presentation

1. Tetanus prevention

2. • Tetanus prevention measures after trauma consist of
inducing active immunity to tetanus toxin and of
passively providing antitoxic antibody.
• Tetanus prophylaxis is an essential part of all wound
management, but specific measures depend on the
nature of the injury and the immunization status of the
patient.
• Prevention of tetanus must be included in planning for
the consequences of bombings, natural disasters, and
other possible civilian mass-casualty events

5. • Tetanus toxoid should always be given after a dog or other animal
bite, even though C. tetani is infrequently found in canine mouth
flora
• Patients with an unknown or incomplete immunization history;
crush, puncture, or projectile wounds; wounds contaminated with
saliva, soil, or feces; avulsion injuries; compound fractures; or
frostbite, TIG 250 units should be administered intramuscularly,
regardless of the patient's age or weight.
• If TIG is unavailable, use of human IVIG may be considered. If
neither of these products is available, 3,000-5,000 units of equine-
derived TAT (in regions of the world where it is available) may be
given intramuscularly after testing for hypersensitivity.
• Serum sickness may occur with TAT

6. PREVENTION OF
S.PNEUMONIA

7. • The highly successful PCVs have resulted in a
marked decrease in IPIs in children.
• PCVs provoke protective antibody responses
in 90% of infants given these vaccines at 2, 4,
and 6 mo of age, and greatly enhanced
responses (e.g., immunologic memory) are
apparent after vaccine doses given at 12-15 mo
of age

8. • In a large clinical trial, PCV7 was shown to
reduce invasive disease caused by vaccine
serotypes by up to 97% and to reduce invasive
disease caused by all serotypes, including
serotypes not in the vaccine, by 89%
• Following PCV13, a 64% reduction in IPIs
caused by vaccine serotypes has been seen,
particularly in children less than 5 years old

9. • The number of cases of pneumococcal meningitis in children remain
unchanged, but the proportion of PCV13 serotypes have decreased
significantly
• Immunologic responsiveness and efficacy after administration of
pneumococcal polysaccharide vaccines (PPSV23) is unpredictable
in children < 2 years old
• PPSV23 contains purified pneumococcal polysaccharide of 23
serotypes responsible for 95% of invasive disease.
• The clinical efficacy of PPSV23 is controversial, and studies have
yielded conflicting results

10. • Immunization with PCV13 is recommended for all infants on a schedule for
primary immunization, in previously unvaccinated infants, and for transition for
those partially vaccinated with PCV7.
• High-risk children ≥2 yr old, may benefit also from PPSV23 administered after 2
yr. of age following priming with the scheduled doses of PCV13.
Asplenia
sickle cell diseases
some types of immune deficiency (e.g., antibody deficiencies),
HIV infection
Cochlear implant
CSF leak
Diabetes mellitus
Chronic lung, heart, or kidney disease (including nephrotic
syndrome)

11. • Thus, it is recommended that children 2 yr of age
and older with these underlying conditions
receive supplemental vaccination with PPSV23.
• A 2nd dose of PPSV23 is recommended 5 yr after
the 1st dose of PPSV23 for persons ≥2 yr old who
are immunocompromised, have sickle cell
disease, or functional or anatomic asplenia.