Pharm Vaccine Presentation for Power Point 97-2004

8/9/2019 Pharm Vaccine Presentation for Power Point 97-2004

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Presented by:Date:

Location:

ChildhoodChildhood

vaccines at workvaccines at workin Canadain Canada


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The case for immunization

Vaccine safety

Vaccines in Canada

Myths, facts and commonly asked questions

Public policy

esources

Presentation overviewPresentation overview

2010 Canadian Paediatric Society I www.cps.ca


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!ased on Your Childs Best Shot:

A parents guide to vaccination

"#rdedition, $%%&'

For updates including position statements from the

CPS Infectious Diseases and Immuniation Committee

and current information for parents! "isit the CPS

we#sites$ www.cps.caand www.caringforkids.cps.ca

%e"iewed #y the CPS Infectious Diseases andImmuniation Committee. &ead re"iewers$

Dr. 'o# 'artolussi and Dr. Dorothy (oore.

Sources of informationSources of information



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The case forThe case for

immunizationimmunization



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Vaccines save lives:A public health success story Vaccines are safeand effective: The diseases they prevent can

cause permanent disability or even death

Its a small world: Travelcan spread rare diseases quickly Many vaccine-preventable diseases have no effective treatments For some diseases like tetanus infection does not produce

immunity: Vaccines produce immunity

! "ast but not least !

Why we immunizeWhy we immunize



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Vaccines protect everyone

Directly:the person vaccinated and

Indirectly:people who are vulnerable to disease e#$ babieschildren the elderly people with a weak immune system Vaccines keep communities healthier: children in school

parents workin# people interactin# normally



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Immunology 101 %acteria and viruses have unique proteins and polysaccharides

&comple' su#ars( on their sur)aces called antigens

Immune system tar#ets anti#ens usin# antibodiesand lymphocytes Lymphocytes &a type o) white blood cell(* include %-cells T-cells

and memory cells emory cells enable the immune system to reco#ni+e #erms it has

seen be)ore creatin# immune memory

How vaccines workHow vaccines work



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) Long!lasting immunity depends on memory cells"Immune

memory is the ability the immune system acquires to identi)y the

presence o) a #erm and destroy it T#o #ays to achieve immunity:,atural in)ection or

immuni+ation

$ %atural infectioncauses illness and can lead to complications

permanent dama#e even death

$ Vaccinesprotect without causin# severe illness

ImmunityImmunity



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Types of (accines

T)P* + V-CC./* *0-MPL*1

*illed! intact "irus Inacti"ated polio "accine! hepatitis + "accine

*illed! intact #acteria ,ral cholera "accine -Duoral/

*illed! disrupted "irus Influena "accine

&i"e! attenuated -weaened/ #acteria ,ral typhoid "accine! 'C "accine -for '/

&i"e! attenuated -weaened/ or genetically modified "irus (easles! mumps! ru#ella! "aricella! yellow fe"er"accines oral polio! rota"irus "accines intranasalinfluena "accine

Purified #acterial protein +cellular pertussis "accine! in3ecta#le typhoid "accine

Purified #acterial polysaccharide -comple4 sugar/ Haemophilus influenzaetype #! pneumococcal andmeningococcal "accines

Purified "iral protein 5epatitis ' "accine! human papilloma"irus "accine

Inacti"ated #acterial to4in Diphtheria and tetanus to4oids

Immunology of vaccinesImmunology of vaccines



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D.1*-1*-V*-2* /3M!* + C-1*1 -/D *L-T*D D*-T41-per year/

!efore Vaccine -fter Vaccine

Diphtheria 12!000 cases with 1!000 deaths 067 cases with 0 deaths

Tetanus 80697 cases with :0670 deaths 062 cases and no deaths since 1;;1

Pertussis Polio 2!000 cases in last epidemic in 1;7; 0

4ib 1!700 cases of meningitis and 1!700 cases ofinfections of #lood! #one! lungs! sin! 3oints

+#out ! or


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D.1*-1*-V*-2* /3M!* + C-1*1 -/D *L-T*D D*-T41-per year/

!efore Vaccine -fter Vaccine

Pneumococcus

4epatitis ! 20!000 new cases! with :>0@700deaths

? 1!000 cases

Menin5ococcus 200@:00 cases! with 20@:0 deaths Program too new to see full effect

4epatitis - 10!000@20!000 cases Program too new to see full effect

4uman papilloma(irus"4PV'

1!


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DISEASE EFFECTS OF DISEASE SIDE EFFECTS OF VACCINE

Diphtheria

Severe sore throat, marked weakness,nerve damage, heart failure !eath in"#$ of cases

!TaP vaccine% $ of infants have localredness, 'ain( ) *$ have fever( moreredness and swelling with +ooster at -.years

Tetanus To/in a0ects nerve endingsleading to'ainful muscle s'asms and seizures

See a+ove for !TaP 1ocal redness and 'aincommon with adult +ooster

Pertussis Severe s'asms of cough lasting 2-.weeks, 'neumonia, convulsions 3raindamage or death in " of every ##infants

See a+ove for !TaP The risk of +rain damageafter 'ertussis vaccine is too small to +emeasured

Polio 4uscle 'aralysis in " out of "## 'ersonsinfected with 'olio !eath in severecases

IPV 5o risk of disease from vaccine 6ivencom+ined with !TaP 7see a+ove for sidee0ects8

Hib 4eningitis kills in *$ of cases and leadsto +rain damage and deafness in "#-

"*$ of survivors

6iven in com+ination with !TaP9IPV 7seea+ove for side e0ects8

Measles Severe +ronchitis, high fever, rash for :-" days( death in " 'er ",### cases(ence'halitis in " 'er ",### cases

6iven com+ined with mum's and ru+ellavaccines 744;8 *-"#$ have fever with orwithout rash


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DISEASE EFFECTS OF DISEASE SIDE EFFECTS OF VACCINE

Rubella =ever, swollen glands, rash 5osym'toms in a+out *#$ of cases

Severe damage to fetus if motherinfected during ?rst trimester of'regnancy

6iven com+ined with mum's andru+ella vaccines 744;8 *-"#$ have

fever withor without rash


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&mallpo' has been eradicated",o cases anywhere in the world

since ./0/$ 1hildren are no lon#er vaccinated a#ainst smallpo' (aralytic polio eliminated from most of the #orld"Today

endemic in only )our countries* A)#hanistan India ,i#eria

2akistan3 1ases dropped )rom 456666 in ./77 to .868 in 966/

3 :ecent outbreaks in )ormer ;oviet republics o) Ta


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*hen vaccination rates decline) rates of disease increase >'ample* In the late ./76s )ormer ;oviet =nion states saw vaccine

supplies disrupted collapse o) their public health system and

socioeconomic instability

:esult* decrease in childhood immuni+ation rates ?iphtheria epidemic )ollowed* more than .56666 cases and more

than @666 deaths in the newly independent and %altic states Mass vaccination pro#ram eventually controlled the epidemic Lesson: +omplacency can be fatal

Why we 7still8 immunizeWhy we 7still8 immunize



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utbreaks occur )or di))erent reasons such as*(ublic doubt:In the early 9666s a )lawed autismBMM: study in the

=$C$ led to decline in measles vaccination

3 :esults* Increase in local measles in)ection rates and deaths and

spread o) measles to other countries

3 "esson* Vaccination must continue to prevent disease outbreaksTravel:Measles and mumps have been introduced into 1anada by

travellers causin# local outbreaks9667* 2olio spread by travellers )rom the @ countries where it remains

endemic to 96 others3 "esson* Its a small worldD Travel can spread a rare disease very

quickly


Why out+reaks 7still8 occurWhy out+reaks 7still8 occur


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*aning immunity:"ar#e mumps outbreak in 9660-67$ ;tarted in,ova ;cotia spread to ,ew %runswick and Alberta with sporadic

cases elsewhere

Mainly a))ected 96 to 9/-year-olds in school settin#s

2rompted recommendation )or a second dose o) vaccine )or hi#h

school colle#eBuniversity students who had received only one dose in

early childhood

Lesson: There may be a need for a second ,booster- dose of

mumps vaccine

Why out+reaks 7still8 occur (contd)


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Vaccine safetyVaccine safety



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%3+I:,ational Advisory 1ommittee on Immuni+ation makes

recommendations to the 1hie) 2ublic Eealth ))icer +I+: 1anadian Immuni+ation 1ommittee assesses ,A1I

recommendations and advises on operational plans (rovinces4territoriesuse ,A1I and 1I1 recommendations to

develop immuni+ation pro#rams ,A1Is Canadian Immunization Guide: Geb-based #uidelines

)rom the 2ublic Eealth A#ency o) 1anadapublished every @ years

&most recent edition 96.6( at www$phac-aspc$#c$ca +anadian (aediatric &ociety:In)ectious ?iseases and

Immuni+ation 1ommittees position statements at www$cps$ca

;ecommendations for;ecommendations for

vaccine usevaccine use



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3dverse events:Eealth e))ects occurrin# a)ter immuni+ation thatmay or may not be related to the vaccine

Mild adverse events such as )ever and swellin# at the in


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+anadian 3dverse 5vents 6ollo#ing Immuni7ations &urveillance

&ystem +356I&&: :eceives reports )romdoctors nurses 3dvisory +ommittee on +ausality 3ssessment 3++3: :eviews all

reported cases o) serious adverse events I(3+T: Immuni+ation Monitorin# 2ro#ram A1Tive The Vaccine 3dverse 5vent 8eporting &ystem &V358&: 2ost-

marketin# sa)ety surveillance pro#ram in the =$;$ Institute of edicine I9) "&":Immuni+ation ;a)ety :eview

1ommittee /3+V& *;9:lobal Advisory 1ommittee on Vaccine ;a)ety

>ntities involved in>ntities involved in

monitoring vaccine safetymonitoring vaccine safety



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Vaccines in CanadaVaccines in Canada



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;outine childhood vaccines;outine childhood vaccines

a#ainst diphtheria tetanus pertussis

polio and bacterial in)ections

caused by Eib &Haemophilus

influenzaetype b( includin#

menin#itis &a brain in)ection( and

other serious in)ections 8: 2rotects a#ainst measles

mumps and rubella

;epatitis . vaccine

Varicella chickenpo' vaccine

&easonal influen7a ,fluvaccine

Tdap: Tetanus diphtheria and

pertussis booster )or teens and

adults


(neumococcal vaccine:2rotects

a#ainst bacterial in)ections caused byStreptococcuspneumoniaeincludin#

menin#itis pneumonia and ear

in)ections

eningococcal vaccine:2rotects

a#ainst bacterial in)ections caused byNeisseria meningitidis includin#

menin#itis and septicemia a serious

blood in)ection

;(V vaccine: 2rotects a#ainst human

papillomavirus types that cause

cervicalBva#inal cancer and #enitalwarts

8otavirus vaccine: 2revents

rotavirus diarrhea


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Additional vaccines or aAdditional vaccines or a

Bcatchu'D scheduleBcatchu'D schedule 1hildren with certain chronic conditions or who travel outside o)

,orth America may require additional vaccines 1hildren new to 1anada may not have received vaccines which are

routine here 1hildren who move within 1anada may miss a dose o) vaccine

because schedules are not uni)orm across the country



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PrecautionsPrecautions

Delay#ivin# vaccine i) child has* Moderate to severe illness 2eople treated with blood products should not #et a live vaccine

&e#$ measles mumps rubella varicella( )or 4 months or more$

?ependin# on the blood product and dose received these vaccinesmay not work

Don=t delayvaccination because o) minor illness &e#$ a cou#h or

cold with or without )ever($



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1aused by a to'in made by bacteria that in)ect the nose throat orskin

1an cause breathin# problems heart )ailure nerve dama#e kidney

)ailure About . person in .6 dies ;pread by close direct contact withdroplets )rom a cou#h or

snee+e %e)ore ./66 one o) the main causes o) childhood death$ An

estimated .9666 casesByear in 1anada with .66 deaths ./9@* /666 cases in 1anada :outine immuni+ation o) 1anadian children a)ter ./46 ;ince ./74*


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Inactivated bacterial to'in

iven with tetanus acellular pertussis polio and Eib vaccines as

5-in-. Also #iven with tetanus and pertussis as a booster in adolescence Also #iven with tetanus as a boosterHrecommended every .6

years )or adults 1ommon local reactions* redness swellin# pain and tenderness at

the in


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1aused by a to'in made by bacteria that block normal control o)nerve re)le'es in the spinal cord* also known as lock


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Inactivated bacterial to'in

Most o)ten #iven with diphtheria acellular pertussis polio and

Eib vaccines as 5-in-. Also #iven with diphtheria and pertussis as a booster in

adolescence Also #iven with diphtheria as a boosterHrecommended every

.6 years )or adults 1ommon local reactions* redness swellin# pain and tenderness

at the in


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:espiratory in)ection caused by bacteria* whoopin# cou#hJ 1auses severe cou#hin# spells )ollowed by a whoopJ sound "asts 8 to .9 weeks 96-46K o) in)ants with pertussis will be hospitali+ed . in @66 in)ants will have brain dama#e Very contagious: &pread by close) direct contact #ithdroplets

from a cough or snee7e

%e)ore vaccine* 46666-56666 casesByear with 56-.66 deaths Today* 4666 cases in 1anada with about 5 deaths each year

8ecent years: increasing number of cases in teens) youngadults" (ertussis still a common cause of chronic cough

> ? #eeks in teens and adults


PertussisPertussis


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Ghole-cell vaccine introduced in 1anada in ./@4

Acellular pertussis replaced whole-cell vaccine in .//0 2uri)ied bacterial proteins* )ewer side e))ects iven with diphtheria tetanus polio and Eib vaccines as 5-in-. 3lso given to older children) teens and adults as a booster)

combined #ith Td

Immuni7ing parents) adults #orking #ith children protects

babies too young to be fully immuni7ed

?oes not prevent in)ection in everyone but e))ective in reducin#

severity o) illness and the risk o) complications

Minor local side e))ects are common nly contraindication* anaphylactic or other serious aller#ic

reaction to a previous dose o) the vaccine

Pertussis vaccine



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1aused by poliovirus %e)ore ./55 a common in)ection in 1anada Most in)ections asymptomatic &no symptoms( or mild but .-5K

cause menin#itis and .K paralytic polio Virus in throat and )eces o) people who are in)ected* spreads by

close direct contact with throat secretions and indirect contact

&e#$ contaminated hands water )ood( ./5/* last epidemic in 1anada with 9666 cases o) paralytic polio 1hildren a#es 5 to / years the most a))ected$

./7/* last case o) paralytic polio due to poliovirus in 1anada 9667* still seen re#ularly in @ countries and can be spread by

travellers

PolioPolio



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I2V &inactivated polio vaccine(* killed intact virus

iven with diphtheria tetanus pertussis and Eib vaccines as5-in-.

2V &oral polio vaccine(* live attenuated virus$ ,ot used in

1anada since .//0-/7 but still used in many countries ;ide e))ects o) I2V are rare >))ective and lon#-lastin#* A)ter 4 doses .66K o) in)ants develop

antibodies a#ainst all 4 types o) poliovirus nly contraindication to I2V* an anaphylactic or other serious

aller#ic reaction to a previous dose o) the vaccine

Polio vaccine



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,ot to be con)used with seasonal in)luen+a or )luJ

Loun# children most at risk =ntil ./75 the most common cause o) bacterial

menin#itis in 1anada* .566 casesByear in children


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2uri)ied bacterial polysaccharide linked to a protein carrier such

as diphtheria or tetanus to'oid iven with diphtheria tetanus pertussis and polio vaccines as

5-in-. (rotects child against ;ib and helps decrease spread among

children generally

"ocal redness and pain in 5-.5K o) in)ants nly contraindication* anaphylactic or other serious aller#ic

reaction to a previous dose o) the vaccine

Hi+ vaccine



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Streptococcus pneumoniae* most common cause o)menin#itis and other invasive serious bacterial

in)ections in children in 1anada especially in children

9 years o) a#e lder children teens and adults with certain chronic

conditions are also at hi#her risk In)ection starts in nose or throat$ any people are

asymptomatic carriers have no symptoms

,ot hi#hly conta#ious but spreads throu#h close direct

contact* children in day care more at risk "ocal in)ections* acute otitis media acute sinusitis

acute bronchitis pneumonia Invasive in)ections* menin#itis bacteremia septicemia

endocarditis septic arthritis osteomyelitis peritonitis any pneumococci are becoming antibiotic!resistant

- recent

success story

Since routine

"accination of

infants #egan in

2007$ ;:=

decrease inin"asi"e disease

in children ? 2

years old

Indirect effect$

decreased

e4posure has ledto a ;1=

decrease in

in"asi"e disease

in the elderly


Pneumococcal diseasePneumococcal disease


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Neisseria meningitides*cancause menin#itis bacteremia septicemia andother invasive in)ections

%e)ore vaccine 966-@66 cases o) invasive in)ectionByear in 1anada with

96-@6 deaths$ ;ince 966. rate in 1anada has decreased to about 966

casesByear

2eople with certain chronic diseases are at hi#her risk ?eath )rom serious disease in 5K o) cases even with treatment and can

occur within 8-.9 hours o) )irst si#ns o) illness Menin#ococcal bacteria are )ra#ile and in)ections are not very conta#ious ost spread occurs via healthy carriersHabout . in 5 adolescents and

adultsHby close direct contact with mouth secretions respiratory droplets

5 sero#roups &A % 1 L and G.45( cause nearly all in)ections in 1anadawith roups % and 1 causin# the most illness

In)ections caused by sero#roups A 1 L and G.45 will likely drop now

that con


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A routine booster dose o) either con


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;evere viral in)ection$ 1auses hi#h )ever runny nose cou#h conncephalitis* . in .666 cases can lead to brain dama#e or death :are cases* ;;2> &subacute sclerosin# panencephalitis( ;ighly contagious: &preads by direct contact and through the air" /erms

become airborne in a cough or snee7e

%e)ore vaccine* lar#e epidemics every 9-4 years$ Most children had measlesusually by .7 years o) a#e

466666 casesByear in 1anada with 466 deaths and 466 children with brain

dama#e Vaccine approved in ./84N two-dose schedule in .//8-/0 966.-68* )ewer than 96 casesByear

?00@ outbreak in 2uebec: A< cases) almost all in persons #ho refused

vaccination

?00B outbreak in 9ntario: in over


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"ive attenuated &weakened( virus iven with mumps and rubella vaccines as MM: or with varicella as MM:-V 9 doses required since about 5K o) vaccinated children remain unprotected a)ter

)irst dose Mild side e))ects* )ever &in 5-.6K o) children( or rash &in 9K o) children( ;evere adverse events rare* risk o) encephalitis is less than . case per one million

doses ,oevidence o) links to other diseasesBdisorders &such as autism developmental

delay 1rohns disease ulcerative colitis(

1ontraindications* Aller#ic reaction to neomycin #elatin or a previous dose o) the vaccine 1ertain immune system disorders 2re#nancy

2recautions* ?elay vaccine )or moderate to severe illness ?elay vaccine )or 4 months or more )or anyone who has received blood products

as the vaccine may not work

4easles vaccine



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Viral in)ection that can cause )ever headache and swellin# o) salivary#lands around the


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"ive attenuated virus

iven in combination with measles and rubella vaccines as MM: orwith varicella as MM:-V* 9 doses

;ide e))ects are rare* Menin#itis reported to occur in . case per 766666

doses

1ontraindications* Aller#ic reaction to neomycin #elatin or a previous dose o) the vaccine 1ertain immune system disorders 2re#nancy

2recautions* ?elay vaccine )or moderate to severe illness ?elay vaccine )or 4 months or more )or anyone who has received blood

products as the vaccine may not work

4um's vaccine



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Viral in)ection also known as erman measles 1an lead to )ever sore throat swollen #lands rash =sually mild in children$ More severe in teens and adults* arthral#ias

arthritis are common in adults In pre#nancy can in)ect the )etus causin# severe disabilities* con#enital

rubella syndrome &1:;( which can result in heart disease dea)ness

cataracts mental retardation ;preads by direct contact with mouth or nose secretions and droplets )rom

a cou#h or snee+e$ "ess conta#ious than chickenpo' or measles %e)ore vaccine 75K o) children had rubella by a#e 96* 956666

casesByear with 966 cases o) con#enital rubella syndrome

Gorldwide epidemic in ./8@* In =$;$ O46666 babies in)ected durin# )irst96 weeks o) pre#nancy$ ) those O96666 cases o) 1:; and 7666 deaths

;ince routine immuni+ation be#an in ./76* nly 6-4 babies with 1:; are

born in 1anada each year to unvaccinated mothers

;u+ella;u+ella



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"ive attenuated virus iven to in)ants with measles and mumps vaccines as MM: or with

varicella as MM:-V* 9 doses

1ontraindications* Aller#ic reaction to neomycin #elatin or a previous dose o) vaccine

1ertain immune system disorders 2re#nancy

2recautions* ?elay vaccine )or moderate to severe illness

?elay vaccine )or 4 months or more )or anyone who has received bloodproducts as the vaccine may not work

;u+ella vaccine



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Gomen o) child-bearin# a#e should be tested )or immunity to rubella

be)ore )irst pre#nancy Gomen not immune and not pre#nant should be vaccinated I) pre#nant and not immune delay vaccine but mother should be

vaccinated as soon as possible a)ter delivery )or )uture protection ;ide e))ects o) vaccine rare in in)ants

95K o) vaccinated women e'perience


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1aused by varicella-+oster virus

Fever headache aches and pains and itchy rash =sually a mild &but costly( disease* 2arents o)ten stay home )or

4 daysN 46-85K o) children are brou#ht to a clinic or hospital 1an lead to complications such as pneumonia bacteremia or

severe skin in)ections Illness is more severe and complications more common in

teena#ers and adults ;evere cases can pose serious health risks especially )or newborn

babies adults or anyone with a weakened immune system ;ighly contagious: Viruses from the throat and scratched

skin lesions spread easily through the air" 3lso spreads by

contact #ith rash

1onta#ious 9 days be)ore rash appears until the last blister has

crustedHusually about 5 days a)ter rash be#ins Virus remains dormant in the nervous system and can be

reactivated later to cause shin#les &+oster(

Varicella 7chicken'o/8Varicella 7chicken'o/8


- recent success

story

'efore "accine

E


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"ive attenuated virus 75-/6K e))ective in preventin# chickenpo' and .66K e))ective in preventin# moderate to

severe disease 9 doses o) vaccine now recommended )or all children one year o) a#e &previously

9 doses #iven only to people vaccinated at P .4 years o) a#e( ?uration o) protection at least 96 yearsHpossibly li)elon# Mild local reactions in about 96K o) children Vaccine-modi)ied disease does occur but is uncommon and the illness less severe Transmission o) vaccine virus )rom healthy vaccinated children to susceptible contacts is rare iven as varicella vaccine or in combination as MM:-V

1ontraindications* Aller#ic reaction to neomycin or #elatin or to a previous dose o) the vaccine 1ertain immune system disorders 2re#nancy

2recautions* ?elay vaccine )or moderate to severe illness ?elay vaccine )or 4 months or more )or anyone who has received blood products as the

vaccine may not work

Varicella vaccine



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Viral in)ection o) the liver Eal) o) in)ected people have no symptoms$ ther hal)

become ill* )ever )ati#ue loss o) appetite and


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2uri)ied viral protein

Available alone or with hepatitis A vaccine ,o uni)orm schedule )or routine immuni+ation but school pro#rams are

widespread$ In some provincesBterritories vaccine #iven durin# in)ancy :ecommended )or*

3 ,ewborns o) mothers who have hepatitis %

3 1hildren attendin# child care pro#rams and their care#ivers

3 All children be)ore or in early adolescence

3 2eople travellin# to countries where there is a risk o) contractin#

hepatitis %

3 1hildren under 0 years o) a#e who have immi#rated to 1anada )rom

areas with hi#h rates o) hepatitis %

3 Eousehold or close contacts o) an in)ected person3 2eople who are at hi#her risk o) contact with blood such as*

health care workerspatients on hemodialysis &treatment )or kidney disease(

He'atitis 3 vaccine



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In)ection o) the liver caused by hepatitis A virus Many youn# children have no symptoms or )ever only but they are still

conta#ious and can in)ect others Adolescents and adults more likely to become ill In)ection causes )ever )ati#ue loss o) appetite nausea vomitin# and


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Cilled intact virus vaccine

,ot on the routine childhood immuni+ation schedule e'cept in Quebec /5K e))ective in preventin# in)ection ,ot recommended )or children . year o) a#e For lon#er protection 9 doses #iven 8 to .9 months apart are recommended :ecommended )or*

3 2eople travellin# to places where hepatitis A is common includin#

children o) new 1anadians who visit relatives abroad

3 2eople with chronic liver disease or hemophilia

3 1ommunities lackin# adequate sanitation or sa)e water supply

3 2eople in ha+ardous occupations &e#$ relie) workers sewer workers(or

with riskier li)estyles &e#$ illicit dru# users men who have se' with men(

3 1lose contacts o) known cases "ocal reactions* mild pain and redness at in


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In)luen+a virus causes yearly epidemics o) respiratory illness

1an cause periodic pandemics when the virus chan#es suddenly and no oneis immune

?urin# outbreaks hospitali+ation rates )or in)ants and the elderly increase ;ighly contagious: spreads in respiratory secretions) on contaminated

hands) droplets from a cough or snee7e) and on contaminated obCects or

surfaces ;preads easily in schools and child care settin#s$ 1hildren brin# the in)ection

home to )amily members 1omplications o) )lu in youn# children can include* pneumonia otitis media

)ebrile sei+ures severe muscle in)lammation and encephalopathy Annual seasonal in)luen+a shot is recommended )or people at hi#h risk o)

complications )rom the )lu includin#*

3 all children a#ed 8 to 94 months and older children with certain chronic

disorders

3 parents siblin#s household contacts and care#ivers o) hi#h-risk children

Seasonal inEuenza 7Eu8Seasonal inEuenza 7Eu8


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Cilled disrupted virus with vaccine strains chan#in# every year

Virus chan#es every year* annual vaccination in )all needed to protecta#ainst seasonal )lu

First year o) immuni+ation* children / years old need 9 doses @ weeks

apart "ocal reactions in .6-56K o) recipients* soreness at in


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A live attenuated intranasal vaccine &"AIV( licensed in 1anada in

96.6 ,ot yet )unded by any provinceBterritory or incorporated into any

public pro#ram "icensed )or all healthy children 9 years o) a#e and all healthy

persons youn#er than 5/ years o) a#e

&ome evidence that in children it #orks better than inactivated fluvaccine

Vaccine strains are adapted to #row only in the nasal passa#es where

they induce immunity but cannot invade the body The )lu strains vary each year and are the same ones included in the

inactivated vaccine

A new Eu vaccine


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In a pandemic*

In)luen+a virus chan#es suddenly spreads quickly around the world andno oneHor only a very small se#ment o) the populationHhas immunity

to the new virus 2opulations at risk o) developin# severe illness may be di))erent than

durin# yearly seasonal in)luen+a

;easonal in)luen+a vaccine is ine))ective a#ainst the new virus strain

Pandemic vs seasonal inEuenza


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lobal national and re#ional health authorities respond to a declared

pandemic by*.eing prepared" overnment health authorities worldwide*

3 activate pandemic plans )or health care workers and the #eneral public

to prevent spread and protect #roups most vulnerable to severe illness

3 conduct a##ressive messa#in# on how to minimi+e spread o) the new

strain &e#$ wash hands cou#h into a sleeve not hands and stay homei) ill() &urveillance" 2ositive cases are tracked monitored and reportedImmuni7ation"A pandemic in)luen+a vaccine intended )or at-risk

populations anywhere in the world is developed and tested*

3 vaccine becomes available in allotments not all at once3 new vaccines #o throu#h a sti)) approval process to ensure hi#h quality

Pandemic inEuenza vaccine


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Most common se'ually transmitted in)ection in 1anada 2revalence in 1anada* between ..K and 9/K Ei#hest rates o) E2V acquisition occur in the )irst 5 years )ollowin#

onset o) se'ual activity$ About 4 in @ se'ually active 1anadians are

in)ected at some point =sually no symptoms but E2V is the ma


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2uri)ied viral protein vaccine

9668* Vaccine approved )or use in 1anada in #irlsBwomen / to 98 years o)a#e

9660* Federal #overnment announced )undin# to implement E2V

immuni+ation pro#rams 96.6* Quadrivalent vaccine approved )or use in both )emales and males

a#es / to 98$ ,A1I reviewin# recommendations with a view to e'pandin#

school pro#rams to boys and youn# men %ivalent vaccine a#ainst E2V-.8 and -.7 and quadrivalent vaccine a#ainst

E2V-8 -.. -.8 and -.7 #enotypes 5ither vaccine needs to be given before the onset of se'ual activity)

bet#een the ages of A and 1 years of age

"ocal reaction* soreness at in


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"eadin# cause o) acute diarrhea in babies and youn# childrenworldwide* at least 96K o) all childhood #astroenteritis caused by

rotavirus Almost all children are in)ected by 5 years o) a#e utbreaks usually happen February to May 1auses )ever vomitin# severe watery diarrhea and rapid dehydration

in youn# children who cannot keep down enou#h )luid ?eath is rare in Gestern countries but in the developin# world rotavirus

kills as many as 5 in .66 children be)ore their 5thbirthday ;ighly contagious before and after symptoms develop* viruses in

stool spread easily by contact with contaminated hands ob


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;otavirus vaccine 96.6* :ecommended )or routine use in 1anada

Two live attenuated &weakened( oral vaccines available )or preventin# rotavirus#astroenteritis in in)ants 8 to 49 weeks o) a#e %oth sa)e e))ective and #iven orally in liquid )orm iven in 9 or 4 doses usually at 9 @ and 8 months o) a#e$ 6irst dose must be

given bet#een E!1F #eeks of age) and all doses completed before B months of

age

Doses are given at least F #eeks apart

1ontraindications* Anaphylactic or other serious aller#ic reaction to a previous dose o) the vaccine A history o) bowel obstruction ?isorders o) the immune system &as sa)ety data is not yet available(

2recautions A weakened immune system ?elay vaccine )or moderate to severe illness especially diarrhea

h f d


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4yths, facts and4yths, facts and

commonly askedcommonly askedFuestionsFuestions


4 th4 th


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63+T&:

Vaccinations are )requently #iven in early in)ancy %rain abnormalities are o)ten not reco#ni+able this early$

?ia#nosis o) cerebral palsy mental retardation or developmental

delay are usually not made until a child is several months old An abnormality is o)ten reco#ni+ed only a)ter one or more

vaccine doses have been #iven but this does not mean the

vaccine caused the problem

4yth%4yth%Vaccines can cause +rain damage and otherVaccines can cause +rain damage and other

illnesses that canGt otherwise +e e/'lainedillnesses that canGt otherwise +e e/'lained


4 th4 th


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63+T:

,ot so$ There were )ewer deaths )rom some diseases &e#$ measles

diphtheria( because o) improved nutrition and health care but )or

other diseases &e#$ polio( healthy children continued to die or

become disabled

4yth%4yth%;ates of disease were declining +efore the;ates of disease were declining +efore the

use of vaccinesuse of vaccines



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63+T:

Vaccination is not compulsory$ %ut not vaccinatin# puts others at

risk o) disease compromisin# their ri#hts

4yth%4yth%Com'ulsory vaccination violates civil rightsCom'ulsory vaccination violates civil rights


4 th4 th


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63+T:

,o in)ection acts as a #eneral stimulus to the immune system$

Measles and in)luen+a actually suppressthe immune system$


4yth%4yth%Infections like measles stimulate theInfections like measles stimulate the

immune systemimmune system

h i hTh ti th 44;


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.//7* The Lancetpublished a study led by ?r$ Andrew Gake)ield

which appeared to link vaccine with autism 1aused MM: immuni+ation rates to drop in %ritain measles

outbreak The study itself has since been thoroughly discredited March 966@* .6 o) ori#inal studys .4 authors published a retraction o)

their interpretation in The Lancet Ranuary 96.6* =$C$s re#ulatin# eneral Medical 1ouncil )ound

Gake)ield had acted dishonestly and irresponsiblyJ in doin# his

research February 96.6* >ditors at The Lancet)ully retracted Gake)ields paper

)rom the published record May 96.6* Gake)ield was struck o)) the medical re#istry in the =$C$ Many recent lar#e studies by ma


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Thimerosal* A preservative used to prevent #rowth o) bacteria and )un#i in

multidose vials o) vaccines ,ot added to sin#le-dose vaccines In the body metaboli+ed to ethyl mercury .///* 1oncern in the =$;$ about possible to'icity o) ethyl mercury 966@* =$;$ Institute o) Medicine review )ound no evidence o) relationship

between thimerosal and autism or any other neurolo#ical disease$ Morerecent studies con)irm their )indin#s ?ia#noses o) autism continued to increase a)ter thimerosal was removed

)rom childhood vaccines Thimerosal is a component in only one vaccine )or routine immuni+ation o)

1anadian childrenH)lu vaccineHwhich is #enerally marketed in multidose

vials A thimerosal-)ree stable in)luen+a vaccine is also available )or children ;till used as a preservative in certain vaccines produced )or adults not

children

The thimerosal mythThe thimerosal myth


C l k d tiCommonly asked Fuestions


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%reast milk is the ideal )ood )or babies$ It provides important

nutritional and immune )actors and contains antibodies that help

prevent some in)ections$

Eowever this protection is incomplete and breast milk does notprotect a#ainst all in)ections preventable by vaccines

%reast)eedin# is not an alternative to immuni+ation and does not

enhance responses to vaccines 2rotection decreases rapidly when breast)eedin# stops

Commonly asked FuestionsCommonly asked FuestionsWonGt +reastfeeding 'rotect +a+ies fromWonGt +reastfeeding 'rotect +a+ies from

infectioninfection


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Immunity a)ter most vaccines is very vaccine-preventable in)ection can cause serious harm

Immune response to natural in)ection may be too late to preventserious harm

Gith vaccines the immune system is stimulated to develop

protection a#ainst the disease without )ull-blown in)ection

Commonly asked FuestionsCommonly asked FuestionsIs BnaturalD immunity more e0ectiveIs BnaturalD immunity more e0ective

Commonly asked FuestionsCommonly asked Fuestions


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,o evidence that side e))ects are more common in in)ants or babies

than in older children ?elayin# vaccination leaves very youn# children at risk o)

complications and death )rom common diseases &e#$ pertussis Eiband pneumococcal in)ections are more severe )or babies(

Commonly asked FuestionsCommonly asked FuestionsShouldnGt vaccines +e delayed until childrenShouldnGt vaccines +e delayed until children

are older and there is less risk of sideare older and there is less risk of sidee0ectse0ects



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In)ants can respond to about .6666 di))erent anti#ens at any one

time %acteria and viruses e'pose an in)ant to lar#e numbers o) anti#ens

at onceH)ar more than are )ound in vaccines ivin# combined vaccines and multiple shots means )ewer needles

)or a child

Commonly asked FuestionsCommonly asked FuestionsCan too many vaccines overload a +a+yGsCan too many vaccines overload a +a+yGs

immune systemimmune system

C l k d tiCommonly asked Fuestions


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As lon# as a vaccine-preventable disease e'ists somewhere in the

world any unimmuni+ed child is at risk*

3 A traveller may brin# the disease to any area

3 A child may travel to an area where the disease is more common Vaccination does not #et rid o) some #erms &e#$ pneumococcus(

which may still be carried by older children and adults

Tetanus bacteria are present in soil and dust everywhere in theworld$ Any child can be in)ected )rom a dirty wound

Commonly asked FuestionsCommonly asked FuestionsSince most other children are vaccinatedSince most other children are vaccinated

and diseases are disa''earing, why +otherand diseases are disa''earing, why +othervaccinating my childvaccinating my child



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For ma'imum protection complete vaccine series well be)ore

se'ual activity starts ;chool-based pro#rams more e))ective in reachin# tar#et

populations in primary school than in secondary school Loun#er children have a better immune response to the vaccine

Commonly asked FuestionsCommonly asked FuestionsWhy should my 'reteen +e vaccinatedWhy should my 'reteen +e vaccinated

against HPVagainst HPV



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Inactivated vaccines do not contain live #erms and cannot cause the

in)ections they protect a#ainst "ive vaccines contain viruses that have been chan#ed so that they

are very weak and unable to cause disease in healthy people$:arely they may cause a very mild )orm o) the in)ection$ 1hildren

with certain immune system disorders may develop an in)ection

with these vaccines and should not receive them

Commonly asked FuestionsCommonly asked FuestionsCan vaccines cause the infection they areCan vaccines cause the infection they are

su''osed to 'reventsu''osed to 'revent

S ki i h +


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S'eaking with 'arents a+outS'eaking with 'arents a+out

vaccinationvaccination


"isten evaluate and cate#ori+e :eco#ni+e le#itimate concerns 2rovide conte't

:e)ute misin)ormation 2rovide valid in)ormation :eco#ni+e that immuni+in# is a parents decision >ducate about potential consequences o) the decision Make a clear recommendation

Source: Dr. Scott A. Halperin, Dalhousie Universit, !anadian "ournal of !#$, "anuar %&&&


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Pu+lic 'olicyPu+lic 'olicy


+li fP +li t f


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In 96.6 .@ vaccines are publicly )unded by all provincesBterritories ;chedules )or some publicly )unded pro#ramsHmenin#ococcal

con


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1anadas roadmap )or ensurin# vaccine access supply sa)ety and

e))icacy >stablished in 9664 with )ive mandates*

3 ?evelop national #oals and recommendations )or immuni+ation

pro#rams

3 Immuni+ation pro#ram plannin#

3 Vaccine sa)ety

3 Vaccine supply

3 An immuni+ation re#istry network 1ross-cuttin# issues* immuni+ation research pro)essional and public

education special populations &immi#rants re)u#ees travellers and

First ,ations and Inuit( and vaccine-preventable disease surveillance

5ational Immunization5ational Immunization

Strategy 75IS8Strategy 75IS8


d SP t d 5IS


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9664* "aunched with S@5 million over )ive years to improve

1anadas vaccination pro#rams and S49 million over )ive years )or anational on-reserve immuni+ation strate#y$ 2art o) a S.$4-billion

pro#ram )or First ,ations and Inuit health 966@* Another S466 million over three years )or vaccine

procurement to allow the provincesBterritories to add newly

recommended vaccines to publicly )unded pro#rams 9660* Federal #overnment created a trust )und )or three years )or

provincesBterritories to initiate E2V pro#ram Further advocacy is needed to ensure other vaccines continue to have

support Federal #overnment currently provides some annual )undin# to

improve e))ectiveness and e))iciency o) immuni+ation pro#rams in

1anada

Progress toward 5ISProgress toward 5IS


C ll iC ll t ti


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2rovide sustained )undin# and support )or a comprehensive ,ationalImmuni+ation ;trate#y

2rovide sustained )undin# to the provinces and territories to allow

them to o))er newly recommended vaccines at no cost to the public ?evelop a national immuni+ation re#istry to track numbers o)

children and youth who are receivin# vaccines$ Ideally this re#istrywould include electronic record-keepin# )unctions )or easy

transmission and monitorin# and )or makin# sure every childs

schedule is up-to-date ;tandardi+e immuni+ation schedule across 1anada

>nsure the involvement o) non#overnmental and pro)essionalor#ani+ations such as the 12; with e'pertise in immuni+ation

Calls to actionCalls to action



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;esources;esources


P f i l l iP f i l l i


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Professional learningProfessional learning


Immunization Competencies for

Health Professionals

2ublished by the

2ublic Eealth A#ency o) 1anada

in ,ovember 9667

www$phac-aspc$#c$caBimBpd)Bichp-cips-en#$pd)

Immunization Competencies or HealthImmunization Competencies or Health


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) >ssential knowled#e and skills )or e))ective immuni+ation ?eveloped to support the ,ational uidelines )or Immuni+ation

2ractices published in the !anadian 'mmunization (uide 1an be adapted and incorporated into all immuni+ation trainin# or

per)ormance evaluations

3 To educate health pro)essionals involved in immuni+ation3 To promote sa)e and competent practices

Immunization Competencies or HealthImmunization Competencies or Health

ProessionalsProessionals


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Immunization Com'etencies >ducation ProgramImmunization Com'etencies >ducation Program


88/93

Immunization Com'etencies >ducation ProgramImmunization Com'etencies >ducation Program

3n online course for health professionals) developed by +(& and the (ublic ;ealth 3gency

of +anada) is available at ###"cps"ca45nglish4(ro5du49nline5du"htm

Multidisciplinary* to meet the needs o) the #rowin# number wider ran#e o) health pro)essionals

involved in administerin# vaccines

1ourse desi#ned to* build immuni+ation skills and knowled#e promote public con)idence around vaccine e))ectiveness and delivery and )oster relationships amon# health pro)essionals unaccustomed to workin# to#ether

%asic competencies* how vaccines work the rationale and bene)its o) immuni+ation the main steps in vaccine development and evaluation

the components and properties o) immuni+in# a#ents principles o) population health )or improvin# covera#e rates

>ach competency is supported by a learnin# domain and a number o) #uidin# learnin# ob


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Immunization we+sitesImmunization we+sites

for 'rofessionals and 'arentsfor 'rofessionals and 'arents 1anadian 2aediatric ;ociety* www$cps$ca Eealth 1anada 2ublic Eealth A#ency o) 1anada*

www$phac-aspc$#c$caBimBinde'$html ,ational Advisory 1ommittee on Immuni+ation* www$naci$#c$ca

1anadian 1oalition )or Immuni+ation Awareness and 2romotion*www$immuni+e$cpha$ca

American Academy o) 2ediatrics* www$aap$or# 1enters )or ?isease 1ontrol and 2revention* www$cdc$#ov Advisory 1ommittee on Immuni+ation 2ractices &A1I2(

www$cdc$#ovBvaccinesBrecsBA1I2Bde)ault$htm Immuni+ation Action 1oalition* www$immuni+e$or# Institute o) Medicine* www$iom$edu


Assessing vaccineAssessing vaccine


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Assessing vaccineAssessing vaccine

information on the Internetinformation on the InternetAskin# a )ew key questions can help you tell whether or not you can trust the

in)ormation you )ind on the Internet*

.$ Ghat is the source o) the in)ormation ?oes the site* Identi)y who has produced the in)ormation

"ist all sources o) )undin# 2rovide a way to contact the provider o) in)ormation

9$ Eas the medical in)ormation been reviewed by scienti)ic e'perts

4$ Is there a date showin# when the in)ormation was posted online andBor last

revised

@$ Is there scienti)ic evidence to back up the claims &e$#$ articles )romrespected medical


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) 1anadian 2aediatric ;ociety$ 4rdedn$ 9668$)our !hild*s +est Shot:

A arent*s (uide to -accination. 1anadian 2aediatric ;ociety$ MM: vaccine* Myths and Facts$J

A tear-away pad )or in)ormin# )amilies$

Fisher Mar#aret 1$ &9668('mmunization and 'nfectious Diseases: An'nformed arent*s (uide$ >lk rove Villa#e Ill$* American Academy

o) 2ediatrics$ 2ublic Eealth A#ency o) 1anada$ 9667$'mmunization !ompetencies

for Health rofessionals.

2ublic Eealth A#ency o) 1anada$ 966/$A arent*s (uide to-accination$

2ublic Eealth A#ency o) 1anada$ !anadian 'mmunization (uide$

7thedn$ 96.6$


3ooks and 'rinta+le resources3ooks and 'rinta+le resources

for 'rofessionals and 'arentsfor 'rofessionals and 'arents


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uestions Commentsuestions Comments


1ea e +ehind materials1eave +ehind materials


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1eave+ehind materials1eave+ehind materials

A list o) resources and the routine immuni+ation schedule are

available as pd)s on the 12; website so users can printphotocopy and distribute )or their presentations at no cost$

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Pharm Vaccine Presentation for Power Point 97-2004

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