), what is the action that has the example of —

Human papilloma virus (HPV): ability to completely prevent persistent vaccine-type infection

pre-exposure administration

in the control of mortality, morbidity, & complications (under the immunization program benefits & impact on public health), what is the action that has the definition of —

pre-exposure vaccination with a combination of several antigens- successful

post exposure administration

in the control of mortality, morbidity, & complications (under the immunization program benefits & impact on public health), what is the action that has the examples of —

rabies, hepatitis A and B, measles, & varicella

- pregnant women

- cancer patients

- immunocompromised individuals

in the control of mortality, morbidity, & complications (under the immunization program benefits & impact on public health), who are included in the groups that are most vulnerable to infections and with greatest need — 3 POSSIBLE ANSWERS

vaccines

in the control of mortality, morbidity, & complications (under the immunization program benefits & impact on public health), what can annually prevent almost 6 million deaths worldwide?

measles & mumps

in the control of mortality, morbidity, & complications (under the immunization program benefits & impact on public health), what infections may lead to neurological problems if there was a failure of prevention? — 2 POSSIBLE ANSWERS

congenital rubella syndrome

in the control of mortality, morbidity, & complications (under the immunization program benefits & impact on public health), what infections may lead to liver cirrhosis & cancer if there was a failure of prevention? — 2 POSSIBLE ANSWERS

herd protection of unimmunized individual

in the protection of the unvaccinated population (under the immunization program benefits & impact on public health), what is the name of the "protection" of the unimmunized individual?

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

in the protection of the unvaccinated population (under the immunization program benefits & impact on public health), what is the first mechanism?

"contact immunization" — where vaccine viruses may infect more individuals than those administered vaccine

in the protection of the unvaccinated population (under the immunization program benefits & impact on public health), what is the second mechanism?

protective effects of vaccines

in the societal & economic benefits of immunization (under the immunization program benefits & impact on public health), what translates into long-term cost savings?

influenza & hepatitis A

in the safe travel & mobility (under the immunization program benefits & impact on public health), what are the 2 most common vaccine-preventable diseases among travelers?

- rabies

- hepatitis B

- typhoid fever

- cholera,

- yellow fever

- Japanese encephalitis

- measles

in the safe travel & mobility (under the immunization program benefits & impact on public health), what are the 7 other common vaccine-preventable diseases among travelers?

cessation

in the protection against bioterrorism (under the immunization program benefits & impact on public health), what action is being made in the potential use of smallpox virus in bioterrorism?

perinatal & early infancy period

in the enhancing equity (under the immunization program benefits & impact on public health), what 2 periods are being focused on?

pregnancy

- inactivated influenza & Tdap vaccines are recommended during this period

live attenuated viral vaccines

e.g., MMR-II, Varivax, FluMist

in pregnancy, live, what is contraindicated due to the theoretical risk of virus transmission to the fetus?

cause severe or fatal reactions to immunosuppressed persons

in immunosuppresion, what can live attenuated vaccines do due to uncontrolled replication of the vaccine virus

to severely immunosuppressed persons with:

- congenital immunodeficiency

- leukemia

- lymphoma

- generalized malignancy

live vaccines are typically not recommended for which groups of immunosuppressed individuals?

disease eradication

disease elimination

what are the main targets of immunization programs?

disease elimination

means locally achieving immunity in more than 95% of the population

COMBINED measles, mumps, and rubbella (MMR) vaccine

what combined vaccine could eliminate rubella and mumps?

- environmental reservoir (tetanus) or animal reservoir (japanese encephalitis and rabies)

- misconceptions and the rise of anti-vaccination movement

what are the challenges of immunization program benefits and impact on public health?

routine vaccines

these are vaccines that may or may not be included in the NIP but are to be routinely used for children according to Philippine Pediatric Society (PPS), Pediatric Infectious Disease Society of the Philippines (PIDSP), and Philippine Foundation for Vaccination (PFV)

Recommended Vaccines for Special Group/Situations

These are vaccines that should be given to certain groups or situations

MR, Td, HPV

what are the vaccines included in the school immunization program?

BCG, monovalent Hep B, Pentavalent vaccine (DTwP-Hib-HepB), bivalent OPV, IPV, PCV, MMR, MR, and Td

what vaccines (9) are in the 2024 NIP?

Flucelvax, FluBlok, Fluzone High Dose, Fluzone Intradermal, Afluria

what are the available (5) preparations for inactivated influenza vaccine (IIV)?

soreness, eythema, and induration (1-2 days)

what is the ADR of inactivated influenza vaccine (IIV)?

egg allergy (epinephrine)

what is the main concern for inactivated unfluenza vaccine (IIV)?

6 months of age and OLDER

what is the recommended age for FLUCELVAX (2012)?

trivalent for 18-49 years old

what is the recommended age for FluBlok?

FluBlok

what is the recombinant influenza vaccine?

for >65 years old

what is the recommended age for Fluzone High dose?

Fluzone High Dose

has 4x as much hemagglutinin vs. regular adult vaccine

for 18-64 years old

what is the recommended age for Fluzone intradermal?

18-64 years old for Pharmajet Stratis 0.5mL needle-free Jet injector

6months and older for needle and syringe

what is the recommended age for Afluria?

for 2-49 years old

what is the recommended age for Flumist (2003)?

Flumist

Example of Live Attenuated Influenza Vaccine (LAIV)

Flumist

contains same virus as in IIV; single dose sprayer unit designed to deliver half a dose in each nostril

for non-pregnant; intranasal

for 50 years of age or older and aged >2 years who are at increased risk of pneumococcal disease; not approved for <2 years of age

what is the recommended age for Pneumovax 23?

Pneumovax 23

[pneumococcal polysaccharide vaccine (PPSV23)]

- contains phenol; single dose vial or syringe and a 5-dose vial; decreased response with immunodeficiency and chronic illness; IM or SQ

pain swelling or erythema

ADR of PPSV and PCV

for 6 weeks and over

what is the recommended age for Prevnar 13?

formaldehyde

tetanus toxin is inactivated by what?

ADR of Tetanus, Diptheria, Pertussis Vaccines

- fever of 40.5°C (48 hours)

- collapse or shock-like state (48 hours)

- persistent, inconsolable crying for more than 3 hours, seizure within 3 days

for 6 weeks to 6 years old

what is the recommended age for DTaP or TdaP?

filamentous hemagluttinin, pertussis toxn, and pertactin

what are the 3 antigens of Infantrix (DTaP)?

FH, PT, pertactin, and fimbriae types 2 and 3

what are the 5 components of Daptacel (DTaP)?

for 10 years and older; third trimester of pregnancy

what is the recommended age for Boostrix (TdaP)?

10 to 64 years old; third trimester of pregnancy

what is the recommended age for Adacel (TdaP)?

Boostrix

3 pertussis agents but in reduced quantity compared to pedriatic TdaP; has aluminum salts

Adacel

5 components but with reduced quantity of PT

Pediarix

what combination vaccine with DTaP is this?

diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B (recombinant) and inactivated poliovirus vaccine; pentavalent (5 components)

Pediarix

what vaccine is this?

DTaP (Infanrix) + Hepatitis B (Engerix B) + IPV

minimum age is 6 weeks old, given 3 doses at 2, 4, and 6 months for 6 weeks to 6 years old

what is the recommended age for Pediarix?

Pediarix

*not approved for 4th and 5th booster dose of DTaP or IPV series; may be used interchangeably with other vaccines

Pentacel

DTaP, IPV, and Haemophilus b Conjugate; DTaP-IPV solution should not be used separately

Kinrix

- DTaP + IPV indicated for 5th dose of DTaP or 4th dose IPV

for 4-6 years old

what is the recommended age for Kinrix?

for 12 months of age and older; administered in 2 doses

what is the recommended age for M-M-R II?

MMR vaccine

live attenuated vaccine that provides life-long immunity to 95% of the population; the second dose is for those 5% who did not respond to the first dose