vaccination in infants pediatrics topic 1.pptx

vaccination

1. VACCINATION

2. IMMUNIZATION Immunization is defined as the procedure by which the body is prepared to fight against a specific disease. It is used to induce the immune resistance of the body to a specific disease. Immunization is of two types: Passive immunization Active immunization.

3. PASSIVE IMMUNIZATION Passive immunization or immunity is produced without challenging the immune system of the body. It is done by administration of serum or gamma globulins from a person who is already immunized (affected by the disease) to a non-immune person. Passive immunization is acquired either naturally or artificially

4. Passive Natural Immunization Passive natural immunization is acquired from the mother before and after birth.  Before birth, immunity is transferred from mother to the fetus in the form of maternal antibodies (mainly IgG) through placenta.  After birth, the antibodies (IgA) are transferred through breast milk Passive Artificial Immunization It is developed by injecting previously prepared antibodies using serum from humans or animals. This type of immunity is useful for providing immediate protection against acute infections like tetanus, measles, etc.

5. ACTIVE IMMUNIZATION Active immunization or immunity is acquired by activating immune system of the body. Body develops resistance against disease by producing antibodies following the exposure to antigens. Active immunity is acquired either ◦ naturally or artificially.

6. CONT Active Natural Immunization Naturally acquired active immunity involves activation of immune system in the body to produce antibodies. It is achieved in both clinical and subclinical infections Active Artificial Immunization Active artificial immunization is a type of immunization that is achieved by the administration of vaccines or toxoids.

7. WHY IMMUNIZATION ? Key strategy to child survival. Protecting infants from diseases. Lower morbidity and mortality rates in children. Indicator of a strong primary health care system.

8. VACCINE Any preparation of a weakened or killed bacteria or viruses introduced into the body to prevent a disease by stimulating antibodies against it. VACCINATION is the administration of antigenic material(the vaccine) to produce immunity to a disease.

9. HOW VACCINES WORK The body is exposed to a weakened or dead pathogen The body’s immune cells make antibodies to attack the pathogen If the body is exposed to the pathogen again, the body will be prepared with antibodies

10. VACCINE DOSING THROUGH THE LIFESPAN Some vaccines provide life-long immunity from a single dose New vaccines are needed frequently for pathogens that mutate often (such as influenza) Others provide greater protection after multiple doses VACCINES AREN’T JUST FOR CHILDREN – OLDER POPULATIONS NEED TARGETED PROTECTION FROM CERTAIN DISEASES

11. VACCINE COMPONENTS: SAFE AND EFFECTIVE Provide immunity Antigens Adjuvants Keep vaccines safe and long lasting Preservatives Stabilizers Used during the production of vaccines Cell culture materials Inactivating ingredients Antibiotics

12. CONT FULL IMMUNIZATION: Beneficiary child(12-23 months) -3 doses of DPT and OPV each, 1 dose of BCG & measles each. Mother- two dose or 1 booster dose of tetanus toxoid during her pregnancy. PARTIAL IMMUNIZATION Child-missed any vaccine or one or more dose Mother- received just one dose of primary tetanus toxoid during last pregnancy

13. CONT NON-IMMUNIZATION Child and/or mother –not received a single dose of vaccine. RING-IMMUNIZATION Vaccination of people in close contact with an isolated infected patient MOP-UP ROUNDS When the final pockets of polio virus transmission have been identified standard surveillance, door to door immunization in high-risk districts.

14. TYPES OF VACCINES Live attenuated: contain weakened pathogen; require 1-2 doses. Ex. MMR, rotavirus, varicella Subunit: contain killed, antigenic component of pathogen; require several doses (booster shots). Ex. Hib, HPV, pneumococcal Inactivated: contain killed pathogen; require several doses (booster shots). Ex. Hepatitis A, rabies, inactivated poliovirus vaccine Toxoid: contain toxin made by pathogen; may require booster shots. Ex. Diphtheria, pertussis

15. Types of Vaccine Vaccine type Vaccines of this type on U.S. Recommended Childhood (ages 0-6) Immunization Schedule Live, attenuated Measles, mumps, rubella (MMR combined vaccine) Varicella (chickenpox) Influenza (nasal spray) Rotavirus, OPV Inactivated/Killed Polio (IPV) Hepatitis A Toxoid (inactivated toxin) Diphtheria, tetanus (part of DTaP combined immunization) Subunit/conjugate Hepatitis B Influenza (injection) Haemophilus influenza type b (Hib) Pertussis (part of DTaP combined immunization) Pneumococcal Meningococcal 15

16. Routes of Administration Deep subcutaneous or intramuscular route (most vaccines) Oral route (oral BCG vaccine) Intradermal route (BCG vaccine) Intranasal route (live attenuated influenza vaccine)

17. Scheme of Immunization Booster vaccination To maintain immunity level after it declines after some time has elapsed (DT, MMR Short period (months): cholera vaccine Multiple dose vaccines (polio, DPT, hepatitis B ) Primary vaccination One dose vaccines (BCG, measles, mumps, rubella, yellow fever)

18. INFANTS VACCINE WHEN TO GIVE MAX.AGE DOSE ROUTE SITE BCG At birth Till 1 yr 0.1 ml (0.05 ml till 1 mth ) Intra - dermal L. Upper arm Hepatitis B At birth In 24 hrs 0.5 ml I.M. Anterolateral aspect of L. Mid thigh OPV₀ At birth In 1 st days 15 2 drops Oral OPV ₁₂ ₃ At 6,10, w 14 Till 5 yrs 2 drops Oral Rota virus vaccine 6 , 10, 14w Till 1 yr drops 5 Oral IPV 14 w Upto 1 yr 0.5 ml i.m . Anterolateral aspect of R. mid thigh Pentavac ₁₂₃ 6 , 10,14w Till 1 yr 0.5 ml I.M. Anterolateral aspect of l. Mid thigh Measles ₁ 9 - months 12 Till 5 yrs ml 0.5 S.C. R. Upper arm Japanese encephalitis 9 - 12 months Till 15 yrs 0.5 ml s.c . L. Upper arm Vitamin A 9 compltd mths Till 5 yrs 1 lakh IU Oral

19. VACCINES WHEN TO GIVE MAX. AGE DOSE ROUTE SITE DPT booster 16 - 24 months 7 yrs 0.5 ml I.M. Anterolateral aspect of l. Mid thigh Measles 2 nd 16 - 24 months Till 5 yrs 0.5 ml s.c . R. Upper arm OPV booster 16 - 24 months Til 5 yrs 2 drops Oral Japanese encephalitis 16 - 24 months 0.5 ml s.c . L. Upper arm Vitamin A 2 nd - 9 th dose 16 months.1 dose every 6 m Till 5 yrs 2 lakh IU Oral DPT 2 nd booster 5 - 6 yrs 7 yrs 0.5 ml i.m . l. Upper arm TT 10 & 16 yrs 0.5 ml i.m . Upper arm

20. MILESTONES IN IMMUNIZATION IN INDIA 1978: EPI 1985: UIP, measles vaccine added 1986: Technology mission 1990: Vitamin A 1992: CSSM 1995: Polio National Immunization days 1997: RCH-I 2005: RCH-II and NRHM

21. COMMONLY USED VACCINES

22. BCG Vaccine A ttenuated strain of M. tuberculosis var. bovis Used as live vaccine against tuberculosis Freeze dried( lyophilized) and stored at 4 C. Dose, Route ‒ 0.1ml, intradermal,on left upper arm at insertion of deltoid Adverse reactions ‒ Local ulceration or discharging sinus, axillary lymphadenitis, disseminated infection, osteomyelitis. Storage ‒ 2-8°C; sensitive to heat & light; discard unused vaccine after 4 hr After 2-3 weeks, a papule develops- heals to scar, local LNs can enlarge. Timing- Any time after birth since mother’s immunity is not transferred to fetus. Significant protection conferred against ,progressive primary tuberculosis and Disseinated TB including TB Meningitis. BCG does not protect from leprosy and other mibcrobial disease.

23. Immunity to diphtheria Antibody production against the exotoxin of C. diphtheria Usually mothers are immune to diphtheria and transplacental passage confers immunity in first few months H Influenzae conjugate vaccine containing PRP-D ( diphtheria toxoid) or CRM 197 ( diphtheria toxin variant) can not be substituted for diphtheria toxoid immunization. Schedule: 4 , 6 or 8th week. Booster recommended during 18 months

24. Poliomyelitis OPV Dose, Route ‒ 2 drops; oral Adverse reactions ‒ Vaccine derived polio virus, VAPP Contraindications ‒ Inherited or acquired immunodeficiency, symptomatic HIV Storage ‒ 2-8˚C ; sensitive to heat ; use vaccine vial monitor IPV Dose,Route-0.5ml,i.m/ s.c Adverse reactions -local pain and swelling Contraindications - Known allergy Storage - 2-8˚C sensitive to light

25. MEASLES VACCINE Dose, route ‒ 0.5ml, sc Site ‒ Right upper arm or anterolateral thigh Adverse reactions ‒ Fever, transient macular rash 5-10 days later. Contraindications ‒ ( i ) immunosuppressive therapy eg:alkylating agents, high dose corticosteroids (ii) malignancy (iii) immunodeficiency eg : advanced HIV (iv) untreated TB Storage- 2-8°C;sensitive to heat and light; use within 4-6 hrs of reconstitution

26. MMR Dose, route ‒ 0.5ml;s.c. Site ‒ Right upper arm or anterolateral thigh Dose, route ‒ 0.5ml, sc Site ‒ Right upper arm or anterolateral thigh Adverse reactions ‒ Fever, transient macular rash 5-10 days later. Contraindications ‒ ( i ) immunosuppressive therapy eg:alkylating agents, high dose corticosteroids (ii) malignancy (iii) immunodeficiency eg : advanced HIV (iv) untreated TB Storage‒ 2-8°C;sensitive to heat and light; use within 4-6 hrs of reconstitution

27. HEPATITIS B • • • Dose, route Site Schedule IAP 2012 ‒ 0.5ML, i.m. ‒ Anterolateral thigh; avoid gluteal region ‒ At birth, 6 weeks & 6 months; may give 3-4 doses in an alternative schedule while ensuring that ‒ Doses 1& 2 are ≥4weeks apart ‒ Doses 2&3 are≥8weeks apart ‒ Final dose is at ≥6mo of age &≥16weeks beyond 1 st dose

28. Catch up Adverse reactions Contraindications storage Complete 3 doses series; 2 nd dose is given ≥4weeks & 3 rd dose ≥8weeks after previous dose Local soreness, fever, fatigue Anaphylaxis after previous dos 2-8˚c ;do not freeze

29. WHAT SHOULD NOT HOLD ROUTINE IMMUNIZATION Minor illnesses such as upper respiratory infections or diarrhoea , mild fever(>38.5 c) Allergy, asthma Prematurity, underweight newborn child Malnutrition Child being breastfed Family history of convulsions Treatment with antibiotics Chronic disease of heart, lung, kidney and liver History of jaundice after birth

30. CONTRAINDICATION A rare condition in a recipient that increases the risk for a serious adverse reaction The only contraindication applicable to all vaccines is a history of a severe allergic reaction after a prior dose of vaccine or to a vaccine constituent PRECAUTION A condition in the recipient that may increase the risk of a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity Vaccine may be administered if the benefit from the vaccine is judged to outweigh the risk CONTRAINDICATIONS & PRECAUTIONS Contraindications and precautions are conditions under which vaccines should not be administered. The majority of these conditions are temporary, so immunizations often can be administered later when the conditions no longer exists.

31. COLD CHAIN A system of transporting and storing vaccines at recommended temperature from the point of manufacture to the point of use To prevent vaccine failure (sensitive to temperature). Potency of the vaccine decreases when exposed to inappropriate temperatures. Heat sensitive vaccine: OPV > Influenza > IPV, MMR > Cholera, Pentavac , Rotavirus > BCG, HPV > Hep B, Hib

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