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VACCINATION-I

VACCINATION-I. 2009. IMMUNIZATION

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VACCINATION-I

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  1. VACCINATION-I 2009

  2. IMMUNIZATION SMALL POX VACCINE WAS THE FIRST VACCINE TO BE APPLIED IN THE 15th CENTURY, OTHER VACCINES WERE THEN DEVELOPED. IT WAS ANNOUCED FIRST TIME IN THE OTTOMAN EMPIRE IN 1721 THAT A VACCINE WAS USED BY LADY MONTAGUE,WIFE OF THE BRITISH CONSULATE GENERAL AT THAT TIME. IT WAS EDWARD JENNER, WHO ESTABLISHED THE BASICS OF VACCINATION IN SCIENTIFIC TERMS

  3. 1811-STARTED BY SANİZADE ABDULLAH EFENDİ 1847-İSMAİL PAŞA RENEWED THE VACCINE AND FOUNDED AN INSTITUTE. 1887-ZOEROS PAŞA ESTABLISHED THE FIRST RABIES VACCINE FOUNDATION. 1900-SMALL POX, SCARLET FEVER AND DIPHTHERIA VACCINES WERE PREPARED AT ETFAL (CHILDREN’S) HOSPITAL. 1916-1917- BACTERIOLOGY LABORATORIES WERE FOUNDED IN IZMIR,SIVAS AND DAMASCUS, SEVERAL VACCINES WERE PREPARED. AFTER FOUNDATION OF TURKISH REPUBLIC, ANKARA CENTRAL HEALTH PROTECTION INSTITUE (HIFZISHHA ENSTİTÜSÜ) HAS PROVIDED VACCINES AND ANTISERUMS NEEDED.

  4. IMMUNIZATION ACTIVE IMMUNIZATION INVOLVES ADMINISTRATION OF ALL OR PART OF A MICROORGANISM OR A MODIFIED PRODUCT OF THAT MICROORGANISM TO EVOKE AN IMMUNOLOGIC RESPONSE WITH ACTIVE IMMUNIZATION, A PERSON IS STIMULATED TO DEVELOP IMMUNOLOGIC DEFENSES AGAINST FUTURE NATURAL EXPOSURE.

  5. PASSIVE IMMUNIZATIONENTAILS ADMINISTRATION OF PREFORMED ANTIBODY TO A RECIPIENT WITH PASSIVE IMMUNIZATION, A PERSON ALREADY EXPOSED OR ABOUT TO BE EXPOSED, TO CERTAIN INFECTIOUS AGENTS IS GIVEN PREFORMED HUMAN OR ANIMAL ANTIBODY.

  6. THE GLOBAL ERADICATION OF SOME DISEASES IS ACHIEVED BY COMBINING AN EFFECTIVE IMMUNIZATION PROGRAM. IN MOST DEVELOPING COUNTRIES INFECTIOUS DISEASES REMAIN AS A MAJOR PROBLEM, BECAUSE OF INAPPROPRIATE IMMUNIZATION.

  7. VACCINES INCORPORATING AN INTACT INFECTIOUS AGENT • LIVE – ATTENUATED (VEAKENED) • KILLED (INACTIVATED OR DETOXIFED AGENTS)

  8. LIVE ATTENUATED VACCINES (LAV) • PRODUCED A COMPLEX IMMUNOLOGIC RESPONSE SIMULATING NATURAL INFECTION • GENERALLY IMMUNITY INDUCED BY ONE DOSE OF LAV IS LONG – LASTING POSSIBLY LIFE LONG • INDUCTION OF IMMUNITY BY LAV CAN BE INHIBITED BY PASSIVE ANTIBODY (FROM MOTHER’S OR RECCIPT OF IVIG)

  9. INACTIVED OR PURIFIED ANTIGEN VACCINE • INDUCE RESPONSE ONLY TO THOSE COMPONENTS PRESENT IN THE VACCINE • GENERALY MULTIBLE DOSES (THREE OR MORE) ARE NECESSARY

  10. NATURE OF RESPONSE • DEPENDS ON ANTIGEN TYPE • PROTEIN (AND GLYCOPROTEIN) ANTIGENS USUALLY INDUCE BOTH HUMORAL AND CELLULER IMMUNİTY • POLY SACCHARIDE ANTIGEN7S INDUCE ONLY HUMORAL ANTİBODY WİTHOUT T LYMPHOCYTE STİMULATİON • BY CONJUGATION OF POLYO ACCHARIDES TO PROTEIN CARRIERS TO INDUCE STRONGER IMMUN RESPONSE IN YOUNGER CHİLDREN

  11. IMMUN RESPONSE TO ACTIVE IMMUNIZATION ANTIGEN ↓ ANTIGEN PROCESING AND ANTIGEN – PRESENTING CELLS (DENDRITIC CELLS OR MACROPHAGES) ↓ INTERACTION OF LYMPHOCTES ↓ T LYMPHOCYTES RESPONSE ↓ ↓ Th1 Th2 ↓ Assist B cells ın antibody production ↓ İmmune response

  12. AFTER VACCINATION IT TAKES SOME TIME UNTIL IMMUNIZATION IS ESTABLISHED IN THE FIRST TWO WEEKS, FIRST IgM THAN IgG ANTIBODIES ARE MADE ACCORDING TO THEIR HALF LIVES ANTIBODIES ARE MADE CONTINUOUSLY IF THE SAME ANTIGEN GETS INTO THE BODY BEFORE DISAPEARANCE OF THE ANTIBODIES, A SMALL AMOUNT OF IgM, BUT A LARGE AMOUNT OF IgG ANTIBODIES ARE MADE AFTER EACH ANTIGENIC STIMULUS, ANTIBODIES OF IgG CLASS ARE MADE IN LARGE AMOUNTS AND THE PATIENT CAN BE PREVENTED FROM THAT DISEASE

  13. ANTIBODIES PRODUCED IN RESPONSE TO • IMMUNIZATION • DIRECT MEUTRALIZATION OF TOXIN • 2) OPSONIZATION OF ORGANISM BY COMPLEMENT PATHWAY • 3) LYSİS SORGANISM OR PROMOTE PHAGOCYTOSIS • 4) REACTION WITH NONSENSITIZED LYMPHOCYTES TO PROMOTE PHAGOCYTOSIS • 5) SENSITIZATION OF MACROPHOGES TO PROMOTE PHAGOCYTOSIS

  14. THOSE SHOULD BE BORN IN MIND TO ACHIEVE AN EFFECTIVE AND PROTECTIVE VACCINATION: • RESPONSE EVOKED BY THE VACCINE IS AFFECTED BY THE • TYPE OF THE VACCINE, i.e. DEAD, WHOLE CELL VACCINES etc. • AS WELL AS ANTIGENIC TYPE OF THE VACCINE, i.e. SINGLE • ANTIGEN OF VIRUSES OR BACTERIA OR ANTIGEN COMPLEXES • FORMING THE VACCINE. • 2. IMMUNIGENICITY INCREASES AS THE SIZE OF THE ANTIGEN INCREASES. SOLUBLEPROTEINS ARE LESS ANTIGENIC COMPARED TO INSOLUBLE PROTEINS. ADJUVANTS CAN BE • ATTACHED TO SOLUBLE PROTEINS TO MAKE THEM LESS SOLUBLE AND MORE ANTIGENIC.

  15. 3. IMMUNOLOGICAL RESPONSE OF THE HOST IS IMPORTANT IN THE EFFECTIVENESS OF THE VACCINE. STARTING FROM THE NEONATAL PERIOD, IMMUNE REACTION IS POSSIBLE. BUT, PASSIVELY ACQUIRED ANTIBODIES CAN INHIBIT SUCH IMMUNOLOGICAL RESPONSES. THESE PASSIVELY ACQUIRED ANTIBODIES MAY BE PROVIDED TO THE NEONATE: - THROUGH TRANSFER OF MATERNAL IgG THROUGH PLACENTA, - INFUSION OF SERUM IMMUNOGLOBULINS, SOME PASSIVELY ACQUIRED ANTIBODIES CAN PROVIDE PROTECTION, NEVERTHELESS MAYINTERFERE WITH ACTIVE IMMUNIZATION WITH VIRUS VACCINES INHIBITING ANTIBODY PROTECTION. THIS IS NOT THE CASE FOR THE DEAD VACCINES; DTP MAY BE STARTED AT 2rd OR 3th MONTHS.

  16. SEVERAL IMPLICATIONS TO BE CAREFUL ABOUT • VACCINES SHOULD BE STORED AND • TRANSPORTED IN APPROPRIATE CONDITIONS • VACCINES SHOULD BE APPLIED THROUGH • APPROPRIATE ROUTE, i.e. SC,ID OR IM. • BOOSTER DOSES SHOULD BE APPLIED TO • PROVIDEADEQUATE RESPONSE

  17. PLEASE NOTE THAT: 1. NOT ONLY THE INGREDIENTS CONTAINED IN THE VACCINE, BUT ALSO THE IMMUNE RESPONSE OF THE PATIENT CAN INFLUENCE THE EFFECT OF THE VACCINE. 2. IMMUNIZATION CAN BE EVOKED ONLY AFTER A PERIOD OF TIME. 3. GENERALLY, BOOSTER DOSES ARE NEEDED IN ORDER TO MAINTAIN AN EFFECTIVE AND LONG LASTING IMMUNIZATION. 4. IF RABIES AND MEASLES VACCINES ARE DONE AT THE INCUBATION PERIOD OF THE DISEASE, THEY CAN PREVENT THE PATIENT FROM GETTING THESE INFECTIONS.

  18. PROLONGATION OF BOOSTER INTERVALS DOES NOT • WEAKEN THE RESPONSE, ON THE CONTRARY EARLY • BOOSTER DOSES MAY INTERFERE WITH THE ADEQUATE • RESPONSE. • MANY VACCINES CAN BE APPLIED SIMULTANOUSLY; e.g. • DTP, OPV AND MMR; HIBAND HBV. THESE ALL PROVOKE • ADEQUATE ANTIBODY PRODUCTION. • TWO LIVE VIRUS VACCINES SHOULD BE APPLIED WITH • AT LEAST 30 DAY INTERVAL, OTHERWISE IMMUNERESPONSE MAY BE INADEQUATE.

  19. LIVE VIRUS VACCINES CAN BE APPLIED TO PATIENTS ON IMMNUNOGLOBULIN TREATMENT THREE MONTHS AFTER • CESSATION OF THE TREATMENT. • IMMUNOGLOBULINS CAN BE GIVEN AT LEASTTHREE WEEKS AFTER THE VACCINATION.

  20. -SUCKLING DOES NOT AFFECT VACCINATION. • DIFFERENT BRANDS UNDER DIFFERENT FIRM • NAMES CAN BE USED IN ROUTINE VACCINATION; • e.g. DT, PER ( WHOLE CELL), OPV,IPV,HAV,HBV, • RABIES, HIB. • -DOSE REDUCTION IS NOT DONE FOR PREMATURES. • HBV VACCINE CAN BE APPLIED TO PATIENTS • WEIGHTING MORE THAN 2000 g.

  21. VACCINATION IS NOT APPLIED IN IMMUNE DEFICIENCY • STATES. IN CONGENITAL OR ACQUIRED IMMUNE • DEFICIENCY STATES, LIVE ATTENUATED VACCINES AND • BACTERIAL VACCINES MAY EVOKE SEVERE SIDE • EFFECTS. LIVE VACCINES SHOULD NOT BE APPLIED TO • THESE PATIENTS. • VACCINATION SHOULD BE STARTED AFTER THREE • MONTHS OF CHEMOTHERAPY, RADIOTHERAPY OR • STEROID TREATMENT. BEFORE THIS PERIOD, IMMUNE • RESPONSE DOES NOT OCCUR.

  22. CONTENTS OF VACCINES • BASIC ANTIGENSCONSIST OF WHOLE BACTERIA OR VIRUSES OR ALL STRUCTURAL ELEMENTS PERTAINING TO THEM. • 2. ANTIGENS THAT THE HOST PRODUCESARE HOST PROTEINS OR PROTEIN DERIVATIVES CARRIED ALONGSIDE WITH THE VIRALPARTICLES. • 3. TRANSFORMED ANTIGENSARE THE PROTEINS OR PROTEIN • DERIVATIVES DENATURED AT THE PLACE OF VIRAL INFECTION OR REPRODUCTION • 4. ANTIBIOTICS ADDED DURING PRODUCTION OF THE VACCINES IN THE MEDIUM.

  23. 5. UNKNOWN AND/OR UNWANTED VIRAL OR BACTERIAL PRODUCTS 6. SUSPENSION FLUID: STERILE WATER OR SALINE ( INCLUDES SERUM PROTEINS, EGG ANTIGENS, TISSUE CULTURE ANTIGENS) 7. STABILIZING PRESERVATIVES; i.e. MERCURY PRODUCTS INHIBITING OTHER BACTERIA FROM GROWTH OR STABILIZING ANTIGENS. 8. ADJUVANTS; i.e. ALIMINUM SALTS PROVOKING HOST RESPONSE BY THE INACTIVATED MICROORGANISMS; e.g. ALIMINUM PHOSPHATES, ALIMINUM HYDROXIDES).

  24. VACCINE TRANSPORT AND STORAGE CONDITIONS CAN CONTRIBUTE TO VACCINE FAILURE. VACCINES SHOULD BE KEPT IN REFRIGERATORS OR FREEZERS ACCORDING TO THE STORAGE RECOMMENDATIONS. VACCINES SENSITIVE TO INCREASED TEMPERATURE: OPV, MEASLES, VARICELLA, YELLOW FEVER VACCINES SENSITIVE TO FREEZING: DIPHTHERIA, TETANUS TOXOIDS, PERTUSIS VACCINES, IPV, HiB CONJUGATE, INFLUENZA VACCINES, HEPATITIS A AND B THE STORAGE TEMPERATURE FOR OPV IS 0-4C (FOR OTHER VACCINES :2-8 C). POLIO VACCINE CAN BE FREEZED AND DEFREEZED REPEATEDLY. DISCARD OPENED MMR VACCINE AFTER 8 HOURS. TOXOID VACCINES CAN BE STORED AT THE REFRIGERATOR FOR 4-5 DAYS.

  25. THE USE OF VACCINES 1.PEOPLE TO DO VACCINATION HAS TO BE FULLY VACCINATED, INORDER TONOT TO SPREAD THE DISEASE. 2.BEFORE THE VACCINATION HANDS MUST BE WASHED. 3.THE ENJECTORS MUST BE DISPOSIBLE. 4.DIFFERENT SORT OF VACCINES SHOULD NOT BE PLACED IN THE SAME ENJECTOR TO BE USED AT THE SAME TIME.

  26. 5.THE VACCINES SHOULD BE APPLIED TO THE SUGGESTED AREAS. THE ADJUVANT VACCINES ARE TO BE APPLIED IM. PREFERABLY ON THE ANTEROLATERAL PART OF THE M.DELTOIDEUS, WITH 2,2-2,5 CM OF ENJECTOR NEEDLE OF AN 22-25 GENJECTOR. SUBCUTENOUS ENJECTIONS 1,6-1,9 CM NEEDLE WITH23-25 G ENJECTOR SHOULD BE USED. THE INTRADERMAL ENJECTIONS MUST BE APPLIED TO THE VOLAR FACE OF THE FORE ARM, WITH THE TIP OF THE ENJECTOR FACING UPWARDS. FOR INTRADERMAL ENJECTIONS 0,95-1 CM NEEDLE, 25-27 G ENJECTOR SHOULD BE USED. THERE MUST BE A SMALL HEAP AT THE PLACE OF INTRADERMAL INJECTION. IF NOT DONE INTRADERMALLY BUT SC, THERE WON’T BE ANTIBODY REACTION. AFTER SC/ID ENJECTION, LOCAL IRRITATION, ENDURATION, COLOUR DIFFERENCE, INFLAMMATION AND GRANULAMATOUS REACTION AT THE SITE OF INJECTION ON THE SKIN SURFACE CAN BE SEEN.

  27. EXTENDED IMMUNIZATION PROGRAM 2010 A-VACCINATION SCHEDULE: 1-UNDER THE AGE OF 1 YEAR OLD (0-11 MONTHS): NEWBORN HBV-1 AT THE FIRST MONTHSHBV-2 AT THE END OF 2nd MONTHS (8 WEEKS OLD) BCG DaPT-IPV-Hib1 CPV1 AT THE END OF 4th MONTHS (16 WEEKS OLD) DaPT-IPV-Hib2 CPV2 AT THE 6 MONTHS DaPT-IPV-Hib3 CPV3 OPV HBV3 AT THE 12 MONTHS MMR1 + CPV4

  28. EXTENDED IMMUNIZATION PROGRAM 2010 2- BOOSTER DOSES ( 18-24 MONTHS OLD) DaPT-IPV-Hib4+ OPV+CPV SCHOOL TIME VACCINATIONS 3- FIRST YEAR OF PRIMARY SCHOOL KKK2 + DaBT-IPA 4- AT THE 8th PRIMARY SCHOOL dT* *dT: ADULT TYPE OF DIPHTHERIA- TETANUS (TETANUS) IS APPLIED

  29. A.AŞI TAKVİMİ: (SAĞLIK BAKANLIĞI 2010) Hep B: Hepatit B aşısı BCG: Bacille Calmette – Guerin aşısı DaBT-İPA-Hib: Difteri, aselüler boğmaca, Tetanoz, İnaktif Polio, Hemofilus influenza tip B aşısı (Beşli Karma aşı) KKK: Kızamık, Kızamıkçık, Kabakulak aşısı OPV: Oral Polio aşısı Td: Erişkin Tipi Difteri – Tetanoz aşısı R: Rapel (Pekiştirme)

  30. UNDER 6 YEARS OLD AND NOT VACCINATED 1ST VISIT: DTaP-IPV-Hib,HBV, CPA(IF OLDER THAN 5 YRS OF AGE MAY NOT BE DONE), PPD TEST MAY ALSO BE DONE FOR BCG. 2 DAYS AFTER THE 1ST VISIT: MMR, PPD İS NEGATİVE BCG. 1 MONTHS AFTER THE 1ST VISIT: DTaP-IPV-Hib,HBV, CPA 2 MONTHS AFTER THE 1ST VISIT:DTaP, IPV, Hib 8 MONTHS AFTER THE 1ST VISIT:DTaP-IPV, HBV, OPV 4-6 YEARS: DTaP-IPV, MMR. 11-12 YEARS: Td.

  31. CHILDREN 6 – 12 YEARS WHICH HAVEN’T BEEN VACCINATED 1ST VISIT:DTaP-IPV,HBV, MMR 1 MONTHS AFTER 1ST VISIT:DTaP-IPV,HBV, MMR, OPV 8 MONTHS AFTER 1ST VISIT:DTaP-IPV, OPV, HBV 11-12 YEARS:Td.

  32. TBC VACCINE (1)   *  BCG IS A LIVE ATTENUATED VACCINE.      *  5 YEAR PROTECTION RATE AFTER VACCINATION IS 0-80%. AFTER 5 YEARS ITS PROTECTIVE COVER DECLINES. *  THE VACCINES PROTECTIVE DURATION SHOULD BE OVER WATCHED BY PPD CONTROLS. *  THE VACCINE IS APPLIED INTRADERMALLY. *  IT IS APPLIED SINCE NEWBORN. * IN TURKEİ IT IS APPLIED BEYOND 2 MONTHS AF AGE.

  33. FOR GLOBAL ADMINISTRATION OF BCG VACCINE(2) 1. THE ANNUAL RATE FOR RISK OF INFECTION SHOULD BE OVER 1/10000. 2. IF THE INCIDENCE OF TBC BACTERIA POSITIVE CASES ARE OVER 5/100000 IN THE LAST 3 YEARS. 3.  IF THE INCIDENCE OF THE CASES WITH ACTIVE TBC ISN’T UNDER 10% IN THE LAST DECADE. 4.  IF THE TBC MENINGITIS OF THE CHILDHOOD IS OVER THE 1/10000000 OF THE GENERAL POPULATION, VACCINATION SHOULD BE APPLIED. ALTHOUGH THERE MAY BE TBC MENINGITIS OR MILIER TBC AMONG VACCINATED PEOPLE AND BECAUSE THERE AREN’T TERMS TO PREVENT THE GLOBAL VACCINATION IN TURKEİ, BCG VACCINATION SHOULD BE APPLIED.

  34. TBC VACCINE (3) * THE VACCINE IS APPLIED TO THE LEFT SHOULDER 0,1 cc ID ON THE 2ND MONTH OF LIFE.

  35. TBC VACCINE (4) • *   IF THE VACCINATION IS APPLIED BY THE RIGHT METHODS, A 6-8 • mm PAPUL WILL FORM ON THE SKIN SURFACE AND WILL VANISH • IN 15 mins. AFTER A MONTH IT WILL HEAL LIVING A SCAR MARK • BEHIND. • *   THERE MUSN’T BE AN APPLICATION OF IODINE SOLUTION OR • BANDAGE ON THE SITE OF ENJECTION. • SIDE EFFECTS • -   ULSERATION AT THE SITE OF ENJECTION. • -   LYMPHADENITIS. • -   OSTEOMYELITIS.

  36. ORAL POLIO VACCINE (OPV)- (2) *   IT’S LIVE ATTENUATED SABIN VACCINE *  ORAL POLIO VACCINE IS PREFERED BECAUSE OF ITS’ CHEAP COST, INFEST THE PEOPLE USING SAME TOILETS AND PREVENTING INTESTINAL INFECTIONS, FROM 1964. *  THE VACCINES USE IS PROOVED BY, REPORTATION OF 1 NATURAL PARALYTIC POLIO CASE AND POLIO SEEN AS ENFECTION BUT NOT AS VACCINE COMPLICATION IN THE COUNTRIES WHERE THE PARALYTIC POLIO HAS BEEN ERADICATED. * THE VACCINE PROVIDES LOKAL IGA AND SYSTEMIC IGG TYPE ANTIBODIES.

  37. IN TURKEİ IPV + OPV IS USED AFTER 2ND month DaPT-IPV-Hib1 AFTER 4ND month DaPT-IPV-Hib2 AFTER 6ND month DaPT-IPV-Hib3+OPV BOOSTER DOSE AT 18-24ND month DaPT-IPV-Hib4 + OPV

  38. SIDE EFFECTS OF THE VACCINE • OPV • *  PARALYTIC POLIO IN EVERY 1/10,000,000 DOSES. • *  THE VACCINE SHOULD BE AVOIDED IN PREGNANCY AND IMMUNCOMPROMIZED. • AFTER VACCINATION, THE BABY SHOULDN’T BE FED AND NO CHLORINATED WATER SHOULD BE DRANK. • IPV • HYPERSENSITIVITY TO STREPTOMISIN, NEOMYCIN, POLYMYXIN B.

  39. TETANOUS VACCINE(1) * IS A TOXOID VACCINE. *TETANOUS MICRO ORGANISM IS NATURALLY FOUND IN HORSE, COWAND EVEN HUMAN FEACES. THE MIKRO ORGANISM MAY MAINTAIN SURVIVAL IN THE CONTAMINATED SOIL FOR YEARS. THE DISEASE ISMORE LIKELY IN THE AGRICULTURAL AREAS THAN HIGHLANDS. THE SPREAD FROM HUMAN TO HUMAN IS UNLIKELY. IT IS SPREAD BY CONTAMINATED WOUNDS SUCH AS THE CAUSES OF TRAFIC ACCIDENTS OR CRUSH WOUNDS. *IN TURKEİ THE TETANOUS VACCINE CAN BE PROVIDED AS DaPT VACCINE.

  40. TETANOUS VACCINE(2) IN TURKEİ THE VACCİNE IS APPLIED 2ND month of age DaPT-IPV-Hib1 4ND month of age DaPT-IPV-Hib2 6ND month of age DaPT-IPV-Hib3 BOOSTER DOSE I- 18-24ND month of age DaPT-IPV-Hib II- WHILE ATTENDING TO THE DaPT-IPV PRIMARY SCHOOL 1 III- WHILE ATTENDING TO THE dT PRIMARY SCHOOL 8

  41. TETANOUS VACCINE (3) IN INJURIES IS DEEP AND 5 YEARS OF TIME 1 DOSE OF CONTAMINATED VACCINATED HAD PASSED VACCINE IF THE WOUND NEVER MORE THAN 5 1 DOSE OF IS DEEP AND VACCINATED YEARS OF TIME VAC.+TIG CONTAMINATED HAD PASSED OR ATS

  42. TETANOUS VACCINE (4) FOR NEONATAL TETANOUS FOR THE PREGNANT MOTHER: ALTHOUGH EVEN ONE DOSE IS ENOUGH 3 DOSES ONE AFTER THE OTHER AT ONE MONTH GAPSHOULD BE APPLIED DURING THE 2ND AND 3RD TRIMESTER.SHOULD BE REPEATED AT THE NEXT PREGNANCY. VACCINE REACTION: ERITEMATOUS REACTION, ENDURATION, SENSITIVITY, RARELY GENERALIZED URTICERIAL RASH, ANAPHYLACTIC REACTIONS AND NEUROPATHY HAS BEEN REPORTED.

  43. DIPHTERIA VACCINE (1) *IS A TOXOID VACCINE *SINCE GLOBAL VACCINATION, NO CASES HAVE BEEN REPORTED IN TURKEİ. *IT IS APPLIED AS DaPT VACCINE IN TURKEİ. *IT HAS NO DIRECT PROTECTION ( THE IMMUNIZED PEOPLE WOULD SUFFER THE DISEASE BUT IN A MILDER FORM. IMMUNIZATION DOESN’T PREVENT FROM BEING A CARRIER). * PROTECTION ACCORDS TO THE DOSAGE; 3 DOSES PROTECTS 74,4 %, 4 DOSES PROVIDES A PROTECTION OF 84 %.

  44. DIPHTERIA VACCINE (2) IN TURKEİ THE VACCİNE IS APPLIED 2ND month of age DaPT-IPV-Hib1 4ND month of age DaPT-IPV-Hib2 6ND month of age DaPT-IPV-Hib3 BOOSTER DOSE I- 18-24ND month of age DaPT-IPV-Hib II- WHILE ATTENDİNG TO THE DaPT-IPV PRIMARY SCHOOL 1 III- WHILE ATTENDİNG TO THE dT PRIMARY SCHOOL 8 SIDE EFFECTS: *   MILD FEVER. *   LOCAL SWELLING AT THE SITE OF ENJECTION.

  45. PERTUSIS VACCINE (1) *IS A KILLED WHOLE CELL VACCINE. IT IS APPLIED AS MIXT VACCINATION AS DTP. *IT IS RAISED IN BACTERIAL CULTURE, SANTRIFUGED, KILLED BY SALTY WATER, DETOXIFIED BY USING HEAT OR CHEMICALS THEN BINDED TO ALUMINIUM ADJUVANT BEFORE USED. * IN TURKEİ ACELLULAR PERTUSIS VACCINE IS APPLEID

  46. PERTUSIS VACCINE (2) *ACELLULAR PERTUSIS VACCINE: THE VACCINE IS PREPEARED BY USING THE BACTERIAS’ AS ANTIGENIC MATERIALS SUCH AS PT, FHA, PERTACTIN. ITS’ PROTECTION IS FINE AND HAS LESS SIDE EFFECTS.

  47. PERTUSIS VACCINE (3) IN TURKEİ THE VACCINE IS APPLIED 2ND month of age DaPT-IPV-Hib1 4ND month of age DaPT-IPV-Hib2 6ND month of age DaPT-IPV-Hib3 BOOSTER DOSE I- 18-24ND month of age DaPT-IPV-Hib II- WHILE ATTENDING TO THE DaPT-IPV PRIMARY SCHOOL 1 III- WHILE ATTENDING TO THE dT PRIMARY SCHOOL 8

  48. PERTUSIS VACCINE (4) *  SIDE EFFECTS: THE WHOLE CELL VACCINES CONTAIN MANY TYPES OF TOXIC MATERIALS; THEREFORE REACTIONS ACCORDING TO THE VACCINE OCCURS. THE SIMILAR REACTIONS ARE SEEN IN ACELLULAR VACCINES BUT IN MILDER FORM. LOCAL ERYTHEMA, SWELLING, SENSITIVITY, SYSTEMIC REACTIONS AS: FEVER OVER 38C, FATIGUE, IRRITABILITY, CRYING MORE THAN 3 HOURS, HYPOTONIA, HYPOREFLEXIA, CONVULSIONS. THERE IS NO DIRECT EVIDENCE SHOWN IN SUDDEN INFANT DEATH.

  49. PERTUSIS VACCINE (5) CAUTIONS WHILE APPLYING PERTUSIS VACCINE ANAFYLACTIC REACTİON, ENCEPHALOPATY. (CI) *  FEVER OCCURING IN 48 HOURS ( FEVER OVER 40C, COLLAPS, SHOCK LIKE CLINIC), AFTER INJECTION. *CRYING EPISODES LASTING MORE THAN 3 HOURS *  FEBRIL OR NON FEBRIL CONVULSIONS SEEN IN THE FIRST 3 DAYS OF ENJECTION. IN THE FUTURE VACCINATIONS THE OUTCOME OF THE VACCINATION HAS TO EVALUATED FOR CONTINUATION. (IF EPIDEMY, DTAB MAY BE USED)

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