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Immunisation Update

Immunisation Update. By Sindy Lee & Eva Wong 27 th March 2003. Case 1. Mr and Mrs Chan bring their 2 month old daughter, Siu-yee for her first immunisation. They say that they have received a reminder letter from the government and ask what their child what their child requires. Question 1.

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Immunisation Update

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  1. Immunisation Update By Sindy Lee & Eva Wong 27th March 2003

  2. Case 1 • Mr and Mrs Chan bring their 2 month old daughter, Siu-yee for her first immunisation. They say that they have received a reminder letter from the government and ask what their child what their child requires.

  3. Question 1 • What immunisation does the child now require?

  4. Question 2 • How and in what sites are these immunisation given?

  5. Question 3 • How should these vaccines be stored?

  6. Question 4 • Where and how should the vaccination be recorded?

  7. Question 5 • The parents ask about possible reactions to the vaccines. What advice would you give about possible adverse reaction?

  8. Question 6 • Mr Chan returns in 2 months for Siu yee’s sencond immunisation and tells you she had a fever after her last immunisation. She cried during the night. What questions would you ask Mr Chan? What would you advise about this immunisation?

  9. Question 7 • You next see Siu-yee at the age of 6 months when she has a slight rhinitis but no fever and her chest is clear. Would you give her immunisation? What precaution would you take?

  10. Case 2 • Siu-ming, an 18 month old infant is brought for his fourth triple antigen immunisation. You have not seen him before.

  11. Question 1 • What information would you requires before giving the injection?

  12. Question 2 • The parent informs you that Siu-ming had his 12month booster at another private doctor’s clinic. The boy has not had an examination since relocating 12 months ago. What questions would you like to ask about his general health and development?

  13. Question 3 • What examination would you perform?

  14. Question 4 • The parent informs you that although there are no hearing problems in the family, Siu-ming does not seem to turn around when spoken to. Otoscopic examination reveals some mucosal swelling and a dull drum on the left side. He has a slight post-nasal drip but is afebrile. • Would you give his immunisation?

  15. Question 5 • What is your management of the ear problem?

  16. Case 1 • Mr and Mrs Chan bring their 2 month old daughter, Siu-yee for her first immunisation. They say that they have received a reminder letter from the government and ask what their child what their child requires.

  17. Question 1 • What immunisation does the child now require?

  18. Question 2 • How and in what sites are these immunisation given?

  19. Case 1- answer 1, 2

  20. Immunization programme in Hong Kong 2003 intradermal

  21. Immunization programme in Hong Kong 2003

  22. Immunization programme in Hong Kong 2003 intramuscular

  23. Immunization programme in Hong Kong 2003 intramuscular

  24. Immunization programme in Hong Kong 2003 Subcutaneous

  25. Question 3 • How should these vaccines be stored?

  26. Case 1- answer 3 • Stored 2-8C • Upper deck: • oral polio, MMR, BCG, rebella • Middle deck: • hepatitis B, DTP, flu • Lower deck: emergency medication, NS • Thermometer for monitoring • Not to store with other foods • Minimize opening • New drug at the back

  27. Question 4 • Where and how should the vaccination be recorded?

  28. Case 1- answer 4 • In practice record • In child health record • Immunization record • Information: • Date • Vaccine • Adverse reaction • Expiratory date and serial number

  29. Question 5 • The parents ask about possible reactions to the vaccines. What advice would you give about possible adverse reaction?

  30. Case 1- answer 5 • BCG: local reaction • Polio: poliomyelitis (1/6.2million) • DPT: fever, seizures • HBV: rare • MMR: fever, rash, joints pain

  31. Question 6 • Mr Chan returns in 2 months for Siu yee’s sencond immunisation and tells you she had a fever after her last immunisation. She cried during the night. What questions would you ask Mr Chan? What would you advise about this immunisation?

  32. Case 1- answer 6 • ? Body temperature • Describe the crying • If temp >40.5C or crying >3-4 hr, child should preclude further pertussis vaccination • Consider prophylactic panadol

  33. Question 7 • You next see Siu-yee at the age of 6 months when she has a slight rhinitis but no fever and her chest is clear. Would you give her immunisation? What precaution would you take?

  34. Case 1- answer 7 • Rhinitis not a contraindication • Principles: • Careful education • Management of fever • Immunisation should not be inappropriately deferred due to infection

  35. Case 2 • Siu-ming, an 18 month old infant is brought for his fourth triple antigen immunisation. You have not seen him before.

  36. Question 1 • What information would you requires before giving the injection?

  37. Case 2 – answer 1 • Check previous immunisation record • Any adverse reaction • Allergies • Past medical history • Neurological diseases

  38. Triple vaccine • Contraindication: • Acute febrile illness • Active or progressive neurological disease • Previous severe reaction e.g. encephalopathy within 7 days after previous injection, immediate severe allergic or anaphylactic reaction

  39. Triple vaccine • Relative contraindications • Convulsion within 2 days • Persistant, inconsolable screaming for more then 3 hours within 2 days • Collapse or shock like state within 2 days • Unexplained high fever with 2 days • Sever local reaction

  40. Triple vaccine • NOT contraindications: • Family history of adverse reaction • Family history of convulsion • Permaturity • Asthma, eczema, allergies • Stable neurological condition

  41. Question 2 • The parent informs you that Siu-ming had his 12month booster at another private doctor’s clinic. The boy has not had an examination since relocating 12 months ago. What questions would you like to ask about his general health and development?

  42. Case 2 – answer 2 • Check previous health record • Discuss developmental milestone

  43. Question 3 • What examination would you perform?

  44. Case 2- answer 3 • Height and weight • Strabismus • Gait • Abdomen and testis • CVS

  45. Question 4 • The parent informs you that although there are no hearing problems in the family, Siu-ming does not seem to turn around when spoken to. Otoscopic examination reveals some mucosal swelling and a dull drum on the left side. He has a slight post-nasal drip but is afebrile. • Would you give his immunisation?

  46. Case 2- question 4 • There is no contraindication

  47. Question 5 • What is your management of the ear problem?

  48. Case 2 – question 5 • Dx: serous otitis media • Take 3 months to resolve • Conservative management • Refer ENT if parents concern or persistent symptoms • Prevent learning and language developmental problem

  49. Categorization of vaccines Live or inactivated ? BCG Live attenuated Inactivated IPV OPV Live attenuated MMR Live attenuated Chickenpox Live attenuated Hepatitis B Hep B surface anitigen DPT D&T toxoid, killed P organism Influenza Inactivated vaccine Haemophilus influenzae type B Inactivated

  50. Family history of any adverse reactions following immunisation Family history of convulsion or epilepsy Prematurity Symptomatic HIV History of anaphylactic reaction Neurological conditions, such as cerebral palsy and Down’s syndrome Those on immunosuppressive agents eg. steroids Asthma. ezema, hay fever, rash to egg protein to receive MMR Those on antibiotic or inhaled steroid Pregnancy Child is being breastfeed Under a certain weight Chronic illness eg. congenital heart disease Are they contraindication for vaccination? No No No Yes Yes No No No No Yes No No No

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