1. IMMUNIZATION

2. Immunization Immunization Vaccination
Deliberate provocation of an adaptive immune response by introducing antigen into the body
Vaccination
Deliberate induction of an adaptive immune response to a pathogen by injecting a vaccine, a killed or attenuated form of the pathogen

3. Vaccination
The best known and the most successful application of immunological principles to human health

4. Vaccine (from vacca, Latin for cow)
Dr. Edward Jenner, 1796
Material from cowpox lesions to vaccine an 8 y/o boy vs smallpox (1st vaccine)

5. Rabies Vaccine Dr. Louis Pasteur, 1885
Vaccinated a 9 y/o boy who had been bitten by a rabid dog
Altered preparations of microbes could be used to generate enhanced immunity vs. the fully virulent organism

6. Ultimate goal: eradication of disease
Immediate goal: prevention of disease
TYPES OF
PROTECTION INDUCED:
Complete protection for life
Partial protection (booster doses)

7. GOALS CAN BE ACHIEVED IN 2 WAYS:
ACTIVE immunization
PASSIVE immunization

8. ACTIVE IMMUNIZATION
Involves administration of all or part of a microorganism or a modified product of that microorganism (toxoid, purified antigen, antigen produced by genetic engineering, to evoke an immunologic response mimicking that of the natural infection but which usually presents little or no risk to the recipient.

9. PASSIVE IMMUNIZATION
the administration of preformed antibody to a recipient for the prevention and amelioration of infectious diseases ( temporary protection)

10. Immunity Active Passive Injection of an antigen Injection of preformed
(vaccine) antibiotics (gammaglobulins)
Protection produced by the Protection transferred from person’s own immune another person or animal
System
Usually permanent Temporary protection that wanes with time

11. Passive Immunity SOURCES Almost all blood or blood products
Homologous pooled human antibody (immune globulin)
Homologous human hyperimmune globulin
Heterologous hyperimmune serum (antitoxin)
Transplacental most important source in infancy

12. ACTIVE IMMUNIZATION
- Live attenuated viral vaccine – Measles, MMR, OPV, Varicella
- Inactivated viral vaccine – Influenza , Hep A, IPV, Hep B (recombinant DNA)
- Detoxified exotoxin (Toxoid) – Diphtheria, Tetanus
- Purified protein antigens – acellular Pertussis, Hep B
- Whole cell pertussis vaccine – DTP
- Inactivated acellular pertussis vaccine – DTaP
- Capsular polysaccharide – Typhoid
- Protein conjugated polysaccharide vaccine – Hib, Pneumococcal
- Live attenuated bacterial vaccine – BCG (Bacille Calmette Guerin)

13. ACTIVE IMMUNIZATION - Generalities
Contraindications to ALL VACCINES:
- serious allergic reaction (anaphylaxis) after a previous vaccine dose
- serious allergic reaction to a vaccine component
Precautions :
- moderate or severe acute
illness with or without fever

14. ACTIVE IMMUNIZATION - Generalities
Contraindications to ALL LIVE VACCINES:
immunocompromised patients
patients given immunoglobulin and blood products for the past 3 months
pregnancy and possibility of getting pregnant within 3 months
household contacts of immunocompromised patients* (OPV)

15. ACTIVE IMMUNIZATION - Generalities
Simultaneous administration of Multiple Vaccines:
no contraindications for multiple vaccines routinely recommended
immune response to one vaccine generally does not interfere with other vaccines

16. ACTIVE IMMUNIZATION - Generalities
There should be an interval of 28 days between administration of live vaccines
After 7th birthday, Td is recommended for both primary and booster vaccination
Interchangeability of vaccine products is allowed for primary and booster doses

17. ACTIVE IMMUNIZATION - Generalities
Lapsed immunizations:
in general, intervals between vaccine doses that exceed those that are recommended do not adversely affect the immunologic response, provided immunization series is completed

18. EXPANDED PROGRAM ON IMMUNIZATION (EPI) by the Department of Health
VACCINE
MINIMUM AGE
DOSE (NO)
ROUTE AND SITE OF ADMINIST-RATION
MINIMUM INTERVAL BETWEEN DOSES
REMARKS
BCG 1
Birth; or any time after birth
0.05 ml for NB; 0.1 ml for infants (1)
Intradermal; deltoid R arm
Vaccine destroyed by heat & sunlight
DTP
6 weeks
0.5 ml (3)
IM; upper outer portion of thigh
4 weeks
Vaccine damaged by heat, freezing
POLIO
2 drops (3)
PO; mouth
Vaccine easily damaged by heat

19. EXPANDED PROGRAM ON IMMUNIZATION (EPI) by the Department of Health
VACCINE
MINIMUM AGE
DOSE (NO)
ROUTE AND SITE OF ADMINIST-RATION
MINIMUM INTERVAL BETWEEN DOSES
REMARKS
HEP B
6 weeks or at birth
Follow manufactur-er’s instructions 0.5 ml (3) - 0,1 & 6 months
IM; anterolateral aspect of thigh
Vaccine destroyed by heat or freezing
MEASLES
9 months
0.5 ml (1)
SC; outer part of the thigh
Vaccine easily damaged by heat

20. EXPANDED PROGRAM ON IMMUNIZATION (EPI) by the Department of Health
VACCINE
MINIMUM AGE
DOSE (NO)
ROUTE AND SITE OF ADMINIST-RATION
MINIMUM INTERVAL BETWEEN DOSES
REMARKS
BCG 2
At school entry, whether or not child has BCG scar
0.1 ml (1)
ID; L deltoid
Vaccine destroyed by heat or sunlight
TETANUS TOXOID
Women of childbrearing age
0.5 ml (5)
IM; deltoid region
TT1 at 1st contact
TT2 at least 4 weeks after TT1
TT3 at least 6 wks after TT2
TT4 at least 1 year after
TT5 at least 1 year after
Vaccine easily damaged by heat & sunlight; given for those not given primary immunization in infancy and childhood

26. Summary of Rules for Childhood Immunization
BCG Vaccine:
- live attenuated bacterial vaccine
- at birth or anytime after birth
ml ID from birth to 4 weeks; 0.1 ml ID beyond 1 month at right upper deltoid
- booster dose given at school entry, 0.1 ml ID at left upper deltoid
Contraindications: immunodeficiency, progressive dermatoses
Reaction: abscess at the site; axillary lymphadenopathy

27. Summary of Rules for Childhood Immunization
BCG Vaccine:
Usual reactions:
induration: 2 – 4 wks
pustule formation: 5 – 7 wks
scar formation: 2 – 3 months
Accelerated Reactions:
induration: 2-3 days
pustule formation: 5-7 days
scar formation: 2-3 weeks

28. Summary of Rules for Childhood Immunization
Hepatitis B vaccine:
- inactivated viral antigen
- 0, 1 & 6 months
- if mother is HBsAg(+): give HBIg & Hep B #1 within 12 hours of birth, Hep B #2 at 1 month and Hep B #3 at 6 months of age
- children and adolescents who have not been vaccinated with Hep B may begin series during any visit
Contraindication: anaphylactic reaction to previous dose
Reactions: pain and swelling at site, fever

29. Summary of Rules for Childhood Immunization
Diphtheria, Tetanus & Pertussis:
DTaP
DT are toxoids
aP is acellular pertussis
DTP or DTwP
P is killed or inactivated whole cell pertussis

30. Summary of Rules for Childhood Immunization
Diphtheria, Tetanus & Pertussis:
Usual Side Effects:
fever up to 72 hours (low to moderate grade)
restlessness and irritability
local reaction: pain and swelling at the site of injection
Contraindications:
encephalopathy (coma, prolonged seizures & decreased level of consciousness) within 7 days of administration of previous dose
anaphylactic shock after a previous dose
progressive neurologic disorders: infantile spasms, uncontrolled epilepsy, progressive encephalopathy

31. Summary of Rules for Childhood Immunization
Diphtheria, Tetanus & Pertussis:
Precautions :
fever greater than 40°C within 48 hours after administration of a previous dose
collapse or shock-like state within 48 hours after receiving a previous dose
seizures within 3 days of receiving a previous dose
persistent, inconsolable crying lasting for 3 hours and within 48 hours after receiving a previous dose
moderate or severe acute illness with or without fever

32. Summary of Rules for Childhood Immunization
Poliomyelitis Vaccine:
2 types of vaccines:
Oral Polio Vaccine (OPV)
- live attenuated (Sabin)
ml orally; or 2 drops (using multiple dose)
Absolute contraindications:
altered immune states (malignancies [lymphoma, leukemia], therapy with alkylating agents, metaboltes, high dose steroids, radiation, HIV/AIDS)
pregnancy
household contacts of immunocompromised patients
Relative contraindications: vomiting and diarrhea
Adverse Reaction: paralysis

33. Summary of Rules for Childhood Immunization
Poliomyelitis Vaccine:
2. Inactivated or Killed Polio Vaccine (IPV)
- given IM
IPV was recommended to decrease the incidence of vaccine-associated paralytic polio (VAPP)

34. Summary of Rules for Childhood Immunization
Measles Vaccine:
- live attenuated
ml SC
- given at 9 months but may be given as early as 6 months during epidemics
Adverse reactions:
fever with or without rashes (5-12 days after administration)
hypersensitivity reaction
Contraindication: immunocompromised state, pregnancy
Relative Contraindication: untreated active tuberculosis

35. Summary of Rules for Childhood Immunization
Measles, Mumps, Rubella (MMR) Vaccine:
- live attenuated
ml SC
- given at months; a booster dose is recommended at 4-6 years old
Reactions:
fever with or without rashes (5-12 days after administration - measles)
fever, swelling of parotid gland (mumps)
fever, mild rash, transient arthritis or arthralgia, post-auricular lymphadenopathy (rubella)

36. Summary of Rules for Childhood Immunization
Measles, Mumps, Rubella (MMR) Vaccine:
Reasons for giving 2 doses of MMR:
only 87-90% of children actually receive the measles vaccine
5% of children who receive the first vaccine won’t develop immunity
children who had an immune response to the first dose could get a “booster” effect
Contraindications: same as other live vaccines

37. Summary of Rules for Childhood Immunization
Varicella Vaccine:
- live attenuated
ml SC
- routinely given at age 12 months and up but can be given as early as 9 months
- can be given within 5 days of exposure
- a patient given varicella vaccine can also develop shingles although the incidence is less frequent and less severe as compared to the actual varicella infection
- varicella vaccine prevents moderate to severe cases of chickenpox

38. Summary of Rules for Childhood Immunization
Varicella Vaccine:
Recommendations:
single dose for ages 1-12 years
2 doses 6-10 wks apart in children >13 years
Safety of Varicella vaccine:
the virus is so weak that it is not transferred from someone who got the vaccine to another person
it can be given to children who are living in the home of someone whose immune system is weak
may also be given to patients whose mother is pregnant

39. Summary of Rules for Childhood Immunization
Varicella Vaccine:
Reactions:
-may develop few varicella-like lesions about month after vaccination

40. Summary of Rules for Childhood Immunization
Hemophilus influenzae b (Hib) Vaccine:
- polysaccharide protein conjugate
ml IM given at 2, 4, 6 and months old
Reactions: low grade fever (2%)
pain and swelling (10-15%)

41. Summary of Rules for Childhood Immunization
Pneumococcal Vaccine:
- PCV is given at 2, 4, 6 and months or 1 dose at 2 yrs of age
- PPV is given for children 2 yrs and above
ml IM
Indications:
patients undergoing splenectomy
sickle cell disease
asplenia
HIV
Routinely for children 2 months and above

42. Summary of Rules for Childhood Immunization
Hepatitis A Vaccine:
- inactivated viral antigen
- given to children 1 year and above in 2 doses:
- first dose: anytime after 1 year
- 2nd dose: (booster) 6-12 months after first dose
- Dose for 1-18 years: 0.5 ml IM (720 U)
for >19 years: 1 ml IM (1440 U)

43. Summary of Rules for Childhood Immunization
Hepatitis A Vaccine:
Indications:
persons traveling to areas with high prevalence of Hepatitis A
occupational hazards
hemophiliacs – contacts of infected persons
Reactions: pain and local swelling

44. Summary of Rules for Childhood Immunization
Influenza Vaccine:
- inactivated vaccine
- dose:
for 3 years and above: 0.5 ml IM or SC
for 6 – 36 months: 0.25 ml IM or SC
- should be administered before the start of flu season (Feb to June)
Indications:
prophylaxis in children older than 6 months and adults
over 60 years
suffer from disease of cardiovascular system, metabolic disease, cystic fibrosis, chronic respiratory disease, chronic renal insufficiency

45. Summary of Rules for Childhood Immunization
Rotavirus Vaccine:
- inactivated vaccine
- given at 2, 4, and 6 months old
- 0.5 ml IM
Human Papilloma Virus Vaccine:
- given from 9 to 26 yrs old at 0, 1, and 4months