childhood Immunization, a powerpoint lecture 2023.pptx

ug pediatric teaching

1. Immunization

2. Impact of vaccines in India

3. Pregnant women

4. Vitamin A At 9 months 1 Lakh units oral From 16 months to 5 years: 2 Lakh units every 6 months (9 doses)

5. BCG Live attenuated vaccine prepared from mycobacterium bovis - Bacillus Calmette – Guérin Danish 1331 strain subcultured every 3 weeks for 13 years. Heat and light sensitive vaccine Scar: 2 to 3 weeks - papule; erthythema 5 weeks - vesicleà pustule 6-12 weeks - shallow ulcer covered with a crust. > 12 weeks: scar complications Abscess Keloid Adenitis Spread of tubercular disease Contraindication: HIV Immunocompromised child Mx + ve child

6. OPV Live attenuated whole virus vaccine; produces herd immunity. Trivalent- types I, II & III; Light and heat sensitive Neurovirulence – vaccine associated poliomyelitis Contraindications: > 5 years; severe immune deficiency; severe diarrhea IPV Fractional IPV is 1/5 of normal dose. This is recommended to prevent live attenuated polio spreading poliomyelitis.

7. Hepatitis B vaccination Hepatitis B is produced by recombinant technology in yeast Infection with HBV is one of the most important causes of chronic hepatitis, cirrhosis of liver, and HCC. These outcomes are all preventable by early childhood immunization. The vaccine is effective and safe.

8. Diphtheria, Tetanus, and Whole Cell Pertussis Vaccines DTwP is composed of tetanus and diphtheria toxoids as well as killed whole-cell pertussis ( wP ) bacilli adsorbed on insoluble aluminum salts which act as adjuvants. The efficacy of wP alone ranged from 61% to 89%, and the efficacy of combination DTwP vaccines ranged from 46% to 92%. Most adverse effects are due to the pertussis component. Pain, swelling, and redness at the local site, fever, anorexia, and vomiting are reported. Persistent crying, hypotonic hyporesponsive episodes (HHEs), seizures and encephalopathy are rare but serious adverse effects. Absolute contraindications are history of anaphylaxis or development of encephalopathy within 7 days following previous DTwP vaccination.

9. Haemophilus influenzae type b Hib is an important invasive pathogen causing diseases such as meningitis, bacteremia , pneumonia, cellulitis, osteomyelitis, septic arthritis, and epiglottitis. Efficacy trials have demonstrated 90–100% efficacy against culture proven invasive Hib disease for 1 year after vaccination. Side effects are mild and usually local.

10. ROTAVIRUS VACCINES Rotaviruses are globally the leading cause of severe, dehydrating diarrhea in children aged <5 years. The efficacy of Rotavirus vaccines against severe Rotavirus diarrhea ranges from 40-60% Rotavirus vaccine is a live attenuated, oral liquid vaccine. Each dose is of 5 drops (0.5ml). Rotavirus vaccine has a good safety record; minor symptoms such as diarrhea, vomiting and irritability may occur in some children. In rare cases, intussusception has been associated with some Rotavirus vaccines. Contrindication : History of documented intussusception or abdominal surgery or intestinal malformation. Š Known case of immunodeficiency.

11. MEASLES-RUBELLA The measles-rubella (MR) vaccine is prepared from the live, attenuated strains of Edmonston -Zagreb measles virus and Wistar RA 27/3 rubella virus. Both measles and rubella viruses are propagated on human diploid cells (HDCs). Seroconversion rates are around 80–85% at the age of 9 months. The MR vaccine is a WHO prequalified vaccine, safe and effective. Measles-containing vaccines vial can get contaminated when the cap is punctured, leading to bacterial growth in the vial as it does not contain preservative. Bacteria-like Staphylococci can cause severe toxic shock syndrome (TSS) The vaccine is contraindicated in the severely immunocompromised, in those with history of severe allergic reactions to the constituents and in pregnancy. The vaccine may contain traces of neomycin. Anaphylactic reactions to neomycin are absolute contraindications. There are extremely rare reports of hypersensitivity reactions with MR vaccines in individuals who are allergic to cow’s milk.

12. Human papillomavirus (HPV) HPV infections are transient, self-regressing and benign, persistent genital infection with certain viral genotypes can lead to the development of anogenital precancers and cancers. The dose is 0.5 mL intramuscular in deltoid. The recommended age for initiation of vaccination is 9 years. 2 doses at 0–6 months. In January 2023, the Indian Ministry of Health and Family Welfare wrote to seven state governments, requesting them to start preparations for the roll-out of the human papillomavirus (HPV) vaccine for girls aged 9–14 years. Once the notified states have covered children aged 9–14 years, HPV vaccination will become part of their routine immunisation programmes .