Vaccination.pdf

Scientific committee of the 23rd batch Vaccination ♣ Definition: vaccinations, also called Immunizations, When you are given an immunization, you receive a vaccine that contains fragments of a disease organism or small amounts of...

Scientific committee of the 23rd batch Vaccination ♣ Definition: vaccinations, also called Immunizations, When you are given an immunization, you receive a vaccine that contains fragments of a disease organism or small amounts of a weakened disease organism. The vaccine causes your immune system to develop antibodies that can subsequently recognize and attack the organism if you are exposed to it. Sometimes an immunization does not completely prevent the disease, but it will significantly reduce its severity. ♣ Types of vaccine: 1) LAV: live-attenuated vaccine. 2) Killed vaccine. ♣ Toxoid: a substance used in vaccination that does not produce toxic effect but able to provoke the immune system. ♣Anti-toxin: antibody derived from the serum of human or animal (horse) which is used to provide immunization. ♣Cold -chain: a series of events aiming to keep the vaccine in the same temperature (ranging from4-8C) from the source to the patient. ♣ The standard childhood immunization schedule includes vaccines for: 1) Diphtheria, tetanus, and pertussis (DTaP). 2) Polio (inactivated poliovirus vaccine or IPV). 3) Measles, mumps, and rubella (MMR). 4) Chickenpox (varicella). 5) Hepatitis B (HepB). 6) Hepatitis A (HepA). 7) Haemophilus influenzae type b (Hib). 8) Pneumococcal conjugate vaccine (PCV) for children younger than 5 years of age. -1-  Scientific committee of the 23rd batch 9) Influenza (flu). The flu vaccine is not given to children younger than 6 months of age. It is recommended for:  All children 6 through 23 months of age.  Children 24 months and older with certain medical conditions (such as asthma, chronic heart or lung disorders, or an impaired immune system).  Close contacts, including household contacts and out-of-home caregivers, of children 23 months of age and younger and of children 24 months and older who are at high risk for complications of the flu. Immunizations begin at birth and are scheduled throughout a baby's first 18 months; booster shots are usually given between the ages of 4 and 6. Fewer immunizations are needed after age 6—mostly just those given yearly (such as a flu shot) or on a regular basis throughout adulthood (such as a tetanus shot). ♣ Side effects from vaccines are generally minor, if they occur at all. They may include:  Redness, mild swelling, or soreness where the shot was given.  Slight fever.  Drowsiness, irritability, and poor appetite in some babies.  A mild rash 7 to 14 days after chickenpox or MMR immunization.  Temporary joint pain after the MMR vaccine.  Severe reactions to immunizations, such as a very high fever [over 104.5°F (40.3C°)] or difficulty breathing, are rare. The risk of a serious complication from a disease is far greater than the risk of having a severe reaction to a vaccine. The only vaccines that have been recalled because of safety concerns were the 1976 swine influenza vaccine and the rotavirus vaccine in 1999. -2-  Scientific committee of the 23rd batch ♣effectivity of vaccines Although no vaccine is 100% effective, most routine childhood immunizations are effective for 85% to 95% of the children who receive them. Some people do not develop complete immunity even when they have had the vaccine. If these people are exposed to the disease, they may become infected. However, symptoms are usually milder as a result of having had the vaccine. ♣ Childhood immunization schedule of Yemen includes the following vaccines : 1. Polio vaccine (OPV). 2. Bacilli Callette-Guerin (BCG) vaccine. 3. DTaP - Hib - HepB (pentavaccine) & PCV. 4. measles vaccine. ♣ Childhood immunization program of Yemen : 1) Already After birth:  (BCG) vaccine ----------- (the only shot).  Polio vaccine (OPV) ------ (the introductory shot). 2) One & half a month after birth:  Polio vaccine (OPV) ------- (the first shot).  DTaP - Hib - HepB & PCV----------- (the first shot). 3) Two months & half after birth :  Polio vaccine (OPV) ------- (the second shot).  DTaP - Hib - HepB & PCV ----------- (the second shot). -3-  Scientific committee of the 23rd batch 4) Three months & half after birth:  Polio vaccine (OPV) ------- (the third shot).  DTaP - Hib - HepB & PCV ----------- (the third shot). 5) Nine months after birth:  Measles vaccine-------- (the first shot).  Vit. A (100,000 unit). 6) One & half a year after birth:  Measles vaccine-------- (the second shot).  Vit. A (200,000 unit). ♣ The nine traditional vaccines are: 1) DTaP Vaccine(Vaccine for Diphtheria, Tetanus, and Pertussis): DTaP is an updated version of DTP vaccine. The "a" stands for "acellular" pertussis, which means that only part of the pertussis bacteria is used in the vaccine. The older DTP vaccine is rarely used in the U.S.  The five DTaP Shots of children for maximum protection:  The first three shots should be given at 2, 4, and 6 months of age.  The fourth (booster) shot is given between 15 and 18 months.  The fifth shot - another booster - is given when the child is about to enter school, at 4-6 years of age.  Side Effects of DTaP Immunization:  Up to 30% of children who get DTaP have local reactions (tenderness, pain, redness, swelling) where the shot was given within two days after the shot. These reactions are more likely after the fourth and fifth doses of DTaP than after the earlier doses. Some children also experience swelling of the entire leg or arm after the fourth or fifth DTaP dose.  Fever is another fairly common reaction. Up to about 5% will get a fever of over 101°F; more often after the fourth or fifth dose, and nearly 10%may be drowsy afterward. also Convulsions may occur after a DtaP immunization -4-  Scientific committee of the 23rd batch  Serious reactions to either DTP or DTaP have been very rare. and the older DTP vaccine was sometimes accused of being "unsafe," mainly because of the pertussis component.  Precautions of DTaP Immunization:  A child who had a severe (life-threatening) allergic reaction after a dose of DTaP vaccine should not get another dose.  A child who has convulsions within 3 days after a dose of DTaP should probably not get another dose of pertussis-containing vaccine.  A child who had encephalopathy (brain illness) within 7 days after a dose of DTaP should not get another dose of pertussis-containing vaccine (see information on DT vaccine, below).  A child who had a temperature of 105°F within 48 hours after a dose of DTaP should probably not get another dose of pertussis- containing vaccine.  A child who has a moderate or severe illness on the day a DTaP (or any) vaccination is scheduled should probably delay the vaccination until he or she has recovered.  Similar Vaccines:  ( Td vaccine ) is a vaccine for children 7 years old and over, and for adults. It does not contain pertussis vaccine, and has less diphtheria toxoid than DTaP.  ( DT vaccine )contains diphtheria and tetanus toxoids but no pertussis vaccine. It is given to children under 7 years old who should not get pertussis vaccine, usually children who have had certain reactions after a previous DTaP shot. The previous two vaccines have no allergic reactions. 2) MMR vaccine( Measles, Mumps, Rubella Vaccine):  Indications: Combines vaccines for measles, mumps and rubella into one shot. Most children who get the vaccine develop immunity to all three diseases, and protection is believed to be lifelong. Two doses of vaccine are recommended:  The first dose given at 12 to15 months of age.  The second may be given four weeks after the first, but it is usually given at 4 to 6 years. No boosters are needed.  Immunization is also indicated in children up to 18 months of age or older, if they have not received immunization against these diseases.  Persons with history of measles, mumps and rubella are also subject to immunization.  Contraindications:  Pregnancy and lactation because they may harm fetus.  Acute infectious diseases. -5-  Scientific committee of the 23rd batch  Febrile state.  Hypersensitivity to vaccine ingredients.  Immune deficiency; primary (congenital) and secondary to malignant disease or drug use such as (antimetabolites, corticosteroids, alkylating agents and radiations).  Because MMR and its component vaccines contain hydrolyzed gelatin, as a stabilizer, and trace amounts of neomycin, extreme caution should be used before the vaccine is given to individuals with a history of anaphylaxis to these additives.  Drug interactions: Vaccine against measles, mumps and rubella may be used simultaneously with other live virus vaccines, (vaccine against polio, hepatitis B and yellow fever) and bacterial vaccines in vaccines against diphtheria, tetanus and Pertussis). Other commercially individual vaccines should not be mixed in the same syringe in the measles, mumps and rubella vaccine (expanded program of immunization of the world health organization).  Side effects of MMR vaccine:  Local: Transient pain and irritation (edema, indurations and erythema) at the site of injection.  General: The most frequent reaction to vaccination with live attenuated morbilla virus are increased body temperature following approximately one week after vaccination and skin rash.. Increased body temperature, parotid swelling and skin rash appear in rare cases as reactions to the mumps component adds side effects to rubella components.  Precautions:  a period of at least one month should expire between two immunizations with live virus vaccines.  Tuberculin skin tests (Mantoux test) should be done before, or least 2 months after administration of measles, mumps and rubella vaccine, because of a possible occurrence of a transient inhibition of cellular immunity.  Children prone to infectious disease should be immunized, like in asthma, celiac disease, chronic lung disease, congenital heart diseases, malnutrition, as well as premature infants.  Dose of 0.5 ml should be injected subcutaneously into the upper arm in the region of the deltoid muscle. 3) polio vaccine: There are two types of vaccine that protect against polio: 1) Inactivated Polio Vaccine (IPV): IPV, used in the U.S. since 1987. Children get 4 doses of IPV, at these ages: 2 months, 4 months, 6-18 months, and booster dose at school entry( 4- 6 years of age). IPV is approved for either subcutaneous or intramuscular administration. Polio vaccine may be given at the same time as other -6-  Scientific committee of the 23rd batch vaccines. IPV should not be administered to persons who have experienced a severe allergic reaction after a previous dose of IPV. Children with minor illnesses, such as a cold, may be vaccinated. Those who are moderately or severely ill should usually wait until they recover before getting IPV vaccine. The schedule for routine polio vaccination of children 4–17 years of age in the U.S.A is 2 doses of IPV separated by 4–8 weeks, and a third dose 6–12 months after the second dose. If an accelerated schedule is needed, three doses separated by at least 4 weeks may be given. Polio vaccine is not routinely administered to persons 18 years of age and older. 2) Oral Polio Vaccine (OPV): OPV has not been used in the United States since 2000 but is still used in many parts of the world. the benefits of OPV use are intestinal immunity & providing secondary spread of the vaccine to unprotected contacts, although OPV may be responsible for vaccine-associated paralytic poliomyelitis (VAPP) which occurred in one child out of every 2.4 million OPV-vaccinated children and may cause vomiting and fever. in polio-endemic countries a child is considered to be fully immunized if he or she has received a primary series of at least three doses of (OPV) at these ages: 2 months, 4 months, 6-18 months, and booster dose at school entry( 4-6 years of age).if the child has already vomitted after vaccination , he or she should be re-vaccinated. 4) Hepatitis – B vaccine :  Indications: hepatitis-B vaccine is indicated for immunization against infection caused by all known subtypes of Hepatitis-B virus. Routine vaccination is recommended for all new born, infants, children and adolescents. Vaccination of defined high risk populations is recommended for persons older than eighteen years of age. × High-risk populations:  People who have a job that involves contact with human blood (Ex: Health care personnel, Military personnel etc.)  Patients who may require multiple blood transfusions or are at a risk of receiving unsafe transfusions or blood products.  Persons originating from areas of high endemicity and travelers to these areas. -7- Scientific committee of the 23rd batch  People who live in the same house with a patient with chronic hepatitis-B virus (HBV) infection.  Infants born to hepatitis-B virus positive mothers.  Contraindications :  Hep-B vaccine should not be administered to any person who has experienced a hypersensitivity reaction to any component of any Hepatitis-B vaccine.  hep-B vaccine should not be administered to subjects with severe febrile infections  side effects:  Most Common side effects: Injection site: Mild soreness, indurations, erythema.  Uncommon side effects classified by body system: 1- systemic: Fatigue, low-grade fever and malaise. 2- Skin & appendages: Rash, pruritis and urticaria 3- Digestive system: Nausea, vomiting, diarrhoea and abdominal pain. 4-hepatobiliary system: Abnormal liver function tests. 5- Nervous system: Dizziness, and paresthesia.  Dosage:  Neonates &children till the age of 18 years: the recommended dose of 0.5mL and should be injected intramuscularly in the anterolateral thigh, for neonates and infants. Three doses of hepatitis B vaccine are needed for full protection of children from the disease. The first dose is usually given at birth. This is particularly important for children whose mothers are chronically infected. For other babies, the first dose can be given between birth and 2 months of age. The second dose is recommended at 1 to 4 months, and the third at 6 to18 months. These three doses should protect children for life.  Adults 19 years of age & older: the recommended dose of 1 mL and should be injected intramuscularly in the deltoid muscle of adults. Primary immunization with Hep-B vaccine consists of three intramuscular doses. The second dose given one month after the first and the third dose administered at least four months after the second dose of Hep- B vaccine.  Immunization Schedule of Hep-B vaccine: 1st dose Given on a fixed date this is the FIRST DOSE 2nd dose 4-10 weeks after the FIRST DOSE 3rd dose 4-20 weeks after the SECOND dose -8-  Scientific committee of the 23rd batch A booster dose is recommended 12 months after the 1st dose. A second booster dose may be required after 8 years in the high risk population if the antibody titre falls below 10mIU/mL. 5) Bacilli Callette-Guerin (BCG) vaccine:  It is live-attenuated vaccine.  Dose: 0.05cc for neonates & 0.01cc for 7-years old.  intra-dermal injection of the live attenuated vaccine is given on the lateral aspect of arm at the level of deltoid insertion or on the upper lateral surface of the thigh. it is indicated for children to produce cross immunity to human tuberculosis.  Drawbacks:  Conversion of tuberculin test into a positive result within 3 years of administration.  Rarely cause fever, convulsion, anorexia, osteomyelitis, axillary lymphadenitis. 6) Hepatitis A vaccine: is 94 percent to 100 percent effective in preventing hepatitis A. Children between 12 and 23 months of age should receive the two-time vaccine, administered at least six months apart. 7) Influenza vaccine: One dose is recommended annually, beginning around October or November. For children younger than 9 who are getting influenza vaccine for the first time, two doses are recommended, at least a month apart, depending on the type of vaccine. 8) Haemophilus influenza type b vaccine (Hib vaccine): Children should get either three or four doses of (Hib vaccine). The vaccine is recommended at 2, 4, 6 and 12 to 15 months of age (the 6-month dose is not given with one brand of vaccine). 9) Varicella vaccine: The separate varicella vaccine prevents chicken pox in 70 percent to 80 percent of people who receive it, and is expected to provide lifelong immunity. A single dose of the vaccine currently is recommended for children at 12 to 18 months of age, usually at the same time as the MMR vaccine. Children who miss this shot can still get a single dose of the vaccine until 13 -9-  Scientific committee of the 23rd batch years of age. After 13 years of age, two doses are recommended, given four to eight weeks apart. 10) Pneumococcal conjugate vaccine (PCV This vaccine is given to people who will go to Mecca for Hajj and this vaccine decrease incidence of meningitis among Hajjis. Four doses of pneumococcal vaccine are recommended, at 2, 4, 6 and 12 to15 months of age. Children who are late starting the series may need fewer doses. Children 5 years old and older usually should not get pneumococcal conjugate vaccine. But some older children (those with certain chronic diseases or damaged immune systems) should still get a pneumococcal vaccine. There is a different vaccine (called pneumococcal polysaccharide vaccine) that can be given to these children and to adults. ♣QUESTIONS Q1) If a 7-years old child is not yet vaccined ,can we give all types of vaccination? Yes ,except pertusis vaccine as the incidence of encephalopathy is high in such cases. Q2) What type of vaccine that should be given to an immuno-copromised child? All types except live attenuated vaccine. Q3) Why polio vaccine is given in the posterior aspect of the tongue? To guarantee that the child will swallow and won't throw it. Q4) oral polio vaccine is given in developing countries & not in developed countries? Because it provides 3 stations of immunity which is needed in such societies. Q5) Is BCG a good way to control TB? No , but it is used only to prevent it (never to be adopted in TB control strategies). - 10 -