1. Immunization Presented By: DR/Amira Yahia

2. Learning outcomes 1.Explain,with examples, the difference between active and passive immunity 2.Describe the community immunization program for preschool children ; school- aged children,and adults. 3.Identify indication and contraindications for immunization

3. Cont… 4- Describe common reactions experienced following immunization. 5- Describe secondary nursing intervention to relieve the above common reactions. 6- Outline a teaching plan for parents of children being immunized

4. Definitions A communicable disease is one that can be transmitted from one person to another. It is caused by an agent that is infectious (capable of producing infection) and is transmitted from a source, or reservoir, to a susceptible host.

5. Horton & Parker: Informed Infection Control Practice Chain of Infection

6. Means of transmission Direct  Skin-skin  Herpes type 1  Mucous-mucous  STI  Across placenta  toxoplasmosis  Through breast milk  HIV  Sneeze-cough  Influenza Indirect  Food-borne  Salmonella  Water-borne  Hepatitis A  Vector-borne  Malaria  Air-borne  Chickenpox  Ting-borne  Scarlatina

7. Levels of Disease Occurrence  Sporadic level: occasional cases occurring at irregular intervals  Endemic level: persistent occurrence with a low to moderate level  Hyperendemic level: persistently high level of occurrence

8. Cont…. Epidemic or outbreak: occurrence clearly in excess of the expected level for a given time period Pandemic: epidemic spread over several countries or continents, affecting a large number of people

9. Immunity: The host` ability to resist a particular infectious disease-causing agent. Acquired immunity : is the resistance acquired by a host as a result of previous exposure to an infection. Nosocomial infection: in the episodic setting an infection that is not present or incubating at the time of admission (hospital infection).

10. Vaccination Vaccination is used to prevent specific infectious disease.they must be given when individual is immunologically capable and before exposure to natural infections

11. Definition of vaccination It is an effort to prevent or modify natural infection by administration of antigen or an antibody. Its aim is to build up resistance in the child against certain infectious disease.

12. Cont… Types Of Immunization

13. (I)-Passive immunity is short-term resistance to a specific disease-causing organism; it may be acquired : A-natural Passive Immunization: It include passage of maternal antibodies to fetus through the placenta (e.g antibodies against measles,poliomyelitis,diphtheria,mumps ).These antibodies disappear from the infant circulation at about 4 month of age

14. Cont…. B- artificially through inoculation with a vaccine that gives temporary resistance. Such immunizations must be repeated periodically to sustain immunity levels. An example is the influenza vaccination.

15. (II)-Active immunity A long –term resistance to specific disease. It is an entrance of antigen,which stimulates formation of antibodies by the immune system A-Natural active through exposure to infection in endemic areas, Ex: Chicken pox B-Acquired active through vaccination ex. DPT

16. Immunization : is the process of introducing some form of disease-causing organism into a person’s system to cause the development of antibodies that will resist that disease. A vaccine: is a preparation made from killed, living attenuated, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease.

17. Types of Vaccines Live vaccine: small pox vaccine is the only live vaccine, made of live virus which is nonpathogenic, but antigenic and gives immunity for the disease. Live attenuated vaccine: virulent pathogenic organisms are so treated to become attenuated and a virulent, but antigenic. E.g. BCG vaccine, measles, mumps, rubella vaccine, yellow fever vaccine and sabin polio vaccine (oral vaccine).

18. Cont….. Killed vaccine: vaccines made of killed organisms which are in activated by heat or chemicals still remain antigenic as cholera vaccine, Pertussis vaccine. Polysaccharide vaccines: prepared from capsule of the organism as meningococcal vaccine & Pneumococcal vaccine. Toxoid: They stimulate formation of antitoxic humeral immunity as diphtheria and tetanus toxoid.

19. IMUNIZATION SCHEDULE

20. visitVaccine At birth -BCG -Hepatitis B 2Months -IPV -DTP -Hep B -Hib -PCV 4Months OPV DTP Hep B Hib PCV

21. Visitvaccine 6MonthsOPV DTP Hep B Hib PCV 9MonthsMeasles (mono) 12monthsOPV MMR PCV

22. VisitVaccine 18MonthsOPV DTP Hib Hepatitis A 2 YearsHepatitis A For new child inter the school - first class OPV DTP (DT) MMR Varicella

24. BCG: There is evidence that BCG provides appreciable protection against tuberculosis. Intra-dermal injection 24

25. BCG: Local lesion, papule, 2 weeks after vaccination. Small abscess might develop, 4-6 weeks. At 6 weeks (crust, detaches, ulcerates),then a scar (typically round and slightly depressed) remains 25

26. BCG: Complications: 1. Local abscess 2. “Not so serious” Lymphadenitis 3. Serious Lymphadenitis : Persistent, recurrent or multiple 4. Disseminated BCG is in immune compromised 26

27. BCG: Contraindications: only “symptomatic HIV infection (i.e. AIDS)” is a contraindication for BCG according to WHO. 27

28. DTP Vaccine

29. DTP Vaccine : Inactivated whole organism vaccine DTP or Acellular vaccine DT Acellular type has less side effects After 6 years of age only DT is given 29

30. DTP Vaccine: Side effects : Mild Problems (Common): Fever, Redness, swelling, Soreness Fussiness,Tiredness or poor appetite and Vomiting. These problems occur more often after the 4th and 5th doses of the DTP series than after earlier doses. 30

31. DTP Vaccine: Moderate Problems (Uncommon): Seizure (1 in 14,000), Non-stop crying for 3 hours or more (1 in 1,000), High fever (1in 16,000) Severe Problems (Very Rare) : Serious allergic reaction (1 in a million dose) Long-term seizures, coma, or lowered consciousness, Permanent brain damage. so RARE that it is hard to tell if they are caused by the vaccine. 31

32. DTP Vaccine: Contraindications: 1. Encephalopathy (coma,altered level of consciousness,prolonged seizures ) within 7 days of previous dose 2. Progressive neurological disorder till neurological state is clarified. 32

33. Precautions: 1. Fever more than 40.5,during 48 hrs of previous dose 2. Collapsed or shock like state during 48 hrs of previous vaccine dose 3. Seizures during 3 days or less of previous vaccine dose 4. Persistent inconsolable crying more than 3 hr during 48 hr of previous vaccine dose 33

34. Hepatitis B vaccine

35. Hepatitis B vaccine: Is a very safe vaccine Very effective Infants born to HBsAg-positive mothers should receive the vaccine and HBIG within 12hr of birth. 35

36. Hib Vaccine

37. Hib Vaccine: Capsular polysaccharide conjugated to protein carrier Contraindicated in less than 6 weeks of age Children over 5 years old usually do not need Hib vaccine 37

38. OPV, IPV

39. OPV, IPV: live attenuated oral polio vaccine (OPV) IPV is inactivated vaccine IPV elicit higher serum IgG antibody levels but OPV also produce mucosal IgA immunity and limit virus replication in gastrointestinal system 39

40. OPV, IPV: Side effects : IPV has no adverse effects OPV may cause (vaccine associated paralytic polio) in 1 in 6.2 million doses. 40

41. Measles vaccine

42. Live attenuated freeze dried tissue culture vaccine. A dose of 0,5 ml is administered sub cutaneously

43. Rotavirus Vaccine : An oral live vaccine Children should get 2 doses : First Dose:6 week of age Second Dose: 10 week of age Contraindications : immunodeficiency Minor side effects 43

44. Vaccines and Cold Chain

45. Cold chain Is term referring to the system by which the vaccines are kept at optimum temperature from the manufacture to the user. Component of cold chain include:- (a ) Walk in cold room, keep vaccine for 3 month (b) Deep freezers & ice linked refrigerators Used to make ice pack & store polio and measles

46. (C) Small deep freezer Supplied to PHC center where vaccine kept in. (d) Cold boxes. (e) Vaccine carriers. (f) Ice packs.

47. Vaccines All vaccines should be stored at plus 2 to plus 8 degrees ideally in Ice Lined Refrigerators/ Domestic Refrigerators All government supply vaccines come with Vaccine Vial Monitors (VVMs) BCG and Measles vaccines are in powder form and come with diluents. Reconstitution is needed before use.

48. Cont… Use reconstituted BCG and Measles vaccines within 4 hours of reconstitution and JE within 2 hours of reconstitution if kept at +2 to +8 degrees Use separate 5 ml syringes for each reconstitution

49. Cold Why have the Cold Chain? If vaccines are exposed to excessive they may lose their potency or effectiveness. Heat Light

50. Reactions Vaccine Oozing, redness, and swelling at siteBCG Some local reaction such as pain, redness, or swelling after the first 3 doses of DTaP. A temperature of 101° F or higher is reported in 3%- 5% of DTaP recipients. Less common reactions (persistent crying, higher fever, febrile seizure) are rare DPT/DT/ Tetanus (IM) a very mild reaction, such as soreness at the injection site Adults are slightly more likely to experience such mild symptoms. Hepatitis B (IM) Redness, warmth, or swellingHib (IM) Slight redness or pain at the injection site.Meningococcal *

51. Reactions ReactionVaccine/Route Fever, Mild rash, SeizureMMR (SC) Up to about 1 infant out of 4 had redness, tenderness, or swelling where the shot was given. Up to about 1 out of 3 had a fever greater than 100.4°F, and up to about 1 in 50 had a higher fever (over 102.2°F). Some children also became fussy or drowsy, or had a loss of appetite. No serious reactions have been associated with this vaccine. Pneumococcal generally mild and include redness, stiffness, and soreness at the injection site Varicella (SC)

52. Vaccine Contraindications Permanent contraindication: 1.Severe allergy to a vaccine. 2.Encephalopathy. Temporary contraindication: 1.Pregnancy. 2.Immunosuppressant. 3.Severe illness. 4.Recent recipient of blood products

53. Individual Contraindications DPT: Acute febrile illness. Exposure to disease Severe allergic reaction. Residual seizure attacks. Measles: hypersensitivity to eggs. Rubella: pregnant women.

54. Individual Contraindications MMR: Recently acquired passive immunity. Blood transfusion of immune serum globulin within last 6 weeks because the presence of passive immunity prevent formation of antibodies to the vaccine. Pregnancy: potential risk to fetus from Rubella vaccine. OPV: Gastroenteritis because it may interfere with colonization of the virus in the intestines which is important for the immunity response to occur.

55. Adult Immunization Many people erroneously assume that vaccinations are for children only. Well-advertised influenza vaccination campaigns in recent years have helped somewhat to correct this notion.

56. Vaccines for Specific Occupations Health care –Hepatitis B –Influenza –Pneumococcal –MMR Animal Handlers –Rabies –Hepatitis B

57. Travelers –All routine vaccines plus: Yellow Fever, Typhoid, Japanese Encephalitis, Meningitis, Rabies, & Malaria prophylaxis –Cholera vaccine only in disaster situations with limited healthcare facilities

58. Heat sensitivity BCG (after reconstitution) OPV Measles (before and after reconstitution) DPT BCG (before reconstitution) DT TT HepB LEAST SENSITIVE MOST SENSITIVE

59. Sensitivity from Freezing HepB DPT DT TT LEAST SENSITIVE MOST SENSITIVE

60. COMMUNICABLE DISEASE PREVENTION COMMUNICABLE DISEASE PREVENTION

61. PRIMARY PREVENTION : In the context of communicable disease control, two approaches are useful in achieving primary prevention:(1) education using mass media and targeting health messages to aggregates and(2) immunization.

62. SECONDARY - Test and counsel for human immunodeficiency virus (HIV) –Monitor for outbreaks of endemic disease –Monitor for outbreaks of pandemic disease –Notify & screen people who have come in contact with communicable disease

63. TERTIARY –Educate parents about universal precautions –Identify community resources for providing supportive care (e.g. funds for medications, etc.) –Set up support groups for persons of HIV, etc.

64. References Community health nursing,Rector, Cherie. Warner, Kristine.D. 7 th edtion. Lippincott WHO (2010) Immunization Schedule. Kuwait. وزارة الصحة – المملكة العربية السعودية