Immunization In Pediatric Practice PDF

IMMUNIZATION IN PEDIATRIC PRACTICE Rofaida Magdy, MD Immunity Natural : transplacental, colostrum Innate Passive Artificial: Immune serum Aquired Natura...

IMMUNIZATION IN PEDIATRIC PRACTICE Rofaida Magdy, MD Immunity Natural : transplacental, colostrum Innate Passive Artificial: Immune serum Aquired Natural : Infection. Active Artificial: Vaccination. What Vaccines do: Increase Resistance to Infection There are many ways to improve general health: Proper nutrition, Exercise, Healthy lifestyle, and… Vaccination!  Why Is Vaccination Important Target specific Protect Stop epidemics diseases everyone who is vaccinated WHAT ARE WE GOING TO STUDY? Historical background. How does the vaccine work? Egyptian schedule of vaccination. Individual Vaccines Complication of vaccination. Contraindication of vaccination Parents ask ….you answer. Historical background. Edward Janner 1797 Smallpox is a history…. Historical background. Louis Pasteur 1822-1895 Historical background. Robert Kock 1845- 1910 Historical background. Albert Sabin Jonas Salk 1906- 1993 1914- 1995 Types of Vaccines: Live (attenuated): BCG, Sabin polio, MMR, Varicella, rotavirus, oral typhoid. Non-live: Killed: Pertussis, Salk polio, hepatitis A, Infleunza. Part of microorganism: Acellular Pertussis. Polysaccharide capsule: Hib, Pneumococcal, meningococcal. Toxoid: Diphteria, Tetanus. Genetically engineered: Hepatitis B How does the Vaccine work? Egyptian schedule of Obligatory Vaccination: At birth Oral polio 2 drops orally BCG, Hepatitis B 0.05 ID left shoulder 2 months DTP 0.5 ml IM left thigh 4 months Hep. B. (2,6) 0.5 ml IM right thigh 6 months Oral polio 2 drops orally ± Hib 9 months Oral polio 2 drops orally 12 months MMR 0.5 ml sc right arm Oral polio 2 drops orally 18 months DPT 0.5 ml IM left thigh MMR 0.5 ml sc right arm Oral polio 2 drops orally Egyptian schedule of Obligatory Vaccination: One capsule of Vitamin A at age of 9 months. Two capsules of Vitamin A at age of 13 months. BCG Vaccine: BCG Vaccine: complications Complication management Abcess or ulcer at Drainge or needle aspiration injection site if indicated and INH Regional lymphadenitis No treatment Surgical + anti TB treatment if - excessive enlargement. - Suppuration - sinus formation Dissiminated diease anti TB treatment BCG Vaccine: complications Contraindications of BCG: - Immunocompromized individuals. - Pregnant woman. Contraindications of vaccinations: To all vaccines: Very ill child. High fever. Previous anaphylaxis. Specific considerations: DPT ( DT is given instead) if: Previous convulsions or epilepsy in previous dose. Uncontrolled or progressive neurological illness. After 6 years. Contraindications of vaccinations: MMR vaccine SHOULD NOT be given if IVIG was given in the preceding ( 3-11) months, depending on the dose of IVIG. Immunocompromised child: Live attenuated vaccines are contraindicated. Steroid therapy for 14 days: delay live vaccines to one month after stopping steroids. Rabies vaccine: Given as 1ml. Subcut. At the day of exposure to animal bites. Repeat the dose at days 3,7,14, and 30. Rabies immunoglobulins : as soon as possible after the exposure. Half the dose is infiltrated around the bite. Other half is injected IM. Vaccination Parents ask……. You answer Child who do not receive BCG vaccine?? Give the vaccine if tuberculin test is negative. The scar of BCG vaccine did not appear. Should I repeat the vaccine? No because there is a risk to have active disease. You should do tuberculin test first. If negative you may repeat the dose. Hepatitis BsAg positive pregnant woman? Pregnant women should be screened for hepatitis B If mother is hepatitis BsAg positive: Newborn should receive Hepatitis B vaccine and hep. B immunoglobulins immediately after birth. Repeat vaccine at 1 and 6 months. Preterm infant vaccination: should receive all vaccines according to his/her postnatal chronologic age regardless of his gestational age. Child going to splenectomy procedure? Vaccinated 2 weeks before operation: Pneumococcal vaccine. Meningococal vaccine. Hemophilus infleunza type b vaccine. Hepatitis B if not administered before. Long acting penicillin. Infleunza vaccine: Annual influenza vaccination is indicated for all children 6 months of age who have a chronic health condition that increases their risk of complications from influenza infection. Hemoglobinopathies. chronic cardiac, pulmonary disease. Asthma. Chronic conditions that may cause repiratory compromise by infleunza infection e.g. neuromuscular diseases. Diptheria and tetanus without pertussis?? Children who developed encephalopathy within 7 days after previous DPT vaccination with no obvious cause. Progressive neurologic disorder such as uncontrolled epilepsy or progressive encephalopathy until control the condition. Caution for: Patients who develop high grade fever Vaccination of child with progressive neurological disorder?? Should receive DT vaccine instead of DPT vaccine. Are there any other vaccines not obligatory in Egypt? Yes such as Haemophilus infleunza vaccine. Rota virus vaccine. Varicella vaccine. Meningococcal vaccine : sometimes given in schools Vaccination of immunocompromised host e.g. HIV patients, congenital immunodeficiency Should not receive live attenuated vaccines. Duration between DPT doses? Recommended interval : 2 months. Minimum interval : 4 weeks. Chemoprophylaxis: Administration of an antimicrobial drug for the purpose of preventing disease or infection. Examples: Tuberculosis (contact). Infective endocarditis. Rheumatic fever. Recurrent UTI. Thank you