Tikrit University/ College of Medicine
Community Medicine Department
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Immunization
• The aim of immunization is to reduce infectious diseases morbidity and mortality with
the ultimate aim of disease eradication.
• Successfully eradicated infections are small pox and cattle plague.
• WHO upcoming goal is polio eradication by year 2023.
WHO immunization schedule applied in iraq
Age
Vaccines
Roate of administration
First 24 hr
BCG, HepB, OPV
Intradermal in left shoulder
• BCG
Oral
• Rotavirus
• OPV
IM in the thigh
• DTP
• Hib
• HepB
• IPV
• Pneumo-conj
Subcutaneous in the arm
• Measles & MMR
2 months
OPV, Rotavirus, pnemo-conj,
DTaPHibHepBIPV
4 months
Same as 2 months
6 months
Same as 2 months
9 months
Measles, Vit-A (100.000 U)
15 months
MMR
18 mmonths
OPV, Vit-A (200.000 U),
DTaPHibIPV
4-6 years
OPV, Vit-A (200.000 U),
DTaPIPV,
MMR
How to deal with interrupted vaccination schedule (WHO)
• Resume without repeating previous dose.
How to deal with delayed start of vaccination schedule (WHO)
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Contraindications to vaccination
• Anaphylaxis or severe allergic reaction (not injection site reactions); to any vaccine.
• Immunodeficiency (AIDS, systemic steroid, congenital immunodeficiency); to live
attenuated vaccines.
• Pregnancy (BCG, MMR & measles, yellow fever, varicella, live influenza).
Precautions vaccination
• Moderate to severe illness. However, if there is in immediate risk of infection,
vaccination should be given.
BCG (Bacillus Calmette Guerin)
• Live attenuated M.bovis.
• 0.1 ml given intradermal into left shoulder.
• Protection is 80% which decreases with age.
• If no scar develop after 2 months, revaccinate with BCG.
BCG normal body response
No previous TB infection
- Papule->abscess->ulcer-> heal with scar by 2-3 months.
Previous TB infected
- Accelerated response, papule 1-2 days, healing in 10-15 days.
Causes of severe BCG reactions
- Deep intradermal injection
- Large dose
- Immunodeficiency
- Strain of M. Bovis (Pasteur & Danish strains >>Tokyo strain)
Side effects of vaccinations
BCG
• Injection site reactions (Erythema, papule & abscess)
• Urticaria, maculopapular rash, vasculitis
• Lymphadenitis
• Tuberculid
• Scrofuloderma
• Osteomyelitis
• Disseminated systemic disease (BCG-itis)
DTP
• Self limited fever and malaise for 48 hours.
• Rarely convulsion
Measles & MMR side effects
• Fever and faint maculopapular rash which are self limited in few days.
• Injection site reactions which are self limited.
Oral polio vaccine side effects
• Rarely (1:3000000) vaccine induced polio.
Tetanus toxoid in pregnancy
• Aim is to induce maternal anti tetanus Ab which are transmitted through the placenta to
the fetus and protecting him from neonatal tetanus (death at age of 7 days - 7
th
day
disease).
