VACCINES AND ANTIBIOTIC PROPHYLACTIC REGIME.ppt

vaccines their indications and regimen

1. VACCINES AND ANTIBIOTIC
PROPHYLACTIC REGIME
PRESENTER –
RUCHI KHINDRIA

2. VACCINES
Vaccine is an immuno-biological substance designed to
produce specific protection against a given disease
•It stimulates the production of antibody and other
immune mechanism's
Vaccines may be prepared from –
•Live modified organism
•Inactivated or killed organism
•Microbial extracts
•Vaccine conjugate
•Toxoid
•combination

3. Impact of Vaccines on Public
Health
Individual
Economical
Societal

4. TYPE OF VACCINES
Three type of vaccine -
-PLAIN VACCINE
-ADJUVANT VACCINE
-FREEZE – DRIED VACCINE
PLAIN vaccine – Less efficacious than adjuvant vaccine
ADJUVANT vaccine – Adjuvant are substance added to vaccine
to potent immune system , so as greater amount of antibodies
are produced , a lesser quantity of antigen is required as a
result fewer dose is to be given

5. •Adjuvant e.g. (aluminum phosphate, aluminum
hydroxide )
It is partly due to formation of local granuloma which
retains antigen and from which antigen is slowly
released
•Freeze-Dried vaccine –
-BCG
-YELLOW FEVER
-MEASELS
•These are stable preparations than liquid vaccines

6. Combination vaccine –
If more than one kind of immunizing agent is included
in vaccine it is called Mixed or Combined vaccine
•DPT
•DT
•DP
•MMR
•DPT plus polio

7. Immunization saves lives
•Immunization saves
the lives of
approximately 3
million people each
year, all over the
world.

8. Immunization is used either to prevent primary infection or to
prevent secondary consequences of an infection
Benefits of proposed immunization program must take into
account-
Likelihood of occurrence of an infection in a definite
population
Likelihood that vaccine will prevent that infection
Benefits should over weigh the adverse effect.
The availability of vaccine has resulted in global eradication of
small pox , and the virtual elimination of poliomyelitis, tetanus
and diphtheria

9. Childhood
Immunization
A worthwhile investment

10. TYPES
•Protection of individuals from disease by vaccine
can take two forms –
•PASSIVE IMMUNIZATION
•ACTIVE IMMUNIZATION

11. PASSIVE IMMUNIZATION
• It is achieved by injecting a recipient with preformed
immunoglobulin obtain from human serum
•It provide immediate protection to individuals who is
exposed to infectious organism and lack active
immunity to that pathogen
•It does not active the immune system, so no memory
response
•It is not permanent and disappears after week or
months as immunoglobulin are cleared from
recipient’s serum

12. Type of immunoglobulin used to give passive
immunity
Non – specific standard immune globulins –
This mixture of plasma protein contain broad
spectrum of antibodies
•These immunoglobulin contains mixture of
antibodies reflecting previous exposure of plasma
donor to various antigen
•It is used for prevention of illness for which there is
no specific immunoglobulin preparation

13. Hyper immune human immunoglobulin –
•This contain high concentration of antibodies directed
against specific antigen
•Hepatitis B – used to prevent infection after exposure
to hepatitis virus
•Rabies – used to prevent infection from rabies after
bite from rabid animal
•Tetanus – vaccine to prevent tetanus after deep
puncture wound

14. ACTIVE IMMUNIZATION
•It is achieved by injecting viable or non- viable pathogens or
purified pathogen products , prompting the body to respond as
if the body were being attacked by infectious organism
•It require several days to months to become effective
•Immunity is prolonged
•Administration of both active as well as passive immunization
may be required after exposure to certain infections e.g.
•Hepatitis B immunoglobulin, in combination with active
immunization provides post-exposure prophylaxis

15. FORMUATIONATION FOR ACTIVE
IMMUNIZATION
LIVE PATHOGENS –
•When live pathogens are used they are attenuated to preclude
clinical consequences of infection
•Attenuated microbes reproduce in the recipient
•Provides long lasting immunity
•However , with live attenuated vaccine there is possibility
that vaccine strain will revert to active pathogen e.g.
Disadvantages - Vaccine associated poliomyelitis with dose of
live polio vaccine
Limitation – Not given in immuno compromised person

16. KILLED MICRORGANISMS –
•No risk of vaccine associated infection
•It provide short lived immune response
•Polio and typhoid vaccine are available in both live and killed
version
MICROBIAL EXTRACTS –
vaccine is composed of antigen molecules extracted from
pathogens
Efficacy of these antigen varies
In some instances ,vaccine antigen is present on all strains of
organism ,with other pathogens such as pneumococcal ,
protective antibodies are present against specific capsular
polysaccharides, so for this reason pneumococcal vaccine is
composed of different polysaccharide , comprising antigen
produced by common type of disease ,causing pneumococci

17. VACCINE CONJUGATES –
vaccine can produce humoral immunity through B cell
proliferation leading to antibody production which
may or may not involve T cell
e.g. H. influenza. These T cell independent responses
have low antibodies titer particular in children less
than 18 months of age . So conjugating H. influenza
with diphtheria toxin give protection to child below
18 months age
TOXOIDS – Derivatives of bacterial exotoxins
produced by chemically altering natural toxins

19. TRASNSPORT OF VACCINES
•COLD – CHAIN – It is a system of transport and
storage of vaccines at low temperature from
manufacture to actual vaccine site
•It is important as failure may occur
•Polio is the most sensitive to heat, requiring
storage at -20 deg c
•Freeze storage vaccine- polio, measles
•Cold storage vaccine – DPT, Tetanus, DT , BCG

20. COLD CHAIN EQUIPMENT
WALK IN COLD ROOMS-
•Located at regional levels
•Vaccine storage for 3 mth
•Serve 4 – 5 districts
DEEP FREEZERS AND ILR-
Located at districts
OPV, Measles
SMALL DEEP FREEZER-
Provided to urban family planning centers
Transport of vaccines

21. COLD BOXES –
•In peripheral centers
•Use to transport vaccine
•Ice packs are placed at bottom
VACCINE CARRIERS-
Use to carry 16 – 20 vials
DAY CARRIERS –
Carry 6 – 8 vials
ICE PACK –
Contain water , no salt should be added

22. STORAGE
•Keep equipment in cool room away from sunlight
•Equipment should be connected to stabilizer
•Vaccine should be kept with air in between
•Equipment should be locked
•Defrost periodically
•Do not store any other drugs
•Do not keep expire date vaccines

23. HAZARDS OF IMMUNIZATION
Reactions inherent to immunization-
- Local reactions
•Pain ,swelling, redness, tenderness and sterile abscess
-General reactions
•Fever, malaise and headache
Reactions due to faulty technique-
•Faulty production of vaccine (inadequate inactivation of
microbe )
•Excess of single dose
•Improper site and route
•Improper sterile syringes

24. Reaction due to hypersensitivity-
•Anaphylactic shock
•Serum sickness- fever, rash, edema and joint pain
Neurological involvement-
•Encephalitis
•Encephalopathy
•Guillain-barre syndrome

25. PRECAUTIONS
•Before administration of antiserum it is important to
test for sensitivity
-Instilling a drop of preparation into conjuctiva
-Intradermal injection of 0.2ml antiserum diluted in
saline . A sensitized person will develop ‘Wheal and
Flare’ within 10 min of injection
•Adrenaline sol should be kept ready
•In case of anaphylaxis 0.5 ml should be injected
intramuscularly

26. If there are risks involved with vaccination,
why vaccinate?
The risks are lower, on average, than they would be if a
person got the disease
It is much easier to give a vaccine than treat the disease
Reduce the number of infected people, protecting the rest of
the population
They save millions of dollars and increase productivity
Less money and other resources spent on medications,
doctor visits

27. UNIVERSAL IMMUNIZATION PROGRAMME
•In May 1974, WHO launched Global immunization
programme –
Expanded Programme On Immunization (EPI)
To protect against 6 vaccines-
•Diphtheria
•Whooping cough
•Tetanus
•Polio
•TB
•Measles

28. IMMUNIZATION SCHEDULE
For infants
At birth - BCG and Polio
At 6 weeks - BCG (if not given at birth)
DPT-1 and OPV-1
At 10 weeks - DPT-2 and OPV-2
At 14 week - DPT-3 and OPV-3
At 9 mth - Measles
At16 -24mth - DPT and OPV
At 5 – 6 yr - DT second dose should be given if no previous
history of DPT
At 10 and 16 yr - TT

29. WHO IMMUNIZATION SCHEDULE
AGE VACCINE

•BIRTH BCG, Oral polio
•6weeks DPT, oral Polio
•10week DPT, oral polio
•14week DPT, oral polio
•9mth Measles

30. Smallpox
Vaccination
• Jenner 1796 :
Cowpox/Swinepox
• 1800’s Compulsory
childhood vaccination

31. Edward Jenner , performed first vaccination against smallpox

32. CHICKENPOX (VARICELLA) VACCINE
•Varicella is an acute infectious disease caused by varicelle –
zoster virus
•Characterized by rash, fever, malaise
Update recommendations include-
•Establishing child care
•In children with HIV infection
•Use in adult and adolescent at risks
VACCINE- A live attenuated varicella zoster vaccine was
developed in Japan
•Vaccine is 100% effective in preventing serious disease
•Immunity persist for more than 20 yr

33. •Preparations available – A live attenuated vaccine (OKA) stain
VZV is produced
•Storage – In freezer at -15 c
•Shelf life – 15 months
•Consumed within 30 min
•Dosage and Schedule – 1.25 – 5 ml given IM
•For healthy children aged 12 mth –13yr
•Children over age 13yr require 2 doses 1 month apart
•Var may be given along with MMR at separate site
•Contraindications – Anaphylactic reactions
Immunosuppressive therapy

34. MEASLES
( RUBEOLA)
•Caused by Myxo virus
•Causes fever, URT infection
•Vaccine administered at the age of 9mth
•If given bet 6 – 9 mth of age 2
nd
dose given 1mth
after 1
st
dose
•Dose 0.5ml subcutaneously

35. RUBELLA VACCINE
(GERMAN MEASLES)
•Rubella or German measles is an acute childhood
infection, usually mild, of short duration
(approximately 3 days) and accompanied by low-
grade fever, lymphadenopathy and a maculo -
papular rash. Infection in early pregnancy may
result in serious congenital defects, including
death of the fetus.

36. Rubella vaccines
•In 1979 the RA 27/3 vaccine, produced in human
diploid fibro-blast has replaced all the other vaccines.
•RA 27/3 vaccine induces higher antibody titers and
produces an immune response more closely
paralleling natural infection than other vaccines
•Dose - HA 27/3 vaccine is administered in a single
dose of 0.5 subcutaneously
• Vaccine—induced immunity persists for at least 14
to 16 years and probably is lifelong

37. MUMPS
•An acute infectious disease caused by a specific virus
which has a prediliction for glandular and nervous
tissues
• A highly effective live attenuated vaccine
• Dose - 0.5 ml intramuscular
• Combined vaccine - Measles-Mumps-Rubella
vaccine/Rubella-Mumps

38. INFLUENZA
•Influenza is an acute respiratory tract infection caused by
influenza virus
Caused by - Influenza A strains
Characterized by sudden onset of chills, malaise, fever
LIVE ATTENUATED VACCINES:
•Administered as - “Nose drops" into the respiratory tract.
•They stimulate local as well as systemic immunity.
•The frequent antigenic mutations of the influenza virus present
difficulties in production of effective vaccines, particularly
live vaccines.

39. KILLED VACCINE
The vaccine is conventionally formulated in aqueous
saline suspension.
Dose - 0.5ml subcutaneous route
One dose of the vaccine contains15 micrograms of HA
•However, in persons with no previous immunological 2 doses
separated by an interval of 3 to 4 weeks to induce satisfactory
antibody levels.
•increase in serum antibodies about one week, which reach a
maximum in about 2 weeks.
•immunity lasts for only 3 to 6 months
•Revaccination on an annual basis is recommended.

40. NEWER VACCINES
•Split virus vaccine
•Neuraminidase
•Split virus vaccine – it
provides lower antigen titer
so more injection required
•Neuraminidase –
antibodies against
neuraminidase antigen

41. DIPTHERIA
•It is an acute infectious disease caused by
Corneybacterium diptheriae
•The bacilli multiply in the throat and elaborate a
powerful toxins –
•Formation of greyish membrane over tonsils, and it
cannot be wiped
•Marked congestion, oedema
•Enlargement of regional lymph node
•Signs and symptoms of toxemia

42. DIPTHERIA IMMUNIZATION
COMBINED or MIXED vaccines –
• DPT
• DT
• dT
SINGLE vaccines -
FT (formal – toxoid)
APT (alum – ppt toxoid)
PTAP (purified toxoid aluminium phosphate)
PTAH (purified toxoid aluminium hydroxide )
TAF (toxoid – antitoxin floccules )
ANTISERA
Diptheria anti - toxin

43. DIPTHERIA VACCINES
•When diptheria is suspected , diptheria antitoxoid
should be given without delay
•Dose – 10,000 – 80,000 units IM or IV
•Test for sensitivity should be done using test dose
of 0.2ml subcutaneously to detect sensitivity to
horse serum

44. COMPOSITON OF DPT
Contents -
•Diptheria toxoid
•Tetanus toxoid
•Pertussis
•Al phosphate
STORAGE –
Stored in a refrigerator between 4 – 8 d c
Optimum age – administered as early as 6 weeks of age,
10wks, 14wks, 1-1 ½ yr and 5-6yr

45. •Interval between doses –Interval of 4wks between 3
doses
Mode of administration –
•IM injected deep may be given in upper and outer
quadrant of gluteal region
Contraindications – since severity of Pertusis decreases
with age, Pertusis component in DPT vaccine is not
recommended after 6 yr age
•So such children requires only 2 doses of DT
•For children over 12yr age dT is given

46. WHOOPING COUGH VACCINE
(PERTUSIS)
•Infectious disease of young children caused by
B. Pertusis .
•Onset with mild fever and irritation cough
•Active immunization – DPT
•Pertussis vaccine – against Pertussis alone
•It is killed whole cell preparation

47. TUBERCULOSIS
•It is a specific infectious disease caused by M.
tuberculosis
•It primarily affects lungs and causes pulmonary
tuberculosis
•India accounts for nearly 1/3
rd
of global burden of
tuberculosis
•Man has no inherited immunity against TB. It is
acquired as a result of natural infection or BCG
vaccination . In most cases, the cellular immunity
is adequate to limit multiplication of the bacilli.

48. THE CONTROL OF TUBERCULOSIS
Control means reduction in prevalence of disease in community
WHO defines that TB ‘control’ is said to be achieved when
prevalence of natural infection in the age group 0 – 14 yr is of
order of 1%
•But this is about 40% in India
The ‘CONTROL’ measure consist of -
•CURATIVE component – case finding and treatment
•PREVENTIVE component - BCG vaccination
•These are two fundamental component of National Tuberculosis
Programme

49. BCG VACCINATION
•Ever since Koch discovered M. tuberculosis attempts have
been made to prepare a prophylactic vaccine against TB using
either attenuated or killed tubercle bacilli.
•Calmette and Guerin two French scientists develop vaccine
against TB , they were able to evolve a strain – known as
bacilli Calmette Guerin or BCG

50. BCG VACCINATION
AIM – Induce a benign, artificial primary infection which will
stimulate acquired resistance with virulent tubercle bacilli
Vaccine – BCG is the only widely used live bacterial
Vaccine
•It consist of living bacteria derived from an attenuated bovine
strain of TB
Types of vaccine – two types of BCG vaccine
•LIQUID vaccine (fresh)
•FREEZE dried vaccine – it is more stable preparation than the
liquid vaccine

51. •It is stable up to 1yr if kept away from sunlight and stored in
cool place
•Reconstituting of vaccine is done with Normal Saline as distill
water will cause irritation
•Dosage – 0.1mg in 0.1ml volume
New born – 0.05ml
•Because the skin of new born is thin and an intradermal
injection with full dose (0.1ml) might penetrate into deeper
tissues and give rise to local abscess and enlargement of local
lymph nodes

52. ADMINISTRATION
•Inject intradermally using ‘Tuberculin ‘Syringe
( omega micro stat syringe fitted with 1cm steel 26
gauge intradermal needle )
•The site of injection should be just above the
insertion of deltoid muscle
•A satisfactory injection should produce a wheel of
5mm in diameter
•AGE – to administer at early age in infancy either at
birth or at 6 weeks of age

53. PHENOMENA AFTER ADMINISTRATION
2- 3 weeks after administration of correct intradermal
injection , a ‘Papule’ develops . Increases slowly in
size up to diameter 4 – 8 mm in 5 wks , breaks into a
shallow ulcer covered with crust .
Healing occurs within 6 – 12 wks leaving a tiny scar
4 – 8 mm in diameter
COMPLICATION –
• ulceration at site of injection
•Suppurative lymphadenitis
•Local abscess – aspiration
•If not successful – incision and drainage

54. •Protective value – 15 – 20 yrs
Contraindications –
•Infective dermatitis
•Immunodefecient
DIRECT BCG vaccination –
•Vaccination without tuberculin test
•Permits rapid and complete coverage
•Reduces cost
•Combined vaccinations –
•BCG +DPT

55. POLIOMYELITIS
•Acute viral disease caused by RNA virus
•It is an infection of human alimentary tract but
may infect CNS resulting in paralysis and death
•Immunization is the sole effective means of
preventing it
•Both live and killed vaccines are available to
immunize infants by 6mth of age

56. VACCINES
Two types of vaccines are used –
•Inactivated (Salk) polio vaccine
•Oral (sabin) polio vaccine

57. Inactivated (Salk) polio vaccine-
Inactivated by formalin
Contains 20, 2 & 4D antigen
It induces humoral antibodies but
does not induce intestinal
immunity
These circulating antibodies
protect body against polio but
does not protect reinfection of the
gut and give infection to others

58. DRAWBACKS OF IPV –
•Immunity is not rapidly achieved
• Avoided during epidemic
ADVANTAGES OF IPV –
Given to person with immune deficient disease
Person on corticosteroid therapy
Improved IPV – Contains 40, 8 & 32D antigen
Acts immediately
2 doses gives 100% effect

59. Oral (sabin) polio vaccine
• It contained live virus
•Grown in monkey kidney or human
diploid cell culture
•Doses – should be given before 6
mth of age as chances of developing
infection are more
•Mode of administration –
• it is given orally by dropper
•It is the most effective and reliable
method

60. •Development of immunity –
It infect intestinal epithelial cells . The virus is
transported to Peyer’s patches where secondary
multiplication occurs there is presence of the
circulating antibodies which prevent circulating
antibodies .intestinal infection stimulates the
production of antibodies which prevent alimentary
tract infection
• Induces both local and systemic immunity

61. PULSE POLIO IMMUNIZATION
•Two immunizations days 6 wks apart on
•9
th
dec 1995 and 20
th
Jan 1996

64. Advantages
•Easy to administer
•Induce both humoral and intestinal immunity
•Controls epidemic
Storage – it is heat stable
•Stored at 4deg C for a year
MOPPING UP –
•the last stage in vaccination
•Involves Door to Door immunization in high risk areas

65. VIRAL HEPATITIS
HEPATITIS A –
Caused by hepatitis A virus
•Characteristic by fever, chills, nausea and vomiting
Human immunoglobulin –
Prepared from pooled plasma of healthy donor to
induce immunity
Dose – 0.2 – 0.12ml /kg
•If given before exposure it will prevent clinical illness
•Efficacy depends on – hepatitis A antibodies, dose
and time of administration

66. VACCINES
Active inactivated vaccines
Haverix -
360 EU – 3 doses
720EU – 2 doses
•2 dose series 6-18mth apart is given paranterally
•It is not used in children below 1 yr age
•Combination vaccine – HA & HB
•3 doses – 0,1,6 mth

67. HEPATITIS B
•Caused by hepatitis B
•Causes liver disease – chronic hepatitis and
hepatocellular carcinoma
HEPATITIS B vaccine –
•1
st
dose - 1ml at birth
•2
nd
dose - 1ml 1mth later
•3
rd
dose - 1ml 6mth after 1
st
dose
•Children under 10yr should be given ½ the above
dose

68. •Hepatitis B immunoglobulin – used in individuals
who are exposed to HBsAg – positive blood like
surgeons , infants of carrier mother , sexual contacts
•Doses – 0.05 – 0.07 ml/kg body wt
•In case of carrier newborn combined active and
passive immunization is given

69. CHOLERA
•It is caused by v. cholera
•It is watery diarrhea followed by vomiting, rapid dehydration
•Given Parenteraly
•Dose – Age 1
st
dose 2
nd
dose
1 -2 yr 0.2ml 0.2ml
2 -10 yr 0.3ml 0.3ml
above 10yr 0.5ml 0.5ml
Oral vaccine
Combination vaccine – killed whole cell with B sub unit of
cholera toxin
•2 doses 10 – 14 days apart
CVD103 HgR genetic manipulation of V.Cholera
•Single dose

70. TYPHOID FEVER
•Infection caused by S.Typhi
•Fever for 3 –4wks along with involvement of
lymphoid tissues
Anti –Typhoid Vaccine –
•Monovalent anti – typhoid vaccine - AKD (acetone
killed and dried )
•Bivalent vaccine – s. typhi and s. paratyphi A
•TAB vaccine – s.typhi, s.paratyphi A & s.paratyphi B

71. Dose –
2 doses 0.5ml each with interval of 4 -6wks
•Children below 10yr – 0.25 ml
•Site – outer aspect of distal part of deltoid
muscle
•Immunity develops 10 – 21 days later
•Protects for 3yrs
•Booster dose – every 3 yr

72. Oral typhoid vaccine (typhoral) –
Used in age above 6yr
One capsule is administered on day 1, 3 and 5
1hr before meal with cold water
Protection commences 2 wks later
Effect lasts for 3yrs

73. RABIES VACCINE
•Rabies is also known as hydrophobia
•It is an acute, highly fatal viral disease of CNS
•Rabies vaccine – It is defined as fluid or dried
preparations of virus grown in neural tissues of
rabbits, sheep, embryonated duck eggs or in cell
culture

74. TYPES OF VACCINES
Nervous tissue vaccine -
•Derived from adult animal nervous tissues
•Derived from mouse brain
Duck embryo vaccine
Cell cultured vaccine-
Human diploid cell
Second generation tissue culture

75. •NTV – It is 5% emulsion of infected sheep’s brain
containing inactivated virus
•Causes severe and fatal reactions
•Mouse brain vaccine – devoid of neuroparalytic
effect
•10 Daily doses
•Booster doses 10 & 20 days later
•Duck embryo vaccine – not be given to person
sensitive to egg protein

76. •Cell cultured vaccine –
•It is potent and safe
•Requires few injections with few side effects
•Human diploid cell vaccine – By propagating the
rabies virus in human diploid fibroblastic cell
•Second generation tissue culture vaccine –
•It cheap and low in cost
•Derived from non – human source

77. DOSAGE SCHEDULE

78. Technique of administration
•Site is anterior abdominal wall , the area is divided
into quadrant and different site is used for each
injection . For proper administration a fold of skin is
lifted and vaccine is injected into this fold using 1.5
mm needle
•Duration of immunity –
•The serum antibodies appear 7 days after
immunization
•It takes 30 days to achieve immunity

79. Anti rabies serum
Anti rabies serum prevents replication of virus at site of bite
• Protection is achieved if sero - therapy is followed by proper
vaccination and booster dose
•Human rabies immunoglobulin –
•Dose – 20IU/ kg body weight
• Part of dose is injected around the bite site and rest IM in
gluteal region
•Booster doses – 10, 20 & 90 days after completion of vaccine
schedule

80. CELL CULTURE AND DUCK EMBRYO
VACCINE
INTRA MUSCULAR SCHEDULE
•It consist of 6 doses , 1ml each
•Days – 0, 3, 7, 14 & 28
•Booster dose – on 90th day

81. TETANUS VACCINE
•An acute disease caused by exotoxin of clostridium tetani
•There is muscular rigidity along with spasm of voluntary
muscles , especially masseter – ‘lock jaw’

PREVENTION
ACTIVE IMMUNIZATION -
Tetanus Toxoid
Stimulates production of anti-toxin
Two preparations are available –
•Combined vaccine – DPT
•Monovalent vaccine –
Plain toxoid
Tetanus vaccine

82. Combined vaccine –
Given to infants in combination with
diphtheria and killed B. Pertusis as
DPT vaccine
Monovalent vaccine –
Purified tetanus toxoid has largely
supplanted plain toxoid because it
provides higher and long lasting
immunity
Primary course – 2 doses of TT each 0.5ml
time interval 1 – 2 mth
1
st
booster dose 1yr after
2
nd
dose

83. PASSIVE IMMUNIZATION
Temporary protection is provided by –
Human Tetanus Hyper immunoglobulin (TIG)
Anti tetanus serum (ATS)
TIG – it is the best prophylactic to be used
Dose – 250 – 500IU
No serum reaction
Protection up to 30 days

ATS – if TIG is not available then ATS is used
Dose – 1500 IU subcutaneously
Protection for 7 – 10 days

84. ACTIVE AND PASSIVE IMMUNIZATION
•Given in case of non – immunized person
• ATS – 1500IU or Human Ig 250 – 500IU in one arm
•Tetanus toxoid 0.5ml in other arm
•2
nd
dose - 6wks later of 0.5ml of TT
•3
rd
dose – 1yr later
•Purpose of anti – toxin is for immediate temporary
protection and purpose of toxoid is for long lasting
protection

85. YELLOW FEVER VACCINE
•Caused by Arbo- virus
•Effects renal and hepatic system in man
•Live vaccination – formed on chick embryo
•17D vaccine
•Dose 0.5ml subcutaneously

86. The World needs an HIV
Vaccine
AIDS kills more people than any other
infectious disease

87. HIV Globally
40 million infected with HIV
worldwide
Over 20 million have died since
1981
5 million were infected in 2004
600 new infections every hour

88. What types of HIV
vaccines are being tested?
Peptide epitomes (protein fragments)
Status: In phase I trials
Live attenuated HIV
Status: Non-human primates
Whole, killed HIV
Status: Not under study in primates
Naked DNA
Status: Phase I trials

89. ANTIBIOTIC PROPHYLAXIS
Antibiotic prophylaxis should provide an adequate
drug level in the tissues before, during and for the
shortest possible time after the procedure
to prevent or reduce postoperative infection.
The antibiotic must be effective against the
bacteria that are most likely to cause infections
The chosen antibiotic must be both bactericidal
and the least toxic agent available

90. •For trans-oral procedures - Penicillin is the first choice
according to Peterson (1990)
•For allergic patients - Clindamycin or first generation
cephalosporin are alternatives.
•For transcutaneous procedures - first generation cephalosporin
such as cefazolin
•Finally, the antibiotic level must be sufficient to ensure adequate
concentration in the contaminated tissues at the time of surgery
•The prophylactic dose must be twice the usual therapeutic dose
•For cefazolin this is 1 g, administered parenteraly on induction
of general anesthesia. As plasma levels need to be maintained

91. American Heart Association Recommended
Standard Prophylactic Regimen for Dental
Procedures
Adults -Amoxicillin 3 g, orally, I hour before procedure,
then 1.5 g 6 hours after initial dose
Children - Amoxicillin 50 mg/kg, orally, I hour before
procedure, then half initial dose 6 hr later
Children less than 15 kg - Initial dose, 750 mg amoxicillin
Children 15 to 30 kg - Initial dose, 1500 mg amoxicillin
Children over 30 kg - Initial dose, 3000 mg amoxicillin
Given I hour before procedure followed 6 hours later with half
initial dose

92. Prophylactic Regimen for Dental Procedures in Patients
Allergic to Penicillin and Intolerant of erythromycin
Adults - Clindamycin 300 mg I hour before
procedure, then 150 mg 6 hours after initial dose
Children - Clindamycin 10 mg/kg I hour before
procedure, then half dose 6 hours after initial dose

93. Prophylactic Regimen for Dental Procedures in Patients
Allergic to Amoxicillin Penicillin or Who Are on Long-Term
Penicillin Therapy for Rheumatic Fever
Adults - Erythromycin ethylsuccinate 800 mg
or
Erythromycin stearate I g, orally,
2 hours before procedure, then half dose
6 hours after initial dose
Children - Erythromycin ethylsuccinate or stearate
20 mg/kg I hour before procedure,
then half dose 6 hours after initial dose

94. ANTIBIOTIC TREATMANT FOR INFECTIVE
ENDOCARDITIS
Organism Regime Duration
S . ViridiansPenicillin G, 4MU,
iv 6hr +gentamycin
1mg/kg iv,12hr
2wks
S. aureusNafcillin 2g,iv
4hr
4wks

95. Prophylactic Regimen for Patients Given General Anesthesia
for Oral Surgical or Dental Procedures or Who Are Unable to
Use Oral Medications
•
•
•
Ampicillin 2 g, IV or 1M, 30 min before procedure,
then 1.5 g amoxicillin 6 hours after initial dose if patient is awake
and stable
if patient unable to take oral medication, then I g Ampicillin, IV or
1M, 6 hours after initial dose
Allergic to penicillin - Clindamycin 300 mg, IV,
30 min before procedure
150 mg orally 6 hours after initial dose
if patient still unable to take oral medication, then 150 mg
clindamycin IV 6 hours after initial dose

96. Conditions for Which the American Heart Associatiol1
Recommends Antibiotic Prophylaxis for Endocarditis
prevention
•Prosthetic cardiac valves
•Bioprosthetic
• Homograft Previous bacterial endocarditis
• Surgically constructed systemic-pulmonary shunts
• Most congenital cardiac malformations
•Rheumatic and other acquired valvular dysfunction
even after surgery
•Hypertrophy cardiomyopathy
•Mitral valve prolapse with regurgitation