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- 1. SEMINAR ABOUT IMMUNIZATION S DEFINITION MMUNIZATION: is the process where by a personis made immune or resistant to an infectious disease typically by the administration of vaccine IMMUNITY: is the ability of the bodyto resist the infecting agent and protect the bodyagainst micro organisms VACCINE : a suspensionof attenuated or killed microorganisms administered for the prevention of a specific infection VACCINATION : A means of producing immunity to a disease by using a vaccines . TYPES OF IMMUNITY Active immunity 1- Natural : acquired active immunity from exposure to disease - Artificial : acquired active immunity from vaccinations - 2-Passiveimmunity Natural : acquired passive immunity by placenta - Artificial : acquired passive immunity by gamma globulin to contact - Expanded Program of Immunity (EPI) The world health organization (who) was establish the expanded program on immunization (EPI) in may 1974 to develop and expand immunization programs throughout the world and make vaccines available to all children throughout the world .In 1977, the goals was set to make immunization against diphtheria , pertussis , tetanus ,poliomyelitis ,measles and tuberculosis available to every child in the world
- 2. by 1990.problems encounteredby the program have include :lack of public and government awareness of the scopeand seriousness of the target disease, ineffective program management , inadequate equipment and skills for vaccine storage and handling ,and insufficient means for monitoring program impact as reflected by increasing immunization coverage level and decreasing incidence of the target diseases .the successes ofthe program represent a major public health achievement ,but much remains to be done. General objectives of EPI 1 – reduction in the morbidity and transmission of vaccine preventable disease, such as pertussis, measles ,hepatitis 2 –reduction in mortality from vaccine preventable disease 3 – elimination and eradication of certain diseases such as smallpox, polio 4 – improvement in national economy – less health care costcaring for sick children, less time off work of parents COLD CHAIN SYSTEM Cold chain : a network of refrigerators , cold stores , freezers and cold boxes organized and maintained so the vaccines are kept at the right temperature to remain potent during vaccine transportation , storage and distribution from factory to the point of use . The cold chain has three main components : transport and storage equipment ,trained personnel ,and efficient management procedures ,all three elements must combine to ensure safe vaccine transport and storage
- 3. COLD CHAIN SYSTEMOF EPI ENSURES 1-potency 2-quality 3-safety The figure above illustrates the cold chain from manufacturer to end user (child to be vaccinated), including all steps along the chain, in order to ensure a proper cold chain.
- 4. Vaccines schedule ofIraqi ministry of health for children 2015 Table1: route dose Vaccine Period of administration I.D Upper left arm I.M Orally 0,05 or 0,1 ml 0,5ml 2 drop -BCG (Bacillus Calmatte Guerin ) HBV(Hepatitis B virus) - -OPV(oral polio vaccine)zero dose After birth-72 hr. I.M Oral drops 0,5 ml 1 ml t n ale ntav e P - dose st 1 (DPT+HBV+HIB) dose) st (1 vaccine Rota virus - dose) st OPV(1 - 2 months I.M Oral drops 0,5 ml 1 ml Tetravalent(DPT+HIB) - Rota virus vaccine - dose) nd 2 ( dose) nd 2 ( OPV - 4 months I.M 0,5 ml (DPT, dose nd 2 Pentavalent - HIB, HBV) e) dos rd (3 OPV - 6 months S.C 0,5 ml 100,000 IU Measle , Vit A 9 months S.C 0,5 ml MMR dose st 1 (measle,mumps,rubella) 15 months
- 5. 200,000 IU dose booster st OPV 1 - boosterdose st 1 ) (DPT+HIB - -VitaminA 18 months boosterdose nd OPV 2 - dose booster d n 2 (DPT+HIB) - dose nd 2 MR M - 4-6 years Roles for vaccination 1- Every child should have a sterile needle and syringe 2- The temperature of the refrigerator where all vaccines are stored should be from 4 to 8 co . 3- Do not put vaccines in the doorof the refrigerator, they warm up each time you open the door put the vaccines loosely , so that cold air can go between them 4- 5- Dissolved live vaccine should be used within one hour, and it should not be exposed to sun light 6- read the paper that comes with the vaccine, you may need to use vaccines from different makers in different ways Always make sure that the vaccine is not expired 7- Put several ice bags in the refrigerator to keep vaccines cold if the refrigerator fail
- 6. Contraindication to immunization 1-severfebrile illness altered immune system 2- -Those with immunological deficiency disease such as lymphoma ,aids -Thosereceiving immunosuppressive therapy such as steroid , chemotherapy or radiation 3-The presence of recently acquired passive immunity including blood transfusion ,immunoglobulin Allergic responseto a previously administration of vaccine 4- 5- Gastroenteritis because it may interfere with colonization of the viruses in the intestine History of nervous system disorders such as convulsion 6- If the child gets the disease e.g : mumps 7- SIDE EFFECT OF VACCINATION 1-Fever,soreness,redness and swelling at the site of injection may last for week and even month but gradually disappears. 2-Loss of consciousness,convulsion and thrombocytopenia may result from pertussis vaccine 3-Local oedema 4-Tenderness TYPES OF VACCINES Inactivated or killed : some vaccines contain inactivated, but previously virulent ,microorganism that have been destroyed with chemical, heat, radiation, or antibiotics. Example: influenza, cholera, bubonic plague, polio, hepatitis A.
- 7. Attenuated Live, attenuated vaccinescontain a version of the living microbe that has been weakened in the lab, these vaccines are good “teachers” of the immune system: They elicit strong cellular and antibody responses and often confer lifelong immunity with only one or two doses .e.g BCG , measle ,mumps, rubella Subunit subunit vaccines include only the antigens that best stimulate the immune system. In some cases, these vaccines use epitopes—the very specific parts of the antigen that antibodies or T cells recognize and bind, e.g. Hepatitis B, Hamophilus influenza type b,Pertussis. Toxoid For bacteria that secrete toxins, or harmful chemicals, a toxoid vaccines are made from inactivated toxic compound that cause illness rather than microorganism examples diphtheria and tetanus Conjugate Certain bacteria have polysaccharide outer coated that are poorly immunogenic.by linking these outer coated to proteins, the immune system can led to recognize the polysaccharide as if it were a protein antigen. This approachis used in the haemophilus influenza type B vaccine. Valence May be monovalent vaccine is designed to immunize against a single antigen or single micro organism. Or multivalent vaccine against two or more strains of same microorganism, or against two or more microorganism.
- 8. Heterotypic Called heterologous orjennerian ,these are vaccines that are pathogens of other animals that cause mild disease in the organism being treated.e.g. use of BCG vaccine made from mycobacterium bovis to protectagainst human tuberculosis. Infectious disease - Poliomylitis : is a viral disease caused by poliovirus mainly affects young children, transmitted by personto person spread through the fecal-oral route or by common vehicle e.g.( contaminated water or food)and multiplied in the intestine, from where it can invade the nervous system and can cause paralysis. Clinical manifestation: fever, fatigue, headache, vomiting, stiffness in the neck, and pain in the limb. the disease cause permanent paralysis ,there is no cure for polio ,only prevented by immunization. -Tuberculosis : is caused by mycobacterium tuberculosis ,spread through the air from personto another . clinical manifestation :bad cough that last 3 weeks or longer, pain in the chest , weakness, weight loss, no appetite, chills, fever, sweating at night ,prevention by BCG vaccine -Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). Hepatitis B is transmitted when blood, semen, or another bodyfluid from a personinfected with the Hepatitis B virus enters the bodyof someone who is not infected. This can happen through sexual contact; sharing needles, syringes, or other drug-injection equipment; or from mother to baby at birth -Rota virus: is a virus that infects the intestinal tract of almost all young children by age 5. Children The virus spreads through contactwith the stoolfrom an infected child Clinical manifestation :Vomiting, fever and diarrhea( watery diarrhea)
- 9. - Diphtheria :is bacterium infection caused by the Coryne bacterium diphtheria . spread by direct contact or through the air or by contaminated objects. Symptoms of diphtheria include fever of 38 °C or above, chills, fatigue, cyanosis, sorethroat, hoarseness, cough, headache, difficulty swallowing, painful swallowing, difficulty breathing, rapid breathing, foul-smelling blood stained discharge and lymphadenopathy, cardiac arrhythmias, myocarditis, and cranial and peripheral nerve palsies .prevention by DPT vaccine. -Tetanus is a serious bacterial disease that affects your nervous system, leading to painful muscle contractions, particularly of your jaw and neck muscles. Tetanus can interfere with your ability to breathe and, ultimately, threaten your life. Tetanus is commonly known as "lockjaw." Prevention by DPT vaccine. - Haemophilusinfluenza type b: is a Gram-negative bacterium that causes meningitis and acute respiratory infections, mainly in children manifestations include epiglottitis, osteomyelitis, septic arthritis and septicemia transmitted by droplets from infected people. -Measlesis a highly contagious, serious disease caused by measles virus infects. It is spread by coughing and sneezing, close personal contactor direct contact with infected nasal or throat secretions. clinical manifestation The first sign of measles is usually a high fever, coryza, conjunctivitis, photophobia, kopliks spots in the mouth, hacking cough, enlarged lymph node,rashlast 5 days. Prevention by measles vaccine -German measles (Rubella): viral infection caused by rubella virus spread by direct or indirect contact with nasopharyngeal secretion also the virus present in urine and stooland blood, from mother to fetus. Clinical manifestation slight fever, mild coryza, pink or pale red malcules closely grouped, swelling of posterior cervical and occipital lymph node. Prevention by MMR vaccine.
- 10. -Mumps: viral infectioncaused by paramyxo virus ,spread by direct or indirect contact with salivary secretion of infected person. clinical manifestations swelling and pain of salivary glands , pain when drink or eat acidic food, difficulty in swallowing ,headache, fever and malaise, Prevention by MMR vaccine. -Pertussis:caused by bordatella pertussis bacteria ,spread by direct contact and air born by droplet .clinical manifestation :there are 3 stages 1- catarrhal stages: begin with URTI eg. Coryza, sneezing, lacrimation, cough, low grade fever for 4-14 days. 2-paroxysmal stage(1 month): series of short, rapid cough at night followed by sudden inspiration associated with whooper. 3- convalescent stage: good appetite, gaining weight. Prevention by DPT vaccine.