Download vaccination

Dr.Hussein K.H. Alatabi
MBChB,DCH,FICMS,CABP
the Vaccination is inoculation of 
any antigenic material for the
purpose of producing active
artificial immunity.so uses of
suspensions or extracts of dead or
attenuated bacterial or viral
cells,usedchiefly in the
prophylactic treatment of certain
infections means vaccinations
A vaccine is any preparation intended to
produce immunity to a disease by stimulating
the production of antibodies.
The term vaccine derived from Edward
Jenner's 1796 use of the cow pox to induce
immunity in humans against smallpox.
(in Latin vacca means cow) 


Edward Jenner's an English Physician
"Nearly nine million children under 14 years of
age die every year from infectious disease. And
at least a third of them could be saved if
existing vaccines were more widely used, but
the rest only if suitable new vaccines were
developed..."
Active immunization
induces immunity by vaccination with a vaccine
or toxoid (inactivated toxin). by
stimulating immune system to produce antibodies and
cellular immune responces that protect against
infectious diseases.
Passive immunization
temporary protection through adminstration of
exogenously prodused antibodies e.g. Immunoglobulin
and monoclonal antibodeis ,It includes also
transplasental passage of
antibodies.

1-Live attenuated organisms (MMR, BCG,
OPV),
Inactivated or killed organisms (DPT) .2
Recombinant products (hepatitis B) .3
Reassortants (rotavirus) .4
Immunogenic components of organism .5
(pertussis, Hib) including toxoids
(diphtheria, tetanus
.1
1-Vaccine : apreperation of proteins,polysaccharides or nucleic acids of pathogens
deliverd to immune system to induce specific
responces that inactivate,destroy or suppress
pathogens.
2-Toxoid : amodified bacterial toxin made nontxic but retains its capacity to stimulate
formation of antitoxin.
3-Immune gloubin (Ig) :antibodies containing
solution derived from human blood by
fractionation of large pools of plasma used to
maintain immunity in immunization.
4-Antitoxin: antibodies derived from human or
animal sera after stimulation with specific
antigen,used to induse passive immunization
A-Live attenuated agents;produce immunologic response
simulating response to anatural infection.Its more likely
confer lifelong
protection.e.g, MMR
B-Inactivated,killed or detoxified agents or their BInactivated,killed or detoxified agents or their
extracts;tend to have lesser antigenic response and
requires repeated vaccine to provide protection,e.g. DPT
vaccine,influenza vaccine,..
C-Others as
Reassortants (rotavirus) .1
Immunogenic components of organism (pertussis, Hib)
including toxoids (diphtheria, tetanus
Recombinant products (hepatitis B) .3
.2
Vaccination
schedule in
Iraq
Date
At birth
Vaccine
BCG, OPV0, HBV1 (at 1st 24 h.)
At 2nd month
OPV1, ROV1, DPT1, Hib1, HBV2
At 4th month
OPV2, ROV2, DPT2, Hib2
At 6th month OPV3, ROV3, DPT3, Hib3, HBV3
At 9th month
Measles vaccine, vit. A 100,000 IU
At 15th
month
MMR 1
At 18th
month
1st booster of OPV, DPT, Hib with vit. A 100,000 IU
At 4-6
years
2st booster of OPV, DPT, MMR 2 with vit. A
100,000 IU
1-Chemical and physical characterestic of a
vaccine.
2-Catobolic state of vaccine.
3-Route of adminstration of vaccine(parent- eral
vaccine are more immunogenic).
4-Host factors:(a- Age of patients as
immunity
develops rapidly in adults after vaccination. bnutritional status.
C-HLA system of person.
4-Previous booster dose
1-Previous anaphylactic reaction to avaccine or
to costituent of vaccine(e.g.:egg,gelatin
,antiboitic.
2-Moderate-severe illness with or without
fever.
3-Immunocompromized persons with
exception of measles and BCG vaccines for
AIDS patients.
1- Mild acute illness with or without low grade
fever.
2-Low-moderate fever post vaccination
3-Mild-moderate local reaction to avaccine e.g.
redness, swelling ,soreness.
4-Current antibiotic therapy.
5-History of penicilline or other non specific
allergies or fact that relatives have such
allergies
6-Premature babies.
7-Malnutrition
8-Breast fed babies
9-Pregnancy(theoritical risk for attenuated
vaccines)
Dr.Hussein K. Alatabi
MBChB,DCH,FICMS,CABP
-Live attenuated Mycobacterium tuberculosis
vaccine.
-50-70% protection for 7-10 years old
children.
-Indused cell-mediated immunity (delayed
type) in 4-8 weeks (SCAR)
-The dose :0.05 ml I.D.(less than 1 yr.), 0.1 ml(
more than 1 yr.).Site ;usually upper
third of forearm e.g.deltoid
Scar of BCG vaccine
Appear at 4-8 weeks
-Generally safe
-fever,pain.axillary lymphadenopathy,ulcer,
lupus vulgaris,kelloid reaction.
*Indications ;
-Tuberculine negative infant in a household
with active disease.
-High TB incidence area.&not given after 1st
year age.
-Tow types of vaccines are available and are
equally protective; 1- IPV,an inactivated or
killed v.(Salk),which not used in in secadule in
Iraq but used in immuncompromised pat.(
USA).
2- OPV,alive attenuated
v.(Sabin)(in Iraq).
*OPV;80% protection,3 doses and boosters, 2-3
oral drops.
-OPV should not given to:-individuals known to
be or suspected of being
immunocompromised., household contacts of
immunocompromised personsand subsequent
siblings of achild with cogenital
immunodeficiency,until the younger children
have been shown to be normal.
OPV vaccine
2-3 oral drops
-DPT(Diphtheria,pertusis,Tetanus), killed
vaccine.-0.5 ml IM or S.C in 3 doses & 3
boosters.
*- 3 major contraindications are;-an acute
fibrile illness,-an evolving or suspected
neurologic disease and –severe reaction to
prior dose of DPT.
*-Adverse reactions after DPT: local swelling
and tenderness at injection site,slight
fever,irritability, protracted inconsolable
crying,unusual shock like
syndrom(uncommon)and convulsions or
manifestations of encephlopathy(rare,
-DT orDaPT wich called(acellular pertusis), its
less antigenic.
*-Percautions(benefits versus risks);
A-Temp.<40 c withen 48 hours.
B-Collapse withen 3 days of 1st dose
C-Collapse withen 48 hours.
D-Persistent inconsolable cry>3 hours withen
48 hours..-E- Development of GBS withen 6
weeks.
-The vaccine used with( the 4th vaccine) or (
with the 5th vaccine).
-As about 90% of infections caused by H.inf.
Due to type B so vaccine used is type B.
-It is polysaccharid vaccine.
-Route: IM
-Compined,live attenuated vaccine, given as
single dose 0.5 ml IM or S.C with 80%
protection.
*-Contraindication;
-pregnency,-immunodeficiency,-theraputic
immunosuppresion,-acute fibrile illness, anaphylaxis to egg ingestion.
*-Adverse reactions;
-transient rashes and fever 6-11 days after
immunization to measles componant.transient artharlgias,rare arthritis and
paresthetic pains to the rubella component.
-Live attenuated virus.,single dose at age of
9 months (Iraq).and 15 months(USA). –
booster dose may be given during
preadolescent school years.,given as 0.5 ml
SC
-Adverse reaction: -mild measles- like rash
10-14 days after adminstration and
cutaneous anergy,which may lasts up to 3
mo.
-Although vaccine is not recommended for
use in patients with T cell dysfunction,it is
recommended for use in patients with AIDS
becouse measles disease in these patients
may be life threatening.
-Live attenuated vaccine.,usully given with
MMR at 15 mo.and for girls at 11-13 yr.(Iq)
,antibody develops in 98% of those
vaccinated and is believed to be lifelong.
-0.5 ml S.C or IM.
-Adverse reactions;arthalgia,rare arathritis
and paresthesia
-Although vaccine has never been shown to
cause the congenital rubella syndrome, it is
not recommended to be given during
pregnancy.
-Inactivated purified protein Ag of virus
(recombinant type).
0.5 ml IM.
80% protection.
*In pretem baby the 1st dose of vaccine
delayed till 1month age.
-
-Rota virus responsible of about 45% of cases
of diarrhea in childreen.
. -The vaccine is given as oral drops at age of
2,4 and 6 months
-The age of child should not more than 3
months at 1st dose of vaccine
-No dose of vaccine should given after 8
months age.
NOTE
Unimmunized infants
between 2 and 14 mo.
Should be started on
the same sequence of
immunizations and
intervals as younger
infants.
*Children 14 mo. -7
yr.require mdified
schedule of vaccinations
-1-Pneumococcal vaccine.(>2 yr. with
functional or anatomic aseplenia).
-2-Meningococcal v.,-3-Cholera v.
-4-Typhoid fever v.., -5-Hepatitis A v..
-6-Influenza v..,-7-Rabies v.
-8-N.meningi. v.,-9-Yellow fever v..
-10-Varicella v...
-1-Immunoglobulin (Ig):
-Measles. –Chicken pox. –Tetanus. –Rabies Hepatitis A&B. –Influenza.
-2-Chemoprophylaxis:(By antibiotics):
-Pertusis(Erythromycin).-Meningitis
(rifampicin).-Diphtheria(Pencillin,Erythr.)
Rheumatic fever(Pencillin). –TB(INH).
SBE(Pencillin).-Neonatal conjunctivitis (Silver
nitrate).
…