Medenilla, Judy; Medina, Kristianne; Medina, Sakura; Mejino, Carla; Melgarejo, Ivy; Mendoza, Alvin; Mendoza, Diana; Mendoza, Donne; Mendoza, Gracielle PEDIATRIC IMMUNIZATION

Immunization ◦ 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

Immunity Active Passive Injection of an antigen (vaccine)Injection of preformed antibiotics (gammaglobulins) Protection produced by the person’s own immune system Protection transferred from another person or animal Usually permanentTemporary protection that wanes with time

ACTIVE IMMUNIZATION Contraindications - 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 Contraindications to ALL LIVE VACCINES: 1. immunocompromised patients 2. patients given immunoglobulin and blood products for the past 3 months 3. pregnancy and possibility of getting pregnant within 3 months 4. household contacts of immunocompromised patients* (OPV)

ACTIVE IMMUNIZATION Simultaneous administration of Multiple Vaccines: No contraindications for multiple vaccines routinely recommended Immune response to one vaccine generally does not interfere with other vaccines There should be an interval of 28 days between administration of live vaccines Interchangeability of vaccine products is allowed for primary and booster doses

ACTIVE IMMUNIZATION Lapsed immunizations 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 VACCINEMINIMUM AGE DOSE (NO) ROUTE AND SITE OF ADMINIST- RATION MINIMUM INTERVAL BETWEEN DOSES REMARKS BCG 1Birth; 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 DTP6 weeks0.5 ml (3)IM; upper outer portion of thigh 4 weeksVaccine damaged by heat, freezing POLIO6 weeks2 drops (3)PO; mouth4 weeksVaccine easily damaged by heat

EXPANDED PROGRAM ON IMMUNIZATION VACCINEMINIMUM AGE DOSE (NO)ROUTE AND SITE OF ADMINIST- RATION MINIMUM INTERVAL BETWEE N DOSES REMARKS HEP B6 weeks or at birth Follow manufacturer’ s instructions 0.5 ml (3) - 0,1 & 6 months IM; anterolateral aspect of thigh Vaccine destroyed by heat or freezing MEASLES9 months0.5 ml (1)SC; outer part of the thigh Vaccine easily damaged by heat

EXPANDED PROGRAM ON IMMUNIZATION VACCIN E MINIMUM AGE DOSE (NO)ROUTE AND SITE OF ADMINIST- RATION MINIMUM INTERVAL BETWEEN DOSES REMARKS BCG 2At school entry, whether or not child has BCG scar 0.1 ml (1)ID; L deltoidVaccine destroyed by heat or sunlight TETANUS TOXOID Women of childbrearing age 0.5 ml (5)IM; deltoid region TT1 at 1 st 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

Childhood Immunization BCG Vaccine - live attenuated bacterial vaccine - at birth or anytime after birth - booster dose given at school entry Contraindications: immunodeficiency, progressive dermatoses Reaction: abscess at the site; axillary lymphadenopathy

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

Hepatitis B vaccine - inactivated viral antigen - 0, 1 & 6 months - 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

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 within 7 days of administration of previous dose ◦ anaphylactic shock after a previous dose ◦ progressive neurologic disorders

Poliomyelitis Vaccine 1. Oral Polio Vaccine (OPV) - live attenuated (Sabin) Absolute contraindications: 1.altered immune states, high dose steroids, radiation, HIV/AIDS 2.pregnancy 3.household contacts of immunocompromised patients Relative contraindications: vomiting and diarrhea Adverse Reaction: paralysis 2. Inactivated or Killed Polio Vaccine (IPV) - recommended to decrease the incidence of vaccine-associated paralytic polio (VAPP)

Measles Vaccine - live attenuated - given at 9 months but may be given as early as 6 months during epidemics Adverse reactions: 1. fever with or without rashes (5-12 days after administration) 2. hypersensitivity reaction Contraindication: immunocompromised state, pregnancy Relative Contraindication: untreated active tuberculosis

Measles, Mumps, Rubella (MMR) Vaccine - live attenuated - given at months; a booster dose is recommended at 4-6 years old Reactions: 1. fever with or without rashes (5-12 days after administration - measles) 2. fever, swelling of parotid gland (mumps) 3. fever, mild rash, transient arthritis or arthralgia, post- auricular lymphadenopathy (rubella)

Measles, Mumps, Rubella (MMR) Vaccine Reasons for giving 2 doses of MMR: 1. only 87-90% of children actually receive the measles vaccine 2. 5% of children who receive the first vaccine won’t develop immunity 3. children who had an immune response to the first dose could get a “booster” effect Contraindications: same as other live vaccines

Varicella Vaccine - live attenuated - 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 - varicella vaccine prevents moderate to severe cases of chickenpox Reactions: -may develop few varicella-like lesions about 1 month after vaccination

Hemophilus influenzae b (Hib) Vaccine - polysaccharide protein conjugate Reactions:low grade fever (2%) pain and swelling (10-15%)

Pneumococcal Vaccine - PPV is given for children 2 yrs and above Indications: 1. patients undergoing splenectomy 2. sickle cell disease 3. asplenia 4. HIV 5. Routinely for children 2 months and above

Hepatitis A Vaccine - inactivated viral antigen Indications: 1. persons traveling to areas with high prevalence of Hepatitis A 2. occupational hazards 3. hemophiliacs – contacts of infected persons Reactions: pain and local swelling

Influenza Vaccine - inactivated vaccine - should be administered before the start of flu season (February to June) Indications: 1. prophylaxis in children older than 6 months and adults 2. over 60 years 3. suffer from disease of cardiovascular system, metabolic disease, cystic fibrosis, chronic respiratory disease, chronic renal insufficiency

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