Prevention and vaccine pediatrics

Family Medicine Training
Dentist Training

PAEDIATRICS
PREVENTION AND
VACCINE
Dr Hussein Abdeldayem
Prof of Pediatrics
Alex University

PREVENTION


Prevention
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention
• Quaternary Prevention


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

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 CP

PKU, Cong Hypothyroidism

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, DISEASE
ABM NO Complication

Prevention
• Quaternary Prevention
set of health activities that
diminish or avoid the
consequences of
unnecessary or excessive
interventions in the health
system

Swine Flu cost


AR Inheritance


Prevention and Neurologic
disorders
• Down syndrome
• PKU
• Congenital hypothyroidism
• galactosemia


Down syndrome
1ry (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
baby
Prevention: avoid late age or
frequent conception

Recent: Pre-implantation selection

Dr Hussein Abdeldayem ?? Folic acid supplementation

Down Syndrome
2ry Prevention ( DS baby)
• 9-12 wks GA:2
1- neck US
2- Blood: hCGTH, PaPPa, fetal RBC
3- Villous biopsy
• 12 -16 wks GA:
1- triad: AFP. UOstriol, hCGTH
2- tetrad: triad + inhibin
• > 16 wks GA:
Amniocentesis


DS
3ry Prevention
• EIP
• Echocardiography
• Visual acuity/y
• Thyroid function/y (TSH,T4)
• Tympanometry/y
• Neck X ray at 3-5 yrs*

*Neutral view, flexion & extension


Galactosemia

Failure to thrive
vomiting
Galactusuria (sugar in urine
AAuria, proteinuria


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)

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


PKU
– AR
– Gene on chromosome 12
– Enzyme deficiency:
phenylalanine hydroxylase
– Types:
1- classic
2- cofactor BH4
(tetrahydrobiopterin )
3- mixed* : mild ( no disease)


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
urine
B- loading test: oral BH4 (20 MG/KG)
then measure phenylalanine
C- enzyme assay
• mixed


PKU
PREVENTION
• 1ry: genetic counseling AR
• 2ry: a- neonatal screening
then low phenylalanine
milk
• 3ry: rehabilitation , diet
resriction


C/P
Some 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


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


Maternal PKU syndrome /
Prevention
During 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


Prevention
• MR PREVENTION:
1- 1ry : vaccine of all females
against (at least 3 mo
preconception) of GM
2- 2ry: screening of
congenital hypothyroidism,
PKU and Galactosemia
3- 3ry: rehabilitation and
early intervention program
as in DS


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 infection
2- 2ry: early treatment of infective
organism (AB)
3- 3ry: early detection of sequelae
as ABR ( for ABM)


Immunity

Passive Acquired
From mother: Vaccine or toxoids
a- transplacental,
b- breast milk

Antibodies Active infection (clinical
administration: or subclinical) = Natural
a- gamma globin,
b- antitoxin


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


Vaccination is better than passive
immunity

• vaccination cause better and
longer immunity than passive
immunity ( from mother or
injection of IG).


Vaccine better than infection

Diisadventages
Advantages

• Safe • Not solid immunity
• Mass protection • S/E
• ?? cost • ?? cost


Vaccines are safe

• Vaccines are easier
and safer to administer
than ever before.
• Being immunized is
much safer than risking
infection and disease.


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.


Immunization can save money

• Immunization is
one of the most
cost-effective
health
interventions.
• Investing in
vaccines SAVES
more money
than it costs.


Immunization Schedule
Age of Infant/Child Type of vaccine

At birth Zero 1st (OPV) oral OPV: live attenuated (LA) 2-3
Dose polio drops

0-1 mo: BCG: against BCG: live attenuated (LA)
(1st contact of child tuberculosis by (intra dermal injection over
with health
authority)
insertion of left deltoid, 0.1ml)

Ist month: all LA


OPV: 3 oral drops
Immunization Schedule DPT: IM 0.5 ml
HBV: IM 0.5 ml

Age of Type of vaccine
DT: killed
Infant/ P: toxoid
Child

2nd 2nd dose: Polio (OPV), DPT & OPV: Ki oral2-3
Month Hepatitis B 1
of DT: toxoid IM
age P: ki IM
4th 3rd dose: Polio (OPV), DPT & HBV: recomb
Month Hepatitis B 2
of Ag
age IM
6th 4th dose: Polio (OPV), DPT &
Month Hepatitis B 3
HBV
of Recomb Ag
age

Immunization Schedule
Age of Infant/Child Type of vaccine

9th mo of Measles SC LA
age Vitamin A Capsule (100.000 Measles: SC
units) MMR :SC

polio(5th dose) ORAL LA
Measles/MMR
LA

12 MMR sc LA
MONTHS 2 Vitamin A Capsule (200.000 units)
polio(6th dose) ORAL LA

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)


Immunization: non obligatory
HIB: 3 doses ( 2, IM
Hemophilus 4 ,6 mo) and Conjugated
Influenzae booster at 18 polysaccharide
type B – 24 mo vaccine

HAV: 1st : +12 mo IM
Hepatitis A 2nd: after 6 – Inactivated
12 mo


Varicella + 12 mo – 13 yr: LA
one dose
Booster: 4- 6 yrs
≥ 13yr: 2 doses
with 6 wk apart

Meningo Over 2 ys SC
coccal Every 3 ys Inactivated
ACWY


Flu Every year Recombinant Antigen
vaccine (septemper/
(>6 mo october)
age)

???? ????? ?????


• Polio vaccine:
1- LA: Oral Sabin
2- killed: IM salk


• BCG : intradermal
• Measles: SC
• MMR: SC


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



3- specific:
i- BCG: TB ulcer, TB lymphadenitis with cold
abscess and sinus/ suppurative
lymphadenitis/ miliary TB

ii- OPV: paralysis



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 ( >40.5ₒC)
e. shock or drowsiness, or somnolence: within
2 days



iv- measles: rash, arthralgia

V- GM: rash, arthralgia, lymphadenopathy,
allergy

Vi-mumps: mild parotitis


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

contraindication
• Pertussis vaccine (DTP)
1- history of fits
2- abnormal neurological
child as CP
2- S/E of vaccine

Give: DT ‫الثنائى‬
or
D T (a)P


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)


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


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


Prevention and vaccine pediatrics

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (11)

Similar to Prevention and vaccine pediatrics

Similar to Prevention and vaccine pediatrics (20)

More from Hussein Abdeldayem

More from Hussein Abdeldayem (20)

Recently uploaded

Recently uploaded (20)

Prevention and vaccine pediatrics

Editor's Notes