Vaccinations Department of Children’s Infectious Diseases MUDr. Martin Sihlovec Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 2 Vaccine types 1.Live weakened = attenuated vaccines •TBC, Polio (Sabin oral), yellow fever) 2.Inactivated vaccines •Hepatitis A, KME 3.Toxoid vaccines •Tetanus, diphtheria, meningococcal diseases, pneumococcal diseases, haemophilus 4.Subunit and conjugate •Flu, meningococcal diseases 5.Recombinant •HPV, Hepatitis B 6.mRNA •SARS-CoV-2 Polyvalent x Combined vaccines (Prevenar 13 x Hexacima) Advantages Disadvantages Application schedule Klinika (ústav) Fakultní nemocnice Brno a Lékařské fakulty Masarykovy univerzity 3 Vaccination schedule valid in CZ from 1 Jan 2022 4 Hexa vaccine = DTaP+VHB+HIB+IPV (2+1) Tetanus – injury by a sharp object, dirty injuries of unvaccinated individuals, abdominal operations Diphtheria Pertussis – pregnancy from od 26 wks to 36 wks Hepatitis B (in CZ, vaccinations started in 7/2001) – injury by a sharp object, rape H. influenzae type B Poliomyelitis (inactivated) -Vaccination from 9 wks of age, max. application by 7 years of age. -We can also vaccinate with split vaccination substances in the same schedule Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 5 M - M - R vaccine (1 + 1) Measles Mumps Rubella -We start the vaccination from 13 months of age up to 1.5 years of age. The second dose is administered between year 5 and 6 of life -live attenuated vaccine, application s.c., i.m. Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 6 Optional vaccinations for children Meningococcal disease (MEN ACWY, MEN B) Pneumococcal disease (Synflorix, Prevenar 13, Vaxneuvance, Prevenar 20?) Varicella Rotavirus infections TBC Flu Tick-borne encephalitis HPV VHA RSV (passively) Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 7 Meningococcal disease Goal: to prevent IMO = invasive meningococcal disease (purul. meningitis, sepsis or both Application i.m., s.c. MEN B vaccines – Trumenba for children from 10 years of age - Bexsero from infant age, from 2 months MEN ACWY vaccines – Nimenrix, MenQuadfi, Menveo -Protection for ca 10 years Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 8 Pneumococcal disease IPO – Invasive pneumococcal disease = a sever disease with a laboratory proof of pneumococcus from a clinical material, which is sterile under normal conditions. Bronchopneumonia with fluidothorax Purulent meningitis Sepsis We can vaccinate from 2 months of age at any time Application i.m., s.c. Recommend this vaccination to children suffering from repeated OMA and sinusitis Pneumococcus, Pneumococcal Disease, and Prevention - ScienceDirect Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 9 Varicella – Zoster virus This vaccine is suitable for all children and adults who have not had varicella yet (except for pregnant women and immunocompromised individuals) to prevent severe course of varicella. Live attenuated vaccine Application primarily s.c. or i.m. This vaccine can be used also as a post-exposure prophylaxis ideally within 72 hrs from exposition, max. 5 days. We start vaccinating against VZ from 9 months of age at the earliest; mostly at 12 months, in 2 doses 4-8 weeks apart. 1720 CZK 1910 CZK Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 10 TBC Only i.d. application Live attenuated vaccine This vaccine is applied within the 4th day and the 6th week of age Only newborns/infants are routinely vaccinated nowadays (from 4th day to completed 6th week of age) to prevent the risk of TBC occurrence. Tuberkulóza (pediatrie) – WikiSkripta Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 11 Rotavirus vaccines Both available vaccines are live attenuated vaccines to be taken orally. Rotateq – from 6 to 32 weeks of age, administered in 3 doses, protection lasts to approx. 7 yes of age, protecting against 5 serotypes Rotarix - from 6 to 24 weeks of age, administered in 2 dávkách, protection lasts for approx. 3 years, protecting against 1 serotype CAVE: Risk of intussusception RotaTeq(1.5 ml/dose) | Healthcare Pharmaceuticals Ltd. (Mfg. by: MSD) | Remedive - Online Medicine Store & Doctor Appointment 1600 CZK A vueltas con la vacuna del rotavirus 1650 CZK Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 12 Flu vaccines We vaccinate primarily to prevent complications (the vaccine does not prevent infection) and to protect vulnerable population groups - do not be afraid to vaccinate pregnant women!!! There are live attenuated and also split (subunit) vaccines available The best vaccination time is before the flu season starts, i.e. October/November In tropical zones, the flu season is year-round!!! I n the southern hemisphere, the flu season is during European summer months. We can vaccinate children from 6 months of age (If the child has never been vaccinated, they have to have the 2nd dose one month apart by the age of 9). From age 9 forward, 1 dose is sufficient for a year of protection. A/Victoria/4897/2022 (H1N1)pdm09 – varianta, A/Darwin/9/2021 (H3N2) – varianta, B/Austria/1359417/2021 – varianta (patřící do linie B/Victoria/2/87). B/Phuket/3073/2013 – varianta (patřící do linie B/Yamagata/16/88) OČKOVÁNÍ Vaxigrip | Medikeo Ambulance Child flu vaccine 'rationing' may force practices to turn away patients | GPonline Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine Various application methods by the given vaccine type – s.c., i.m., i.n. 13 Tick-borne encephalitis - it is not a virus occurring exclusively in Europe Meningoencephalitis, Encephalomyelitis The best prevention and “treatment” is the vaccination There are 2 vaccines available – Encepur and FSME-Immun, we can vaccinate from 1 year of age, in 2+1 schedule or in an accelerated schedule 0-7-21, re-vaccination as age appropriate every 3-5 years. Application i.m., s.c. Výskyt TBEV v klíšťatech Klíšťovou encefalitidou se v ČR stále nakazí stovky lidí ročně | Aktuality | Zpravodajství | FLORENCE - Odborný časopis pro ošetřovatelství a ostatní zdravotnické profese Očkování proti klíšťové encefalitidě | Klíšťovka - O klíšťové encefalitidě 1090 CZK Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 14 Human papillomaviruses (HPV) The vaccine only has preventative effects – genital warts, cervical cancer, cancer of vagina, vulva, anus and penis, cancer in the head and throat (pharynx), larynx papillomatosis. Approx. 80 % of men and women encounter HPV in their life. The vaccine protects against 2 types causing genital warts (6, 11) and also against 7 high risk types of HPV causing malignant diseases (16, 18, 31, 33, 45, 52, 58). We can start the vaccination from the 9 year of life, according to SPC up to 45 years of age, but there is no factual age limit. Application - i.m. Respirační papilomatóza - příznaky, projevy, symptomy - Příznaky a projevy nemocí Icons For Male Or Female Gender Themosaurus Support 3672 | Hot Sex Picture Gardasil 9 Full Prescribing Information, Dosage & Side Effects | MIMS Singapore 3528 Kč Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 15 Injury by a sharp or contaminated object Always check the vaccination log and the last dose of tetanus vaccination! Vaccination against: •Hepatitis A •Hepatitis B •Tetanus Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 16 Vaccinations for travel Regular “Routine” vaccinations (T/Tdap, poliomyelitis, MMR, sezónní chřipka, IPO, MEN “Required” vaccinations YF, IMO ACWY, poliomyelitis “Recommended” vaccinations Always plan your vaccinations in advance! Complications from “vaccination” infections are approx. 1 % of health issues during travels. Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 17 Hepatitis A = VHA The “unwashed hands” disease We administer 2 vaccine doses 6-18 months apart. Protection comes into effect approx. 14 days after the first dose. After completing the full vaccination schedule, the vaccinated person becomes immune to Hep A for at least 20 years. Post-exposure prophylaxis is also possible. We can vaccinate as early as from 1 year of age. The vaccine is inactivated, application i.m, s.c. Map 5-06 Estimated age at midpoint of population immunity (AMPI) to hepatitis A, by country Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 18 Yellow fever Hemorrhagic fevers We can vaccinate from 9 months of age, according to SPC up to 60 years. Live attenuated vaccine, application i.m., s.c. Protection for at least 10 yrs, vaccination certificate even state is as “lifelong” Map: Africa showing areas at risk for Yellow Fever Transmision in Angola, Tanzania, Democratic Republic of the Congo, Republic of the Congo, Gabon, Equatorial Guinea, Burundi, Rwanda, Uganda, Kenya, Somalia, Ethiopia, Central African Republic, Cameroon, Nigeria, Benin, Ghana, Cote d'Ivoire, Liberia, Sierra Leone, Guinea, Buinea-Bissau, The Gambia, Senegai, Burkina Faso, Togo, and parts of Mauritania, Mali, Niger, Chad, and Sudan. Map: South America showing areas at risk for Yellow Fever Transmision in Columbia, Venezuela, Guyana, Suriname, French Guiana, Brazil, Paraguay, and parts of Ecuador, Peru, Bolivia, Argentina, and Uruguay Aedes Species Eggs, Larvae, Pupae, and Adults | Mosquitoes Image Gallery | CDC STAMARIL - KalbeMed Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 19 Typhoid fever Typhoid fever – fever, headaches, diarrhea is not typical! Salmonella typhi - ATB treatment! Typhim Vi – polysacharid vaccine, protection for 3 years, repeated vaccination reduced efficiency. According to vaccine type, application i.m. or p.o. Typhoid | Beware of the Bugs TYPHIM VI - Ruzovadistribuce.cz Vivotif®, the oral alternative to injectable typhoid Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 20 Poliomyelitis Transferable polio ≠ Cerebral palsy ImovaxPOLIO – inactivated vaccine, schedule 2+1, protects against all 3 serotypes, application i.m. or s.c. Required vaccination when traveling to Mecca (SA) Výskyt poliovirů ve světě Imovax Polio Vaccine: View Uses, Side Effects, Price and Substitutes | 1mg Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 21 Rabies, Lyssa If the virus gets into the neuron = 100% death (ID: 7 days to 6 months) Pre-exposition prophylaxis: 0 – 7 – (21/28) Post-exposition prophylaxis: 0-3-7-14-28 + RIG (Rabies imunoglobulin) We can administer this vaccine from 2 months of age, but there is essentially no contraindication to the vaccine! Verorab – inactivated vaccine with a good safety profile, well tolerated, application i.m. or s.c. Rabies Lyssavirus - microbewiki Transmission and pathogenesis | Rabies - Bulletin - Europe Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 22 Dengue fever “Break-bone fever” Transmitted from Aedes mosquitoes, 4 sérotypy We use the Qdenga vaccine for rophylaxis. We use the Dengvaxia vaccine after the dengue fever infection. Qdenga – live attenuated vaccine, administered in 2 doses 3 months apart, only s.c. application https://www.ockovacicentrum.cz/userfiles/image/horecka%20dengue.png Qdenga Full Prescribing Information, Dosage & Side Effects | MIMS Thailand Pregnant and breastfeeding women must not use this vaccine! Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine 23 Resources Infectious Diseases Textbook, School of Medicine MUNI – L. Krbková, P. Husa https://www.vakcinace.eu/ https://www.cdc.gov/vaccines/index.html https://wwwnc.cdc.gov/travel https://www.cdc.gov/vaccines/acip/recommendations.html https://infektologie.cz/ Department of Children’s Infectious Diseases, University Hospital Brno and Masaryk University School of Medicine