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Immunization

Immunization. By: Ana Khouri. Ultimate goal: - eradication of disease Immediate goal: - prevention of disease. Types of Immunization. Active immunization : - vaccine - live attenuated

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Immunization

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  1. Immunization By: Ana Khouri

  2. Ultimate goal: - eradication of disease • Immediate goal: - prevention of disease

  3. Types of Immunization • Active immunization : - vaccine - live attenuated - killed inactivated • Passive immunization

  4. National Childhood Vaccine Injury Act (NCVIA) • Vaccine benefits and risks,manufactor,lot number, date of administration • VIS (vaccine information statement) • AAP (above + site and route and expiration date)

  5. Vaccine Handling and Storage • Freezer: - varicella • Refrigerator (2-8 degrees C): - use plug guard to prevent accidents - thermometer in refrigerator and freezer - logbook - fill with bottle of chilled water and icepack

  6. Administration • Hand hygiene • Gloves are not required • IM - <1y anterolateral aspect of the thighs - >1y deltoids • SQ 45 angle -MMR,Varicella -IPV, menomune -Yellow fever

  7. (DTaP)(DT)(Td)(Tdap) • (DTaP) Diphtheria and Tetanus Toxoid and Acellular Pertussis(2m-6y) • (DT) Diphtheria and Tetanus Toxoids (6y-11y)or hx of seizure or severe reaction to TDap • (Td)Tetanus and diphtheria Toxoid(>11y) has1/10 diphtheria antigen

  8. (Tdap)Tetanus and diphtheria and acellular pertussis -Boostix (10-18y) -ADACEL (11-64y)

  9. Schedule: • 2m – 4m – 6m -(12-15m)-(4-6y)-(11-12y) • Minimum age:6 weeks • Minimum Interval:Dose1-2 4weeks 2-3 4 weeks 3-4 6 months 4-5 6 months • Fifth dose is not necessary if the forth dose was given after the forth birthday • Td,Adacel at 11-12y(at least 5y since last dose and every 10 y after)

  10. IPV • Inactivated Polio Vaccine • (2m)-(4m)-(6-18m)-(4-6y) • Minimum age:6 weeks • Minimum interval: dose 1-2 4 weeks 2-3 4 weeks 3-4 4 weeks • 4th dose is not necessary if third dose was given>4y of age • Not recommended for people >18 y .

  11. HIB • Hemophilus Influenza Type B • (2m)-(4m)-(6m)-(12-15m) • Minimum age: 6weeks • Minimum interval; 1-2 4 weeks 2-3 4 weeks 3-4 8 weeks -8 weeks if first dose given at (12-14m) -No further doses needed if first dose is given at 15m or older -No need for the vaccine after 5 years of age

  12. PCV7 • Pneumococcal 7 Valent vaccine • (2m)-(4m)-(6m)-(12-15m) • Minimum age:6 weeks • Minimum intervals: 1-2 4 weeks 2-3 4 weeks 3-4 8 weeks

  13. Primary Series Booster PCV7 < 6 months 3 doses 1 dose 7-11 months 2 doses 1 dose 12-23 months 2 doses none 1 dose none 24-59 months

  14. MMR • Live attenuated Measles-mumps- rubella • (12m)-(4-5Y) • Minimum age:12 months • Minimum interval:1 month • SAFE IN EGG ALLERGIC CHILDREN • Transient rash and fever 6-12 days after vaccine are reported in 5% of kids

  15. VARICELLA • Live attenuated • (12m)-(4-5y) • Minimum age:12 months • Minimum intervals: <13years 3 Months >13years 1 Month

  16. MMRV(ProQuad) • MMR+Varicella • (12m)-(4-5y) • 3 months between

  17. HBV • Hepatitis B vaccine • (Birth)-(2-4m)-(6-18m) • Minimum intervals: 1-2 4 weeks 2-3 8 weeks (16 weeks after the first dose and . > 24 weeks)

  18. Infants born to HBsAg positive Mother: -HepB+0.5ML(HBIG)within 12 hour of birth at separate sites. -Should be tested for HBsAg and anti HBs At(9-15m)

  19. Infants born to mothers whose HBsAg isunknown - HepB within12 hours - Draw maternal blood if + give HBIG as soon as possible (no later than one week)

  20. HepA • Hepatitis A • (12m)-(18m) • Minimum age:12m • Minimum intervals:6 months

  21. MENACTRA • Meningococcal(GroupA,C,Yand W-135)polysaccharide conjugated to diphtheria toxoid protein • All person 11-12 years of age • Just approve for 2-10 years (Nov.07)

  22. INFLUENZA • INACTIVATED: IM >6 Months -Preservative free:6-35 M .First time:0.25 ml,2 doses 4 weeks apart then 0.25 ml yearly after. -Fluzone: >6 months .First time:3-9 years 0.5 ml , 2 doses 4 weeks apart then yearly after. - Fluvirin:>4 years - Fluarix:>18 years DO NOT GIVE IF ALLERGIC TO EGGS

  23. INFLUENZA (cont.) • Live attenuated: (2 -49 years) intranasal -First time :<9 years, 2 doses 4 weeks apart -contraindication: -RAD,Asthma -Egg allergies -Salicylates -Hx of Guillan- Barre’ -Immune defficiency

  24. GARDASIL • Human Papiloma Virus • Types 6,11,16,18 • 90% G warts,70% of Cervical cancer • Indication:Women(9-26y) • 3 Doses • Intervals:1-2 2 months after 1st Dose 2-3 6 months after 1st Dose

  25. ROTATEQ • Live oral • 3 Doses (2m,4m,6m) -Do not start>12 weeks -Do not administer a dose >32 weeks

  26. COMBINATION VACCINE

  27. PEDIARIX • DTaP+HBV+IPV • Intervals:6-8 weeks

  28. COMVAX • HIB+HBV • Give at:2 months 4 months 12-15 months OMIT THE 6 MONTHS DOSAGE

  29. TRIHIBIT • DTaP+HIB • BOOSTER For Children>12 months

  30. RULES FOR VACCINATION • Can give Simultaneously except for cholera and yellow fever • Live vaccine 28 days interval if not administered simultaneously • 4 Days GRACE PERIOD • No need to restart vaccine regardless of the time that has elapsed between dosage • Interchangeability of vaccine products is OK(limited data)

  31. Do not change vaccine dosage • Live vaccine (mainly MMR)can interfere with the immune response to PPD,wait 4-6 weeks • Live vaccine may have diminished immunogenicity when given shortly before or during the several months after receiving IG (no interference with synergis) • Avoid pertussis for a child with seizure until the cause has been determined

  32. PRETERM AND LOW BIRTH WEIGHT INFANTS • They should receive all routinely recommended childhood vaccine at the same chronologic age as full term infants.

  33. PREGNANCY • The only vaccine recommended for routine administration during pregnancy in the US is TD,Tdap,and inactivated influenza • Live vaccines are contraindicated • If possible delaying vaccine until the second or third trimester.

  34. IMMUNOCOMPROMIZED CHILDREN • Primary immunodeficiency -B lymphocyte: no live vaccine, consider MMR -T lymphocyte: no live vaccine -Complement: can give any vaccine • Secondary -HIV/AIDS:no live vaccine exeptMMR and varicella(if CD4+lymphocyte>25%)

  35. Immunosuppressive therapy ;wait 3 months before giving vaccine. • Steroid treatment: -not a contraindication if: -topical therapy -low dosage -high doses<14 days -wait one month after high dose >14days

  36. Immunization Schedule

  37. Accelerated Schedule

  38. Accelerated Schedule

  39. Joseph ,6 years old DTaP 12y IPV since he did not have any after4 y No HIB (older than 5 y) No PCV (older than 5 y) MMR and in 4weeks another MMR Varicella repeat in 3 months

  40. 2 Arthur (5y old) DTaP repeat in 6 months(3rd -4th) IPV(no need for 4th if the 3rd IPV is given after the 4th birthday) NO HIB or PCV Varicella MMR repeat in 4 weeks (DTaP,IPV,Proquad)

  41. 3- Rashad (8 y 0ld) (Varicella) 4-Chaniya(22 month) (Varivax,PCV) (DTaP after 6 month from the 3rd, in February)

  42. 5- China (2y) (DTaP,IPV,HIB,HBV,PCV,MMR,VARIVA In 4 weeks (DTaP,IPV) In 6 months (DTaP)

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