Childhood Immunization

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Childhood Immunization

• Directed by Dr. J. Halazoun
• Presented by Dr. F. Abu Eida

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ROUTINE VACCINES IN CHILDHOOD ADOLESCENSE

• ALL CHILDREN SHOULD BE VACCINATED AGAINST
• Diphtheria,Tetanus,Pertussis,Polio
  Myelitis,Measles, Mumps, Rubella, Hepatitis B
  Varicella , unless contraindicated.
• Completion of the vaccination schedule by 18
  months of age requires 16-20 injection, in 4-5
  visits .
• The number of injections is likely to be reduced
  by the introduction of combination vaccines.

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General Rules for all Vaccines

• True Contraindications
• Serious allergic reaction after previous vaccine
  dose.
• Serious allergic reaction to vaccine component.
• Precautions
• Moderate to severe acute illness with or without
  fever.

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Untrue contraindications

• Mild acute illness with or without fever.
• Mild to moderate local reaction (swelling ,
  redness) , low grade or moderate fever after
  previous dose.
• Current anti microbial therapy.
• Convalescent phase of illness
• Premature birth ( hepB is an exception in certain
  circumstances)
• History of penicillin allergy, other non vaccine
  allergies
• Recent exposure to an infectious disease

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Hepatitis B Vaccine

• All infants should receive the first dose soon
  after birth , before hospital discharge .
• Infants born to HBsAg ve mothers should receive
  the 2nd dose at least one month after the 1st
  dose.
• The 3rd dose should be given at least 4 months
  after the second dose, but not before 6 months of
  age.
• Infants of HBsAg ve mother should receive
  hepatitis B vaccine and 0.5 ml HepB Ig within 12
  hours after birth, at separate sites.

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Hepatitis B Vaccine

• The second dose is recommended at 1-2 month of
  age 3rd dose at 6 month of age.
• Infants of mothers of unknown HBsAg status should
  receive HBV vaccine within 12 hrs of birth
  maternal blood should be drawn at delivery to
  determine the mother status.
• If HBs Ag is ve the infant should receive HB Ig
  as soon as possible ( not later than 1/52 of age).

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Hepatitis B Vaccine
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DTaP Vaccine

• The 4th dose of DTaP may be administered as early
  as 12 month of age, provided 6/12 have elapsed
  since the 3rd dose if the child is unlikely to
  return at age 15 18 month.
• Tetanus diphtheria toxoids (Td) is recommended
  at age 11-12 yrs, if at least 5 yrs have elapsed
  since the last dose.
• Subsequent routine (Td) boosters are recommended
  every 10 yrs.

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Contraindications

• Encephalopathy ( coma , decreased level of
  consciousness, prolonged seizures ) within 7 days
  of administration of previous dose.
• Progressive Neurologic disorder including
  Infantile spasm , uncontrolled epilepsy ,
  progressive Encephalopathy, defer DTaP until
  neurologic status clarified .

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Precautions

• Fever of 40.5 ?c or more , within 48 hrs after
  vaccination with previous dose of DTP or DTaP .
• Collapse or shock like state
• Hyporesponsive Hypotonic episode within 48 hrs
  after receiving previous dose of DTP or DTaP.
• Seizures within 3 days of receiving previous dose
  of DTP or DTaP.
• Persistent , inconsolable crying lasting gt 3 hrs
  lt 48 hrs after previous dose.
• Guillian- Barre Syndrome within 6 weeks after
  previous dose.

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These are not contraindications

• Temperature lt 40.5
• Fussiness or mild drowsiness after previous dose.
• Family Hx of seizures .
• Family Hx of SIDS
• Family Hx of adverse reaction after DTP or DTaP
  vaccination.
• Stable neurologic condition ( CP, well controlled
  convulsions , developmental delay)

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DTP continue

• Pertussis is common in developing countries and
  some developed nations ,where immun. Is not
  provided.
• Protection is attained with four doses and
  booster at 4-6 yr of age
• DT should be used for children who are younger
  than 7years and who have contraindication to
  pertussis vaccine . Pertussis vacc. Has not
  recommended for persons 7 yr of age or older.
• Dose and administration0.5ml in anterolateral
  thigh.
• Acetaminophen administered before DTaP or DTP
  vaccination and thereafter every 4 hours for 24
  hours,for children with personal or family Hx of
  convulsions

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Hib Conjugate Vaccine

• Vaccine is administered at 2/12 4/12 (a dose
  at 6/12 not required).
• Contraindications Age below 6 weeks.
• Precautions moderate to severe acute illness
  with or without fever.

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IPV OPV

• All children should receive 4 doses of IPV at age
  2,4,6-18 months and 4-6 yrs.
• Two doses of IPV administered at ages 2 4
  months, followed by two doses of OPV at 12-18
  months 4-6 yr.
• IPV is recommended for Immunocompromised persons
  .
• Precaution pregnancy.

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IPV OPV cont

• IPV is recommended to reduce the risk of vaccine
  associated paralytic poliomyelitis associated
  with OPV.
• OPV is recommended in areas where polio is
  endemic in unvaccinated children who will
  travel within 4 weeks to endemic areas.

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Measles, Mumps Rubella

• The 1st dose at 12 months or after.
• The 2nd dose of MMR is recommended at 4-6 yrs and
  may be given during any visit .
• Those who have not previously received the 2nd
  dose should complete the schedule by the visit at
  11- 12 yrs.

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Contraindications

• Immunodef.,immunosupppresive therapy ,HIV
  infection.
• Pregnancy
• Severe allergic reaction after previous dose or
  to vaccine component.
• Precautions
• thrombocytopenia hx of TP.
• History of receipt of antibody containing bld
  products lt 11 months

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Varicella Vaccine

• Live attenuated Varicella virus vaccine is
  recommended at any visit , at or after age 12
  months for susceptible children.
• Patients on salicylate therapy have a risk of
  developing Reye syndrome after vaccination.
• Persons 13 yrs or older should receive 2 doses,
  given at least 4 weeks apart.

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Varicella cont..

• Varicella should not be given to a member of
  family hx of immunodef. Until the immune status
  documented.
• Pregnancy .
• All children 12 months of age or older ,who have
  no hx of varicella vaccination or chicken pox
  should be vaccinated .
• Infants younger than 6 months protected by
  maternal antibodies.
• VZIG is recommended for newborn whose mother had
  onset of chicken pox within 5 days before to2
  days after delivery
• Children and adoles. With ALL in remission can
  receive varicella vaccine

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Pneumococcal Vaccine

• It is a conjugate vaccine.PCV
• It is recommended for all children aged 2-23
  months.
• It is also recommended for certain children aged
  24-59 months
• Pneumococcal polysaccharide vaccinePPV is
  recommended in addition to PCV for certain high
  risk groups
• Sickle cell disease
• Asplenia
• HIV
• Congenital ID
• CRF- nephrotic syndrome
• Chronic cardiac disease
• CSF leak

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Hepatitis A Vaccine

• It is an inactivated vaccine.
• This vaccine is recommended for use in selected
  states regions.
• Given in 2 doses
• 0.5 ml for 2 17 yrs of age
• 1 ml for 18 yrs or older
• Protective immunity develops 2-4 weeks after
  receiving the initial vaccine dose.

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Hepatitis A Vaccine

• If immediate protection( before 2 weeks) is
  necessary , IM Ig can be given
• for short protection of 1 2 months.
• 0.02 ml / kg
• For long time protection of 3-5 months
• 0.06 ml / kg can be repeated every 5 months if
  exposure continues

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Influenza Vaccine

• Influenza vaccine is recommended for
• persons at increased risk of complications of
  influenza.
• The elderly.
• Children 6 months or older
• Asthma
• Cardiac disease
• Sickle cell disease
• HIV
• others

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Influenza vaccine

• Can be given annually from 6 months of age
• 6- 35months
• 0.25 ml
• 3yrs or more
• 0.5 ml
• Children 8 yrs or less who are receiving the
  vaccine for the first time , should receive 2
  doses at least 4 weeks apart.

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Influenza vaccine

• Contraindications
• Severe allergic reaction to egg protein , or
  other component
• Untrue contraindication
• Concurrent administration of aminophyllin
  comadine
• Severe contact allergy to latex

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Meningococcal Vaccine

• Serogroup A is the most common cause of
  meningococcal meningitis.
• Group C B are less common.
• The quadrivalent polysaccharide A/C/Y/W- 135 is
  available in USA.
• The vaccine is ineffective against serogroup A in
  infants less than 3 months may be partially
  effective in children 3 11months of age.

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Meningococcal Vaccine

• Children younger than 2 yrs , are not protected
  against serogroup C .
• The meningococcus vaccine(0.5 ml SQ) is
  recommended for persons 2 yrs or older.
• Children vaccinated before 4 yrs of age , should
  be revaccinated after 2 3 yrs, if they remain in
  endemic areas.

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Meningococcal Vaccine

• Indications
• Functional or anatomic asplenia
• Travel to endemic areas

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Typhoid Vaccine

• Recommended for persons traveling to endemic
  areas.
• Three typhoid vaccine
• oral vaccine
• for 6 yrs older
• 4 doses of one enteric coated capsule EOD
• Repeated every 5 yrs as booster
• 2 parenteral vaccines younger than 6 yrs
• 0.25 ml from 6 months 10 yrs
• 0.5 ml for 10 yrs and older

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Rabies Immunization

• The risk of rabies is currently the highest in
  countries where rabies in dogs is uncontrolled.
• Children should be considered for pre exposure
  prophylaxis ,if they will be in an endemic area
  fore more than 1 month.
• There are two available vaccines
• HDCV Human Diploid Cell Rabies Vaccine
• RVA Rabies Vaccine Absorbed

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Rabies Immunization

• Preexposure
• 3 intradermal doses of HDCV 0.1 ml on days
  0,7,28 days.
• RVA IM as 3 doses 1ml on days 0,7,28
• Post exposure
• Rabies IG given IM as 5 doses of 1 ml on days
  0, 3, 7, 14, 28,if previously unvaccinated 2
  doses on days 0, 3 if vaccinated.

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ROTA VIRUS

• First dose should not be given before 6 weeks .
• C/o hypersensitivity to aminoglicoside,ampho B
  ,febrile illness ,immunodef. Precaution is acute
  vomiting or diarrhea

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THANK YOU

• Special thanks
• Yaman Abou Zanouna
• Deena abdel Hadi