immunization

University of Basrah

College of Medicine
Department of Community Medicine

Dr. Lamis Aziz

Vaccination
Significance
*Reduce the mortality and morbidity of infectious diseases
*Eradication of certain diseases, such as smallpox, polio
*Decreased transmission of other diseases such as pertussis, measles, hepatitis B
*Improvement in national economy less health care cost caring for sick children, less time off work of parents

Forms of immunization

1/ Active immunization
Development of sensitized lymphocytes and active antibodies by giving viral/ bacteria protein, killed viral particles, or changed virus/bacterial particles
Protects for many years
Examples polio, tetanus, diphtheria, pertussis, measles

2/ Passive immunization
Giving preformed antibodies, from animal or human origin
Protects for short period, usually months only
Examples gamma globulin for hepatitis or measles protection, tetanus Ig, rabies Ig


3/ Live virus immunization
Uses live, but modified, non pathogenic (attenuated) virus/bacterial particles
Generally must be refrigerated to preserve potency
Example oral polio, measles, varicella, oral typhoid fever
The vaccine should be cooled from the time of production to the time of administration cool chain

4/ Toxoid immunization

Uses modified version of toxin that causes disease
Examples tetanus, diphtheria

Vaccines currently part of the national immunization program

BCG vaccine
Protects against tuberculosis, primarily in children
Type live affected bacterial vaccine
Given by intradermal injection in arm usually produces an inflammatory reaction and small scar
60 80% effective in preventing TB in infants, but protection decreases significantly after 2-3 years. Much less effective in adults.
Adverse effects
Local reaction of inflammtion
Regional lymphadenopathy
Triple vaccine - DPT
Protects against diphtheria, tetanus and pertussis
Type D toxoid, T toxoid, P inactivated bacterial antigen
Route of administration intramuscular
Require minimum of three doses and one booster dose for full immunization
Efficacy 90%
Adverse effects
Fever and malaise up to 30% of children- rarely last for more than 48 hours
Swelling at injection site can be minimized by using longer needle (>35 mm.) for deep IM injection
Rarely convulsions, prolonged crying, unresponsiveness
Oral polio
Protects against polio, given by oral administration
Live, attenuated (weakened) virus
Requires minimum of three doses and one booster dose for maximum public immunity
Efficacy 95%
Adverse effects very rare incidence of vaccine related polio (< 1 per million children)
Measles vaccine (also MMR)
Protects against measles; MMR against measles, rubella, and mumps
Type live attenuated virus
Route of administration - subcutaneous
Measles vaccine given in two doses, at 9-12 months, and again at 18 months
In countries revaccination required at 4-12 years of age
MMR now given instead of single measles vaccine
Efficacy - 95%

Adverse effects-
Slight pain or swelling at injection site
Faint rash 5 8 days after injection, with fever 39
No added adverse effects with combination MMR
Hepatitis B Vaccine
Protects against hepatitis B, but not against other forms
Type- Inactivated vaccine (conjugate protein)
Route of administration - intramuscular
Requires total of 3 doses, first two one two months apart, and 3rd at least 4 months later
Adverse effects- Mild fever and soreness at injection site
Hib Vaccine Protects against Hib disease
Polysaccharide-protein conjugate vaccine
Three to four doses are required (at age two, four, six and 1215 months of age.  Route of administration -- intramuscular
Efficacy- more than 95%
Adverse events- are uncommon. The most common reactions are local reactions at the injection site,fever
Rota virus vaccine
Indicated for the prevention of rotavirus gastroenteritis
live attenuated vaccine
given orally
2 or 3 doses are recommended at ages 2, 4, and 6 months.
The minimum age for dose 1 of rotavirus vaccine is 6 weeks; the maximum age for dose 1 is 14 weeks and 6 days.
- Efficacy- 85%-98% protective against severe rota virus diseaseSide effects-
A small increase in intussusception cases during the first week after the first dose. Stomach pain, vomiting, blood in the stool, weakness, irritability.


Injectable polio vaccine - inactivated poliovirus - four doses at ages: 2 months, 4 months, 6-18 months, and a booster dose at 4-6 years.
- given intramuscularly
-Efficacy- 90% or more of individuals develop protective antibody after two doses, and at least 99% are immune to polio virus following three doses.

Side effects-
pain and redness at the injection site, & tirednessSevere allergic reaction, the risk is extremely small.

Immunization contraindications & precautions

General for all routine vaccines
1. Anaphylactic reaction to a vaccine contraindicates further doses of that vaccine.
2. Anaphylactic reaction to a vaccines constituent contraindicates the of vaccines containing that substance.
3. Moderate or severe illness with or without a fever.
4. Immunodeficiency disease including AIDS.

BCG Contraindications

1. Anaphylaxis or a severe hypersensitivity reaction is an absolute contraindication to subsequent doses of a vaccine

2. Immunodeficiency disease including AIDS

DtaP/DTP
Contraindications
1.DTP should not be given to children older than six years of age.Instead of DTP Td or Ap are sauitable for those children


2.Encephalopathy within 7 days of administration of previous dose
Precautions.
1. Temp. of > 4o.5 C within 48 hr
2. Convulsions within 3 days
3. Persistent, inconsolable crying lasting > 3 hr. within 48 hr.
4. guillian-Barre syndrome within 6 wk after a dose

OPV
Contraindications
1. Infection with HIV or a household contact with HIV infection
2. Known immunodeficiency (hematologic and solid tumors; long-term immunosuppressive therapy)
3. Imunodeficient household contact
Precaution
Pregnancy

MMR
Contraindications
1. Anaphylactic reaction to neomycin, eggs or gelatin
2. Pregnancy
3. Known immunodeficiency, immunosuppressive therapy, HIV infection with evidence of immunosuppression
Precautions
1.Recent (<11 month) administration of a blood product or immune globulin preperation
2. Thrombocytopenia
3. history of thrombocytopenic purpura


Hepatitis BContraindications1.Severe allergic reaction to previous dose or vaccine component.2.Infant weighing < 2,000 grams 3.Moderate or severe acute illness with or without fever
Hib Contraindications 1. Severe allergic reaction to a previous dose  2. Children younger than six weeks of age
3. Moderate or severe acute illness

Rota virus

Contraindications
1. Allergy after getting a dose of the vaccine 2. Immunodeficiency syndrome

IPV

Is contraindicated if patient has developed severe adverse effect to its use in the past.