Adolescent Immunization

IAP VISION 2007
IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE
Adolescent IMMUNIZATION
Adolescent Friendly School Initiative
IAP VISION 2007
INTRODUCTION
What is Immunization?
- Administration of all or part of micro organism or modified product. - Resulting in protection against the disease.
IAP VISION 2007
INTRODUCTION
When you were small you were protected against certain infections by Immunization: BCG-Tuberculosis DPT-Diphtheria, Whooping Cough (Pertussis), Tetanus OPV-Polio Measles
IAP VISION 2007
Importance of adolescent immunization
Prevention and control of disease is important for their healthy growth. They must be provided with the opportunity of healthy growth and development. Routine immunization also provides a chance of a health visit Gives further chance for preventive services and health counseling.
IAP VISION 2007
Why adolescents should be immunized?
Success of Immunization Program has resulted in the decrease in incidence of the vaccine preventable diseases. But unimmunized adolescents have become more susceptible. TT is the only vaccine included in the National Immunization Schedule in India.
IAP VISION 2007
Why Adolescent Immunization is important?
To boost immunity that is decreasing Efforts to decrease disease To have specific Protection To provide recent vaccines available for immunization
IAP VISION 2007
IAP VISION 2007
Current Status
Scenario in West Indian Scenario
IAP VISION 2007
http://www.cdc.gov/nip. Accessed May, 26th 2007
IAP VISION 2007
IAP COI Recommendations
IAP VISION 2007
IAP adolescent immunization schedule

TT
Booster at 10 and 16 years As part of MMR vaccine or (Monovalent) 1 dose to girls at 12-13 years of age, if not given earlier 1 dose at 12-13 years of age. (if not given earlier) 3 Doses (0, 1 and 6 m) if not given earlier TA, Vi or Oral typhoid vaccine every 3 years 1 dose upto 12-13 years, and 2 doses after 13 years of age. (if not given earlier) 2 doses (0 and 6 months) if not given earlier
Rubella MMR Hepatitis B Typhoid Varicella* Hepatitis A*
IAP VISION 2007
Tetanus Prophylaxis In Routine Wound Management

Doses of TT Given in past
Clean, minor wounds TT Yes No** TIG* No No
All other wounds TT Yes No*** TIG* Yes No
Unknown, < 3 doses 3 doses
*TIG: Tetanus immunoglobulin (250 IU IM) **Yes, if more than 10 years since last dose ***Yes, if more than 5 years since last dose For children less than 7 years, DTPw may be given and above 7 years TT or Td .
IAP VISION 2007
Td Vaccine
Td vaccine has become available, should this vaccine be preferred over TT?
IAP VISION 2007
Diphtheria
Pre-vaccine Era (Before 1920)

Diphtheria a leading cause of child mortality Primarily a disease of < 15 yr Most children acquired immunity naturally Most infections sub-clinical 15% symptomatic Wide spread circulation p natural boosting of immunity in adults Disease was rare in adults
IAP VISION 2007
Diphtheria
Vaccine Era
Diphtheria toxoid vaccine introduced in 1920s Widespread public use in 1940s Diphtheria became uncommon disease in developed world In USA 1980 1995, Only 41 cases reported Many European countries have not reported cases for decades
IAP VISION 2007
Vaccination Coverage & Diphtheria

Absence of natural boosting in adults susceptibility in adults Drop in coverage for children below 70% leads to spread of disease affecting children and adults both More than 1,50,000 reported cases and 5,000 deaths by end of 1996 More than 60% cases occurred in >14years
IAP VISION 2007
Diphtheria in India
Diphtheria - Down but not out
S K Kabra AIIMS Indian Ped. 2000 July
Patch remains
Nandy et al Indian Pedicatrics 2001
Diphtheria Certainly not out

Poddar B. Indian Pediatrics 2000
IAP VISION 2007
IAP VISION 2007
Is it feasible to incorporate Td in Immunization Schedule?

At 10 & 16yr instead of TT - Reasonable
Cost is little higher (Rs. 5.50 for TT and Rs. 6.10 for Td) Diphtheria toxoid one of the safest vaccines. Td is not much more reactogenic than TT. In some parts of world Td is preferred in place of TT in pregnancy & adults In India Td should be preferred over TT
IAP VISION 2007
dTap vaccine
dTap vaccine is also available, should this vaccine be preferred over dT?
IAP VISION 2007
Pertussis in adolescents: Implications
Adolescence : a critical time for acquisition of disease. Immunity from childhood vaccination starts waning after 4 5 yr & virtually absent after 10 12 yr
IAP VISION 2007
Resurgence of Pertussis: India

Pertussis cases & Immunization coverage (INDIA)
400000 350000 120
DPT3 coverage
100 80 Immunization coverage (%)
300000 No. of cases (Pertussis) 250000 200000 150000 100000 20 50000 0 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Year 0 60
Pulse polio
40
Adolescent of data from :Source: WHO World Health Organization Immunization, Vaccines And Biologicals_ Vaccine preventable diseases Vaccines Graphical representation Friendly School Initiative
monitoring system 2006 Global Summary Reference Time Series.htm Oct.2006 & WHO immunization profile India Sept.2006 (web)
IAP VISION 2007
Pertussis in adolescents
There is a need to vaccinate all adolescents & adults against pertussis.

Recommended by ; international consensus group on pertussis & global pertussis initiative.
IAP VISION 2007
Tdap vaccine
Tdap instead of Td is recommended by many authorities to prevent pertussis in adolescents and adults The major benefit is protection of infants and children from pertussis Cost is major obstacle 50 times Being used in Canada, Not yet licensed in USA
IAP VISION 2007
Rubella
Aim is to;
prevent congenital rubella syndrome (CRS), and not to prevent rubella infection per se, as it is usually benign and inconsequential.
IAP VISION 2007
Rubella
Haphazard use of rubella vaccine in young children may shift the epidemiology of rubella to the right with more clinical cases occurring in young adults leading to increase in cases of CRS.
IAP VISION 2007
MMR
Recommended to all adolescents (sp. Girls) irrespective of previous immunization status no upper age limit. Many states are likely to include MMR in UIP.
IAP VISION 2007
Mumps
There is no difference in efficacy or safety among available different strains. Aseptic Meningitis following vaccination is mild, without any sequel or mortality. No association with either autism or Crohns dis. (URABE V/S L.Z.)
IAP VISION 2007
Hepatitis B
WHO has recommended universal Hepatitis B vaccination. In 2002 GOI also initiated incorporation of HB vaccine as universal vaccine in a phased manner. For previously unvaccinated adolescents 0,1 & 6 mo. is a preferred schedule. No booster.
IAP VISION 2007
Hepatitis B Immunogloulin (HBIG)
HBIG provides immediate passive immunity Indications; individuals with recent exposure to hepatitis B virus prevention of mother to child transmission and following sexual exposure like in rape cases. Dose: Adults: 1000-2000 IU; Children:- 32-48 IU/kg body wt.
IAP VISION 2007
Typhoid
Peak in school age children (5-19 yrs) Endemic areas peak incidence school children. 33m cases & 5 lac deaths 3 populations are at particularly high risk a. Children in endemic areas b. Travelers to endemic areas c. Clinical microbiology technicians Vi capsular polysaccharide vaccine Typhoid: in endemic areas every 3 yearly.
IAP VISION 2007
Varicella
The IAP COI opines that varicella vaccine is not recommended for universal immunization in India at present. It may be offered to children from high socio-economic strata of society after explaining the pros and cons to the parents on a one-to-one named child basis.
IAP VISION 2007
Varicella IAP COI

It is indicated for ;
In children with chronic lung/heart disease, Humoral immunodeficiencies, HIV infection (but with C4 counts above 15% of the age related norms), Leukemia (but in remission and off chemotherapy for at least 3-6 months) and those on long term salicylates/high dose long term oral steroids. In household contacts of immuno-compromised. In children attending crches and day care centers.
IAP VISION 2007
Varicella Schedule
One dose below 13 year and two doses after that 4 wk apart. For post-exposure within 72 hrs of exposure. Ensure that adolescent girl is not pregnant and she should not conceive for 4 wk after vaccination
IAP VISION 2007
Hepatitis A
The IAP COI opines that HA vaccine is not recommended for universal immunization in India at present. It may be offered to children after explaining the parents on a one-to one named child basis. . Post exposure to contacts with in 10 days. Two doses at 6 mo interval from 2 yr onwards
IAP VISION 2007
Indications in Adolescents;
Who have not had viral hepatitis in past, especially those who are leaving home for further studies.
In all sero negative patients with chronic liver disease Family contacts of patients with chronic liver disease. In children attending crches and day care centers and In travelers from abroad visiting endemic areas.
IAP VISION 2007
Proposed immunization schedule

BCG
All adolescent without a scar -Tdap booster dose in previously immunized -Three doses of Tdap in previously unimmunized or partially unimmunized -Single booster dose in all the adolescent -Two doses at 4 weeks in previously unimmunized Full course in previously unimmunized child
Diphtheria, Pertussis, Tetanus MMR
Hepatitis b
IAP VISION 2007
Newer and Future Vaccines for Adolescent
IAP VISION 2007
Further Vaccines
Present
?
RSV mening A, C conjugate mening B Herpes hep E
2010 - 2020 ?
HIV?
Hib acP acP
pneumo conjugate rotavirus
otitis media grpB Strep hep C? H. Pylori HPV EBV dengue ETECETEC-cholera new TB Shigella
(adapted from EPI)
DTacPDTacP-IPV/Hib
DTacPDTacP-HB/Hib DTacP-IPVDTacP-IPV-HB/Hib
malaria
IAP VISION 2007
Vaccines under discussion

Meningococcal Influenza HPV e IPV

Salk Vero cell IPV [v IPV]
JE CMV Herpes HIV
EB V Parvovirus, Para I E Coli Adeno Malaria Dengue Hepatitis E Cholera Shigella Campylobacter Schistosomiasis
IAP VISION 2007
Vaccination in special Situations

Rabies Pre/post exposure Meningococcal vaccine Pneumococcal Influenza
IAP VISION 2007
Influenza vaccine -1
There are 2 influenza viruses, types A and B. Type A :subtypes based on two surface antigens Hemagglutinin (H) and Neuraminidase (N). eg H1N1 Influenza type B is not categorized into subtypes. There are two vaccines available, The inactivated killed Vaccine & Live attenuated influenza vaccine (LAIV) Both vaccines includes Two type A strains (e.g. H3N2 and H1N1) & One type B strain
Centers for Disease Control and Prevention. Prevention and control of influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2005;54 (RR08):1-40
IAP VISION 2007
Influenza Vaccine -2
The inactivated influenza vaccine contains killed, partially purified viruses. IM inj . All of the groups for which annual influenza vaccination is indicated may receive the inactivated vaccine Medical conditions at increased risk
Pulmonary or cardiovascular disease, Neuromuscular dysfunction, Immuno-suppression, Long-term aspirin therapy.
IAP VISION 2007
LAVI (Live Attenuated Influenza Vaccine ) -3
The LAIV licensed USA- FluMist (MedImmune, Inc.). Intra nasally annually to optimize protection. Given only to healthy persons 5 to 49 yrs of age who are in contact with severely immuno-suppressed persons. Both vaccines are made from viruses grown in eggs /avoid in allergy to chicken or egg protein
IAP VISION 2007
Human Papilloma Virus (HPV)
HPV is now implicated as a causative agent > 99% of cervical cancer cases. Also pharyngeal and ano-genital cancers . Lifetime risk among sexually active men & women - 50%. Most common sexually transmitted infection in the USA Genital infections occur via G-G; O-G; H-G and AG contact The vast majority of infections go unrecognized
Adolescent Friendlyfor Pediatricians,Vol. 19, No. 1 November 2006 Patients A Clinical Guide School Initiative
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent
IAP VISION 2007
Human Papilloma Virus (HPV)
100 types of HPV identified 30 -40 types infect ano-genital region. Low-risk and high-risk oncogenic potential 15 -20 oncogenic HR HPV 16 /18 - 70% cancer LR HPV 6 / 11)
IAP VISION 2007
HPV Vaccines available
Quadrivalent HPV vaccine FDA licensed Gardasil, Merck Bivalent vaccine, Cervarix,GSK Biologicals soon Both vaccines protect against HPV types 16 and 18. In clinical phase 2 and 3 trials, both vaccines were found to be safe and effective in females. Quadrivalent vaccine is found to be 100% efficacious against high-grade dysplasia, the predecessor to cervical cancer.
IAP VISION 2007
HPV vaccine schedule
Studies show a rapid rise in ano-genital HPV infections by 15 yrs age hence ensure immunization completed prior to it. 11-12 yrs endorsed by the Society for Adolescent Medicine (SAM), 9-10 yrs left to the discretion of the care provider. 3 doses of HPV given at 0, 2 and 6 months in the Deltoid. Both have stable antibody levels and continued efficacy 5 years post vaccination.
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent Patients A Clinical Guide for Pediatricians,Vol. 19, No. 1 November 2006
IAP VISION 2007
? ? Parental reaction
Major Worry : Stigma related to the sexual transmission of HPV. Vaccine will increase sexual activity among teens. Vaccine will not gain widespread acceptance Studies show Parents decisions based on severity of disease, efficacy and safety of the vaccine; the mode of transmission is less important to them. Once educated about HPV, provided with accurate information in a calm and reassuring way majority of parents have positive response .
Diekema DS and the American Academy of Pediatrics Committee on Bioethics. Responding to parental refusals of immunization of children. Clinical Report. Pediatrics. 2005;115:1428-1431
IAP VISION 2007
How to introduce the topic of HPV vaccine ?
Visit of 10-12 yrs Open the conversation with parents and adolescents about preventive strategy for all adolescent risk-taking behaviors Clarify their values about a whole range of subjects (eg, sexuality, drinking) Be sensitive to parental anxieties and possible discomfort with discussing these subjects. Then talk of HPV as preventive vaccine for cancer and STD
Richard E. Rupp, ,Susan L. Rosenthal, PhD New Immunization , Strategies for Adolescent Patients A Clinical Guide for Pediatricians,Vol. 19, No. 1 November 2006
IAP VISION 2007
My child is too young to get HPV. Why cant we wait ?
You could wait. ButTwo important reasons to do this now : The immune response appears to be better in younger girls. It takes 6 months to be fully immunized and the vaccine has to be given before any risk of exposure. It makes sense to provide it before any possible exposure might occur.
IAP VISION 2007
Can HPV vaccine be given to boys ?
At present it is only licensed for girls. The FDA wants more data about boys before they approve it. Males are a potential target for the vaccine for protection against warts, penile or anal cancer & as a vector for transmission to females.
IAP VISION 2007
Dont you think it will encourage my daughter to having early and risky sex?
Does telling young people to wear bicycle helmets or seatbelts encourage anyone to bicycle or drive recklessly? Your child may never be at risk for HPV infection, or may not be at risk for many years, but we are recommending that all girls get this before anyone is at risk of infection. It is very effective at this age and vaccinating now eliminates the worry about risk into adulthood.
IAP VISION 2007
Pneumococcal vaccine
Risk of serious Pneumococcal disease is relatively low, not recommended for routine use .
Recommended in; anatomic or functional asplenia (also sickle cell ),nephritic syndrome, CSF leak, immunosuppression Revaccination : >5 yrs after the 1st dose, highest risk for serious Pneumococcal infection and rapid waning of antibodies, Spleenic dysfunction, Sickle cell disease, HIV infection, Hodgkins disease, Lymphoma, Multiple myeloma, Chronic renal failure, Nephritic syndrome, undergoing organ transplantation and receiving chemotherapy
IAP VISION 2007
Barriers to Adolescent Immunization

Government Barriers Health Care Provider Barrier Parent and Adolescent Barrier Economical Factor
IAP VISION 2007
Strategies to increase adolescent immunisation:
1. Increasing Demand 2. Enhancing Access 3. Addressing provider barrier
IAP VISION 2007
Strategies to increase adolescent immunisation
Increasing Demand
Establish a platform for adolescent immunization Provider and professional recommendation School based immunization requirements State based immunization laws Education and awareness programs
IAP VISION 2007
Enhance Access
Health care coverage Partner with local communities and institutions
IAP VISION 2007
Addressing Provider Barrier
Minimized missed opportunities to vaccinate Use standing order Review and update office immunization practices
IAP VISION 2007
Key messages
Pediatricians need to update periodically about new recommendations Students going abroad will come for advise and certificates Newer vaccines New recommendations for Booster doses Preventive /prophylactic vaccines
IAP VISION 2007
References;
Reference CDC. MMWR. 1999; 48(12):241-243.2. Dr CP Bansal, Dr Swati Bhave, Adolescent immunization, textbook of adolescent medicine. Singh A, Arora AK. Tetanus immunization among adolescent girls in rural Haryana. Indian J Pediatr. 2000 Apr;67(4):255-8. U.S. Department of Health and Human Services. Healthy People 2010. With Understanding and Improving Health and Objectives for Improving Health. 2nd ed. 2 vols. Washington, DC: U.S. Government Printing Office, November 2000. CDC. Recommended childhood and adolescent immunization scheduleUnited States, 2005. Available at: http://www.cdc.gov/nip. Accessed January 11, 2005.
IAP VISION 2007
References;

Adolescent Vaccination, National centre for infectious diseases, United States, 2005. Trunz BB, Fine P, Dye C. Effect of BCG vaccination on childhood tubercular meningitis and miliary tuberculosis worldwide: a meta-analysis and assessment of cost-effectiveness. Lancet. 2006 Apr 8; 367(9517):1173-80. Soysal A, Millington KA et al, Effect of BCG vaccination on risk of Mycobacterium tuberculosis infection in children with household tuberculosis contact: a prospective community-based study. Lancet. 2005 Oct 22-28; 366 (9495):1443-51. Rodrigues LC et al, Effect of BCG revaccination on incidence of tuberculosis in school-aged children in Brazil: the BCG-REVAC clusterrandomized trial. Lancet. 2005 Oct 8; 366(9493):1290-5. Epub 2005 Aug 31. Dasgupta S, Karmakar PR et al; Routine primary immunization: status in two district of West Bengal. Indian J Public Health. 2005 Oct-Dec;49(4):2236. Bhatia V et al, Immunization status in children. Indian J Pediatr. 2004 Apr; 71(4):313-5.
IAP VISION 2007
References;

Ray SK, Das Gupta S, Saha I. A report of diphtheria surveillance from a rural medical college hospital. J Indian Med Assoc. 1998 Aug; 96(8):236-8. Galazka AM, Robertson SE. Diphtheria: changing patterns in the developing world and the industrialized world. Eur J Epidemiol. 1995 Feb;11(1):107-17. Heininger U, Cherry JD. Pertussis immunisation in adolescents and adults-Bordetella pertussis epidemiology should guide vaccination recommendations. Expert Opin Biol Ther. 2006 Jul;6(7):685-97. Review. Hitchcock WP. Rationale for use of Tdap booster vaccines for adolescent immunization: overview of efficacy, safety, and clinical use. Clin Pediatr (Phila). 2006 Nov; 45(9):785-94. Thwaites CL. Impact of improved vaccination programme and intensive care facilities on incidence and outcome of tetanus in southern Vietnam, 19932002. Trans R Soc Trop Med Hyg. 2004 Nov;98(11):671-7. Arguelles MH et al. Measles virus-specific antibody levels in individuals in Argentina who received a one-dose vaccine. J Clin Microbiol. 2006 Aug; 44(8):2733-8.
IAP VISION 2007
References;

Bhaskaram P et al. Post-vaccination scenario of measles: a retrospective analysis. Natl Med J India. 1999 May-Jun;12(3):111-2. Chowdhury A et al. Prevalence of hepatitis B infection in the general population: a rural community based study. Trop Gastroenterol. 1999 AprJun;20(2):75-7. Duszczyk E et al. Mumps--an underestimated disease. Przegl Epidemiol. 2006;60(1):99-104. Philip J et al. Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility? BJU Int. 2006 Jan; 97(1):138-41. Ramamurty N. Serosurvey of rubella in five blocks of Tamil Nadu. Indian J Med Res. 2006 Jan; 123(1):51-4. Tarkowski TA, Koumans EH, Sawyer M, et al. Epidemiology of human papillomavirus infection and abnormal cytologic test results in an urban adolescent population. J Infect Dis 2004;189(1):46-50. IAP guide book on immunization, 2000.
IAP VISION 2007
Example of Chicken POX coverage in Schools
IAP VISION 2007
CHICKENPOX:
ITS MORE SERIOUS THAN YOU THINK WHAT IT IS ????
It is an infectious disease caused by the varicellazoster virus. It results in a blister-like rash, itching, tiredness and fever. The rash appears first on the trunk and face, but can spread over the entire body causing between 250 to 500 itchy blisters. Most cases of chickenpox occur in persons less than 15 years old. Can cause at least 5-6 days of school loss. Prior to the use of varicella vaccine, the disease had annual cycles, peaking in the spring of each year.
IAP VISION 2007
CHICKENPOX:
What are the serious complications from chickenpox?
Bacterial infections which can involve many sites of the body including the skin, tissues under the skin, bone, lungs (pneumonia), joints and the blood. Due to the virus infection directly include viral pneumonia, bleeding problems and infection of the brain (encephalitis). It may lead to Herpes Zoster later in life vaccine protects from this as well
IAP VISION 2007
Do children prefer vaccination over having chickenpox ?

In a recent study, 7 out of 10 children preferred a shot over natural disease. 7 out of 10 children considered chickenpox to be worse than many other common childhood ailments, including colds, earaches, sore throat, and fever. The study also found that 3 out of 4 parents are unaware that death is a potential complication of chickenpox.
IAP VISION 2007
Who should be vaccinated?
All children between 12 and 18 months of age should have one dose of chickenpox vaccine. Children who have had chickenpox do not need the vaccine. Children between 19 months 13 year should get a single dose. People 13 and older should get two doses - 4 to 8 weeks apart. For more information on who should be vaccinated visit the following site: (ACIP) http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/rr48 06a1.htm
IAP VISION 2007
I don't think I have had chickenpox, but I am not sure. Is there a blood test available to determine whether or not I have had the disease?
Yes, a blood test is available to check immunity. If it is not available, it is still safe to receive the vaccine even if you have previously had chickenpox.
IAP VISION 2007
My child was vaccinated 2-3 years ago and he/she developed a mild case of chickenpox this year. Why did this happen?
After vaccination, some persons (about 1 person in 10) do not develop enough protection to completely prevent them from developing chickenpox. Hence, they may develop a mild case of disease with less than 50 spots or bumps. This form of chickenpox is also called breakthrough disease.
IAP VISION 2007
Chickenpox in children is usually not serious. Why not let children get the disease?
It is never possible to predict who will have a mild case of chickenpox and who will have a serious or even deadly case of disease. Now that there is a safe and effective vaccine available, it is not worth taking this chance.
IAP VISION 2007
Varicella (Chickenpox)
Chickenpox vesicle behind the ear. Notice the translucent quality of the vesicle on the skin, the classic "dew drop on a rose petal" appearance.
Chickenpox on the palate. Notice the glistening, water-drop characteristic of the chickenpox vesicle on the palate.
IAP VISION 2007
IAP VISION 2007

Adequate immunization is one of the most important preventive health services that can be provided for an adolescent.
THANKS

Adolescent Immunization

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

Adolescent Immunization

Hochgeladen von

Copyright:

Verfügbare Formate

IAP VISION 2007

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

Importance of adolescent immunization

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

IAP VISION 2007

Why adolescents should be immunized?

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

Why Adolescent Immunization is important?

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Scenario in West Indian Scenario

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

http://www.cdc.gov/nip. Accessed May, 26th 2007

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

IAP COI Recommendations

Adolescent Friendly School Initiative

IAP VISION 2007

IAP adolescent immunization schedule

Rubella MMR Hepatitis B Typhoid Varicella* Hepatitis A*

Adolescent Friendly School Initiative

IAP VISION 2007

Tetanus Prophylaxis In Routine Wound Management

Clean, minor wounds TT Yes No** TIG* No No

All other wounds TT Yes No*** TIG* Yes No

Unknown, < 3 doses 3 doses

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

Pre-vaccine Era (Before 1920)

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

IAP VISION 2007

Vaccination Coverage & Diphtheria

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Adolescent Friendly School Initiative

IAP VISION 2007

ADOLESCENT FRIENDLY SCHOOL INITIATIVE

Diphtheria Certainly not out

Adolescent Friendly School Initiative

IAP VISION 2007