vaccination: current application - lookusfile.lookus.net/millipediatri/sunumlar/2015/201524.pdf ·...
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Elif N.Özmert, MD, PhD
Professor in Pediatrics
Hacettepe University Faculty of Medicine
Department of Pediatrics
Socail Pediatrics & Developmental Pediatrics
Vaccination: Current Application
What Is Vaccine ?
Antigen Other• Live
• Bakteri• Virüs
• Inaktive• Bactria• Virüs• Rekombinant DNA• Toksoid• Antigen
• Kombined
• Adjuvant• Aluminum salts
• Konjugation substance
• Diluent
• Preservative, stabilisator• Antibiotic
• Timerasol
What Is Vaccine ?
1800, used by British physician Edward Jenner (1749-1823) for the technique he devised of preventing smallpox by injecting people with the cowpox virus (variolae vaccinae), from vaccine (adj.) "pertaining to cows, from cows" (1798), from Latin vaccinus"from cows," from vacca "cow"
At the first meeting of the Royal Jennerian Society , Edward Jenner insisted that the origin of the term vaccination, from the Latin for cow (“vacca”), be
credited to his friend and fellow physician, Richard Dunning.
History of Vaccines900
Measles &Smallpox described separatelyby Rhazes, Persian physician
1000
Early Chinese inoculation
1718
Variolationin Turkey
Lady Mary Montagu
1800-1810
Jenner's breakthrough
Origin of the term vaccination
Serial vaccinationof cows In Naples
1880-1900
Louis Pasteur first laboratoryvaccine (chickencholera)
Rabies Vaccine usedin human
Cholera VaccineSpanish Jaime Ferrán
1882Anti-Vaccination Arguments Spread
The Anti-Vaccination League of America held its first meeting
in New York
History of Vaccines1920-1930
-Ramon & Glenny Diphteria toxoidvaccine
Al salt adjuvant
-Albert Calmette& Camille Guérinfirst human testsof BCG
1935-1945
-Max Theiler develops yellowfever vaccine
-Pearl Kendrick & Grace Elderdingpertussis vaccine
-Influenza vaccineapproved
1947-1955
-Tuberculosis International Campaign
-The first combined DTP
-Salk givesvaccine to his family & vaccinelicenced
1958-1970
-Measles vaccine
-Mumps vaccine
-Rubella vaccine
-Sabin oral polio vaccine Licensed
-Smallpoxeradicationprogramme
1972-1980
-WHO advocates DTPfor new EPI-Michiaki Takahashichickenpox vaccine-Smallpox declarederadicated
History of Vaccines1981-1985
Hepatit B vaccine
P.Pneumococcal v.
1986-1990
Conjugate Hib vaccinelicensed
Oral Typhoid vaccinelicensed
Measles eliminationgoals
MNT elimination goals
Global Polio Eradication Initiative
1991-2000
Maurice Hilleman’s hepatitis A vaccinelicenced
2000-2015
Global Alliance forVaccines andImmunizationRotavirus vaccineC.Pneumococcal v.C.Meningococcal v.Group B meningoccocal v.HPVHepatitis E v.
MMR safetyquestioned
Vaccine Preventable Diseases
• Cholera
• Diphtheria
• Hepatitis A
• Hepatitis B
• Hepatitis E
• Haemophilus influenzae type b (Hib)
• Human papillomavirus (HPV)
• Influenza
• Japanese encephalitis
• Malaria
• Measles
• Meningococcal meningitis
• Mumps
• Pertussis
• Pneumococcal disease
• Poliomyelitis
• Rabies
• Rotavirus
• Rubella
• Tetanus
• Tick-borne encephalitis
• Tuberculosis
• Typhoid
• Varicella
• Yellow Fever
25 Diseases
Pipeline Vaccines
• Campylobacter
• Chagas disease
• Enterotoxigenic E.coli
• Streptococcus pyogenes
• HIV
• Herpes Simplex Virus
• Human Hookworm infection
• Leishmaniasis
• Malaria
• Nontyphoidal Salmonelloses
• Norovirus
• Paratyphoid fever
• Rotavirus vaccines (next-generation)
• Schistosomiasis
• Shigella
• Streptococcus pneumoniae (pediatric vaccines)
• Tuberculosis (new vaccines)
• Universal Influenza vaccine
• RSV (Respiratory Syncytial Virus)
Why Do We Vaccinate
Personalrisks
Cocoon strategy
Diseases
Long-term complications-malignancy
Morbidity
Mortality
Why Do We Vaccinate
Personalrisks
Cocoon strategy
Diseases
Long-term complications-malignancy
Disability
Mortality
Why Do We Vaccinate
Personalrisks
Cocoon strategy
Diseases
Long-term complications-malignancy
Disability
Mortality
Why Do We Vaccinate
Personalrisks
Cocoon strategy
İllness
Long-term complications-malignancy
Disability
Mortality
Why Do We Vaccinate
Personalrisks
Cocoon strategy
İllness
Long-term complications-malignancy
Disability
Mortality
Why Do We Vaccinate
Personalrisks
Cocoon strategy
İllness
Long-term complications-malignancy
Disability
Mortality
Current Situation
•Immunization currently averts an estimated 2 to 3 million deaths every year.•But an estimated 18.7 million infants worldwide are still missing out on basic vaccines.
•Global vaccination coverage is generally holding steady.•Uptake of new and underused vaccines is increasing.
Global Immunization 1980-2014, DTP3 Coverage
Source: WHO/UNICEF coverage estimates 2014 revision. July 2015
Immunization Vaccines and Biologicals, (IVB), World Health Organization.
194 WHO Member States. Date of slide: 21 July 2015. Global coverage 86% in 2014
18.7 million infants not immunized (DTP3), 2014
African
American
Eastern Mediterranean
European
South East Asian
Western Pacific
Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 / United Nations, Population Division. The World Population Prospects - the 2012 revision". New York, 2013.
Immunization Vaccines and Biologicals, (IVB), World Health Organization.
194 WHO Member States. Date of slide: 23 July 2015.
21
Polio Eradication Progress, 1988 – 2014
Source: WHO/POLIO database, as of Jul 2015
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2015. All rights reserved
Certified polio-free regions (126 countries)
Endemic with wild poliovirus ( 3 countries)
Not certified but non-endemic (65 countries)
2000: ≈3000 wild polio cases reported2014: 359 wild polio cases reported
0 2,100 4,2001,050 Kilometers
Immunization Coverage With 1st Dose of Measles ContainingVaccines in Infants, 2014
Source: WHO/UNICEF coverage estimates 2014 revision. July 2015. Map
production: Immunization Vaccines and Biologicals, (IVB). World Health
Organization
Date of slide: 16 July 2015
The boundaries and names shown and the designations used on this map do not imply the
expression of any opinion whatsoever on the part of the World Health Organization
concerning the legal status of any country, territory, city or area or of its authorities, or
concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement. © WHO 2015. All
rights reserved
<50% (4 countries or 2%)
50-79% (33 countries or 17%)
80-89% (35 countries or 18%)
>=90% (122 countries or 63%)
Not available
Not applicable
0 1,500 3,000 4,500 6,000750
Kilometers
35 Countries Eliminated MNT Between 2000 & 2014 (Plus 30 States out of 36 in India, Ethiopia all except Somali region and 30/34 provinces in Indonesia) leaving 24 countries yet to eliminate MNT
Source: WHO/UNICEF Database
Date of slide :26 May 2015
Map production: Immunization Vaccines and
Biologicals, (IVB), World Health Organization
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. ©WHO 2015. All rights reserved
MNT eliminated from 2000-2014
MNT not eliminated
MNT eliminated before 2000
Number of Countries Introduced HepB Vaccine &Global Infant HepB3 Coverage, 1989-2014
*excluding 3 countries where HepB administered for adolescence
Source: WHO/UNICEF coverage estimates 2014 revision. July 2015 and WHO database as
at 07 July 2015
Immunization Vaccines and Biologicals, (IVB), World Health Organization.
194 WHO Member States. Date of slide: 29 July 2014.
0 2,100 4,2001,050 Kilometers
Immunization Coverage With 3rd Dose of HepB VaccinesIn Infants, 2014
Source: WHO/UNICEF coverage estimates 2015 revision. July 2015. Map
production: Immunization Vaccines and Biologicals, (IVB). World Health
Organization
Date of slide: 16 July 2015
The boundaries and names shown and the designations used on this map do not imply the expression of any
opinion whatsoever on the part of the World Health Organization concerning the legal status of any country,
territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted
lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO
2015. All rights reserved
<50% (7 countries or 4%)
50-79% (30 countries or 16%)
80-89% (32 countries or 17%)
>=90% (115 countries or 62%)
Not available / HepB not introduced or no coverage data available (10 countries or 5%)
Not applicable
Countries Introduced Hib Vaccine1997 and 2014
29 countries introduced
1997
190 countries introduced
2014
2 countries partially introduced
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health
Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the del imitation of its frontiers or boundaries.
Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.
© WHO 2015. All rights reserved
2 countries partially introduced
Source: WHO/IVB Database as at 24 July 2015.
Map production: Immunization Vaccines and Biologicals, (IVB),
World Health Organization.
194 WHO Member States. Date of slide: 28 July 2014
0 2,100 4,2001,050 Kilometers
0 2,100 4,2001,050 Kilometers
Immunization Coverage With PCV3 Containing VaccinesIn Infants, 2014
Source: WHO/UNICEF coverage estimates 2015 revision. Map production:
Immunization Vaccines and Biologicals, (IVB). World Health Organization
Date of slide: 16 July 2015
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion
whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area
or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent
approximate border lines for which there may not yet be full agreement. © WHO 2015. All rights reserved
<50% (11 countries or 6%)
50-79% (22 countries or 11%)
80-89% (20 countries or 10%)
>=90% (49 countries or 25%)
Not available / not in national immunization schedule (77 countries or 40%)
Not applicable
PCV in schedule but no coverage data available (15 countries or 8%)
0 2,100 4,2001,050 Kilometers
Immunization Coverage With Rotavirus Vaccine In Infants, 2014
Source: WHO/UNICEF coverage estimates 2015 revision. Map production:
Immunization Vaccines and Biologicals, (IVB). World Health Organization
Date of slide: 16 July 2015
The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part
of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the
delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full
agreement. © WHO 2015. All rights reserved
<50% (15 countries or 8%)
50-79% (15 countries or 8%)
80-89% (15 countries or 8%)
>=90% (20 countries or 10%)
Not applicable
Rotavirus vaccine in schedule but no coverage data available (9 countries or 5%)
Not available / not in national immunization schedule (120 countries or 62%)
0
20
40
60
80
100
120
140
160
180
200
DBT MEASLES POLİO HİB BCG RUBELLA MUMPS PCV ROTA HPV
194 194 194 192
158
140
121 117
7463
Number of Countries With Vaccines In The National Programme, 2014
No of countries
0
10
20
30
40
50
60
70
80
90
BCG DBT POLİO MEASLES HEP B HİB PCV ROTA
8986 86 85
82
56
31
19
Global Coverage % of Vaccines, 2014
Global Coverage %
Six Strategic Objectives
1. All countries commit to immunization as a priority.
2. Individuals and communities understand the value of vaccines and demand immunization as both their right and responsibility.
3. The benefits of immunization are equitably extended to all people.
4. Strong immunization systems are an integral part of a well functioning health system
5. Immunization programmes have sustainable access to predictable funding, quality supply and innovative technologies.
6. Country, regional and global research and development innovations maximize the benefits of immunization.