Dr. Raju Sahetya discusses adolescent immunization in India. He outlines the vaccines routinely recommended for adolescents including TT, rubella, MMR, hepatitis B, typhoid, varicella, and hepatitis A. He recommends Tdap instead of Td or TT to provide protection against diphtheria, pertussis, and tetanus, given the high disease burden. Dr. Sahetya also discusses recommendations for the HPV vaccine in India to prevent cervical cancer, noting over 500,000 new cases annually in India. Educating parents and addressing concerns is important for acceptance of adolescent vaccines.
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Adolescent immunization final
1. Adolescent Immunization
Dr. Raju R Sahetya
M.D., D.G.O., D.F.P., F.C.P.S., F.I.C.O.G.,
OBSTETRICIAN & GYNAECOLOGIST
Infertility & Laparoscopic Surgeon
Pushpaa Hospital
Lokhandwala Complex, Andheri
(w), Mumbai, India
www.pushpaahospital.com
drrajusahetya@gmail.com
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2. Positions
Honorary
Hinduja Healthcare – Surgical Hospital, Khar, Mumbai
Visiting Hospitals
BSES * Mumbadevi * Hiranandani
Vice President
Indian Society for Prenatal Diagnosis & Fetal Therapy (ISPAT)
Member Excecutive Council
Mumbai Obstetrics & Gynaecology Society (MOGS)
Association of Fellow Gynaecologist (AFG)
Assciation of Medical Consultant (AMC)
Current Position Held
MOGS – PNDT & Academic Cell,
FOGSI – Sexual Medicine Committee
Editorial Board – ISPAT Int. Journal of Prenatal Diagnosis & AFG Times
Rotarian
Past President Rotary Club of Bombay Airport
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4. What is Immunization?
- Administration of all or part of micro
organism or modified product.
- Resulting in protection against the
disease.
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5. Prevention and control of disease is important
for their healthy growth.
Routine immunization also provides a chance of
a health visit
Gives further chance for preventive services and
health counseling.
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6. Immunization Program has resulted in the decrease
in incidence of the vaccine preventable diseases.
Unimmunized adolescents are more susceptible.
TT was the only vaccine included in the National
Immunization Schedule in India - 2004.
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7. ◦ To boost immunity that is decreasing
◦ Efforts to decrease disease
◦ To have specific Protection
◦ To provide recent vaccines available for
immunization
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12. TT Booster at 10 and 16 years
Rubella As part of MMR vaccine or (Monovalent) 1 dose to
girls at 12-13 years of age, if not given earlier
MMR 1 dose at 12-13 years of age. (if not given earlier)
Hepatitis B 3 Doses (0, 1 and 6 m) if not given earlier
Typhoid TA, Vi or Oral typhoid vaccine every 3 years
Varicella* 1 dose upto 12-13 years, and 2 doses after 13 years
of age. (if not given earlier)
Hepatitis A* 2 doses (0 and 6 months) if not given earlier
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13. BCG All adolescent without a scar
Diphtheria, -Tdap booster dose in previously
Pertussis, immunized
Tetanus -Three doses of Tdap in previously
unimmunized or partially unimmunized
MMR -Single booster dose in all the
adolescent
-Two doses at 4 weeks in previously
unimmunized
Hepatitis b Full course in previously unimmunized
Adolescents
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14. Td vaccine has become available, should
this vaccine be preferred over TT?
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15. In 2007, India contributed 6081 (86.66%) of
the 7017 diphtheria cases reported globally
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20. There is a need to vaccinate all adolescents &
adults against pertussis.
Recommended by ;
international consensus group on pertussis &
global pertussis initiative.
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21. Tdap instead of Td is recommended by many
authorities to prevent pertussis in adolescents and
adults
The major benefit is protection of infants, children
and Adolescents from pertussis
Cost is major obstacle – 50 times
Being used in Canada, Not yet licensed in USA
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22. Aim is to;
◦ prevent congenital rubella syndrome (CRS)
◦ Not just to prevent rubella infection per se, as it is
usually benign and inconsequential.
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23. 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.
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24. • Rubella during pregnancy: up to
80% chance of baby born with
CRS
• Growth retardation, eye
problems, deafness, heart
defects, mental retardation
• Many other organs and body
systems can be affected
• Onset of signs, symptoms and
abnormalities may be delayed
Thrombocytopenia in a baby born
with CRS
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26. VZV transmitted from pregnant
woman to fetus during
1st trimester. Can cause:
stillbirth
abortion
pre-maturity
malformations
low birth weight
herpes zoster may develop
in early childhood
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28. 100 HPV Types Have Been Identified1
30 HPV Types are Transmitted by Genital skin to
skin Contact
15 HPV Types are Oncogenic
In India 4 HPV Types: HPV 16, 18, 31 and 45 are
responsible for
>90% Squamous Cell Carcinoma2
>95% Adenocarcinoma2
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29. 500,000 women diagnosed per year1
270,000 deaths per year1
◦ >1 million new cases of cervical cancer each year, 20502
1 out of 4 women who die due to Cervical Cancer in
the world is an Indian3
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30. Every year 134000 Indian women are diagnosed
with Cervical cancer and around 72000 die from
the disease
Cervical cancer ranks No. 1 among cancers in
Indian women, that’s even more than Breast Cancer
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31. * Global total HPV-attributable cancers in 2002
Attributable to HPV
Site Total cancers % Cases
Cervix 492,800 100 492,800
Vulva, vagina 40,000 40* 16,000
Anus 15,900 90* 14,300
Oropharynx 9,600 12* 1,100
Mouth 98,400 3* 2,900
Total 527,100
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33. Progression*
Time Months Years
Normal HPV infection CIN1 CIN2 CIN3 Invasive
epithelium koilocytosis carcinoma
Low-grade squamous intraepithelial High-grade squamous intraepithelial
lesion (ASCUS/LSIL) lesion (HSIL)
Regression
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34. HPV infections are very common and up to 80% of women will
acquire an HPV infection in their lifetime5–7
The risk of oncogenic HPV infection is high even after first
intercourse and continues throughout a woman’s sexually
active lifetime2–4
Although new infections decrease with age, risk of their
persistence infection increases with age8
The cumulative risk of acquiring cervical HPV infection in
women with only one sexual partner is 46% (3 years after first
sexual encounter)1
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35. Natural HPV infection induces a weak immune
response1-4
No inflammation, no danger signals
Local immunosuppression
No viremia
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36. Vaccination induces higher antibodies in the
blood and site of infection
• Vaccine induces higher antibody
levels in the blood which means
higher antibody levels at the site of
infection4
• These Antibodies neutralize the
virus & prevent entry into cells5,6
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37. Quadrivalent HPV vaccine FDA licensed Gardasil, Merck
Bivalent vaccine, Cervarix,GSK Biologicals
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 and
genital warts.
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38. 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, 1 and 6 months in the Deltoid.
Both have stable antibody levels and continued efficacy -
5 years post vaccination.
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39. 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 .
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40. 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, smoking)
•Be sensitive to parental anxieties and possible discomfort with
discussing these subjects.
•Talk of HPV as preventive vaccine for cancer and STD
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41. •You could wait. But…Two 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.”
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42. 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.
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43. “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.
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46. Pediatricians & Gynaecologists 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
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47. Adolescent Immunization
Adequate immunization
is one of the most important
preventive health services
that can be provided for an
adolescent.
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