Immunization

Objectives

Types of vaccination Contraindications Discussion of individual vaccines

Preparations Administration Precautions and contraindications Side effects

Active Immunization
Types Live attenuated

Virus Bacteria

Measles, mumps, rubella BCG

Killed

Virus Hepatitis B Bacteria Pertussis Tetanus Meningoccocal

Human Immune Serum Globulin

Specific IM

Hepatitis B (HBIG) Rabies (RIG) Tetanus (TIG) Varicella (VZIG)

Human Immune Serum Globulin

Non-specific IM Immune serum globulin(ISG)

Hepatitis Measles

IV

Intravenous immune globulin(IGIV)

Antibody

deficiency disorders

Recommended Immunization Schedule for KSA 2008

RECOMMENDED AGE
BIRTH 2 MONTHS 4 MONTHS 6 MONTHS 9 MONTHS 12 MONTHS

VACCINE(S)
BCG, Hepatitis B (HBV) [DTP, HIB, HBV] Injectable Polio Vaccine (IPV) [DTP, HIB, HBV] Oral Polio Vaccine (OPV) [DTP, HIB, HBV] Oral Polio Vaccine (OPV) Measles vaccine (mono) Oral Polio Vaccine (OPV) MMR Varicella Oral Polio Vaccine (OPV) DTP, HIB Hepatitis A Hepatitis A Oral Polio Vaccine (OPV) DTP MMR Varicella

1 8 MONTHS

24 MONTHS 4 6 YEARS

General Contraindications

Moderate or severe illness with or without fever Anaphylactic reaction to vaccine or vaccine constituent Live attenuated vaccines Pregnant women Immunocompromised / Immunosuppressed children within 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 Prematurity and low birth weight History of penicillin or other nonspecific allergies Malnutrition

Compulsory Vaccines

Bacillus Calmette-Guerin Vaccine (BCG)

INDICATIONS All newborns All tuberculin negative infants PRECAUTIONS & CONTRAINDICATIONS(CI): Give only to PPD negative children CI in persons with immunodeficiencies CI during pregnancy

Bacillus Calmette-Guerin Vaccine (BCG)

SIDE EFFECTS Local

Skin ulceration, regional lymphadenitis Subcutaneous abscess

Generalized

Anaphylaxis, generalized BCG infection (rare): osteitis

Hepatitis B

PREPARATIONS ENGERIX-B RECOMBIVAX HB

Hepatitis B

ADMINISTRATION: 0.5 -1 ML, anterolateral thigh or deltoid IM injection at 0,1 and 6 months SIDE EFFECTS: Pain Arthralgia

Poliomyelitis Prophylaxis

PREPARATIONS

(A) Oral (OPV) (B) Inactivated (eIPV) OPV eIPV (a) OPV (b) IPV OPV

SABIN (Live attenuated) SALK (killed) 2 drops orally SC injection

ADMINISTRATION

PRECAUTIONS & CONTRAINDICATIONS(CI)

pregnancy, immunodeficiency neomycin hypersensitivity paralytic disease (rare)

ADVERSE REACTIONS

Diphtheria, Tetanus & Pertussis (DTP)

PREPARATIONS

< 7 years : DTP, DT, DTaP (acellular pertussis vaccine) > 7 years : Td, TdaP IM

ADMINISTRATION

Diphtheria, Tetanus & Pertussis (DTP)

CONTRAINDICATIONS (CI)

Encephalopathy within 7 days Progressive or unstable neurological disorders Anaphylactic reaction to a previous dose
severe systemic reactions such as Temp > 40.50C persistent inconsolable crying > 3 hours Collapse episodes Convulsions

PRECAUTIONS

Measles, Mumps & Rubella (MMR)

PREPARATIONS:

MEASLES. MMR. SC.

ADMINISTRATION:

INDICATIONS:

Primary immunization at 1 & 6 years.

Measles, Mumps & Rubella (MMR)

PRECAUTIONS & CONTRAINDICATIONS Pregnancy Anaphylaxis to eggs Immunodeficiency and immunosuppression Immunoglobulins within 3-11 months

Measles, Mumps & Rubella (MMR)

ADVERSE REACTIONS

Fever ,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 Children under 5 years of age High risk children
Local pain and erythema Mild fever

INDICATIONS

SIDE EFFECTS:

Varicella Prophylaxis

PREPARATIONS:

Varivax vaccine (MSD)

ADMINISTRATION:
0.5 ml IM 12 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 patients Within 5 months of IG Children on long term salicylates Fever , rash Zoster

SIDE EFFECTS:

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 disease Hemophilia

Hepatitis A

ADMINISTRATION: IM injection 2 doses, at least 6 months apart ADVERSE REACTIONS: Local reactions, fever Rare: anaphylaxis

Additional Vaccines

Pneumococcal Prophylaxis

ADMINISTRATION:

IM / SC 1 dose/booster 5 years

Pneumococcal Prophylaxis

INDICATIONS:) children 2 yr. or older with Sickle cell disease Nephrotic syndrome Immunosuppression

Pneumococcal Prophylaxis

SIDE EFFECTS: Soreness , erythema, fever, myalgia Anaphylactic reactions (rare)

Meningococcal Prophylaxis

PREPARATIONS: monovalent (A or C) bivalent (A & C) quadrivalent (A,C,Y & W-135) ADMINISTRATION:

SC

Meningococcal Prophylaxis

INDICATIONS: Control of outbreaks Children with complement deficiencies or asplenia SIDE EFFECTS: local erythema and discomfort transient fever

Influenza Virus

Nature of vaccine:

Killed vaccine. Live attenuated whole and split virus vaccines. split virus vaccines are recommended for children 6 months and older. composition of the vaccine is changed annually.

Preparations:

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

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.