1. IMMUNITY AND IMMUNIZATION FAHAD AL ZAMIL Professor & Consultant Paediatric Infectious Diseases King Khalid University Hospital King Saud University, Riyadh Keeps Kids Healthy!

2. IMMUNITY & IMMUNIZATION I.Immunity A.Components of the Immune Systems ● Lymphocyte ● B. T. Killer ● Neutrophils ● Macrophage ● Complement

3. IMMUNITY & IMMUNIZATION B.Features suggestive of immune deficiency ● Increased susceptibility to infection. ● Types of infection ● Skin manifestation

4. IMMUNITY & IMMUNIZATION C.Facts and types of immunodeficiency B, T, combined, phagocyte and complements. D.Few examples of disorders. E.Evaluations of a patient suspected of having immunodeficiency. F.Management.

5. Historical Milestones  1000 years ago: Chinese inhaled dried crusts from smallpox pustules  1721:“variolation” was introduced from Turkey to Britain by Lady Montagu  1796:Edward Jenner: 1 st scientific attempt of immunization (cowpox)  19 th Century:Anthrax 1881, Rabies 1885, Diphtheria antitoxin 1891, Plague 1895, Cholera 1896, Typhoid 1898  Early 20 th Century:BCG 1921, Diphtheria toxoid 1923, Pertusis 1926, Tetanus 1927, Yellow fever 1937, Influenza 1941  Post World War II:Polio, MMR, Pneumococcal, Meningococcal, HiB, Hepatitis B, Hepatitis A  1980:Eradication of Smallpox  What’s New in the 21 st Century??

6. IMMUNITY & IMMUNIZATION II.Immunizations: A.Types: ● Active ● Active ● Passive ● Passive

7. IMMUNITY & IMMUNIZATION Active: ● Immunizing antigens ● Site, route and dose ● Scheduling ● Simultaneous administration of vaccines

8. IMMUNITY & IMMUNIZATION Immunization in special clinical circumstances: ● Preterm ● Pregnancy ● Immunodeficient ● Asplenic children

9. IMMUNITY & IMMUNIZATION ● History and family seizures ● Children with chronic diseases ● Foreign travel

10. IMMUNITY & IMMUNIZATION ● Lapsed immunizations and unknown immunization status. ● Reimmunization ● Interference with immunoglobulin ● Vaccine safety and contraindications ● Immunization after exposure to disease.

11. ROUTINE ACTIVE IMMUNIZATION FOR INFANTS & CHILDREN VaccineAge BCG, HBV 1 st At birth DPT + HiB + OPV 1 st, HBV 2 nd 2 months DPT + HiB + OPV 2 nd 4 months DPT + HiB + OPV 3 rd, HBV 3 rd 6 months MMR 1 st 12 months DPT + HiB + OPV 1 st booster 18 months DPT + OPV 2 nd booster, MMR 2 nd 4 – 6 years Td (Repeated every 10 yrs.) 14 – 16 years

12. Revised Basic Vaccination Schedule Activated in January 1 st, 2008 اللقاحVaccineAge الدرن ، الالتهاب الكبدي (ب) BCG, HepB At birth شلل الاطفال المحلل ( الثلاثي البكتيري،الالتهاب الكبدي ب، المستديمة النزلية) IPV (DTP, HepB, Hib) 2 months شلل الأطفال الفموي (الثلاثي البكتيري، الالتهاب الكبدي ب، المستديمة النزلية) OPV (DTP, HepB, Hib) 4 months شلل الاطفال الفموي OPV (DTP, HepB, Hib) 6 months الحصبة المفرد Measles (Mono) 9 months شلل الاطفال الفموي، الثلاثي الفيروسي، الجديري المائي OPV, MMR, Varicella 12 months شلل الاطفال الفموي (الثلاثي البكتيري،المستديمة النزلية) ، الالتهاب الكبدي(أ) OPV (DTP, Hib), HepA 18 months الالتهاب الكبدي(أ) HepA 24 months شلل الأطفال، الثلاثي البكتيري، الثلاثي الفيروسي، الجديري المائي OPV, DTP, MMR, Varicella 4 – 6 Years

13. VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION RouteTypeVaccine Intradermal (Preferred) or subcutaneous Live bacteria BCG Subcutaneous intramuscular or intradermal Inactivated bacteria Cholera Intramuscular Toxoids and inactivated bacteria DTP

14. VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont) RouteTypeVaccine Subcutaneous Live virus Rubella IntramuscularToxoids Tetanus & TD, DT Subcutaneous (Boosters may be intradermal) Inactivated bacteria Typhoid Subcutaneous Live virus Yellow fever

15. VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont) RouteTypeVaccine Subcutaneous Live viruses MMR Subcutaneous Live virus Mumps Oral OPV Intramuscular Inactivated bacteria Plague Intramuscular or subcutaneous PolysaccharidePneumococcal Intramuscular Inactivated virus Rabies

16. VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont) RouteTypeVaccine Intramuscular Inactivated viral antigen Hep. B Subcutaneous intramuscular Polysaccharide Haemop. B Intramuscular (Preferred) or subcutaneous Inactivated virus Influenza Subcutaneous IPV Subcutaneous Live virus Measles SubcutaneousPolysaccharideMeningococcal

17. Immunization & Immunity Misconceptions concerning vaccine contraindications  Mild acute illness with low-grade fever or mild diarrhea illness in an otherwise well child.  Current antimicrobial therapy or the convalescent phase of illness.

18. Immunization & Immunity  Recent infection to an infectious disease  Breast feeding  A history of non-specific allergies or relatives with allergies

19. Immunization & Immunity  Reaction to a previous DTP dose that involved only soreness, redness, or swelling in the immediate vicinity of the vaccination site or temperature less than 105F (40.5 C).  Prematurity  Pregnancy of mother or other household contact.

20. Immunization & Immunity  Family history of Sudden Infant Death Syndrome in children considered for DTP vaccination.  Family history of an adverse event, unrelated to immunosuppression, after vaccination.  Malnutrition

21. Immunization & Immunity  Allergies to penicillin or any other antibiotic, except anaphylactic reactions to neomycin or streptomycin.  Allergies to duck meat or duck feathers.  Family history of convulsion in persons considered for pertussis or measles vaccination.

22. Immunity & Immunization Comments Recommended Vaccine (s) Before giving BCG, Tuberculin, skin testing is recommended if feasible. BCG, Td, OPV 1 st visit Interval after 1 st visit MMR 1 month Td, OPV 2 months Td, OPV 8 – 14 months Repeat every 10 yrs. throughout life Td 10 years

24. IMMUNITY AND IMMUNIZATION Comments Recommended Vaccine (s) Before giving BCG, Tuberculin, skin testing is recommended if feasible. BCG, Td, OPV 1 st visit Interval after 1 st visit MMR if child > 12 mos. MMR 1 month DTP, OPV 2 months DTP, OPV 4 months Td 10 – 16 months DT and OPV are not necessary If the 4 th dose of each were given after 4 yrs. of age DTP, OPV 4 – 6 years Repeat every 10 yrs. throughout life Td 14 – 16 years

27. IMMUNITY AND IMMUNIZATION Questions to be answered: Q.Is it possible to immunize a child with neurological disorder? Q.Is it possible to immunized a child during a minor illness? Q.My child is having eczema and evidence of atopy. Can he be immunized?

28. IMMUNITY AND IMMUNIZATION Questions to be answered: Q.Is it possible to administer multiple vaccines simultaneously? Q.Does the lapse in the immunization schedule require re-institution of the entire series? Q.If a child immunization status is unknown – what to do?

29. IMMUNITY AND IMMUNIZATION Questions to be answered: Q.Is it possible to give vaccines during immunosuppressive therapy? Q.Is it possible to immunize a child who recently received immune globulins? Q.When to immunize a child born prematurely? Q.My child is allergic to egg, can he be immunized?

30. Further Reading http://www.vaccineinformation.org