Immunization.pdf

IMMUNIZ ATION D R. A H M E D A L M U TA I R I A S S I S TA N T P R O F E S S O R P E D I AT R I C D E PA RT M E N T CONTENTS Overview General Principles of Immunization Types and Biology Routes Schedule Contraindications Special Cases  the "Ten Great Public Health Achievements in the 2...

IMMUNIZ ATION D R. A H M E D A L M U TA I R I A S S I S TA N T P R O F E S S O R P E D I AT R I C D E PA RT M E N T CONTENTS Overview General Principles of Immunization Types and Biology Routes Schedule Contraindications Special Cases  the "Ten Great Public Health Achievements in the 20th Century". LESSONS FROM HISTORY LESSONS FROM HISTORY  GENERAL PRINCIPLES OF IMMUNIZATION Passive Immunization ✓Pre-formed antibodies to a person to provide them limited immunity. ✓Provide immediate protection for short period. I. Natural : Transplacental maternal antibodies. II. Artificial : A. Immunoglobulin : ✓Is a preparation derived from a large pool of human plasma that contains antibodies to a variety of common infectious diseases Active Immunization ✓To stimulate a protective antibody or a cell- mediated response in a person. ✓Acquired when the antigen is introduced to the host. ✓Takes time to induce the protection effect but of longer duration I. Natural : eg: previous Infection. II. Artificial : with Vaccine A. A suspension of either whole or part of an organism. B. Toxoid ( a modified microbial toxin ). C. New technology (genetic approach, viral vectors etc...)  BIOLOGY OF VACCINES The immune response-similar to natural infection. Capable to replicate, provide longer duration of immunity. usually no need for booster except for oral dose Live attenuated can produce disease in immunocompromised children. vaccines : Live attenuated viral vaccines: measles, mumps, rubella, varicella, rotavirus, OPV & intranasal influenza Live attenuated bacterial vaccines: BCG & typhoid (oral)  BIOLOGY OF VACCINES Not Capable to replicate, provide shorter Inactivated duration of immunity. vaccine Require multiple doses(boosters) (Killed): Could not cause disease even in an Produced by immunodeficient person growing the Inactivated whole virus vaccines: IPV and Hep-A microorganism in Inactivated whole bacterial vaccines: Pertusis culture media, Fractional vaccines: subunits-Hep B, inactivating with inactivated influenza, vaccine, acellular heat and/or pertussis, HPV; toxoids-Diptheria & tetanus chemicals  BIOLOGY OF VACCINES Protein based eg. aP ,Hep B Subunit Vaccines: PS e.g. pneumococcal, meningococcal & typhoid polysaccharide vaccines Conjugation of PS vaccine with a protein molecule increases immunogenicity & booster response; Hib, Pneumococcal & Meningococcal conjugate vaccine ROUTS SITE OF IM  BCG Contains a live attenuated (weakened) strain of Mycobacterium bovis. It does not prevent primary infection. Has a documented protective effect against meningitis and disseminated TB in children. Intradermal route in the deltoid region of the left upper arm. Adverse reaction : ✓Superficial irritation ✓Abscess at injection site ✓Regional lymphadenopathy ‫؟؟؟‬  POLIO VACCINE There are two types of vaccine that protect against polio: inactivated polio vaccine (IPV) and oral polio vaccine (OPV). IPV appears to produce less local gastrointestinal immunity than does OPV. Vaccine-associated paralytic polio (VAPP) is a rare adverse reaction following live OPV. Is more likely to occur in persons 18 years of age and older. Is much more likely to occur in immunodeficient children. DTaP Upper case “D” and “P” means there is more diphtheria and pertussis in DTaP than in Tdap. (acellular) pertussis vaccines that are associated with fewer side effects. For younger than 7 years. Tdap T = contains tetanus toxoid. d = reduced diphtheria toxoid. ap = acellular pertussis vaccine = more purified = less side effect. HEPATITIS B HBsAg-positive mother — Infants of such mothers should receive hepatitis B immune globulin (HBIG) shortly after birth and should be immunized with HepB vaccine, preferably within 12 hours of age.  PNEUMOCOCCAL VACCINE There are two types on pneumococcal vaccines : 1- Pneumococcal Conjugated PCV13 ( Prevnar13 ) A 13-valent vaccine contains polysaccharides of the capsular antigens of 13 pneumococcal serotypes. For primary immunization series starting from age of 2months  PNEUMOCOCCAL VACCINE 2- Pneumococcal polysaccharide vaccine , PCV23 ( Pneumovax23 ) For more than 2 years with special situation : ✓Chronic Lung illness. ✓Anatomic or functional asplenia , SCA. ✓Immunocompromised patients , Nephrotic syndrome. ✓HIV infection ✓Cochlear implant. ✓CSF leaks. MENINGOCOCCAL VACCINE Meningococcal disease occurs in the form of epidemics in sub- saharan Africa and in large gatherings as in Hajj or Umrah. N. Meningitidis has several sero-groups ( include sero- groups A, B, C, Y and W-135 ). 90% of all disease is caused by these. Most epidemics in the “meningitis belt” in Africa are caused by sero-group A, whereas B and C are more common elsewhere in the world. However, recent reports of W-135 meningococcal disease in Saudi Arabia and Y- group in the US are evidence of shifting MENINGOCOCCAL VACCINE There are two types of meningococcal vaccines available: Polysaccharide and Conjugate. The quadrivalent Vaccine covered (A, C, Y and W-135). MENINGOCOCCAL VACCINE Booster doses after primary vaccination are important for persons with : 1. Prolonged increased risk (persons with asplenia, or with complement component deficiencies ) 2. Travel to endemic area (Hajj) CONTRAINDICATION & PRECAUTION Situation which makes a Situation which makes a particular treatment or particular treatment or procedure absolutely procedure relatively inadvisable inadvisable.. Doesn't rule it out. Benefits Vs Risks CONTRAINDICATION Permanent contraindications: 1- Severe (anaphylactic) allergic reaction to a vaccine. 2- Encephalopathy not due to another identifiable cause occurring within seven days of pertussis vaccination; 3- Severe combined immunodeficiency (SCID) to Live vaccine. 4- History of intussusception as contraindications to rotavirus vaccine. Temporary contraindications to vaccination with live vaccines: Pregnancy and immunosuppression. PRECAUTIONS Permanent Precautions To further doses of pediatric DTaP are 1- Temperature of 40.5°C or higher within 48 hours of a dose, 2- Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours of a dose, 3- Persistent inconsolable crying lasting 3 or more hours occurring within 48 hours of a dose, or a 4- Seizure, with or without fever, occurring within 3 days of a dose.  PRECAUTIONS Temporary precautions : 1- Moderate or severe acute illness (all vaccines), 2- Recent receipt of an antibody-containing blood product. only to MMR and varicella-containing vaccines.  ANTIBODY-VACCINE INTERACTIONS The presence of circulating antibody to a vaccine antigen may reduce or completely eliminate the immune response to the vaccine. TIMING AND SPACING OF VACCINES NON-SIMULTANEOUS ADMINISTRATION THANK YOU