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Posted: January 31st, 2023

Immunization is the most effective and risk-free public health

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

Post 1

Immunization is the most effective and risk-free public health measure for reducing the incidence, prevalence, morbidity, and death of infectious illnesses. However, the timing of each vaccine dosage is determined by two things. First, the age at which the body’s immune system will provide the best protection following immunization. Second, the individual is at danger for the sickness as soon as possible. This is why immunizations are typically administered in age groups. For example, when it comes to influenza vaccine, the minimum age for inactivated vaccine is six months and two years for live vaccine. For individuals receiving them for the first time, two doses four weeks apart are recommended for children aged 6 months to 8 years. In succeeding years, children up to the age of eight can only receive one dose each year. All individuals over the age of nine should take one dose. Individuals with egg sensitivities can also receive the influenza vaccine under physician care (Balasundaram & Sakr, 2022).
On the other hand, many individuals believe they do not need immunizations or are concerned about vaccine side effects, while people (male and female) 65 and older are at a higher risk of consequences from the diseases themselves. Seniors must maintain their vaccines up to date for several reasons: they may not have been vaccinated as children, new vaccinations may now be available, immunity may have diminished, and, most significantly, seniors are more susceptible to serious and potentially life-threatening diseases. The flu vaccine, pneumococcal vaccine to prevent pneumonia, shingles vaccine, and tetanus-diptheria-pertussis vaccine (Tdap) are the most critical vaccinations seniors should consider with their doctors (Cunningham et al, 2021).
Furthermore, infectious diseases that can be prevented by vaccination have a severe course in people with congenital or acquired immune deficits because the disease or treatment procedures depress the immune system. As a result, immunization is critical in immunological insufficiency. Although the protective antibody levels obtained in healthy individuals cannot be delivered in patients with immunological deficiencies, there is no disadvantage to providing inactive vaccines in accordance with the immunization protocol. Live viral and bacterial vaccinations, on the other hand, should not be administered during immunosuppression in cases where the immune system is severely reduced by diseases or medicines, as they could result in systemic infection. Clinicians should be well-versed in the contraindications to vaccination in patients with immune deficiencies and in people who reside in the same dwelling as these people (Arvas, 2014.)
References:
Vaccination in immunocompromised patients, Arvas A. PMID: 26078660; PMCID: PMC4462293. Turk Pediatr Ars. 2014 Sep 1;49(3):181-5. doi: 10.5152/tpa.2014.2206.
Understanding and Applying CDC Immunization Guidelines, Balasundaram P, Sakr M. [Updated on September 3, 2022] Statistics on pearls [Internet].

Post 2 Vaccination Throughout Life
Vaccinations varies based on the patient’s age. The disparities in immunizations among age groups are attributed to changes in disease vulnerability that occur with age.
11 to 24 years old
Individuals between the ages of 11 and 12 should begin receiving influenza vaccinations (CDC, 2022). This influenza immunization is given once a year. Individuals should also have their first dose of tetanus, diphtheria, pertussis, and meningococcal vaccine between the ages of 11 and 12. (CDC, 2022). At the age of 16, the second dose of meningococcal vaccination is administered. Human papillomavirus immunization is administered between the ages of 11 and 12 years (CDC, 2022). This vaccine is only given to females. From the age of 19, an inactivated, recombinant, or live attenuated influenza vaccine is administered as a single dose each year (CDC, 2022). Tetanus, diphtheria, and pertussis vaccine (Tdap) can be given as a single dose throughout any pregnancy beginning at the age of 19 years. From the age of 19 years, one or two doses of measles, hepatitis A vaccination, hepatitis B vaccine, mumps, rubella vaccine, two doses of varicella vaccine, two doses of zoster recombinant, one dose of Pneumoccocal (PCV15), then PPSV23 or one dosage of PCV 20 are administered (CDC, 2022).
25 to 64 years old
The annual dosage of inactivated, recombinant, or live attenuated influenza vaccine is administered, as with the prior age group. If the measles, mumps, and rubella vaccination was not given in the previous age group, 1 or 2 doses can be administered in this age group. If the patient is pregnant at this age, Tdap may be administered. This age group also receives varicella vaccine, measles, mumps, and rubella vaccine, recombinant zoster vaccine, pneumococcal vaccine, meningococcal vaccine, Hemophilus influenza type B vaccine, and hepatitis A and B vaccines. Human papillomavirus can be given to people aged 27 to 45. (CDC, 2022).
65 years and older
This age group continues to receive annual influenza vaccinations using inactivated or recombinant vaccine (CDC, 2022). Unlike the other age groups, this age group receives no live attenuated influenza vaccine. Furthermore, no measles, mumps, rubella, or human papillomavirus vaccine is administered to this age range. It is possible to administer two doses of varicella vaccination and two doses of recombinant zoster vaccine. As with the preceding age group, this age group receives one dose of PCV15 followed by PPSV23 or a dose of PCV20 for pneumococcal prophylaxis. Hepatitis A, meningococcal A, C, W, Y, and B vaccines, as well as Hemophilus influenza type B vaccines, can be administered to children in this age group.
Vaccinations and Immunocompromised Patients
Patients with immune deficiencies include those suffering from diseases such as cancer and HIV/AIDS. Immunocompromised patients get immunosuppressive medication for the maintenance of transplants such as kidney transplants and other conditions needing immunosuppression. Vaccination in these immunocompromised states may have a variety of effects. Immunosuppressive medicines reduce vaccination response (Papp et al., 2019). As a result, for patients who will be receiving immunosuppressive drugs, vaccination must be administered before to the start of the treatments. This prevents vaccine response attenuation caused by immunosuppressive medication. Some drugs, however, do not require a break before delivery. Papp et al. (2019), for example, state that no immunosuppressive drugs can be stopped for the delivery of inactivated vaccinations. Some live vaccinations can be used safely by immunocompromised persons. Subunit vaccinations and live zoster vaccines are used safely and efficiently in immunocompromised patients (Papp et al., 2019). The CDC recommends that persons over the age of 19 who are receiving immunosuppressive medication take the herpes zoster vaccine.
HIV/AIDS is one of the immunocompromised states that affects vaccine response. HIV/AIDS affects vaccine response even in patients on antiretroviral therapy whose viral load has been controlled (El Chaer & El Sahly, 2019). AIDS-related vaccination response impairment alters vaccine effectiveness. The Hepatitis A vaccine is safe in HIV/AIDS patients, however its immunogenicity is lower than in healthy people (El Chaer & El Sahly, 2019). Furthermore, El Chaer and El Sahly (2019) report that hepatitis B vaccination in HIV/AIDS patients is associated with a lower sero-response than in those without HIV/AIDS. In HIV/AIDS patients, influenza vaccination immunogenicity is reduced. In patients with HIV/AIDS, an inactivated influenza vaccination rather than a live influenza vaccine can be utilized. In HIV/AIDS patients, the reaction to the human papillomavirus vaccine is similar to that of seronegative individuals. As a result, adolescents and eligible adults can receive the human papillomavirus vaccine. Although pneumococcal and meningococcal immunizations are safe, they have a decreased immunogenicity in HIV/AIDS patients.
Some immunizations are not recommended for HIV/AIDS patients due to safety concerns. Varicella, measles, mumps, rubella, and live attenuated varicella-zoster vaccines are all contraindicated in HIV/AIDS patients (El Chaer & El Sahly, 2019). These immunizations have been linked to a variety of negative side effects in HIV/AIDS patients. El Chaer and El Sahly (2019), for example, report that severe pneumonitis develops in HIV/AIDS patients who have received the measles, mumps, and rubella vaccine. There are no gender variances in these contraindications.
Infections are more common in patients with malignancies, such as hematological malignancies (Mikulska et al., 2019). Changes in immune system reaction due to cancer may impact the response when a vaccine is recommended. Patients with malignancies, especially hematological malignancies, who get live vaccinations are at an increased risk of acquiring the disease (Mikulska et al., 2019). Bitterman et al. (2019) discovered that the influenza vaccination is efficacious in cancer patients and hence justifies vaccine delivery. There is no gender difference in the responsiveness and efficacy to influenza vaccine in cancer patients.
References
R. Bitterman, N. EliakimRaz, I. Vinograd, A. Z. Trestioreanu, L. Leibovici, and M. Paul (2018). Influenza vaccines in immunocompromised cancer patients. Systematic Review Cochrane Database (2). https://doi.org/10.1002/14651858.CD008983.pub3 External website links
External website links
CDC. (2022, June 22). (2022, June 22). Schedules for immunization. The CDC stands for the Centers for Disease Control and Prevention. https://www.cdc.gov/vaccines/schedules/index.html External website links
F. El Chaer and H. M. El Sahly (2019). Vaccination in HIV-infected adults: a review of vaccine effectiveness and immunogenicity. 437-446 in the American Journal of Medicine. https://doi.org/10.1016/j.amjmed.2018.12.011 External website links
M. Mikulska, S. Cesaro, H. de Lavallade, R. Di Blasi, S. Einarsdottir, G. Gallo,… and C. Cordonnier (2019). Vaccination of patients with hematological malignancies who did not receive transplants: recommendations from the European Conference on Infections in Leukaemia in 2017. (ECIL 7). The Lancet Infectious Diseases, vol. 19, no. 6, pp. e188-e199. https://doi.org/10.1016/S1473-3099(18)30601-7 External website links
K. A. Papp, B. Haraoui, D. Kumar, J. K. Marshall, R. Bissonnette, A. Bitton, and J. Wade (2019). Vaccination recommendations for patients on immunosuppressive therapy who have immune-mediated diseases. Cutaneous Medicine and Surgery, 23(1), pp. 50-74. https://doi.org/10.1177/1203475418811335

StatPearls Publishing, Island (FL), 2022 Jan-. Accessible at: https://www.ncbi.nlm.nih.gov/books/NBK567723/
AL Cunningham, P McIntyre, K Subbarao, R Booy, and MJ Levin. Vaccines for the elderly.
PMID: 33619170. BMJ. 2021 Feb 22;372:n188. doi: 10.1136/bmj.n188.

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