Childhood Immunization

1
Childhood Immunization

• Directed by Dr.J. Halazoun
• Presented by Dr.Y. Abu Zanouna

2
Childhood Immunization

• Definitions General Concepts
• Immune Response Its Determinants
• Safety of Immunization
• Standards for child and adolescent immunization
  practices.
• Post exposure Immunoprophylaxis.
• Passive Immunization.

3
Immunization WHY ??

• Immunization is a remarkably successful very
  cost effective means of preventing infectious
  diseases.
• A leading achievement of public health
  pediatrics
• It is either to prevent primary infection or
  secondary consequences of infection

4
Immunization.

• Routine childhood immunization
• Resulted in a decline global eradication of
  previously common contagious diseases
• Smallpox
• Wild type poliovirus
• Hib
• Congenital rubella,tetanus, diphtheria
• Rubella , measles

5
Recommendations Want to be Updated??

• Morbidity Mortality Weekly Report, Published
  weekly by the Centers for Disease Control
  Prevention( CDC ) ACIP
• The Red Book Report of the Committee on
  Infectious Diseases AAP

6
Definitions

• Vaccination Administration of any vaccine or
  Toxoid for prevention of disease.
• Immunization The process of inducing immunity
  artificially.
• Active Immunization Stimulating the immune
  system to produce antibodies cellular elements
  against an infectious agent.
• Passive Immunization The acquisition of readily
  formed antibodies ( Transplacental transmission,
  immunoglobulin administration)

7
Immunizing Agents

• Vaccine A preparation of proteins ,
  polysaccharides, or nucleic acids that are
  delivered to the immune system as single
  entities, part of a complex,or by live attenuated
  agents or vectors to induce specific responses
  that inactivate , destroy or suppress the
  pathogen.

8
Immunizing Agents

• Toxoid A modified bacterial toxin that has been
  made non-toxic but retains the capacity to
  stimulate the formation of antitoxin.
• Antitoxin An antibody derived from the serum of
  humans or animals after stimulation with specific
  antigens ,used to provide passive immunity.

9
Immunizing Agents

• Immunoglobulin An antibody-containing solution
  derived from human blood by fractionation of
  large pools of plasma and used primarily for the
  maintenance of immunity of immunodefficient
  persons or for passive immunization.

10
IMMUNIZATION..

• Active immunization
• Live attenuated (M,M,R)
• Inactivated,killed
• Whole cell ,Hep A
• Purified proteins ( HepB, aP )
• Polysaccharides (Meningococcal )
• Conjugated (Hib , pneumococcal)
• organism components ( Influenza subunits )
• detoxified (tetanus ,Diphtheria)
• Recombinant products (Hep B )

11
Constituents of Vaccines

• Preservatives,stabilizers,antibiotics
• Inhibit or prevent bacterial growth,allergic
  reaction may occur to any of these.
• Adjuvants
• Enhance the immune response ( aluminum salts )
• Suspending Fluid
• Sterile water , saline or biologic system in
  which agent is produced ( egg ag, cell culture
  ingredients , serum proteins )

12
Determinants of the Immune Response

• To vaccinate a whole population efficiently , a
  vaccine must contain epitopes that are processed
  bound to the product of at least one MHC allele
  in most individuals .

13
Determinants of response

• Genetics
• Chemical Physical state of antigen
• Mode of administration
• Catabolic rate of antigen
• Host factors
• Age , nutrition, gender, preexisting immunity
• Route of administration

14
Immune response to vaccine agents

• Antibody Response
• Inactivating ( antitoxins)
• Facilitate phagocytosis ( opsonins)
• Interact with Complement (Lysins)
• Prevent proliferation ( neutralizing ab)
• Antiadhesins
• Cellular response
• T dependant
• T- Independent

15
Immune Response ..

• The primary response
• Latent period
• Antibodies are detected 7-10 days
• Early IgM complement fixation.
• IgG 2nd week, peaks 2-6 weeks
• Oral live vaccines secretory IgA

16
Immune response

• Secondary response
• Upon A second exposure to ag
• Rapidly within 4-5 days
• Immunologic memory T-dependant
• Response is assessed by serum concentration of
  antibodies
• Cellular immunity is difficult to assess
• Lack of serum ab does not necessarily mean lack
  of protection
• Immune system stimulation with no antibody
  production may result in unanticipated response.

17
Safety of Immunization

• Vaccine Factors
• Licensed by FDA
• Viral bacterial contamination
• Vaccine administration
• Disposable syringes vs.reusable glass syringes.
• 70 alcohol solution
• All vaccines containing an adjuvant should be
  given IM to avoid granuloma or necrosis.
• Given in the antlat. Of thigh lt 18 months,
  deltoid or triceps in older children
• Aqueous vaccines may be given IM , SQ , ID

18
Vaccine factors

• It is safe to administer many combinations of
  vaccines simultaneously.
• Inactivated vaccines can be given together or at
  any time after different vaccines.
• Live-virus vaccines,if not on the same day ,
  should be given at least 30 days apart.
• If Ig has been administered , live vaccines
  should be delayed 6-10 months to avoid
  interference with immune response

19
Host Factors

• Healthy Children
• Minor acute illnesses,with or without fever , are
  not contraindications to vaccination.
• Moderate to severe febrile illness maybe a reason
  to postpone vaccination.
• Routine P/E and Taking Temp are not necessary in
  healthy children.

20
Children with Chronic Illnesses

• Most chronic diseases are not contraindications
  to vaccination
• Premature Infants should be immunized according
  to their chronological age ,not gestational age.
• Vaccine doses should not be reduced for preterm
  or LBW infants.
• Vaccination May be avoided in those with a
  progressive CNS disorder.

21
Immunodeficient Children

• Congenital Immunodeficient children Not to be
  vaccinated with live vaccines
• Other vaccines may be safe , yet they may fail to
  evoke a proper immune response.
• Children with cancer,on steroids ,or
  Immunosuppressive agents are not to receive live
  vaccines.
• Exceptions
• Malignancy in remission, Chemotherapy 90 days
  prior to vaccine.
• Low moderate dose of steroids lt 14 d
• Physiologic steroid replacement
• topical., inhaled or IA steroids

22
Immunodeficient Children

• HIV MMR are recommended, OPV varicella are
  not.
• Siblings contacts of ID patients
• OPV vs. IPV
• MMR

23
Breast Feeding

• Human milk does not adversely affect the immune
  response to any vaccine is not a
  contraindication to vaccination
• Live virus vaccines are not excreted in breast
  milk
• Breast feeding mothers may receive any vaccine
  safely

24
Allergic or Hypersensitive Children

• Hypersensitivity reactions are rare following
  vaccination.
• MMR, IPV ,VZV contain microgram amounts of
  neomycin,IPV contains polymyxin B.
• M M ,Influenza yellow fever contain egg
  antigens.
• MMR ,Varicella , Yellow fever gelatin.
• Skin testing may be done if nature of immune
  reaction is unknown.

25
List of Revised Standards for Child and
Adolescent Immunization Practices

• Availability of Vaccines
• Vaccination services are readily available.
• Vaccinations are coordinated with other
  healthcare services and provided in a medical
  home when possible.
• Barriers to vaccination are identified and
  minimized.
• Patient costs are minimized.

26
Assessment of Vaccination Status

• Healthcare professionals review the vaccination
  and health status of patients at every encounter
  to determine which vaccines are indicated.
• Healthcare professionals assess for and follow
  only medically indicated contraindications.

27
Effective Communication about Vaccine Benefits
and Risks

• Parents/guardians and patients are educated about
  the benefits and risks of vaccination in a
  culturally appropriate manner and in
  easy-to-understand language.
• Persons who administer vaccines and staff who
  manage or support vaccine administration are
  knowledgeable and receive ongoing education.
• Healthcare professionals simultaneously
  administer as many indicated vaccine doses as
  possible.

28
Proper Storage and Administration of Vaccines and
Documentation of Vaccinations

• Healthcare professionals follow appropriate
  procedures for vaccine storage and handling.
• Up-to-date, written vaccination protocols are
  accessible at all locations where vaccines are
  administered.

29
CONTINUE.

• Vaccination records for patients are accurate,
  complete, and easily accessible.
• Healthcare professionals report adverse events
  following vaccination promptly and accurately to
  the Vaccine Adverse Events Reporting System
  (VAERS) and are aware of a separate program, the
  National Vaccine Injury Compensation Program
  (NVICP).
• All personnel who have contact with patients are
  appropriately vaccinated.

30
Implementation of Strategies to Improve
Vaccination Coverage

• Systems are used to remind parents/guardians,
  patients, and healthcare professionals when
  vaccinations are due and to recall those who are
  overdue.
• Office- or clinic-based patient record reviews
  and vaccination coverage assessments are
  performed annually.
• Healthcare professionals practice community-based
  approaches.

31
Post exposure Immunoprophylaxis

• For certain Infections,active or passive
  immunization shortly after exposure can prevent
  or ameliorate disease.
• Rabies Rabies Vaccine RIG
• Varicella VZIG vaccine
• Measles Vaccine IG
• Tetanus,Hep a , Hep B

32
Passive Immunization

• Ig IV , IM .
• Hyperimmunoglobulins
• VZIG
• RIG
• HBIG
• CMVIG
• RSV- IGIV
• Hep A

33
THANK YOU ALL !