5. Immunization mine................pptx

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1. Immunization Dr Meron August, 2023 1

2. Objectives Define Immunization and discuss the classification of immunization. Discuss periods of effectiveness of Vaccines Define Cold chain Discuss Expanded program of immunization in Ethiopia Discuss catch up immunization practice List contraindications for vaccination 2

3. Introduction Immunization : is the process of inducing immunity against a specific disease. is one of the most beneficial and cost-effective disease prevention measures available. Vaccination is act of administering vaccines. 3

4. Vaccines are products that produce immunity from disease. can be given orally , via injection or through aerosol spray. Vaccines can be live or in activated ,part or whole organism. Toxoid is a modified bacterial toxin that is made non toxic but is still able to induce an active immune response against the toxin. 4

5. Classification Passive immunization : administration of antibody containing preparation. Natural: trance-placental transfer of antibodies. Artificial: by giving immunogloblins or antiserum. Protection is immediate, yet transient, lasting weeks to months. 5

6. Active immunization : administration of vaccine or toxoids to stimulate the immune system to produce a prolonged humeral and /or cellular immune response. 6

7. PERIODS OF MAINTAINED IMMUNITY BY VACCINES Short period (months): cholera vaccine Three to five years: DPT vaccine Five or more years: BCG vaccine Ten years: yellow fever vaccine Solid immunity: measles, mumps, and rubella vaccines. 7

8. THE COLD CHAIN The "cold chain" is a system of storage and transport of vaccines at low temperature from the manufacturer to the actual vaccination site. The cold chain system is necessary because vaccine failure may occur due to failure to store and transport under strict temperature controls. 8

9. THE COLD CHAIN EQUIPMENT Walk in cold rooms : They are located at regional level, meant to store vaccines up to 3 months and serve districts. Deep freezers (300 ltr) and Ice lined Refrigerators : supplied to all districts and the WIC locations to store vaccines. Deep freezers are used for making ice packs and to store OPV and measles vaccines. 9

10. THE COLD CHAIN EQUIPMENT cont’d… Small deep freezers and ILR (140 ltr) : One set is provided to PHCs, and Family Planning Centers Cold boxes : Cold boxes are supplied to all peripheral centers. These are used mainly for transportation of the vaccines. 10

11. THE COLD CHAIN EQUIPMENT cont’d… Vaccine carriers : Vaccine carriers are used to carry small quantities of vaccines (16-20 vials) for the out of reach sessions. 4 fully frozen ice packs are used for lining the sides, and vials of DPT, DT, TT and diluents should not be placed in direct contact with frozen ice packs. The carriers should be closed tightly. Ice packs : The ice packs contain water and no salt should be added to it. 11

12. THE COLD CHAIN cont’d… Vaccines which must be stored in the freezer compartment are : polio and measles. Vaccines which must be stored in the COLD PART but never allowed to freeze are : typhoid, DPT, tetanus toxoid, DT, BCG and diluents 12

13. Ethiopian Program of Immunization EPI was Introduced by WHO in 1974 to control vaccine preventable diseases In Ethiopia, routine immunization was launched in 1980 with the six traditional antigens provided for children below two years of age. The schedule was revised in 1986 to include only infants under one year in line with the global target. 13

14. Immunization schedule -Ethiopia VACCINATION FOR INFANTS AGE VISIT ANTIGEN BIRTH 1 BCG, OPV0 6 weeks 2 DPT-HepB1-Hib1, OPV1, PCV1, Rota1 10 weeks 3 DPT-HepB2-Hib2, OPV2, PCV2, Rota2 14 weeks 4 DPT-HepB3-Hib3, OPV3, PCV3, IPV 9 months 5 Measles, IPV 15 months 6 Measles 6-59 months Vitamin A Supplement 14

15. Vaccines Type of Vaccine Dose Mode of administration 1.BCG 0.1ml upper right arm , intradermal 2..OPV 2 drops oral 3.DPT-hepB-Hib 0.5ml Anterolateral left thigh , IM 4.Rota The whole bottle oral 5.PCV 10 0.5ml Anterolateral right thigh , IM 6. IPV O.5ml Anterolateral right thigh , IM 6. Measles 0.5ml Upper right arm ,subcutaneous 15

16. 10 vaccine preventable diseases are targets of current Ethiopian routine Immunization OPV BCG Penta-valent PCV RotA Measles 16

17. BCG( Bacilli Calmettie Guerin ) It contains freeze, dried live attenuated strains of M.bovis. Is given at birth or first week of life(as early as 3 months) Its efficacy is 0-80%(average of 50%) for pulmonary TB. And is 50-80% for severe forms of TB. Like meningitis, miliary , and disseminated TB.. 17

18. BCG (cont’d) Unknown duration of immunity, some evidences suggest the immunity wanes after 10-15 years. It is stored at 2 ̊c-8 ̊c,not to be frozen. It is sensitive to heat and light and might be killed by alcohol used to clean the top of the vial. 18

19. BCG (cont’d) Side effects: Small swelling at the site of injection with in 2weeks and after a week it form a small abscess, ulcerate and leaves a scar. The scar has 2 uses Witnesses the child is vaccinated Good degree of immune response 19

20. BCG (cont’d) Other rare S/E Deep abscess and involvement of LN ( right axillary LAP) Extension of infection to bones  osteomyelitis It is contraindicated in those children with severe immunodeficiency. 20

21. Polio vaccine OPV or sabin( is a live vaccine); had been used in our setting. Contain attenuated polio virus type 1,2 and 3. Given orally in three doses each two drops at 6,10 and 14 Wks. Provides local protection(IgA antibody in GI tract). 21

22. Polio vaccine (cont’d) Stored at 2ᵒc to 8 ᵒc. The only vaccine which can be frozen safely. Can be stored for years at -20 ᵒc. For one year at -10 ᵒc. Causes paralytic disease(VAPP)1 case/6.2 million doses both in recipients and their contacts. Efficacy: >90% in industrialized countries. 22

23. Polio vaccine ( cont’d ) Inactivated /killed (salk) polio vaccine : Given by injection. Does not need freezing Efficacy is >93 % after two doses Not associated with paralytic disease. Is started recently in Ethiopia. Can be used in HIV symptomatic patients. 23

24. Pentavalent Vaccine ( Hib+DPT+Hepatitis-B ) The Pentavalent vaccine combines five different vaccines in one injection to protect against Five diseases: Haemophilus influenzae type B (Hib) disease Diphtheria Pertussis Tetanus and Hepatitis-B 24

25. Diphtheria vaccine Is a toxoid prepared by formaldehyde inactivation of diphtheria toxin. Efficacy :> 87% Duration of immunity : variable probably around 5 yrs. no significant adverse reaction. 25

26. Pertussis vaccine Killed whole vaccine. Stored at 2ᵒc to 8ᵒc. Efficacy: around 80% with 3 doses Duration of immunity : unknown but it wanes over time. 26

27. Pertusis (cont’d) Side effects : fever, drowsiness, persistent cry, fever>40 ᵒc, seizure(febrile in 3-90 in a million who took it) and hypotonia . C/I : encephalopathy(seen in 3-6 in a million who took it) within seven days of administration of DPT dose. :shock like state. Not given in those who are >7 years of age. 27

28. Tetanus vaccine I s inactivated toxin with formaldehyde. It should be stored at 2ᵒc to 8ᵒc. Vaccine efficacy :>90% with two doses. Duration of immunity:5yrs after primary series. Booster doses should be given every 5-10yrs. Side effect : safe preparation. Rare side effects includes anaphylaxis ,GBS and brachial neuritis. 28

29. Heamophilius influenza type b vaccine: Is a polysaccharide conjugate vaccine. It should be stored at 2ᵒc to 8ᵒc.Don’t freeze. Hib polysaccharide conjugated to diphtheria to tetanus toxiod or to an outer membrane protein complex of Neisseria meningitis group B. It is virtually free of side effect. Efficacy : ≥95 percent against invasive Hib disease after completion of the two- or three-dose 29

30. Pneumococcal vaccine : Is a polysaccharide conjugate vaccine. It contains a polysaccharide of 10 serotypes of pneumococcus (10-valent vaccine )conjugated to carrier protein, tetanus and diphtheria toxin. It is given intramuscular in children <2yrs of age at 6,10 and 14 Wks. 30

31. Pneumococcal vaccine (cont’d) Efficacy: decrease infection caused by the serotype by 60-70% Side effect : rarely injection site hematoma, fever , and rash 31

32. Hepatitis B vaccine : Contains a purified inactive sub-unit of the virus. Efficacy: 85% effective in preventing perinatally acquired infection and 80-95% effective in preventing postnatally acquired infection . Infants born from HbsAg positive mother should receive the vaccine at birth ,1-2 months and at 6 months. 32

33. Rota virus vaccine Is al live a attenuated vaccine. is a monovalent vaccine derived from the most common human rotavirus serotype(G1P strains) . is administered orally in two doses at 6 and 10 wks. The first dose is not given for those 15 weeks of age or older. The final dose must be administered not later than 8 months. 33

34. Rota virus vaccine It should be given to children who have had rotavirus gastroenteritis before completing the two-dose series because the initial infection frequently provides only partial immunity. Side effect: vomiting,diarrhea, rhinorhea C/I: anaphylactic RXN, history of intussusception after 1st dose and immunodeficiency. Efficacy: against gastroenteritis caused by G1P strains was 92 %. 34

35. Measles vaccine Is a live attenuated vaccine. It should be stored at 2ᵒc to 8ᵒc. Given subcutaneously(IM or deep SC) in the left deltoid at 9 months (at 6 months for those at risk of acquiring the virus) and 15 months of age. Efficacy:>90% at 12 months and >85% at 9 months(lower efficacy when maternal antibody presents), >95% when 2 doses given. 35

36. Measles (cont’d) Duration of immunity: life long Side effects: mild febrile illness or morbilifom rash,febrile convulsion. C/I : immunodeficiency and pregnancy . 36

37. Catch-up immunization “ Take every opportunity to vaccinate children and adults ” For people with no documented vaccine history age at 1 st visit = age of the person at presentation for 1 st series of vaccine visit number = e.g.1 st visit is the day first doses of vaccines are given Interval due =time interval required b/n doses minimum spacing requires 1 month .some vaccines require longer spacing 37

38. Catch-up immunization For such children immunization is started with vaccines at birth,6 weeks,10 weeks,14 weeks given 4 weeks apart. If child is >9 months measles vaccine should be given 4 weeks after Penta-3. NB; No catch-up for Rota vaccine should be started after 15 weeks. 38

39. PRECAUTION AND RECOMMENDATION A general contraindication for all vaccines is anaphylactic reaction to a prior dose. Anaphylactic hypersensitivity to vaccine constituents is also a contraindication. Live vaccine should not be given to immunodeficient children . Administration of live vaccine should be delayed for at least 6 weeks when there is recent administration immunogobulin. 39

40. PRECAUTION AND RECOMMENDATION cont’d… Vaccines usually should be deferred (postpone) in children with moderate to severe acute illnesses, regardless of the presence of fever, until the child recovers. Simultaneous administration of multiple vaccines generally is safe and effective In events of an epidemic or high risk measles vaccine can be given at 6 month . 40

41. Thank You ! 41