World immunization week

Immunization 101 World Immunization Week 2015 24 - 30 April

VACCINES: DID YOU KNOW...?

Less than 20%

1 in 5

of children suffering from pneumonia receive antibiotics they need to recover.

chield deaths are caused by pneumonia

1 chield dies every

20 seconds

from vaccine-preventable diseases.

380 000

Deaths per year caused by Haemophilus influenzae the b (Hib), which can cause meningitis and pneumonia.

Every year, 1.7 million children die from preventable diseases because they do not have access to lifesaving vaccines. By pooling demand and providing predictable financing, the GAVI business model encourages vaccine manufacturers to expand capacity and attracts new suppliers to the market, resulting in increased supply at lower prices.

With its continued focus on market shaping, GAVI expects to further reduce costs and enable vaccines to become even more affordable for countries.

US$ 2.58

1 VACCINE* CAN PREVENT 5 DISEASES

Weighted average price of the pentavalent vaccine.

(A decrease of almost 30% since GAVI began to support the vaccine)

Haemophilus influenzae type b (Hib) Hepatitis B Diphtheria Tetanus Pertussis (whooping cough)

Vaccines are among the best public health tools available to saive lives and protect the health of children so they can grow up to lead healthy, productive lives. But even with this compelling evidence, 23 million children, mainly in the developing world, are still not vaccinated against common but lifethreatening diseases.

*pentavalent vaccine

27 million 0

Additional children immunized against Hib with support from GAVI in 2010.

Hib meningitis has been virtually eliminated in young children in Uganda just five years after the Hib vaccine was introduced.

Immunization 101

What will you learn?

Project and Target Goals p4 The Immunization Gap p6 Immunization Coverage and Vaccine-preventable Diseases p8 Immunization Policies p10 Fact Sheet Developed vs. Developing Countries p11 Outbreaks & Most Affected Countries p12 Have You Heard About Herd Immunity? p13 Why Vaccinate? p14 Vaccination: Myths and Facts p16 Not vaccinating: The Consequences? p18 What other things do you need to know? p19

3 Immunization Week | 24th - 30th April 2015 | International Pharmaceutical Student’s Federation

Immunization 101

THE PROJECT

For the first time, the International Pharmaceutical Students’ Federation (IPSF) will join the World Health Organizations’ efforts in regards to vaccination and immunization during World Immunization Week 2015, from the 24th to the 30th of April 2015. During these seven days we will join the challenge to “close the immunization gap” from WHO’s campaign, with the “Mind the Immunization Gap” project directed at future pharmacists, health professionals and the world population.

How can you participate?

SHARE this information UPDATE your Facebook JOIN

our Daily Chalanges

Friends Family Faculty Local Association Pharmacy Use our campaign badge on your profile picture, you can find it on the following website: https://www.picbadges.com/ community/55382ba0844a9d4775697ec4 Or change your cover picture to the one available at our facebook page (facebook. com/ipsforg) Find our Daily Chalanges on facebook.

Stay alert!!

Follow the campaign with hashtags: #IPSFmindthegap #ImmunizationMatters

4 Immunization Week | 24th - 30th April 2015 | International Pharmaceutical Student’s Federation

Immunization 101

OUR GOALS Advocate for global access to vaccination

Fight against common misconceptions about vaccines

Promote understanding of people’s’ responsibility to vaccinate in order to protect themselves and others

Raise awareness to vaccination outcomes in reducing the financial burden of diseases.

Join the effort to eradicate vaccinepreventable diseases 5 Immunization Week | 24th - 30th April 2015 | International Pharmaceutical Student’s Federation

Immunization 101

IMMUNIZATION GAP The problem Some of the main problems in developing nations include: poor health care systems and supervision, limited resources, and inadequate medication producing systems. A problem seen in some developed nations is an increase in personal anti-vaccination agendas by parents, which contributed to the recent increase in certain diseases such as measles and pertussis, that were once contained through vaccination endeavours.

The reasons behind the gap • • • • • • •

Wars Political instability Poverty Overpopulation Inefficient national immunization policies Insufficient road access which affects outreach to affected regions Inbalance between supply and demand of vaccines

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Immunization 101

What has been done: things you should know about immunization 1988: Partners such as UNICEF, WHO, Rotary International (RI), and the United States Centers for Disease Control and Prevention (CDC) established the Global Polio Eradication Initiative (GPEI).

1999: UNICEF, WHO and UNFPA launched the Maternal and Neonatal Tetanus Elimination.

2000: Global Alliance for Vaccines and Immunization (GAVI), an alliance that works to strengthen immunization systems, increased access to new and under-used vaccines to spur the development of new vaccines against major killers.

2001: The Measles & Rubella Initiative was launched, aimed at preventing child mortality caused by measles and congenital rubella syndrome. It is led by the American Red Cross, the United Nations Foundation, CDC, UNICEF and WHO. 2003: UNICEF procured 2.5 billion doses of vaccines for nearly 100 developing countries.

2012: The Global Vaccine Action Plan (GVAP), created a framework to prevent millions of deaths by 2020 through the provision of stable access to vaccines for people in all communities.

What needs to be done?

• • • • • • •

Creation of new vaccine-focused partnerships Eradication of misconceptions Defusion of wars and conflicts Poverty alleviation Increased funding for vaccine-focused research Increased road access and transportation conditions Increased training of health care providers in the concerned countries

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Immunization 101

IMMUNIZATION COVERAGE & VACCINE-PREVENTABLE DISEASES Immunization remains the most effective means of prevention against illness, disability and death from vaccine-preventable diseases. It prohibits an estimated 2 to 3 million deaths every year from tetanus, pertussis, diphtheria and measles.

Despite its proven positive impact, the global vaccination coverage; defined as the proportion of all children globally who receive recommended vaccines, has remained steady for the past few years.

Overview: Global immunization coverage 2013 Haemophilus influenzae type b (Hib) The global coverage with three doses of Hib vaccine, a gram negative bacteria which can cause meningitis and pneumonia, is estimated at 52%. However, there is a great variation between the American (90% coverage) (gegenĂźber), Western Pacific (18% coverage) and South-East Asia regions (27% coverage).

dose as part of routine immunization has been included in 148 countries.

Meningitis A Meningitis A is an infection that can cause severe brain damage, often resulting in death. In 2013, 150 million people in African countries who were affected by the disease had received their vaccination, which was developed by WHO and PATH.

Hepatitis B The global vaccination coverage of Hepatitis B, a viral infection that attacks the liver, is estimated at 81%. This Mumps figure is somewhat lower than the high coverage of 92% Mumps is a highly contagious viral disease that causes in the Western Pacific region. painful swelling under the ears, fever, headaches and muscle aches which can lead to viral meningitis. In Human papillomavirus (HP) 2013 the mumps vaccine had been introduced in 120 The Human papillomavirus is the most common viral countries. infection of the reproductive tract and can cause cervical cancer, as well genital warts in both men and women. Pneumococcal The HPV vaccine was introduced in 55 countries by the The global vaccination coverage of pneumococcal end of 2013. disease, which includes pneumonia, meningitis and febrile bacteraemia, but also otitis media, sinusitis and Measles bronchitis, is estimated at 25%.

Measles is an extremely contagious viral disease, which usually results in a high fever and rash, but also can lead Poliomyelitis to blindness, encephalitis or even death. It is estimated The global vaccination coverage of poliomyelitis, a that in 2013, 84% of children received one dose of highly infectious viral disease that can cause irreversible measles vaccine by their second birthday. A second paralysis, was estimated at 84% in 2013. Through a

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Immunization 101 global effort to eradicate polio, cases have decreased by over 99%, and stopped in all countries except from three; Afghanistan, Nigeria and Pakistan. In 2013, 416 cases were reported, also from polio-free countries, probably as a result of infection by imported virus. As long polio isn't fully eradicated it will be a risk for all countries, especially those experiencing conflicts and political instability.

Rotavirus A vaccine against rotavirus, the most common cause of severe diarrhoeal disease in young children, has been introduced in 52 countries and its global coverage was estimated at 14% in 2013.

Tetanus The global vaccination coverage of Tetanus, a bacterium which produces a toxin causing serious complications or death, is estimated on 82% through the immunization of newborns. Maternal and neonatal tetanus persists as a public health issue in 25 countries, mainly in Africa and Asia.

Yellow fever The vaccination coverage in countries and territories at risk of yellow fever, a viral haemorrhagic disease transmitted by infected mosquitoes, is estimated at 41%.

Rubella Rubella is a viral disease, although usually mild in children it can cause severe infection during early pregnancy and cause fetal death or congenital rubella syndrome leading to defects of the brain, heart, eyes and ears. In 2013 the vaccine was introduced in 137 countries.

Which are the future challenges?

Despite improvements in global vaccine coverage during the past decade, regional and local disparities remain, mainly resulting from limited resources, competing health priorities, poor management of health systems, as well as inadequate monitoring and supervision.

In 2013, an estimated 21.8 million infants worldwide were not provided with routine immunization services, of whom nearly half live in India, Nigeria and Pakistan. Thus, priority needs to be given to strengthening routine vaccination globally, especially in those countries with the highest number of unvaccinated children.

The Global Vaccine Action Plan The Global Vaccine Action Plan (GVAP) was developed to prevent millions of deaths through more equitable access to vaccines, and aims to achieve vaccination coverage of ≼ 90% nationally and ≼80% in every district by 2020.

It is planned to strengthen control of all vaccine-preventable diseases and support research and development, setting polio eradication as the first milestone. WHO is leading efforts to support regions and countries to adapt and implement the GVAP, which was developed by multiple stakeholders - UN agencies, governments and global agencies, health professionals and manufactures.

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Immunization 101

IMMUNIZATION POLICIES Vaccines for large scale health interventions should meet WHO quality requirements. These include being safe, having a significant impact on the disease state, being easily adaptable for immunization programmes, not interfere with other vaccines given concurrently and with formulations that meet common technical limitations including price, refrigeration and storage capacity.

WHO policies are specific to each particular vaccine. Outlines of these are listed below.

Measles Countries aiming at measles elimination should achieve ≼ 95% coverage in every district.

Rubella All countries that have not yet introduced rubella vaccine should consider including Rubella containing vaccines in their immunization programme. The preferred approach is with the MMR vaccine.

Pertussis WHO priority is to reach over 90% coverage with 3 doses of the vaccine in infants, especially in areas where the disease poses serious threats.

Polio The WHO position on the polio vaccine states that all children should be fully vaccinated against the disease and all countries should strive to maintain high levels of coverage in order to eradicate Polio on a global scale.

HPV WHO recommends that the HPV vaccine should be included in national vaccination programmes provided that; its implementation is economically feasible, prevention of cervical cancer is a public health priority and that cost-effectiveness is considered.

Mumps This vaccination is recommended in all countries that have a well established and effective childhood vaccination program as well the capacity to maintain high levels of vaccination coverage. However WHO also states that the control of measles should be given a higher importance if both vaccines cannot be given.

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Immunization 101

FACTSHEET DEVELOPED vs DEVELOPING COUNTRIES 10 Facts About Developed Countries ____________________________________________

10 Facts About Developing Countries ____________________________________________

1. Measles immunization rates in certain areas of Western Europe 1. In 2013, 21.8 million babies did not receive the 3rd dose of

and the United States have decreased or plateaued. This is vaccinations needed to protect them against preventable, but suspected to be due to an incorrect popular assumption that the deadly diseases. In other words, 1 in 5 babies were unprotected. measles vaccine causes autism.

Seventy percent of these babies live in only 10 countries: India, Nigeria, Pakistan, Ethiopia, DR Congo, Indonesia, Vietnam, Mexico, 2. Anti-Vaccination movements have evolved in developed South Africa and Kenya. countries, urging parents to re-think before getting their children vaccinated.

2. WHO’s response to vaccine distribution inequality was established in 2012 as The Global Vaccine Action Plan (GVAP). Countries are 3. Measles is re-emerging as a public threat, even in developed aiming to achieve vaccination coverage of ≥90% nationally and countries. Mumps and Rubella are less common but also continue ≥80% in every district by 2020. to occur across developed countries. All three are part of the MMR (measles, mumps, and rubella) vaccine.

3. Many developing countries may rely heavily on WHO for immunization policies and on donor funding for immunization.

4. As of January 1-March 13, 2015, there have already been 176 reported cases of measles in 17 states in the United States this year. 4. Through vaccine policy and mass measles vaccination campaigns, in Cambodia, there have been no confirmed cases of measles since 5. Over 22,000 cases of measles were reported in Europe in 2014 November 2011.

- February 2015.

5. Since 2001, the Measles and Rubella Initiative has supported 6. In Europe, Measles cases fell by 50% from 2013 to 2014, but 88 countries to deliver more than 1.8 billion doses of measles vaccines. This raised global vaccination coverage to 84 % and large outbreaks still continue to emerge. reduced measles deaths by 75 %.

7. There has been an overall increasing trend in the incidence of

reported Pertussis (Whooping Cough) cases in the United States 6. Global Vaccine Action Plan (GVAP) tends to expand immunization from 1991 to 2011, going from 2,719 to 48,277 cases respectively. coverage: reaching 90% of children under the age of one nationwide The incidence of Pertussis decreased in 2013 to 28,639 cases, but with routine immunization, and at least 80% of coverage for every is expected to exceed that number when the 2014 data has been country district by the year 2020. compiled.

7. In 2013, UNICEF procured 2.79 billion doses of vaccines for 100 8. The number of Pertussis cases reported to the European Centre countries, from polio and measles to tetanus, BCG and yellow fever for Disease Prevention and Control has been increasing since 2011, vaccines. reaching about 45,000 cases in 2012 8. Polio remains active in 10 countries, primarily among the most 9. The majority of Pertussis-related deaths in the United States disadvantaged, remote and conflict-affected populations for whom its continued existence remains a dangerous threat. Only three have occurred in infants less than 3 months old. endemic polio transmission—Nigeria, Pakistan and Afghanistan.

10. Young children and adolescents are the most affected age

groups for Pertussis. Signs and symptoms of this age group can 9. WHO estimates that in 2008, global vaccination against pertussis be unrecognized at first, allowing for increased disease spread to averted about 687 000 deaths. others 10. A malaria vaccine for children in developing countries could be available as early as this year.

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Immunization 101

OUTBREAKS & MOST AFFECTED COUNTRIES Several diseases such as measles and whooping cough, are nowadays easily considered as eradicated. The truth is that the present perception about vaccination and the lack of information has made these diseases re-emerge around the globe.

Recent outbreaks of certain diseases that are preventable by vaccination, are the result of the rising of “anti-vaccination” movements which are increasing the gaps in childhood immunization rates.

The Council on Foreign Relations has been detecting since 2008 all cases of measles, mumps, rubella, polio and whooping cough around the world, illustrating them as circles in annual maps where we are able to locate the impact and spread.

of information and the rise of the anti-vaccination movements, whilst in underdeveloped countries economic issues are important factors to take in account.

The outbreaks of measles in Europe reached a peak in 2011 and 2012. France suffered a massive measles outbreak in 2011 with nearly 15,000 cases. The biggest outbreak documented in 2012 in Europe was in the UK, the largest since 1994, with more than 2000 cases. Still, the number of measles outbreaks in Europe has been decreasing in recent years, reaching less than 3000 cases in 2014. In the USA the number of measles outbreaks have been slowly increasing, reaching more than 1000 cases in 2014. Africa and Asia have the highest incidence of measles, reaching numbers of around 100,000 cases in 2014.

The number of whooping cough cases in the USA reached a peak in 2012, with more than 23,000 cases reported, but also in Australia it appears to be a problem. Last year in Europe there was also a rise in disease outbreak, reaching over 12,000 whooping cough cases.

Rubella also made a comeback in 2012 with two large outbreaks in Europe, reaching more than 30,000 cases.

Polio outbreaks in Africa and Asia still affect hundreds of people each year and only slowly declining in number year by year.

Contributing factors affecting developed countries include lack

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Immunization 101

HAVE YOU HEARD ABOUT HERD IMMUNITY?

The concept of “Herd Immunity” or “Community Acquired Immunity” describes the way that vaccination of a large amount of the population reduces the spreading of an infection, working as a chain-reaction breaker. Immunization of the majority of the population will lead to a reduction of the probability of a susceptible individual coming into contact with the pathological agent. This represents a great alternative for those who can’t be vaccinated and those for whom vaccination was not successful. This may also be used as a strategic way to prevent the spread of an infection by selecting groups of individuals that are more likely to transmit the disease, and ensuring that they receive vaccinations.

Herd immunity threshold is the term applied to the percentage of the population needed to be vaccinated in order to successfully halt the spread of an infection. It depends of different factors, such as the transmissibility of the infectious agent, the nature of immunity induced by the vaccine, the pattern of transmission in populations, and the distribution of the vaccine.

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Immunization 101

WHY VACCINATE? 6 reasons to vaccinate 1. Immunizations an save your child’s life 5. Immunization protects future generations Advances in medical science have created Vaccines (such as the smallpox vaccine) have the opportunity for children to be protected been known to reduce and eliminate many against more diseases than ever before! Certain diseases that killed or severely disabled people diseases that once disabled or killed thousands just a few generations ago. If we choose to of children, have been completely eradicated continuously and completely vaccinate now, due to the creation of safe and effective vaccines. parents in the future may be able to hope that some diseases that are present today will no longer 2. Vaccination is very safe and effective be around to harm their children in the future.

Vaccines are only given to children after a long and careful review by scientists and healthcare 6. Serious Diseases Are Still Out There professionals. Although they may cause some Reducing and subsequently eliminating vaccinediscomfort, redness, or tenderness at the site preventable diseases is one of the top priorities in of injection, these are much less than the pain, the history of public health. But this success can discomfort, and trauma of the diseases these cause some people to think of these diseases as vaccines prevent. Benefits resulting from disease only existing in the past; the truth is they still exist prevention by getting vaccinated are much greater in many countries around the world. With the great than any possible side effects for almost all children! increase in inter-country travel and migration, all it takes is a plane ride for these diseases to arrive in 3. Immunization protects others you care about your community. One example is measles; this year Getting your child vaccinated also protect others in the US is experiencing a record number of reported your community, such as people who have cancer measles cases, most of which occurred in people and cannot get certain vaccines, or newborn babies who were not vaccinated. that are too young to be fully vaccinated. When everyone in a community who can get vaccinated does get vaccinated, it helps to prevent the spread of disease and can slow or stop an outbreak.

4. Immunizations can save your family time and money Children with any vaccine-preventable disease can be denied attendance at schools or child care facilities. Some vaccine-preventable diseases can also result in disabilities, and can cause financial burdens on families due to lost time at work, medical bills or long-term disability care.This is why getting vaccinated is a good investment!

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Immunization 101

VACCINATION: Myths and Facts Myth: “Vaccines cause autism” Fact: This is one of the most debunked myths of vaccines. This ‘theory’ came from a flawed study which concluded that there was a link between the measles, mumps, and rubella (MMR) vaccine and the appearance of autism. The article was later retracted and the author was found guilty of study related misconduct. No link has ever been found since.

Myth: “Vaccines can cause serious side effects” Fact: There has never been any credible study that links vaccines to any long term adverse health conditions.

It is important to note that vaccines are continually monitored for safety. Like any medication, vaccines can cause side effects which in most cases are minor. In terms of the potential for allergic reactions, the incidence of death from these are so rare that they cannot even truly be calculated.

Myth: “Vaccines can infect me or my child with the disease it is made to prevent” Fact: While it is true that vaccines can sometimes lead to mild symptoms resembling the disease against which they provide protection, a common misconception is that these symptoms suggest infection. A typical example is measles; the MMR vaccine contains a weakened but live measles virus and can cause a rash in about 5% of people. This typically occurs about one week after immunization however is much more mild than the actual illness.

Myth: “Vaccines contain toxic chemicals that can be harmful” Fact: Most concerns about toxins in vaccines have revolved around three chemicals: mercury, aluminum and formaldehyde.

Before 2001, some vaccines contained a preservative made with ethyl mercury called thimerosal. Ethyl mercury is safe, and is also very different from methyl mercury, which is toxic.

Aluminum is incorporated into some vaccines as an adjuvant to increase the immune response. A study done by the FDA showed that the risk from exposure to Aluminium is extremely low.

In certain vaccines, formaldehyde is used to inactivate bacterial products. The majority of formaldehyde is removed from the vaccine before it is packaged, however it may be present in trace amounts. These traces are not dangerous to humans.

Myth: “Vaccines are not necessary; better hygiene and sanitation can eradicate diseases”.

Fact: Certain diseases like polio and measles reappear regardless of hygiene habits or sanitation. In 1963, the first measles vaccine was introduced and the incidence rate of measles was found to be 400,000 cases per year. The rate gradually dropped to 25,000 cases per year by 1970 while the hygiene habits and sanitation remained the same, proving that there is no substitute for vaccination.

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Immunization 101

Myth: “The DTP vaccine and the vaccine against poliomyelitis can cause sudden infant death syndrome.”

Fact: It is important to understand that there is no link between the administration of the vaccines and sudden infant death syndrome.The misconception arose as these vaccines are administered during early stages of life when there is a maximum probability of sudden infant death syndrome (SIDS) in babies. The facts to be remembered are: SIDS deaths would have occurred even if no vaccinations had been given and that DTP and Poliomyelitis are life threatening diseases and can lead to death if babies are not vaccinated.

An example of this are the measles outbreaks in unvaccinated populations in Austria, Belgium, Denmark, France, Germany, Italy, Spain, Switzerland and the United Kingdom since 2005.

Myth: “Giving a child more than one vaccine at a time can increase the risk of harmful side-effects, which can overload the child’s immune system.”

Fact: The Advisory Committee on Immunization Practices and the American Academy of Pediatrics recommends simultaneous administration of a combination vaccine; consisting of two or more different vaccines that have been combined into a single shot. Evidence shows that combination vaccines have no adverse effect on a child’s Myth: “I don’t need vaccination as Vaccine-preventable immune system. diseases are almost eradicated in my country!!”

Fact: Agents causing disease can cross geographical borders to attack people who are not vaccinated.

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Immunization 101

NOT VACCINATING:

which are the consequences?

1. Certain

preventable diseases could reappear if people are not vaccinated. Children could contract diseases such as measles, rubella, and pertussis (or whooping cough) if not vaccinated, leading to risk of hospitalization, brain damage, paralysis, and even death.

2. There are chances of mass recurrence of almost -

eradicated diseases due to the risk of developing diseases in non-vaccinated children. (As per Jason Glanz study, children who are not vaccinated are 23 times more likely to contract by pertussis.)

3. Non-vaccinated threat to - people naturally pregnant diseases,

children present as a major individuals with weak immune systems who can neither get vaccinated nor fight off antibodies. For example, women and people with serious such as leukemia and certain cancers.

7. Depending

on immunization records, the non-vaccinated children can also legally be banned from certain day care facilities, as well as after-school programs as they can spread disease to fellow classmates.

8. Get ready to face stringent travel restrictions, if you are not vaccinating your child.

“The True Cost of Not Vaccinating Your Children: Reviving a Dead Disease�

4. Pregnant

women who are not vaccinated are vulnerable to diseases which may complicate their pregnancy. For example; If a pregnant woman contracts rubella in the 1st trimester, she may give birth to a baby with congenital rubella syndrome (CRS), which can cause heart defects, developmental delays and deafness.

5. Children

and families of un-immunized children may face isolation or be quarantined during an outbreak as they are more prone to the disease.

6. Most the doctors and pediatricians refuse to treat non-vaccinated children.

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Immunization 101

WHAT OTHER THINGS YOU NEED TO NOW? How do vaccines work?

Vaccines reduce the risk of infection by working with the body’s natural defenses to safety develop immunity to disease.

antibodies A weakened or killed form of the disease is injected into the body.

The body creates antibodies to fight the germs.

If the actual disease germs over attacks the body, the antibodies returns to destroy them.

How does the immune system works? http://vaccine-safety-training.org/how-the-immune-system-works.html Different types of Vaccines There are are six different types of vaccines; similar-pathogen vaccines, attenuated vaccines, killed vaccines, toxoid vaccines, subunit vaccines and naked-DNA vaccines. Live vaccines contain a less threatening version of the living pathogen, allowing the immune system to recognize and destroy the more harmful version if it invades the body.

Examples include the smallpox vaccine (similar pathogen vaccine) and the measles vaccine (attenuated vaccine).

Live vaccines and naked DNA vaccines contain genetic material, and work by triggering a full immune response.

Killed, "subunit," and "toxoid" are examples of non-live vaccines that trigger a partial immune response.

Live attenuated vaccine

Chimeric live attenuated vaccine

Inactivated vaccine

Subunit vaccine

Nucleic acid-based vaccine

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Immunization 101 How vaccines are made and most common ingredients Vaccines can be made in several ways, but all have the same goal of creating an immune response to a virus or bacteria without causing infection. Steps in vaccine manufacture: 1. Grow the antigen of the virus in cell cultures that replicate easily, such as chicken embryos. The pathogen is harvested and later inactivated, or a subunit is isolated.

2. Release the antigen from the cells and isolate the materials in the cell culture medium.

3. Purify the antigen 4. Add an adjuvant which helps to enhance the immune response to the antigen. Preservatives can also be added at this step to prolong their shelf-life and allow use of multi-dose vials.

5. Add all the components of the vaccines to a single vessel to be distributed.

Most Common Ingredients Common substances found in vaccines: 1. Aluminum gels or salts which are added as adjuvants to help the vaccine stimulate a better response.

Adjuvants help to promote an earlier, more potent response, and a more persistent immune response to the vaccine.

2. Antibiotics which are added to some vaccines to prevent the growth of bacteria during production and storage. No vaccine produced in the United States contains penicillin.

3. Egg protein is found in influenza and yellow fever vaccines, which are prepared using chicken eggs. Ordinarily, people who are unable to eat eggs or egg products safely can still receive these vaccines.

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Immunization 101

ACTIVE COMPONENTS

STABILISERS

A form of the virus, bacteria or toxin that causes the disease is used as the antigen. This antigen is modified from the original form so it no longer causes disease, but still illicit an immune responde from the body. To modify the disease-causing agent, it can be treated with specific chemicals, so it cannot replicate.

It can also be treated so it does not cause serious disease, or only parts of the diseasecausing agent that do not cause serious symptoms can be used.

Vaccines need to be storable, so stabilizers are added to ensure the various components remain stable and effective. A variety of different stabilizers are used; either inorganic magnesium salts such as magnesium sulfate or magnesium chloride, or mixtures of lactose, sorbitol and gelatin. Monosodium glutamate and glycine are also used in some cases.

PRESERVATIVES ADJUVANTS Added to enhance the body’s immune response to the vaccine. How they work isn’t entirely understood, but it’s thought they help keep antigens near the site of injection.

This means they can be easily accessed by the immune system cells. There is no evidence of any serious adverse effects from adjuvants thought they can cause some minor reaction near the infection site.

ANTIBIOTICS Antibiotics are used in the manufacturing process of the vaccine to prevent bacterial contamination. They are later removed and only residual quantities remain in the vaccine after the production process.

Preservatives help prevent contamination of vaccines. They are used particularly in multidose vaccines. Thiomersal is a common preservative, thought use declined in the late 1990s when vaccines were falsely linked to child autism. This link was later shown to be an elaborate medical hoax, and there is no link between thiomersal and autism.

TRACE COMPONENTS These are left-over from the vaccine production process. Though they are purposefully removed, residual amounts remain. Formaldehyde is one such agent, used to deactivate viruses and detoxify bacteria, but amount remaining is several hundred times lower than the smallest amount known to cause harm in humans.

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Immunization 101 Recommended vaccines and time schedule:

Ch

Vaccine Age at 1st Dose

Doses in Primary series

As soon as possible after birth

1

Option 1

As soon as possible after birth (<24h)

3

4 weeks minimum with DTP 1

Option 2

As soon as possible after birth(<24h)

4

4 weeks minimum with DTP 1

4

4 weeks minimum with DTP 2

BCG

Hepatitis B

Oral polio vaccine (OPV) + inactivated polio vaccine (IPV) Polio

6 weeks

IPV/OPV Sequential

8 weeks (IPV 1st)

1-2 IPV 2 OPV

4-8 weeks

IPV

8 weeks

3

4-8 weeks

6 weeks minimum

3

4 weeks (minimum)8 weeks

3

4 weeks (min) with DTP2

2-3

8 weeks (min) if only 2 doses 4 weeks (min) if 3 doses

DTP (diphtheria, tetanus and and pertussis) Option 1 Haemophilus influenzae type b

1st to 2nd

Option 2

6 weeks (min) 59 weeks (max)

Option 1

6 weeks (min)

3

4 weeks (min)

Option 2

6 weeks (min)

2

8 weeks (min)

Rotarix

6 weeks (min) with DTP1

2

4 weeks (min) with DTP 2

Rota Teq

6 weeks (min) with DTP 1

3

4 weeks (min) - 10 weeks with DTP 2

Measles

9 or 12 months (6 months min)

2

4 weeks (min)

Rubella

9 or 12 months with measles containing vaccine

1

HPV

As soon as possible from 9 years of age (females only)

2

Pneumococcal

Rotavirus

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6 months (min 5 months)

Immunization 101 Dosage Schedule

hildren Interval between doses 2nd to 3rd

3rd to 4th

Booster Dose

4 weeks minimum with DTP 3 4 weeks minimum with DTP 2

Adolescents

Adults

3 doses (for high-risk groups if not previously immunized)

4 weeks minimum with DTP 3

4 weeks minimum with DTP 3

4-8 weeks

4-8 weeks

4-8 weeks 4 weeks (minimum)8 weeks

1-6 years of age

Booster (Td)

Booster (Td) in early adulthood or pregnancy

4 weeks (min) with DTP3 4 weeks (min) if 3 doses

At least 6 months (min) after last dose

4 weeks 9-15 months

4 weeks (min) with DTP 3

1 dose (adolescent girls and/or child bearing aged women if not previously vaccinated) 2 doses (females)

23 Immunization Week | 24th - 30th April 2015 | International Pharmaceutical Studentâ&#x20AC;&#x2122;s Federation

Immunization 101

REFERENCES http://www.who.int/mediacentre/factsheets/fs378/en/ http://www.cdc.gov/measles/cases-outbreaks.html http://vaccine-safety-training.org/Importance-of-immunizationprogrammes.html http://vaccine-safety-training.org/vaccine-preventable-diseases. html http://www.cdc.gov/measles/cases-outbreaks.html Poland GA, Jacobson RM. The re-emergence of measles in developed countries: time to develop the next-generation measles vaccines?. Vaccine. 2012;30(2):103-4. http://www.euro.who.int/en/media-centre/sections/pressreleases/2015/whoeurope-calls-for-scaled-up-vaccination-againstmeasles http://www.cdc.gov/pertussis/outbreaks/trends.html http://ecdc.europa.eu/en/publications/Publications/AER-2014VPD-FINAL.pdf The Council on Foreign Relations interactive map – Vaccinationpreventable outbreaks along the years (www.cfr.org/interactives/ GH_Vaccine_Map/#map) http://www.npr.org/blogs/health/2014/01/25/265750719/howvaccine-fears-fueled-the-resurgence-of-preventable-diseases http://www.vaccines.gov/basics/protection/ http://www.historyofvaccines.org/content/herd-immunity Paul Fine, Ken Eames, and David L. Heymann: ‘‘Herd Immunity’’: A Rough Guide. Clin Infect Dis. (2011) 52 (7): 911-916 http://www.vaccines.gov/more_info/features/five-importantreasons-to-vaccinate-your-child.html http://www.cdc.gov/features/ReasonsToVaccinate/ http://vaccine-safety-training.org/adverse-events-classification. html http://vaccine-safety-training.org/adverse-events-causes.html http://vaccine-safety-training.org/frequency-and-severity.html http://www.who.int/immunization/monitoring_surveillance/ burden/en/ Taylor LE, Swerdfeger AL, Eslick GD et al. Vaccines are not associated with autism: An evidence-based meta-analysis of casecontrol and cohort studies. Vaccines. 2014 Jun 17;32(29):3623-9.

Vaccines: Facts vs. Myths. http://www.usatoday.com/story/ news/2015/02/06/debunking-vaccine-myths/22886985/ Understanding vaccines. Public Health. http://www.publichealth. org/public-awareness/understanding-vaccines/vaccine-mythsdebunked/ Study Reports Aluminum in Vaccines Poses Extremely Low Risk to Infants. http://www.fda.gov/BiologicsBloodVaccines/ ScienceResearch/ucm284520.htm Ingredients of Vaccines-Fact Sheet. Centers for Disease Control and Prevention. http://www.cdc.gov/vaccines/vac-gen/additives. htm

What are some of the myths – and facts – about vaccination? http://www.who.int/features/qa/84/en/ Administering vaccines - Dose, Route, Site and Needle size. http:// www.immunize.org/catg.d/p3085.pdf Vaccine Facts and Myths http://texaschildrens.org/Locate/ Departments-and-Services/Vaccine/Vaccine-Facts-and-Myths/ Vaccine administration http://www.cdc.gov/vaccines/pubs/ pinkbook/downloads/appendices/D/vacc_admin.pdf FAQ’s about multiple vaccination and immune system http://www. cdc.gov/vaccinesafety/Vaccines/multiplevaccines.html 10 effects of not vaccinating your children (http://thestir. cafemom.com/toddlers_preschoolers/171638/10_effects_of_ not_vaccinating) The harm of skipping vaccines or delaying (https://www.health. ny.gov/prevention/immunization/vaccine_safety/harm.htm) http://vaccine-safety-training.org/how-vaccines-work.html http://vaccine-safety-training.org/how-the-immune-system-works. html http://www.vaccines.gov/more_info/types/ http://vaccine-safety-training.org/types-of-vaccine-overview.html http://www.historyofvaccines.org/content/how-vaccines-aremade http://www.cdc.gov/vaccines/vac-gen/additives.htm ttp://www.who.int/immunization/policy/Immunization_routine_ table2.pdf?ua=1 http://www.who.int/immunization/policy/Immunization_routine_ table1.pdf?ua=1 http://vec.chop.edu/service/parents-possessing-accessingcommunicating-knowledge-about-vaccines/global-immunization/ global-immunization-vaccine-coverage-is-variable.html WHO vaccine-preventable disease monitoring system, 2014 global summary MMWR / November 21, 2014 / Vol. 63 / No. 46

24 Immunization Week | 24th - 30th April 2015 | International Pharmaceutical Student’s Federation

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