Vaccinations

Passive Active Immunity - after infection* - transplacental transfer of maternal antibodies* - vaccinations** -the administration of antibody, either as immunoglobulin or monoclonal antibody ** * Naturally acquired immunity ** Artificially acquired immunity

Active immunity requires more time to get effect long acting safer (less side effects) cheaper

Vaccinations- some definitons VACCINE=  is a biological preparation that improves immunity to a particular disease VACCINATION= a medical procedure of giving a vaccine to prevent infectious diseases

Classification of vaccines TYPE OF ANTIGENS: Live atenuated Bacterial- BCG Viral- mumps, measles, rubella(MMR),polio vaccine OPV Killed Bacterial -pertussis Viral- polio vaccine IPV Biosynthetic vaccines (contain man-made substances that are very similar to pieces of the virus or bacteria) Haemophilus influenzae type B vaccine Toxoid vaccines (contain a toxin or chemical made by the bacteria or virus) diphtheria and tetanus vaccines ( DTP)

Classification of vaccines Composition: Monovalent (hepatitis B vaccine) Polyvalent (IPV, Pnemococcal vaccine) Conjugated (MMR, DTP)

Live and killed vaccines- differences Live vaccines Produce immunity faster Immunity after one dose Immunity lasts longer More dangerous- especially in immunocompromised patients

Immunization schedule in Poland Tuberculosis Diphteria Tetanus Pertussis Polio Hepatitis Mumps, Rubella Haemophilus influenze infection Invasive pneumococcal diseaese

The immunization schedule in Poland established by Chief Sanitary Inspector. It is updated according to epidemiological stuation and european standards It comprises mandatory vaccinations in children and adolescents’ population: the kind,number and age of vaccinations and the way of administration. Mandatory vaccines are refunded by National Health Fund Reccomended vaccinations are not refunded

Mandatory vaccinations in children First 24 hours of life I dose – hepatits B intramusculary( thigh) BCG vaccine intradermally ( left arm) Second month of life (after 6 weeks of life) II dose – hepatits B intramusculary( thigh) I dose DTP vaccination I dose – Hib vaccination I dose – Streptococcus pneumoniae subcutaneously or intramusculary 4 month of life (after 14 weeks of life, 8 weeks after previous vaccination) II dose DTP vaccination II dose – Hib vaccination II dose – Streptococcus pneumoniae I dose polio vaccination IPV

Mandatory vaccinations in children 5-6 month of life (8 weeks after previous vaccination) III dose DTP vaccination III dose – Hib vaccination II dose polio vaccination IPV subcutaneously or intramusculary 7 month of life( 6 weeks after previous vaccination) III dose – hepatits B intramusculary( thigh) (immunization completed) 13 month of life MMR vaccination III dose – Streptococcus pneumoniae

Mandatory vaccinations in children 16 month IV dose DTP vaccination (immunization completed) IV dose Hib vaccination( immunization completed) III dose IPV(immunization completed) subcutaneously or intramusculary 6 year DTaP revaccination dose subcutaneously or intramusculary Polio revacination dose( OPV) orally only to 31.03.2016/ since 01.04.2016 only IPV 10 year MMR revaccination subcutaneously or intramusculary

Mandatory vaccinations in children 14 year dTaP II revaccination dose subcutaneously or intramusculary 19 year Td III revaccination dose

Contraindications All vaccines Severe acute or febrile infections (pneumonia, pyelonephritis, meningitis), common contagious diseases (chickenpox, rubella) Acute severe non infectious disease (trauma, acute renal failure, circulatory failure) Exacerbation of chronic diseases (asthma, diabetes, congenital heart defects)

Contraindications LIVE VACCINES Inherited immunodeficiencies Acquired immunodeficiencies HIV infection splenectomy neoplasmatic diseases, radiotherapy, chemotherapy, systemic steroids, (transient contraindications)

Contraindications INDIVIDUAL VACCINES Allergy to a vaccine component (egg protein- MMR, yeast hepatitis B vaccine, neomycin-) Severe side effects after previous dose of vaccine -Anaphylactic reaction -Other severe side effects( convulsions, fever>40°, hupotonic-hyporesponsive episodes, non-stop crying longer than 3 hours after DTP) Other : progressive neurological disorder-DTP, diarrhoea - OPV

Characteristics of vaccines

Tuberculosis vaccination only 1 dose, in first 24 hours of life( no revaccination) live vaccine- brasilian strain of Mycobacterium bovinum-relatively low immunogenity intradermal injection , 1/3 upper external part of an arm proper administration very important to avoid local complications no tuberculin test to check efficacy of vaccination

Tuberculosis vaccination Evolution of skin lesions in a place of injection small 6-8 mm wheal present within the first day→ next 2-3 days infiltration with a small vesicle in the middle→ ulceration smaller than10 mm in the middle → after 2-3 months healing with a scar

Tuberculosis vaccination Specific complications local: Ulceration larger than10 mm in a place of injection , Dermal abscess larger than 10 mm regional Involvment of regional – axillar lymphnodes larger than10 mm), general: General infection (BCGitis) : sepsis ostitis, pulmonary tuberculosis,(hospitalisation neccessary, tuberculostatic treatment, congenital immunodeficiency suspected)

Tuberculosis vaccination no tuberculin test to check efficacy of vaccination Tuberculin test presently used as diagnostic procedure Specific contraindications: - acute diseases of neonatal age (Rhesus incompatibility, very low birth weight , prematurity)

Hepatitis B Vaccine Recombinant vaccine , viral surface antigen Hbs produced by yeast cells with changed genome Very safe-complications very slight and rare In immunization schedule since 1996 Scheme of vaccination :0-1-6 Medical workers – a group of risk

Hib Vaccine Introduced into immunization schedule as mandatory in 2007 In children born before 2007 recommended( number of doses depends on age) High technology conjugated vaccine polisaccharides conjugated with proteins enhancing their immunogenity Given together with DTP Very safe

DTP Vaccine concentrated, purified diphtheria anatoxin, concentrated, purified tetanus anatoxin whole,killed pertussis bacterial cells

DTP Vaccine Characteristic complications: convulsions with/without fever 72 hours after vaccination non-stop crying >3 hours loss Of conciousness fever>40° hipotensive- hiperreactive syndrom anaphylactic reaction All the mentioned conditions are contraindication to next DTP vaccinations Other contraindications convulsions in patients history progressive neurologic disorders

Polio Vaccination 2 kinds of vaccines IPV-killed, inactivated virus first 3 doses OPV-live, last dose- revaccination dose In immunocompromised patients virus can in digestive tract, penetrate into blood vessels and finally enters CNS causing poliomyelitis Incidence of this complication 1:10 000 000 Individual contraindication to OPV vaccination is diarrhoea, and allergy to aminoglycosydes ( IPV,OPV) OPV vaccine is extremely dangerous to immunocompromised patients and immunocompromised relatives of healthy patients

Pneumococcal vaccine protect from invasive pneumococcal disease( meningitis, pneumonia, sepsis) polisaccharide antigens conjugated vaccine the number of doses depends on age

MMR Vaccine 3 live atenuated viruses Safe- side effects similar to a miled version of diseases caused by viruses included in the vaccine( swelling of the salivary glands, rash, slight fever, lymphnodes enlargment) Good immunogenity- one dose

Vaccinations- side effects (adverse reactions)

Adverse reactions Symptom(s)time related to vaccination It may result from Effect of vaccine antigen *allergic reactions to vaccine antigen or nonspecific component ( rashes, infiltration in a place of injection) *pathologic hyperreactivity of organism(measles-like or rubella-like symptoms- MMR, convulsions- DTP; lymphonodes enlargmennt-BCG) *reversion of atenuated viruses ( extremely rare)-polio unproper injection ( mainly BCG) time coincidence

Adverse reactions Classification of adverse reactions to vaccinations according to localisation local: redness, swelling, infiltration,pain in a place of injection, limphadenopathy, abscess general: anaphylactic shock, hypotension, fever, rash, hives CNS: convulsions other organs and sytems: arthralgia( rubella), orchitis, parottiditis (mumps), trombocytopenia ( rubella )

Adverse reactions Classification of adverse reactions to vaccinations according to life threatening: severe moderate mild There is a list of side effects that should be reported.

Recommended vaccinations

Recommended vaccinations not mandatory, not refunded

Recommended vaccinations Vaccines reccomended due to epidemiologic causes hepatitis B vaccination in workers of medical services tick-borne encephalitis vaccine in woodmen in the regions of a high incidence of this disease hepatitis A to persons traveling to tropic countries of low sanitary standards influenza vaccine in endemic incidence of disease

Recommended vaccinations Vaccines reccomended due to individual clinical causes Hepatitis B vaccination in patients ,who start dialysis, oncological treatment or are planned for surgery vaccines against Capsulate bacteria in patients who are planned for splenectomy influenza vaccination in children suffering from asthma,chronic heart diseases

Recommended vaccinations Vaccines reccomended to all children: Vaccination against Neiseria meningitidis Vaccination against chickenpox Vaccination against Rotavirus

Meningoccocal vaccine protect from meningitis, sepsis Monovalent Men type C vaccine conjugated vaccine (type A,C,Y,W-135) Monovalent Men type B vaccine the number of doses depends on age

Influenza vaccine modified every year( variability of viral genome) given once a year! intramuscular injection recomended for patients suffering from diabetes, renalfailure, asthma, chronic pulmonary and cardiovascular diseases

Recomended vaccinations can be given together with mandatory If contraindications occur interval can be prolonged , never shortened

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