Adult Immunization

Prof. Dr. Yasemin Akkoyunlu

BVU Infectious Diseases and Clinical Microbiology
Immunization

▪Immunization is a process performed passively and/or

actively to prevent infectious diseases.

▪Passive immunization provides short-term recovery

▪Antiserum, immunoglobulin or hyperimmunoglobulin

▪Active immunization: vaccines

Terminology

▪Vaccine
Attenuated (live) or dead microorganisms or different
antigenic parts of microorganisms induce immunity in
the host and prevent the relevant disease.
▪Toxoid
It is obtained by rendering the bacterial toxin harmless
after processing (treatment with formaldehyde) while
it’s antigenic properties continue, and it stimulates the
formation of antitoxin after application.
Immune globulin (IG)
Antibody-containing part obtained from pools where
plasma taken from people is collected; given for
maintenance of optimal immunity or passive
immunization in immunocompromised persons

Antitoxin
It is an antibody obtained from the serum of animals
after stimulation with a specific antigen and is used
for passive immunization purposes.
▪Childhood vaccination for vaccine-preventable diseases
is generally successful
▪Children who were vaccinated with excitement
through campaigns were now grown up
▪Is acquired immunity protective until death?
▪Where are we as adults???
Adult Immunization

✓ Diphtheria outbreaks among vaccinated people in

China and the former Soviet Union
✓ In the USA, 95% of all tetanus cases and all deaths
occur in adults.
✓ 2/3 of diphtheria deaths and 1/3 of measles
deaths are in adults.
✓ Most cases of diphtheria occur in the population
>50 years of age.
 Active Immunization
Toxoid vaccines Diphtheria, Tetanus
Inactivated bacterial Pertussis, Cholera, Typhoid, Plague
vaccines
Polysaccharide vaccines H.influenza type b, Pneumococcus,
Meningococcus
Live attenuated bacterial BCG, Anthrax
vaccines

Live attenuated viral MMR, oral polio, chickenpox, yellow fever,

vaccines adenovirus, rotavirus

Inactivated viral vaccines Rabies, influenza, hepatitis A

Purified antigen vaccines Hepatitis B, Lyme disease vaccine

Important notes:

• Vaccinations should be postponed in severe and

moderate acute infections

• Live vaccines (MMR, varicella, etc.) should be

administered either at the same time or at least 4
weeks apart.
https://www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined-schedule.pdf
Influenza Vaccines
• There are 3 types of influenza vaccines;

• Inactivated

• Recombinant

• Live attenuated (Contraindicated in immunosuppressive and pregnant women)

• Influenza vaccine is a trivalent or quadrivalent vaccine that contains two types of Influenza A
and one or two types of Influenza B strains, representing the influenza viruses that caused
infection in the world in the previous year.

• Its protection is reported to be between 65-85%. (Although it cannot completely prevent

respiratory tract infection, it is stated that it limits it and makes it mild.)

• It is performed once a year, intramuscularly (IM). Immunity begins two weeks after
vaccination, peaks at two months, and lasts for about a year.

• Vaccination should be completed between September and November.

 Influenza Vaccine

• Contraindication: Egg allergy

• Side effect:
• Local redness and hardness (25-60%)
• Subfebrile fever, muscle aches, weakness (30%) last for a maximum of 24 hours.

• The vaccine may increase blood levels of theophylline and oral anticoagulants.
• It is also important to know that a false positive ELISA test for HIV and HCV can be
obtained (2%). Tests should be checked as they will become negative within a few
months.
 Adult Diphtheria-Tetanus-Pertussis vaccine(Tdap)
• Every 10 years following the 0,1,6 month vaccination schedule (Intramuscular)
• 2 doses for pregnant women in the 6th and 7th months
• Vaccination schedule to be applied in injuries:
Number of Last Clean injury Dirty injury
vaccination Vaccination Vaccine Ig Vaccine Ig
s year
3 <5 - - - -
3 5-10 - - + -
3 >10 + - + -
2 - + - + +
0 - + + + +
◼ Side effects: local reaction, rarely Arthus type reactions,
peripheral neuropathy or very rarely anaphylaxis
◼ Contraindication: known neurological or allergic reaction to
diphtheria toxoid
 Measles-Rubella-Mumps (MMR) vaccine
• People who do not have laboratory evidence of having the disease or who
have not been vaccinated;
• Single dose for those born after 1957
• Students, healthcare workers, travelers two doses (subcutaneous)

• One dose only for rubella, 2 doses 4 weeks apart for measles or mumps

• Side effects:
• -Fever is the most common (5-15%)
• -Rash (5%) appears 7-10 days after vaccination.
• -Joint pain in approximately 25% of women (depends on the rubella component).
• -More serious reactions such as allergic reactions are rare.

• Contraindications:
• It should not be administered to pregnant women and people with severe
immune system deficiency.
Chickenpox (Varicella) vaccine
• In adults, the rate increases to 78-82% with a single dose of vaccine, and to 99%
with two doses of vaccine. (subcutaneous)
•
• 2 doses 4-8 weeks apart
• Those who have previously received a single dose of vaccine will receive a single
dose.

• Side effects:
• Local side effects such as redness, hardness and pain at the injection site
• rash around the area where the vaccine was administered

• Contraindications:
• It should not be administered to pregnant women, people with HIV and severe
immune system deficiency.
HPV Vaccine
Human Papillomavirus > 100 types
• >60 cutaneous types
• wart
• 40 mucosal types
• high risk (16 and 18)
• cervical cell changes
• some anogenital cancers
• Low risk (6 and 11)
• cervical cell changes
• genital wart
• respiratory papilloma
HPV Aşısı
• For women and men aged 9-26
• 3 doses 0, 2, and 6 months (Intramuscular)

• High effectiveness with vaccination given before infection

• Existing disease or infection-activity??
• Infection with one HPV type does not reduce the
effectiveness of other types of the vaccine.

• KE: Pregnant women

Pneumococcal Vaccine
• Pneumococcal infections are the diseases that cause the most
deaths among vaccine-preventable diseases.

• Despite treatment, the mortality rate of bacteremia in adults is

15-20%, in the > 64 age group it is 40%

• 1. Polysaccharide pneumococcal vaccine (PPSV23) is obtained

by purifying the capsule antigens of 23 types of S.pneumonia,
which is the most common cause of disease.
• 2. Conjugated pneumococcal vaccine (13-valent) (PCV 13)

• (Intramuscular or subcutaneous)
Pneumococcal Vaccine
• Conjugate vaccine; single dose
• Polysaccharide vaccine;
• In risk groups other than age, 2 doses with an interval of 4-8 weeks,
• >65 years of age single dose (<65 years of age, if vaccinated, single dose booster at
the end of the 5th year)
• Side effects:
It mostly occurs during repeat vaccination.
• Regional reactions (pain, redness at the vaccination site)
• 1% fever and muscle aches,
• <1% severe regional reactions and rarely anaphylaxis

• Contraindications:
It is not safe to administer the vaccine to pregnant women. Women in high-
risk groups should be vaccinated before becoming pregnant, if possible. If
necessary, they can be vaccinated after the first trimester.
Hepatitis A (HAV) Vaccine

• Hepatitis A;
• Fecal-oral transmission
• Does not become chronic
• While 1/10 of the children are icteric, 2/3 of the adults are icteric and severe.
• Fulminant hepatitis and mortality increase after puberty
 HAV Vaccine
• 0-6 or 0-12. two doses per month, (Intramuscular)

• Indications;

• Those with chronic liver disease

• Travel to an endemic area

• For hemophilia patients

• For drug addicts

• Seronegative mentally disabled people during epidemics

• Seronegatives working in child care homes

• To laboratory workers, healthcare workers

• To homosexuals

• Cleaning and food workers working in poor hygienic conditions

• Seronegative adults
 HAV Vaccine

◼ Side effects:
◼ Mild reactions such as pain or swelling at the injection site (50%)
◼ Fatigue or mild fever in less than 10%

◼ Contraindication:
◼ Like all vaccines or medications, the hepatitis A vaccine can
theoretically cause serious reactions in people who are allergic to its
ingredients.
HBV Vaccine
• One of the two most carcinogenic viruses
• Chronicity occurs in >95% of newborns, 25% in 7-year-
olds, and 10% in adults.

HBsAg
HBcAg

HBV DNA
DNA polimeraz

DANE PARTICLE
 HBV Vaccine
• 0-1st-6th month (standard vaccination) (IM)
• 0-1st 2nd-12th month (rapid vaccination) (IM)

• 0-7days-21/30days-12th month (new rapid vaccination method) (IM)

• 95% successful
• If unsuccessful, additional 0-3 months (50% successful)

• Immediate immunization (within 72 hours after exposure or following birth to the newborn
child of a mother with HBV): 0-1-2-12 months vaccine + 0.06 ml/kg Hepatitis B Ig

• Side effects: local tenderness and fever, rarely Gullain-Barre syndrome.

 Meningococcal Vaccine
• Polysaccharide vaccine (MCV4), containing serogroups A+C+Y+W135, (IM)
• Conjugate vaccine containing serogroups A+C+Y+W135 (MenACYW)
• Vaccine containing serogroup B (MenB)

• Indications;
-Aspleni
-In public places during epidemics
-Traveling to risky areas
-Complement deficiency

• Routine is not recommended for healthcare workers

• In high-risk cases, the vaccine can be repeated every 3-5 years

• Side effect: local reaction

• Contraindication: known hypersensitivity reaction to vaccine components

Rabies Vaccine
• HDCV vaccine, prepared by inactivating the rabies virus produced in human
diploid cells, was administered to the deltoid muscle (IM).

• Indication:
• Pre-exposure: 0-7-21 days (3 doses) vaccine
• Veterinarians
• They will travel to an area where rabies is endemic
• Laboratory workers working with rabies virus
• After contact:
• Injuries that pose a risk of rabies
• Previously vaccinated: wound cleaning with soapy water + 0-3rd day (2 doses) vaccine
• Not previously vaccinated: wound cleaning with soapy water + 0-3-7-14-28th day (5 dose HDCV) vaccine
+ Human Rabies Ig (20IU/kg)

• VERO vaccines prepared from monkey kidney cells 0-7-21 days (2+1+1=4doses) + Horse serum (ERIG)
(40IU/kg)

• Side effects: local reaction, headache, nausea, rarely neurological findings