Written By: Hanan Khalaf. RPH.

What is immunization?

Immunization is the process of introducing a killed or weakened form of an infectious germ or a derivative of it (vaccine), into the body for the purpose of triggering an immune response. Creating such an immune response means that the body will destroy the invading organism each time it attacks. Immunization process is usually carried out by injection through the skin except for oral polio.

Immunization plays a tremendous role in reducing morbidity and mortality from various infectious diseases, particularly for children below the age of 5 years.

What is the difference between natural immunity and acquired immunity?

The main difference lies in the way of acquiring the immunity. So with natural immunity, the body becomes immune by being exposed to the invading germ, while with acquired immunity it becomes immune by getting the vaccine. The end result is almost the same on the immune system, which in both cases it will attack the invading germ and produce antibodies that are responsible for fighting the germ each time it attacks the body in the future. It can also produce more antibodies if needed. However, getting immune through acquiring the disease, carries a considerable risk of morbidity depending on the type of the disease.

Do vaccines provide 100% protection against the diseases they are used for?

Most vaccines are effective for 85-95% of persons receiving them. They do not provide 100% immunity. However, some of people who are vaccinated might indeed catch the disease, but they tend to have less serious symptoms compared to non-immunized individuals.

Why are some vaccines given as single shots others as several shots?

Several doses of the same vaccine are often needed to achieve full immunity, depending on the type of the vaccine, since some people do not achieve full immunity except with the last dose.

How long does immunity last after getting vaccinated?

Some vaccines do not provide life-long immunity since immunity tend to decrease by time and a booster shot is often needed to cover the problem like tetanus. Others, however, can provide life long immunity like hepatitis B and measles.

What are different types of vaccines?
There are 4 types of vaccines commonly used nowadays:

Live Attenuated vaccines: these contain live viruses but weakened. They usually result in a strong immune response which makes one dose, sometimes, enough to provide life long immunity examples are measles, mumps, varicella (chickenpox).Inactivated vaccines: Such vaccines involve killed (inactivated) bacteria or viruses.Example is polio vaccine.Toxoid vaccine: Involve the use of bacterial toxins, after rendering them inactive, to stimulate the immune system against them. These toxins are produced by bacteria when they invade the body as with Diphtheria and Tetanus.Acellular and subunit vaccines: Involve the use of only part of the virus of bacteria to stimulate the immunity example hepatitis B and Haemophilus influenzae type b.

What types of reactions are to be expected after vaccinations?

Vaccination results mostly in no or only minor local reactions in the form of: Redness and swelling at the injection site, fever, rash. In rare occasions, however, it can trigger seizures, or other types of severe reactions like severe allergic reactions.

At what age should we start with vaccination?

Vaccination usually starts at birth or by 2 months of age, based on current vaccination schedule, and ends by the age of 6 years. However, it is not limited to childhood, adolescents and adults have their own recommended vaccination schedules. It is very important to keep a record of the vaccination history.

Is there any reason why vaccination should not be given to any person?

Vaccination should not be carried on during an acute febrile illness, and should be postponed afterwards. In addition, some vaccines should not be given to persons who suffer from severe allergic reaction to eggs as with measles (egg is used during the process of preparation of measles vaccine) and such cases should be dealt with individually. Moreover, persons with severely disturbed immunity like those immune-deficiency diseases should not receive vaccines that contain live attenuated viruses.

Can vaccination be carried out during pregnancy or lactation?

The general rule is to avoid the vaccination during pregnancy and lactation. Exceptions should be evaluated by the physician on individual basis weighing the risk to the baby versus benefit to the mother and baby as well.

What about the link between some vaccines and occurrence of autism and social and cognitive disorders?

Numerous studies have been conducted but fail to confirm a link between some vaccines as MMR and autism or other social and cognitive disorders. Despite this, numerous parents are still refusing to vaccinate their children. Its good to remember that FDA in association with CDC and National Institute of Health are working continuously to research and monitor vaccine safety and effectiveness

July 1st, 2006

References:

Center of Disease Control
Kids Health

National Library of Medicine

Vaccine InformationWorld Health Organization

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Written by Hanan Khalaf

Category: English Contents

Written by:, Hanan Khalaf, RPH.

It is well known today that hands play a major role in transmitting infections. In order to avoid getting infected and hence sick, appropriate hand hygiene is largely advocated. The ideal way of doing this is through washing with soap and water. However, if water is not accessible for one reason or another, hand sanitizer can be used, but should not be considered a replacement for soap and water.

CDC of USA recommends the use of alcohol-based hand sanitizers with at least 60% alcohol content. Such sanitizers have shown the ability to reduce considerably the number of germs contaminating hands, but they are definitely not active against all type of germs. Moreover, they are not that effective when the hands are visibly dirty.

Hand sanitizers exit in different formulations as liquid, gel, or foam.

The proper way to use a hand sanitizer is by applying some on the palm of one hand, rub both hands together to cover all skin with the sanitizer and keep rubbing until it dries of.

What do they contain? Most of alcohol-based hand sanitizers contain ethyl alcohol (ethanol), Isopropanol, or a mixture of both in a total concentration that ranges from 60-90% which act to kill most germs on the skin by denaturing their protein content. In addition, they usually have moisturizer like glycerine to counteract the drying effect of alcohol, and a fragrance.

Do hand sanitizers keep their efficacy beyond their expiry date!? As a matter of fact, all hand sanitizers should bear a distinct expiry date by legislation. However, some manufacturers report that ethanol-based hand sanitizers continue to be efficacious for up to 60+ months (up to 5 + years) after manufacture. The storage conditions and physical appearance of the product should be checked before any anticipated use beyond the expiry date.

References:
CDC, http://www.cdc.gov/handwashing/

http://www.hand-cleaners.co.uk/contents/en-uk/d68_hand_sanitizers_frequently_asked_questions.html

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Written By: Hanan Khalaf. RPHWhat could be the harm of the sun while we are enjoying its warmth?

The main concern about the sun is the invisible form of radiation it sends to us, namely ultraviolet (UVR). This kind of radiation is able to penetrate and change the structure of skin cells leading to various problems, depending on the duration of exposure. Short term exposure leads to acute effects such as burns and blisters. On the other hand long term exposure leads to chronic effects as early aging of the skin with deep wrinkling, risk of photosensitivity, and various forms of skin cancers.

Labels on some eyeglasses indicate they provide protection against UVA & UVB, what does that mean?

This means that there is more than one type of UVR, A, B, & C.
UVA is the most abundant on earth, available throughout the year, and it has the ability to penetrate the human skin deeply causing damage to connective tissue and premature aging.
UVB is less abundant since it is absorbed to some extent by the ozone and it penetrates human skin less deeply compared to UVA. They are known to cause skin burns.
UVC is extremely hazardous, but the good thing it is totally absorbed by the ozone layer.
Accordingly, protection against UVA and UVB is required to get a healthy skin.
How can we protect ourselves and our children from the sun?

Most important ways are:

Avoid outdoor activities during the peak time for UVR as much as possible.Wear protective clothing as tightly knitted, long sleeved, and dark-colored.Eye protection is warranted and can be accomplished using wraparound glasses that provide 100% UVR protection against both UVA & UVB.Apply sunscreens with a SPF of 15 at least to the skin and lips.

What is the peak time for UV rays during the day?
It is estimated that the peak time for UVR during the day is between 10 a.m to 4 p.m. This time might be different from one country to another.

How do sunscreens work?

Chemical sunscreens work by absorbing, reflecting or scattering a certain portion of UVR from your skin to prevent its penetration. Their activity is measured by what is called Sun Protection Factor (SPF). The higher the value, the greater the protection offered by the sunscreen. A value of 15 for example means, if the sunscreen is applied evenly, it will allow you to stay in the sun 15 times longer than you could without the sunscreen.
It is important to remember that sunscreens should be applied at least 30 minutes before going out-door to get the maximum effect.

How can I choose the best sunscreen for me?

The choice of the right type of sunscreen for you depends on several factors as color of the skin, condition of the skin (wet or dry), type of outdoor activity, site of application, and presence of allergic reactions. In general, we can say that fair skin needs SPF of 15 at least while very dark skin needs lower SPF values. When around water or if you sweat profusely, the use of water-proof sunscreen is a good choice, or consider reapplication of the regular preparation. ? If your skin is dry, then lotion or cream will work better for you than gel. Person with known allergies should apply a small amount of the product on a small area of the skin to observe the effects 24hours before using it.
You should follow manufacturer’s recommendation for any reapplication indicated.

Do I need to use sunscreens during summer only?

Sunscreens should be applied during summer even if you are in shade and during winter as well, since UVR can reflect off any surface as sand, concrete, clouds and snow. These reflective surfaces can get you 80% of the sun’s harmful rays.

How important it is to get sun-protection for my kids?

It is very important to make sure that kids are protected from the sun’s rays. This is due to the fact that one-half of persons’ lifetime exposure to UVR occur by the time they are 18 years old. Moreover, studies have shown that severe sunburns during the first 18 years of life can lead to skin cancer later in life.

December 6, 2005.

References:
http://www.cdc.gov/ChooseYourCover/qanda.htm
http://www.surgerydoor.co.uk/coe/skincentre/sun1.shtml
Compendium of Nonprescription products, Canadian Pharmacists Association 2000.

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Written by Hanan Khalaf

Category: English Contents

Written By: Abier Hamami. RPH. CPHQWhat are NSAIDs?
Nonsteroidal Anti-inflammatory Drugs (NSAIDs) are commonly prescribed medications for the inflammation of arthritis and other body tissues, such as in tendinitis and bursitis. Examples of traditional NSAIDs include Aspirin, Indomethacin, Ibuprofen, Naproxen, Piroxicam, and Diclofenac.

How do NSAIDs work?

NSAIDs block the release of Prostaglandins which are chemicals produced within the body's cells by the enzyme Cyclooxygenase (Cox). Prostaglandins have several important functions:

Promote inflammation, pain, and fever.Support the function of platelets that are necessary for the clotting of blood.Protect the lining of the stomach from the damaging effects of acid.

What are COX-2 inhibitors?

Cox-2 inhibitors are a new class of (NSAIDs). They selectively block Cyclooxegenaze-2( COX-2), so inhibit the production of prostaglandins that cause the pain and swelling of arthritis inflammation. Examples include Celecoxib (Celebrex®), Rofecoxib(Vioxx® ,no longer on market as of September 2004), and Valdecoxib (Bextra®, no longer on market as of April 2005).

How do traditional NSAIDs differ from new COX-2 inhibitors?
COX-1 enzyme is normally present in a variety of areas of the body, including sites of inflammation and the stomach. While COX-2 enzyme, is located specifically in areas of the body that are responsible for inflammation and not in the stomach.

Traditional NSAIDs block the function of COX-1 enzyme which means beside reducing inflammation, they also reduce the protective mucus lining of the stomach causing stomach upset, ulceration, and bleeding. On the other hand, new COX-2 inhibitors block the function of COX-2, thus reduces inflammation, but do not affect the stomach and intestines compared to the traditional NSAIDs

How should you take a NSAID?
You should take a traditional NSAID with food, and do not lie down for 15 to 30 minutes after taking it, whereas, COX-2 inhibitors could be taken with or without food.

What are the side effects of NSAIDs?
The most common side effects of traditional NSAIDs are abdominal pain, diarrhea, bloating, heartburn, water retention, and upset stomach (dyspepsia). Approximately 15% of patients on long- term NSAID treatment develop ulceration of the stomach and duodenum.

Notify your doctor if you notice any black or bloody stools, chronic indigestion or heartburn, or vomiting of blood or “coffee ground” like material.

COX-2 inhibitors are linked to serious side effects as blood clots, stroke, and heart attacks; other less serious side effects include heart burn, stomach pain and upset, headache, and swelling of the legs/feet.

What factors can increase the risk of NSAIDs use?
For traditional NSAIDs, risk factors include high blood pressure, asthma, a history of kidney or liver disease, past ulcers, and people over age 65.

For COX-2 inhibitors, risk factors include also heart attack, stroke, angina, blood clot or hypertension.

What about taking NSAIDs with other medications?
NSAIDs may intensify or counteract the effects of some medications. Therefore, it is very important that your doctor knows if you are taking any other medicine. This includes prescription and non–prescription medicines as well as birth control pills, Vitamins, and herbal supplements. In general NSAIDS can be taken with other medications, but should not be taken with other blood thinners such as Heparin, or other Anti–Coagulants. Please inform your doctor if you are taking any of these types of medicines.

If you are taking a COX-2 inhibitor, you should not use a traditional NSAID (prescription or over-the-counter). Also be sure to tell your doctor if you are sensitive to Aspirin, Sulfa drugs, or other NSAIDs.

References:

Arthritis Foundation
John Hopkins Arthritis Center
American Academy of Orthopaedic Surgeons
http://www.medicinenet.com/cox-2_inhibitors/articlehtm
http://www.medicinenet.com/nonsteroidal_antiinflammatory_drugs/article.htm

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Written by Hanan Khalaf

Category: English Contents