vaccine and prevention ..cold chain of vaccines

1. Dr Hussein Abdeldayem
Family Medicine Training
Dentist Training
PAEDIATRICS
PREVENTION AND
VACCINE
Dr Hussein Abdeldayem
Prof of Pediatrics
Alex University

2. Dr Hussein Abdeldayem
Prevention
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention
• Quaternary Prevention

3. Dr Hussein Abdeldayem
Prevention
• Primary Prevention
prevent the occurrence of
the disease
as: by immunization
by Genetic counseling
NO DISEASE
AR disorders
Infectious Disease as MMR, polio,etc

4. Dr Hussein Abdeldayem
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 C/P
PKU, Cong Hypothyroidism

5. Dr Hussein Abdeldayem
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)
DISEASE
NO ComplicationABM

6. Dr Hussein Abdeldayem

7. Dr Hussein Abdeldayem

8. Dr Hussein Abdeldayem
Immunity
Passive Acquired
From mother:
a- transplacental,
b- breast milk
Vaccine or toxoids
Antibodies
administration:
a- gamma globin,
b- antitoxin
Active infection (clinical
or subclinical) = Natural

9. Dr Hussein Abdeldayem
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

10. Dr Hussein Abdeldayem
Vaccination is better than passive
immunity
• vaccination cause better and
longer immunity than passive
immunity ( from mother or
injection of IG).

11. Dr Hussein Abdeldayem
Vaccine better than infection
• Safe
• Mass protection
• ?? cost
• Not solid immunity
• S/E
• ?? cost
Diisadventages
Advantages

12. Dr Hussein Abdeldayem
Vaccines are safe
• Vaccines are easier
and safer to administer
than ever before.
• Being immunized is
much safer than risking
infection and disease.

13. Dr Hussein Abdeldayem
Immunization can protect the
unprotected
• 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.

14. Dr Hussein Abdeldayem
Immunization can save money
• Immunization is
one of the most
cost-effective
health
interventions.
• Investing in
vaccines SAVES
more money
than it costs.

15. Dr Hussein Abdeldayem

16. Dr Hussein Abdeldayem
Age of Infant/Child Type of vaccine
At birth Zero
Dose
1st
(OPV) oral
polio
OPV: live attenuated (LA) 2-3
drops
0-1 mo:
(1st contact of child
with health
authority)
BCG: against
tuberculosis by
BCG: live attenuated (LA)
(intra dermal injection over
insertion of left deltoid, 0.1ml)
Immunization Schedule
Ist month: all LA

17. Dr Hussein Abdeldayem
Immunization Schedule
Age of
Infant/
Child
Type of vaccine
2nd
Month
of
age
2nd
dose: Polio (OPV), DPT &
Hepatitis B 1
4th
Month
of
age
3rd
dose: Polio (OPV), DPT &
Hepatitis B 2
6th
Month
of
age
4th
dose: Polio (OPV), DPT &
Hepatitis B 3
OPV: 3 oral drops
DPT: IM 0.5 ml
HBV: IM 0.5 ml
DT: killed
P: toxoid
HBV
Recomb Ag
OPV: Ki oral2-3
DT: toxoid IM
P: ki IM
HBV: recomb
Ag
IM

18. Dr Hussein Abdeldayem
Age of Infant/Child Type of vaccine
9th mo of
age
Measles SC LA
Vitamin A Capsule (100.000
units)
polio(5th
dose) ORAL LA
Immunization Schedule
Measles: SC
MMR :SC
Measles/MMR
LA
12
MONTHS
MMR sc LA
2 Vitamin A Capsule (200.000 units)
polio(6th
dose) ORAL LA

19. Dr Hussein Abdeldayem
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
age
(preschool)
MMR 2nd
dose(0.5 ml SC)
6 – 12 yrs of
age
(start
schooling)
Booster dose of OPV,
DT,BCG ± MMR (if not
given at 4-6 yrs)

20. Dr Hussein Abdeldayem

21. Dr Hussein Abdeldayem
Immunization
HIB:
Hemophilus
Influenzae
type B
Obligatory
since 2016
in Egypt
3 doses ( 2,
4 ,6 mo) and
booster at 18
– 24 mo
IM
Conjugated
polysaccharide
vaccine

22. Dr Hussein Abdeldayem
Immunization: non obligatory
Varicella + 12 mo – 13 yr:
one dose
Booster: 4- 6 yrs
≥ 13yr: 2 doses
with 6 wk apart
LA
Meningo
coccal
ACWY
Over 2 ys
Every 3 ys
SC
Inactivated

23. Dr Hussein Abdeldayem
Immunization: non obligatory
Flu
vaccine
(>6 mo
age)
Every year
(septemper/
october)
Recombinant Antigen
???? ????? ?????

24. Dr Hussein Abdeldayem

25. Dr Hussein Abdeldayem
• Polio vaccine:
1- LA: Oral Sabin
2- killed: IM salk

26. Dr Hussein Abdeldayem
• BCG : intradermal
• Measles: SC
• MMR: SC

27. Dr Hussein Abdeldayem
Side Effects (Adverse reactions)
• 1- general : fever, allergy, anaphylaxis
• 2- local: pain, redness, swelling, sterile
abscess
• 3- specific:

28. Dr Hussein Abdeldayem
Side Effects (Adverse reactions)
3- specific:
i- BCG: TB ulcer, TB lymphadenitis with cold
abscess and sinus/ suppurative
lymphadenitis/ miliary TB
ii- OPV: paralysis

29. Dr Hussein Abdeldayem
Side Effects (Adverse reactions)
iii- Pertussis ( DTP):
a. Encephalopathy: within 7 days
b. Convulsions: within 2-3 days,
c. Persistent high – pitched cry: for 3 hrs within
2 days
d. Persistent fever: for 2 days ( >40.5ₒ
C)
e. shock or drowsiness, or somnolence: within
2 days

30. Dr Hussein Abdeldayem
Side Effects (Adverse reactions)
iv- measles: rash, arthralgia
V- GM: rash, arthralgia, lymphadenopathy,
allergy
Vi-mumps: mild parotitis

31. Dr Hussein Abdeldayem

32. Dr Hussein Abdeldayem
Don’t immunize if there is:
1-Anaphylactic reaction to a
vaccine
2-Untreated moderate to severe
illness + fever
3-Seizure or fever > 40 .5 C within
48 hr of pertussis vaccine
3-True Egg Allergy (MMR)
4-Neomycine allergy (MMR)
6-Immunocompromized patient
(LIVE ATTENUATED)
contraindication

33. Dr Hussein Abdeldayem
contraindication
• Pertussis vaccine (DTP)
1- history of fits
2- abnormal neurological
child as CP
2- S/E of vaccine
Give: DT
or
D T (a)P

34. Dr Hussein Abdeldayem
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)

35. Dr Hussein Abdeldayem
Cold Chain
transportation - storage
• OPV not yet used: at
freezer (-20C)
• On top shelf (under freezer)
: opened OPV, measles
• On 2nd
shelf: BCG, DTP, DT,
TT
• ( 0-8C):
all vaccine and diluents

36. Dr Hussein Abdeldayem
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