IMMUNITY AND IMMUNIZATION

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IMMUNITY AND IMMUNIZATION

• FAHAD AL ZAMIL
• Professor Consultant
• Paediatric Infectious Diseases
• King Khalid University Hospital
• King Saud University, Riyadh

Keeps Kids Healthy!
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IMMUNITY IMMUNIZATION

• I. Immunity
• A. Components of the Immune Systems
• ? Lymphocyte
• ? B. T. Killer
• ? Neutrophils
• ? Macrophage
• ? Complement

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IMMUNITY IMMUNIZATION

• B. Features suggestive of immune deficiency
• ? Increased susceptibility to infection.
• ? Types of infection
• ? Skin manifestation

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IMMUNITY IMMUNIZATION

• C. Facts and types of immunodeficiency B, T,
  combined, phagocyte and complements.
• D. Few examples of disorders.
• E. Evaluations of a patient suspected of having
  immunodeficiency.
• F. Management.

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Historical Milestones

• 1000 years ago Chinese inhaled dried crusts
  from smallpox pustules
• 1721 variolation was introduced from Turkey to
  Britain by Lady Montagu
• 1796 Edward Jenner 1st scientific attempt of
  immunization (cowpox)
• 19th Century Anthrax 1881, Rabies 1885,
  Diphtheria antitoxin 1891, Plague 1895, Cholera
  1896, Typhoid 1898
• Early 20th Century BCG 1921, Diphtheria toxoid
  1923, Pertusis 1926, Tetanus 1927, Yellow fever
  1937, Influenza 1941
• Post World War II Polio, MMR, Pneumococcal,
  Meningococcal, HiB, Hepatitis B, Hepatitis A
• 1980 Eradication of Smallpox
• Whats New in the 21st Century??

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IMMUNITY IMMUNIZATION

• II. Immunizations
• A. Types
• ? Active
• ? Passive

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IMMUNITY IMMUNIZATION

• Active
• ? Immunizing antigens
• ? Site, route and dose
• ? Scheduling
• ? Simultaneous administration of vaccines

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IMMUNITY IMMUNIZATION

• Immunization in special clinical circumstances
• ? Preterm
• ? Pregnancy
• ? Immunodeficient
• ? Asplenic children

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IMMUNITY IMMUNIZATION

• ? History and family seizures
• ? Children with chronic diseases
• ? Foreign travel

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IMMUNITY IMMUNIZATION

• ? Lapsed immunizations and unknown immunization
  status.
• ? Reimmunization
• ? Interference with immunoglobulin
• ? Vaccine safety and contraindications
• ? Immunization after exposure to disease.

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ROUTINE ACTIVE IMMUNIZATION FOR INFANTS
CHILDREN
Vaccine Age
BCG, HBV 1st At birth
DPT HiB OPV 1st, HBV 2nd 2 months
DPT HiB OPV 2nd 4 months
DPT HiB OPV 3rd, HBV 3rd 6 months
MMR 1st 12 months
DPT HiB OPV 1st booster 18 months
DPT OPV 2nd booster, MMR 2nd 4 6 years
Td (Repeated every 10 yrs.) 14 16 years
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Revised Basic Vaccination Schedule Activated in
January 1st, 2008
?????? Vaccine Age
????? ? ???????? ?????? (?) BCG, HepB At birth
??? ??????? ?????? ( ??????? ????????????????? ?????? ?? ????????? ???????) IPV (DTP, HepB, Hib) 2 months
??? ??????? ?????? (??????? ????????? ???????? ?????? ?? ????????? ???????) OPV (DTP, HepB, Hib) 4 months
??? ??????? ?????? OPV (DTP, HepB, Hib) 6 months
?????? ?????? Measles (Mono) 9 months
??? ??????? ??????? ??????? ????????? ??????? ?????? OPV, MMR, Varicella 12 months
??? ??????? ?????? (??????? ?????????????????? ???????) ? ???????? ??????(?) OPV (DTP, Hib), HepA 18 months
???????? ??????(?) HepA 24 months
??? ???????? ??????? ????????? ??????? ????????? ??????? ?????? OPV, DTP, MMR, Varicella 4 6 Years
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VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION
Route Type Vaccine
Intradermal (Preferred) or subcutaneous Live bacteria BCG
Subcutaneous intramuscular or intradermal Inactivated bacteria Cholera
Intramuscular Toxoids and inactivated bacteria DTP
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VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont)
Route Type Vaccine
Subcutaneous Live virus Rubella
Intramuscular Toxoids Tetanus TD, DT
Subcutaneous (Boosters may be intradermal) Inactivated bacteria Typhoid
Subcutaneous Live virus Yellow fever
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VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont)
Route Type Vaccine
Subcutaneous Live viruses MMR
Subcutaneous Live virus Mumps
Oral Live virus OPV
Intramuscular Inactivated bacteria Plague
Intramuscular or subcutaneous Polysaccharide Pneumococcal
Intramuscular Inactivated virus Rabies
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VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont)
Route Type Vaccine
Intramuscular Inactivated viral antigen Hep. B
Subcutaneous intramuscular Polysaccharide Haemop. B
Intramuscular (Preferred) or subcutaneous Inactivated virus Influenza
Subcutaneous Inactivated virus IPV
Subcutaneous Live virus Measles
Subcutaneous Polysaccharide Meningococcal
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Immunization Immunity

• Misconceptions concerning vaccine
  contraindications
• Mild acute illness with low-grade fever or mild
  diarrhea illness in an otherwise well child.
• Current antimicrobial therapy or the convalescent
  phase of illness.

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Immunization Immunity

• Recent infection to an infectious disease
• Breast feeding
• A history of non-specific allergies or relatives
  with allergies

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Immunization Immunity

• Reaction to a previous DTP dose that involved
  only soreness, redness, or swelling in the
  immediate vicinity of the vaccination site or
  temperature less than 105F (40.5 C).
• Prematurity
• Pregnancy of mother or other household contact.

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Immunization Immunity

• Family history of Sudden Infant Death Syndrome in
  children considered for DTP vaccination.
• Family history of an adverse event, unrelated to
  immunosuppression, after vaccination.
• Malnutrition

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Immunization Immunity

• Allergies to penicillin or any other antibiotic,
  except anaphylactic reactions to neomycin or
  streptomycin.
• Allergies to duck meat or duck feathers.
• Family history of convulsion in persons
  considered for pertussis or measles vaccination.

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Immunity Immunization
Comments Recommended Vaccine (s) Recommended Vaccine (s)
Before giving BCG, Tuberculin, skin testing is recommended if feasible. BCG, Td, OPV 1st visit
Interval after 1st visit
MMR 1 month
Td, OPV 2 months
Td, OPV 8 14 months
Repeat every 10 yrs. throughout life Td 10 years
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IMMUNITY AND IMMUNIZATION
Comments Recommended Vaccine (s) Recommended Vaccine (s)
Before giving BCG, Tuberculin, skin testing is recommended if feasible. BCG, Td, OPV 1st visit
Interval after 1st visit
MMR if child gt 12 mos. MMR 1 month
DTP, OPV 2 months
DTP, OPV 4 months
Td 10 16 months
DT and OPV are not necessary If the 4th dose of each were given after 4 yrs. of age DTP, OPV 4 6 years
Repeat every 10 yrs. throughout life Td 14 16 years
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IMMUNITY AND IMMUNIZATION

• Questions to be answered
• Q. Is it possible to immunize a child with
  neurological disorder?
• Q. Is it possible to immunized a child during a
  minor illness?
• Q. My child is having eczema and evidence of
  atopy. Can he be immunized?

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IMMUNITY AND IMMUNIZATION

• Questions to be answered
• Q. Is it possible to administer multiple vaccines
  simultaneously?
• Q. Does the lapse in the immunization schedule
  require re-institution of the entire series?
• Q. If a child immunization status is unknown
  what to do?

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IMMUNITY AND IMMUNIZATION

• Questions to be answered
• Q. Is it possible to give vaccines during
  immunosuppressive therapy?
• Q. Is it possible to immunize a child who
  recently received immune globulins?
• Q. When to immunize a child born prematurely?
• Q. My child is allergic to egg, can he be
  immunized?

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Further Reading

• http//www.vaccineinformation.org