Immunization2

Immunization

Dr.Khalid Hama
,salih
Pediatrics specialist
M.B.Ch.; D. C.H
F.I.B.M.S.ped

Bacille Calmette-Guérin (BCG
Bacille Calmette-Guérin (BCG) is a live strain of
Mycobacterium bovis developed by Calmette and Guérin for
use as an attenuated vaccine to prevent tuberculosis and other
mycobacterial infections. The vaccine was first administered
to humans in 1921 and remains the only vaccine against
tuberculosis
BCG is the most widely administered vaccine in the world; it
has been given to over 3 billion individuals, principally in the
setting of routine newborn immunization (as dictated by
guidelines of the World Health Organization)
.

EFFICACY — BCG vaccine efficacy appears to
depend on three factors: the underlying immune status
of the recipient, the extent of background exposure to
mycobacteria prior to vaccination, and perhaps the
potency of the BCG strain used in the vaccine

Active disease — A widely cited meta-analysis suggests that
BCG vaccination reduces the risk of active TB by about 50
percent, Vaccination of newborns and infants appears to
, confer protection in about 80 percent of cases
The greatest benefit of BCG appears to be diminished risk of
tuberculous meningitis and disseminated disease in children
((75 to 86 percent efficacy

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 intradermally
Durability of protection — The duration of BCG induced
protection against tuberculosis is generally believed to be
approximately 10 to 15 years

GROUPS TO CONSIDER FOR VACCINATION — The
approach to BCG vaccination policy depends on the
regional 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 Health
Organization (WHO) and is administered routinely
The WHO does not recommend use of BCG vaccine in the
;countries meeting the following criteria
Average annual rate of smear-positive pulmonary TB below.1
5 per 100,000
Average annual rate of tuberculous meningitis in children.2
under five years below 1 per 10 million population
Average annual risk of TB infection below 0.1 percent.3

( Bacillus Calmette‑ Guerin Vaccine (BCG

SIDE 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

( Bacillus Calmette‑ Guerin Vaccine (BCG

 PRECAUTIONS & CONTRAINDICATIONS(CI):
 CIPosative tubercline skine test

 CI in persons with immunodeficiencies

 CI during pregnancy

Hepatitis B Virus Vaccine
Vaccination with hepatitis B virus (HBV) vaccine
prevents HBV infection and its complications, which
include hepatocellular cancer. Thus hepatitis B
vaccinewas the 1st anticancer vaccine

The initial strategy of targeting hepatitis B vaccination
toward high-risk persons failed to significantly reduce the
incidence of HBV infection

STORAGE. The vaccine should arrive at the office with a
refrigerant but unfrozen. It should be refrigerated on arrival
and stored at 2° to 8° C. The vaccine should not be frozen. The
shelf life is up to 3 years
ADMINISTRATION:
0.5 ‑1 ML, anterolateral thigh or deltoid
IM injection

:Adminstration
A 3-dose( 0.5 mL) schedule is recommended for active
immunization. For routine infant immunization, the initial
dose should be given to the newborn before hospital
discharge. 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 weeks
The 3rd dose should be administered no earlier than 24
weeks of age. For infants, children, and adolescents through
19 years of age, the dose is 0.5 mL.

adverse effect
The most common adverse event after
receiving the hepatitis B vaccine is
1.pain at the injection site.
2.Mild systemic complaints, including fatigue ,

headache, and irritability, occur in fewer
than 20% of children. Low-grade fever
occurs in up to 6% of children.
3.Serious systemic adverse events and
allergic reactions are rare.

CONTRAINDICATIONS AND
PRECAUTIONS
Administration of hepatitis B vaccine is
contraindicated for individuals who had a serious
(anaphylactic) allergic reaction to a prior dose of
hepatitis B vaccine or a vaccine component

infants born to women who are
HBsAg positive
All infants born to women who are HBsAg positive should
receive hepatitis B vaccine and HBIg (at a different injection
site) within 12 hours of birth, regardless of gestational age or
.birth weight
For infants weighing less than 2000 g, this birth dose should
not be counted as part of the series; that is, 3 additional doses
of hepatitis B vaccine should be given, the first of which
should be at 1 month of age

Infants born to women who were not tested for HBsAg should
receive an initial dose of hepatitis B vaccine within 12 hours
of birth. The mother should be tested immediately, and if she
tests positive, then the infant should receive HBIg within
.7day
/ NB
LOW-BIRTH-WEIGHT INFANTS. Hepatitis B vaccination
should be postponed if an infant is born to an HBsAg-negative
woman and weighs less than 2000 g. Low-birth-weight infants
whose mother's surface antigen status is positive or unknown
should receive immediate vaccination and HBIg, as previously
described

After the hepatitis B immunization series is complete
(preferably at 6 months of age), all infants of HBsAg-positive
mothers should be tested for the presence of anti-HBs and
HBsAg at 9 to 15 months of age.

Tetanus and Diphtheria component is
Toxoid, the pertusis component is whole
. cellular
PREPARATIONS
< 7 years : DTP, DT, DTaP (acellular
pertussis vaccine)
> 7 years : Td, TdaP

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
doses
ADMINISTRATION. The vaccine is administered
intramuscularly using a dose of 0.5 mL

;Side effect
local reactions of ress, swelling, induration, and tenderness( 1
and
.
systemic reactions : drowsiness, vomiting, crying, and( 2)
.
low-grade fever. Moderate-to-severe reactions include high
fevers of 40.5° C (105° F) or higher, persistent and
inconsolable 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

( 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

Polio Vaccine
Two polio vaccines have been developed:
enhanced-potency IPV and OPV
PREPARATIONS:
(A) Oral (OPV) SABIN(Live attenuated)
(B) Inactivated (eIPV) SALK (killed)
Routine polio vaccination in the United States is
currently accomplished with IPV, which is
administered subcutaneously (or intramuscularly)
with a dose of 0.5 mL and consists of
formaldehyde-killed poliovirus. OPV, in contrast, is
a live attenuated vaccine that is administered orally.
Though still used routinely in many countries

STORAGE:opv should be frozen but IPV should arrive
at the office unfrozen and should be refrigerated
between 2° and 8° C. The shelf life is up to 18 months.
ADMINISTRATION:
OPV 2 drops orally
IPV SC injection
PRECAUTIONS &
CONTRAINDICATIONS(CI) :
(a) OPV pregnancy, immunodeficiency
(b) IPV neomycin hypersensitivity
ADVERSE REACTIONS:
OPV paralytic disease (rare

Haemophilus Influenzae Type B Vaccine:

In the prevaccination era, 1 in 200 children developed
invasive Hib disease by the age of 5 years.31 The most
recent surveillance data show that the annual number of
cases decreased by 99%

.STORAGE
Hib vaccines should arrive in insulated containers to prevent
freezing. They should arrive unfrozen and should be
refrigerated immediately and stored between 2° and 8° C.
Freezing reduces or destroys potency. Shelf life is up to 2years
ADMINISTRATION: im
If a child receives different brands of Hib vaccine at 2 and 4
months 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

.ADVERSE EVENTS
Adverse events after Hib vaccination are mild and infrequent.
Between 5% and 30% will have a local reaction consisting of
swelling, redness, or pain. Systemic adverse events such as
fever are uncommon

CONTRAINDICATIONS AND
PRECAUTIONS
.
The only contraindication to Hib vaccination is a history of
severe (anaphylactic) allergic reaction after a prior dose of
Hib vaccine or a vaccine component. Vaccination should be
deferred in the event of a moderate to severe acute illness
until the patient's health improves

Measles, Mumps & Rubella
( (MMR
MMR vaccine is a combination of 3 live attenuated
vaccines that together protect against measles, mumps,
and rubella. The purpose of the measles and mumps
vaccines is to protect against these specific diseases;
the purpose of the rubella vaccine is to prevent
congenital rubella syndrome by preventing the
occurrence of rubella, which, itself, is a mild disease,
in the general population, thereby preventing its
spread to susceptible pregnant women. The incidence
of all 3 viruses has declined more than 99% compared
with the prevaccination era

( 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 hours
ADMINISTRATION:. administration of 2 doses of MMR
vaccine for children; these doses are 0.5 mL delivered
subcutaneously. The 1st dose should be given at 12 to 15
months of age and the 2nd before elementary school entry (4
to 6 years of age

( 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

( Measles, Mumps & Rubella (MMR
PRECAUTIONS & 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)

Rotavirus Vaccine

Rotavirus is the most common cause of severe
gastroenteritis in infants and young children in The
CDC estimates that rotavirus infection leads to
55,000 hospitalizations each year for acute
gastroenteritis
In February 2006 an attenuated pentavalent bovine-
human rotavirus vaccine (PRV) was licensed for use

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 the
series.. Age should be calculated based on chronologic age.
Premature infants can be immunized if they are clinically
stable and are being or have been discharged from the hospital
nursery. If a child spits out or vomits after vaccination, then
the dose should not be repeated; the series should simply
continue according to the recommended intervals

STORAGE. The recommended dose of PRV is 2 mL
orally. PRV should be transported and stored at 2° to
8° 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

. ADVERSE REACTIONS :Within a week of
receiving PRV, children are slightly (1% to 3%) more
likely to have mild, temporary diarrhea or vomiting
than unvaccinated children. Unlike a previously
licensed rotavirus vaccine, no evidence has been
found that PRV causes intussusception or other
serious adverse events

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%

Varicella Prophylaxis

 PRECAUTIONS &
CONTRAITNDICATIONS:
 Immunocompromised patients
 Within 5 months of IG
 Children on long term salicylates
 SIDE EFFECTS:
 Fever , rash
 Zoster

Hepatitis A
 NATURE OF VACCINE:
 Killed formalin inactivated vaccine.

 INDICATIONS:
 children 1 year and above

 Susceptible children in endemic areas

 Chronic liver disease

 Hemophilia

Hepatitis A
 ADMINISTRATION:
 IM injection

 2 doses, at least 6 months apart

 ADVERSE REACTIONS:
 Local reactions, fever

 Rare: anaphylaxis

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



Pneumococcal Prophylaxis
 SIDE EFFECTS:
 Soreness , erythema, fever, myalgia

 Anaphylactic reactions (rare)

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

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.

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.

Influenza Virus
 Indications:
 chronic cardio-respiratory disease
 asthma

 cystic fibrosis

 bronchopulmonary dysplasia

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.

Influenza Virus
 Contraindication:
 Anaphylaxis to previous dose.
 Hypersensitivity to eggs.

 Adverse Reaction:
 Soreness at injection site.
 Allergic response.

 Guillain-Barré Syndrome.

Interval (months) Product

Intramuscular immune globulin
3 Hepatitis A prophylaxis (IG)
Measles prophylaxis (IG)
5 Standard
6 Immunocompromised host
3 Tetanus immune globulin
3 Hepatitis B immune globulin
4 Rabies immune globulin
5 Varicella prophylaxis (as VariZIG)
None RSV prophylaxis (Palivizumab [Synagis])
Intravenous immune globulin
Replacement therapy (IVIG)
8 300-400 mg/kg
For ITP (IVIG)
8 400 mg/kg
10 1000 mg/kg
For ITP or Kawasaki syndrome (IVIG)
11 1600-2000 mg/kg
6 Cytomegalovirus immune globulin
Blood products
0 Washed RBCs
3 RBCs, adenine-saline added
5 Packed RBCs
6 Whole blood
7 Plasma or platelet products

Immunization2

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