response week 1

Please respond to the two posy below ( separate responses with 2 citations each )

Post 1

Immunization is the most effective and safe public health intervention in reducing the incidence, prevalence, morbidity, and mortality of various infectious diseases.  However, the timing for each dose of a vaccine is based on 2 factors.  First, the age when the body’s immune system will provide optimal protection after vaccination.  Second, the earliest possible time the individual is at risk for that disease.  This is the reason why vaccinations are normally given in age groups.  For example, when it comes to the FLU, the minimum age for influenza vaccine is six months for inactivated vaccine and two years for the live vaccine. For the age group 6 months to 8 years, two doses four weeks apart are recommended for those getting them for the first time. In subsequent years kids up to 8 years can get only one dose annually. One dose is recommended for all individuals above nine years of age.  Additionally, Individuals with egg allergies can get the influenza vaccine under medical supervision (Balasundaram & Sakr, 2022).

           On the other hand, many adults feel that they do not need vaccinations, or worry about side effects from the vaccine itself, but people (male & female) ages 65 and older are at higher risk of complications from the actual diseases.  It is important for older adults to keep vaccines current: they may not have been vaccinated as a child, new vaccinations may now be available, immunity may have faded, and most importantly, seniors are more susceptible to serious and possibly life-threatening infections.  The most important vaccinations seniors should discuss with their physicians include the flu vaccine, pneumococcal vaccine to prevent pneumonia, shingles vaccine, and a tetanus-diptheria-pertussis vaccine (Tdap) (Cunningham et al, 2021).

           Furthermore, in congenital or acquired immune deficiencies, infectious diseases which can be prevented by vaccination have a severe course because of suppression of the immune system by the disease itself or the treatment methods used. Therefore, vaccination is important in immune deficiency. Although the protective antibody levels achieved in healthy individuals can not be provided in patients with immune deficiency, there is no drawback in administering inactive vaccines in accordance with the vaccination program. On the other hand, live viral and bacterial vaccines should not be administered during periods of immunosuppression in conditions where the immune system is strongly suppressed by diseases or drugs, since they would cause systemic infection.  Clinicians should have sufficient knowledge about contraindications of vaccination in individuals with immune deficiency and in people who live in the same house with these individuals (Arvas, 2014.)

References:

Arvas A. Vaccination in patients with immunosuppression. Turk Pediatri Ars. 2014 Sep 

1;49(3):181-5. doi: 10.5152/tpa.2014.2206. PMID: 26078660; PMCID: 

PMC4462293.

Balasundaram P, Sakr M. Understanding and Application of CDC Immunization 

Guidelines. [Updated 2022 Sep 3]. In: StatPearls [Internet]. Treasure 

Post 2

Vaccination Across the Lifespan

            Vaccinations differ depending on the age group of the patients. The differences in the vaccinations across the age group are due to differences in vulnerability to diseases that occur with changes in age.

11 to 24 Years

            Between 11 and 12 years an individual should start receiving the vaccination for influenza (CDC, 2022). This influenza vaccination is given annually as one dose. Individuals should also receive the first dose of tetanus, diphtheria, pertussis vaccine, and meningococcal vaccine between 11 and 12 years (CDC, 2022). The second dose of the meningococcal vaccine is given at 16 years.  Human papillomavirus vaccination is given at around 11 and 12 years (CDC, 2022). This vaccine is given only to females. From 19 years, inactivated, recombinant, or live attenuated influenza vaccine is given as one dose each year (CDC, 2022). Tetanus, diphtheria, and pertussis vaccine (Tdap) can be given as a single dose during every pregnancy from 19 years and above. One or two doses of measles, hepatitis A vaccine, hepatitis B vaccine, mumps, rubella vaccine, 2 doses of varicella vaccine for a patient born in 1980, 2 doses of zoster recombinant, 1 dose of Pneumoccocal (PCV15) then PPSV23 or 1 dose of PCV 20 are given from 19 years (CDC, 2022).

25 to 64 years

     Just like the previous age group, the annual dose of inactivated, recombinant or live attenuated influenza vaccine is given. 1 or 2 doses of the measles, mumps, and rubella vaccine can be given in this age group if it was not given in the previous age group. Tdap may be given if the patient is pregnant in this age group. As in the previous age group, varicella vaccine, measles, mumps, and rubella vaccine, recombinant zoster vaccine, pneumococcal vaccine, meningococcal vaccine, Hemophilus influenza type B vaccine, hepatitis A and B vaccines are given in this age group. Human papillomavirus can be given from 27 years to 45 years (CDC, 2022).

65 years and above

     Annual vaccination for influenza with inactivated, or recombinant vaccine continues in this age group (CDC, 2022). No live attenuated influenza vaccine is given in this age group, unlike the previous age groups. Additionally, no measles, mumps, and rubella vaccine, or human papillomavirus vaccine are given in this age group. 2 doses of varicella vaccine and 2 doses of recombinant zoster vaccine can be given. As in the previous age group 1 dose of PCV15 followed by PPSV23 or a dose of PCV20 is given in this age group for pneumococcal prevention. Hepatitis A, meningococcal A, C, W, Y, and B, and Hemophilus influenza type B vaccines can be given in this age group as in the previous age group.

Effect of Vaccinations on Immunocompromised Patients

     Immunocompromised patients include patients with diseases such as cancer and HIV/AIDs. Patients receiving immunosuppressive therapy for maintenance of transplants such as kidney transplants, and other diseases requiring immunosuppression are immunosuppressed. Vaccination in these immunosuppressed states may result in diverse outcomes. Response to vaccines is attenuated by immunosuppressive medications (Papp et al., 2019). Therefore, for patients who will receive immunosuppressive medications, vaccination needs to be given before starting the medications. This avoids the attenuation of vaccination response due to immunosuppressive therapy. However, some medications do not require discontinuation before their administration. For instance, Papp et al. (2019) note that no immunosuppressive medications can be stopped for the administration of inactivated vaccines. Some live vaccines can be used safely by patients on immunosuppressive therapy. Use of subunit vaccines and live zoster vaccines are used safely and effectively in patients on immunosuppressive therapy (Papp et al., 2019). CDC recommends that people above 19 years undergoing immunosuppressive therapy can receive the herpes zoster vaccine.

      HIV/AIDs is one of the immunosuppressed states that have an impact on the response to vaccination. HIV/AIDs impairs the response to vaccination even in patients on antiretroviral therapy whose viral load has been suppressed (El Chaer & El Sahly, 2019). This vaccine response impairment by HIV/AIDs changes the efficacy of vaccines. The Hepatitis A vaccine is safe in patients with HIV/AIDs but the immunogenicity is lower than the healthy individuals (El Chaer & El Sahly, 2019). Moreover, El Chaer and El Sahly (2019) note that the vaccination for hepatitis B infection in HIV/AIDs infected people is associated with lower sero-response than in people with no HIV/AIDs. Immunogenicity to influenza vaccine is lower in HIV/AIDs infected persons. Inactivated influenza vaccine rather than a live influenza vaccine can be used in patients with HIV/AIDs. The response to the human papillomavirus vaccine in HIV/AIDs infected patients is similar to that of seronegative patients. Therefore, the human papillomavirus vaccine can be given to adolescents and eligible adults.  Pneumococcal and meningococcal vaccinations are safe but have lower immunogenicity in HIV/AIDs.

      Some vaccinations in HIV/AIDs infected patients are contraindicated due to safety concerns. The vaccinations contraindicated in HIV/AIDs patients include varicella, measles, mumps, and rubella, and live attenuated varicella-zoster vaccines (El Chaer & El Sahly, 2019). These vaccinations are associated with various adverse effects in patients with HIV/AIDs. For instance, El Chaer and El Sahly (2019) note that severe pneumonitis occurs in HIV/AIDs patients vaccinated with the measles, mumps, and rubella vaccine. No gender variations are given in these contraindications.

      Patients with malignancies such as hematological malignancies have higher incidences of infections (Mikulska et al., 2019). The changes in the response of the immune system due to malignancies may affect the response when a vaccine is prescribed. Live vaccines in patients with malignancies including hematological malignancies are at higher risk of developing the disease (Mikulska et al., 2019). A study by Bitterman et al. (2019), showed that the influenza vaccine in patients with cancers is effective and hence supports the administration of the vaccine. No gender variation in the response and efficacy to influenza vaccine in patients with cancer is noted.

References

Bitterman, R., Eliakim‐Raz, N., Vinograd, I., Trestioreanu, A. Z., Leibovici, L., & Paul, M. (2018). Influenza vaccines in immunosuppressed adults with cancer. Cochrane Database of Systematic Reviews, (2).  https://doi.org/10.1002/14651858.CD008983.pub3 Links to an external site.

 Links to an external site. CDC. (2022, June 22).  Immunization schedules. Centers for Disease Control and Prevention.  https://www.cdc.gov/vaccines/schedules/index.html Links to an external site.

El Chaer, F., & El Sahly, H. M. (2019). Vaccination in the adult patient infected with HIV: a review of vaccine efficacy and immunogenicity. The American journal of medicine, 132(4), 437-446.  https://doi.org/10.1016/j.amjmed.2018.12.011 Links to an external site.

Mikulska, M., Cesaro, S., de Lavallade, H., Di Blasi, R., Einarsdottir, S., Gallo, G., ... & Cordonnier, C. (2019). Vaccination of patients with hematological malignancies who did not have transplantations: guidelines from the 2017 European Conference on Infections in Leukaemia (ECIL 7). The Lancet Infectious Diseases, 19(6), e188-e199.  https://doi.org/10.1016/S1473-3099(18)30601-7 Links to an external site.

Papp, K. A., Haraoui, B., Kumar, D., Marshall, J. K., Bissonnette, R., Bitton, A., & Wade, J. (2019). Vaccination guidelines for patients with immune-mediated disorders on immunosuppressive therapies. Journal Of Cutaneous Medicine and Surgery, 23(1), 50-74.  https://doi.org/10.1177/1203475418811335

Island (FL): StatPearls Publishing; 2022 Jan-. Available from: 

https://www.ncbi.nlm.nih.gov/books/NBK567723/

Cunningham AL, McIntyre P, Subbarao K, Booy R, Levin MJ. Vaccines for older adults. 

BMJ. 2021 Feb 22;372:n188. doi: 10.1136/bmj.n188. PMID: 33619170.