Active immunization of children, its importance for the Active immunization of children, its importance for the infectious diseases prophylaxis. Vaccination schedule. Postvaccinal complications. Lecturer: Gorishna Ivanna Lubomyrivna

Plan of the lecture Short history about immunization Short history about immunization Recommended immunization schedule for infants and children Recommended immunization schedule for infants and children Vaccinal reactions Vaccinal reactions Postvaccinal complications Postvaccinal complications Contraindications to the vaccination Contraindications to the vaccination

The immune system is a complex system of interacting cells whose primary purpose is to identify foreign (“non-self”) substances referred to as antigens. is a complex system of interacting cells whose primary purpose is to identify foreign (“non-self”) substances referred to as antigens. The immune system develops a defense against the antigen. The immune system develops a defense against the antigen. This defense is known as the immune response and usually involves the production of protein molecules, called antibodies (or immunoglobulins), and of specific cells (also known as cell-mediated immunity) whose purpose is to facilitate the elimination of foreign substances. This defense is known as the immune response and usually involves the production of protein molecules, called antibodies (or immunoglobulins), and of specific cells (also known as cell-mediated immunity) whose purpose is to facilitate the elimination of foreign substances.

The task of immuneprophylaxis management of immunological answer to prevent the disease between separate persons and groups of the population. management of immunological answer to prevent the disease between separate persons and groups of the population.

There are two basic mechanisms for acquiring this protection active and passive. active and passive.

Active immunity Active immunity are defenses developed by the body that last many years or even a life time. 1. Active-natural immunity – means invasion of the body by microorganisms resulting in development of antibodies and sensitized lymphocytes. Examples: childhood diseases - chicken pox, measles. 1. Active-natural immunity – means invasion of the body by microorganisms resulting in development of antibodies and sensitized lymphocytes. Examples: childhood diseases - chicken pox, measles. 2. Active-artificial immunity is attained by inoculation or immunization with antigen of live or killed vaccines that are less virulent than contacting the disease. 2. Active-artificial immunity is attained by inoculation or immunization with antigen of live or killed vaccines that are less virulent than contacting the disease.

Passive immunity is temporary, trasmitted from another source that has developed immunity through previous disease or immunization. Passive-natural immunity is trasplacental and colostrum transfer from mother to child of antibodies. Immunity does not last. Passive-natural immunity is trasplacental and colostrum transfer from mother to child of antibodies. Immunity does not last. Passive-artificial immunity is injections with Gamma Globulin. Passive-artificial immunity is injections with Gamma Globulin.

Classification of vaccine Vaccines, which include complete killed microorganisms (pertussis, typhoid, cholera) or inactivated viruses (influenza, poliomyelitis Salk vaccine) Vaccines, which include complete killed microorganisms (pertussis, typhoid, cholera) or inactivated viruses (influenza, poliomyelitis Salk vaccine) Anatoxins, which contains inactivated toxin of the bacteria (diphtheria, tetanus) Anatoxins, which contains inactivated toxin of the bacteria (diphtheria, tetanus) The vaccines from alive attenuated viruses (measles, mumps and others.) The vaccines from alive attenuated viruses (measles, mumps and others.) Vaccines, which contains crossing alive microorganisms (BCG) Vaccines, which contains crossing alive microorganisms (BCG) Chemical vaccines from fraction of killed microorganisms (pneumococcal, meningococcal) Chemical vaccines from fraction of killed microorganisms (pneumococcal, meningococcal) Gene-engineering recombinant, chemical synthesized (hepatitis В, influenza) Gene-engineering recombinant, chemical synthesized (hepatitis В, influenza) Associated (in composition of which enters several vaccines) Associated (in composition of which enters several vaccines)

Composition of vaccines Active or immunizing antigens Active or immunizing antigens Fluid base Fluid base Preservatives, stabilizers, antibiotics Preservatives, stabilizers, antibiotics Auxiliary facilities Auxiliary facilities

Provide active life long immunity against disease Provide active life long immunity against disease 1. Recommended immunization Schedule for Healthy Infants and Children

The recommended childhood vaccination schedule (Ukraine) Birth Hepatitis B 3-7 days BCG BCG 1 month Hepatitis B 3 month IPV, DTaP, Hib 4 month IPV, DTaP, Hib 5 month OPV, DTaP, Hib 6 month Hepatitis B 12MMR 18 month OPV, DTaP 6 years DT-M, OPV, MMR 7 years BCG 14 years Tetanus-diphtheria booster, OPV 15 years Rubella, Mumps 18 years Tetanus-diphtheria booster

Ways of the vaccination 1.Intramuscular (DTP, DT, DT-M, antirhabic, meningococcal B) 1.Intramuscular (DTP, DT, DT-M, antirhabic, meningococcal B) 2.Subcutaneous (measles, mumps, rubella, meningococcal A+C) 2.Subcutaneous (measles, mumps, rubella, meningococcal A+C) 3.Intracutaneous (BCG) 3.Intracutaneous (BCG) 4.On skin (plague, tularemia, brucellosis) 4.On skin (plague, tularemia, brucellosis) 5.Peroral (poliomyelitis) 5.Peroral (poliomyelitis) 6.Intranasal (Influenza, inactivated) 6.Intranasal (Influenza, inactivated)

Vaccination for tuberculosis prevention could not be done in the same day with other vaccines or other parenteral manipulations Vaccines are injected to all newborns, which has no contraindications. Immunization is done by a vaccine to prevent tuberculosis (BCG). For vaccination of premature infants weighing ≥ 2000 g should be used TB vaccine with reduced antigen content (BCG-M).

Mantoux test Mantoux test before vaccination against TB should be done for babies elder than 2 months. A negative test result allows making vaccination

Immunization by monovalent hepatitis B vaccine If mother of a newborn is HBsAg "-" (negative), the child may begin vaccination during the first months of life, or combined with vaccination against pertussis, diphtheria, tetanus, polio. The recommended scheme is: months, or: mo. Newborns weighing <2000 g born by HBsAg negative mothers, vaccination is done when the child’s weight will be 2000 g or at the age of 1 mo. If the newborn child is in critical condition, the child immunization should be done when he will be better before hospital discharge. Vaccination against viral hepatitis B of newborns, whose mothers are carriers of HBsAg, is necessary to do by the accelerated scheme: and 12 mo.

Vaccinations for the prevention of diphtheria, tetanus and pertussis in the age 3, 4 and 5 months by diphtheria-tetanus-pertussis vaccine (DTP), or vaccine with acellular pertussis component (DTaP) The interval between the first and second, second and third vaccination is 30 days, the interval between the third and fourth vaccination should be not less than 12 months. The first booster at 18 months is done by DTaP. The second and third booster at 6, 14 years is done by DT. The first adult booster vaccination should be made by DT-M at interval of 5 years after the last vaccination. Further booster vaccinations for adults by DT-M with a minimum 10 years interval from the previous vaccination.

For the prevention of diphtheria, tetanus, pertussis, polio, hepatitis B and infections caused by bacteria Haemophilus influenza type b (Hib), you can use the combined vaccine

Inactivated vaccine to prevent polio (IPV) is used for the first two immunizations oral polio vaccine (OPV) is used for 3 - 6th vaccination (third vaccination and age revaccination) with no contraindications to OPV. After the OPV is proposed to restrict injections, parenteral intervention, routine operations for 40 days, exclude contact with HIV-infected

Vaccination to prevent Hib-infection can be done by mono- and combined vaccines containing Hib- components. It is advisable to use combined Hib-vaccines for primary vaccination.

Vaccination to prevent measles, mumps and rubella by the combined vaccine (hereafter - MMR) at the age of 12 months. The second vaccine to prevent measles, mumps and rubella - in 6 years. Kids who were not vaccinated vaccination can begin at any age before 18 years (2 doses with the minimum spacing between them). Children age 15 who received 1 or 2 vaccinations against measles, but not vaccinated against rubella and mumps and didn’t ill with these infections, vaccinations against mumps (guys) or rubella (girls) is scheduled. 18-teens or older who have not previously been vaccinated can be vaccinated with one dose before 30 years.

Recommended vaccinations Varicella zoster Hepatitis A Hepatitis B Flu Pneumococcal infection

Passive immunization is indicated To children with insufficient antibodies syntheses as a result of congenital or acquired cellular defects of В- lymphocytes. At absence of vaccines against infection, when single way of protection is introduction of ready antibodies. If required immediate preventive maintenance of the disease for epidemiological causes (the contact with sick on measles, preventive maintenance of rabies, tetanus). For neutralization of the antigen-toxin by specific antitoxic antibodies. With medical purpose at the beginning of the diseases (at diphtheria, botulism, tetanus).

Vaсcinal process is a change of homeostasis, which appears in organism in response to introduction of vaccinal preparation and include the complex of reactions to which belongs: formation of antibodies, adaptation and postvaccinal reactions, postvaccinal complications. is a change of homeostasis, which appears in organism in response to introduction of vaccinal preparation and include the complex of reactions to which belongs: formation of antibodies, adaptation and postvaccinal reactions, postvaccinal complications.

Vaccinal reactions appear in response to entering the vaccines, are characterized by appearance of clinical manifestations typical to this type of vaccine, which have a round-robin duration, are short, do not cause serious changes of vital activity in the organism. appear in response to entering the vaccines, are characterized by appearance of clinical manifestations typical to this type of vaccine, which have a round-robin duration, are short, do not cause serious changes of vital activity in the organism.

Vaccinal reactions Increased temperature to 39˚ C. Increased temperature over 39˚ C (severe total reaction). Temperature, which is not registered in medical documentation. Pain, soft tissue swelling > 50 mm, hyperemia in the place of injection > 80 mm, infiltration > 20 mm (severe local reaction). Lymphadenopathy. Headache. Irritability, sleep disturbance. Non allergic rash. Anorexia, nausea, abdominal pain, indigestion and diarrhea. Catarrhal phenomena. Myalgia, arthralgia.

Postvaccinal complications - all pathological phenomena, which appear after vaccination and are not inherent to the usual vaccinal process, but obvious, their relationship with performed vaccination: - all pathological phenomena, which appear after vaccination and are not inherent to the usual vaccinal process, but obvious, their relationship with performed vaccination: 1.Postvaccinal unusual reactions and complications, caused strictly by vaccine ("true"). 1.Postvaccinal unusual reactions and complications, caused strictly by vaccine ("true"). 2.Joining of intercurrent infections in postvaccinal period. 2.Joining of intercurrent infections in postvaccinal period. 3.Exacerbation of chronic diseases and primary manifestations of latent diseases. 3.Exacerbation of chronic diseases and primary manifestations of latent diseases.

Complication of vaccination 1. Anaphylactic shok Angioneurotic edema 2. General rash, Stenen-Johnson syndrome, Lyell’s syndrome, 3. Encephalitis, encephalopathy, polyradiculoneuritis, mononeuritis 4. Febril seizures unfebril seizures 5. Serous meningitis, myocarditis, anemia, hemorrhagic vasculitis, trombocytopenia 6. Sudden death syndrome First 24 hr. First 10 days First 15 days 30 days

Angioneurotic edema ( Quincke’s edema Angioneurotic edema ( Quincke’s edema )

urticaria (hives)

Stevens- Johnson’s syndrome

Lyell’s syndrome

DTP-vaccine Postvaccinal reactions Postvaccinal complications Temperature ºС, anxiety, poor sleeping, rarely - vomiting. anxiety, poor sleeping, rarely - vomiting. Local reaction (more often on revaccination) - in the manner of hyperemia, infiltration. Febrile seizures Exacerbation allergic manifestations ( in children with exudative-catarrhal diathesis ) seizuresEncephalitis Anaphylactic shok Angioneurotic edema febril temperature with seizures persistent, uncontrolled crying that lasts for more than 3 hours at a time within 2 days after injection

OPV-vaccine Postvaccinal reactions Postvaccinal complications No Anaphylactic shok Angioneurotic edema Vaccinassocated poliomyelitis in immunized and in contact persons (on background of immunodeficiency) - 1:1,

MMR vaccine Postvaccinal reactions Postvaccinal complications Fever of 39.4°C Rash develops at 7-10 days after vaccination. Arthralgia Increasing of paroid glands Serous meningitis Angioneurotic edema febril temperature Seizures Hemorrhagic vasculitis Mild lymphadenopathy Arthritis thrombocytopenia thrombocytopenia

BCG-Vaccination BCG-Vaccination Postvaccinal reactions Postvaccinal complications Local reaction: papule, vesicle, lymphadenitis lymphadenitis 1. Subcutaneous cool abscess 2. Purulent lymphadenitis. 3. Keloid scars. 4. Lymph nodes calcification. 5. Generalized BCG-infection on background of immune deficiency (4: ) Osteitis, osteomyelitis

Main rules of vaccination Take allergic history Take allergic history Take life history Take life history Take history of vaccination Take history of vaccination Take family history Take family history Do objective exanimation of the child Do objective exanimation of the child Take temperature of the body Take temperature of the body Do vaccination at special room Do vaccination at special room Follow the instruction of vaccine Follow the instruction of vaccine Supervise the vaccinated person for 30 days Supervise the vaccinated person for 30 days

CONTRAINDICATIONS TO THE VACCINATION by all vaccines and toxoids Severe complications from the previous dose in the form of anaphylactic shock. Severe complications from the previous dose in the form of anaphylactic shock. Allergy to any vaccine component. Allergy to any vaccine component. Progressive diseases of the nervous system, hydrocephalus in decompensation stage, epilepsy, epileptic syndrome with convulsions 2 times a month and more often. Progressive diseases of the nervous system, hydrocephalus in decompensation stage, epilepsy, epileptic syndrome with convulsions 2 times a month and more often. Acute illness or chronic disease exacerbation Acute illness or chronic disease exacerbation

CONTRAINDICATIONS TO THE VACCINATION by all live vaccines Congenital combined immune deficiency, Congenital combined immune deficiency, primary hypogammaglobulinemia (entering the vaccine is not contraindicated in selective Ig A and Ig M immunodeficiency), primary hypogammaglobulinemia (entering the vaccine is not contraindicated in selective Ig A and Ig M immunodeficiency), transitional hypogammaglobulinemia transitional hypogammaglobulinemia malignant tumors, malignant tumors, pregnancy, pregnancy, AIDS, AIDS, immune suppression therapy immune suppression therapy

baby weight less than 2000 g: baby weight less than 2000 g: g vaccinations are not done up to 1 month g vaccinations are not done up to 1 month g - up to 2 months g - up to 2 months. Complicated reactions to previous vaccine (adenitis, cold abscess, skin ulcers over 10 mm in diameter, kelloid scar, osteomyelitis, generalized BCG infection). Complicated reactions to previous vaccine (adenitis, cold abscess, skin ulcers over 10 mm in diameter, kelloid scar, osteomyelitis, generalized BCG infection). Tubinfection. Tubinfection. Defects of phagocytosis Defects of phagocytosis CONTRAINDICATIONS TO THE BCG-VACCINATION

CONTRAINDICATIONS TO THE VACCINATION OPV Children whom live vaccine is contraindicated, as well as to members of their families is recommended vaccination by polio inactivated vaccine (IPV) DTP A history of convulsions (instead DTP vaccine - DTaP vaccine or DT toxoid is injected)

By living vaccine against measles, living mumps vaccine, vaccine against rubella or trivaccine (measles, mumps, rubella) Allergic reactions on Aminoglucosides Allergic reactions on Aminoglucosides Anaphylactic reactions on eggs protein Anaphylactic reactions on eggs protein CONTRAINDICATIONS TO THE VACCINATIONS