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  1. 1. Immunization Dr.Khalid Hama ,salih Pediatrics specialistM.B.Ch.; D. C.H F.I.B.M.S.ped
  2. 2. Bacille Calmette-Guérin (BCGBacille Calmette-Guérin (BCG) is a live strain ofMycobacterium bovis developed by Calmette and Guérin foruse as an attenuated vaccine to prevent tuberculosis and othermycobacterial infections. The vaccine was first administeredto humans in 1921 and remains the only vaccine againsttuberculosisBCG is the most widely administered vaccine in the world; ithas been given to over 3 billion individuals, principally in thesetting of routine newborn immunization (as dictated byguidelines of the World Health Organization).
  3. 3. EFFICACY — BCG vaccine efficacy appears todepend on three factors: the underlying immune statusof the recipient, the extent of background exposure tomycobacteria prior to vaccination, and perhaps thepotency of the BCG strain used in the vaccine
  4. 4. Active disease — A widely cited meta-analysis suggests thatBCG vaccination reduces the risk of active TB by about 50percent, Vaccination of newborns and infants appears to, confer protection in about 80 percent of casesThe greatest benefit of BCG appears to be diminished risk oftuberculous meningitis and disseminated disease in children((75 to 86 percent efficacy
  5. 5. Dose — The standard dose of BCG vaccine is 0.1 mg in 1 mL.Other childhood vaccines can be administered simultaneously.with BCG BCG can be administered intradermallyDurability of protection — The duration of BCG inducedprotection against tuberculosis is generally believed to beapproximately 10 to 15 years
  6. 6. GROUPS TO CONSIDER FOR VACCINATION — Theapproach to BCG vaccination policy depends on theregional prevalence of TB and is variable around the world.In countries where the prevalence of TB is moderate to high,neonatal vaccination is recommended by the World HealthOrganization (WHO) and is administered routinelyThe WHO does not recommend use of BCG vaccine in the;countries meeting the following criteriaAverage annual rate of smear-positive pulmonary TB below.15 per 100,000Average annual rate of tuberculous meningitis in children.2under five years below 1 per 10 million populationAverage annual risk of TB infection below 0.1 percent.3
  7. 7. ( Bacillus Calmette‑ Guerin Vaccine (BCGSIDE EFFECTS Local  Skin ulceration, regional lymphadenitis  Subcutaneous abscess Generalized  Anaphylaxis, generalized BCG infection  (rare): osteitis  Potential factors affecting the rate of adverse reactions include the BCG dose, vaccine strain, and method of vaccine administration
  8. 8. ( Bacillus Calmette‑ Guerin Vaccine (BCG PRECAUTIONS & CONTRAINDICATIONS(CI):  CIPosative tubercline skine test  CI in persons with immunodeficiencies  CI during pregnancy
  9. 9. Hepatitis B Virus VaccineVaccination with hepatitis B virus (HBV) vaccineprevents HBV infection and its complications, whichinclude hepatocellular cancer. Thus hepatitis Bvaccinewas the 1st anticancer vaccineThe initial strategy of targeting hepatitis B vaccinationtoward high-risk persons failed to significantly reduce theincidence of HBV infection
  10. 10. STORAGE. The vaccine should arrive at the office with arefrigerant but unfrozen. It should be refrigerated on arrivaland stored at 2° to 8° C. The vaccine should not be frozen. Theshelf life is up to 3 years ADMINISTRATION: 0.5 ‑1 ML, anterolateral thigh or deltoid IM injection
  11. 11. :AdminstrationA 3-dose( 0.5 mL) schedule is recommended for activeimmunization. For routine infant immunization, the initialdose should be given to the newborn before hospitaldischarge. The minimal intervals between doses are8:• Between the 1st and 2nd doses—4 weeks• Between the 2nd and 3rd doses—8 weeks• Between the 1st and 3rd doses—16 weeksThe 3rd dose should be administered no earlier than 24weeks of age. For infants, children, and adolescents through19 years of age, the dose is 0.5 mL.
  12. 12. adverse effectThe most common adverse event afterreceiving the hepatitis B vaccine is1.pain at the injection site.2.Mild systemic complaints, including fatigue ,headache, and irritability, occur in fewerthan 20% of children. Low-grade feveroccurs in up to 6% of children.3.Serious systemic adverse events andallergic reactions are rare.
  13. 13. CONTRAINDICATIONS AND PRECAUTIONSAdministration of hepatitis B vaccine iscontraindicated for individuals who had a serious(anaphylactic) allergic reaction to a prior dose ofhepatitis B vaccine or a vaccine component
  14. 14. infants born to women who are HBsAg positiveAll infants born to women who are HBsAg positive shouldreceive hepatitis B vaccine and HBIg (at a different injectionsite) within 12 hours of birth, regardless of gestational age or.birth weightFor infants weighing less than 2000 g, this birth dose shouldnot be counted as part of the series; that is, 3 additional dosesof hepatitis B vaccine should be given, the first of whichshould be at 1 month of age
  15. 15. Infants born to women who were not tested for HBsAg shouldreceive an initial dose of hepatitis B vaccine within 12 hoursof birth. The mother should be tested immediately, and if shetests positive, then the infant should receive HBIg within.7day/ NBLOW-BIRTH-WEIGHT INFANTS. Hepatitis B vaccinationshould be postponed if an infant is born to an HBsAg-negativewoman and weighs less than 2000 g. Low-birth-weight infantswhose mothers surface antigen status is positive or unknownshould receive immediate vaccination and HBIg, as previouslydescribed
  16. 16. After the hepatitis B immunization series is complete(preferably at 6 months of age), all infants of HBsAg-positivemothers should be tested for the presence of anti-HBs andHBsAg at 9 to 15 months of age.
  17. 17. Tetanus and Diphtheria component isToxoid, the pertusis component is whole. cellular PREPARATIONS < 7 years : DTP, DT, DTaP (acellular pertussis vaccine) > 7 years : Td, TdaP
  18. 18. STORAGE DTaP, DTP, or DTP-Hib vaccines should arrive at the office unfrozen and should be refrigerated on arrival at a temperature of 2° to 8° C. The vaccine should not be frozen. The shelf life is up to 1 year. The vials must be shaken vigorously before withdrawing the individual dosesADMINISTRATION. The vaccine is administeredintramuscularly using a dose of 0.5 mL
  19. 19. ;Side effectlocal reactions of ress, swelling, induration, and tenderness( 1 and .systemic reactions : drowsiness, vomiting, crying, and( 2) .low-grade fever. Moderate-to-severe reactions include highfevers of 40.5° C (105° F) or higher, persistent andinconsolable crying of more than 3 hours duration, hypotonic-hyporesponsive episodes, and febrile seizure In this vaccine the Pertusis component is acellular. and it has less .side effects than the previous vaccine
  20. 20. ( 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 > 40.50C  persistent inconsolable crying > 3 hours  Collapse episodes  Convulsions NB/ Vaccination should be deferred in the event of a moderate to severe acute illness until the illness subsides
  21. 21. Polio VaccineTwo polio vaccines have been developed:enhanced-potency IPV and OPVPREPARATIONS: (A) Oral (OPV) SABIN(Live attenuated) (B) Inactivated (eIPV) SALK (killed) Routine polio vaccination in the United States iscurrently accomplished with IPV, which isadministered subcutaneously (or intramuscularly)with a dose of 0.5 mL and consists offormaldehyde-killed poliovirus. OPV, in contrast, isa live attenuated vaccine that is administered orally.Though still used routinely in many countries
  22. 22. STORAGE:opv should be frozen but IPV should arriveat the office unfrozen and should be refrigeratedbetween 2° and 8° C. The shelf life is up to 18 months.ADMINISTRATION: OPV 2 drops orally IPV SC injectionPRECAUTIONS &CONTRAINDICATIONS(CI) : (a) OPV pregnancy, immunodeficiency (b) IPV neomycin hypersensitivityADVERSE REACTIONS: OPV paralytic disease (rare
  23. 23. Haemophilus Influenzae Type B Vaccine:In the prevaccination era, 1 in 200 children developedinvasive Hib disease by the age of 5 years.31 The mostrecent surveillance data show that the annual number ofcases decreased by 99%
  24. 24. .STORAGEHib vaccines should arrive in insulated containers to preventfreezing. They should arrive unfrozen and should berefrigerated immediately and stored between 2° and 8° C.Freezing reduces or destroys potency. Shelf life is up to 2yearsADMINISTRATION: imIf a child receives different brands of Hib vaccine at 2 and 4months of age, then a Hib vaccine dose should be given at 6.should be followed by a booster at 12 to 15 months of age
  25. 25. .ADVERSE EVENTSAdverse events after Hib vaccination are mild and infrequent.Between 5% and 30% will have a local reaction consisting ofswelling, redness, or pain. Systemic adverse events such asfever are uncommon
  26. 26. CONTRAINDICATIONS AND PRECAUTIONS.The only contraindication to Hib vaccination is a history ofsevere (anaphylactic) allergic reaction after a prior dose ofHib vaccine or a vaccine component. Vaccination should bedeferred in the event of a moderate to severe acute illnessuntil the patients health improves
  27. 27. Measles, Mumps & Rubella ( (MMRMMR vaccine is a combination of 3 live attenuatedvaccines that together protect against measles, mumps,and rubella. The purpose of the measles and mumpsvaccines is to protect against these specific diseases;the purpose of the rubella vaccine is to preventcongenital rubella syndrome by preventing theoccurrence of rubella, which, itself, is a mild disease,in the general population, thereby preventing itsspread to susceptible pregnant women. The incidenceof all 3 viruses has declined more than 99% comparedwith the prevaccination era
  28. 28. ( Measles, Mumps & Rubella (MMR . STORAGE:It should be refrigerated on arrival and stored between 2° and 8° C (never frozen). The shelf life is up to 2 years; On reconstitution, the vaccine should be stored in a dark place between 2° and 8° C and must be used within 8 hoursADMINISTRATION:. administration of 2 doses of MMRvaccine for children; these doses are 0.5 mL deliveredsubcutaneously. The 1st dose should be given at 12 to 15months of age and the 2nd before elementary school entry (4to 6 years of age
  29. 29. ( Measles, Mumps & Rubella (MMR: ADVERSE REACTIONS  Fever ,rash (7 days post vaccination)  Arthralgia , arthritis (rubella)  Encephalitis [rare] (measles, mumps)  Suppression of PPD skin test (measles)  Convulsions in prone children(measles)  Thrombocytopenia
  30. 30. ( Measles, Mumps & Rubella (MMRPRECAUTIONS & CONTRAINDICATIONS Pregnancy Anaphylaxis to eggs Immunodeficiency and immunosuppression Immunoglobulins Recent receipt of a blood transfusion, blood products within 3-11 months Moderate or severe acute illness (defer vaccination until illness improves)
  31. 31. Rotavirus VaccineRotavirus is the most common cause of severegastroenteritis in infants and young children in TheCDC estimates that rotavirus infection leads to55,000 hospitalizations each year for acutegastroenteritis In February 2006 an attenuated pentavalent bovine-human rotavirus vaccine (PRV) was licensed for use
  32. 32. The 1st dose should be given between 6 and 12 weeks of age.An interval of 4 to 10 weeks should pass between doses in theseries.. Age should be calculated based on chronologic age.Premature infants can be immunized if they are clinicallystable and are being or have been discharged from the hospitalnursery. If a child spits out or vomits after vaccination, thenthe dose should not be repeated; the series should simplycontinue according to the recommended intervals
  33. 33. STORAGE. The recommended dose of PRV is 2 mLorally. PRV should be transported and stored at 2° to8° C (36° to 46° F) and protected from light CONTRAINDICATIONS AND PRECAUTIONS. Contraindications to PRV include a severe (anaphylactic) allergic reaction after a prior dose of the vaccine or its components. Vaccination should be deferred for children with a moderate-to-severe acute illness until the illness improves. Other precautions to use include altered immunocompetence, preexisting chronic gastrointestinal disease, and history of intussusception
  34. 34. . ADVERSE REACTIONS :Within a week ofreceiving PRV, children are slightly (1% to 3%) morelikely to have mild, temporary diarrhea or vomitingthan unvaccinated children. Unlike a previouslylicensed rotavirus vaccine, no evidence has beenfound that PRV causes intussusception or otherserious adverse events
  35. 35. Varicella Prophylaxis ADMINISTRATION:  0.5 ml IM  12 months and above……..2 doses INDICATIONS:  All children 12 months‑18 years: (if no history of varicella) EFFICACY:  70‑90%
  36. 36. Varicella Prophylaxis PRECAUTIONS & CONTRAITNDICATIONS:  Immunocompromised patients  Within 5 months of IG  Children on long term salicylates SIDE EFFECTS:  Fever , rash  Zoster
  37. 37. Hepatitis A NATURE OF VACCINE:  Killed formalin inactivated vaccine. INDICATIONS:  children 1 year and above  Susceptible children in endemic areas  Chronic liver disease  Hemophilia
  38. 38. Hepatitis A ADMINISTRATION:  IM injection  2 doses, at least 6 months apart ADVERSE REACTIONS:  Local reactions, fever  Rare: anaphylaxis
  39. 39. Pneumococcal Prophylaxis PREPARATIONS:  Purified capsular polysaccharide of 23 serotypes of Streptococcus pneumoniae  7 valent conjugated vaccine ADMINISTRATION:  IM / SC 1 dose/booster 5 years INDICATIONS:  Primary vaccination (conjugate vaccine)  children 2 yr. or older with  Anatomical or functional asplenia  Sickle cell disease  Nephrotic syndrome 
  40. 40. Pneumococcal Prophylaxis SIDE EFFECTS:  Soreness , erythema, fever, myalgia  Anaphylactic reactions (rare)
  41. 41. Meningococcal Prophylaxis PREPARATIONS:  quadrivalent conjugate quadrivalent ADMINISTRATION: SC INDICATIONS:  Control of outbreaks  Children with complement deficiencies or asplenia SIDE EFFECTS:  local erythema and discomfort  transient fever
  42. 42. 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.
  43. 43. 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.
  44. 44. Influenza Virus Indications:  chronic cardio-respiratory disease  asthma  cystic fibrosis  bronchopulmonary dysplasia
  45. 45. 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.
  46. 46. Influenza Virus Contraindication:  Anaphylaxis to previous dose.  Hypersensitivity to eggs. Adverse Reaction:  Soreness at injection site.  Allergic response.  Guillain-Barré Syndrome.
  47. 47. Interval (months) ProductIntramuscular immune globulin3 Hepatitis A prophylaxis (IG)Measles prophylaxis (IG)5 Standard6 Immunocompromised host3 Tetanus immune globulin3 Hepatitis B immune globulin4 Rabies immune globulin5 Varicella prophylaxis (as VariZIG)None RSV prophylaxis (Palivizumab [Synagis])Intravenous immune globulinReplacement therapy (IVIG)8 300-400 mg/kgFor ITP (IVIG)8 400 mg/kg10 1000 mg/kgFor ITP or Kawasaki syndrome (IVIG)11 1600-2000 mg/kg6 Cytomegalovirus immune globulinBlood products0 Washed RBCs3 RBCs, adenine-saline added5 Packed RBCs6 Whole blood7 Plasma or platelet products