Childhood immunization

By: 5th year Medicine and surgery students, UST Sana’a, Republic of Yemen

*Childhood Immunization

*Importance of Vaccination

*Prevention of infectious disease spread worldwide

*A key to public health maintenance

*Protection for one self and the surrounding in contact

*To eradicate diseases (e.g. Smallpox)

*Enhancement of the immune system response by “letting it learn something new”

*Importance of childhood

vaccination*Maternal Antibodies against certain disease do not offer a life long immunity to the baby

*Many fatal childhood diseases can be prevented through vaccination (e.g. Whooping cough)

*Protection of those with weak immune system from disease (e.g. Leukemia)

*To maintain healthy, active and productive community members

*How vaccines work*Vaccines are weakened or killed forms of disease

causing micro organisms

*When the antigen is injected into the body → this allows the immune system to deal with and neutralize the invader.

*Next time the same micro organism enters the body, the body has already preformed antibodies to destroy the invader

*How do vaccines work?

*BCG

*Causative MO: Mycobacterium tuberculosis

*Disease transmitter: Droplet

*Type: Live attenuated bacilli

*Age of vaccine administration: As soon as possible after birth

*Route of administration: ID

*Doses: 1

*Interval between each dose: -

*Booster dose: -

*Special considerations: Those of low immunity should be excluded from vaccination (HIV etc)

*Adverse reactions: If administered SC instead of ID, this may cause lymphadenitis.

*C/I: In those with compromised immune system

*Hepatitis B

*Causative MO: Hepatitis B virus (dsDNA)

*Disease transmitter: Blood transfusion, sexually, through the birth canal

* Type: Subunit

*Age of vaccine administration: After birth

*Route of administration: IM

*Doses: 3

* Interval between each dose: →1st to 2nd: 4 weeks→2nd to 3rd: 4 weeks

*Booster dose: -

* Special considerations: -Premature infants’ 1st dose after 1 month of age-Infants to infected mother receive hepatitis B immunoglobulins with the initial dose.

*Adverse effects: Those of importance which require prompt treatment included: anaphylaxis; Tachycardia; Numbness.

*C/I: Infants weighing less than 2 kgs

*Polio

*Causative MO: Poliovirus (Enteroviruses of the family Picorna viridae)

*Disease transmission: Droplet

* Type: Salk: Killed vaccineSabine: Live attenuated vaccine,

*Route of administration:OPV: OrallyIPV: IM in arm or leg

*Age of vaccine administration: 6th week for OPV8th week for IPV

*Doses: 3 (4)

* Interval between each dose: At least 4 weeks between each vaccine

*Booster dose: IPV booster dose 6 months after the 3rd dose

* Special considerations: -

*Adverse effects: Anaphylaxis, tachycardia, pyrexia

*C/I: Immunosuppressed individuals should not receive the vaccine

*DTP

*Causative MO: Diphteria, Tetanus, Pertussis

*Disease transmission: Droplet, contaminated wound, droplet

*Type: Diphteria and tetanus toxoids, acellular pertussis

*Age of vaccine administration: Minimum age is 2 months


*Doses: 3

*Interval between each dose: 1-2 months between each dose

*Booster dose: 1-6 years of age

*Special considerations: Patients older than 7 years whom did not get vaccinated, receives toxoids of 3 doses (1, 4w, 6-12m)

*Adverse effects: Excessive crying, encephalopathy (usually occurring with pertussis)

*C/I: Hypersensitivity to any vaccine component

*Haemophilus influenza type B

*Causative MO: Haemophilus influenza type B

*Disease transmitter: Droplet/aerosol

*Type: Conjugate vaccine

*Age of vaccine administration: 6 weeks of age

*Route of administration: IM (Part of pentavalent)

*Doses: 3

*Interval between each dose: 4 weeks

*Booster dose: -

*Special considerations: Those older than 12 months who did not receive the vaccine should receive a single dose

*Adverse reactions: rare, but if occurring, are in the form of redness, pain and hotness at site of injection.

*C/I: Severe allergic reaction to any component

*Measles

*Causative MO: Paramyxovirus


*Type: Chicken embryo cell culture (attenuated)

*Age of vaccine administration: 9 or 12 months of age

*Route of administration: SC

*Doses: 2

*Interval between each dose: Minimum 1 month between the 1st and 2nd

*Booster dose: -

*Special considerations: Early to HIV (sufficient CD4+ count).

*Adverse effects: Idiopathic epilepsy, febrile seizures

*C/I: Allergy to any vaccine component.

*Pneumococcal(Conjugate)

*Causative MO: Pneumococcus pneumonia


*Type: Conjugate

*Age of vaccine administration: 1,5 months of age (minimum)


*Doses: 2 or 3

* Interval between each dose: 4 weeks between each of the 2nd and 3rd doses (for the 3 dosed variety) and at 8th week interval for the 2 dosed variety)

*Booster dose: For the 2 dosed type given a booster at 9-15th month later

*Special considerations: Use the same type of product vaccine when giving the other doses

*Adverse effects: Redness, swelling, tenderness (at site of injection)

*C/I: Any kind of hypersensitivity (anaphylaxis)

*Rotavirus

*Causative MO: Rotavirus

*Disease transmitter: Contaminated water

*Type: Attenuated virus

*Age of vaccine administration: Rotarix (at 6 weeks of age)

RotaTeq (at 6 weeks of age)

*Route of administration: RotaTeq (oral), Rotarix (Oral)

*Doses: Rotarix (2), RotaTeq (3)

* Interval between each dose: Rotarix (4 weeks), RotaTeq (4 weeks between the 2nd and 3rd doses)

*Booster dose: -

*Special considerations: -

*Adverse effects: Intussusception

*C/I: Anaphylaxis due to vaccine component; Intussusception (especially in patients with previous history of intussusception)

*Rubella

*Causative MO: Rubella virus


*Type: Live attenuated

*Age of vaccine administration: 9 or 12 months with measles


*Doses: 1


*Booster dose: -

*Special considerations: Has a coverage of more than 80% of the population when vaccinated

*Adverse effects: Thrombocytopenia, arthritis, febrile seizures, anaphylaxis

*C/I: Allergy, thrombocytopenia, immunosuppression

*HPV

*Causative MO: Human Papilloma virus (dsDNA)

*Route of transmission: Sexual transmission

*Type: Protein subunit

*Route of administration: IM (deltoid)

*Age of vaccine administration:

-Quadrivalent (HPV types 6,11,16 and 18): Females 9-13 years of age

-Bivalent vaccine: Females 10-13 years of age

*HPV continued*Doses: 3

*Interval between each dose:

→1st to 2nd :

-Quadrivalent - 2 months (min 4 weeks)

-Bivalent - 1 months (max 2.5 months)

→2nd to 3rd:

-Quadrivalent - 4 months (min 12 weeks)

-Bivalent - 5 months

*Booster dose: No need for a booster dose

*Considerations: The vaccination has not been recommended for males yet.

*Adverse effects: Allergy (due to wheat component)

*C/I: Pregnant women, Immunosuppressed individuals

*Japanese Encephalitis

*Causative MO: Japanese encephalopathy virus (Flavivirus- a ssRNA)

*Disease transmitter: Culex tritaeniorhynchus mosquito

*Type of vaccine: Brain mouse derived or Live attenuated

*Route of administration: IM (deltoid muscle)


- Brain mouse derived: 1 year of age

- Live attenuated: 9-12 months of age

*Doses:

-Mouse brain derived: 2 doses

-Live attenuated: 1 dose

*Japanese Encephalitis continued


-Mouse brain derived: 1st to 2nd dose: 4 weeks

-Live attenuated: no second dose

*Booster dose:

*-Mouse brain derived: After 1 year and every 3 years up to 10-15 years of age

-Live attenuated: After 1 year

*Special considerations: WHO recommends these two types of vaccines

*Adverse effects: Headache, myalgia, local pain and tenderness, multiple sclerosis

*C/I: Anaphylaxis due to any component

*Yellow Fever

*Causative MO: A flaviviridae (ssRNA virus)

*Disease transmitter: The Yellow fever mosquito, Aedes Aegypti

*Type of vaccine: Attenuated virus


*Age of vaccine administration: 9-12 months with measles

*Doses: 1


*Booster dose: -

*Special considerations: Children of endemic areas

*Adverse effects: Fever, headache, anaphylaxis, swelling at the injection site

*C/I: Immunosuppressed individuals, patients younger than 6 months of age

*Tick-Borne Encephalitis

*Causative MO: Tick-borne encephalitis virus (a flavivididae ssRNA)

*Disease transmitter: Ixodes mite

*Type: Inactivated

*Route of administration: IM (deltoid)

*Age of vaccine administration: ≥ 1 yr FSME-Immun and Encepur

*≥ 3 yrs TBE_Moscow and EnceVir

*Doses: 3

*Tick-Borne Encephalitis Continued*Interval between each dose:

*-FSME-Immun and Encepur:1st to 2nd: 1-3 months

2nd to 3rd: 5-12 months

*TBE_Moscow and EnceVir: 1st to 2nd: 1-7 months

2nd to 3rd: 23 months

*Booster dose: Atleast 1 every 3 years

*Special considerations: Vaccination is recommended for high risk areas

*Adverse effects: Loss of appetite, headache, allergic reaction, visual disturbances

*C/I: Patients with severe egg allergy, Any autoimmune disease, RA, MS, Pregnancy, immunosuppressed

*Typhoid

*Causative MO: Salmonella enterica typhi

*Disease transmitter: Contaminated food items with the bacteria

*Type: Ty21a: a live attenuated vaccine

*Age of vaccine administration: Minimum 5 years of age

*Route of administration: Oral

*Doses: 3 or 4

*Interval between each dose: 2 day between each dose

*Booster dose: every 3-7 years

*Special considerations: Preschool and school children of high risk areas of the disease

*Adverse effects: Anaphylaxis, fever, headache, nausea

*C/I: Recent illness with fever, immunosuppressed individuals

*Cholera

* Causative MO: Vibrio cholera

* Disease transmitter: Contaminated drinking water

* Type: Killed/inactivated

* Route of administration: Oral, IM, ID

* Age of vaccine administration: Dukoral: 2 years at minimum

Shanchol And mORCVAX: 1 year minimum

* Doses: Dukoral: 3

Shanchol And mORCVAX: 2

* Interval between each dose: Dukoral: between 1 and 6 weeks between each other dose

Shanchol And mORCVAX: 14 days

* Booster dose: Dukoral: every 6 months

Shanchol And mORCVAX: After 2 years

* Special considerations:The vaccine (dukoral) is not licensed for children below the age of 2 years

* Advese effects: Erythema, pain, malaise, headache

* C/I: IV infusion of the vaccine; Pregnants (category C)

*Meningococcal Vaccine

*Causative MO: Neisseria meningitidis

*Disease transmitter: Saliva, close contact

*Type: -MenA conjugate

-MenC conjugate

-Quadrivalent conjugate



-MenA conjugate: 1-29 years

-MenC conjugate: 2-11 months

-Quadrivalent conjugate: at about the age of 2 years

*Meningococcal vaccine continued

*Doses: -MenA conjugate: 1

-MenC conjugate: 2

-Quadrivalent conjugate: 1


-MenC conjugate: 1st to 2nd: 8 weeks

*Booster dose: After 1 year

*Special considerations:-

*Adverse effects: Pain at the site of injection, redness

*C/I: Currently ill patient, immunocompromised

*Rabies

*Causative MO: Rhabdoviridae

*Disease transmitter: Through animal byte

*Type: Purified chicken embryo cell vaccine

*Age of vaccine administration: Any age requiring protection


*Doses: 3

* Interval between each dose: 1st to 2nd: 7 days

2nd to 3rd: 14-21 days

*Booster dose: Only if rabies-virus neutralizing antibody titers fall to <0.5 IU/ml.

*Special considerations: Antibody testing should be done every 6 months for people at risk

*Adverse effects: Stomach pain, dizziness, headache

*C/I: Any allergy to: Chicken protein, neomycin, amphotericin, bovine gelatin, as these can cause anaphylaxis

*Mumps

*Causative MO: Paramyxovirus (ssRNA)


*Type: Live attenuated

*Age of vaccine administration: 12-18 months with measles


*Doses: 2

*Interval between each dose: 1st to 2nd: at least 1 month between

*Booster dose: -

*Special considerations: The vaccine has a coverage of more than 80%

*Adverse effects: Parotitis, fever, rash

*C/I: Pregnancy, Low immunity (e.g. Leukemia)

*Infleunza (Inactivated)

*Causative MO: Orthomyxoviridiae (RNA)


*Type: Avian (H5N1) or Swine (H1N1)- Live attenuated

*Age of vaccine administration: Minimum age is 6 months


*Doses: 1(>9 years) or 2 (<9 years)


*Booster dose: Annual dose (as strains mutate)

*Special considerations: Prioritization of those at risk (children and elderly)

*Adverse effects: Pain and redness at site of injection, narcolepsy has been noted in some patients receiving the vaccine

*C/I: Allergy to any drug component or egg allergy.

*Thank you for listening

Education

Childhood immunization