04 -immunization


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04 -immunization

  1. 1. Immunization Dr.Khalid Hama ,salih Pediatrics specialist M.B.Ch.; D. C.H F.I.B.M.S.ped
  2. 2. Historical point: in 1796Edward Jenner’s use of material from cowpox pustules to provide protection against smallpox. Louis Pasteur’s 1885 rabies vaccine was the next to make an impact on human disease 1923 dyphtheria 1926 pertusis 1955 IPV 1960 OPV 1964 Measles
  3. 3. Immunity Specific defenses Immunity Active immunity Following clinical infection Passive immunity natural Following subclinical infection Transfer of maternal Antibodies Through placenta Transfer of maternal Antibodies Through milk acquired Following vaccination Following administration of Immunoglobulin or antiserum
  4. 4. Active immunity  Resistance developed in response to stimulus by an antigen (infecting agent or vaccine) and is characterized by the production of antibodies by the host.
  5. 5. Passive immunity  Immunity conferred by an antibody produced in another host. It may be acquired naturally or artificially (through an antibody-containing preparation).
  6. 6. immunization: is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen).through either active or passive immunization vaccination :is a process of live attenuated,inactivated,fractionate of organism
  7. 7. Immunizing agents Immunizing agents vaccines immunuglobulins antisera
  8. 8. Immunoglobulins   There are 5 major classes: IgM, IgA, IgG, IgE, IgD. Two types of immunoglobulin preparations are available for passive immunization:   Normal human immunoglobulin Specific (hyper-immune) human immunoglobulin
  9. 9. Antisera or antitoxins  These are materials prepared in animals or non human sources such as horses.
  10. 10. Immunoglobulin and antiserum Human normal Human specific Non human ig immunoglobulin immunoglobulin (antisera) Hepatitis A Measles Rabies Tetanus Mumps Hepatitis B Varicella Diphtheria Diphtheria Tetanus Gas gangrene Botulism Rabies
  11. 11. Vaccination  Vaccination is a method of giving antigen to stimulate the immune response through active immunization.  A vaccine is an immuno-biological substance designed to produce specific protection against a given disease. A vaccine is “antigenic” but not “pathogenic”. 
  12. 12. Types of vaccines       Live vaccines Attenuated live vaccines Inactivated (killed vaccines) Toxoids Polysaccharide and polypeptide (cellular fraction) vaccines Surface antigen (recombinant) vaccines.
  13. 13. Live vaccines   Live vaccines are made from live infectious agents without any amendment. The only live vaccine is “Variola” small pox vaccine, made of live vaccinia cow-pox virus (not variola virus) which is not pathogenic but antigenic, giving cross immunity for variola.
  14. 14. Live attenuated (avirulent) vaccines   Virulent pathogenic organisms are treated to become attenuated and avirulent but antigenic. They have lost their capacity to induce full-blown disease but retain their immunogenicity. Live attenuated vaccines should not be administered to persons with suppressed immune response due to:      Leukemia and lymphoma Other malignancies Receiving corticosteroids and anti-metabolic agents Radiation pregnancy
  15. 15. Inactivated (killed) vaccines  Organisms are killed or inactivated by heat or chemicals but remain antigenic. They are usually safe but less effective than live attenuated vaccines. The only absolute contraindication to their administration is a severe local or general reaction to a previous dose.
  16. 16. Toxoids  They are prepared by detoxifying the exotoxins of some bacteria rendering them antigenic but not pathogenic. Adjuvant (e.g. alum precipitation) is used to increase the potency of vaccine.  The antibodies produces in the body as a consequence of toxoid administration neutralize the toxic moiety produced during infection rather than act upon the organism itself. In general toxoids are highly efficacious and safe immunizing agents.
  17. 17. Polysaccharide and polypeptide (cellular fraction) vaccines  They are prepared from extracted cellular fractions e.g. meningococcal vaccine from the polysaccharide antigen of the cell wall, the pneumococcal vaccine from the polysaccharide contained in the capsule of the organism, and hepatitis B polypeptide vaccine.  Their efficacy and safety appear to be high.
  18. 18. .Surface antigen (recombinant) vaccines  It is prepared by cloning HBsAg gene in yeast cells where it is expressed. HBsAg produced is then used for vaccine preparations.  Their efficacy and safety also appear to be high.
  19. 19. Types of vaccines Live vaccines Live Killed Attenuated Inactivated vaccines vaccines Toxoids Cellular fraction vaccines Recombinant vaccines Small pox variola vaccine • BCG •Typhoid oral •Plague •Oral polio •Yellow fever •Measles •Mumps •Rubella •Intranasal Influenza •Typhus • Diphtheria •Tetanus • Meningococcal polysaccharide vaccine •Pneumococcal polysaccharide vaccine •Hepatitis B polypeptide vaccine • • Typhoid •Cholera •Pertussis •Plague •Rabies •Salk polio •Intramuscular influenza •Japanise encephalitis • Hepatitis B vaccine
  20. 20. Routes of administration      Deep subcutaneous or intramuscular route (most vaccines) Oral route (sabine vaccine, oral BCG vaccine) Intradermal route (BCG vaccine) Scarification (small pox vaccine) Intranasal route (live attenuated influenza vaccine)
  21. 21. Administering Vaccines: Dose, Route1, Site, and Needle Size Injection site & neeedle Subcutaneous (SC) injection Use a 23–25 gauge needle. Choose the .injection site that is appropriate to the person’s age and body mass Administering Vaccines: Dose, Route, Site, Age Needle Needle Size Injection Site and Length ( Infants (1–12 mos , Children 12 mos or older 5/8 (16mm) Fatty tissue over anterolat- eral thigh muscle 5/8 Fatty tissue over anterolatadolescents, and adults eral thigh muscle or fatty tissue over triceps
  22. 22. Intramuscular (IM) injection Use a 22–25 gauge needle. Choose the injection .site and needle length appropriate to the person’s age and body mass Age Needle Length (Newborns (1st 28 days (Infants (1–12 mos Injection Site 5/8 Anterolateral thigh muscle 1 Anterolateral thigh muscle Anterolateral thigh muscle or (Toddlers (1–2 yrs ( Children & teens(3–18 years 1-1.1/4 1__5/8 1—5/8 deltoid muscle of arm 1---1.1/4 arm or anterolateral thigh muscle
  23. 23. Scheme of immunization  Primary vaccination    One dose vaccines (BCG, variola, measles, mumps, rubella, yellow fever) Multiple dose vaccines (polio, DPT, hepatitis B, hib) Booster vaccination To maintain immunity level after it declines after some time has elapsed (DT, MMR,opv).
  24. 24. Periods of maintained immunity due to vaccines      Short period (months): cholera vacc Three to five years: DPT vaccine Five or more years: BCG vaccine Ten years: yellow fever vaccine Solid immunity: measles, mumps, and rubella vaccines.
  25. 25. Levels of effectiveness     Absolutely protective(100%): yellow fever vaccine Almost absolutely protective (99%): Variola, measles, mumps, rubella vaccines, and diphtheria and tetanus toxoids. Highly protective (80-95%): polio, BCG, Hepatitis B, and pertussis vaccines. Moderately protective (40-60%) cholera vaccine, and influenza killed vaccine.
  26. 26. :Storage Among the vaccines, polio is the most sensitive to heat, requiring storage at minus 20 degree C.  Vaccines which must be stored in the freezer compartment are : polio and measles.  Vaccines which must be stored in the COLD  PART but never allowed to freeze are : typhoid, DPT, tetanus toxoid, DT, BCG ......vaccinationvaccine storage.pdf Refrigerato  r Freezer
  27. 27. The Cold Chain   The "cold chain" is a system of storage and transport of vaccines at low temperature from the manufacturer to the actual vaccination site. The cold chain system is necessary because vaccine failure may occur due to failure to store and transport under strict temperature controls.
  28. 28. RECOMMENDED AGE BIRTH MONTHS 2 (VACCINE(S MONTHS 9 BCG, Hepatitis B (HBV)opv0 [DTP, HIB, HBV]PENTA Opv1,ROTA1 [DTP, HIB]TETRA Oral Polio Vaccine (OPV2)ROTA2 [DTP, HIB, HBV]PENTA (OPV3),ROTA3 Measles vaccine (mono)+VIT.A 100000 MONTHS 15 MMR MONTHS 8 1 1ST BOSTER DOSE (OPV) 1ST BOSTER DOSE DTP, HIB VIT. A 200000 YEARS 6 – 4 2nd booster dose (OPV) 2nd booster dose DTP MMR 2 MONTHS 4 MONTHS 6
  29. 29. HAZARDS OF IMMUNIZATION  1. 2. 3. 4. 5. 6. No immune response is entirely free from the risk of adverse reactions or remote squeal. The adverse reactions that may occur may be grouped under the following heads: Reactions inherent to inoculation Reactions due to faulty techniques Reactions due to hypersensitivity Neurological involvement Provocative reactions Others
  30. 30.    1. Reactions inherent to inoculation: A.local reactions may be pain, swelling, redness, tenderness and development of a small nodule or sterile abscess at the site of injection. B.general reactions may be fever, malaise, headache and other constitutional symptoms..
  31. 31.  2. Reactions due to faulty techniques: Faulty techniques may relate to  faulty production of vaccine (e.g. inadequate inactivation of the microbe, inadequate detoxication),  too much vaccine given in one dose,  improper immunization site or route, ,  vaccine stored incorrectly,  contraindications ignored (e.g. a child who experienced a severe reaction after a previous dose of DPT vaccine is immunized with he same vaccine), .
  32. 32.    4. Neurological involvement: Neuritic manifestations may be seen after the administration of serum or vaccine. The well-known examples are the post-vaccinial encephalitis and encephalopathy following administration of anti -rabies and smallpox vaccines. Guillain-Barre syndrome in association with the swine influenza vaccine is another example.
  33. 33.    5. Provocative reactions: Occasionally following immunization there may occur a disease totally unconnected with the immunizing agent (e.g., provocative polio after DPT or DT administration against diphtheria). The mechanism seems to be that the individual is harboring the infectious agent and the administration of the vaccine shortens the incubation period and produces the disease or what may have been otherwise only a latent infection is converted into a clinical attack.
  34. 34.   6. Others: These may comprise damage to the fetus (e.g., with rubella vaccination); displacement in the age-distribution of a disease (e.g., a potential problem in mass vaccination against measles, rubella and mumps).
  35. 35. Vaccination for special occupations       Health care workers: hepatitis B, influenza, MMR, polio Public safety personnel (police, fire fighters) and staff of institutions for the developmentally disabled: hepatitis B, influenza Vets and animal handlers: rabies, plague and anthrax Sewage workers: DT, hepatitis A, polio, TAB Food handlers: TAB Military troops and camp dwellers: pneumococcal, meningococcal, influenza, BCG (for non reactors), tetanus
  36. 36. Vaccinations for special health status persons Immuno-compromised persons ( Leukemia, lymphoma, HIV, malignancy…)  Hemodialysis and transplantation Should receive the following vaccines according to their situation: HBV, Influenza, Pneuomococcal vaccines 
  37. 37. 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
  38. 38. 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
  39. 39. 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
  40. 40. THANK YOU