Posted: September 20th, 2022

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the instructions are attached in the word document. Please read the instructions carefully.

Instructions for assignment

· Submissions must be double-spaced, with 1-inch margins (top, bottom, left, and right) and in 12-point font, Times New Roman or Calibri, and consistently adhere to the APA Formatting and Style Guide.

· Students are advised to carefully proofread all papers before submitting them.

· If additional sources are provided other than the module resources, they should be cited and referenced in APA Formatting and Style.

·
This paper should mostly be a collection of your thoughts.

·
Try to not restate the facts provided in the module throughout the paper.

Read the PowerPoint attached and write the reflection on it.

Based on the module resources, please write a 500-word paper discussing the following:

1. Many healthcare facilities have instituted policies threatening dismissal or disciplinary action if a worker refuses to receive certain vaccines. What are your thoughts regarding these types of policies and explain how a worker’s decision to or not to vaccinate would affect patients?

2. What do you think are medical providers’ best “pieces of advice” to increase influenza vaccine confidence in adults?

3. With respect to the diseases covered in this module, is natural immunity better than vaccine-acquired immunity? Why or why not?

4. Explain some of the differences in vaccination rates between adults and children. Are adults at a higher risk of severe outcomes from vaccine-preventable diseases? If so, identify which diseases and why?

VACCINE PREVENTABLE DISEASES
ADOLESCENTS AND ADULTS

GLOBAL IMMUNIZATION STRATEGIES

• Immunization programs increasingly including, in their national immunization
schedules, vaccines that target age groups beyond infancy and early childhood

• One of the objectives of the Global Vaccine Action Plan (GVAP) is to extend the
benefits of immunization to all children, adolescents and adults

• School-based immunization

• Due to increases in school enrollment rates, particularly in low-income countries, the
school immunization strategy has become even more promising

• Outside agencies (CDC, WHO, UNICEF) assisting ministries of health in planning
and managing immunization programs effectively

• Vaccine delivery coordinated with other preventive health care services for
adolescents and adults

ADOLESCENTS

• Of the 7.2 billion people worldwide, over 3 billion are younger than 25 years,

• Make up 42% of the world population

• Approximately 1.2 billion of these young people are adolescents aged between 10 and

19 years

• Largely due to receiving vaccines as young children

• Vaccination of adult population not as successful

ADULTS AND VACCINATIONS

• Aging increases the risk and severity of infectious diseases

• Vaccination of adult population not as successful compared to children

• Improving the uptake rates of adult vaccination is essential to healthy aging

• The double threat of infectious diseases and NCDs continues to have an

impact globally in adults

• Resources rarely invested for this subpopulation

• Despite rising prevalence of these diseases

RAPID INCREASE IN GLOBAL POPULATION
60+ YEARS (1950 – 2015)

GLOBAL BURDEN OF KEY VACCINE
PREVENTABLE CONDITIONS

IMMUNIZATIONS AND CANCER

• Every year, more than seven million people die from cancer worldwide

• Burden increasingly carried by developing countries

• Vaccines prevent infections that cause certain cancers such as liver and cervical

cancers

• One fifth of all cases of cancer are caused by infections like hepatitis B and

human papillomavirus (HPV)

• In the past decade, more than 3 million future deaths from liver cancer have

been prevented

IMMUNIZATIONS AND CANCER

• One in five cases of cancer is caused by infections like hepatitis B and human
papillomavirus (HPV)

• Hepatitis B vaccine was the first vaccine developed to protect against a cancer

• Protects against the hepatitis B infection that causes an estimated 600,000 deaths from liver
cancer.

• Cervical cancer is the number one cause of cancer deaths in adult women in low-
income countries

• Kills 270,000 women each year, and over 80% of these deaths occur in the developing world

• HPV vaccines protect against human papillomaviruses types 16 and 18 which cause about
70% of cervical cancer cases

ADOLESCENT AND ADULT
VACCINE PREVENTABLE DISEASES

HEPATITIS B

• Viral infection that attacks the liver and can cause both acute and chronic

disease

• Transmitted through contact with the blood or other body fluids of an infected

person

• Occupational hazard for health workers

• An estimated 296 million people were living with hepatitis B virus infection at

the end of 2019 with an estimated 1.5 new infections each year

• In 2019, hepatitis B resulted in 820,000 deaths, mostly from complications

HEPATITIS B VACCINE

• Vaccine against hepatitis B has been available since 1982.

• Is 95% effective in preventing infection and the development of chronic disease

and liver cancer due to hepatitis B

HEPATITIS B

TRANSMISSION

• Virus can survive outside the body for at least 7 days.

• During this time, the virus can still cause infection if it enters the body of a person

who is not protected by the vaccine

• Incubation period is 75 days on average, but can vary from 30 to 180 days

• The virus may be detected within 30 to 60 days after infection and can persist

and develop into chronic hepatitis B

• In highly endemic areas, hepatitis B is most commonly spread from mother to

child at birth or through exposure to infected blood

HEPATITIS B TRANSMISSION

• Also spread by various body fluids, as well as through saliva, menstrual, vaginal,
and seminal fluids

• Sexual transmission of hepatitis B may occur, particularly in unvaccinated men
who have sex with men and heterosexual persons with multiple sex partners
or contact with sex workers

• May also occur through reuse of needles and syringes either in health-care
settings or among persons who inject drugs

• Infection can also occur during medical, surgical and dental procedures,
through tattooing, or through the use of razors and similar objects that are
contaminated with infected blood

HEPATITIS B SYMPTOMS

• Most people do not experience any symptoms during the acute infection phase

• However, some people have acute illness with symptoms that last several

weeks, including yellowing of the skin and eyes (jaundice), dark urine, extreme

fatigue, nausea, vomiting and abdominal pain

• A small subset of persons with acute hepatitis can develop acute liver failure,

which can lead to death

• In some people, the hepatitis B virus can also cause a chronic liver infection

that can later develop into cirrhosis or liver cancer

RISK FACTORS FOR CHRONIC DISEASE
FROM HEPATITIS B

• The likelihood that infection becomes chronic depends upon the age at which a

person becomes infected.

• Children less than 6 years of age who become infected with the hepatitis B virus are the

most likely to develop chronic infections.

• 80–90% of infants infected during the first year of life develop chronic infections; and

30–50% of children infected before the age of 6 years develop chronic infections

• In adults, less than 5% of otherwise healthy persons who are infected as adults will develop

chronic infection; and

• 20–30% of adults who are chronically infected will develop cirrhosis and/or liver cancer

HEPATITIS B GEOGRAPHICAL
DISTRIBUTION

• Prevalence is highest in the Western Pacific Region and the African Region,

where, respectively, 6.1% and 6.6% of the population is infected

• In the Eastern Mediterranean Region, the South-East Asia Region and the

European Region, an estimated 3.3%, 2.0% and 1.6% of the general population

is infected, respectively

• 0.7% of the population of the Region of the Americas is infected

HEPATITIS B VACCINE

• Recommended to be given at birth in most countries, usually within 24 hours

• Global coverage of birth dose for hepatitis B vaccine was 42%

• 3 doses, however, are required which provide protective antibody levels in more than

95% of infants, children and young adults

• All children and adolescents younger than 18 years-old and not previously

vaccinated should receive the vaccine if living in countries where there is low

or intermediate endemicity

HIGH RISK GROUPS

• In these settings more people in high-risk groups may acquire the infection:

• People who frequently require blood or blood products, dialysis patients, recipients of solid organ
transplantations

• People interned in prisons

• Persons who inject drugs

• Household and sexual contacts of people with chronic HBV infection

• People with multiple sexual partners

• Healthcare workers and others who may be exposed to blood and blood products through their
work

• Person who have not completed their hepatitis B vaccination series and are travelling to endemic
areas

HUMAN PAPILLOMAVIRUS (HPV)

• Group of viruses that are extremely common worldwide

• More than 100 types of HPV, of which at least 14 are cancer-causing

• Primarily transmitted through sexual contact

• Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous
cervical lesions

• Non-cancer causing types of HPV (especially types 6 and 11) can cause genital
warts and respiratory papillomatosis (a disease in which tumors grow in the air
passages leading from the nose and mouth into the lungs)

• Rarely result in death but may cause significant occurrence of disease

• Genital warts are very common, highly infectious, and affect sexual life

CERVICAL CANCER

• Cervical cancer is the second most common cancer in women living in less developed regions
with an estimated 604,000 new cases in 2020

• Approximately 90% of all new cervical cancer cases occurred in low- and middle-income
countries

• Cervical cancer is by far the most common HPV-related disease. Nearly all cases of cervical
cancer can be attributable to HPV infection.

• In 2020, approximately 342,000 women died from cervical cancer

• 90% of these deaths occurred in low- and middle-income countries

• Takes 15 to 20 years for cervical cancer to develop in women with normal immune systems

• Can take only 5 to 10 years in women with weakened immune systems, such as those with
untreated HIV infection

CERVICAL CANCER CONTROL

• Comprehensive approach to cervical cancer prevention and control

• Includes interventions across the life course

• Should be multidisciplinary, including components from community education,

social mobilization, vaccination, screening, treatment and palliative care

• Begins with HPV vaccination of girls aged 9-14 years, before they become

sexually active

• Education about safe sexual practices

• Promotion and provision of condoms

CERVICAL CANCER CONTROL

• Sexually active women screened for abnormal cervical cells and pre-cancerous

lesions, starting at 30 years of age

• If treatment of pre-cancer is needed, cryotherapy is recommended

• If signs of cervical cancer are present, treatment options for invasive cancer

include surgery, radiotherapy, and chemotherapy

MENINGOCOCCAL MENINGITIS

• Bacterial form of meningitis, a serious infection of the thin lining that surrounds

the brain and spinal cord

• High fatality rates (up to 50% when untreated) and can cause severe brain

damage

• Early antibiotic treatment is the most important measure to save lives and reduce

complications

• The disease can affect anyone of any age, but mainly affects babies, preschool

children, adolescents, and young adults

MENINGOCOCCAL MENINGITIS

• Twelve types of N. meningitides, called serogroups, have been identified, six of

which (A, B, C, W, X and Y) can cause epidemics

• Geographic distribution and epidemic potential differ according to the

serogroup

• No reliable estimates of global meningococcal disease burden due to

inadequate surveillance in several parts of the world

• The largest burden of meningococcal disease occurs in an area of sub-Saharan

Africa known as the meningitis belt, which stretches from Senegal in the west

to Ethiopia in the east (26 countries)

MENINGOCOCCAL MENINGITIS

• During the dry season between December to June, dust winds, cold nights and

upper respiratory tract infections combine to damage the nasopharyngeal

mucosa, increasing the risk of meningococcal disease

• Transmission of N. meningitidis may be facilitated by overcrowded housing

• This combination of factors explains the large epidemics which occur during the dry

season in the meningitis belt (Sub-Saharan Africa)

• Stretches from Senegal in the west to Ethiopia in the east (26 countries)

MENINGOCOCCAL MENINGITIS:
TRANSMISSION

• Transmitted from person-to-person through droplets of respiratory or throat

secretions from carriers

• Smoking, close and prolonged contact facilitates the spread of the disease.

• The bacteria can be carried in the throat and sometimes overwhelms the

body’s defenses allowing the bacteria to spread through the bloodstream to

the brain

• Believed that 1% to 10% of the population carries N. meningitidis in their throat

at any given time.

• Carriage rate may be higher (10% to 25%) during epidemics

MENINGOCOCCAL MENINGITIS:
SYMPTOMS

• Average incubation period is four days, but can range between two and 10 days

• Common symptoms – stiff neck, high fever, sensitivity to light, confusion, headaches

and vomiting

• Less common but even more severe (often fatal) form is meningococcal septicemia,

• Characterized by a hemorrhagic rash and rapid circulatory collapse

• Even when the disease is diagnosed early and adequate treatment is started, 8% to

15% of patients die, often within 24 to 48 hours after the onset of symptoms

• If untreated, meningococcal meningitis is fatal in 50% of cases and may result in

brain damage, hearing loss or disability in 10% to 20% of survivors

PREVENTION: VACCINATION

• Licensed vaccines against meningococcal disease have been available for more
than 40 years

• No universal vaccine against meningococcal disease exists

• Vaccines are serogroup specific and confer varying degrees of duration of protection

• Types of vaccines available

• Vaccines used during a response to outbreaks, mainly in Africa

• Vaccines are used in routine immunization schedules and preventive campaigns and
outbreak response

• Recommended during adolescence

PREVENTION: CHEMOPROPHYLAXIS

• Antibiotic prophylaxis for close contacts, when given promptly, decreases the

risk of transmission

• Outside the African meningitis belt, chemoprophylaxis is recommended for

close contacts within the household

• In the meningitis belt, chemoprophylaxis for close contacts is recommended in

non-epidemic situations

GLOBAL PUBLIC HEALTH RESPONSE –
RECENT MENINGOCOCCAL A CONJUGATE

VACCINE INTRODUCTION SUCCESS IN
AFRICA

• Meningitis epidemics in the African meningitis belt constitute an enormous public
health burden.

• In December 2010, a new meningococcal A conjugate vaccine was introduced in
Africa through mass campaigns targeting persons 1 to 29 years of age.

• As of November 2017, more than 280 million persons have been vaccinated in 21
African belt countries.

• Considered safe and is cheap

• Associated with a 58% decline in meningitis incidence and 60% decline in the risk of
epidemics

• Can be given as soon as 1 year of age, thus it has now been introduced into routine
infant immunization

INFLUENZA

• Circulate throughout the world

• 4 types of seasonal influenza viruses, types A-D

• Influenza A and B viruses circulate and cause seasonal epidemics of disease

• Characterized by a sudden onset of fever, cough, headache, muscle and joint
pain, severe malaise, sore throat and a runny nose. The cough can be severe
and can last 2 or more weeks

• Most people recover from fever and other symptoms within a week without
requiring medical attention.

• Can cause severe illness or death especially in people at high risk.

INFLUENZA

• Hospitalization and death among high risk groups.

• Worldwide, annual epidemics are estimated to result in about 3 to 5 million cases
of severe illness, and about 290,000 to 650,000 respiratory deaths

• In industrialized countries most deaths associated with influenza occur among
people age 65 or older

• Epidemics can result in high levels of worker/school absenteeism and productivity
losses. Clinics and hospitals can be overwhelmed during peak illness periods

• Effects of seasonal influenza epidemics in developing countries are not fully known

• Research estimates that 99% of deaths in children under 5 years of age with influenza
related lower respiratory tract infections are found in developing countries

HIGH RISK GROUPS

• People at greater risk of severe disease or complications when infected are:

• Pregnant women

• Children under 59 months

• Elderly individuals

• Individuals with chronic medical conditions

• Individuals with immunosuppressive conditions

• Health care workers are at high risk to acquire influenza

TRANSMISSION

• Seasonal influenza spreads easily

• Rapid transmission in crowded areas including schools and nursing homes

• When an infected person coughs or sneezes, droplets containing viruses (infectious

droplets) are dispersed into the air and can infect persons in close proximity

• Can also be spread by hands contaminated with influenza viruses.

• In temperate climates, seasonal epidemics occur mainly during winter, while in

tropical regions, influenza may occur throughout the year, causing outbreaks more

irregularly

• Incubation period – 2 days, but ranges from one to four days

INFLUENZA AND VACCINATION

• The most effective way to prevent the disease is vaccination.

• Safe and effective vaccines used for more than 60 years

• Immunity from vaccination wanes over time so annual vaccination is

recommended to protect against

influenza

• Vaccination is especially important for people at high risk of influenza

complications, and for people who live with or care for the people at high risk

INFLUENZA AND VACCINATION

• Annual vaccination recommended for:

• Pregnant women at any stage of pregnancy

• Children aged between 6 months to 5 years

• Elderly individuals (aged more than 65 years)

• Individuals with chronic medical conditions

• Health-care workers

• In the US, the strains that the influenza vaccine protects against may change

from year to year

INFLUENZA PERSONAL PROTECTIVE
MEASURES

• Apart from vaccination personal protective measures are also recommended

• Regular hand washing

• Good respiratory hygiene

• Early self-isolation of those feeling unwell, feverish, and having other symptoms of

influenza

• Avoiding close contact with sick people

• Avoiding touching one’s eyes, nose or mouth

THANK YOU

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