FAQs on Vaccines and Immunization Practices Naveen C Thacker, Vipin M Vashishtha, Ajay Kalra
INDEX
×
Chapter Notes

Save Clear

1FAQs on Vaccines and Immunization Practices2
3FAQs on Vaccines and Immunization Practices
Second Edition
Chief Editor Vipin M Vashishtha MD FIAP National Convener IAP Advisory Committee on Vaccines and Immunization Practices, 2013–14 Mangla Hospital and Research Center Bijnor, Uttar Pradesh, India Editors Ajay Kalra MD DCH MNAMS FIAP Erstwhile Professor SN Medical College Agra, Uttar Pradesh, India Naveen Thacker MD (Ped) FIAP Past President—Indian Academy of Pediatrics Coordinator of Development—International Pediatric Association President Elect—Asia Pacific Pediatric Association CSO Alternate Representative—Gavi Alliance Board Foreword Walter A Orenstein
4
Jaypee Brothers Medical Publishers (P) Ltd
Headquarters
Jaypee Brothers Medical Publishers (P) Ltd
4838/24, Ansari Road, Daryaganj
New Delhi 110 002, India
Phone: +91-11-43574357
Fax: +91-11-43574314
Email: jaypee@jaypeebrothers.com
Overseas Offices
J.P. Medical Ltd
83 Victoria Street, London
SW1H 0HW (UK)
Phone: +44 20 3170 8910
Fax: +44 (0)20 3008 6180
Email: info@jpmedpub.com
Jaypee-Highlights Medical Publishers Inc
City of Knowledge, Bld. 237, Clayton
Panama City, Panama
Phone: +1 507-301-0496
Fax: +1 507-301-0499
Email: cservice@jphmedical.com
Jaypee Medical Inc
The Bourse
111 South Independence Mall East
Suite 835, Philadelphia, PA 19106, USA
Phone: +1 267-519-9789
Email: jpmed.us@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd
17/1-B Babar Road, Block-B, Shaymali
Mohammadpur, Dhaka-1207
Bangladesh
Mobile: +08801912003485
Email: jaypeedhaka@gmail.com
Jaypee Brothers Medical Publishers (P) Ltd
Bhotahity, Kathmandu, Nepal
Phone: +977-9741283608
Email: kathmandu@jaypeebrothers.com
Website: www.jaypeebrothers.com
Website: www.jaypeedigital.com
© 2015, Jaypee Brothers Medical Publishers
The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book.
All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers.
All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book.
Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book.
This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought.
Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any have been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity.
Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com
FAQs on Vaccines and Immunization Practices
First Edition: 2011
Second Edition: 2015
9789351521471
Printed at5
6
7
8
9Contributors
Chief Editor
Editors
Contributors
13Foreword
Few measures in preventive medicine can compare with the impact of vaccines. Smallpox has been eradicated and polio is on the verge of eradication. Measles transmission has been terminated in large areas of the world. Most recommended vaccines are highly effective in preventing vaccine-preventable diseases in vaccine recipients. But nearly all vaccines have another special property, the induction of herd immunity or community protection. Most vaccine-preventable diseases are transmitted from person to person in a chain of transmission from infectious case to susceptible. When a transmitting case comes in contact with an immune person, transmission does not occur and the chain of transmission is broken. Since infectious cases do not have unlimited contacts, if the immunity levels are high enough in a community, the likelihood that such cases will meet a susceptible is very low. Thus, transmission can be terminated for many diseases in a given community before 100% vaccine coverage is achieved. Who are the people indirectly protected? They are children too young for vaccination, persons with compromised immunity who cannot make adequate immune responses to vaccines, persons with contraindications to vaccination, and persons who do not respond to vaccine for other reasons. All are protected indirectly by high levels of immunity in the population.
Prevention from vaccines is very attractive because generally with a few doses, long term, even lifelong, protection can be achieved with many vaccines. In contrast, the lifestyle changes needed to prevent many chronic diseases require a lifetime of continued implementation.
During the last few decades, there has been a revolution in vaccinology. Vaccines have been produced that prevent cancer. The human papilloma virus vaccine (HPV) prevents approximately 70% of cervical cancers globally. Similarly, hepatitis B vaccine can prevent one of the major causes of liver cancer. Antibodies against polysaccharides are key to the defense against several bacteria that cause pneumonia, meningitis, and other serious clinical syndromes. However, young infants make poor immune responses against plain polysaccharides. By conjugating polysaccharides to protein carriers, excellent immune responses can be achieved even in very young infants. Conjugation technology is the basis for vaccines against Haemophilus influenzae type b (Hib), pneumococci, and meningococci. We can now prevent one of the most common causes of severe diarrhea and dehydration, leading to death, rotavirus. Other new technologies, including the use of recombinant DNA, vaccine vectors, genetic reassortment and other techniques are being brought to bring us new and better vaccines.14
This decade has been called the “Decade of Vaccines”. Efforts are underway to develop new vaccines against more infectious diseases as well as enhancing more widespread and better use of existing vaccines.
The most favorable benefits of vaccines are only achieved when they are used widely in populations for whom they are recommended. Vaccines don't save lives, vaccinations save lives. This handbook provides a major resource to vaccine providers in using vaccines optimally. This book is devoted to answering practical questions on recommended vaccines and schedules, indications, contraindications, and precautions. It tries to answer questions regarding particular clinical situations, which may not be easily answered from reading existing recommendations. Use of the book, will help you minimize the risks of vaccine-preventable diseases in the populations you serve, while maximizing the safe use of those vaccines.
Walter A Orenstein MD
Co-editor, Vaccines, Ed. Plotkin SA, Orenstein W, Offit P. Saunders Elsevier, 6th Edition, 2013
Professor of Medicine, Pediatrics, Global Health and Epidemiology, Emory University and,
Associate Director, Emory Vaccine Center
Former Deputy Director for Immunization Programs, Bill & Melinda Gates Foundation
Former Assistant Surgeon General, United States Public Health Service Former Director, National Immunization Program, Centers for Disease Control and
Prevention, Atlanta, Georgia
15Preface to the Second Edition
Vaccination continues to be the most cost-effective and reliable preventive measure. Its important has increased all the more in recent times when we are having difficulty in treating infections in the face of antibiotic resistance.
It is an extremely dynamic subject where new developments take place at an appreciable speed. No wonder, it attracts the maximum number of queries compared to any other field of medicine. The last edition of the book was conceived to answer the questions arising at that time. The response to the first edition has been quite gratifying.
Ever since then, many changes have occurred. There are new vaccines and so many new studies. These have led to new guidelines and new schedules. Hence, many new questions and the motivation impelled us to work on the second edition of this fascinating subject. Hope it delivers what it is aimed for.
Vipin M Vashishtha
Ajay Kalra
Naveen Thacker16
17Preface to the First Edition
“The Greeks had two gods of health: Aesculapius and Hygeia, therapy and prevention, respectively. Medicine in the twentieth century retains those two concepts, and vaccination is a powerful means of prevention. What follows is information on the vaccines that, together with sanitation, make modern society possible, and that if wisely used, will continue to bestow on humankind the gift of prevention, which according to proverb is worth far more than cure.”
—Stanley A Plotkin and Edward A Mortimer, Jr
in the preface to the first edition of their book, “Vaccines”
Immunization is a lively subject where changes in the field happen more rapidly than one can anticipate. This makes it a very dynamic subject and underlines the need to remain updated more frequently. Though the general attitude of both physicians and patients finds cure more interesting than prevention, the truth is the latter is far more vital than the former, though less appealing. While dealing with infections, development of newer antibiotics may have some limitations but the possibilities of developing vaccines are immense. Despite the high cost involved in developing a new vaccine, the opening up of the huge markets of developing world has offered a new incentive to vaccine industry. With the advent of vaccine industry in the developing world, and ample availability of global funding opportunities through giant philanthropic organizations have further reinvigorated the vaccine manufacturers to readily invest in developing newer products for future needs by embracing newer technologies. Therefore, any discussion on the subject of vaccinology covers not only the several vaccines per se but also the changes in technology and the exciting possibilities of various combinations and permutations in the making of various vaccines, which further extend to the ingenuity of newer modes of vaccines’ delivery.
In view of the above, it is no wonder that medical students, pediatricians and general practitioners are paying more attention to vaccines than ever before. As a proof of this trend, the sessions on vaccinology get a prime slot in all pediatric conferences and are usually jam-packed. Yet, in the short time frame that these conferences allow, not all questions can be answered and many delegates have often gone back home with doubts and queries unanswered.
Therefore, this book is an attempt to fill this void by providing contributions from experts who have a vast information and knowledge on the subject. They have devoted a lot of time and efforts to answer the questions on the basis of the latest information that is available today right from the Basics of Immunology to Vaccines in the Pipeline and Therapeutic Vaccines, besides talking about the changes in technologies and evolution of different adjuvants and combinations.18
Of late, there is a paucity of a decent book on immunization in this format. Often, the FAQ books are criticized as being meant only to provide a superficial account of the subject; however, our effort is to provide a more in-depth account of the given subject. The hallmark of this book is its comprehensive nature—almost all the aspects related to pediatric vaccination today are covered in depth. Hopefully, the book will not only be handy for the busy practitioners but even postgraduate students will find it attractive to browse pages to find answers of their queries.
Vipin M Vashishtha
Ajay Kalra
Naveen Thacker
19Acknowledgments
The editors acknowledge the efforts of Dr Neeraj Choudhary, Senior Medical Editor, Ms Shweta Tiwari, and Mr Manoj Kumar, from Jaypee Brothers Medical Publishers (P) Ltd., New Delhi, India, for their untiring efforts to publish this book in time.
Indian Academy of Pediatrics (IAP) for the excerpts from the e-manual of its program, “IAP Advancing Science of Vaccinology 2009.”
IAP Committee on Immunization (IAPCOI) for the excerpts from its guidebook, “IAP Guidebook on Immunization, 2007–08.”
IAP Advisory Committee on Vaccines & Immunization Practices (ACVIP) for the excerpts from its guidebook, “IAP Guidebook on Immunization, 2013–14.” and reproducing its immunization timetable for the year 2014.
Claire-Anne Siegrist, for allowing us to use excerpts from her chapter on Vaccine Immunology from the book, “Vaccines” (Ed. Plotkin SA, Orenstein W, Offit P Saunders Elsevier, 5th Edition, 2008) and her presentations delivered during 11th ADVAC at Annecy, France 2010.