Immunization PPT - PDF

Immunizations Dr Bushra Al Jabri Pediatric Endocrinologist  Goals of Immunization SHORT-TERM :Disease prevention in individuals. LONG-TERM: Eradication of disease from the world. Immunization-Definition (WHO) Immunization is the process whereby a person i...

Immunizations Dr Bushra Al Jabri Pediatric Endocrinologist  Goals of Immunization SHORT-TERM :Disease prevention in individuals. LONG-TERM: Eradication of disease from the world. Immunization-Definition (WHO) Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease Types of Immunization  Active immunity Protection that is produced by an individual’s own immune system and is usually long- lasting. Can be acquired by natural disease or by vaccination. Vaccines generally provide immunity similar to that provided by the natural infection, but without the risk from the disease or its complications.  Passive immunity Passive immunity is protection provided from the transfer of antibodies from immune individuals, – Most common: Across the placenta & mother milk – Less often: Blood transfusion & blood products including immunoglobulin This protection is temporary – commonly for only a few weeks or months  Herd Immunity OR community immunity The risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals "indirect protection" or a "herd effect" In this way transmission falls or stops without universal immunity. The more children in a community that are fully immunized, the more everyone is safe. Immunization can protect the unprotected  Immunity Two Artificial Methods of Immunity Active immunity by stimulating the adaptive immune system using a vaccine.(Vaccination) Passive immunity is induced by administering antibodies ( Immunoglobulins)  Immunity Immunity Active immunity Passive immunity Following clinical infection natural Transfer of maternal Antibodies Through placenta Following subclinical infection Transfer of maternal Antibodies Through milk acquired Following vaccination Following administration of Immunoglobulin  Rationale behind Vaccination Hib – meningitis, throat swelling and suffocation, pneumonia, infection, death Diphtheria – throat infection with membrane, systemic as myocarditis, CNS, paralysis, death (in 7% of cases) Tetanus – muscle spasms, breathing problems, convulsions, death if untreated Whooping Cough – coughing fits, convulsions, coma, brain damage, death Polio – Fever, vomiting, muscle stiffness, nerve damage, muscle paralysis, death if lung muscles paralysed Measles – High fever, cough, conjunctivitis, red rash, pneumonia, inflammation of brain, brain damage, death Mumps – fever, infection of salivary glands, deafness, infertility (males), brain inflammation Rubella – swollen glands, joint pain, rash, birth defects in unborn children – including blindness, deafness, mental retardation.  Live attenuated Vaccines Modified living organisms that are weakened Advantage Potent, response close to the optimal naturally acquired immune response Disadvantage May produce features of the disease as sub-clinical or mild form of the infection Cannot be given to immunosuppressed or pregnant patients  Inactivated(Killed) Vaccines It could contain: Whole dead organisms (killed by chemicals or heat) but remain antigenic e.g: IPV, Influenza V OR Parts of the organism( capsule, toxoid,..) e.g: Diphtheria, pneumococcal, HPV, HBV Advantages Cannot cause clinical infection Can be given to immunosuppressed and pregnant individuals Disadvantages Less immunogenic  Examples Live attenuated BCG Inactivated/Killed Pertusis, typhoid & cholera Tetanus, diphtheria Bacterial Capsular meningococcal Acellular pertussis Hib & pneumococcal conjugate vaccines Live attenuated OPV, MMR, Rotavirus Viral Inactivated IPV, hepatitis A Hepatitis B Subunit influenza vaccine  Routes of Administrating Vaccines – Oral : OPV, Rota Virus V – Intradermal injections Delivered into dermis (top layer of skin) BCG – Subcutaneous injections area of insertion does not need to be rubbed or moved. MMR & Varicella – Intramuscular injections given in muscle tissue. Others & Varicella  BCG(Bacille Calmette Guerin) The live attenuated strain of Mycobacterium bovis known as bacillus Calmette-Guérin (BCG) Not 100% protection from tuberculosis. BCG Prevents life- threatening complications such as meningitis and miliary TB.  Route of administration: BCG is given as a single intra dermal injection at the insertion of the deltoid into the lateral aspect of the left upper arm. local complication rate is smallest when that site is used.  Successful BCG vaccination A small bleb is rised and a successful vaccination leads to the development of a small local swelling within 2 weeks. Then progresses to a papule or shallow ulcer which heals within 12 weeks to form a small, flat scar.  Polio Vaccine They are divided into: Live Attenuated Oral Polio Vaccine(OPV). Inactivated Polio Vaccine (IPV) Both vaccines contain type I,II and III strains. Duration of Immunity: Lifelong if boosted.  OPV proved to be superior in administration, and also provided longer lasting immunity than the IPV vaccine. OPV on very rare occasions has been associated with paralysis (vaccine- associated paralytic poliomyelitis, about 1 case per 750,000 vaccine recipients).  DTP( Diptheria,Tetanus,Pertussis) 3 doses given I/M (In Oman 2,4,6 months of age)  MMR(Measles, Mumps, Rubella) R.O.A: S/C Two doses are recommended, at 12 and 18 months of age respectively. ?association with Autism reduced confidence on it and increased refusal to take  surge of measles (2019)  Hepatitis B vaccine *R.O.A: IM in 4 doses(0,2,4,6) * Site: Deltoid muscle - Children and Adolescents Anterolateral thigh – Neonates & Infant * If the mother is HBeAg positive then the baby should additionally receive Hep B IG at birth.  Hemophilus Influenza Type B(Hib) Given in combination with DTaP at 2,4 and 6 months. R.O.A: IM  Pneumococcal Vaccine Conjugated –PCV 13(Prevenar)(used in Oman) It is the most common type , effective againt 13 serotypes, protects against 90% of the disease causing pneumococcal serotypes R.O.A: IM  Varicella Vaccine Live attenuated virus against Chicken Pox caused by Varicella Zoster virus. One dose only at 12 months R.O.A: S/C Hepatitis A vaccine Two doses of a hepatitis A containing vaccine are usually needed to develop long term protection against hepatitis A virus. IM aged 12 months and older  Rota vaccine oral, live attenuated vaccine WHO recommend that the first dose of rotavirus vaccine be administered as soon as possible after 6 weeks of age Apart from a low risk of intussusception (up to 6 per 100 000 infants vaccinated) the current rotavirus vaccines are considered safe and well tolerated.  General Contraindications Serious allergic reaction (e.g., anaphylaxis) after a previous vaccine dose Moderate or severe current illnesses with or without a fever (more than 38 C )  Vaccination Program in Oman Age at vaccination Schedule At birth BCG HBV 2 months Hexa-1(HBV,DTaP,Hib,IPV) PCV13-1 Rota Vaccine-1 4 months Hexa-2(HBV,DTaP,Hib,IPV) PCV13-2 OPV-1 Rota vaccine-2 6 months Penta-1(HBV, DTwP, Hib) OPV-2 12 months Vitamine A 100.000 IU MMR-1 Varicella 13 months PCV 13- Booster Penta Booster 18 months MMR-2 + OPV Booster+HAV-1 Vitamin A 200.000 IU 24 months HAV-2 Influenza Seasonal(optional)  School Immunization schedule Oman Grade 1: DT and OPV Grade 6: Td Grad 11: Td and OPV