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Immunization

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

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  1. Immunization Dr. Tanveer Ashraf

  2. Objectives • Types of vaccination • Contraindications • Discussion of individual vaccines • Preparations • Administration • Precautions and contraindications • Side effects

  3. Active Immunization • Types • Live attenuated • Virus Measles, mumps, rubella • Bacteria BCG • Killed • Virus Hepatitis B • Bacteria • Whole Pertussis • Toxoid Tetanus • Polysaccharide Meningoccocal

  4. Human Immune Serum Globulin • Specific • IM Hepatitis B (HBIG) • Rabies (RIG) • Tetanus (TIG) • Varicella (VZIG) • IV CMV (CMV-IG) • RSV (RSV-IG)

  5. 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

  6. Passive Immunization (Cont) • SPECIFIC EQUINE ANTIBODIES (IM) • BOTULISM ANTITOXIN • DIPHTERIA ANTITOXIN • TETANUS ANTITOXIN • SNAKE & SPIDER ANTI-VENOM • MONOCLONAL ANTIBODIES (IV) • ANTI-ENDOTOXIN ANTIBODIES

  7. Recommended Immunization Schedule

  8. 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

  9. 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

  10. 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

  11. 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

  12. Compulsory Vaccines

  13. 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

  14. Bacillus Calmette‑Guerin Vaccine (BCG) • SIDE EFFECTS • Local • Skin ulceration, regional lymphadenitis • Subcutaneous abscess • Generalized • Anaphylaxis, generalized BCG infection • (rare): osteitis

  15. Hepatitis B • PREPARATIONS • ENGERIX‑B • RECOMBIVAX HB

  16. Hepatitis B • ADMINISTRATION: • 0.5 ‑1 ML, anterolateral thigh or deltoid • IM injection • at 0,1 and 6 months • SIDE EFFECTS: • Pain • Arthralgia

  17. 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)

  18. Diphtheria, Tetanus & Pertussis (DTP) • PREPARATIONS • < 7 years : DTP, DT, DTaP (acellular pertussis vaccine) • > 7 years : Td, TdaP • ADMINISTRATION • IM

  19. 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

  20. Measles, Mumps & Rubella (MMR) • PREPARATIONS: • MEASLES. • MMR. • ADMINISTRATION: • SC. • INDICATIONS: • Primary immunization at 1 & 6 years.

  21. Measles, Mumps & Rubella (MMR) • PRECAUTIONS & CONTRAINDICATIONS • Pregnancy • Anaphylaxis to eggs • Immunodeficiency and immunosuppression • Immunoglobulins within 3-11 months

  22. 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

  23. 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

  24. Varicella Prophylaxis • PREPARATIONS: • Varivax vaccine (MSD) • ADMINISTRATION: • 0.5 ml IM • 12 months and above……..2 doses

  25. Varicella Prophylaxis • INDICATIONS: • All children 12 months‑18 years: (if no history of varicella) • EFFICACY: • 70‑90%

  26. Varicella Prophylaxis • PRECAUTIONS & CONTRAITNDICATIONS: • Immunocompromised patients • Within 5 months of IG • Children on long term salicylates • SIDE EFFECTS: • Fever , rash • Zoster

  27. Hepatitis A • NATURE OF VACCINE: • Killed formalin inactivated vaccine. • PREPARATIONS: • Various preparations available • e.g. Havrix 720 Junior, Havrix 1440 etc.

  28. Hepatitis A • INDICATIONS: • children 1 year and above • Susceptible children in endemic areas • Chronic liver disease • Hemophilia

  29. Hepatitis A • ADMINISTRATION: • IM injection • 2 doses, at least 6 months apart • ADVERSE REACTIONS: • Local reactions, fever • Rare: anaphylaxis

  30. Additional Vaccines

  31. Pneumococcal Prophylaxis • PREPARATIONS: • Purified capsular polysaccharide of 23 serotypes of Streptococcus pneumoniae • 7 valent conjugated vaccine • ADMINISTRATION: • IM / SC • 1 dose/booster 5 years

  32. Pneumococcal Prophylaxis • INDICATIONS: • Primary vaccination (conjugate vaccine) • children 2 yr. or older with • Anatomical or functional asplenia • Sickle cell disease • Nephrotic syndrome • Immunosuppression

  33. Pneumococcal Prophylaxis • SIDE EFFECTS: • Soreness , erythema, fever, myalgia • Anaphylactic reactions (rare)

  34. Meningococcal Prophylaxis • PREPARATIONS: • monovalent (A or C) • bivalent (A & C) • quadrivalent (A,C,Y & W‑135) • quadrivalent conjugate quadrivalent • ADMINISTRATION: • SC

  35. Meningococcal Prophylaxis • INDICATIONS: • Control of outbreaks • Children with complement deficiencies or asplenia • SIDE EFFECTS: • local erythema and discomfort • transient fever

  36. 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.

  37. 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.

  38. Influenza Virus • Indications: • chronic cardio-respiratory disease • asthma • cystic fibrosis • bronchopulmonary dysplasia

  39. 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.

  40. Influenza Virus • Contraindication: • Anaphylaxis to previous dose. • Hypersensitivity to eggs. • Adverse Reaction: • Soreness at injection site. • Allergic response. • Guillain-Barré Syndrome.

  41. New Vaccines • Rota virus vaccines • Human papilloma virus vaccine

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