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Immunization
Dr. Tanveer Ashraf
Objectives
Types of vaccination Contraindications Discussion of individual vaccines
PreparationsAdministrationPrecautions and contraindicationsSide effects
Active Immunization Types Live attenuated
Virus Measles, mumps, rubella Bacteria BCG
Killed Virus Hepatitis B Bacteria
Whole PertussisToxoid TetanusPolysaccharide Meningoccocal
Human Immune Serum Globulin
SpecificIM Hepatitis B (HBIG)
Rabies (RIG)Tetanus (TIG)Varicella (VZIG)
IV CMV (CMV-IG)
RSV (RSV-IG)
Human Immune Serum Globulin
Non-specificIM Immune serum globulin(ISG)
Hepatitis AMeasles
IV Intravenous immune globulin(IGIV)Antibody deficiency disordersITPKawasaki syndrome
Passive Immunization (Cont)
SPECIFIC EQUINE ANTIBODIES (IM)BOTULISM ANTITOXINDIPHTERIA ANTITOXINTETANUS ANTITOXINSNAKE & SPIDER ANTI-VENOM
MONOCLONAL ANTIBODIES (IV)ANTI-ENDOTOXIN ANTIBODIES
Recommended Immunization Schedule
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)MMRVaricella
1 8 MONTHS Oral Polio Vaccine (OPV)DTP, HIB Hepatitis A
24 MONTHS Hepatitis A
4 – 6 YEARS Oral Polio Vaccine (OPV)DTPMMRVaricella
General Contraindications
Moderate or severe illness with or without fever Anaphylactic reaction to vaccine or vaccine
constituent Live attenuated vaccines
Pregnant womenImmunocompromised / Immunosuppressed
childrenwithin 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
Compulsory Vaccines
Bacillus Calmette‑Guerin Vaccine (BCG)
INDICATIONSAll newbornsAll tuberculin negative infants
PRECAUTIONS & CONTRAINDICATIONS(CI):
Give only to PPD negative childrenCI in persons with immunodeficienciesCI during pregnancy
Bacillus Calmette‑Guerin Vaccine (BCG)
SIDE EFFECTSLocal
Skin ulceration, regional lymphadenitisSubcutaneous abscess
Generalized
Anaphylaxis, generalized BCG infection(rare): osteitis
Hepatitis B
PREPARATIONSENGERIX‑BRECOMBIVAX HB
Hepatitis B
ADMINISTRATION:0.5 ‑1 ML, anterolateral thigh or deltoidIM injectionat 0,1 and 6 months
SIDE EFFECTS:PainArthralgia
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
ADMINISTRATIONIM
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 > 40.50Cpersistent inconsolable crying > 3 hoursCollapse episodesConvulsions
Measles, Mumps & Rubella (MMR)
PREPARATIONS:MEASLES.MMR.
ADMINISTRATION:SC.
INDICATIONS:Primary immunization at 1 & 6 years.
Measles, Mumps & Rubella (MMR)
PRECAUTIONS & CONTRAINDICATIONS PregnancyAnaphylaxis to eggsImmunodeficiency and
immunosuppression Immunoglobulins within 3-11 months
Measles, Mumps & Rubella (MMR)
ADVERSE REACTIONSFever ,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 IM12 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 patientsWithin 5 months of IGChildren on long term salicylates
SIDE EFFECTS:Fever , rashZoster
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 diseaseHemophilia
Hepatitis A
ADMINISTRATION:IM injection2 doses, at least 6 months apart
ADVERSE REACTIONS:Local reactions, feverRare: anaphylaxis
Additional Vaccines
Pneumococcal Prophylaxis
PREPARATIONS:Purified capsular polysaccharide of 23
serotypes of Streptococcus pneumoniae7 valent conjugated vaccine
ADMINISTRATION:IM / SC1 dose/booster 5 years
Pneumococcal Prophylaxis
INDICATIONS:Primary vaccination (conjugate vaccine)children 2 yr. or older with
Anatomical or functional aspleniaSickle cell diseaseNephrotic syndromeImmunosuppression
Pneumococcal Prophylaxis
SIDE EFFECTS:Soreness , erythema, fever, myalgiaAnaphylactic 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 outbreaksChildren with complement deficiencies
or aspleniaSIDE EFFECTS:
local erythema and discomforttransient 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 vaccinesHuman papilloma virus vaccine