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ADULT IMMUNISATION 2Nd Edition Malaysian Society of Infectious Diseases and Chemotherapy GUIDELINES FOR ADULT IMMUNISATION 2nd Edition 1 Quick Guide3 19-21 22-26 27-49 50-59 60-64 ≥65 yrs yrs yrs yrs yrs yrs Influenza* 1 dose annually Tetanus, diphtheria, Substitute 1-time dose of Tdap for Td booster; pertussis (Td/Tdap)* then boost with Td every 10 yrs Varicella* 2 doses Human papillomavirus 3 doses (HPV) Female* Human papillomavirus 3 3 (HPV) Male* doses doses Zoster* 1 dose Measles, mumps, 1 or 2 doses rubella (MMR)* Pneumococcal 1 dose conjugate (PCV)* Pneumococcal 1 or 2 doses 1 dose polysaccharide (PPV)* Meningococcal* 1 or more doses Hepatitis A* 2 doses Hepatitis B* 3 doses Haemophilus 1 or 3 doses influenzaetype b (Hib)* For all persons in this category who meet the age requirements and who lack documentation of vaccination or have no evidence of previous infection; zoster vaccine recommended regardless of prior episode of zoster Recommended if some other risk factor is present (eg, on the basis of medical, occupational, lifestyle, or other) No recommendation *Please refer to relevant section for more details 2 Malaysian Society of Infectious Diseases and Chemotherapy GUIDELINES FOR ADULT IMMUNISATION 2nd Edition Supported by an educational grant from 3 Malaysian Society of Infectious Diseases and Chemotherapy ISBN 978-967-13054-0-9 First Edition Published December 2003 Second Edition Published April 2014, Revised November 2014 Copyright © Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC) 2014 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording and/or otherwise, without the prior written permission from the publisher. Applications for such permission should be addressed to Malaysian Society of Infectious Diseases and Chemotherapy. Published by: Malaysian Society of Infectious Diseases and Chemotherapy c/o Department of Medical Microbiology, Faculty of Medicine, University Kebangsaan Malaysia, Hospital Univeristy Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur, Malaysia. Printed by: Print Wise Enterprise Sdn Bhd 4 Expert Panel Chair Prof Dr Victor K E Lim Vice President (Education) and Professor of Pathology International Medical University (IMU) Kuala Lumpur Members Assoc Prof Dr Ariza Adnan Dr Timothy William Deputy Dean (Academic & Student) & State Infectious Disease Consultant Consultant Clinical Microbiologist Queen Elizabeth Hospital Faculty of Medicine Sabah Universiti Teknologi MARA Selangor Prof Dr Yasmin A Malik Consultant Microbiologist (Virology) & Dato Dr Chang Kian Meng Head Department of Pre-Clinical Sciences Head & Consultant Haematologist Faculty of Medicine & Health Sciences Department of Haematology Universiti Tunku Abdul Rahman (UTAR) Hospital Ampang Selangor Selangor Prof Dr Zamberi Sekawi Prof Datin Dr Ilina Isahak Deputy Dean & Professor of Medical Microbiology Medical Professor Faculty of Medicine & Health Sciences Faculty of Medicine & Health Sciences Universiti Putra Malaysia (UPM) Universiti Sains Islam Malaysia (USIM) Selangor Kuala Lumpur Assoc Prof Dr Zetti Zainol Rashid Mrs Noraisyah Mohd Sani Senior Lecturer & Clinical Microbiologist Senior Principal Assistant Director Department of Medical Microbiology & Immunology Pharmacovigilance Section Faculty of Medicine Centre for Post Registration of Products Universiti Kebangsaan Malaysia Medical Centre National Pharmaceutical Control Bureau Kuala Lumpur Selangor External reviewers Dr Nor Liza Ariffin Senior Lecturer Dr Rohani binti Jahis Monash University Malaysia Head of the Vaccine Prevention of Disease/Food & Consultant Infectious Diseases Physician Water Borne Diseases Sime Darby Medical Center Disease Control Division, Ministry of Health Malaysia Selangor Wilayah Persekutuan Dr Suresh Kumar Chidambaram Ms Sameerah Shaikh Abdul Rahman Consultant Infectious Diseases Physician Deputy Director Hospital Sungai Buloh Centre for Post Registration of Products Selangor National Pharmaceutical Control Bureau Selangor 5 Contents Introduction 10 General Advice on Immunisation 12 Vaccine-preventable Diseases • Cholera 30 • Diphtheria, Tetanus, Pertussis (DTP) 34 • Haemophilus influenzae Type b Infections 51 • Hepatitis A 55 • Hepatitis B 60 • Human Papillomavirus Infections 67 • Influenza 77 • Japanese Encephalitis 84 • Measles, Mumps, Rubella (MMR) 90 • Meningococcal Disease 102 • Pneumococcal Disease 107 6 • Poliomyelitis 114 • Rabies 118 • Typhoid 126 • Varicella 132 • Yellow Fever 138 • Zoster 141 Passive Immunisation 144 Upcoming Vaccines 148 Special Groups 156 7 Abbreviations ADR adverse drug reactions HBIG hepatitis B immunoglobulin AEFI adverse event following HBsAg hepatitis B surface antigen immunisation HBV hepatitis B virus AIDS acquired immunodeficiency HCW healthcare worker syndrome HDCV human diploid cell vaccine (rabies) anti-HBc antibody to hepatitis B core HepA hepatitis A vaccine antigen HepB hepatitis B vaccine anti-HBe antibody to hepatitis B e antigen HHE hypotonic-hyporesponsive episode anti-HBs antibody to hepatitis B surface antigen Hib Haemophilus influenzae type b AOM acute otitis media Hib-MenCCV Haemophilus influenzae type b-Meningococcal C conjugate AVA anthrax vaccine adsorbed vaccine BCG bacille Calmette-Guérin HIV human immunodeficiency virus CCID50 cell culture infectious dose 50% HPV human papillomavirus CCVs cell culture vaccines HPV2 bivalent HPV vaccine CI confidence interval HPV4 quadrivalent HPV vaccine CIN cervical intraepithelial neoplasia HRIG human rabies immunoglobulin CRS congenital rubella syndrome HSCT haematopoietic stem cell transplant CSF cerebrospinal fluid HZ herpes zoster DNA deoxyribonucleic acid HZV herpes zoster (Shingles) vaccine DT diphtheria-tetanus (vaccine for use in (formerly called ZOS) children) ID intradermal DTaP diphtheria and tetanus toxoids and IgA/G/M immunoglobulin A/G/M acellular pertussis vaccine (pediatric formulation replaced DTP) IIV inactivated influenza vaccine (formerly called TIV) EIA enzyme immunoassay IM intramuscular eIPV enhanced inactivated polio vaccine IPD invasive pneumococcal disease ELISA enzyme-linked immunosorbent assay IPV inactivated poliomyelitis vaccine FHA filamentous haemagglutinin IS intussusception FIM fimbriae (pertussis) ITP idiopathic thrombocytopenia purpura GBS Guillain-Barré syndrome IU international units GP general practitioner IV intravenous GVHD graft-versus-host disease JE Japanese encephalitis HAV hepatitis A virus JE-MB inactivated, mouse brain-derived Japanese encephalitis vaccine HBcAg hepatitis B core antigen LAIV live, attenuated influenza vaccine HBeAg hepatitis B e antigen (nasal spray) 8 LT-ETEC heat-labile toxin producing PRP polyribosylribitol phosphate enterotoxigenic Escherichia coli PRP-OMP PRP conjugated to MCV measles antigen-containing vaccines the outer membrane protein MCV4 meningococcal conjugate vaccine (of Neisseria meningitidis) (quadravalent) PRP-T PRP conjugated to tetanus toxoid MenACWY-CRM meningococcal PT pertussis toxoid conjugate vaccine, quadrivalent PVRV purified vero cell-based vaccine MenACWY-D meningococcal conjugate RCT randomised controlled trial vaccine, quadrivalent RIG rabies immunoglobulin MenC meningitis C RNA ribonucleic acid MMR measles-mumps-rubella SC subcutaneous MMRV measles-mumps-rubella-varicella SCID severe combined immunodeficiency NHIG normal human immunoglobulin SIDS sudden infant death syndrome NIP National Immunisation Program SOT solid organ transplant NPCB National Pharmaceutical Control SSPE subacute sclerosing Bureau panencephalitis NTHi non-typeable Haemophilus TB tuberculosis influenzae TCID50 tissue culture infectious dose 50% OMP outer membrane protein Td tetanus & diphtheria vaccine (adult/ OPV oral poliomyelitis vaccine adolescent formulation) PCECV purified chick embryo cell vaccine Tdap tetanus, diphtheria & acellular (rabies) pertussis vaccine (adult/adolescent PCR polymerase chain reaction formulation) PCV pneumococcal conjugate vaccine TGA Therapeutic Goods Administration PCV10 pneumococcal conjugate vaccine TIG tetanus immunoglobulin (10 valent) TST tuberculin skin test PCV13 pneumococcal conjugate vaccine TT tetanus toxoid (13 valent) Ty21a live oral typhoid vaccine PCV7 pneumococcal conjugate vaccine (7 valent) VAR varicella vaccine PEP post-exposure prophylaxis VLP virus-like particle pH1N1 pandemic influenza A(H1N1) VNAb (rabies) virus neutralising antibody pdm09 VPD vaccine-preventable disease PHN post-herpetic neuralgia VV varicella vaccine PI product information VZV varicella-zoster virus PPV23 pneumococcal polysaccharide WA Western Australia vaccine (23-valent) WHO World Health Organization PRN pertactin ZIG zoster immunoglobulin 9 Introduction mmunisation against infectious diseases has been primarily directed towards infants, children and adolescents and has become a routine Ipractice in paediatrics. In many countries, including Malaysia, adult immunisation is not commonly practised. There is a lack of awareness of the benefits of immunisation for adults, even though there is considerable morbidity and mortality within this age group due to vaccine-preventable diseases. Vaccine-preventable diseases are still commonly encountered in Malaysia. The Ministry of Health Malaysia data for 2011, showed that the incidence rates for measles, hepatitis B and pertussis were 5.42, 4.32, 0.86 per 100,000 population respectively. In Singapore, it has been reported that the proportion of influenza associated
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