PHICS HCW Immunization Recommendation Update
PHICS HCW Immunization Recommendation Update
Update
Rontgene M. Solante, MD., FPCP, FPSMID
Phillipine Hospital Infection Control Society
Annual Convention
Crowne Plaza Hotel
May 27, 2016
Rontgene M. Solante, MD
Phil Society for Microbiology and Infectious Diseases (PSMID), Past
President
Global Steering Committee Member , MEDSCAPE for Pneumococcal
Disease Prevention and Education thru vaccination
Asian Advisory Board , Community Acquired Pneumonia Immunization Trial
Adults (CAPiTA) 2015
Chairman, Fellowship Program Adult Infectious Disease and Tropical
Medicine- San Lazaro Hospital
Medical Specialist III , National Reference Laboratory for HIV/AIDS San
Lazaro Hospital
Infection Control Chair: ManilaMed MCM, San Lazaro Hospital
Assistant Professor , UERMMMC
Fellow, Philippine College of Physicians and PSMID
Disclosure
Pfizer vaccines , Asian and local advisory board member
MSD vaccines Phil advisory board member
Sanofi Pasteur Phil advisory board
Objectives
Discuss the following:
Why vaccinate healthcare workers?
What are the currently recommended vaccines?
PRIVATE
Informal survey conducted during the HcW annual conventions (AMHOP, PHICS)
Healthcare risk
Hepatitis B
Influenza
Healthcare risk
Measles
Healthcare risk
Mumps
Pertussis
Healthcare risk
Varicella
Evidence of immunity
for HCP
Healthcare risk
Meningococcal Disease
Typhoid Fever
Hepatitis A
Zoster
2012 PSMID-PFV-PHICS
2016 ACIP
Routinely Recommended
Hepatitis B
Hepatitis B
Influenza
Influenza
Varicella
Varicella
Human Papilloma virus
Zoster
Hepatitis A
Hepatitis A
Meningococcal
Meningococcal
Rabies
Typhoid
HIV
infection
CD4 <200
Immunocom
promising
conditions
Chronic
liver ,heart
and lung
dses and
alcoholism
Asplenia and
complement
component
deficiencies
Kidney
failure, endstage renal
disease,
receipt of
hemodialysis
Diabetes
Men sex
with
men
MSM)
Influenza
Tdap
Varicella
HPV
Rabies
Zoster
MMR
Pneumococcal (PCV13
Pneumococcal (PPV23)
Hepatitis A
Hepatitis B
Meningococcal
R- recommended;
Specific indications
Typhoid vaccine
Meningococcal
Rabies
Vaccine schedule
HEPATITIS B
Vaccine type:
Inactivated vaccine
intramuscularly (IM)
3 doses :0,1,6-12 months
Accelerated schedule
Days 0, 7, 21-30,
and at 12 months
Booster is not routinely
recommended
Vaccine efficacy:
>90% after the 3rd dose
40 y.o., <90%
60 y.o, 75%
Target individuals
Those without documented evidence of immunity to
Hepatitis B
All healthcare workers
Sexually active persons, MSMs, IV drug users,
Clients and staff members of institutions for persons
with disabilities
Travelers to countries with high or intermediate
prevalence of chronic Hepatitis B infection
Diabetics, Persons with HIV/AIDS
Chronic liver disease, Hemodialysis patients
Household contacts of HBV carrier
Recipients of blood products
Immigrants from areas of high HBsAg endemicity
Post-exposure
Pre-exposure
Management for
Healthcare Personnel
with a Documented
Hepatitis B Vaccine
Series Who Have Not
Had Post- vaccination
Serologic Testing
INFLUENZA
Vaccine type and schedule
2 types:
trivalent inactivated
quadrivalent inactivated
IM route
Southern Hemisphere strain
February to June, but maybe
given throughout the year.
Vaccine efficacy:
varies from year to year
age and health status of the person
similarity match between the
viruses or virus in the vaccine and
those in circulation
Vaccine type/route
MEASLES, MUMPS, RUBELLA (MMR)
live attenuated, SQ
Schedule
2 doses
0, 1 month interval
2 doses
0, 1-2 months
Post-exposure Prophylaxis
Given within 72 hours of exposure;
Single dose
Target individuals
Inactivated
Recommended for:
Females: 9-55 years old
Males: 10-26 years old
Schedules
Bivalent for females only
2 doses: 9 to 13 years old, (0, 6 or 12 months)
3 doses: >13 years old, (0, 1, 6 months)
Quadrivalent - for males and females
3 doses 0,2,6 months
Females: 14 to 45 years old
Males: 14 to 26 years old
Vaccine type
Pneumococcal vaccine
(inactivated)
Polysaccharide (PPSV23)
IM or SQ
Conjugate (PCV13) IM route
Sequential pneumococcal
vaccination (PCV13-PPV23)
Meningococcal Vaccine
Polysaccharide (MPSV): SQ/IM
Conjugate (MCV4) : IM
Hepatitis A
IM; Single antigen or in
combination with Hepatitis B
HERPES ZOSTER
Vaccine type:
Live, attenuated VZV
vaccine
single-dose 0.65 ml SQ
Prevention of herpes zoster (HZ)
Prevention of postherpetic
neuralgia (PHN)
Reduction of acute and chronic
HZ-associated pain
Target individuals
Adults 60 years old with or without a prior
episode of herpes zoster
Persons with history of zoster
Men sex with men (MSMs)
Persons with chronic medical conditions
chronic renal failure
diabetes mellitus
rheumatoid arthritis
Heart disease, chronic lung and
chronic liver disease
healthcare workers
Asplenia
Vaccine type/route
Schedule
TYPHOID
IM,
VI capsular polysaccharide
RABIES
IM/Intradermal
(HDCV , PVRV, PCECV)
Pre-exposure:
3 injections on days 0, 7 & 21 or 28
Post-exposure :
IMPACT OF VACCINES
JAMA. 2007;298(18):2155-2163
CDC. MMWR January 7, 2011;59(52);1704-1716.
IMPACT OF VACCINES
*? ?JAMA. 2007;298(18):2155-2163
?CDC. Active Bacterial Core surveillance Report; S. pneumoniae 2008.
?2008 Active Bacterial Core surveillance
?CDC. MMWR. February 6, 2009 / 58(RR02); 1-25
?New Vaccine Surveillance Network
PRIVATE
PATIENT
AWARENESS/B
ELIEFS
MYTHS
PHYSICIAN
RESOURCES /
KNOWLEDGE
INFRASTRUCTURE
BARRIER
S
National Foundation for Infectious Diseases. Call To Action: Adult Vaccination Saves Lives.
Bethesda, MD, 2012.
KEY CHALLENGE
-- Paul Sax, MD
http://www.vaccines.gov/basics/protection/
http://www.vaccines.gov/basics/protection/
Thank you
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