1. Administrative Principles of Vaccination
Prof. Dr. AHMET ARVAS
I.U. Cerrahpasa Medical Faculty, Department of Pediatrics

3. Vaccine preventable diseases

4. infant mortality in world-2010
Lancet 2012;380:

5. child mortality (1-4 y)
Lancet 2012;380:

6. Vaccine preventable deaths in world-2008
Measles
Hib inf
Pertussis
Tetanus
N. Tetanus
Yellow fever
Diphteria
Rotavirus inf
Pneumococcal dis
Hepatitis B inf
1.5 million of deaths among children under 5 years are due to
diseases that could have been prevented by routine vaccination

7. Measles: 2011:111; 2012:101 cases

8. Active vaccination Protection produced by vaccine Usually permanent
Immunity and immunologic memory similar to natural infection but without risk of disease

9. Classification of vaccines
Live attenuated
bacterial
viral
Inactivated
whole: viruses, bacteria
fractional: protein based (toxoid, subunit)
polysaccharide-based (pure, conjugate)

10. Live Attenuated Vaccines
Attenuated (weakened) form of the "wild" virus or bacterium
Must replicate to be effective
Immune response similar to natural infection
Usually produce immunity with one dose
(except those administrated orally)
*except those administered orally

11. Inactivated Vaccines Cannot replicate
Generally not as effective as live vaccines
Less interference from circulating antibody than live vaccines
Generally require 3-5 doses
Immune response mostly humoral
Antibody titer may diminish with time

12. General Rules
Inactivated vaccines are generally not affected by circulating antibody to the antigen
Live attenuated vaccines may be affected by circulating antibody to the antigen

13. Polysaccharide Vaccines
Pure polysaccharide
pneumococcal
meningococcal
Salmonella Typhi (Vi)
Haemophilus influenzae type b
Pneumococcal (PCV-7, PCV-10, PCV13)
Meningococcal (MenC, MCV4)
Conjugate polysaccharide

14. Immunization Schedule-Turkey
2012
birth 1
month 2
months 4
months 6
months
First school grade (6 yrs)
Eighth school grade (13-14 yrs) m m P v B
PCV B
MMR B
OPV
DaPT/IPV
HepA II
Varicella ı

15. Source: Turhish Health Ministry Public Health Institute
Immunization coverage rate in Turkey (%)
Source: Turhish Health Ministry Public Health Institute

16. Immunization schedule (unvaccinated children: > 1 year)
12-59 mos(1-5 yrs)
6-13 yrs
>14 yrs
at first time
DaPT/IPV/Hib,HepB,
ppd
DaPT/IPV, HepB, KKK
Td, OPV, HepB, KKK
>2 days
KKK, ppd: BCG -
2 months
DaPT/IPV/Hib or
DaPT/IPV,HepB,OPV
DaPT/IPV, HepB, KKK,
OPV
Td, OPA, HepB, KKK
8 months
DaPT/IPV, HepB, OPV
Td, HepB

22. All vaccines can be administered at the same visit as all other vaccines

23. Spacing of Vaccine Combinations Not Given Simultaneously
two live injected or intranasal influenza vaccine
all other
Minimum Interval
4 weeks
None

24. Increasing the interval between doses of a multidose vaccine does not diminish the effectiveness of the vaccine. It is not necessary to restart the series or add doses because of an extended interval between doses
Decreasing the interval between doses of a multidose vaccine may interfere with antibody response and protection
Vaccine doses should not be administered at intervals less than the minimum intervals or earlier than the minimum age
*after the series has been completed

25. Time limits for using vaccines after reconstitution
MMR≤ 8 hrs
BCG ≤ 4-8 hrs protect from ligth
Varicella ≤ 30 min

26. Types of administration errors
wrong vaccine or wrong diluent
wronge dosage
expired vaccine
wrong route/site/needle size
wrong time
wrong patient

29. Correct route, site, needle size

31. Vaccine Adverse Reactions
Local
pain, swelling, redness at site of injection
common with inactivated vaccines
usually mild and self-limited

32. Vaccine Adverse Reactions
Systemic
fever, malaise, headache
nonspecific
may be unrelated to vaccine

33. Vaccine Adverse Reactions
Allergic
due to vaccine or vaccine component
rare
risk minimized by screening

34. Contraindication
A condition in a recipient that greatly increases the chance of a serious adverse reaction

35. Precaution
A condition in a recipient that might increase the chance or severity of an adverse reaction, or
Might compromise the ability of the vaccine to produce immunity

36. Contraindications Permanent contraindications to vaccination:
severe allergic reaction to a vaccine component or following a prior dose
(anaphylactic reaction: all vaccines)
Encephalopathy/encephalitis not due to another identifiable cause occurring within 7 days of pertussis vaccination
Severe combined immunodeficiency (live vaccines)

37. Immunosuppression Disease congenital immunodeficiency
leukemia or lymphoma
generalized malignancy
Chemotherapy
alkylating agents
antimetabolites
radiation

38. Immunosuppression Corticosteroids 20 mg or more per day of prednisone*
2 mg/kg or more per day of prednisone*
NOT aerosols, alternate day, short courses, topical
*for 14 days or longer

39. Vaccination of household contacts of immunosuppressed persons
Healthy household contacts of immunosuppressed persons should receive MMR and varicella vaccines and annual influenza vaccination

40. Invalid contraindications to vaccination
Mild illness
Antimicrobial therapy
Disease exposure or convalescence
Pregnant or immunosuppressed person in the household
Breastfeeding
Preterm birth
Allergy to products not present in vaccine or allergy that is not anaphylactic
Family history of adverse events
Tuberculin skin testing
Multiple vaccines

41. Vaccination during acute illness
No evidence that acute illness reduces vaccine efficacy or increases vaccine adverse reactions
Vaccines should be delayed until the illness has improved
Mild illness, such as otitis media or an upper respiratory infection, is NOT a contraindication to vaccination

42. Missed opportunity
A healthcare encounter in which a person is eligible to receive vaccination but is not vaccinated completely

43. Reasons for missed opportunities
Lack of simultaneous administration
Unaware child needs additional vaccines
Invalid contraindications
Inappropriate clinic policies

44. Vaccine Adverse Event Reporting System (VAERS)
National reporting system

45. Vaccine Adverse Event Reporting System (VAERS)
Detects
new or rare events
increases in rates of known side effects
patient risk factors
Additional studies required to confirm VAERS signals
Not all reports of adverse events are causally related to vaccine

46. Adverse Event Classification
Vaccine-induced: Due to the intrinsic characteristic of the vaccine preparation and the individual response of the vaccinee. These events would not have occurred without vaccination (e.g., vaccine-associated paralytic poliomyelitis after oral polio vaccine).
Vaccine-potentiated: The event would have occurred anyway, but was precipitated by the vaccination (e.g., first febrile seizure in a predisposed child).
Programmatic error: Due to technical errors in vaccine storage, preparation, handling, or administration.
Coincidental: The reported event was not caused by vaccination but happened by chance occurrence or due to underlying illness.

47. Vaccine-associated paralytic polio (VAPP): overall incidence of once case of VAPP: per
2.4 million doses of OPV
Rotavirus vaccine/ increased risk of intussusception: no evidence for a causal link (coins.)
MMR-V: additional 4.3 febrile seizures per MMR-V doses compared to MMR and
V administered separately
MCV4/ Guillain-Barre Syndrome: no evidence for a causal link (coincidental)
Hep B V/ Guillain-Barre Syndrome, transverse myelitis: no evidence for a causal link
MMR/ autism, inflammatory bowel diseases: no evidence for a causal link (coinc.)
Thimerosal (mercury containing preservative)-containing vaccines/ autism, inflammatory
bowel diseases, ADHD : no evidence for a causal link (coincidental)
Vaccines/ ITP: vaccine potentiated