1. 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

2. 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

3. 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

4. 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)

5. 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

6. Measles, Mumps, Rubella (MMR) Vaccine - live attenuated - given at 12-15 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)

7. 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

8. 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

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

10. 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

11. 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

12. 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

13. THANK YOU