Importancia de la vacunación. Generalidades.

Transcripción

1 Importancia de la vacunación. Generalidades. Curso Trienal de Infectología Círculo Médico de Córdoba Prof. Dr. Rubén D. Motrich 16 de Diciembre de 2017

2 QUÉ SON LAS VACUNAS? Medicamentos cuyo principio activo son microorganismos muertos o vivos atenuados, o algunos de sus componentes (antígenos), que al ser administradas a una persona inducen activamente una repuesta inmune específica (anticuerpos y linfocitos de memoria) que lo protegen contra diferentes enfermedades infectocontagiosas. Importancia Erradican y/o disminuyen enfermedades inmunoprevenibles y sus secuelas y consecuencias. Disminuyen/evitan la transmisión a otras personas (epidemias).

3 Que características debe tener? Ser seguras Evitar la enfermedad Proteger a una proporción alta de quienes la reciben Inducir protección duradera Carecer de efectos secundarios Ser estables Tener bajo costo

4 Cuál es el objetivo de vacunar? No ocurrencia de casos con desaparición de las causas en el mundo (ej.: Viruela) No ocurrencia de casos pero persistencia de las causas (ej.: Poliomielitis) Disminución del número de casos y mayor intervalo entre las epidemias (ej.: Sarampión)

5 Es lo mismo Vacunar que Inmunizar?

6 Inmunizar Conferir inmunidad ante determinados microorganismos/ enfermedades mediante la administración de antígenos (inmunidad activa) o mediante la administración de anticuerpos específicos (inmunidad pasiva). ~ Vacunar Inducir inmunidad activa (memoria) en un huésped susceptible

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8 Qué pasa en nuestro Sistema Inmune cuando se administra una Vacuna?

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10 Infección natural Calostro Vacunación Antisueros

11 Generalidades del Sistema Inmune Agresiones del ambiente o injuria producidas por agentes patógenos ALTERACIONES DE LA HOMEOSTASIS SISTEMA NERVIOSO SISTEMA INMUNE SISTEMA ENDOCRINO INMUNIDAD NATURAL O INESPECÍFICA Primeros efectores ante la infección (sin memoria) INMUNIDAD ADAPTATIVA O ESPECIFICA Efectores secundarios. Inducidos por la inmunidad innata (con memoria) BARRERAS FÍSICAS BARRERAS QUÍMICAS CÉLULAS FAGOCITARIAS PROTEÍNAS PLASMATICAS INMUNIDAD HUMORAL (Anticuerpos) INMUNIDAD CELULAR (Linfocitos T)

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16 Inducción de la Respuesta Inmune

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18 Acs: mecanismos de eliminación de Ags

19 INMUNIDAD MEDIADA POR CÉLULAS

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29 Hay factores que pueden influir en la Respuesta Inmune tras la administración de una Vacuna?

30 1. Presencia o ausencia de anticuerpos maternos 2. Naturaleza y dosis del antígeno administrado 3. Modo de administración de la vacuna 4. Utilización o no de adyuvantes 5. Utilización o no de carriers 6. Edad 7. Estado nutricional 8. Condición general del huésped

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32 Es el grado de protección contra una infección conferida por una vacuna, determinado por un ensayo clínico, randomizado y controlado.

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34 Se logra cuando se vacuna 95% de la población

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36 Clasificación de acuerdo a su aplicación Sistémicas Indicadas para toda la población a partir de la edad infantil y se encuentran incluidas en el calendario oficial de vacunación. No sistémicas No están incorporadas al calendario de vacunación y sólo se aconsejan a ciertas personas (niños, adultos o grupos de riesgo, por ejemplo, veterinarios, trabajadores de salud, viajeros, etc.).

37 Clasificación de acuerdo a su composición

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39 Vacunación simultánea Es la administración de 2 o más vacunas en el mismo momento, en diferentes sitios anatómicos. No se aconseja la administración simultánea de OPV (Sabin) con vacuna anticolérica inactivada y/o vacuna contra la fiebre amarilla.

40 Vacunas combinadas Contienen antígenos de varios agentes infecciosos, o diferentes serotipos/serogrupos de un mismo agente, que se aplican en una sola administración. La combinación puede realizarse: Durante la fabricación En el curso de la obtención y preparación En el momento de la administración

41 Edad Varios factores intervienen para determinar la edad de vacunación: Riesgos específicos de enfermar según grupo de edad. Epidemiología de la enfermedad. Capacidad para responder a una vacuna específica. La interferencia por inmunidad pasiva transferida por la madre. Madurez del sistema inmune. En niños prematuros, aunque la respuesta a la vacuna es variable, se deben aplicar las vacunas correspondientes a la edad al momento de la vacunación, sin tener en cuenta ningún tipo de ajuste en cuanto a su edad por el antecedente de su prematurez.

42 * Ej.: sarampión, rubeola, paperas o fiebre amarilla * Excepto vacuna anticolérica inactivada y de la fiebre amarilla, que deben separarse 3 semanas.

43 Recomendaciones frente a esquemas interrumpidos Se debe continuar con las dosis restantes independientemente del tiempo transcurrido. No reiniciar el esquema en ninguna circunstancia. No demorar su cumplimiento.

44 Intercambiabilidad de las marcas de vacunas Las vacunas similares elaboradas por distintos fabricantes se pueden utilizar indistintamente respetando las indicaciones del fabricante.

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46 Antes de vacunar Observar el estado general del individuo. Preguntar a los padres si el niño está bien. Preguntar a los padres sobre contraindicaciones. Preguntar a los padres sobre reacciones previas a las vacunas. Explicar en forma clara y concisa las ventajas de la vacunación, características de la enfermedad a prevenir, reacciones 2º a las vacunas esperadas, y qué hacer frente a éstas. Sugerir analgesia. Fijar cita para próxima vacunación.

47 Contraindicaciones Reacción anafiláctica a una dosis previa de la vacuna. Reacción anafiláctica previa a componentes de la vacuna.

48 Resfrío o catarro de vía aérea superior Tratamiento con antibióticos y/o convalescencia de enfermedad leve Tratamiento con corticoides a dosis bajas o inhalados Enfermedad leve como diarrea y poca fiebre Exposición reciente a la enfermedad infecciosa Reacción leve en una dosis previa Prematuridad Lactancia Historia familiar de alergia inespecífica o convulsiones Alergia a la penicilina (excepto reacción anafiláctica) Historia familiar de muerte súbita

49 Seguridad de las vacunas

50 Seguridad de las vacunas

51 Seguridad de las vacunas Para el seguimiento post-vacunación Farmacovigilancia. Conjunto de métodos, observaciones y disciplinas que permiten, durante la etapa de comercialización o uso extendido de un medicamento, detectar reacciones adversas y efectos farmacológicos o terapéuticos beneficiosos, no previstos en las etapas previas de control y evaluación. La aplicación de las vacunas ha llevado a los expertos a denominar a estos eventos como Efectos adversos supuestamente atribuibles a la vacunación e inmunización (ESAVI).

52 Qué ESAVI deben comunicarse?

53 Recomendaciones para sostener la seguridad de las vacunas

54 Algo de historia

55 1000-A.C CHINA: previenen la viruela HISTORIA Del latín INMUNITAS: Protección contra las enfermedades infecciosas INMUNE = Estar libre de 430 A.C. TUCÍDIDES. Primer concepto de Inmunidad: los que enferman y sobreviven, no enferman nuevamente. INMUNIDAD, Roma = exento de impuestos 500 D.C VARIOLIZACIÓN, Medio oriente preserva Belleza de sus mujeres, inhalaban polvo de lesiones de viruela 1700 VARIOLIZA a sus hijos Lady MARY WORTLEY MONTAGU en Inglaterra 1798 JENNER, INMUNIZACIÓN contra la viruela. Transfiere pus de una lesión de vacuna al brazo de un niño y observa protección contra la viruela. Vacuna: Erupción viral leve que afectaba al ganado y ordeñadores

56 Las vacunas han sido el desarrollo biomédico con mayor impacto positivo en la Salud Pública luego de la potabilización del agua

57 Investigaciones de Edward Jenner En Jenner obtuvo pus de una pústula de una ordeñadora que tenia cowpox Jenner inoculó el material de la pústula, en el brazo de un niño Una semana después contrajo el cowpox y se sintió ligeramente enfermo Cuatro días más tarde se sintió bien Jenner vuelve a inocular pus de viruela y el niño no enfermó.

58 - 1796: Vacunación contra la viruela : Vacuna contra la rabia : Toxoide diftérico, Toxoide tetánico y tos convulsa : Vacuna contra la fiebre amarilla : Vacuna contra influenza : Vacuna inactivada contra virus de la polio : Vacuna viva atenuada contra virus de la polio : Vacuna contra el sarampión : Vacuna contra la rubeóla : Vacuna contra hepatitis B Cronograma de aparición de Vacunas de uso humano : Erradicación de la Viruela : Primera vacuna recombinante (hepatitis B) : Vacuna conjugada contra H. influenzae B

59 El Valor Social de las Vacunas La vacunación beneficia a toda la población, pero sobretodo a los niños. Anualmente, en el mundo mueren 10 millones de niños menores de 5 años. 25% de esas muertes son provocadas por enfermedades prevenibles por vacunación.

60 LA VACUNACIÓN EN EL MUNDO Evita la muerte de más de 20 millones de personas por año HERRAMIENTA CON MAYOR IMPACTO EN EL FORTALECIMIENTO DE LOS SISTEMAS SOCIALES Y SANITARIOS Es la que tiene el mayor impacto en la disminución de la mortalidad Permitió que la Viruela sea erradicada de la faz de la tierra Ha reducido la Poliomielitis en un 99%. Actualmente presente en solo dos países: Afganistán y Pakistán Ha logrado una reducción del Sarampión en un 78% Virtual desaparición de difteria, tétanos, paperas, y Haemophilus influenzae B Control de Hepatitis B Sanmarco y Motrich. Bitácora digital. América : región libre de Viruela (1971), Poliomielitis (1994), Rubéola y Síndrome de Rubéola Congénito (2015),

61 Incremento de la población mundial durante los últimos 2000 años Antibióticos Vacunas Aguas saneadas

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66 Countries with Hib vaccine in the national immunization programme; and planned introductions in 2017 Introduced* to date (191 countries or 98%) * Includes partial introduction Not Available, Not Introduced/No Plans (3 countries or 2%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

67 Countries with Pneumococcal Conjugate vaccine (PCV) in the national immunization programme; and planned introductions in 2017 * Includes partial introduction Introduced* to date (136 countries or 70%) Planned introductions in 2017 (4 countries or 2%) Not Available, Not Introduced/No Plans (54 countries or 28%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

68 Countries with Rotavirus vaccine in the national immunization programme; and planned introductions in 2017 * Includes partial introduction Introduced* to date (91 countries or 47%) Planned introductions in 2017 (6 countries or 3%) Not Available, Not Introduced/No Plans (97 countries or 50%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

69 Immunization coverage with Rotavirus vaccine in infants, ,050 2,100 4,200 Kilometers Source: WHO/UNICEF coverage estimates 2016 revision, July Map production: Immunization Vaccines and Biologicals, (IVB). World Health Organization. 194 WHO Member States. Date of slide: 24 July 2017 <50% (9 countries or 5%) 50-79% (22 countries or 11%) 80-89% (15 countries or 8%) >=90% (38 countries or 20%) Rotavirus vaccine in schedule but no coverage data available (7 countries or 4%) Not available / not in national immunization schedule (103 countries or 53%) Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

70 Countries with HPV vaccine in the national immunization programme Introduced* to date (74 countries or 38.1%) * Includes partial introduction Not Available, Not Introduced/No Plans Not applicable (120 countries or 61.9%) Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

71 Countries using Measles Second Dose vaccine to date; and planned introductions in 2017 Introduced to date (165 countries or 85.1%) Planned introductions in 2017 (7 countries or 3.6%) Not Available, Not Introduced/No Plans (22 countries or 11.3%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

72 Countries with Rubella vaccine in the national immunization programme; and planned introductions in 2017 * Includes partial introduction Introduced to date* (159 countries or 82%) Planned introductions in 2017 (5 countries or 2.6%) Not Available, Not Introduced/No Plans (30 countries or 15.5%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

73 Countries with Mumps containing vaccine in the national immunization programme 0 1,200 2,400 4,800 Kil Introduced* to date (121 countries or 62%) Not Available, Not Introduced/No Plans (73 countries or 38%) Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

74 Countries with Hepatitis B Birth dose (HepB-BD) vaccine in the national immunization programme ,700 3,400 Kilometers HepB-BD introduced to date (100 countries or 52%) HepB-BD only for infants born to HBsAG-positive mothers (21 countries or 11%) Data source: WHO/IVB Database as at 9 August 2017 and ECDC published data at WHO Member States Map production Immunization Vaccines and Biologicals (IVB), World Health Organization Date of slide: 9 August 2017 HepB in schedule but no HepB-BD HepB given only for risk groups or adolescents (3 countries or 2%) Not available Not applicable (70 countries or 36%) The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

75 Countries and Territories using Yellow fever* vaccine to date * WHO considers that 44 countries/territories are at risk for Yellow fever Introduced to date (32 countries or 73%) Introduced in Hig risk areas (3 countries or 7%) At risk but not introduced (9 countries or 20%) Not Available / Not at risk Not applicable Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

76 Immunization coverage with DTP3 vaccines in infants (from <50%), ,050 2,100 4,200 Kilometers Source: WHO/UNICEF coverage estimates 2016 revision, July Map production: Immunization Vaccines and Biologicals, (IVB). World Health Organization. 194 WHO Member States. Date of slide: 19 July 2017 <50% (8 countries or 4%) 50-79% (27 countries or 14%) 80-89% (29 countries or 15%) >=90% (130 countries or 67%) Not available Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

77 19.5 million infants not immunized (DTP3), 2016 African American Eastern Mediterranean European South East Asian Western Pacific Source: WHO/UNICEF coverage estimates 2016 revision, July United Nations, Population Division. The World Population Prospects revision. New York, Immunization Vaccines and Biologicals, (IVB), World Health Organization. 194 WHO Member States. Date of slide: 17 July 2017.

78 Number of vaccines/antigens introduced in national immunization schedules compared to July Selected antigens are : Diphtheria, Tetanus, Pertussis, Measles, Polio - universal use Hepatitis B, Heamophilius Influenza type B, Pneumococcal conjugate Rotavirus Rubella 0 2,650 5,300 Kil 5 antigens (DTP, Measles and Polio) 6 antigens 7 antigens 8 antigens 9 antigens 10 antigens Not applicable Not available The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved 2016 Source:WHO/IVB Database, as at 11 July Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization 194 WHO Member States. Date of slide: 31 July 2017.

79 Immunization coverage with 1st dose of measles containing vaccines in infants, ,050 2,100 4,200 Kilometers Source: WHO/UNICEF coverage estimates 2016 revision, July Map production: Immunization Vaccines and Biologicals, (IVB). World Health Organization. 194 WHO Member States. Date of slide: 19 July 2017 <50% (7 countries or 4%) 50-79% (32 countries or 16%) 80-89% (32 countries or 16%) >=90% (123 countries or 64%) Not available Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

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81 Polio Eradication Progress, Certified polio-free regions (126 countries) Not certified but non-endemic (65 countries) Endemic with wild poliovirus ( 3 countries) Source: WHO/POLIO database, as of Aug member states. The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

82 El efecto de la vacunación en la prevalencia mundial de Poliomielitis 84

83 41 Countries* have eliminated MNT (materno-neonatal tetanus) between 2000 & 2016 *Plus Ethiopia except Somali region, 16/17 regions in Philippines, and Punjab region of Pakistan - leaving 18 countries yet to eliminate MNT Source: WHO/UNICEF Database. Map production: Immunization Vaccines and Biologicals, (IVB), World Health Organization. Date of slide: 06 July MNT eliminated from MNT not eliminated MNT eliminated before 2000 The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

84 Countries having introduced Hib vaccine in the last 20 years ( ) countries introduced 2 countries partially introduced countries introduced 1 countries partially introduced 0 2,100 4,200 1,050 Kilometers Source: WHO/UNICEF coverage estimates 2016 revision, July WHO Member States. Map production: Immunization Vaccines and Biologicals, (IVB). World Health Organization. Date of slide: 27 July The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved

85 Countries with a 3-5 year strategic plan for the national immunization system, ,050 2,100 4,200 Kilometers Source: WHO/IVB Database, as at 11 July Map production: Immunization Vaccines and Biologicals (IVB), World Health Organization. 194 WHO Member States Date of slide: 28 July Yes (146 countries or 75%) No (32 countries or 16%) No data (16 countries or 8%) Not available Not applicable The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved 87

86 Recientes avances en vacunación

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92 Muchas gracias