Immunization (summary from slides).pdf

Immunization Objectives: 1. Define active, passive immunization 2. Define booster, toxoid and antitoxin 3. Define killed, live and attenuated vaccine 4. Define conducted and un-conjugated vaccine. 5. Discuss the indications for administra...

Immunization Objectives: 1. Define active, passive immunization 2. Define booster, toxoid and antitoxin 3. Define killed, live and attenuated vaccine 4. Define conducted and un-conjugated vaccine. 5. Discuss the indications for administration, appropriate dosage schedule, possible side effects and contraindications for use of commonly used vaccines. 6. Describe the standard vaccination schedule for ministry of health and WHO. 7. Identify the recommended indications for the less commonly used vaccines (Meningiococal vaccination, Rota vaccination, RSV immunoglobulin, Influenza virus & rabies virus) 8. Understand the recommenced immunization schedule for unimmunized or partially immunized children. Done by Maha Albarrak ! Blue: Main Category ! Orange: Subcategory. ! Black: Original slides content. ! Red: Important information. ! Green: Doctor notes. ! Blue highlight: Info that came in previous batches questions.  Immunizzation _______________________________________________________________ General Principles of Immunization Passive Immunization - Preformed antibodies to a person to provide them limited immunity. - Provide immediate protection (rapid) but for short period. Natrual Artificial - Transplacental maternal antibodies. A. Immunoglobulin: which is a preparation derived from a large pool of human plasma that contains antibodies to a variety of common infectious diseases. B. Antitoxins 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. Natrual Artificial (by vaccine) - Previous Infection. A. Suspension of either whole or part of an organism. B. Toxoid ( a modified microbial toxin ) C. New technology (genetic approach, viral vectors) !1  Types of vaccines Type of Vaccine Features Example Live attenuated - The immune response-similar to natural - Live Viral vaccines: infection. 1. Measles - Capable to replicate & provide longer 2. Mumps 3. Rubella duration of immunity. 4. Varicella - Usually no need for booster except for oral 5. Rotavirus doses. 6. OPV - Can produce disease in 7. Intranasal influenza immunocompromised children, so they 8. Yellow fever vaccine shouldn’t recieve it. 9. Zoster - Stronger effect than killed vaccines, so - Live Bacterial vaccines: sometimes it requires less doses. 1. BCG 2. Typhoid (oral) Inactivated vaccine - Produced by growing the microorganism in - Inactivated Whole Virus vaccines: culture media, inactivating with heat and/or 1. Injectable Polio Vaccine (IM) (Killed) chemicals. 2. Hep-A - Not Capable to replicate, provide shorter duration of immunity. - Inactivated other Virus vaccines: 3. Hep-B - Require multiple doses(boosters) 4. Influanza - Could not cause disease even in an 5. Rabies immunodeficient person. 6. HPV - Bacterial vaccines: 1. Pertusis (whole bacterial) 2. Meningococal vaccine 3. Cholera *Mnemonic to memorize Live vs Killed vaccines 4. Pneomococaccal 5. Haemophilus influenzae Type B 6. Typhoid capsular polysacharide _______________________________ Fractional vaccines: (Subunits) 1. Hep B 2. Inactivated influenza 3. Acellular pertussis 4. HPV - Fractional vaccines (Toxoids) 1. Diptheria 2. Tetanus (DTP/DTap/Tdap), (TT), (DT/Td) Subunits Vaccines Protein based Polysacharide “PS” Conjugate (Protein molecule + PS) 1. aP Polysaccharide alone is poorly Conjugation of PS vaccine with a 2. Hep B recognized by children so usually we protein molecule increases need to conjugate it with a protein to immunogenicity & booster increase the response & response. immunogenicity. 1. Pneumococcal 1. Hib 2. Meningococcal 2. Pneumococcal 3. Typhoid Polysaccharide vaccines. 3. Meningococcal conjugate !2  Routes - Most common route is IM 90 degrees, mostly with Killed vaccines. - Live vaccines usually given orally, SC, or ID Site of IM - We mostly use the thigh (anterolateral) in the vastus lateralis muscle. - If it was infant less than 2 years we give in the thigh. - If 2 years & more we can give in the deltoid muscle or the vastus lateralis. - We don’t recommend posterior ( gluteus Maximus) bc there is a lot of fatty layers+ the immune cells aren’t there + transportation through fat is affected. !3  Vaccination Schedule I !4  Specific vacciens Vaccine Features Side effects/Types BCG - Contains a live attenuated (weakened) strain of Mycobacterium - Superficial irritation bovis. - Abscess at injection site - It does not prevent primary infection. - Regional - Has a documented protective effect against meningitis & lymphadenopathy disseminated TB in children. - Disseminated BCGitis - Intradermal route in deltoid reigon of left upper arm. (in patients with immunodeficiency) - There’re 2 types of vaccine that protect against polio: - IPV appears to produce less Polio 1- Inactivated polio vaccine (IPV) local gastrointestinal 2- Oral polio vaccine (OPV). immunity than does OPV. - OPV is stronger than IPV in preventing infection & - Vaccine-associated transmission. paralytic polio (VAPP) is a - Is more likely to occur in persons 18 years of age and older. rare adverse reaction following live OPV. - Is much more likely to occur in immunodeficient children. - Upper case “D” & “P” means there is more diphtheria and - Small letters = Less dose DTaP - Capital letters = Higher pertussis in DTaP than in Tdap. - Aacellular pertussis vaccines are associated with fewer side effects. dose - For younger than 7 years. - Effectiveness? same - T = contains tetanus toxoid. - What is the difference btw DTP Tdap - d = reduced diphtheria toxoid. & DTaP? Less SE but the same effectiveness. - For older than 7 years - Every 10 years in US. - ap = acellular pertussis vaccine = more purified = less side effect Hepatitis B - Infants of HBsAg-positive mother should receive hepatitis B - immune globulin (HBIG) shortly after birth and should be immunized with HepB vaccine, preferably within 12 hours of age. Pneumococal 1- Pneumococcal Conjugated - PCV13 ( Prevnar13 ) - Vaccine - A 13-valent vaccine contains polysaccharides of the capsular antigens of pneumococcal serotypes. - For primary immunization series starting from age of 2months 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, Cochlear implant, CSF leaks) Meningococcal - Meningococcal disease occurs in forms of epidemics in subsaharan - Africa & in large gatherings as in Hajj or Umrah. - N. Meningitidis sero-groups (include A, B, C, Y & W-135 ) - In Africa are caused by sero-group A, whereas B & C are common elsewhere in the world - W-135 meningococcal disease in Saudi Arabia & Y- group in the US are evidence of shifting trends. - There are two types of meningococcal vaccines available Polysaccharide and Conjugate - The quadrivalent Vaccine “MCV4” coveres (A, C, Y and W-135) !5  Recommended indications for the less commonly used vaccines (not in the slides but it’s mentioned in the objectives) Vaccine Indication Meningiococal 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) Rota - Live, attenuated oral vaccine indicated for immunization to prevent rotavirus gastroenteritis in infants and children. RSV - Respiratory syncytial virus immune globulin intravenous (RSV-IGIV) has been approved by the Food and Drug Administration for use in the prevention of immunoglobulin severe RSV infections in infants and children younger than 24 months with bronchopulmonary dysplasia or a history of premature birth (≤35 weeks of gestation) Influenza virus - All persons aged 6 months of age and older are recommended for annual flu vaccination, with rare exception. Vaccination is especially important for people at higher risk of serious influenza complications or people who live with or care for people at higher risk for serious influenza complications. Rabies virus - People at high risk of exposure to rabies should be offered pre-exposure rabies vaccination, including: Veterinarians, animal handlers, and veterinary students. Rabies laboratory workers. - The first dose of the 5-dose course should be administered as soon as possible after exposure. General rules: Timing & spacing of vaccines - All vaccines can be administered at the same visit as all other vaccines without any problems. - Exception: 2 live parenteral or live intranasal vaccines needs minimal interval of 4 weeks. - MMR, Varicella & BCG needs 1 month interval at least. Antibody-vaccine reaction - The presence of circulating antibody to a vaccine antigen may reduce or completely eliminate the immune response to the vaccine. - Inactivated vaccines generally NOT affected by circulating A.B to antigen. - Live attenuated vaccines MAY BE affected by circulating A.B to antigen. - If the child has antibodies in the blood we delay the administration of the vaccines. !6  Contraindications & precautions - Situation which makes a particular treatment or procedure absolutely inadvisable. - Situation which makes a particular treatment or procedure relatively inadvisable (Doesn’t rule it out, Benefits Vs Risks) Contraindications Permanent Temporary 1- Severe (anaphylactic) allergic reaction to a vaccine. - Pregnancy and immunosuppression. 2- Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination. 3- Severe combined immunodeficiency (SCID) to Live vaccine. 4- History of intussusception as contraindications to rotavirus vaccine. Precautions Permanent Temporary To further doses of pediatric DTaP are 1. Moderate or severe acute illness (all 1. Temperature of 40.5°C or higher within 48 hours of a dose. vaccines) 2. Collapse or shock-like state (hypotonic hyporesponsive episode) 2. Recent receipt of an antibody-containing within 48 hours of a dose. blood product, only to MMR & varicella 3. Persistent inconsolable crying lasting 3 or more hours occurring containing vaccines. within 48 hours of a dose, or Seizure, with or without fever, occurring within 3 days of a dose. Catch-up imunization schedule - For persons aged 4 months through 18 years who start late or who are more than 1 month behind. Post expoure prophylaxis “Important” 1. The worst scenario: dirty wall + not well vaccinated? get them the vaccine. 1. Someone is vaccinated a long time ago 10 yrs? Yes give them vaccine. 3. The IG only in the worst scenario, not vaccinated + dirty wounds. !7