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Immunization
- 1. IMMUNIZATION & NEWBORN NUTRITION MS. SUMAN BISHT M.SC (N) 1ST YR RCN BAREILLY
- 2. INTRODUCTION ο Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Immunization against vaccine preventable diseases is essential to reduce the child mortality, morbidity and handicapped condition.
- 3. IMMUNIZING AGENTS ο Vaccines ο Immunoglobulin ο Antisera or antitoxins
- 4. VACCINES ο Vaccines are immune- biological substance which produce specific protection against a given disease. ο It stimulate active production of protective antibody and other immune mechanisms. ο Vaccines are prepared from live attenuated organism and killed attenuated organism.
- 5. Live attenuated vaccines- ο BACTERIAL- BCG, typhoid (oral), plague ο VIRAL- oral polio , measles, mumps, rubella, yellow fever, influenza
- 6. Killed vaccines- ο BACTERIAL- Pertussis, typhoid, cholera ο VIRAL- Rabies, Hepatitis B, Influenza, Japanese encephalitis ο COMBINATION- DTP, MMR, DT, Hib- Hep B
- 7. IMMUNOGLOBULIN ο The human immunoglobulin (Ig) system is composed of 5 major classes (IgG, IgM, IgA, IgD & IgE) and subclasses within them.
- 9. ANTISERA OR ANTITOXINS ο The term antisera is applied to the material prepared in animal. Organically passive immunity was achieved by the administration of antisera or antitoxins prepared from non-human sources like horse. ο Bacteria- Diphtheria, tetanus, Gas gangrene ο Viral β Rabies
- 10. BCG VACCINE (BACILLUS CALMETTE GUERIN) ο It is made up of live , weakened strain of mycobacterium bovis ο ROA β intradermal ο Dose β 0.05 ml in term 0.01 ml in preterm Site β the recommended site of injection is the deltoid region in arm
- 11. ο Efficacy β 0-80% for lung TB - 75-86% for meningitis and miliary TB Duration of immunity β 10-15 yrs
- 12. COMPLICATION ο Deep abscess and ulceration ο Axillary and supraclavicular lymphadenopathy ο Kochβs pheumonia ο Erythema nodosum
- 13. CONTRAINDICATION ο Neonate with immuno-deficiency ο Neonate receiving corticosteroids ο Neonate born to a mother with HIV ο Neonate with a generalized septic skin condition
- 14. POLIO VACCINE They are divided into ο Live attenuated oral polio vaccine (OPV- Sabin) ο Injectable polio vaccine (IPV- Salk) ο Efficacy β 95-99% ο Duration of immunity- lifelong
- 15. DPT( DIPTHERIA, PERTUSSIS, TETANUS) ο The vaccine contain toxoid of diptheria and tetanus with suspension of killed whole bacillus pertussis ο 3 doses of 0.5ml given I/M at 4-8 weeks interval starting at 6 wks ο Booster given 1 yr after 3rd dose and another between 4-6 yrs of age
- 16. DIPTHERIA ο It is prepared by formaldehyde inactivation of diptheria toxin absorbed into aluminum salt to increase antigenicity ο Protect against diptheria toxin ο Dose - 0.5 ml ο Site β I/M ο Duration β 5 years Complication - Nil
- 17. SPECIAL CONSIDERATION ο Diptheria toxoid is used only when tetanus and pertussis vaccine are contra-indicated ο D-T is used when Pertussis vaccine is contraindicated ο T-D is used in person 7 yrs of age or older
- 18. PERTUSSIS ο It is used against Bordtella Pertussis ο Dose β 0.5ml ο Site β IM ο Efficacy β 80%
- 19. COMPLICATION - ο Acute encephalopathy CONTRAINDICATION ο Family history of convulsion ο Family history of sudden infant death syndrome
- 20. TETANUS TOXOID (TT) ο It is prepared by inactivating the toxin by formaldehyde ο Dose β 0.5 ml ο ROA β IM ο Efficacy β 95% ο Duration β 5yrs
- 21. COMPLICATION ο Gullain barre syndrome ο Anaphylaxis ο Brachial neuritis
- 22. HEPATITIS B ο This vaccine consist of a purified inactivated sub- unit of hepatitis virus ο It is non infectious ο Dose β 0.5ml <19yrs 1ml>19yrs ROA - IM
- 23. ο Site β deltoid muscle (children & adult) Anterolateral thigh (neonate & infant) Efficacy β 95%
- 24. COMPLICATION ο Fever ο Swelling ο Headache ο Weakness
- 25. HEMOPHILUS INFLUENZA TYPE B (HIB) ο It is conjugate vaccine developed against Hemophilus influenza type B bacteria ο Given in combination with DPT at 6,10,14 weeks ο Booster given at 18months
- 26. ο Dose β 0.5ml ο ROA β IM ο Efficacy- 95-100% ο Side effect β temporal local inflammatory reaction ο Contraindication β anaphylaxis
- 27. MEASLES ο It is live attenuated vaccine ο Monovalent and in combination (MMR,MMRV) ο Dose β 0.5 ml ο ROA β SC ο Efficacy - >85% at 9 month of age ο >90% at 12 month of age
- 28. Side effect ο Morbiliform rashes ο Encephalitis Contraindication ο Immunodeficiency ο Pregnancy ο Neomycin resistance
- 29. MMR (MEASLES, MUMPS & RUBELLA) ο It is live attenuated, combination vaccine ο Dose β 0.5ml ο ROA β SC ο Two doses are recommended at 1 yr and 4-6 yr of age respectively ο Minimum dose interval β 28 days
- 30. ο Efficacy β 75-90% ο Duration 95% after first dose, lifelong after 2nd dose Complication ο Fever ο Malaise ο Rashes
- 31. Contraindication ο Severe allergic reaction ο Immunodeficiency ο Long term immunosuppressive therapy ο Pregnancy
- 32. ο DIAGRAM
- 33. NATIONAL IMMUNIZATION SCHEDULE ο Immunization schedule should be planned according to the needs of the community. ο It must be effective, feasible and acceptable by the community. Every country has its own immunization schedule.
- 34. ο The WHO launched global immunization program in 1974, known as Expended Program on Immunization(EPI) to protect all the children of the world against six killer disease. ο In INDIA EPI was launched in January 1978 ο The EPI is now renamed as Universal Child Immunization, as per declaration sponsored by UNICEF
- 35. ο In INDIA, it is called Universal Immunization Program (UIP) and was launched in November 1985.
- 39. NUTRITIONAL NEEDS OF THE NEWBORN ο Proper nutrition is essential for optimal growth and development ο First few months of life, the brain grows at a rapid rate ο Adequate food and nutrition is for physiological and psychological needs ο During feeding the parent is close to the infant
- 40. ο If a warm relationship does not happen the baby may fail to thrive nutritional allowance for the newborn
- 41. NUTRITIONAL REQUIREMENT ο Healthy term babies grow well with intake of 90- 120 kcal/kg/D ο 125-140 kcal/kg/D is the energy required by preterm infants to achieve a growth rate of 15g/kg/D
- 42. NUTRITIONAL REQUIREMENT PROTEIN β ο Recommendation allowance 15-20% daily calories ο If energy intake is low, dietary protein cannot be utilized fully for tissue synthesis hence azothemia can occur
- 43. ο Term infant β 2.2g/kg/D ο VLBW infant β 3 - 3.5/kg/D ο ELOW infant β 3.6 β 3.8/kg/D
- 44. FAT ο Recommended daily intake : 50% of daily calories for preterm infants 30-40% for term and mature infants ο Fat intake of >60% of total calories may lead to ketosis
- 45. ο CARBOHYDRATES- ο Carbohydrates constitute 40-50% of total daily calories ο Almost all the carbohydrates in the human milk and infant formula is lactose ο Preterm formula contains 50% lactose and 50% glucose
- 46. MINERALS- ο Accretion of calcium, phosphorus , magnesium and iron is maximal at third trimester of pregnancy ο Preterm infants are more prone to mineral deficiency because of this as well as difficulty in stabilizing adequate enter ο minerals are inorganic element required for growth, repair and regulation of vital body function.
- 47. Sodium / Potassium β 2-3mE/kg/D Calcium β 210mg/kg/D Phosphorus β 140 mg/kg/D Magnesium β 10mg/kg/D
- 48. VITAMINS- Are essential metabolic factors Toxicity can occur with fat soluble vitamin because it can be stored in the tissues Toxicity with water-soluble vitamin is unusual because of high renal clearance and low storage capacity Vitamin content in breast milk change with course of lactation
- 49. Daily recommended intake ο Vitamin A β 1500iu/kg/D ο Vitamin D β 400iu/kg/D ο Vitamin E β 6-12iu/kg/D ο Vitamin K β 0.5-1 mg
- 50. HUMAN MILK ο It is preferred wholesome milk for infant ο When fortified, it is also the nutritionally optimal diet for preterm infant ο Milk produced by women who delivered prematurely contains increased amount of protein, sodium and zinc but decreased amount of vitamin A
- 51. ο Human milk contain factors protective of infections- leucocytes, immunoglobulins, lactoferrin, lysozymes ο Human milk has growth an differentiation factors that may promote intestinal maturation ο Composition of milk varies with motherβs health & nutritional status
- 52. NURSES RESPONSIBILITY ο The important responsibility of the pediatric nurse is to provide nutritional counseling and guidance to the parents, with goal of achieving optimum nutrition throughout the year of growth and development. ο At 6 month- ο Complementary feeding to be initiated. ο Each food should be given for 3-6 times/day
- 53. 6-9 months- ο Food items given in this period include rice, dal, khichadi, pulses, boiled potato, bread, mashed fruits etc ο Egg yolk can be given from 6-7 months onwards ο
- 54. 9-12 months- ο New food items like fish, meat, chicken can be introduced in this period. ο Spices and condiments to be avoided ο Breastfeeding to be continued
- 55. 12-18 months- ο The child can take all food cooked in family and needs half amount of mothers diet ο Number of feeds can be 4-5 times or according to the child need ο Breastfeeding to be continued, especially at night
- 56. -