【正文】 eonatorum in the newborn. In the first pregnancy on the third month and after 1 month. The third dose in the second pregnancy, and the fourth on the third pregnancy with a maximum of 5 doses. If 10 years elapse, and then pregnancy occurs, the doses are given from the start. ? Live attenuated vaccines should not be given during pregnancy. Vaccination for special occupations ? Health care workers: hepatitis B, influenza, MMR, polio ? Public safety personnel (police, fire fighters) and staff of institutions for the developmentally disabled: hepatitis B, influenza ? Vets and animal handlers: rabies, plague and anthrax ? Sewage workers: DT, hepatitis A, polio, TAB ? Food handlers: TAB ? Military troops and camp dwellers: pneumococcal, meningococcal, influenza, BCG (for non reactors), tetanus Vaccination for special life styles and special environmental situations ? Homosexually active males, Heterosexual with promiscus sexual partner specially who has STDs, and Injecting drug users ? Inmates of long term correctional institutes, residents of institutions for the developmentally disabled, and household contacts of HBV carriers or patients All should receive hepatitis B vaccine Vaccinations for special health status persons ? Immunopromised persons ( Leukemia, lymphoma, HIV, malignancy…) ? Hemodialysis and transplantation Should receive the following vaccines according to their situation: HBV, Influenza, Pneuomococcal vaccines Vaccinations in travel ? Varies according to the country of arrival and departure. – Primary vaccine series – Continuation of booster doses – Specific vaccine according to the country traveled to: ? TAB, YF, cholera, meningiococcal, pneuomococcal, HIB, influenza, rabies, plague, Japanese encephalitis. ? Haj for instance necessates meningococcal vaccination from all over, and YF from places like south Africa, and cholera from places like India. Vaccines against bioterrorism ? Anthrax ? Small pox ? plague New approaches ? Schistosomiasis ? Cancer ? HIV/AIDS ? Malaria Vaccine surveillance and testing “monitoring vaccine effectiveness” Through: ? Randomized field trials ? Retrospective cohort studies ? Casecontrol studies ? Incidence density measures Randomized field trials – The standard way to measure the effectiveness of a new vaccine introduced. – In this type of trial, susceptible persons are randomized into two groups and are then given the vaccine or the placebo – The vaccinated and the unvaccinated are followed through the high risk season of the year Randomized field trials (cont.) ? The attack rate (AR) is then determined in each group: ? AR = Number of persons ill Number of persons exposed to the disease ? next the vaccine effectiveness (VE) is calculated: VE = AR (unvaccinated) AR (vaccinated) AR (unvaccinated) X 100 Retrospective cohort studies ? The antigenic variability of influenza virus necessitates frequent (often yearly) changes in the constituents of the vaccine to keep them up date with the new strains. Retrospective cohort studies are thus done to evaluate the protective efficacy of the vaccines. Casecontrol studies ? Done because randomized control trials are very costly. ? VE = 1 AR (vaccinated) AR (unvaccinated) = (1 RR) or (1 OR) Incidence density measures ? They are used to determine the the optimal timing for administration of a new vaccine and the duration of the immunity produced. It has the following formula: ? ID = Number of new cases of a disease Persontime of exposure (days, weeks, months, years..) THANK YOU