Immunization

Dr. Tanveer Ashraf

Objectives

 Types of vaccination  Contraindications  Discussion of individual vaccines

PreparationsAdministrationPrecautions and contraindicationsSide effects

Active Immunization Types Live attenuated

Virus Measles, mumps, rubella Bacteria BCG 

Killed Virus Hepatitis B Bacteria

Whole PertussisToxoid TetanusPolysaccharide Meningoccocal

Human Immune Serum Globulin

SpecificIM Hepatitis B (HBIG)

Rabies (RIG)Tetanus (TIG)Varicella (VZIG)

 IV CMV (CMV-IG)

RSV (RSV-IG) 

Human Immune Serum Globulin

Non-specificIM Immune serum globulin(ISG)

Hepatitis AMeasles

IV Intravenous immune globulin(IGIV)Antibody deficiency disordersITPKawasaki syndrome

Passive Immunization (Cont)

SPECIFIC EQUINE ANTIBODIES (IM)BOTULISM ANTITOXINDIPHTERIA ANTITOXINTETANUS ANTITOXINSNAKE & SPIDER ANTI-VENOM

MONOCLONAL ANTIBODIES (IV)ANTI-ENDOTOXIN ANTIBODIES

Recommended Immunization Schedule

RECOMMENDED AGE VACCINE(S)

BIRTH BCG, Hepatitis B (HBV)2 MONTHS [DTP, HIB, HBV]

Injectable Polio Vaccine (IPV)4 MONTHS [DTP, HIB, HBV]

Oral Polio Vaccine (OPV)6 MONTHS [DTP, HIB, HBV]

Oral Polio Vaccine (OPV)9 MONTHS Measles vaccine (mono)

12 MONTHS Oral Polio Vaccine (OPV)MMRVaricella

1 8 MONTHS Oral Polio Vaccine (OPV)DTP, HIB Hepatitis A

24 MONTHS Hepatitis A

4 – 6 YEARS Oral Polio Vaccine (OPV)DTPMMRVaricella

General Contraindications

Moderate or severe illness with or without fever Anaphylactic reaction to vaccine or vaccine

constituent Live attenuated vaccines

Pregnant womenImmunocompromised / Immunosuppressed

childrenwithin 3-11 months of immunoglobulin

administration

Invalid Contraindications

Mild to moderate local reaction Mild acute illness with or without low grade fever Current antimicrobial therapy Convalescent phase of illnesses Prematurity and low birth weight History of penicillin or other nonspecific allergies Malnutrition

Immunization Of Special Groups

IMMUNOCOMPROMISED HOSTS Avoid MMR, measles (may be used in HIV) Avoid OPV; use IPV for these children and their

household contacts

PRETERM INFANTS Treat as term babies Avoid OPV in hospital Influenza vaccine in BPD may delay HBV if <2 kg & mother is HBsAG negative

Compulsory Vaccines

Bacillus Calmette‑Guerin Vaccine (BCG)

INDICATIONSAll newbornsAll tuberculin negative infants

  PRECAUTIONS & CONTRAINDICATIONS(CI):

Give only to PPD negative childrenCI in persons with immunodeficienciesCI during pregnancy 

Bacillus Calmette‑Guerin Vaccine (BCG)

SIDE EFFECTSLocal

Skin ulceration, regional lymphadenitisSubcutaneous abscess

Generalized

Anaphylaxis, generalized BCG infection(rare): osteitis

Hepatitis B

PREPARATIONSENGERIX‑BRECOMBIVAX HB

Hepatitis B

ADMINISTRATION:0.5 ‑1 ML, anterolateral thigh or deltoidIM injectionat 0,1 and 6 months 

SIDE EFFECTS:PainArthralgia

Poliomyelitis Prophylaxis

PREPARATIONS (A) Oral (OPV) SABIN (Live attenuated) (B) Inactivated (eIPV) SALK (killed)

ADMINISTRATION OPV 2 drops orally eIPV SC injection

PRECAUTIONS & CONTRAINDICATIONS(CI)  (a) OPV pregnancy, immunodeficiency (b) IPV neomycin hypersensitivity

ADVERSE REACTIONS OPV paralytic disease (rare)

Diphtheria, Tetanus & Pertussis (DTP)

PREPARATIONS< 7 years : DTP, DT, DTaP (acellular

pertussis vaccine)> 7 years : Td, TdaP

ADMINISTRATIONIM

Diphtheria, Tetanus & Pertussis (DTP)

CONTRAINDICATIONS (CI) Encephalopathy within 7 days Progressive or unstable neurological disorders Anaphylactic reaction to a previous dose

PRECAUTIONS severe systemic reactions such as

Temp > 40.50Cpersistent inconsolable crying > 3 hoursCollapse episodesConvulsions

Measles, Mumps & Rubella (MMR)

PREPARATIONS:MEASLES.MMR.

ADMINISTRATION:SC.

 INDICATIONS:Primary immunization at 1 & 6 years.

Measles, Mumps & Rubella (MMR)

PRECAUTIONS & CONTRAINDICATIONS PregnancyAnaphylaxis to eggsImmunodeficiency and

immunosuppression Immunoglobulins within 3-11 months

Measles, Mumps & Rubella (MMR)

ADVERSE REACTIONSFever ,rash (7 days post vaccination)Arthralgia , arthritis (rubella)Encephalitis [rare] (measles, mumps)Suppression of PPD skin test (measles) Convulsions in prone children(measles)Thrombocytopenia

Haemophilus Influenzae Type B

ADMINISTRATION IM 2,4,6 months, booster at 15 months

INDICATIONS Children under 5 years of age High risk children

SIDE EFFECTS: Local pain and erythema Mild fever

Varicella Prophylaxis

PREPARATIONS:Varivax vaccine (MSD)

ADMINISTRATION:0.5 ml IM12 months and above……..2 doses 

 

Varicella Prophylaxis

INDICATIONS:All children 12 months‑18 years: (if no

history of varicella)EFFICACY:

70‑90% 

Varicella Prophylaxis

PRECAUTIONS & CONTRAITNDICATIONS:Immunocompromised patientsWithin 5 months of IGChildren on long term salicylates 

SIDE EFFECTS:Fever , rashZoster

Hepatitis A

NATURE OF VACCINE:Killed formalin inactivated vaccine.

PREPARATIONS:Various preparations available

e.g. Havrix 720 Junior, Havrix 1440 etc.

Hepatitis A

INDICATIONS:children 1 year and above

Susceptible children in endemic areas

Chronic liver diseaseHemophilia

Hepatitis A

ADMINISTRATION:IM injection2 doses, at least 6 months apart

ADVERSE REACTIONS:Local reactions, feverRare: anaphylaxis

Additional Vaccines

Pneumococcal Prophylaxis

PREPARATIONS:Purified capsular polysaccharide of 23

serotypes of Streptococcus pneumoniae7 valent conjugated vaccine

ADMINISTRATION:IM / SC1 dose/booster 5 years

Pneumococcal Prophylaxis

INDICATIONS:Primary vaccination (conjugate vaccine)children 2 yr. or older with

Anatomical or functional aspleniaSickle cell diseaseNephrotic syndromeImmunosuppression

Pneumococcal Prophylaxis

SIDE EFFECTS:Soreness , erythema, fever, myalgiaAnaphylactic reactions (rare)

Meningococcal Prophylaxis

PREPARATIONS:monovalent (A or C)bivalent (A & C)quadrivalent (A,C,Y & W‑135)quadrivalent conjugate quadrivalent

ADMINISTRATION:SC

Meningococcal Prophylaxis

INDICATIONS:Control of outbreaksChildren with complement deficiencies

or aspleniaSIDE EFFECTS:

local erythema and discomforttransient fever

Influenza Virus

Nature of vaccine:Killed vaccine.Live attenuated

 Preparations:whole and “split virus” vaccines.“split virus” vaccines are recommended for

children 6 months and older.composition of the vaccine is changed

annually.

Influenza Virus

ADMINISTRATION: IM (killed).Live attenuated (intranasal).1 dose during influenzae season.Children 6months-9 years should receive an

additional dose, 4 weeks after the 1st dose, if not previously immunized.

Influenza Virus

Indications:chronic cardio-respiratory disease

asthma cystic fibrosis bronchopulmonary dysplasia

Influenza Virus

Indications: Sickle cell anemia. Chronic salicylate therapy. Diabetes mellitus. Chronic renal disease. Chronic metabolic disease. immunosuppressive conditions: cancer, HIV etc. Hospital personnel with significant patient contact.

Influenza Virus

Contraindication:Anaphylaxis to previous dose.Hypersensitivity to eggs.

Adverse Reaction:Soreness at injection site.Allergic response.Guillain-Barré Syndrome.

New Vaccines

Rota virus vaccinesHuman papilloma virus vaccine