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Pertussis and Influenza Vaccination PowerPoint Presentation

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Description : Biological preparation that provides active acquired immunity against a particular disease......

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Published on : May 03, 2022 | Views : 2568 | Downloads : 0

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Overview: Pertussis and Influenza vaccination Dr Sharol Maila (Supervisor: Dr Nemukula)
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Table of contents Introduction Pertussis Influenza South African Antenatal Care Conclusion References
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Introduction Vaccine: Biological preparation that provides active acquired immunity against a particular disease
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Introduction First vaccine: Cowpox vaccine 1771 (Latin vacca- cow) Vaccines: Live, live attenuated, Inactivated, Toxoids, polysaccharide/polypeptide and surface antigen Inactivated and toxoids vaccines relatively safe in Pregnancy Immunization in pregnancy: Maternal, fetal and neonatal protection
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Pertussis Bordetella Pertussis bacteria attach to cilia Respiratory infection (whooping cough) Discovered in 1906 (Octave Gengou and Jules Bordet) Pertussis Vaccine 1940 = ↓incidence by 75% Major cause of childhood morbidity and mortality in USA
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Pertussis Worldwide incidence 48.5 million Mortality ~ 295000/year Case fatality rate in infants <1 yr ~ 4% 2014: 24 mil cases globally in children less than 5 yrs with 160700 deaths 2018: 72.3/100000 incidence in infants less than 6 months
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Pertussis vaccine Trivalent vaccine Combined: inactivated/antigen (pertussis) and toxoid (diphtheria and tetanus) Available as DTaP (children)/Tdap (adults: lower conc. of dipth and pertussis) Safe in pregnancy
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Maternal vaccination NEONATAL PROTECTION (DTaP at 6 weeks) Maternal IgG antibodies transported by Placental neonatal Fc receptor (peak in last trimester) Peak response to Tdap = 2 weeks postvaccination Tdap at 27-36 gestation Antibodies by half at 12 months
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ACOG Recommendations Tdap during EACH pregnancy (27-36 gestation) Counsel patients on its safety Stock and administer vaccine Everyone that baby will be exposed to get vaccinated atleast 2 weeks prior to being in contact with baby
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ACOG Recommendations If no prior Tdap, then immediately postpartum Anytime: In cases of pertussis outbreak, wound management If given before 27-36, no need for repeat dose “cocooning” – not recommended anymore
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Influenza Single-stranded RNA Virus Subtypes: A, B and C (subclinical infection) First pandemic in 1580, 4 x pandemics in 19th century, 3 x in 20th century and 1 in 21st century WHO estimate 3-5 mil severe illness, 250000-500000 deaths Vulnerable groups: pregnant women, children <5yrs, elderly, chronic medical conditions and immunosuppressed
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Influenza 1936 Macfarlane Burnet: virus can grow on embryonated hens’ egg Inactivated vaccines late 1930s Live attenuated vaccine licensed in 2003
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Influenza Vaccine Inactivated influenza vaccine: IMI (IIV) and live attenuated influenza vaccine: Nasally (LAIV) Trivalent vaccines (H3N2, H1N1 and Influenza B) IIV safe in pregnancy at any trimester (CDC: egg allergy) Maternal, fetal and neonatal benefits Influenza vaccine not effective before 6 months, passive immunity NB! Influenza vaccine annually (every pregnancy)
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Maternal Protection Cox et al Higher hospitalization rate of pregnant women with respiratory illness during influenza season Neuzil et al Pregnant women more likely to be hospitalized with cardiopulmonary illness compared to postpartum
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1918 H1N1 pandemic report:
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Cook County Hospital (Sept – Nov 1918) 2154 Admitted (101 Pregnant) Pregnant: 52 died (51.4% mortality ~ 18.1% higher than general population) Non-pregnant: 719 died (33.3% mortality) 49 discharged but 42.7% aborted or went into preterm labour
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CDC and ACOG Recommendations Annual influenza vaccine (IIV) Counsel patients as part of ANC care OBGYN encouraged to stock, administer as well as vaccinate If cannot offer vaccine, to refer
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CDC and ACOG Recommendations OBGYN should encourage staff to get vaccinated Egg allergy (hives) should get vaccine appropriate for age and health status Egg allergy with severe symptoms : to administer in health setting Treat those with flue-like symptoms PEP in patients with potential high morbidity
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SA: Antenatal Care Do not form part of basic maternal care Td offered (no aP - Tdap) DTaP in the EPI schedule from 6 weeks Influenza vaccine for everyone annually (optional) Incidence of Pertussis and Influenza in South Africa
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20536 enrolled and 19429 tested (56.5% <5 yrs) 239/19429 tested positive (191 <5 yrs) Highest detection rates <2month (3.3%) and 2-5 months (2.3%) Higher Pertussis-associated hospitalization among HIV infected individuals 236 hospitalized: 10 mortalities (7 infants <6 months)
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Conclusion Influenza and pertussis: preventable contagious respiratory conditions Immunity not permanent Vaccination vital part of ANC ACOG encourages to recommend and offer (have in stock) to consider in RSA Tdap and IIV can be administered at same visit Passive immunity vital for the newborn
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References ACOG COMMITTEE OPINION. Sept 2017. Update On Immunization and Pregnancy: Tetanus, Diphtheria, and Pertussis Vaccination. ACOG. No. 718 ACOG COMMITTEE OPINION. April 2018. Influenca Vaccination During Pregnancy. ACOG. No. 732 Luteijn MJ, Brown MJ, Dolk H. Influenza and congenital anomalies: a systemic review and meta-analysis. Hum Reprod. 2014 April ; 29(4)809-23 Lingam GA, Letley L, Campbell H, Green D, Yarwood J, Ramsay M. Lessons learnt from the implementation of amternal immunization programs in England. Hum. Vaccines Immunoter. 2012, Vol 12, No.11, 2934-2939 Kara E, Lingan GA, Andrews N, Campbell H, Ribeiro S, Donegan K. Effectiveness of maternal pertussis vaccination in England: an observational study. 25 July 2014 The Lancet. Vol 384, Issue 9953 Pg 1521-1528 Rasmussed SA, Jamieson DJ, Uyeki TM. Effects of influenza on pregnant women and infants. Sept 2012. AJOG Vol 207, Issue 3. Pages S3-S8
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References Havers FP, Moro PL, Hariri S, Skoff T. Epidemiology and Prevention of vaccine-preventable diseases. CDC Chapter 16: Pertussis. Available on: https://www.cdc.gov/vaccines/pubs/pinkbook/pert.html#:~:text=Outbreaks%20of%20pertussis%20were%20first,mortality%20in%20the%20United%20States. [Accessed 17/01/2022] Hall E. Epidemiology and Prevention of Vaaccine-preventable disease. CDC. Chapter 12: Influenza. Available on: https://www.cdc.gov/vaccines/pubs/pinkbook/flu.html [Accessed 17/01/2022] Woolston WJ, Conley DO. Epidemic pneumonia (spanish influenza) in Pregnancy: Effect in one hundred and one cases. JAMA: 7 December 1918; 71 (23):1898-1899 Wolter N, Cohen C, Tempia S, Walaza S, Moosa F, du Plessis M, McMorrow ML, Treurnicht FK, Hellferscee O, Dawood H, Variava E, Gottberg A. Epidemiology of Pertussis in Individualls of all ages Hospitalized with Respiratory Illness in South Africa January 2013 – December 2018. Clinical Infectious Diseases: 1 August 2021. Vol 73: Issue 3 Pg: e745 – e753 National Institute for communicable diseases. 17 November 2021. Alert: Increase in influeza cases in South Africa. Available on: https://www.nicd.ac.za/alert-increase-in-influenza-cases-in-south-africa/ [accessed 29/01/2022]