IMMUNIZATION

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

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

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)

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

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

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

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.

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

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

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

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)

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

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)

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

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

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

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

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

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

Summary of Rules for Childhood Immunization BCG Vaccine: - live attenuated bacterial vaccine - at birth or anytime after birth - 0.05 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

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

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

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

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

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

Summary of Rules for Childhood Immunization Poliomyelitis Vaccine: 2 types of vaccines: Oral Polio Vaccine (OPV) - live attenuated (Sabin) - 0.5 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

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)

Summary of Rules for Childhood Immunization Measles Vaccine: - live attenuated - 0.5 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

Summary of Rules for Childhood Immunization Measles, Mumps, Rubella (MMR) Vaccine: - live attenuated - 0.5 ml SC - given at 12-15 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)

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

Summary of Rules for Childhood Immunization Varicella Vaccine: - live attenuated - 0.5 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

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

Summary of Rules for Childhood Immunization Varicella Vaccine: Reactions: -may develop few varicella-like lesions about 1 month after vaccination

Summary of Rules for Childhood Immunization Hemophilus influenzae b (Hib) Vaccine: - polysaccharide protein conjugate - 0.5 ml IM given at 2, 4, 6 and 12 - 15 months old Reactions: low grade fever (2%) pain and swelling (10-15%)

Summary of Rules for Childhood Immunization Pneumococcal Vaccine: - PCV is given at 2, 4, 6 and 12 -15 months or 1 dose at 2 yrs of age - PPV is given for children 2 yrs and above - 0.5 ml IM Indications: patients undergoing splenectomy sickle cell disease asplenia HIV Routinely for children 2 months and above

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)

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

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

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