Updates in Iraq national program of immunization 2012

ROTA VIRUS

ROTA VIRUS First identified in 1973 by Bishop (wheel-shaped). There are six species of this virus, referred to as A - F. Responsible for 5% to 10% of all gastroenteritis episodes among children < 5 years of age. Most common cause of severe diarrhea in under 5 years. Responsible for up to 500.000 diarrheal death each year worldwide.

Rota virus Epidemiology All children has at least 1 infection by age 5 years. Highest infection rates between 3months-3years.

Rotavirus Epidemiology Reservoir: Human Transmission: Fecal-oral Temporal pattern: Fall and winter (temperate areas) Communicability: 2days before to 10days after onset

1999-2009 over 5 million children died from Rotavirus disease

Local harm induced by rotavirus in the gut Normal Intestinal Villi Rotavirus-infected Microvilli Tips 7

Rotavirus Immunity First infection usually dose not lead to permanent immunity. Reinfection can occur at any age. Subsequent infections generally less severe.

Rotavirus Clinical Features Incubation period 1-3 days. Variable clinical presentation asymptomatic to severe diarrhea. Confirmation requires laboratory testing (enzyme immunoassay or RT-PCR).

Rotavirus vaccines There are two rotavirus vaccines. RV5 (RotaTeq), is a live oral vaccine manufactured by Merck and licensed by the FDA in 2006 RV1 (Rotarix), a live oral vaccine manufactured by GlaxoSmithKline, was licensed by the FDA in 2008

Rotavirus vaccine (Rota teq) 11

Rotavirus vaccine storage and handling 12 Provided as a single 2ml oral dose In a buffered stabilizer solution. Store at (2°- 8° C). Shelf life of properly stored vaccine is 24 months. Do not freeze. Administer as soon as possible after being removed from refrigeration.

Rotavirus vaccine recommendations Routine immunization of all infants without contraindications . Administered at 2, 4 , 6 months of age. First dose should be administered between 6 and 12 weeks of age (until age 13 weeks). Do not initiate series after 12 weeks of age. 3 doses better to be completed within 26 weeks of age

Rotavirus vaccine recommendations 14 Minimum interval between doses is 4 weeks. Do not administer ANY dose on or after age 32 weeks , even if fewer than three doses have been administered. Do not repeat dose if infant spits out or regurgitates vaccine. Administer simultaneously with all other indicated vaccines.

Rotavirus vaccine Contraindications 15 Severe combined immune deficit disease (SCID) Severe allergic reaction to a vaccine component or following a prior dose of vaccine Patient with problem of glucose- galactose or sucrose malabsorption

Rotavirus vaccine precautions Recent receipt of blood product. Altered immunity (child & household contact). Acute, moderate to severe gastroenteritis or other acute illness. pre- existing chronic GI disease. Preterm infants Infants with history of intussusceptions. Infants of HIV mother infants with precautions to vaccination, described below, should not receive the vaccine until the condition improves unless the benefit of vaccination outweighs the risk of an adverse reaction. 16 28 نيسان، 17

Intussusception & Rota teq vaccine The phase 3 clinical trials to study the occurrence of intussusceptions in Rota teq More than 69,000 infants, of whom half received vaccine and half received a placebo. In the 42 days after vaccination 6 cases of intussusceptions were diagnosed among the vaccinated infants and 5 cases were diagnosed among the placebo recipients.

HAEMOPHILUS INFLUENZA

Haemophilus Influenza, history In 1892 it was first described by PFIEFFER In 1920 WINSLOW give name Haemophilus Gram negative coccobacillus Enter through nasopharynx and colonize and may remain only transiently or for several months in the absence of symptoms (Asymptomatic carrier)

Haemophilus Infleunza (Hib) Reservoir: Only human (asymptomatic carrier) Transmission: Respiratory droplet, Hib doesn’t survive in the environment.

Clinical features Invasive disease A-Common Meningitis 50-65% Pneumonia Epiglottitis Arthritis Cellulitis

Clinical features, cont. B- less common Osteomyelitis Pericarditis Acute bronchitis Otitis media (5-10% due to Hib)

Global Burden of Hib diseases 1. Mortality: 400,000 deaths/year out of 2 million deaths /year due to ARI Acute respiratory infections (2 million deaths each year) are the leading infectious cause of death in children 1mo to 5 years of age. S. pneumo causes approximately 800,000 of those deaths, Hib accounts for almost 400K. Diarrheal diseases are the second leading cause of death with 1.7M deaths – 500K are estimated to be due to rotavirus. Other leading causes of death include Malaria (853), Measles (395) HIV aids (321) The case-fatality rate in Hib meningitis is 2%–5%, despite appropriate antimicrobial therapy. 23

Haemophillus influenza type-b-vaccines Hib polysaccharide vaccine. Available in 1985. Not effective in children younger than 18 months of age.

Haemophilus influenza type-b-vaccines, cont`d Hib polysaccharide conjugated vaccine. Available in 1987. conjugation: chemical bonding process of the polysaccharide to carrier protein, immune response will be:- Effective below 18 months of age. Repeated doses elicit booster response.

Vaccination schedule Booster dose is recommended at 12-15 months. All infants, including those born prematurely , should receive a primary series of conjugate Hib vaccine. Primary series is 3 doses 2,4,6 months of age. The recommended interval between primary series doses is 8 weeks with a minimum interval is 4 weeks. Booster dose is recommended at 12-15 months.

Vaccination schedule Conj-Hib Vaccine given before 6 weeks of age may induce immunological tolerance to subsequent doses of Hib vaccine. ((Hib vaccine should never be given to a child younger than 6 weeks of age))

Vaccination schedule Use in older children and adults: Generally not recommended for persons older than 59 months of age. Consider for high risk persons: Asplenia. Immune-deficiency. HIV.

Hib vaccine precaution and contraindication Anaphylactic reaction to previous dose. Moderate or severe acute illness. Age younger than 6 weeks.

Vaccine Storage and Handling All Hib conjugate vaccines should be stored at 2-8 c must not freeze. Should be used within 24 hours of reconstitution.

دلائل التعرض الى درجة حرارة الأنجماد 10 20 30 40 -10 -20 اختبار الرج

يتلف اللقاح المتجمد تماما

تأثير درجة الحرارة (عندما تصبح ما دون الصفر المئوي ) الغير متجانس DTP يتلف تأثير درجة الحرارة (عندما تصبح ما دون الصفر المئوي )

The recommended schedule of immunization in Iraq 2011 Rout Vaccines Age ID+ORAL+IM B.C.G+POLIO(0)+HB1 1 week IM+ORAL+IM D.P.T(1)+POLIO(1)+HB2 2 Months IM+ORAL D.P.T(2)+POLIO(2) 4 Months D.P.T(3)+POLIO(3)+HB3 6 Months SC+ORAL MEASLES+VIT A 9 Months SC M.M.R 15Months ORAL+IM FIRST.B00STER POLIO+D.P.T 18-24 Months 2nd..B00STER POLIO+D.P.T 4-6 Years

The new recommended schedule of immunization in Iraq 2012 Rout Vaccines Age ID+ORAL+IM B.C.G+POLIO(0)+HB1 1st 24 hours IM+ORAL+ORAL Penta(1)+POLIO(1)+Rota(1) 2 Months Tetra(1)+POLIO(2)+Rota(2) 4 Months Penta(2)+POLIO(3)+Rota(3) 6 Months SC+ORAL MEASLES+VIT A(100000IU) 9 Months SC M.M.R 15Months ORAL+IM+ORAL FIRST.B00STER POLIO+Tetra+ 20000IU VIT. A 18-24 Months ORAL+IM+SC 2nd..B00STER POLIO+D.P.T+ MMR 4-6 Years Penta=DPT+HB+HiB Tetra=DPT+HiB

Thank you