Vaccinations in patients with rheumatic diseases
|
|
|
- Julius Carter
- 7 years ago
- Views:
Transcription
1 Vaccinations in patients with rheumatic diseases Silja Bühler 10 April 2014 Page 1
2 Table of Contents 1. Increased risk of infection in patients with rheumatic diseases 2. Example from the travel medicine clinic 3. Existing recommendations for vaccinations in patients with rheumatic diseases 4. Existing data on vaccinations in patients with rheumatic diseases under immunosuppression with a focus on biological drugs - live vaccines - inactivated vaccines 5. Recommendations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 2
3 Increased risk of infection in patients with rheumatic diseases Risk of a confirmed infection in patients with rheumatoid arthritis is 1.7 times higher compared to healthy individuals Because of underlying condition Because of immunosuppressive/immunomodulating therapy 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 3
4 Infections preventable by vaccinations Increased risk of infection Influenza Pneumococcal infection HPV infection (SLE) Herpes zoster Severe courses of disease reported Hepatitis B Varicella Measles References: Blumentals, W., et al. BMC Musculoskelet Disord 2012 / Wotton, CJ,. J Epidemiol Community Health 2012 / Santana. Clin Rheumatol 2011 / Smitten, Arthritis Care & Research 2007 / Durmus et al, Rheumatol Int 2013 / Vonkeman, et al,j Rheumatol 2004 / Takahashii et al, J. Clin. Immunol April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 4
5 Table of Contents 1. Increased risk of infection in patients with rheumatic diseases 2. Example from the travel medicine clinic 3. Existing recommendations for vaccinations in patients with rheumatic diseases 4. Existing data on vaccinations in patients with rheumatic diseases under immunosuppression with a focus on biological drugs - live vaccines - inactivated vaccines 5. Recommendations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 5
6 Institute of Social and Preventive Medicine Travel medicine clinic (i) Patient - female, 35 years old, with long history of rheumatoid arthritis - Tx: etanercept, 15mg methotrexate / week Journey - 3 weeks in Brazil with husband - Rio de Janeiro - Iguaçu waterfalls - tour on amazon river from Belém to Manaus 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 6
7 Travel medicine clinic (ii) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 7
8 For a journey to Brazil, there should be protection against Diphtheria, Tetanus Hepatitis A Hepatitis B: in case of longer stay or at risk Typhoid fever: recommended in case of stay >4 weeks and for groups at risk (e.g. insufficient food hygiene): Vivotif, Typhim Vi Rabies: for travellers with high individual risk or stay >6 months for immunodeficient travellers: Influenza and Pneumococcal disease Mumps, Measles, Rubella (if born after 1963) Varicella (if <40 years of age) Yellow Fever: depending on destination (recommended for Iguaçu and Amazon) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 8
9 Table of Contents 1. Increased risk of infection in patients with rheumatic diseases 2. Example from the travel medicine clinic 3. Existing recommendations for vaccinations in patients with rheumatic diseases 4. Existing data on vaccinations in patients with rheumatic diseases under immunosuppression with a focus on biological drugs - live vaccines - inactivated vaccines 5. Recommendations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 9
10 patients with autoimmune diseases (e.g. rheumatoid arthritis) without immunosuppressive therapy may be vaccinated like any other healthy traveller patients with autoimmune diseases with immunosuppressive therapy may not be vaccinated with live vaccines such as yellow fever 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 10
11 Where does the fear of live vaccinations in immunodeficient travellers come from? Risk of infection through vaccination BUT no severe side effects in patients with rheumatic diseases under immunosuppressive therapy after administration of live vaccine have been reported 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 11
12 Under which conditions is the administration of live vaccines possible? Live vaccinations may be administered if low-dose or short-term corticosteroid therapy (<20mg/day prednisone or equivalent) or if applied locally sulfasalazine / mesalazine hydroxychloroquine Herpes zoster vaccine may be administered in case of low-dose immmunosuppression methotrexate ( 0.4mg / kg / week) azathioprine ( 3.0 mg / kg / day) 6-mercaptopurine ( 1.5mg / kg / day) References: CDC Yellow Book 2014 / Prevention of Herpes Zoster Recommendations of Advisory Committee on Immunization Practices (ACIP), 2008 / SGR, April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 12
13 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 13
14 Reference: Eperon, G., Vaudaux, B. Vaccination chez levoyageur immunosupprimé. Rev Med Suisse 2013 ; 9 : April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 14
15 Table 1: Immunsuppressants and Vaccinations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 15
16 Table 2 (mostly based on half lives expert opinion) Time interval between immunosuppressive agent and live vaccination 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 16
17 One dose of the 13-valent conjugate vaccine (Prevenar ) generate antibody responses with higher affinity generate longer-lasting immune responses induce development of memory B cells booster vaccinations are possible In contrary, in case of polysaccharid vaccines, secondary vaccinations generate weak immune responses only due to lack of memory cells A minimum time interval of 12 months should elapse since last pneumococcal polysaccharide vaccination (Pneumovax ) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 17
18 Safety of administration of live vaccines to contacts of immunocompromised persons 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page IDSA guidelines
19 Table of Contents 1. Increased risk of infection in patients with rheumatic diseases 2. Example from the travel medicine clinic 3. Existing recommendations for vaccinations in patients with rheumatic diseases 4. Existing data on vaccinations in patients with rheumatic diseases under immunosuppression with a focus on biological drugs - live vaccines - inactivated vaccines 5. Recommendations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 19
20 Live vaccines Mumps, Measles and Rubella MMR Booster has been safe in 207 juvenile idiopathic arthritis (JIA) patients of which 49 patients received methotrexate 6 patients received classical DMARDs 1 patient received TNF inhibitor MMR Booster has been safe and immunogenic in 15 JIA patients (6-17y) under therapy with low-dose methotrexate in some cases in combination with etanercept MMR Booster has been safe and immunogenic in 63 JIA patients of which - 6 patients received etanercept - 3 patients received anakinra after pausing during 5 half-lives (half-lives are 2 days for anakinra and 2 weeks for etanercept) Heijstek et al, Ann Rheum. Dis April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Borte et al, Rheumatology 2009 Heijstek et al, JAMA 2013 Page 20
21 Live vaccines Yellow Fever a secondary yellow fever vaccination has been safe in 70 patients with rheumatic diseases (of which 54 with rheumatoid arthritis) under therapy with methotrexate corticosteroids sulfasalazine leflunomide cyclophosphamide biologicals a secondary yellow fever vaccination has been safe in 17 patients with rheumatoid arthritis under therapy with infliximab, in some cases with 15-20mg methotrexate per week. The yellow fever vaccination has been administered 1 month after infliximab therapy In tendency, the vaccination was less immunogenic in patients with rheumatoid arthritis than in the 14 healthy controls De Mota et al, Rev da Soc Bras Med Trop April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Scheinberg et al, Arthritis Care & Research Page
22 Live vaccines Varicella A primary varicella vaccination was safe in 25 patients with juvenile rheumatic diseases (of these 20 showed negative varicella antibody titers). All patients were treated with methotrexate (12-25mg/ m 2 / week) 13 patients additionally received prednisone (2-20mg/ day) 5 patients additionally received classical DMARDs (cyclosporine, leflunomide, penicillamine) limited immunogenicity number of people developing a positive antibody titer: 10 out of 20 (50%) seronegative patients versus 13 out of 18 (72.2%) health controls 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 22
23 Live vaccines Herpes zoster retrospective analysis in > people insured in «medicare», 60 years of age Herpes zoster vaccination was safe and immunogenic in patients with the following conditions: rheumatoid arthritis psoriasis psoriatic arthritis ankylosing spondylitis auto-inflammatory bowel diseases under treatment with nonbiological DMARDs, corticosteroids, TNF inhibitors (etanercept, adalimumab, infliximab, certolizumab, golimumab) und other biologicals (abatacept, rituximab) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 23
24 Replication capacity of live vaccines high risk: yellow fever medium risk: measles low risk: varicella, rubella, mumps negligible risk: oral typhoid vaccine (Vivotif ) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 24
25 Table of Contents 1. Increased risk of infection in patients with rheumatic diseases 2. Example from the travel medicine clinic 3. Existing recommendations for vaccinations in patients with rheumatic diseases 4. Existing data on vaccinations in patients with rheumatic diseases under immunosuppression with a focus on biological drugs - live vaccines - inactivated vaccines 5. Recommendations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 25
26 Inactivated vaccines in patients with and without immunosuppressive therapy are safe! 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 26
27 Inactivated vaccines in patients with and without immunosuppressive therapy are but immunogenic as well? 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 27
28 Inactivated vaccines and biologicals (mostly trials with small sample sizes) TNF Alpha inhibitor (most data available) okay for seasonal influenza, H1N1, pneumococcal vaccine limited for Hepatitis A, Hepatitis B) TNF Alpha inhibitor plus methtotrexate - considerably reduced (pneumococcal, hepatitis A vaccine) Abatacept considerably reduced (H1N1, pneumococcal, tetanus vaccine) Rituximab depends on time point of vaccine administration! up to 6 months after rituximab therapy, antibody immune response quasi inexistent (seasonal influenza, H1N1, pneumococcial, tetanus vaccine) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 28
29 Recap: patient example Patient female, 35 years old, with long history of rheumatiod arthritis Tx: etanercept, 15mg methotrexate / week Journey 3 weeks in Brazil toghether with husband Rio de Janeiro Iguaçu waterfalls tour through amazon from Belém to Manaus 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 29
30 recommended inactivated vaccinations and consequences for our patient Diphtheria, Tetanus if no vaccination in past 10 years Influenza Pneumococcal disease vaccination Hepatitis A Hepatitis B in case of longer stay or at risk vaccination and antibodies Typhoid fever: Vivotif, Typhim Vi Rabies for travellers with high individual risk or stay >6 months discuss risk, vaccination not required for this journey 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 30
31 recommended live vaccinations and consequences for our patient Mumps Measles Rubella Varicella do not vaccinate! history of disease? vaccinated 2 times? antibody titer? vaccination of contacts (e.g. family) interruption of therapy? Yellow Fever do not vaccinate! advise against journey in areas with risk of infection prior vaccination: antibody titer? pause etanercept for > 1 month, vaccination possible under MTX 15mg / week in individual cases* * This recommendation is based on expert opinions and is being applied at Service de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de Genève since This recommendation requires future follow-up. 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 31
32 Table of Contents 1. Increased risk of infection in patients with rheumatic diseases 2. Example from the travel medicine clinic 3. Existing recommendations for vaccinations in patients with rheumatic diseases 4. Existing data on vaccinations in patients with rheumatic diseases under immunosuppression with a focus on biological drugs - live vaccines - inactivated vaccines 5. Recommendations 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 32
33 Recommendations (i) administration of vaccines as soon as possible after diagnosis and prior to start of immunosuppression inactivated vaccines up to 2 weeks live vaccines up to 4 weeks prior to start of therapy there is no evidence for vaccines to cause exacerbation or first occurrence of rheumatic diseases patients with rheumatic diseases without immunosuppressive therapy may be vaccinated the same way as a healthy person, with both live and inactivated vaccines 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 33
34 Recommendations (ii) inactivated vaccines may be administered to patients with rheumatic diseases under immunosuppression but immunogenicity may be reduced administer when immunosuppression is at the lowest in case of Rituximab: think of time lag! In addition to generally recommended vaccinations, vaccines against seasonal influenza pneumococcal disease shoud be administered Hepatitis B vaccination can be administered generously HPV vaccination should be administered to women between 11 and 26 years of age with systemic lupus erythematodes (SLE) 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 34
35 Recommendations (iii) If patient is under immunosuppressive therapy, administration of live vaccines should be avoided, but there are exeptions: low-dose corticosteroid therapy local steroid therapy hydroxychloroquine Herpes zoster under low-dose corticosteroid therapy low dose azathioprine low dose methotrexate low dose 6-mercaptopurine Novel exeption in individual cases, administration of live vaccines to clinically stable patients under low dose methotrexate (<20mg / week) is possible* Alternatives to administration of live vaccines measurement of antibody titer e.g. after yellow fever vaccination, in many people, protective antibodies remain for more than 20 years * This recommendation is based on expert opinions and is being applied at Service de Médecine Tropicale et Humanitaire, Hôpitaux Universitaires de Genève since This recommendation requires future follow-up. 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 35
36 Recommendations (iv) if possible, choose conjugate vaccines over polysaccarid vaccines. Example: preferably administer Pevenar instead of Pneumovax vaccination of people living in the same household as immunocompromised person and people working in health care seasonal influenza varicella as well as mumps, measles and rubella 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 36
37 Thank you...for your attendance and interest. Please don t hesitate to get in touch silja.buehler@ifspm.uzh.ch 10 April 2014 Vaccinations in patients with rheumatic diseases, Silja Bühler Page 37
Current Rheumatoid Arthritis Treatment Options: Update for Managed Care and Specialty Pharmacists
Current Rheumatoid Arthritis Treatment Options: Update for Managed Care and Specialty Pharmacists 1. Which of the following matches of biologic targets that contribute to rheumatoid arthritis (RA) and
DISEASE-MODIFYING ANTIRHEUMATIC DRUG THERAPY FOR RHEUMATOID ARTHRITIS
DISEASE-MODIFYING ANTIRHEUMATIC DRUG THERAPY FOR RHEUMATOID ARTHRITIS APPLICATIONS OBJECTIVE Purpose of Measure: ELIGIBLE POPULATION Which members are included? STANDARD OF CARE NCQA APPROVED CODES HEDIS
Biologic Treatments for Rheumatoid Arthritis
Biologic Treatments Rheumatoid Arthritis (also known as cytokine inhibitors, TNF inhibitors, IL 1 inhibitor, or Biologic Response Modifiers) Description Biologics are new class of drugs that have been
Rheumatic Diseases, Psoriasis, and Crohn s Disease
Rheumatic Diseases, Psoriasis, and Crohn s Disease What does this handout cover? This handout has information about rheumatic disease, psoriasis, and Crohn s disease. It also has information on how these
Immune Modulating Drugs Prior Authorization Request Form
Patient: HPHC member ID #: Requesting provider: Phone: Servicing provider: Diagnosis: Contact for questions (name and phone #): Projected start and end date for requested Requesting provider NPI: Fax:
Immune modulation in rheumatology. Geoff McColl University of Melbourne/Australian Rheumatology Association
Immune modulation in rheumatology Geoff McColl University of Melbourne/Australian Rheumatology Association A traditional start to a presentation on biological agents in rheumatic disease is Plasma cell
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Health Technology Appraisal
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Health Technology Appraisal Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure
Rheumatoid Arthritis:
Rheumatoid Arthritis Update 2014 Mark Hulsey, MD FACR Rheumatoid Arthritis Key Features Symptoms >6 weeks duration Often lasts the remainder of the patient s life Inflammatory synovitis Palpable synovial
Evidence-based Management of Rheumatoid Arthritis (2009)
CPLD reviews its distance learning programmes every twelve months to ensure currency. This update has been produced by an expert and should be read in conjunction with the Evidencebased Management of distance
subcutaneous initially every 4 weeks then every 12 weeks Coverage Criteria: Express Scripts, Inc. monograph dated 02/24/2010
BENEFIT DESCRIPTION AND LIMITATIONS OF COVERAGE ITEM: PRODUCT LINES: COVERED UNDER: DESCRIPTION: CPT/HCPCS Code: Company Supplying: Setting: Humira (adalimumab subcutaneous injection) Commercial HMO/PPO/CDHP
Mantoux testing is not performed in the clinic on a Thursday, as it would need to be read on a Sunday, when we are closed.
VACCINE SCHEDULES The vaccine schedules detailed below are those recommended by the vaccine manufacturers. Many vaccines can be given at short notice or schedules shortened to accommodate your travel plans.
Can Rheumatoid Arthritis treatment ever be stopped?
Can Rheumatoid Arthritis treatment ever be stopped? Robert L. DiGiovanni, DO, FACOI Program Director Largo Medical Center Rheumatology Fellowship robdsimc@tampabay.rr.com Do not pour strange medicines
Immunisation schedule of the Spanish Association of Paediatrics: 2014 recommendations
VACCINE Table 1. Spanish Association of Paediatrics Immunisation Schedule. Recommendations of the Advisory Committee on Vaccines Age in months Age in years 0 2 4 6 12-15 15-18 2-3 4-6 11-12 Hepatitis B
Administrative Code. Title 23: Medicaid Part 224 Immunizations
Administrative Code Title 23: Medicaid Part 224 Immunizations Table of Contents Title 23: Division of Medicaid... 1 Part 224: Immunizations... 1 Part 224 Chapter 1: General... 1 Rule 1.1: Reserved... 1
VACCINE SCHEDULES. Vaccination Vaccine Type Contraindications Schedule Other information. Those who have already had a BCG vaccine.
VACCINE SCHEDULES The vaccine schedules detailed below are those recommended by the vaccine manufacturers. Many vaccines can be given at short notice or schedules shortened to accommodate your travel plans.
accination of the immunocompromised travellers
8 th National Seminar on Travel Medicine 19 November 2009 Vaccination of the immunocompromised travellers 5.15-15.45 accination of the immunocompromised travellers rof F. Van Gompel, ITG Antwerpen Adapted
Crohn s Disease. From research to bedside
Crohn s Disease From research to bedside Primary Care Of The Crohn s Disease Patient Primary Physician s Concerns Vaccination Cancer Cervical Skin Osteoporosis Problems Associated With Vaccinating The
Rheumatoid Arthritis
Rheumatoid Arthritis While rheumatoid arthritis (RA) has long been feared as one of the most disabling types of arthritis, the outlook has dramatically improved for many newly diagnosed patients. Certainly
11/8/2011. Administrative Definitions of Rheumatoid Arthritis: Rising Prevalence Regardless of Definition Used. No Disclosures. Background.
Administrative Definitions of Rheumatoid Arthritis: Rising Prevalence Regardless of Definition Used Christine A. Peschken, Carol A. Hitchon, Hui Chen, Allan Garland, Hani S. El-Gabalawy, Charles N. Bernstein
Disclosures. None. Seth Compton, MD Fellow of Rheumatology University of Mississippi Medical Center. Thank you for coming
Disclosures None Seth Compton, MD Fellow of Rheumatology University of Mississippi Medical Center Steroids Steroids Thank you for coming 1 Outline Osteoarthritis Rheumatoid Arthritis Monoarthritis Systemic
Addition of vaccination against hepatitis B infection and change of the HPV vaccination programme
Change to DENMARK S CHILDHOOD VACCINATION PROGRAMME 2014 Addition of vaccination against hepatitis B infection and change of the HPV vaccination programme 2014 Addition to the Danish Health and Medicines
These are illnesses which might not only spoil your holiday but might also pose a risk to your life.
Travel Vaccinations Travel vaccinations are an essential part of holiday and travel planning, particularly if your journey takes you to an exotic destination or 'off the beaten track'. The risks are not
Rheumatoid Arthritis. Outline. Treatment Goal 4/10/2013. Clinical evaluation New treatment options Future research Discussion
Rheumatoid Arthritis Robert L. Talbert, Pharm.D., FCCP, BCPS University of Texas at Austin College of Pharmacy University of Texas Health Science Center at San Antonio Outline Clinical evaluation New treatment
Guidelines for Vaccinating Pregnant Women
Guidelines for Vaccinating Pregnant Women U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control & Prevention Guidelines for Vaccinating Pregnant Women from Recommendations of the Advisory
Immunization Information for Blinn College Students
1 Immunization Information for Blinn College Students *Important Information Regarding the Bacterial Meningitis Vaccine* The State passed Senate Bill 1107 in 2011 and recently Senate Bill 62 in 2013, which
Appendix 7.5: Immunization for Children Expecting Solid Organ Transplant after 18 Months of Age (Catch-up and Ongoing Schedule)
Appendix 7.5: Immunization for Children Expecting Solid Organ Transplant after 18 Months of Age (Catch-up and Ongoing Schedule) Revision Date: September 5, 2014 Note: These guidelines are intended as a
Rheumatoid Arthritis Medicines. A Guide for Adults
Rheumatoid Arthritis Medicines A Guide for Adults Fast Facts Medicines for rheumatoid arthritis (RA) can slow down the disease and reduce damage to joints. They can relieve pain and make it easier to do
Regulations of Connecticut State Agencies. R.C.S.A. 10-204a-1 10-204a-4 CONTENTS. Procedures for reporting immunization data
Agency Subject School Immunizations Requirements Inclusive Sections 10-204a-1 10-204a-4 Sec. 10-204a-1. Sec. 10-204a-2. Sec. 10-204a-2a. Sec. 10-204a-3. Sec. 10-204a-3a. Sec. 10-204a-4. CONTENTS Definitions
Influenza virus Vaccine, Split Virus, When administered to individuals 3 years or older, for intramuscular use (Agriflu)
Adult Immunization Codes State and School Employees Life and Health Insurance Plan Not Subject to Calendar Year Deductible 100% of allowable for covered procedures Payable only for Network Providers (In-State
Principles of Vaccination
Immunology and Vaccine-Preventable Diseases Immunology is a complicated subject, and a detailed discussion of it is beyond the scope of this text. However, an understanding of the basic function of the
Drug Therapy Guidelines: Humira (adalimumab)
Drug Therapy Guidelines: Humira (adalimumab) Effective Date: 5/1/08 Committee Review Date: 1/6/01, 9/18/01, 1/15/02, 1/7/03, 1/20/04, 1/18/05, 12/7/05, 10/15/06, 7/2/07, 11/5/07, 3/25/08 Policy Statements:
http://www.ilga.gov/commission/jcar/admincode/077/077006650b0240...
1 of 5 7/30/2014 9:47 AM TITLE 77: PUBLIC HEALTH CHAPTER I: DEPARTMENT OF PUBLIC HEALTH SUBCHAPTER i: MATERNAL AND CHILD HEALTH PART 665 CHILD HEALTH EXAMINATION CODE SECTION 665.240 BASIC IMMUNIZATION
Immunosuppressive drugs
Immunosuppressive drugs RJM ten Berge Afd. Inw. Geneeskunde AMC contents overview targets mechanism of action Effects on immune capacity measured by responses to vaccination Immune response 1 calcineurin
Plan early - get your vaccinations in time for full protection. To prepare for your trip, schedule an appointment: (910) 347-2154, option #2.
The Onslow County Health Department Travel Clinic offers a complete line of immunizations and prescriptions to protect you while traveling abroad. The most appropriate immunizations and travel medications
OREGON HEALTH AUTHORITY IMMUNIZATION PROGRAM RECOMMENDED SITES FOR SIMULTANEOUS VACCINE ADMINISTRATION
OREGON HEALTH AUTHORITY MUNIZATION PROGRAM RECOMMENDED SITES FOR SULTANEOUS VACCINE ADMINISTRATION 03-29-2016: Addition of travel vaccines to tables Update to TST administration I. OREGON MUNIZATION MODEL
Guidelines for the Pharmaceutical Management of Rheumatoid Arthritis Swedish Society of Rheumatology, April 14, 2011
Guidelines for the Pharmaceutical Management of Rheumatoid Arthritis Swedish Society of Rheumatology, April 14, 2011 Working party: Eva Baecklund, Helena Forsblad d Elia, Carl Turesson Background Our purpose
Recommended Adult Immunization Schedule
Recommended Adult Immunization Schedule UNITED STATES 2011 Note: These recommendations must be read with the footnotes that follow containing number of doses, intervals between doses, and other important
CLINICAL POLICY Department: Medical Management Document Name: Rheumatoid & Juvenile Arthritis and Ankylosing Spondylitis Treatments
Page: 1 of 18 IMPORTANT REMINDER This Clinical Policy has been developed by appropriately experienced and licensed health care professionals based on a thorough review and consideration of generally accepted
Methods for Measuring Dose Escalation in TNF Antagonists for Rheumatoid Arthritis Patients Treated in Routine Clinical Practice
Methods for Measuring Dose Escalation in TNF Antagonists for Rheumatoid Arthritis Patients Treated in Routine Clinical Practice Gu NY 1, Huang XY 2, Globe D 2, Fox KM 3 1 University of Southern California,
MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES `I. Requirements for Prior Authorization of Cytokine and CAM Antagonists
MEDICAL ASSISTANCE HBOOK `I. Requirements for Prior Authorization of Cytokine and CAM Antagonists A. Prescriptions That Require Prior Authorization All prescriptions for Cytokine and CAM Antagonists must
Principles of Vaccination
Immunology and Vaccine-Preventable Diseases Immunology is a complicated subject, and a detailed discussion of it is beyond the scope of this text. However, an understanding of the basic function of the
ALLIED HEALTH AND NURSING PROGRAM HEALTH REQUIREMENTS
IMMUNIZATIONS: Page 1 ALLIED HEALTH AND NURSING PROGRAM HEALTH REQUIREMENTS Measles 2 MMR Vaccinations 2 Measles Vaccinations Positive antibody titer for Measles (lab report required or employer health
Treatment of Rheumatoid Arthritis in the New Millennium. Neal I. Shparago, D.O., FACP, FACR
Treatment of Rheumatoid Arthritis in the New Millennium Neal I. Shparago, D.O., FACP, FACR What is RA? Symmetric inflammatory polyarthritis Rheumatoid factor positive in 80% Anti-CCP positive in approximately
COLORADO BONE & JOINT NEWSLETTER
COLORADO BONE & JOINT NEWSLETTER A publication of Colorado Center for Arthritis & Osteoporosis, PLLC Copyright 2012 VOLUME 4, ISSUE 1 SPRING 2013 W. Edwards Deming, the father of systems thinking and the
Let s talk about Arthritis
Let s talk about Arthritis Osteoarthritis Rheumatoid Arthritis Kam Shojania, MD, FRCPC Clinical Professor and Head, St. Paul s, UBC and VGH Divisions of Rheumatology Slides with thanks to: Cheryl Koehn
Vaccination Requirements for U.S. Immigration: Technical Instructions for Panel Physicians. December 14, 2009
Vaccination Requirements for U.S. Immigration: Technical Instructions for Panel Physicians December 14, 2009 Table of Contents Preface... iii Significant Changes in the Vaccination Requirements... 1 Procedure
(THE CHANGING LANDSCAPE)
Updating the therapeutic strategy in RA What is effective, what is changing in daily practice regarding the use of DMARDs and biological agents in the Balkan countries The Greek experience (THE CHANGING
TEXAS ADMINISTRATIVE CODE
TEXAS ADMINISTRATIVE CODE TITLE 25 PART 1 CHAPTER 97 SUBCHAPTER B HEALTH SERVICES DEPARTMENT OF STATE HEALTH SERVICES COMMUNICABLE DISEASES IMMUNIZATION REQUIREMENTS IN TEXAS ELEMENTARY AND SECONDARY SCHOOLS
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC)
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC) September 2014 Review date: September 2017 Bulletin 203: Tocilizumab (subcutaneous) in combination with methotrexate or as monotherapy for the treatment
Travel Vaccine Schedule
Travel Vaccine Schedule This table acts as a quick guide to vaccine schedules. The Summary of Product Characteristics should always be referred to for more detailed information. Vaccine Cholera Dukoral
Rheumatoid Arthritis: Constantly Evolving Treatment Approaches
Rheumatoid Arthritis: Constantly Evolving Treatment Approaches Jody Garry, Pharm.D. Primary Care Pharmacy Resident VA Medical Center - Iowa City Presentation Overview Pathophysiology & epidemiology Diagnostic
Medicines for Rheumatoid. Arthritis. A Review of the Research for Adults
Medicines for Rheumatoid Arthritis A Review of the Research for Adults Is This Information Right for Me? Yes, this summary is for you if: Your doctor* has told you that you have rheumatoid (pronounced
CHF INCLEN ADVAC 2011. Vaccination in Special Situations: Break-out sessions. Group B
CHF INCLEN ADVAC 2011 Vaccination in Special Situations: Break-out sessions Group B 1 Group B. Moderator: Dr. Rohit Agrawal Expert: Dr. Walter Orenstien 2 Learning objectives: What are the special situation
IMMUNIZATION IN SPECIAL SITUATIONS
143 IMMUNIZATION IN SPECIAL SITUATIONS Immunization in preterm/low birth weight infants In principle, all vaccines may be administered as per schedule according to the chronological age irrespective of
MEASURING CARE QUALITY
MEASURING CARE QUALITY Region November 2015 For Clinical Effectiveness of Care Measures of Performance From: Healthcare Effectiveness Data and Information Set (HEDIS ) HEDIS is a set of standardized performance
ALBERTA BLOOD AND MARROW TRANSPLANT PROGRAM NEW GUIDELINES FOR THE IMMUNIZATION OF HEMATOPOIETIC STEM CELL TRANSPLANT(HSCT) RECIPIENTS JULY 11, 2013
ALBERTA BLOOD AND MARROW TRANSPLANT PROGRAM NEW GUIDELINES FOR THE IMMUNIZATION OF HEMATOPOIETIC STEM CELL TRANSPLANT(HSCT) RECIPIENTS JULY 11, 2013 RE-IMMUNIZATION IS IMPORTANT! There should be no assumptions
Immunity and how vaccines work
1 Introduction Immunity is the ability of the human body to protect itself from infectious disease. The defence mechanisms of the body are complex and include innate (non-specific, non-adaptive) mechanisms
Immunization Program: Planning and Forecasting
Immunization Program: Planning and Forecasting Anne Schuchat, MD Director, NCIRD and RADM, US Public Health Service Centers for Disease Control and Prevention National Vaccine Advisory Committee June 10,
Main Changes to the Vaccination Schedule Recommended by the Japan Pediatric Society January 12, 2014
Main Changes to the Vaccination Schedule Recommended by the Japan Pediatric Society January, 04 ) 3-valent Pneumococcal conjugate vaccine (PCV3) The description of catch-up schedule for PCV3 has been revised
Preventive Health Services
understanding Preventive Health Services For the most current version of this document, visit www.wellwithbluemt.com or www.bcbsmt.com. Preventive health services include evidence-based screenings, immunizations,
Once the immune system is triggered, cells migrate from the blood into the joints and produce substances that cause inflammation.
HealthExchange Points For Your Joints An Arthritis Talk Howard Epstein, MD Orthopaedic & Rheumatologic Institute Rheumatic & Immunologic Disease Cleveland Clinic Beachwood Family Health & Surgery Center
Immunisation. Immunisation
Immunisation Immunisation Immunisation What is immunisation and why does my child need it? Immunisation is a simple, safe and effective way to protect children (and adults) from serious diseases. Immunisation
Preventive health guidelines As of May 2014
To learn more about your plan, please see anthem.com/ca. To learn more about vaccines, please see the Centers for Disease Control and Prevention (CDC) website: cdc.gov. Preventive health guidelines As
Recommendations for Early RA Patients
SUPPLEMENTARY APPENDIX 5: Executive summary of recommendations for patients with early RA, established RA, and high-risk comorbidities Recommendations for Early RA Patients We strongly recommend using
Rheumatoid Arthritis. Disease RA Final.indd 2 15. 6. 10. 11:23
Rheumatoid Arthritis Disease RA Final.indd 2 15. 6. 10. 11:23 Understanding what to expect can help you prepare for your transition into treatment. Rheumatoid Arthritis What You Need To Know About Rheumatoid
New Jersey Immunization Requirements
New Jersey Immunization Requirements Jenish Sudhakaran, MPH Jennifer Smith, MPH, CHES Vaccine Preventable Disease Program NJ Department of Health & Senior Services March 2012 Purpose of N.J.A.C. 8:57-4
Rheumatoid Arthritis Information
Rheumatoid Arthritis Information Definition Rheumatoid arthritis (RA) is a long-term disease that leads to inflammation of the joints and surrounding tissues. It can also affect other organs. Alternative
STUDY ABROAD HEALTH CLEARANCE INSTRUCTIONS. For Students
STUDY ABROAD HEALTH CLEARANCE INSTRUCTIONS For Students 1. Fill out the student sections on pages 1, 2 and 5. Take all the pages with you to your physical exam appointment. 2. During your physical exam,
SECTION 3. Criteria for Special Authorization of Select Drug Products. Section 3 Criteria for Special Authorization of Select Drug Products
SECTION 3 Criteria for Special Authorization of Select Drug Products Section 3 Criteria for Special Authorization of Select Drug Products CRITERIA FOR SPECIAL AUTHORIZATION OF SELECT DRUG PRODUCTS The
Anthrax vaccine side-effects
Anthrax vaccine side-effects What are the risks from anthrax vaccine? Like any medicine, a vaccine could cause a serious problem, such as a severe allergic reaction. Anthrax is a very serious disease,
Core Topic 2. The immune system and how vaccines work
Core Topic 2 The immune system and how vaccines work Learning outcome To be able to describe in outline the immune system and how vaccines work in individuals and populations Learning objectives Explain
Medication Guide Enbrel (en-brel) (etanercept)
Medication Guide Enbrel (en-brel) (etanercept) Read the Medication Guide that comes with Enbrel before you start using it and each time you get a refill. There may be new information. This Medication Guide
Medicines for Psoriatic Arthritis. A Review of the Research for Adults
Medicines for Psoriatic Arthritis A Review of the Research for Adults Is This Information Right for Me? Yes, this information is right for you if: Your doctor* has told you that you have psoriatic (pronounced
Frequently Asked Questions PROPOSED REVISIONS TO SCHOOL IMMUNIZATION REGULATIONS IN PENNSYLVANIA
Frequently Asked Questions PROPOSED REVISIONS TO SCHOOL IMMUNIZATION REGULATIONS IN PENNSYLVANIA What is the current school vaccination rate in Pennsylvania? Given the way in which data is collected, we
Childhood Immunization Status (CIS)
Childhood Immunization Status (CIS) Description The percentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV); one measles, mumps and rubella
Rheumatoid Arthritis
Rheumatoid Arthritis Carole Callaghan Principal Pharmacist NHS Lothian Aim To update pharmacists on the current management of rheumatoid arthritis and explore ways to implement pharmaceutical care for
Master Thesis in Medicine
RISK OF INFECTIONS IN RHEUMATOID ARTHRITIS PATIENTS TREATED WITH TOCILIZUMAB IN CLINICAL PRACTICE Master Thesis in Medicine Joyce Åkerlund Supervisor: Catharina Lindholm, MD, PhD, Associate Professor Department
Finding out your child has Juvenile Idiopathic Arthritis (JIA)
Finding out your child has Juvenile Idiopathic Arthritis (JIA) Information for parents, families and carers Jetstar Flying Start Ambassador Steve Price with Tamsin Taylor and Jennifer McNaughton Did you
Cytokine and CAM Antagonists
Texas Prior Authorization Program Clinical Edit Criteria Drug/Drug Class Clinical Edit Information Included in this Document Actemra (Tocilizumab) Drugs requiring prior authorization: the list of drugs
MEDICATION GUIDE. ACTEMRA (AC-TEM-RA) (tocilizumab) Solution for Intravenous Infusion
MEDICATION GUIDE ACTEMRA (AC-TEM-RA) (tocilizumab) Solution for Intravenous Infusion ACTEMRA (AC-TEM-RA) (tocilizumab) Injection, Solution for Subcutaneous Administration Read this Medication Guide before
Roche s RoACTEMRA improved rheumatoid arthritis signs and symptoms significantly more than adalimumab as single-agent therapy
Media Release Basel, 6 June 2012 Roche s RoACTEMRA improved rheumatoid arthritis signs and symptoms significantly more than adalimumab as single-agent therapy Roche (SIX: RO, ROG; OTCQX: RHHBY) today announced
The Affordable Care Act: Overview & Impact on Adult Immunizations
The Affordable Care Act: Overview & Impact on Adult Immunizations Adult Immunization Leadership Summit February 1, 2013 Barbara Flye, Senior Health Policy Advisor Office of the Insurance Commissioner 1
Immunization Frequently Asked Questions for K-12 th Grades 2015-2016 Colorado School Required Immunizations
Immunization Frequently Asked Questions for K-12 th Grades 2015-2016 Colorado School Required Immunizations General Colorado Immunization Guidelines... 3 What does is mean for a school to be in compliance
Take advantage of preventive care to help manage your health
Take advantage of preventive care to help manage your health Preventing disease and detecting health issues at an early stage, if they occur, are important to living a healthy life. Following these recommended
Methotrexate treatment
Methotrexate treatment Oral methotrexate pre-treatment patient information leaflet This leaflet has been prepared to support information given to you as part of your discussions with the doctor, nurse
Care Gap Care Reminder Description Reference 900-2035-1210. Cardiovascular Persistence of Beta- Blocker Treatment After a Heart Attack (PBH)
Below is a list of the current Care Reminders shown in the Patient Care Summary Clinical Messaging section of the Availity web portal. These Florida Blue clinical alerts are based on claim data and are
FOR INFORMATION CONTACT:
NEWS RELEASE FOR INFORMATION CONTACT: Caroline Calderone Baisley Deborah C. Travers Director of Health Director of Family Health Tel [203] 622-7836 Tel [203] 622-7854 September 10, 2014 For Immediate Release
biologics for the treatment of psoriasis
How to contact us The Psoriasis Association Dick Coles House 2 Queensbridge Northampton NN4 7BF tel: 08456 760 076 (01604) 251 620 fax: (01604) 251 621 email: mail@psoriasis-association.org.uk www.psoriasis-association.org.uk
METHOTREXATE TREATMENT
METHOTREXATE TREATMENT This leaflet has been prepared to support information given to you as part of your discussions with the doctor, nurse or pharmacist before you start treatment with oral methotrexate.
The timing of vaccination with respect to anaesthesia and surgery. 1. Surgery following immunisation with inactivated vaccines
The timing of vaccination with respect to anaesthesia and surgery Main recommendations: 1. Surgery following immunisation with inactivated vaccines Delay surgery 48 hours post vaccination to avoid postvaccination
Health Careers and Nursing Immunization and Health Requirement Completion Guide
Health Careers and Nursing Immunization and Health Requirement Completion Guide Table of Contents OVERVIEW... 2 TITERS AND IMMUNIZATIONS... 2 MMR Titer (Measles, Mumps, Rubella)... 2 Varicella (Chicken
Recommended Immunization Schedules for Persons Aged 0 Through 18 Years UNITED STATES, 2014
Recommended Immunization Schedules for Persons Aged 0 Through 18 Years UNITED STATES, 2014 This schedule includes recommendations in effect as of January 1, 2014. Any dose not administered at the recommended
2016 BlueCare Plus (HMO SNP) Provider Attestation Form
2016 BlueCare Plus (HMO SNP) Provider Attestation Form Provider Name Contract Entity/Group Name Patient Preventive Screenings Breast Cancer Screening The Breast Cancer Screening quality measure focuses
ABOUT RHEUMATOID ARTHRITIS
MEDIA BACKGROUNDER ABOUT RHEUMATOID ARTHRITIS Rheumatoid arthritis (RA) is a type of arthritis (chronic inflammatory polyarthritis) that typically affects hands and feet, although any joint in the body
Preventive Health Guidelines
Preventive Health Guidelines As of April 2010 What is your plan for better health? Make this year your best year for overall wellness. Your health benefits plan may cover early detection screenings and
APPENDIX EE VACCINE STATUS AND DATE
VACCINE STATUS AND DATE Vaccine Status, Date is a ten-character field which presents information about each of the vaccines required for children. For most cases, the first character tells the vaccine
Rheumatoid Arthritis monitoring of DMARDs
www.bpac.org.nz keyword: DMARDS Rheumatoid Arthritis monitoring of DMARDs Key reviewers: Professor John Highton, Head of Section, Department of Medical and Surgical Sciences, Dunedin School of Medicine,
Procedure Code(s): n/a This counseling service is included in a preventive care wellness examination or focused E&M visit.
Coding Summary for Providers NOTE THE FOLLOWING: The purpose of this document is to provide a quick reference of the applicable codes for UnitedHealthcare plans that cover preventive care services in accordance
Proposed Vaccine Information Materials for HPV (Human. AGENCY: Centers for Disease Control and Prevention (CDC),
This document is scheduled to be published in the Federal Register on 10/22/2015 and available online at http://federalregister.gov/a/2015-26868, and on FDsys.gov BILLING CODE: 4163-18-P DEPARTMENT OF
Arthritis and Rheumatology Clinics of Kansas Patient Education. Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis
Arthritis and Rheumatology Clinics of Kansas Patient Education Reactive Arthritis (ReA) / Inflammatory Bowel Disease (IBD) Arthritis Introduction: For as long as scientists have studied rheumatic disease,