Childhood Immunization

1. Childhood Immunization Lucy Dirie

2. Objectives • Types of immunity • Immunization schedule • Types of vaccine • Contraindications

3. Curriculum statements • Statement 5: Healthy people; promoting health and preventing disease • Statement 8: Care of children and young people

4. “It is every child’s right to be protected against infectious diseases. No child should be denied immunization without serious thought as to the consequences, both for the individual child and for the community” Department of Health Immunization against infectious disease, 1996

5. Immunity • Active • Inactivated/attenuated live organisms or products • Induces cell-mediated immunity & serum abs • Long lasting • Passive • Transfer of abs /Injection of human Ig • Immediate protection • Lasts few weeks

6. Herd immunity • Vaccination of specific proportion of population confers protection to the unvaccinated • ↓likelihood of coming into contact with infected individual

8. For each age choose correct routine immunizations…

10. When to immunise Diseases protected against Vaccine given Two months Diphtheria, tetanus, pertussis, polio DTaP/IPV/Hib Haemophilus influenzae type b (Hib) +PCV Pneumococcal infection Three months Diphtheria, tetanus, pertussis, polio DTaP/IPV/HibHaemophilus influenzae type b (Hib) +Men C Meningitis C Four months Diphtheria, tetanus, pertussis, polio DTaP/IPV/HibHaemophilus influenzae type b (Hib) + MenC + PCV Meningitis C + Pneumococcal infection

11. Around 12 monthsHaemophilus influenza type b Hib/MenC Meningitis C Around 13 months Measles, mumps & rubella MMR+ PCV Pneumococcal infection Three years & four Diphtheria, tetanus, pertussis & polio DTaP/IPV Months/soon Measles, mumps and rubella dTaP/IPV after +MMR Girls aged 12 to 13 years Cervical cancer types 16,18 HPV 13to 18years old Diphtheria, tetanus, polio Td/IPV

12. Non routine At birth Tuberculosis BCG (to babies who aremore likely to come intocontact with TB thanthe general population) At birth Hepatitis B Hep B (to babies whose mothers are hepatitis B positive)

13. Premature babies • Corrected age?

14. No • At greater risk of infection, should be immunized according to the recommended schedule from 2 months after birth regardless of gestation at birth.

15. Match them up….

16. Answers

17. Live attenuated organism • MMR, BCG • Inactivated organism • Pertussis • Inactivated poliomyelitis virus • Inactivated toxin • Tetanus, Diptheria • Conjugated • Hib, MenC

18. Contraindications to vaccination • None • Egg allergy • Acute febrile illness • Local erythema post previous dose

19. Contraindications to vaccination • None • Egg allergy • Acute febrile illness • Local erythema post previous dose

20. Contraindications • Acute febrile illness • Evolving neurological condition • Severe local reaction to preceding dose • Generalized reaction to preceding dose

21. Contraindications to live vaccines • Immunocompromised • High-dose steroids for >1/52 • Haematological malignancy • Radio/chemotherapy in last 6/12 • Another immunodeficiency syndrome • <3/52 after another live vaccine • With immunoglobulin

22. The Green Book

23. Important to be familiar with immunization schedule • Few true contraindications • Easy marks in AKT!!

24. References • Simon, C., Everitt, H., Kendrick, T. Oxford Handbook of General Practice. 2nd edition Oxford: Oxford Univeristy Press 2006 • The Green Book www.dh.gov.uk/greenbook • NHS Immunisation Information www.immunisation.nhs.uk • Mehrani, T. Childhood immunization. Innovait (Feb 2009) 2: p86-90 • Dawson, H., Trigell, A. EMQs for the MRCGP paper 2. Master Pass 2005

25. Thanks for listening