Active immunization of Active immunization of children, its importance children, its importance

for thefor the infectious diseases prophylaxis. Vaccination schedule.

Postvaccinal complications.

Lecturer:Lecturer:Gorishna Ivanna LubomyrivnaGorishna Ivanna Lubomyrivna

Plan of the lecturePlan of the lecture

Short history about Short history about immunization immunization

Recommended immunization Recommended immunization schedule for infants and childrenschedule for infants and children

Vaccinal reactionsVaccinal reactions Postvaccinal complicationsPostvaccinal complications Contraindications to the Contraindications to the

vaccinationvaccination

The immune systemThe immune system is a complex system of interacting cells whose is a complex system of interacting cells whose

primary purpose is to identify foreign (“non-self”) primary purpose is to identify foreign (“non-self”) substances referred to as antigens. substances referred to as antigens.

The immune system develops a defense against the The immune system develops a defense against the antigen. antigen.

This defense is known as the immune response and This defense is known as the immune response and usually involves the production of protein molecules, usually involves the production of protein molecules, called antibodies (or immunoglobulins), and of called antibodies (or immunoglobulins), and of specific cells (also known as cell-mediated immunity) specific cells (also known as cell-mediated immunity) whose purpose is to facilitate the elimination of whose purpose is to facilitate the elimination of foreign substances.foreign substances.

The task of immuneprophylaxis

management of immunological management of immunological answer to prevent the disease answer to prevent the disease between separate persons and between separate persons and groups of the population.groups of the population.

There are two basic There are two basic mechanisms for mechanisms for

acquiring this protectionacquiring this protection

active and passiveactive and passive. .

Active immunityActive immunity

Active immunityActive immunity are defenses developed by the are defenses developed by the body that last many years or even a life time.body that last many years or even a life time.

11. . Active-natural immunityActive-natural immunity – means invasion of the body by – means invasion of the body by microorganisms resulting in development of antibodies and microorganisms resulting in development of antibodies and sensitized lymphocytes. Examples: childhood diseases - sensitized lymphocytes. Examples: childhood diseases - chicken pox, measles.chicken pox, measles.

2.2. Active-artificial immunityActive-artificial immunity is attained by inoculation or is attained by inoculation or

immunization with antigen of live or killed vaccines that are immunization with antigen of live or killed vaccines that are less virulent than contacting the disease.less virulent than contacting the disease.

Passive immunityPassive immunity

is temporary, trasmitted from another source that is temporary, trasmitted from another source that has developed immunity through previous has developed immunity through previous disease or immunization.disease or immunization.

Passive-natural immunity is trasplacental and Passive-natural immunity is trasplacental and colostrum transfer from mother to child of antibodies. colostrum transfer from mother to child of antibodies. Immunity does not last.Immunity does not last.

Passive-artificial immunity is injections with Passive-artificial immunity is injections with Gamma Globulin.Gamma Globulin.

Classification of vaccineClassification of vaccine Vaccines, which include complete killed microorganisms Vaccines, which include complete killed microorganisms

(pertussis, typhoid, cholera) or inactivated viruses (influenza, (pertussis, typhoid, cholera) or inactivated viruses (influenza, poliomyelitis Salk vaccine)poliomyelitis Salk vaccine)

Anatoxins, which contains inactivated toxin of the bacteria Anatoxins, which contains inactivated toxin of the bacteria (diphtheria, tetanus)(diphtheria, tetanus)

The vaccines from alive attenuated viruses (measles, mumps The vaccines from alive attenuated viruses (measles, mumps and others.)and others.)

Vaccines, which contains crossing alive microorganisms Vaccines, which contains crossing alive microorganisms (BCG)(BCG)

Chemical vaccines from fraction of killed microorganisms Chemical vaccines from fraction of killed microorganisms (pneumococcal, meningococcal)(pneumococcal, meningococcal)

Gene-engineering recombinant, chemical synthesized Gene-engineering recombinant, chemical synthesized (hepatitis В, influenza)(hepatitis В, influenza)

Associated (in composition of which enters several vaccines) Associated (in composition of which enters several vaccines)

Composition of vaccines

Active or immunizing antigensActive or immunizing antigens Fluid baseFluid base Preservatives, stabilizers, Preservatives, stabilizers,

antibioticsantibiotics Auxiliary facilities Auxiliary facilities

Provide active life long immunity against Provide active life long immunity against diseasedisease

1. 1. Recommended immunization Schedule Recommended immunization Schedule for Healthy Infants and Childrenfor Healthy Infants and Children

The recommended childhood The recommended childhood vaccination schedule (Ukraine)vaccination schedule (Ukraine)

BirthBirth Hepatitis BHepatitis B

3-7 days3-7 days BCGBCG

1 month1 month Hepatitis BHepatitis B

3 month3 month IPV, DTaP, HibIPV, DTaP, Hib

4 month4 month IPV, DTaP, HibIPV, DTaP, Hib

5 month5 month OPV, DTaP, HibOPV, DTaP, Hib

6 month6 month Hepatitis BHepatitis B

1212 MMRMMR

18 month18 month OPV, DTaP OPV, DTaP

6 years6 years DT-M, OPV, MMRDT-M, OPV, MMR

7 years7 years BCGBCG

14 years14 years Tetanus-diphtheria boosterTetanus-diphtheria booster, , OPV OPV

15 years15 years Rubella, Mumps Rubella, Mumps

18 years18 years Tetanus-diphtheria boosterTetanus-diphtheria booster

Ways of the vaccinationWays of the vaccination

1.1. Intramuscular (DTP, DT, DT-M, Intramuscular (DTP, DT, DT-M, antirhabic, meningococcal B)antirhabic, meningococcal B)

2.2. Subcutaneous (measles, mumps, Subcutaneous (measles, mumps, rubella, meningococcal A+C)rubella, meningococcal A+C)

3.3. Intracutaneous (BCG)Intracutaneous (BCG) 4.4. On skin (plague, tularemia, On skin (plague, tularemia,

brucellosis)brucellosis) 5.5. Peroral (poliomyelitis)Peroral (poliomyelitis) 6.6. Intranasal (Influenza, inactivated)Intranasal (Influenza, inactivated)

Vaccination for tuberculosis prevention could not be done in the same day with

other vaccines or other parenteral

manipulations Vaccines are injected to all newborns, which has no contraindications. Immunization is done by a vaccine to prevent tuberculosis (BCG). For vaccination of premature infants weighing ≥ 2000 g should be used TB vaccine with reduced antigen content (BCG-M).

Mantoux testMantoux

test before vaccination against TB should be done for babies elder than 2 months. A negative test result allows making vaccination

Immunization by monovalent hepatitis B vaccine

If mother of a newborn is HBsAg "-" (negative), the child may begin vaccination during the first months of life, or combined with vaccination against pertussis, diphtheria, tetanus, polio. The recommended scheme is: 3-4-5-18 months, or: 3-4-9 mo.

Newborns weighing <2000 g born by HBsAg negative mothers, vaccination is done when the child’s weight will be 2000 g or at the age of 1 mo.

If the newborn child is in critical condition, the child immunization should be done when he will be better before hospital discharge.

Vaccination against viral hepatitis B of newborns, whose mothers are carriers of HBsAg, is necessary to do by the accelerated scheme: 0-1-2 and 12 mo.

Vaccinations for the prevention of diphtheria,

tetanus and pertussis in the age 3, 4 and 5 months by diphtheria-tetanus-

pertussis vaccine (DTP), or vaccine with acellular pertussis component (DTaP)

The interval between the first and second, second and third vaccination is 30 days, the interval between the third and fourth vaccination should be not less than 12 months.

The first booster at 18 months is done by DTaP. The second and third booster at 6, 14 years is done by

DT. The first adult booster vaccination should be made by

DT-M at interval of 5 years after the last vaccination. Further booster vaccinations for adults by DT-M with a minimum 10 years interval from the previous vaccination.

For the prevention of diphtheria, tetanus, pertussis, polio, hepatitis B

and infections caused by bacteria Haemophilus influenza type b (Hib),

you can use the combined vaccine

Inactivated vaccine to prevent polio (IPV) is used for the first two

immunizations oral polio vaccine (OPV) is used for 3 - 6th vaccination (third vaccination and age revaccination) with no contraindications to OPV.

After the OPV is proposed to restrict injections, parenteral intervention, routine operations for 40 days, exclude contact with HIV-infected

Vaccination to prevent Hib-infection

can be done by mono- and combined vaccines containing Hib- components.

It is advisable to use combined Hib-vaccines for primary vaccination.

Vaccination to prevent measles, mumps and

rubella by the combined vaccine (hereafter - MMR) at

the age of 12 months. The second vaccine to prevent measles, mumps

and rubella - in 6 years. Kids who were not vaccinated vaccination can

begin at any age before 18 years (2 doses with the minimum spacing between them).

Children age 15 who received 1 or 2 vaccinations against measles, but not vaccinated against rubella and mumps and didn’t ill with these infections, vaccinations against mumps (guys) or rubella (girls) is scheduled.

18-teens or older who have not previously been vaccinated can be vaccinated with one dose before 30 years.

Recommended vaccinations

Varicella zoster Hepatitis A Hepatitis B Flu Pneumococcal infection

Passive immunization is indicated

To children with insufficient antibodies syntheses as a result of congenital or acquired cellular defects of В-lymphocytes.

At absence of vaccines against infection, when single way of protection is introduction of ready antibodies.

If required immediate preventive maintenance of the disease for epidemiological causes (the contact with sick on measles, preventive maintenance of rabies, tetanus).

For neutralization of the antigen-toxin by specific antitoxic antibodies.

With medical purpose at the beginning of the diseases (at diphtheria, botulism, tetanus).

Vaсcinal process

is a change of homeostasis, which is a change of homeostasis, which appears in organism in response to appears in organism in response to introduction of vaccinal preparation introduction of vaccinal preparation and include the complex of reactions and include the complex of reactions to which belongs: formation of to which belongs: formation of antibodies, adaptation and antibodies, adaptation and postvaccinal reactions, postvaccinal postvaccinal reactions, postvaccinal complications.complications.

Vaccinal reactionsVaccinal reactions

appear in response to entering appear in response to entering the vaccines, are characterized the vaccines, are characterized by appearance of clinical by appearance of clinical manifestations typical to this manifestations typical to this type of vaccine, which have a type of vaccine, which have a round-robin duration, are short, round-robin duration, are short, do not cause serious changes of do not cause serious changes of vital activity in the organism.vital activity in the organism.

Vaccinal reactionsVaccinal reactions Increased temperature to 39˚ C. Increased temperature over 39˚ C (severe total

reaction). Temperature, which is not registered in

medical documentation. Pain, soft tissue swelling > 50 mm, hyperemia

in the place of injection > 80 mm, infiltration > 20 mm (severe local reaction).

Lymphadenopathy. Headache. Irritability, sleep disturbance. Non allergic rash. Anorexia, nausea, abdominal pain, indigestion

and diarrhea. Catarrhal phenomena. Myalgia, arthralgia.

Postvaccinal Postvaccinal complicationscomplications - - all pathological phenomena, which all pathological phenomena, which

appear after vaccination and are not appear after vaccination and are not inherent to the usual vaccinal process, inherent to the usual vaccinal process, but obvious, their relationship with but obvious, their relationship with performed vaccination:performed vaccination:

1.1. Postvaccinal unusual reactions Postvaccinal unusual reactions and complications, caused strictly by and complications, caused strictly by vaccine ("true").vaccine ("true").

2.2. Joining of intercurrent infections Joining of intercurrent infections in postvaccinal period.in postvaccinal period.

3.3. Exacerbation of chronic diseases Exacerbation of chronic diseases and primary manifestations of latent and primary manifestations of latent diseases.diseases.

Complication of Complication of vaccination vaccination

1. Anaphylactic shok 1. Anaphylactic shok

Angioneurotic edemaAngioneurotic edema

2. General rash, Stenen-Johnson 2. General rash, Stenen-Johnson syndrome, Lyell’s syndrome,syndrome, Lyell’s syndrome,

3. Encephalitis, encephalopathy, 3. Encephalitis, encephalopathy, polyradiculoneuritis, mononeuritispolyradiculoneuritis, mononeuritis

4. Febril seizures4. Febril seizures

unfebril seizuresunfebril seizures

5. 5. Serous meningitis, myocarditis, Serous meningitis, myocarditis, anemia, hemorrhagic vasculitis, anemia, hemorrhagic vasculitis, trombocytopeniatrombocytopenia

6. Sudden death syndrome 6. Sudden death syndrome

First 24 hr.First 24 hr.

First 10 daysFirst 10 days

First 15 daysFirst 15 days

First 15 daysFirst 15 days

30 days30 days

30 days30 days

Angioneurotic edemaAngioneurotic edema ( (Quincke’s Quincke’s edemaedema )

urticaria (hives)

Stevens-Johnson’s syndrome

Lyell’s syndrome

DTP-vaccine DTP-vaccine Postvaccinal reactionsPostvaccinal reactions Postvaccinal complicationsPostvaccinal complications

Temperature 37.5-39 ºС,Temperature 37.5-39 ºС,

anxiety, poor sleeping, rarely - anxiety, poor sleeping, rarely - vomiting.vomiting.

Local reaction (more often on Local reaction (more often on revaccination) - in the revaccination) - in the manner of hyperemia, manner of hyperemia, infiltration.infiltration.

Febrile seizuresFebrile seizures

Exacerbation allergic Exacerbation allergic manifestations (manifestations (in children in children with exudative-catarrhal with exudative-catarrhal

diathesisdiathesis))

seizures seizures

EncephalitisEncephalitis

Anaphylactic shok Anaphylactic shok

Angioneurotic edemaAngioneurotic edema

febril temperature with seizuresfebril temperature with seizures

persistent, uncontrolled crying that persistent, uncontrolled crying that lasts for more than 3 hours at a time lasts for more than 3 hours at a time within 2 days after injectionwithin 2 days after injection

OPV-vaccine OPV-vaccine Postvaccinal reactionsPostvaccinal reactions Postvaccinal complicationsPostvaccinal complications

No No Anaphylactic shok Anaphylactic shok

Angioneurotic edemaAngioneurotic edema

Vaccinassocated poliomyelitis in Vaccinassocated poliomyelitis in immunized and in contact persons immunized and in contact persons (on background of (on background of immunodeficiency) - 1:1,500000.immunodeficiency) - 1:1,500000.

MMR vaccineMMR vaccine Postvaccinal reactionsPostvaccinal reactions Postvaccinal complicationsPostvaccinal complications

Fever of 39.4°C Fever of 39.4°C

Rash develops at 7-10 days Rash develops at 7-10 days after vaccination. after vaccination.

ArthralgiaArthralgia

Increasing of paroid glands Increasing of paroid glands

Serous meningitisSerous meningitis

Angioneurotic edemaAngioneurotic edema

febril temperaturefebril temperature

Seizures Seizures

Hemorrhagic vasculitisHemorrhagic vasculitis

Mild lymphadenopathyMild lymphadenopathy

ArthritisArthritis

thrombocytopeniathrombocytopenia

BCG-Vaccination BCG-Vaccination Postvaccinal reactionsPostvaccinal reactions Postvaccinal complicationsPostvaccinal complications

Local reaction: Local reaction: papule, papule, vesicle, vesicle,

lymphadenitislymphadenitis

1.1. Subcutaneous cool Subcutaneous cool abscess abscess

2.2. Purulent Purulent lymphadenitis.lymphadenitis.

3.3. Keloid scars.Keloid scars.

4.4. Lymph nodes Lymph nodes calcification.calcification.

5.5. Generalized BCG-Generalized BCG-infection on infection on background of background of immune deficiency (4: immune deficiency (4: 1000000).1000000).

6.6. 6.6. Osteitis, Osteitis, osteomyelitis osteomyelitis

Main rules of vaccinationMain rules of vaccination Take allergic history Take allergic history Take life historyTake life history Take history of vaccinationTake history of vaccination Take family historyTake family history Do objective exanimation of the Do objective exanimation of the

childchild Take temperature of the bodyTake temperature of the body Do vaccination at special roomDo vaccination at special room Follow the instruction of vaccine Follow the instruction of vaccine Supervise the vaccinated person for Supervise the vaccinated person for

30 days30 days

CONTRAINDICATIONS TO THE CONTRAINDICATIONS TO THE VACCINATION by all vaccines and VACCINATION by all vaccines and

toxoidstoxoids Severe complications from the previous Severe complications from the previous

dose in the form of anaphylactic shock. dose in the form of anaphylactic shock. Allergy to any vaccine component. Allergy to any vaccine component. Progressive diseases of the nervous Progressive diseases of the nervous

system, hydrocephalus in system, hydrocephalus in decompensation stage, epilepsy, decompensation stage, epilepsy, epileptic syndrome with convulsions 2 epileptic syndrome with convulsions 2 times a month and more often. times a month and more often.

Acute illness or chronic disease Acute illness or chronic disease exacerbationexacerbation

CONTRAINDICATIONS TO CONTRAINDICATIONS TO THE VACCINATION by all live THE VACCINATION by all live

vaccinesvaccines Congenital combined immune Congenital combined immune

deficiency,deficiency, primary hypogammaglobulinemia primary hypogammaglobulinemia

(entering the vaccine is not (entering the vaccine is not contraindicated in selective Ig A and contraindicated in selective Ig A and Ig M immunodeficiency), Ig M immunodeficiency),

transitional hypogammaglobulinemiatransitional hypogammaglobulinemia malignant tumors, malignant tumors, pregnancy, pregnancy, AIDS, AIDS, immune suppression therapyimmune suppression therapy

baby weight less than 2000 g: baby weight less than 2000 g: 1500 - 1999 g vaccinations are not 1500 - 1999 g vaccinations are not

done up to 1 month. done up to 1 month. 1000 - 1499 g - up to 2 months. 1000 - 1499 g - up to 2 months. Complicated reactions to previous Complicated reactions to previous

vaccine (adenitis, cold abscess, skin vaccine (adenitis, cold abscess, skin ulcers over 10 mm in diameter, ulcers over 10 mm in diameter, kelloid scar, osteomyelitis, kelloid scar, osteomyelitis, generalized BCG infection). generalized BCG infection).

Tubinfection. Tubinfection. Defects of phagocytosisDefects of phagocytosis

CONTRAINDICATIONS TO THE BCG-VACCINATION

CONTRAINDICATIONS TO THE CONTRAINDICATIONS TO THE VACCINATIONVACCINATION

OPV Children whom live vaccine is

contraindicated, as well as to members of their families is recommended vaccination by polio inactivated vaccine (IPV)

DTP A history of convulsions (instead DTP

vaccine - DTaP vaccine or DT toxoid is injected)

By By living vaccine against measles, living living vaccine against measles, living mumps vaccine, vaccine against rubella or mumps vaccine, vaccine against rubella or

trivaccine (measles, mumps, rubella)trivaccine (measles, mumps, rubella)

Allergic reactions on Aminoglucosides Allergic reactions on Aminoglucosides Anaphylactic reactions on eggs proteinAnaphylactic reactions on eggs protein

CONTRAINDICATIONS TO CONTRAINDICATIONS TO THE VACCINATIONSTHE VACCINATIONS