Varicella Zoster Update on vaccination

Views:
 
     
 

Presentation Description

Varicella Zoster Update on vaccination

Comments

Presentation Transcript

Varicella Zoster Vaccination update:

Varicella Zoster Vaccination update Dr.T.V.Rao MD Dr.T.V.Rao MD 1 4/13/2012

Herpesviridae:

Herpesviridae The Herpesviridae are a large family of DNA viruses that cause diseases in animals, including humans The family name is derived from the Greek word herpein ("to creep"), referring to the latent, relapsing infections typical of this group of viruses. Herpesviridae can cause latent or lytic infections. Dr.T.V.Rao MD 2 4/13/2012

Herpes Viruses DNA group :

Herpes Viruses DNA group Most important Human Pathogens Wide Host cell range Life Long Infection –Periodic reactivation Immunocompromised Large number of genes, Some viruses susceptible to treatment. Dr.T.V.Rao MD 3 4/13/2012

Varicella Zoster :

Varicella Zoster Dr.T.V.Rao MD 4 4/13/2012

Properties of Virus.:

Properties of Virus. Like Herpes Virus Icosahedrons shape ds DNA Dr.T.V.Rao MD 5 4/13/2012

Properties of Herpes Viruses.:

Properties of Herpes Viruses. Spherical in Shape Icosahedral 150 to 200 nm in size Genome – Double stranded DNA Linear Envelope contains Glycoprotein's Dr.T.V.Rao MD 6 4/13/2012

PowerPoint Presentation:

Dr.T.V.Rao MD 7 4/13/2012

Varicella Zoster:

Varicella Zoster Varicella -Chicken pox. Contagious Disease Mainly Children Generalized Vesicular eruptions on Skin and Mucous membranes Severe manifestations in Adults and Immune compromised. Dr.T.V.Rao MD 8 4/13/2012

Herpes viruses:

Varicella-zoster virus (Human herpes virus 3) Transmitted by the respiratory route Causes pus-filled vesicles Virus may remain latent in dorsal root ganglia Herpes viruses Figure 21.10a Dr.T.V.Rao MD 9 4/13/2012

HERPES VARICELLA ZOSTER HVZ:

HERPES VARICELLA ZOSTER HVZ Causes chicken pox -fever + characteristic rash variable incubation period 14-21 days usually mild in children and more severe in adults complications secondary infection - uncommon varicella pneumonia secondary bacterial pneumonia S aureus & pneumococci post-infectious encephalitis generalized varicella (in immunocompromised patients) congenital and neonatal varicella Dr.T.V.Rao MD 10 4/13/2012

Herpes Zoster:

Herpes Zoster Rash Limited to Distribution of Single Sensory Ganglion In Adults and immune compromised patients Reactivation of latent HHV-3 releases viruses that move along peripheral nerves to skin. Dr.T.V.Rao MD 11 4/13/2012

Clinical Findings.:

Clinical Findings. Varicella, Incubation 10-20 days Fever, Malaise Rash Trunk –Face –Limbs – Buccal and Pharyngeal mucosa Lesions at all stages Macules, Papules, Vesicles, Crusts, May last 5 days, Hundreds of eruptions. Dr.T.V.Rao MD 12 4/13/2012

HERPES VARICELLA ZOSTER HVZ:

HERPES VARICELLA ZOSTER HVZ Causes chicken pox -fever + characteristic rash variable incubation period 14-21 days usually mild in children and more severe in adults complications secondary infection - uncommon varicella pneumonia secondary bacterial pneumonia S aureus & pneumococci post-infectious encephalitis generalized varicella (in immunocompromised patients) congenital and neonatal varicella Dr.T.V.Rao MD 13 4/13/2012

Chicken pox. :

Chicken pox. Dr.T.V.Rao MD 14 4/13/2012

Skin lesions of chickenpox:

Skin lesions of chickenpox Dr.T.V.Rao MD 15 4/13/2012

Skin lesions showing different stages:

Skin lesions showing different stages Dr.T.V.Rao MD 16 4/13/2012

Chicken pox:

Chicken pox Dr.T.V.Rao MD 17 4/13/2012

Pathogenesis and Pathology:

Pathogenesis and Pathology Varicella virus enter through URT/Conjunctiva. Lymph nodes Viremia Liver and spleen Secondary viremia Infects Mononuclear Cells Rash Vesicle formation Dr.T.V.Rao MD 18 4/13/2012

Herpes Zoster:

Herpes Zoster Skin Lesions Inflammation of Sensory Nerves and Ganglia Single Ganglion Dorsal root Ganglion Dr.T.V.Rao MD 19 4/13/2012

Herpes Zoster involving a Nerve segment:

Herpes Zoster involving a Nerve segment Dr.T.V.Rao MD 20 4/13/2012

Complications:

Complications Bacterial Infections Viral Pneumonia Bleeding Problems Infection of the brain Dr.T.V.Rao MD 21 4/13/2012

Other Complications.:

Other Complications. Encephalitis, Mother to Child transmission Varicella Pneumonia. Fatal Complications . Dr.T.V.Rao MD 22 4/13/2012

Herpes Zoster in Immune compromised :

Herpes Zoster in I mmune compromised HIV / AIDS Malignancies. Organ transplantations Corticosteroid usage Leukaemia's. Dr.T.V.Rao MD 23 4/13/2012

PowerPoint Presentation:

Pain and hyperesthesia Dr.T.V.Rao MD 24 4/13/2012

Laboratory Diagnosis.:

Laboratory Diagnosis. Smears --Scrapings from Lesions Demonstration of Multi nucleated giant cells Tzanck smears DNA Demonstration Cell cultures, Fluorescent –antibody ELISA PCR Dr.T.V.Rao MD 25 4/13/2012

Epidemiology :

Epidemiology Communicable Disease World wide prevalence Common in < 10 year olds. Zoster in Adults Droplet spread Dr.T.V.Rao MD 26 4/13/2012

Treatment :

Treatment Specific treatment is indicated mainly in Immunodeficient and elderly subjects and also in complicated with Varicella pneumonia,encephalitis,and disseminated zoster Acyclovir and Famiciclovir. Dr.T.V.Rao MD 27 4/13/2012

Prevention of Chickenpox:

Prevention of Chickenpox Susceptible population children adults living in close proximity Do nothing Immunize live attenuated vaccine Protect if contact with patient with chickenpox and at risk of severe disease Zoster Immune Globulin (ZIG) Dr.T.V.Rao MD 28 4/13/2012

Vaccines available:

Vaccines available A live modified Varicella virus lyophilised vaccine which can be stored at low temp is available for protection Children 1 -12 years given single dose. >12 years 2 doses 2 -6 weeks apart High titre serum from convalescing from herpes zoster protect Immunocompromised children. But not useful for treatment Dr.T.V.Rao MD 29 4/13/2012

Varicella Vaccines:

Varicella Vaccines Two live attenuated varicella virus vaccines licensed for use in US: Varivax ® and Proquad ® Both vaccines may be used for first and second doses of varicella vaccine Varivax ® (1,400 pfu) is the single-antigen varicella vaccine licensed in 1995 for use among healthy persons aged ≥ 12 months Proquad ® or MMRV (9,800 pfu) is a combination measles, mumps, rubella, and varicella vaccine licensed in 2005 for use among healthy children aged 12 months-12 years CDC. Prevention of Varicella . MMWR 2007; 56(No. RR-4) Dr.T.V.Rao MD 30 4/13/2012

Current Varicella Vaccination Policy in the United States:

Current Varicella Vaccination Policy in the United States Implemented routine 2-dose childhood varicella vaccination program in 2006 1 st dose at age 12-15 months 2 nd dose at age 4-6 years Catch-up vaccination of children and adolescents who had previously received one dose 2 doses for all adolescents and adults without evidence of immunity Pre-natal screening and post-partum vaccination CDC. Prevention of Varicella. MMWR 2007; 56(No. RR-4) Dr.T.V.Rao MD 31 4/13/2012

To vaccinate or not ? Positive Side:

To vaccinate or not ? Positive Side Saves lives Saves Money, Time Children and Students don’t miss school 85% percent affective in preventing disease Less likely to develop Shingles If someone does get Chicken Pox after vaccination, it usually is a lot less worse than a typical case resulting in a few skin lesions, little to no fever and lasting fewer days Dr.T.V.Rao MD 32 4/13/2012

Contra-indications and Precautions for Varicella Vaccination :

Contra-indications and Precautions for Varicella Vaccination Severe allergic reaction to vaccine component or following a prior dose Immunosuppression Pregnancy Moderate or severe acute illness Recent blood product (due to potential inhibition of response to varicella vaccination) CDC. Prevention of Varicella. MMWR 2007; 56(No. RR-4) Dr.T.V.Rao MD 33 4/13/2012

Varicella Vaccination in Certain Groups of Immunocompromised Persons:

Varicella Vaccination in Certain Groups of Immunocompromised Persons Varicella vaccine may be administered to persons with isolated Humoral immunodeficiency Patients with leukemia, lymphoma, or other malignancies whose disease is in remission and those chemotherapy have been terminated ≥ 3 months can receive live-virus vaccines Consider varicella vaccination for HIV-infected children with CD4+ T-lymphocyte percentage of 15% or higher Eligible children should receive 2 doses of single-antigen varicella vaccine 3 months apart CDC. Prevention of Varicella. MMWR 2007; 56(No. RR-4) Dr.T.V.Rao MD 34 4/13/2012

HIV and Varicella Vaccine:

HIV and Varicella Vaccine Data on use of varicella vaccine in HIV-infected adolescents and adults lacking, but safety is likely to be similar to response in HIV-infected children. Vaccination may be considered for HIV-infected persons with CD4+T-lymphocyte count ≥ 200 cells/ m l Dr.T.V.Rao MD 35 4/13/2012

Post-exposure Prophylaxis:

Post-exposure Prophylaxis Varicella vaccine recommended for use in healthy persons without evidence of immunity within 3-5 days after exposure to varicella ≥ 90% effective in preventing varicella if vaccinated within 3 days of exposure and ~ 70% effective in preventing varicella and ~100% effective in modifying severe disease if given within 5 days Vaccination still recommended for those with no other evidence of immunity even after 5 days of exposure because it will help provide protection against future exposures CDC. Prevention of Varicella. MMWR 2007; 56(No. RR-4) Dr.T.V.Rao MD 36 4/13/2012

Varicella Vaccine Adverse Events:

Varicella Vaccine Adverse Events Non-serious adverse events Rash, Fever Injection site reactions Possible vaccine failure Serious adverse events are rare Encephalitis Ataxia Pneumonia Arthritis Hepatitis Vasculitis Thrombocytopenia Chaves J Infect Dis 2008 Dr.T.V.Rao MD 37 4/13/2012

Use of Hyper immune Globulins in Varicella Infection:

Use of Hyper immune Globulins in Varicella Infection Varicella Zoster Immune Globulin (available product, VariZIG™) recommended for certain groups at high risk for severe disease within 96 hours after exposure Dr.T.V.Rao MD 38 4/13/2012

To Vaccinate or Not ? Other Side:

To Vaccinate or Not ? Other Side Vaccine is new. Don’t know about long term side affects yet Chicken Pox is usually pretty harmless. No use in vaccinating The vaccine is only expected to be effective for 20 years. Those who were vaccinated will need a booster shot. Between the time the original shot wears off and the booster shot, those who were vaccinated can now develop Chicken Pox later in life when its more dangerous Dr.T.V.Rao MD 39 4/13/2012

People who should not be vaccinated:

People who should not be vaccinated If you had a serious allergic reaction to Chicken Pox vaccine You have a moderate to serious illness You’re pregnant Unable to fight off serious infection People that have been vaccinated for Chicken Pox can still get Shingles, but they are less likely than someone that hasn’t been vaccinated to get it Dr.T.V.Rao MD 40 4/13/2012

PowerPoint Presentation:

Programme Created by Dr.T.V.Rao MD for Medical and Health Care Workers Email doctortvrao@gmail.com Dr.T.V.Rao MD 41 4/13/2012

authorStream Live Help