1. Immunization Dr. Tanveer Ashraf

2. Objectives Types of vaccination Contraindications Discussion of individual vaccines Preparations Administration Precautions and contraindications Side effects

3. Active Immunization Types Live attenuated VirusMeasles, mumps, rubella BacteriaBCG Killed VirusHepatitis B Bacteria WholePertussis ToxoidTetanus PolysaccharideMeningoccocal

4. Human Immune Serum Globulin Specific IMHepatitis B (HBIG) Rabies (RIG) Tetanus (TIG) Varicella (VZIG) IVCMV (CMV-IG) RSV (RSV-IG)

5. Human Immune Serum Globulin Non-specific IMImmune serum globulin(ISG) Hepatitis A Measles IVIntravenous immune globulin(IGIV) Antibody deficiency disorders ITP Kawasaki syndrome

6. Passive Immunization (Cont) SPECIFIC EQUINE ANTIBODIES (IM) BOTULISM ANTITOXIN DIPHTERIA ANTITOXIN TETANUS ANTITOXIN SNAKE & SPIDER ANTI-VENOM MONOCLONAL ANTIBODIES (IV) ANTI-ENDOTOXIN ANTIBODIES

7. Recommended Immunization Schedule

8. RECOMMENDED AGEVACCINE(S) BIRTHBCG, Hepatitis B (HBV) 2 MONTHS[DTP, HIB, HBV] Injectable Polio Vaccine (IPV) 4 MONTHS[DTP, HIB, HBV] Oral Polio Vaccine (OPV) 6 MONTHS[DTP, HIB, HBV] Oral Polio Vaccine (OPV) 9 MONTHSMeasles vaccine (mono) 12 MONTHSOral Polio Vaccine (OPV) MMR Varicella 1 8 MONTHSOral Polio Vaccine (OPV) DTP, HIB Hepatitis A 24 MONTHSHepatitis A 4 – 6 YEARSOral Polio Vaccine (OPV) DTP MMR Varicella

9. General Contraindications Moderate or severe illness with or without fever Anaphylactic reaction to vaccine or vaccine constituent Live attenuated vaccines Pregnant women Immunocompromised / Immunosuppressed children within 3-11 months of immunoglobulin administration

10. Invalid Contraindications Mild to moderate local reaction Mild acute illness with or without low grade fever Current antimicrobial therapy Convalescent phase of illnesses Prematurity and low birth weight History of penicillin or other nonspecific allergies Malnutrition

11. Immunization Of Special Groups IMMUNOCOMPROMISED HOSTS Avoid MMR, measles (may be used in HIV) Avoid OPV; use IPV for these children and their household contacts PRETERM INFANTS Treat as term babies Avoid OPV in hospital Influenza vaccine in BPD may delay HBV if <2 kg & mother is HBsAG negative

12. Compulsory Vaccines

13. Bacillus Calmette ‑ Guerin Vaccine (BCG) INDICATIONS All newborns All tuberculin negative infants PRECAUTIONS & CONTRAINDICATIONS(CI): Give only to PPD negative children CI in persons with immunodeficiencies CI during pregnancy

14. Bacillus Calmette ‑ Guerin Vaccine (BCG) SIDE EFFECTS Local Skin ulceration, regional lymphadenitis Subcutaneous abscess Generalized Anaphylaxis, generalized BCG infection (rare): osteitis

15. Hepatitis B PREPARATIONS ENGERIX ‑ B RECOMBIVAX HB

16. Hepatitis B ADMINISTRATION: 0.5 ‑ 1 ML, anterolateral thigh or deltoid IM injection at 0,1 and 6 months SIDE EFFECTS: Pain Arthralgia

17. Poliomyelitis Prophylaxis PREPARATIONS (A) Oral (OPV)SABIN(Live attenuated) (B) Inactivated (eIPV)SALK(killed) ADMINISTRATION OPV2 drops orally eIPV SC injection PRECAUTIONS & CONTRAINDICATIONS(CI) (a) OPVpregnancy, immunodeficiency (b) IPVneomycin hypersensitivity ADVERSE REACTIONS OPVparalytic disease (rare)

18. Diphtheria, Tetanus & Pertussis (DTP) PREPARATIONS < 7 years : DTP, DT, DTaP (acellular pertussis vaccine) > 7 years : Td, TdaP ADMINISTRATION IM

19. Diphtheria, Tetanus & Pertussis (DTP) CONTRAINDICATIONS (CI) Encephalopathy within 7 days Progressive or unstable neurological disorders Anaphylactic reaction to a previous dose PRECAUTIONS severe systemic reactions such as Temp > 40.5 0 C persistent inconsolable crying > 3 hours Collapse episodes Convulsions

20. Measles, Mumps & Rubella (MMR) PREPARATIONS: MEASLES. MMR. ADMINISTRATION: SC. INDICATIONS: Primary immunization at 1 & 6 years.

21. Measles, Mumps & Rubella (MMR) PRECAUTIONS & CONTRAINDICATIONS Pregnancy Anaphylaxis to eggs Immunodeficiency and immunosuppression Immunoglobulins within 3-11 months

22. Measles, Mumps & Rubella (MMR) ADVERSE REACTIONS Fever,rash (7 days post vaccination) Arthralgia, arthritis (rubella) Encephalitis [rare] (measles, mumps) Suppression of PPD skin test (measles) Convulsions in prone children(measles) Thrombocytopenia

23. Haemophilus Influenzae Type B ADMINISTRATION IM 2,4,6 months, booster at 15 months INDICATIONS Children under 5 years of age High risk children SIDE EFFECTS: Local pain and erythema Mild fever

24. Varicella Prophylaxis PREPARATIONS: Varivax vaccine (MSD) ADMINISTRATION: 0.5 ml IM 12 months and above……..2 doses

25. Varicella Prophylaxis INDICATIONS: All children 12 months ‑ 18 years: (if no history of varicella) EFFICACY: 70 ‑ 90%

26. Varicella Prophylaxis PRECAUTIONS & CONTRAITNDICATIONS: Immunocompromised patients Within 5 months of IG Children on long term salicylates SIDE EFFECTS: Fever, rash Zoster

27. Hepatitis A NATURE OF VACCINE: Killed formalin inactivated vaccine. PREPARATIONS: Various preparations available e.g. Havrix 720 Junior, Havrix 1440 etc.

28. Hepatitis A INDICATIONS: children 1 year and above Susceptible children in endemic areas Chronic liver disease Hemophilia

29. Hepatitis A ADMINISTRATION: IM injection 2 doses, at least 6 months apart ADVERSE REACTIONS: Local reactions, fever Rare: anaphylaxis

30. Additional Vaccines

31. Pneumococcal Prophylaxis PREPARATIONS: Purified capsular polysaccharide of 23 serotypes of Streptococcus pneumoniae 7 valent conjugated vaccine ADMINISTRATION: IM / SC 1 dose/booster 5 years

32. Pneumococcal Prophylaxis INDICATIONS: Primary vaccination (conjugate vaccine) children 2 yr. or older with Anatomical or functional asplenia Sickle cell disease Nephrotic syndrome Immunosuppression

33. Pneumococcal Prophylaxis SIDE EFFECTS: Soreness, erythema, fever, myalgia Anaphylactic reactions (rare)

34. Meningococcal Prophylaxis PREPARATIONS: monovalent (A or C) bivalent (A & C) quadrivalent (A,C,Y & W ‑ 135) quadrivalent conjugate quadrivalent ADMINISTRATION: SC

35. Meningococcal Prophylaxis INDICATIONS: Control of outbreaks Children with complement deficiencies or asplenia SIDE EFFECTS: local erythema and discomfort transient fever

36. Influenza Virus Nature of vaccine: Killed vaccine. Live attenuated Preparations: whole and “split virus” vaccines. “split virus” vaccines are recommended for children 6 months and older. composition of the vaccine is changed annually.

37. Influenza Virus ADMINISTRATION: IM (killed). Live attenuated (intranasal). 1 dose during influenzae season. Children 6months-9 years should receive an additional dose, 4 weeks after the 1 st dose, if not previously immunized.

38. Influenza Virus Indications: chronic cardio-respiratory disease asthma cystic fibrosis bronchopulmonary dysplasia

39. Influenza Virus Indications: Sickle cell anemia. Chronic salicylate therapy. Diabetes mellitus. Chronic renal disease. Chronic metabolic disease. immunosuppressive conditions: cancer, HIV etc. Hospital personnel with significant patient contact.

40. Influenza Virus Contraindication: Anaphylaxis to previous dose. Hypersensitivity to eggs. Adverse Reaction: Soreness at injection site. Allergic response. Guillain-Barré Syndrome.

41. New Vaccines Rota virus vaccines Human papilloma virus vaccine