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Immunization. Dr. Tanveer Ashraf. Objectives. Types of vaccination Contraindications Discussion of individual vaccines Preparations Administration Precautions and contraindications Side effects. Active Immunization. Types Live attenuated Virus Measles, mumps, rubella Bacteria BCG

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Immunization

Dr. Tanveer Ashraf


Objectives

  • Types of vaccination

  • Contraindications

  • Discussion of individual vaccines

    • Preparations

    • Administration

    • Precautions and contraindications

    • Side effects


Active Immunization

  • Types

  • Live attenuated

    • Virus Measles, mumps, rubella

    • Bacteria BCG

  • Killed

    • Virus Hepatitis B

    • Bacteria

      • Whole Pertussis

      • Toxoid Tetanus

      • Polysaccharide Meningoccocal


Human Immune Serum Globulin

  • Specific

    • IM Hepatitis B (HBIG)

  • Rabies (RIG)

  • Tetanus (TIG)

  • Varicella (VZIG)

    • IV CMV (CMV-IG)

  • RSV (RSV-IG)


Human Immune Serum Globulin

  • Non-specific

    • IM Immune serum globulin(ISG)

      • Hepatitis A

      • Measles

  • IV Intravenous immune globulin(IGIV)

    • Antibody deficiency disorders

    • ITP

    • Kawasaki syndrome


  • Passive Immunization (Cont)

    • SPECIFIC EQUINE ANTIBODIES (IM)

      • BOTULISM ANTITOXIN

      • DIPHTERIA ANTITOXIN

      • TETANUS ANTITOXIN

      • SNAKE & SPIDER ANTI-VENOM

    • MONOCLONAL ANTIBODIES (IV)

      • ANTI-ENDOTOXIN ANTIBODIES



    RECOMMENDED AGE

    VACCINE(S)

    BIRTH

    BCG, Hepatitis B (HBV)

    2 MONTHS

    [DTP, HIB, HBV]

    Injectable Polio Vaccine (IPV)

    4 MONTHS

    [DTP, HIB, HBV]

    Oral Polio Vaccine (OPV)

    6 MONTHS

    [DTP, HIB, HBV]

    Oral Polio Vaccine (OPV)

    9 MONTHS

    Measles vaccine (mono)

    12 MONTHS

    Oral Polio Vaccine (OPV)

    MMR

    Varicella

    1 8 MONTHS

    Oral Polio Vaccine (OPV)

    DTP, HIB

    Hepatitis A

    24 MONTHS

    Hepatitis A

    4 – 6 YEARS

    Oral Polio Vaccine (OPV)

    DTP

    MMR

    Varicella


    General Contraindications

    • Moderate or severe illness with or without fever

    • Anaphylactic reaction to vaccine or vaccine constituent

    • Live attenuated vaccines

      • Pregnant women

      • Immunocompromised / Immunosuppressed children

      • within 3-11 months of immunoglobulin administration


    Invalid Contraindications

    • Mild to moderate local reaction

    • Mild acute illness with or without low grade fever

    • Current antimicrobial therapy

    • Convalescent phase of illnesses

    • Prematurity and low birth weight

    • History of penicillin or other nonspecific allergies

    • Malnutrition


    Immunization Of Special Groups

    • IMMUNOCOMPROMISED HOSTS

    • Avoid MMR, measles (may be used in HIV)

    • Avoid OPV; use IPV for these children and their household contacts

    • PRETERM INFANTS

    • Treat as term babies

    • Avoid OPV in hospital

    • Influenza vaccine in BPD

    • may delay HBV if <2 kg & mother is HBsAG negative



    Bacillus Calmette‑Guerin Vaccine (BCG)

    • INDICATIONS

      • All newborns

      • All tuberculin negative infants

    • PRECAUTIONS & CONTRAINDICATIONS(CI):

      • Give only to PPD negative children

      • CI in persons with immunodeficiencies

      • CI during pregnancy


    Bacillus Calmette‑Guerin Vaccine (BCG)

    • SIDE EFFECTS

    • Local

      • Skin ulceration, regional lymphadenitis

      • Subcutaneous abscess

    • Generalized

      • Anaphylaxis, generalized BCG infection

      • (rare): osteitis


    Hepatitis B

    • PREPARATIONS

      • ENGERIX‑B

      • RECOMBIVAX HB


    Hepatitis B

    • ADMINISTRATION:

      • 0.5 ‑1 ML, anterolateral thigh or deltoid

      • IM injection

      • at 0,1 and 6 months

    • SIDE EFFECTS:

      • Pain

      • Arthralgia


    Poliomyelitis Prophylaxis

    • PREPARATIONS

      • (A) Oral (OPV) SABIN (Live attenuated)

      • (B) Inactivated (eIPV) SALK (killed)

    • ADMINISTRATION

      • OPV 2 drops orally

      • eIPV SC injection

    • PRECAUTIONS & CONTRAINDICATIONS(CI)

      • (a)OPV pregnancy, immunodeficiency

      • (b)IPV neomycin hypersensitivity

    • ADVERSE REACTIONS

      • OPV paralytic disease (rare)


    Diphtheria, Tetanus & Pertussis (DTP)

    • PREPARATIONS

      • < 7 years : DTP, DT, DTaP (acellular pertussis vaccine)

      • > 7 years : Td, TdaP

    • ADMINISTRATION

      • IM


    Diphtheria, Tetanus & Pertussis (DTP)

    • CONTRAINDICATIONS (CI)

      • Encephalopathy within 7 days

      • Progressive or unstable neurological disorders

      • Anaphylactic reaction to a previous dose

    • PRECAUTIONS

      • severe systemic reactions such as

        • Temp > 40.50C

        • persistent inconsolable crying > 3 hours

        • Collapse episodes

        • Convulsions


    Measles, Mumps & Rubella (MMR)

    • PREPARATIONS:

      • MEASLES.

      • MMR.

    • ADMINISTRATION:

      • SC.

    • INDICATIONS:

      • Primary immunization at 1 & 6 years.


    Measles, Mumps & Rubella (MMR)

    • PRECAUTIONS & CONTRAINDICATIONS

    • Pregnancy

    • Anaphylaxis to eggs

    • Immunodeficiency and immunosuppression

    • Immunoglobulins within 3-11 months


    Measles, Mumps & Rubella (MMR)

    • ADVERSE REACTIONS

      • Fever ,rash (7 days post vaccination)

      • Arthralgia , arthritis (rubella)

      • Encephalitis [rare] (measles, mumps)

      • Suppression of PPD skin test (measles)

      • Convulsions in prone children(measles)

      • Thrombocytopenia


    Haemophilus Influenzae Type B

    • ADMINISTRATION

      • IM

      • 2,4,6 months, booster at 15 months

    • INDICATIONS

      • Children under 5 years of age

      • High risk children

    • SIDE EFFECTS:

      • Local pain and erythema

      • Mild fever


    Varicella Prophylaxis

    • PREPARATIONS:

      • Varivax vaccine (MSD)

    • ADMINISTRATION:

      • 0.5 ml IM

      • 12 months and above……..2 doses


    Varicella Prophylaxis

    • INDICATIONS:

      • All children 12 months‑18 years: (if no history of varicella)

    • EFFICACY:

      • 70‑90%


    Varicella Prophylaxis

    • PRECAUTIONS & CONTRAITNDICATIONS:

      • Immunocompromised patients

      • Within 5 months of IG

      • Children on long term salicylates

    • SIDE EFFECTS:

      • Fever , rash

      • Zoster


    Hepatitis A

    • NATURE OF VACCINE:

      • Killed formalin inactivated vaccine.

    • PREPARATIONS:

      • Various preparations available

      • e.g. Havrix 720 Junior, Havrix 1440 etc.


    Hepatitis A

    • INDICATIONS:

      • children 1 year and above

        • Susceptible children in endemic areas

        • Chronic liver disease

        • Hemophilia


    Hepatitis A

    • ADMINISTRATION:

      • IM injection

      • 2 doses, at least 6 months apart

    • ADVERSE REACTIONS:

      • Local reactions, fever

      • Rare: anaphylaxis



    Pneumococcal Prophylaxis

    • PREPARATIONS:

      • Purified capsular polysaccharide of 23 serotypes of Streptococcus pneumoniae

      • 7 valent conjugated vaccine

    • ADMINISTRATION:

      • IM / SC

      • 1 dose/booster 5 years


    Pneumococcal Prophylaxis

    • INDICATIONS:

      • Primary vaccination (conjugate vaccine)

      • children 2 yr. or older with

        • Anatomical or functional asplenia

        • Sickle cell disease

        • Nephrotic syndrome

        • Immunosuppression


    Pneumococcal Prophylaxis

    • SIDE EFFECTS:

      • Soreness , erythema, fever, myalgia

      • Anaphylactic reactions (rare)


    Meningococcal Prophylaxis

    • PREPARATIONS:

      • monovalent (A or C)

      • bivalent (A & C)

      • quadrivalent (A,C,Y & W‑135)

      • quadrivalent conjugate quadrivalent

    • ADMINISTRATION:

      • SC


    Meningococcal Prophylaxis

    • INDICATIONS:

      • Control of outbreaks

      • Children with complement deficiencies or asplenia

    • SIDE EFFECTS:

      • local erythema and discomfort

      • transient fever


    Influenza Virus

    • Nature of vaccine:

      • Killed vaccine.

      • Live attenuated

    •  Preparations:

      • whole and “split virus” vaccines.

      • “split virus” vaccines are recommended for children 6 months and older.

      • composition of the vaccine is changed annually.


    Influenza Virus

    • ADMINISTRATION:

      • IM (killed).

      • Live attenuated (intranasal).

      • 1 dose during influenzae season.

      • Children 6months-9 years should receive an additional dose, 4 weeks after the 1st dose, if not previously immunized.


    Influenza Virus

    • Indications:

      • chronic cardio-respiratory disease

        • asthma

        • cystic fibrosis

        • bronchopulmonary dysplasia


    Influenza Virus

    • Indications:

      • Sickle cell anemia.

      • Chronic salicylate therapy.

      • Diabetes mellitus.

      • Chronic renal disease.

      • Chronic metabolic disease.

      • immunosuppressive conditions: cancer, HIV etc.

      • Hospital personnel with significant patient contact.


    Influenza Virus

    • Contraindication:

      • Anaphylaxis to previous dose.

      • Hypersensitivity to eggs.

    • Adverse Reaction:

      • Soreness at injection site.

      • Allergic response.

      • Guillain-Barré Syndrome.


    New Vaccines

    • Rota virus vaccines

    • Human papilloma virus vaccine


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