Prevention and vaccine pediatrics


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Prevention and vaccination for Egyptian children . For Medical student , postgraduate, FM doctors and Pedo doctors

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  • Family Medicine Training IDC, Zagazig University & Nicare
  • Family Medicine Training IDC, Zagazig University & Nicare hyperphenylalanemia - mild type (non PKU-HPA) biopterin deficiency dihydropteridine reductase (DHPR) deficiency Guanosine triphosphate cyclohydrolase (GTPCH) deficiency 6-pyruvoyl tetrahydrobiopterin synthase (PTPS) deficiency Pterin-4 acarbinolamine dehydratase (PCD) deficiency
  • Prevention and vaccine pediatrics

    1. 1. Family Medicine TrainingDentist Training PAEDIATRICS PREVENTION AND VACCINE Dr Hussein Abdeldayem Prof of Pediatrics Alex University Dr Hussein Abdeldayem
    2. 2. PREVENTIONDr Hussein Abdeldayem
    3. 3. Prevention• Primary Prevention• Secondary Prevention• Tertiary Prevention• Quaternary Prevention Dr Hussein Abdeldayem
    4. 4. Prevention • Primary Prevention prevent the occurrence of the disease as: by immunization by Genetic counseling NO DISEASEAR disordersInfectious Disease as MMR, polio,etc Dr Hussein Abdeldayem
    5. 5. Prevention• Secondary Prevention early detection of the disease for stopping or reversing its progress as: by prenatal diagnosis by newborn screening DISEASE NO or MILD CPPKU, Cong Hypothyroidism Dr Hussein Abdeldayem
    6. 6. Prevention • Tertiary Prevention stop the development of complication of the previously diagnosed disease as: by EIP, by treating ABM with corticosteroid AND follow up for complications (ABR)EIP, DISEASEABM NO Complication Dr Hussein Abdeldayem
    7. 7. Prevention • Quaternary Prevention set of health activities that diminish or avoid the consequences of unnecessary or excessive interventions in the health systemSwine Flu cost Dr Hussein Abdeldayem
    8. 8. AR InheritanceDr Hussein Abdeldayem
    9. 9. Prevention and Neurologicdisorders• Down syndrome• PKU• Congenital hypothyroidism• galactosemia Dr Hussein Abdeldayem
    10. 10. Down syndrome1ry (no DS baby)• Translocated mother (4%)Risk 10%Risk 100% (21/21)Prevention: genetic counseling (prevent conception)• Non-Disjunction (95%)Risk: 1/1000 increase by: age or has a DS babyPrevention: avoid late age or frequent conceptionRecent: Pre-implantation selection Dr Hussein Abdeldayem ?? Folic acid supplementation
    11. 11. Down Syndrome 2ry Prevention ( DS baby)• 9-12 wks GA:21- neck US2- Blood: hCGTH, PaPPa, fetal RBC3- Villous biopsy• 12 -16 wks GA:1- triad: AFP. UOstriol, hCGTH2- tetrad: triad + inhibin• > 16 wks GA:Amniocentesis Dr Hussein Abdeldayem
    12. 12. DS3ry Prevention• EIP• Echocardiography• Visual acuity/y• Thyroid function/y (TSH,T4)• Tympanometry/y• Neck X ray at 3-5 yrs**Neutral view, flexion & extension Dr Hussein Abdeldayem
    13. 13. GalactosemiaFailure to thrivevomitingGalactusuria (sugar in urineAAuria, proteinuria Dr Hussein Abdeldayem
    14. 14. Galactosemia• Milk lactose  G + Gal Gal G Sugar excretion in infancy• AR 3 genes Leloir 1970 Nobel prize• galactosemia 1: (classic) GALT Def (galactose 1p uridyl transferase)• Galactosemia 2: GALK (Galactase=galactokinase)• Galactosemia 3: GALE (uridyl diphosphogalactose- 4 – epimerase) Dr Hussein Abdeldayem
    15. 15. Prevention• 1ry: Genetic counseling AR• 2ry: early Screening- blood and urine: increased gal and Gal 1 P- decreazed enzymes (UT, Galactokinase, epimerase) Lactose free milk• 3ry: rehab, treat cataract Dr Hussein Abdeldayem
    16. 16. PKU – AR – Gene on chromosome 12 – Enzyme deficiency: phenylalanine hydroxylase – Types: 1- classic 2- cofactor BH4 (tetrahydrobiopterin ) 3- mixed* : mild ( no disease) Dr Hussein Abdeldayem
    17. 17. PKU• Classic: P Hydroxylase deficiency - blood: severe hyperphenylalaninemia >20 mg/dl• Cofactor BH4 deficiency - normal phenylalanine in blood or mild raised - BH4 Cofactor for phenylalanine, tyrosine and tryptophan - diagnosis:A- measure neopterin and biopterin in urineB- loading test: oral BH4 (20 MG/KG) then measure phenylalanineC- enzyme assay• mixed Dr Hussein Abdeldayem
    18. 18. PKUPREVENTION• 1ry: genetic counseling AR• 2ry: a- neonatal screening then low phenylalanine milk• 3ry: rehabilitation , diet resriction Dr Hussein Abdeldayem
    19. 19. Dr Hussein Abdeldayem
    20. 20. C/PSome CNS effects of untreated PKU include: 1- fair hair and skin• mental retardation 2- a “musty” or “mousy” body odor• behavior problems, autism 3- Eczema• hyperactivity• restlessness or irritability• seizures Dr Hussein Abdeldayem
    21. 21. maternal PKU syndrome• Pregnancy in women with PKU (“Maternal PKU”) Women with PKU who are not on the low-Phe diet when they become pregnant have a high chance of having babies with• birth defects as congenital HD• mental retardation• microcephaly (recurrent)• SGA Dr Hussein Abdeldayem
    22. 22. Maternal PKU syndrome /PreventionDuring pregnancy, they need to:• stay on the low-Phe diet• visit their PKU clinic on a regular basis• have their blood Phe levels checked often Dr Hussein Abdeldayem
    23. 23. Prevention• MR PREVENTION:1- 1ry : vaccine of all females against (at least 3 mo preconception) of GM2- 2ry: screening of congenital hypothyroidism, PKU and Galactosemia3- 3ry: rehabilitation and early intervention program as in DS Dr Hussein Abdeldayem
    24. 24. Prevention• Infectious disease prevention:1- 1ry : (as ABM , H1N1flu disease) a- Vaccine b- Anti-organism prophylaxis c- isolation of infected persons d- Eradication of factors transmit the infection2- 2ry: early treatment of infective organism (AB)3- 3ry: early detection of sequelae as ABR ( for ABM) Dr Hussein Abdeldayem
    25. 25. Dr Hussein Abdeldayem
    26. 26. Dr Hussein Abdeldayem
    27. 27. Immunity Passive AcquiredFrom mother: Vaccine or toxoidsa- transplacental,b- breast milkAntibodies Active infection (clinicaladministration: or subclinical) = Naturala- gamma globin,b- antitoxin Dr Hussein Abdeldayem
    28. 28. Natural infection is better than immunization• Actual Infection usually does cause better and longer immunity than vaccination.• Measles, GM, mumps, & chicken pox produce long life immunity• However, the price paid for natural disease can cause morbidity ( complications) up to death Dr Hussein Abdeldayem
    29. 29. Vaccination is better than passive immunity• vaccination cause better and longer immunity than passive immunity ( from mother or injection of IG). Dr Hussein Abdeldayem
    30. 30. Vaccine better than infection DiisadventagesAdvantages• Safe • Not solid immunity• Mass protection • S/E• ?? cost • ?? cost Dr Hussein Abdeldayem
    31. 31. Vaccines are safe • Vaccines are easier and safer to administer than ever before. • Being immunized is much safer than risking infection and disease. Dr Hussein Abdeldayem
    32. 32. Immunization can protect theunprotected • When immunization coverage is high, it can prevent viruses and bacteria from circulating. • The more children in a community that are fully immunized, the more everyone is safe. Dr Hussein Abdeldayem
    33. 33. Immunization can save money• Immunization is one of the most cost-effective health interventions.• Investing in vaccines SAVES more money than it costs. Dr Hussein Abdeldayem
    34. 34. Dr Hussein Abdeldayem
    35. 35. Immunization ScheduleAge of Infant/Child Type of vaccineAt birth Zero 1st (OPV) oral OPV: live attenuated (LA) 2-3Dose polio drops0-1 mo: BCG: against BCG: live attenuated (LA)(1st contact of child tuberculosis by (intra dermal injection overwith healthauthority) insertion of left deltoid, 0.1ml) Ist month: all LA Dr Hussein Abdeldayem
    36. 36. OPV: 3 oral drops Immunization Schedule DPT: IM 0.5 ml HBV: IM 0.5 mlAge of Type of vaccine DT: killedInfant/ P: toxoidChild2nd 2nd dose: Polio (OPV), DPT & OPV: Ki oral2-3Month Hepatitis B 1of DT: toxoid IMage P: ki IM4th 3rd dose: Polio (OPV), DPT & HBV: recombMonth Hepatitis B 2of Agage IM6th 4th dose: Polio (OPV), DPT &Month Hepatitis B 3 HBVof Recomb Agage Dr Hussein Abdeldayem
    37. 37. Immunization ScheduleAge of Infant/Child Type of vaccine9th mo of Measles SC LAage Vitamin A Capsule (100.000 Measles: SC units) MMR :SC polio(5th dose) ORAL LA Measles/MMR LA12 MMR sc LAMONTHS 2 Vitamin A Capsule (200.000 units) polio(6th dose) ORAL LA Dr Hussein Abdeldayem
    38. 38. Dr Hussein Abdeldayem
    39. 39. Immunization ( Booster)18 – 24 mo Booster of DTP (0.5 ml IM) 7th OPV (3 drops) 2 capsules Vit A (200,000 units)4 – 6 yrs of MMR 2nd dose(0.5 ml SC)age(preschool)6 – 12 yrs of Booster dose of OPV,age DT,BCG ± MMR (if not(start given at 4-6 yrs)schooling) Dr Hussein Abdeldayem
    40. 40. Immunization: non obligatoryHIB: 3 doses ( 2, IMHemophilus 4 ,6 mo) and ConjugatedInfluenzae booster at 18 polysaccharidetype B – 24 mo vaccineHAV: 1st : +12 mo IMHepatitis A 2nd: after 6 – Inactivated 12 mo Dr Hussein Abdeldayem
    41. 41. Immunization: non obligatoryVaricella + 12 mo – 13 yr: LA one dose Booster: 4- 6 yrs ≥ 13yr: 2 doses with 6 wk apartMeningo Over 2 ys SCcoccal Every 3 ys InactivatedACWY Dr Hussein Abdeldayem
    42. 42. Immunization: non obligatoryFlu Every year Recombinant Antigenvaccine (septemper/(>6 mo october)age)???? ????? ????? Dr Hussein Abdeldayem
    43. 43. Dr Hussein Abdeldayem
    44. 44. • Polio vaccine: 1- LA: Oral Sabin 2- killed: IM salk Dr Hussein Abdeldayem
    45. 45. • BCG : intradermal• Measles: SC• MMR: SC Dr Hussein Abdeldayem
    46. 46. Side Effects (Adverse reactions)• 1- general : fever, allergy, anaphylaxis• 2- local: pain, redness, swelling, sterile abscess• 3- specific: Dr Hussein Abdeldayem
    47. 47. Side Effects (Adverse reactions)3- specific:i- BCG: TB ulcer, TB lymphadenitis with cold abscess and sinus/ suppurative lymphadenitis/ miliary TBii- OPV: paralysis Dr Hussein Abdeldayem
    48. 48. Side Effects (Adverse reactions)iii- Pertussis ( DTP):a. Encephalopathy: within 7 daysb. Convulsions: within 2-3 days,c. Persistent high – pitched cry: for 3 hrs within 2 daysd. Persistent fever: for 2 days ( >40.5ₒC)e. shock or drowsiness, or somnolence: within 2 days Dr Hussein Abdeldayem
    49. 49. Side Effects (Adverse reactions)iv- measles: rash, arthralgiaV- GM: rash, arthralgia, lymphadenopathy, allergyVi-mumps: mild parotitis Dr Hussein Abdeldayem
    50. 50. Dr Hussein Abdeldayem
    51. 51. contraindicationDon’t immunize if there is:1-Anaphylactic reaction to a vaccine2-Seizure or fever > 40 .5 C within 48 hr of pertussis vaccine3-True Egg Allergy (MMR)4-Neomycine allergy (MMR)5-Immunocompromized patient (OPV)6-Untreated moderate to severe illness + fever Dr Hussein Abdeldayem
    52. 52. contraindication• Pertussis vaccine (DTP)1- history of fits2- abnormal neurological child as CP2- S/E of vaccineGive: DT ‫الثنائى‬ or D T (a)P Dr Hussein Abdeldayem
    53. 53. Vaccine of immunodeficiency child• immunodeficiency child as AIDS, NS (steroid tt)• Not GIVE: BCG/ OPV/ MEASLES/MMR• not give Oral OPV to his HOUSEHOLD contacts (siblings) Dr Hussein Abdeldayem
    54. 54. Cold Chain transportation - storage• OPV not yet used: at freezer (-20C)• ( 0-8C): all vaccine and diluents• On top shelf (under freezer) : opened OPV, measles• On 2nd shelf: BCG, DTP, DT, TT Dr Hussein Abdeldayem
    55. 55. Cold Chain transportation - storage• In vaccine clinic: keep the vaccine in a cup containing ice• Sensitive to strong light: BCG, measles, MMR• Away from HEAT, and direct SUNLIGHT• DISCARD any vaccine remained in opened vials Dr Hussein Abdeldayem