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Fifth stage
Pediatric
Lec-6
د.ربيع
14/3/2016
Childhood Immunization
Learning objectives
To know the Iraqi immunization schedule (2012& 2015)
To understand the details of each vaccine (type, route, doses, side effects&
contraindications).
To understand what to check before giving a vaccine.
Immunization
Types of vaccine :
2 type of vaccine : Bacterial & Viral
1- Bactrial vaccine :
a. Live attenuated : e.g: BCG.
b. Killed vaccine : e.g: pertussis.
c. Toxoid :e.g. tetanus.
d. polysaccharide: e.g: pneumococcus.
2. Viral vaccine :
a. Live attenuated :. (measles, mumps, rubella [MMR], varicella, nasal influenza)
b. completely inactivated (polio, hepatitis A, intramuscular influenza) .
c. recombinant products (hepatitis B, human papillomavirus), d. reassortants (rotavirus)
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Vaccination schedule in Iraq (2012)
At birth: BCG, OPV-0, HBV-1
2 months completed: PENTA valent vaccine (DTP-1, Hib1, and HBV-2), OPV1 and
Rotavirus1.
4 months completed: TETRA1 vaccine (DTP-2, and Hib2) OPV2 and Rotavirus2.
6 months completed: Pentavalent vaccine (DTP-3, Hib3, and HBV-3), OPV3 and
Rotavirus3.
9 months completed: Measles + VIT A
15 months completed: MMR1
18 months completed: TETRA2 vaccine (DTP, and Hib) OPV. (booster no.1)
4-6 years: DTP, OPV (booster no.2) and MMR2
Vaccination schedule in Iraq (2015)
At birth: BCG, OPV-0, HBV-1
2 months completed: HEXA1, ROTA1,PREV13-1+OPV1
4 months completed: HEXA2,ROTA2, PREV13-2 +OPV2
6 months completed: HEXA3,ROTA3, PREV13-3 +OPV3
9 months completed: Measles + VIT A
15 months completed: MMR1
18 months completed: DTP+ IPV+ Hib + OPV + VIT A
4-6 years: DTaP + IVP + OPV + MMR2
BCG: Bacillus Calmette-Guerin
DPT: Diphtheria, Tetanus, Pertussis
Hib: Haemophillus influenza type B
HEXA: HEXAVALENT Vaccine: (DPT +Hepatitis B (HBV) +Hib) + injectable Polio Vaccine (IPV).
PENTA: DPT + Hib + Hepatitis B
TETRA : Tetravalent Vaccine: DPT + Hib
MMR: Measles, Mumps, Rubella
OPV : Oral Polio Vaccine
PREV13: Pneumococcal Conjugate Vaccine (PCV13)
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Bacille Calmette-Guẻrin (BCG) vaccine
The live attenuated strain of Mycobacterium bovis known as bacillus Calmette-Guérin (BCG)
uses shared antigens to stimulate the development of cross-immunity to Mycobacterium
tuberculosis.
Benefit:
No prevention of tuberculosis.
BCG Prevents life-threatening complications such as meningitis and miliary TB.
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Route of administration
BCG is given as a single intradermal injection at the insertion of
the deltoid into the lateral aspect of the left upper arm. (local complication rate is smallest
when that site is used) .
Successful BCG vaccination
A small bleb is raised and a successful vaccination leads to the development of a small
local swelling within 2 weeks.
The lesion progresses to a papule or shallow ulcer of approximately 10 mm diameter
and heals within 12 weeks to form a small, flat scar.
Adverse effects:
1. Local ulceration and regional suppurative adenitis occur in 0.1-1% of vaccine recipients
2. Keloids: large, raised and ugly scars.
3. If BCG is accidentally given to an immunocompromised patient, it can cause disseminated
or life threatening infection
Polio vaccines
Poliovirus
Enterovirus (RNA), Three serotypes: 1, 2, 3
Human is the reservoir, transmission by fecal-oral
The virus present in stool for 3-6 weeks.
The two vaccines have eradicated polio from most of the countries in the world and
reduced the worldwide incidence from an estimated 350,000 cases in 1988 to less than
2000 cases in 2008.
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Salk’s Polio vaccine “Inactivated Polio Vaccine” IPV, injectable;
Based on polio grown in a type of monkey kidney tissue culture, which is then inactivated
with formalin.
Contains 3 serotypes of vaccine virus
The injected Salk vaccine confers IgG-mediated immunity in the bloodstream, which
prevents polio infection from progress to viremia and protects the motor neurons, thus
eliminating the risk of bulbar polio and post-polio syndrome.
It offers no protection to the mucosal lining of the intestine, ie; people vaccinated with
Salk's vaccine can still carry the disease and spread it to unvaccinated individuals.
IPV has essentially no adverse effects associated with it other than possible rare
hypersensitivity reactions to trace quantities of antibiotics.
Sabin's polio vacci
ne “Oral live-attenuated vaccine”;
Sabin's “Oral Polio Vaccine" is a live-attenuated vaccine;
Contains 3 serotypes of vaccine virus
It replicates very efficiently in the gut, the primary site of infection and replication
(confers local GI immunity).
Unable to replicate efficiently within nervous system tissue.
Shed in stool for up to 6 weeks following vaccination
Advantages & Disadvantages of Oral Polio Vaccines:
The OPV proved to be superior in administration, and also provided longer lasting
immunity than the Salk vaccine.
The trivalent Oral Polio Vaccine (Sabin) on very rare occasions has been associated with
paralysis (vaccine- associated paralytic poliomyelitis, about 1 case per 750,000 vaccine
recipients).
DPT (Diphtheria, Pertussis,& Tetanus)vaccine
DPT:
mixture of three vaccines, to immunize against Diphtheria, Pertussis, and Tetanus.
DTP and DTaP( acellular) are administered in a dose of 0.5 mL intramuscularly, five
vaccinations before age 7 years (at 2, 4, 6, and 15–18 months and at 4–6 years).
Local reactions include: inflammation, induration or a painless nodule at the site of
injection. These are progressively more common after the first injection
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Contraindications:
Absolute contraindications to DTP and DTaP:
1. immediate anaphylactic reaction
2. encephalopathy within 7 days. The latter is defined as a severe, acute central nervous system
disorder unexplained by another cause, which may be manifested by major alterations of
consciousness or by generalized or focal seizures that persist for more than a few hours without
recovery within 24 hours.
Precautions for immunization : are adverse events that were formally contraindications but now
require careful consideration before administration of additional doses.
These reactions have not proven to cause permanent sequelae. They are:
1. Seizures with or without fever, occurring within 3 days of immunization with DTP or DTaP.
2. Persistent, severe, inconsolable screaming or crying within 3 days for 3 or more hours within
48 hours.
3. Collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours.
4. Temperature ≥ 40.5°C (104°F), unexplained by another cause, within 48 hours.
MMR vaccine (Measles, Mumps, Rubella):
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MMR vaccine:
Composed of three live attenuated vaccines (Measles, Mumps & Rubella).
This highly effective vaccine is administered subcutaneously in two doses.
The first MMR dose is recommended at age 12 to 15 months and the second at the
child's entry into school (age 4 to 6 years), A dose given before 12 months of age will not be
counted.
The purpose of the rubella portion of this vaccine is to protect against congenital
rubella syndrome by preventing the occurrence of rubella which, by itself, is a mild disease.
Because MMR is a live-attenuated vaccine, non–allergy-related side effects are noted 5
to12 days following immunization.
Fever and rash are relatively common, experienced by 5% to 15% of recipients.
Transient arthritis has been reported.
Thrombocytopenia (rare)
Encephalopathy (very rare)
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Contraindications and Precautions
1. Severe allergic reaction to vaccine component or following prior dose.
2. Pregnancy.
3. Immunosuppression.
4. Moderate or severe acute illness.
5. Recent blood product.
Hepatitis B vaccine
Hepatitis B vaccine consists of purified HBsAg particles produced through recombinant DNA
technology in yeast.
Vaccine usually is given intramuscularly as a three-dose series.
Rotavirus vaccine
In early childhood, the single most important cause of severe dehydrating diarrhea is
rotavirus infection.
Rotaviruses; Reoviridae family
The Pentavalent vaccine protects against rotavirus gastroenteritis.
Oral route
Three doses; 2, 4, and 6 months.
Haemophilus influenzae type b(Hib) vaccine
Type of vaccine: Conjugate.
Adverse reactions: Mild local reaction
Injection site: Given IM in the outer mid-thigh for infants.
Immunodeficiency:
Live-bacteria (e.g., oral typhoid) and live-virus vaccines (e.g., MMR, varicella, and rotavirus)
are contraindicated in most circumstances involving clinically significant
immunosuppression.
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Vaccination check list:
Be sure to ask these questions before giving the vaccines:
1. Is your child sick today? (More than a common cold, earache, etc.)
2. Does your child have any severe (life-threatening) allergies?
3. Has your child ever had a severe reaction after a vaccination?
4. Does your child have a weakened immune system (because of diseases such as cancer, or
medications such as steroids)?
5. Has your child gotten a transfusion, or any other blood product, recently?
6. Has your child ever had convulsions or any kind of nervous system problem?
7. Does your child not seem to be developing normally?
8. Children who are allergic to eggs can have all the usual childhood immunizations. The
only immunization that should be avoided if your child is allergic to egg is influenza vaccine.
9. Even if your baby is premature,the infant immunizations start at the baby's chronological
age, not their gestational age.