Immunization Schedule in Shanghai

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Immunization Schedule in Shanghai

• Gao Yijin
• Childrens Hospital Fudan University

Sep. 2005
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BCG Vaccine (Bacille Calmette Guerin)

• a vaccine for tuberculosis (TB) disease
• not generally recommended for use in the United
  States
• recommended in developing countries with a high
  prevalence of tuberculosis (where skin test
  conversions exceed 1 annually)

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Prevalence of Active Pulmonary TB in Children in
China
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Course of BCG vaccine

• 1st dose at birth

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Hepatitis B Vaccine

• Hepatitis B --- a serious disease caused by a
  virus that attacks the liver
• Hepatitis B is highly endemic in eastern and
  southeastern Asia
• Hepatitis B virus spread through contact with the
  blood and body fluids of an infected person

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Course of HB vaccine

• Hepatitis B Vaccine
• available for all age groups to prevent hepatitis
  B virus infection
• the first anti-cancer vaccine

• 1st dose is given at birth
• 2nd dose is given at 1 mo of age
• 3rd dose is given at 6 mo of age

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Poliovirus Vaccines

• Polio is a disease caused by a virus
• The virus enters a childs body through the mouth
• Kill people by paralyzing the muscles that help
  breathe
• Polio vaccine can prevent polio
• two types of poliovirus vaccine
• OPV, a live, attenuated trivalent poliovirus
  vaccine (Sabin)
• IPV, an inactivated (killed) trivalent
  poliovirus vaccine (Salk)

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Course of OPV

• started at 2 mo of age
• two additional doses are given at 1-mo interval
• (gt99 immunity after 3 doses)
• a 4th dose is given at 15-24 mo of age
• a 5th dose is give at 4 yr of age

a full course of either vaccine protects the
recipient against paralytic poliomyelitis almost
without exception
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Poliomyelitis in Shanghai

• 1963 OPV vaccination began
• 1987 the last indigenous wild-type polio case
• 1990 the last wild-type poliovirus isolated
  
• from a child from another province

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Measles-Mumps-Rubella Vaccine (MMR)

• these diseases spread form person to person
  through the air
• live, attenuated viruses, combined in a single
  preparation
• MMR vaccine can prevent these diseases

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Measles-Mumps-Rubella Vaccine (MMR)

• initiated at 15 mo of age
• second dose
• at 5 yr of age
• (recommended by the American Academy of
  Pediatrics)
• or at 12 yr of age
• (recommended by US Public Health Service)

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Measles vaccine

• Measles is endemic in many developing countries
• age of vaccination should be lowed for children
  (compared to United States schedule)
• Course of measles vaccine in Shanghai
• started at 8 mo of age
• boosted at 4 yr of age

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Japanese Encephalitis (JE) Vaccine(Encephalitis
type b Vaccine)

• JE
• the leading cause of viral encephalitis worldwide
  ( 510 cases annually in our hospital )
• endemic in China, India, Korea, Japan,
  Philippines, eastern Russia, and Southeast Asia
• Spread through the bite of infected mosquitoes

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Course of JE vaccine

• primary immunization at 1 yr old
• 2 doses are administered at a 12 wk
  interval
• 3rd dose is given at 2 yr of age
• 4th dose is given at 5 yr of age

JE vaccine can prevent JE, but is not 100 and is
not a substitute for mosquito precautions.
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Meningococcal Vaccine

• Meningococcal infection
• A serious illness caused a bacteria
• common in temperate and tropical climates
• transmitted through air
• serogroup A is the most common cause of epidemics
  in China (510 cases annually in
  our hospital)

Meningococcal vaccine can prevent meningococcal
infection
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Course of meningococcal vaccine

• 1st dose at 3 yr of age
• 2nd dose at 7 yr of age
• 3rd dose at 10 yr of age

• Meningococcal infection can be treated with
  drugs. Still, about 1 out of every ten people who
  get the disease dies from it

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Hepatitis A Vaccine

• Hepatitis A
• Caused by the hepatitis A virus (HAV)
• HAV spread by close personal contact or by eating
  food or drinking water containing HAV
• Outbreak of hepatitis A in Shanghai in 1988
• Hepatitis A vaccine can prevent hepatitis A

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• Course Hepatitis A Vaccine
• 2 doses after 1 yr of age at a 6 mo 12 mo
  interval
• People with hepatitis A have to be hospitalized

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• Varicella Vaccine (Chickenpox)
• Hemophilus influenzae b Vaccine (Hib)
• Vaccine for Diphtheria, Tetanus and Pertussis
  (DTP)

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Influenza (Flu) vaccine
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What is Influenza (also called Flu)?

• a contagious respiratory illness caused by
  influenza viruses
• mild to severe illness, and at times can lead to
  death
• best way to prevent this illness is by getting a
  flu vaccination each fall.

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How Flu Spreads

• Flu viruses spread in respiratory droplets caused
  by coughing and sneezing
• you can pass on the flu to someone else before
  you know you are sick, as well as while you are
  sick

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Preventing the Flu Get Vaccinated

• to get a flu vaccination each fall
• about two weeks after vaccination, antibodies
  develop that protect against influenza virus
  infection

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When to Get Flu Vaccinated

• October or November --- the best time to get
  vaccinated, but getting vaccinated in December or
  even later can still be beneficial
• Flu season can begin as early as October and last
  as late as May

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• Course of Flu shot
• one flu shot each year

Flu vaccines are updated every year An annual
vaccination is recommended Flu vaccine will not
prevent flu-like illness caused by other
viruses.
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• Thank you !

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Varicella Vaccine (Chickenpox)

• Varicella
• mainly between January and June in Shanghai
• the peak age of incidence is 3 13 yr (our
  hospital data)
• course of varicella vaccine
• one dose after 1 yr of age
• vaccine efficacy was 80 in children subsequently
• exposed to varicella

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Hemophilus influenzae b Vaccine (Hib)

• caused by a bacteria
• usually strike children under 5 years old
• spread from person to person
• Hib vaccine can prevent Hib disease

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Hemophilus influenzae b Vaccine (Hib)

• 1st dose at 2 mo of age
• 2nd dose at 4 mo of age
• 3rd dose at 6 mo of age
• 4th dose at 15 mo of age
• no interference among DTP, OPV, MMR, and Hib
  vaccine

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Vaccine for Diphtheria, Tetanus and Pertussis
(whooping cough) (DTP)

• Serious diseases caused by bacteria
• Diphtheria and pertussis are spread from person
  to person
• Tetanus enters the body through cuts or wounds
• protect your children by getting them immunized
  with DTP vaccine

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Vaccine for Diphtheria, Tetanus and Pertussis
(DTP)

• usually started at 3 mo of age
• two additional doses are given at 1-mo intervals
• a 4th dose is given at 15-24 mo of age
• Td are given at the time of school entry
• another dose of Td is given at 15 yr of age

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Contraindications to administering OPV

• individuals proven or suspected to be
  immunocompromised
• those with congenital and acquired
  immunodeficiencies
• those whose immune mechanisms are impaired
  by therapy
• Household contacts of immunocompromised
  individuals or to subsequent siblings of a child
  with congenital immunodeficiency until the
  younger child is shown to be normal

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Contraindications to administering DTP

• an acute febrile illness (a minor respiratory
  infection is not a contraindication)
• an evolving or suspected neurologic illness
• a severe reaction to a prior dose of DTP
• a fever of greater than 40.50 C (1050 F)
• shock-like syndrome
• neurologic reactions

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Surveillance of Vaccine-associated Paralytic
Poliomyelitis (VAPP)
(Beijing,19892002)

• 20 cases of VAPP
• (through acute flaccid
  paralysis surveillance system)
• 18/20 related the first dose of OPV
• 2/20 close contacted with child having OPV
• 17/20 lt 6 mo (all cases lt 1 yr)
• overall estimated risk of OPV 1.59 per 1
  million OPV doses administered
• the risk of first time recipients 13.18 per 1
  million OPV doses administered
• the risk of contacts 0.16 per 1
  million OPV doses administered

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Reactions follow DPT injection

• local swelling, tenderness at the site of
  injection, slight fever, irritability
• upsetting but without demonstrated sequelae
• excessive somnolence, protracted inconsolable
  crying
• neurologic reactions within 3 days of DPT

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Symptoms of Flu

• fever (usually high)
• headache
• extreme tiredness
• dry cough
• sore throat

• runny or stuffy nose
• uscle aches
• stomach symptoms

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Complications of Flu

• bacterial pneumonia, dehydration
• worsening of chronic medical conditions, such as
  congestive heart failure, asthma, or diabetes
• children may get sinus problems and ear infections

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Who Should Get Vaccinated ?

• people aged 65 years and older
• people aged 264 years with chronic health
  conditions
• children aged 623 months
• women who will be pregnant during the influenza
  season
• health-care personnel who provide direct patient
  care
• household contacts and out-of-home caregivers of
  children less than 6 months of age

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Course of HB vaccine (adolescent
and adult schedule)
Third must be separated from first dose by at
least 16 weeks
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Hepatitis B Vaccine

• Efficacy 95 (range, 80100)
• Duration of immunity gt15 years
• Schedule 3 doeses
• Booster does not routinely recommended

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