IPOPHL Adult Immunization in The Workplace For Email

Adult Immunization in
the Workplace:
IMMUNIZATION FACTS AND MYTHS
JOSEFINA PAMELA O. CARPIO, MD, DPCOM
Outline
• Immunization basics
• Workplace vaccines included in IPOPHL
Immunization Program 2019
• Other Vaccines for Adults
• Side Effects of Vaccines
• Facts and Myths
IMMUNIZATION BASICS
Our Immune System
SOURCE • https://airfreshener.club/quotes/works-system-immune-it-how-visual.html (accessed 14 April 2019)

Immunity
Passive
(maternal)
Innate Natural
Immunity Active
Immunity (infection)
Adaptive
Immunity Passive
(antibody
transfer)
Artificial
Active
(immunization)
SOURCE • Med in Action. Your Immune System, Vaccines and Traveling. https://www.medinaction.com/your-immune-system-vaccines-and-traveling/ (accessed 14 April 2019)
Immunization
“Immunization is the process
whereby a person is made immune or resistant
to an infectious disease,
typically by the administration of a vaccine.”
SOURCE • World Health Organization. Immunization. https://www.who.int/topics/immunization/en/ (accessed 08 April 2019)

How Vaccines Work
SOURCE • European Patient’s Academy. Vaccines. https://www.eupati.eu/types-of-medicines/vaccines/ (accessed 14 April 2019)

SOURCE • Northern Rivers Vaccination Supporters. Can Vaccines Overwhelm the Immune System? https://nrvs.info/faqs/toomanytoosoon/ (accessed 14 April 2019)
Types of Immunization
Active Passive
• A form of the bacteria or • Antibodies are administered
virus is administered • Usually post – exposure
• Immune system develops • Examples:
antibodies – Rabies
• Usually pre‐exposure – Tetanus
Types of Vaccines
Live, Attenuated Inactivated
• Live, but rendered unable to • Killed bacteria or virus
cause infection or disease • Examples: Whole cell
• Examples: BCG, OPV, Pertussis, IPV
Measles, Rotavirus
Sub‐Unit Toxoid
• Purified antigen • Inactivated toxin
• Example: Acellular • Example: Tetanus Toxoid
Pertussis, Hib, PCV13, HepB
SOURCE • World Health Organization. Vaccine Safety Basics Module 1. https://vaccine-safety-training.org/types-of-vaccine-overview.html (accessed 11 April 2019)
Routes of Vaccine Administration
SOURCE • World Health Organization. Vaccine Safety Basics. http://vaccine-safety-training.org/history-of-vaccine-development.html (accessed 16 April 2019)
History of Vaccines
Vaccination Buddhist monks drank snake venom
(Cowpox virus for Smallpox) China, 17th Century
Edward Jenner, England, 1790s
Variolation (nasal
insufflation)
China, 10th to 16th
Century
Variolation (via skin?)

India, Before 10th to 18th Century
Variolation (“buying the small pox” or

“hitting the pox”)
Sudan, Africa, 10th to 19th Century
SOURCE • The Immunisation Advisory Centre. A Brief History of Vaccination. http://www.immune.org.nz/vaccines/vaccine-development/brief-history-vaccination (accessed 08 April 2019)
• Riedel, Stefan. Edward Jenner and the history of smallpox and vaccination. Proc (Bayl Univ Med Cent). 2005 Jan; 18(1): 21–25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200696/ (accessed 08 April 2019)
• Wikipedia. Variolation. https://en.wikipedia.org/wiki/Variolation (accessed 08 April 2019)
• Immunization Action Coalition. Vaccine Timeline. http://www.immunize.org/timeline/ (accessed 11 April 2019)
• Smithsonian Institute. Image from The Mysterious Origins of the Smallpox vaccine. https://www.smithsonianmag.com/science-nature/mysterious-origins-smallpox-vaccine-
180970069/
Vaccines Through the Ages
SOURCE • World Health Organization. Vaccine Safety Basics. http://vaccine-safety-training.org/history-of-vaccine-development.html (accessed 16 April 2019)
Phases of Vaccine Development
SOURCE • https://www.researchgate.net/figure/The-different-stages-of-vaccine-development_fig2_301917070 (accessed 20 April 2019)

(ADULT) VACCINES INCLUDED IN THE
IPOPHL IMMUNIZATION PROGRAM
Influenza Vaccine
Fluarix (GSK)
Fluquadri (Sanofi)
Agrippal S1 (Seqirus)
Influenza (Flu, Trangkaso)
• Virus
Infectious Agent • Influenza virus types A and B
• Airborne
Mode of
• Objects and surfaces contaminated with respiratory
Transmission secretions
Clinical • Fever, headache
Presentation / • Respiratory symptoms
Signs and • Muscle and joint pain
Symptoms • Weakness and easy fatigability
SOURCE • Republic of the Philippines, Department of Health. Philippine Health Advisories 2012.
https://www.doh.gov.ph/sites/default/files/publications/PhilippineHealthAdvisories2012.compressed.pdf (accessed 13 April 2019)
Influenza Vaccine
TYPE OF VACCINE SCHEDULE AND ROUTE
• Inactivated • Single dose, annually (February to
• Trivalent or Quadrivalent June)
• Intramuscular
TARGET INDIVIDUALS CONTRAINDICATIONS
• ALL individuals • Severe allergic reaction to vaccine
• Chronic Diseases: Asthma, COPD, component (e.g. egg) or to prior
CVD dose
• Immunocompromised • Moderate to severe illness with or
• At increased risk (Healthcare without fever
workers, community – service • Guillain Barre Syndrome within 6
providers) months after previous dose
SOURCE • Philippine Foundation for Vaccination. Adult Immunization Schedule. http://www.philvaccine.org/vaccination-schedules/adult-immunization-schedule (accessed 13 April 2019)
Pneumococcal Vaccine
PCV 13: Prevnar (Pfizer)
PPSV 23: Pneumo 23 (Sanofi)
Pneumovax (Merck)
Pneumococcal Infection
• Bacteria
Infectious Agent • Strep. pneumoniae
Mode of • Airborne
Transmission • Objects contaminated with respiratory secretions
• Ear Infections
Clinical
• Sinusitis
Presentation /
• Pneumonia
Signs and • Meningitis
Symptoms • Sepsis
Pneumococcal Conjugated Vaccine (PCV13)
and Polysaccharide Vaccine (PPSV23)
SCHEDULE AND ROUTE
TYPE OF VACCINE • Single dose
• Inactivated • PCV13 (IM) first – PPSV23 at
• Contains 13 or 23 strains least 2 months after
• PPSV23 (IM/SC) first – PCV at
least 1 year after
• PPSV23 booster after 5 years
TARGET INDIVIDUALS from initial dose
• ALL individuals
• Chronic diseases
• Immunocompromised CONTRAINDICATIONS
• Residents of nursing / long‐term • Severe allergic reaction to vaccine
care facilities component (e.g. phenol or
• Smokers thimerosal) or to prior dose
• Individuals >/=50yo • Moderate to severe illness with or
without fever
Human Papillomavirus (HPV)
Vaccine
Cervarix (GSK)
Gardasil (Merck)
HPV Infection
• Virus
Infectious Agent
• Human papillomavirus (HPV)
Mode of
• Direct contact with skin lesions
Transmission
Clinical Presentation
/ Signs and • Warts
Symptoms
Complications • Cervical cancer
Genital Warts in HPV Infection
SOURCE New Health Advisor. Do Genital Warts Hurt? https://www.newhealthadvisor.com/do-genital-warts-hurt.html (accessed 15 April 2019)
HPV Vaccine
• Inactivated • 3 doses: 0, 1‐2, 6 months
• Quadrivalent or Nonavalent • Intramuscular
• Immunocompetent adults, • Severe allergic reaction to
ideally until the age of 26yo vaccine component or to prior
• Quadrivalent – for females dose
• Nonavalent – for males and • Moderate to severe illness with
females or without fever
• Pregnancy
Hepatitis Vaccines
Hepatitis A: Havrix (GSK), Avaxim 160 (Sanofi)

Hepatitis B: Engerix – B (GSK), Euvax (Sanofi)
Hepatitis A and B: Twinrix Adult (GSK)
Hepatitis A
Infectious • Virus
Agent • Hepatitis A virus (HAV)
Mode of
• Fecal – oral route
Transmission
Clinical
Presentation / • Flu‐like symptoms and abdominal pain
Signs and • Jaundice, dark urine, chalk‐colored stool
Symptoms
Hepatitis B
• Virus
Infectious Agent
• Hepatitis B virus (HBV)
Mode of
• Blood
Transmission
Clinical Presentation • Flu‐like symptoms and abdominal pain
/ Signs and
Symptoms • Jaundice, dark urine, chalk‐colored stool
• Chronic Hepatitis B
Complications
• Cirrhosis, Liver Cancer
Hepatitis A and B Vaccine
• Inactivated / Recombinant • HepA: 2 doses ‐ 0, 6 months
• Single antigen, or combined • HepB or combined: 3 doses ‐
0, 1, 6 months
TARGET INDIVIDUALS
• ALL individuals
• Healthcare workers, and
others with occupational CONTRAINDICATIONS
hazards • Severe allergic reaction to
• Residents and workers of vaccine component (e.g.
institutions baker’s yeast) or to prior dose
• Travelers • Moderate to severe illness
• Contacts of infected persons with or without fever
• Sexually active • Pregnancy is NOT a
• Chronic liver disease contraindication
• PLHIV
• Frequent recipients of blood
Typhoid Vaccine
Typherix (GSK)
herixTyphim VI (Sanofi)
Typhoid (Enteric Fever)
Infectious • bacteria
Agent • Salmonella typhi
Mode of
• Fecal – oral route
Transmission
Clinical
• High fever and headache
Presentation /
• Weakness, loss of appetite
Signs and • Abdominal pain with diarrhea or constipation
Symptoms
Typhoid Vaccine
• Capsular polysaccharide • Single dose
• Booster every 2 years
• Intramuscular
TARGET INDIVIDUALS
CONTRAINDICATIONS
• Immunocompetent
individuals in areas with high • Severe allergic reaction to
incidence of typhoid fever vaccine component or to
prior dose
• Moderate to severe illness
with or without fever
OTHER VACCINES FOR ADULTS
Varicella Vaccine
Varilrix (GSK)
Varivax (Merck)
Zostavax (Merck)
Varicella (Chickenpox, Bulutong)
• Virus
Infectious Agent • Varicella zoster virus (VZV)
• Airborne
Mode of
• Objects contaminated with respiratory secretions
Transmission or fluid from blisters
Clinical Presentation • Flu‐like symptoms
/ Signs and • Blisters or vesicles, entire body (Primary
Symptoms infection) or localized (Zoster)
• Permanent pain, numbness, muscle twitching
• Visual disturbances
Complications • Decreased hearing
• Zoster
Varicella Infection: Chickenpox
SOURCE The Asian Parent Singapore. Adult chickenpox strikes 97-year-old who dies from complications. https://sg.theasianparent.com/adult-chickenpox (accessed 15 April 2019)
Varicella Infection: Zoster / Shingles
SOURCE Medscape. https://reference.medscape.com/features/slideshow/herpes-zoster (accessed 15 April 2019)

Varicella Vaccine
SCHEDULE AND ROUTE
TYPE OF VACCINE • 2 doses: 0, 1‐2 months
• Post‐exposure prophylaxis: 1
• Live attenuated dose within 72 hours of exposure
• Subcutaneous
CONTRAINDICATIONS
• Severe allergic reaction to
TARGET INDIVIDUALS vaccine component (e.g. gelatin
• Immunocompetent adults or neomycin) or to prior dose
• Healthcare workers • Moderate to severe illness with
or without fever
• Pregnancy
• Immunosuppressed state
• Recent recipient of blood product
Measles, Mumps, Rubella (MMR)
Vaccine
Priorix (GSK)
MMR II (Merck)
Trimovax (Sanofi)
Measles or Rubeola (Tigdas)
• Virus
Infectious Agent • Measles or Rubeola virus
Mode of
• Airborne / respiratory secretions
Transmission
/ Signs and • Red eyes
Symptoms • Reddish rash, generalized, more than 3 days
• Diarrhea and Dehydration
• Ear Infections
Complications • Pneumonia
• Encephalitis
• Blindness
Measles
SOURCE United Kingdom National Health Services. Measles. https://www.nhs.uk/conditions/measles/symptoms/ (accessed 16 April 2019)
Mumps (Beke)
• Virus
Infectious Agent
• Mumps Virus
Mode of
• Airborne / respiratory secretions
Transmission
/ Signs and
Symptoms • Inflammed salivary glands
Complications • Infertility (males only)
Mumps
SOURCE WebMD. Chickenpox, Mumps and Measles: Not Just for Kids. https://www.webmd.com/vaccines/ss/slideshow-conditions-children-adults (accessed 16 April 2019)
Rubella
(German Measles, Tigdas Hangin)
• Virus
Infectious Agent • Rubella Virus
Mode of • Airborne / respiratory secretions
Transmission
Clinical Presentation • Swollen lymph nodes
/ Signs and • Flu‐like symptoms
Symptoms • Reddish rash, generalized (head to toe), 3 days or less
• Miscarriage or Stillbirth
Complications • Congenital Rubella Syndrome (deafness, cataracts,
heart defects, intellectual disabilities, low birth weight)
Congenital Rubella Syndrome
Blueberry muffin rash
Congenital cataract
SOURCE Makadia S, Shah H, Patel B, Bhuptani N. Gregg syndrome: With blueberry muffin rash and congenital cataract. Indian J Paediatr Dermatol 2016;17:229-31.
http://www.ijpd.in/text.asp?2016/17/3/229/179496 (accessed 16 April 2019)
MMR Vaccine
SCHEDULE AND ROUTE
TYPE OF VACCINE
• 1‐2 doses at least 28 days apart
• Live attenuated • Subcutaneous
CONTRAINDICATIONS
TARGET INDIVIDUALS
• Incomplete vaccination for MMR vaccine component (e.g. gelatin
during childhood or neomycin) or to prior dose
• No previous infection • Moderate to severe illness with
• With high risk of infection or without fever
(healthcare workers, travelers) • Immunocompromised
• Pregnancy ‐ Women should be
advised not to get pregnant until
3 months after vaccination
Meningococcal Vaccine
Mencevax ACWY (GSK)
Menactra (Sanofi)
Meningococcal Infection
• Bacteria
Infectious Agent • Nisseria meningitides
• Airborne
Mode of
• Other objects contaminated with respiratory droplets,
Transmission including food and eating utensils
Clinical • Fever and respiratory symptoms
• Pinpoint rash, progressing into bruises
Presentation / • Gangrene
Signs and • Unstable vital signs
Symptoms • Neurologic signs (if with Meningitis)
Meningococcemia
SOURCE McLaren Flint. Meningococcemia on the leg. http://mclarenhealthplan.org/flint/health-information/2242.aspx (accessed 16 April 2019)
Meningococcal Vaccine
• Single dose
• Polysaccharide
• High‐risk groups: 2 doses 2
• Quadrivalent months apart, and every 5 years
• Subcutaneous
• Travelers to highly endemic areas • Severe allergic reaction to
vaccine component or to prior
dose
• Moderate to severe illness with
or without fever
Rabies Vaccine
Rabipur (GSK)
Verorab (Sanofi)
Rabies
Infectious • Virus
Agent • Rabies virus
• Bite of infected animal
Mode of
• Open wound contaminated with saliva of infected
Transmission animal
Clinical • Headache and fever
• Pain or numbness on bite area
Presentation / • Delirium, paralysis, muscle spasm
Signs and • Hydrophobia or aerophobia
Symptoms • 100% fatal
Rabies Vaccine
• Purified Vero cell (PVRV) • PRE‐EXPOSURE PROPHYLAXIS:
• Purified chick embryo cell (PCEC) • Intradermal: Day 0, 7, 21/28
• Intramuscular: Day 0, 7, 21/28
• POST‐EXPOSURE:
TARGET INDIVIDUALS • Intradermal 2 site: Days 0, 3, 7,
• Healthcare workers directly and 28
caring for rabies patients • Intramuscular: Days 0, 3, 7, 24,
• Pet – owners and 28
• Animal handlers
• Animal bite victims
CONTRAINDICATIONS
Severe allergic reaction to
vaccine component or to prior
dose
Tetanus, Diphtheria, Pertussis
Vaccine
Boostrix (GSK)
Adacel (Sanofi)
Tetanus
• Bacteria
Infectious Agent
• Clostridium tetani
Mode of • Contamination of wounds
Transmission
Clinical Presentation • Localized muscle rigidity
/ Signs and • Trismus / lockjaw
Symptoms • Generalized muscle spasm
• Asphyxia
Complications • Fractures and dislocations
SOURCE • Hinfrey, Patrick et al. Tetanus. Medscape. https://emedicine.medscape.com/article/229594-overview (accessed 15 April 2019)
Tetanus
Sir Charles Bell’s portrait of a soldier dying of tetanus.
SOURCE • No Measles. Tetanus. https://www.nomeasles.com/tetanus/ (accessed 16 April 2019)

Diphtheria
• Bacteria
Infectious Agent • Corynebacterium diphtheria
Mode of • Airborne (respiratory droplets)
• Fever, chills, malaise
• Throat pain, difficult / painful swallowing
Signs and • Hoarseness
Symptoms • Graying membrane covering throat and tonsils
• Difficulty breathing
Tonsillitis and Diphtheria
SOURCE • Abas, Azura. Five Diphtheria Deaths in Malaysia So Far. New Straits Times. https://www.nst.com.my/news/2016/06/155591/five-diphtheria-deaths-malaysia-so-far (accessed
13 April 2019)
Pertussis (Whooping Cough)
Infectious • Bacteria
Agent • Bordetella pertussis
Mode of • Airborne / respiratory secretions
• Cough persisting 2 or more weeks
Signs and
• Coughing fits
Symptoms • Cough followed by vomiting
Tetanus, Diphtheria,
and Pertussis Vaccine
• Inactivated • 3 doses: 2nd dose 4 – 8
weeks after 1st dose, 3rd
dose 6 – 12 months after
TARGET INDIVIDUALS 2nd dose
• last vaccination 10 years ago • 1 dose of the 3 should be
• close contact to infants Tdap
• before pregnancy or
immediately after delivery CONTRAINDICATIONS
• Healthcare workers
vaccine component or to
prior dose
• Moderate to severe
illness
SIDE EFFECTS OF IMMUNIZATION
Common Side Effects of Vaccines
• injection site reactions (pain, swelling and
redness)
• fever
• shivering / chills
• fatigue / extreme tiredness
• headache
• muscle and joint pain
SOURCE • United Kingdome National Health Services. Vaccination. https://www.nhs.uk/conditions/vaccinations/reporting-side-effects/ (accessed 16 April 2019)
Relief of Side Effects
• Hydrate
• Cold compress
• OTC pain reliever
• Move arm around
SOURCE • US Department of Health and Human Services. What to Expect – for Adults. https://www.vaccines.gov/getting/for_adults (accessed 16 April 2019)
Rare Side Effects of Vaccination
• Allergic reactions
• Severe allergic reaction Æ Anaphylaxis
• Guillain Barre Syndrome
SOURCE • United Kingdome National Health Services. Vaccination. https://www.nhs.uk/conditions/vaccinations/reporting-side-effects/ (accessed 16 April 2019)
Immunization
FACTS AND MYTHS
True or False?
False / Myth Facts
Better hygiene and • Better hygiene protects people from
sanitation will make many infectious diseases.
diseases disappear – • Many infections can spread
vaccines are not regardless of how clean we are.
necessary • If we stop vaccination, diseases that
have become uncommon (e.g. polio
and measles) will quickly reappear.
SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

(accessed 16 April 2019)
True or False?
False / Myth Facts
Vaccine‐preventable • Infectious agents continue to
diseases are almost circulate in some parts of the world
eradicated in my and can cross geographical borders
country, so there is no and infect anyone who is not
reason to be protected.
vaccinated. • Example: Measles outbreaks

True or False?
False / Myth Facts
Vaccine‐preventable • Illnesses such as measles, mumps and
childhood illnesses rubella are serious and can lead to
severe complications (pneumonia,
are just an encephalitis, blindness, diarrhoea, ear
unfortunate fact of infections, congenital rubella syndrome,
life. and death)
• Failure to vaccinate against these
diseases leaves children unnecessarily
vulnerable.
• All these diseases and suffering can be
prevented with vaccines, and do not
necessarily have to be “facts of life.”

True or False?
True / Fact Facts
Giving a child more • Giving several vaccines at the same time
than one vaccine at a has no adverse effect on a child’s
time does not immune system
increase the risk of • Children are exposed to several hundred
harmful side‐effects, foreign substances that trigger an
and will not overload immune response every day.
the child’s immune • Key advantages of having several
system. vaccines at once:
– Fewer clinic visits
– Fewer injections
– Better compliance to schedule

True or False?
False / Myth Facts
Vaccines contain • Thiomersal
mercury, which makes – organic, mercury‐containing compound
vaccines dangerous. – added in safe quanities to some
vaccines as a preservative
– usually used in multi‐dose vials
• No evidence suggesting thiomersal
amount in multi‐dose vials poses a
health risk

True or False?
True / Fact Facts
Vaccines do not cause • 1998 ‐ study showed possible link
autism. between measles‐mumps‐rubella
(MMR) vaccine and autism
• Discovered to be seriously flawed,
and paper has been retracted by the
journal that published it

True or False?
False / Myth Facts
Dengue vaccine • Dengue infection may cause severe
(Dengvaxia) causes and fatal bleeding
bleeding, which may • Autopsy studies of alleged deaths
be severe and life‐ due to Dengvaxia, done by UPCM
threatening. team of experts, showed that fatal
hemorrhage was due to Dengue
infection.

SOURCE • Sio – Aguilar, Julieta. Highlights of the PGH DITF Findings and Recommendations. UPCM – PGH, UP Med Webinars. February 7, 2018.
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Adult Immunization in

SOURCE • https://airfreshener.club/quotes/works-system-immune-it-how-visual.html (accessed 14 April 2019)

SOURCE • World Health Organization. Immunization. https://www.who.int/topics/immunization/en/ (accessed 08 April 2019)

SOURCE • European Patient’s Academy. Vaccines. https://www.eupati.eu/types-of-medicines/vaccines/ (accessed 14 April 2019)

Variolation (via skin?)

Variolation (“buying the small pox” or

SOURCE • https://www.researchgate.net/figure/The-different-stages-of-vaccine-development_fig2_301917070 (accessed 20 April 2019)

Hepatitis A: Havrix (GSK), Avaxim 160 (Sanofi)

SOURCE Medscape. https://reference.medscape.com/features/slideshow/herpes-zoster (accessed 15 April 2019)

SOURCE • No Measles. Tetanus. https://www.nomeasles.com/tetanus/ (accessed 16 April 2019)

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

SOURCE • World Health Organization. Questions and Answers on Immunization. https://www.who.int/vietnam/news/feature-stories/detail/questions-and-answers-on-immunization

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