Lecturer: Gorishna Ivanna Lubomyrivna

1. Active immunization of children, its importance for theinfectious diseasesprophylaxis. Vaccination schedule. Postvaccinal complications. Lecturer: GorishnaIvannaLubomyrivna

2. Plan of the lecture • Short history about immunization • Recommended immunization schedule for infants and children • Vaccinal reactions • Postvaccinal complications • Contraindications to the vaccination

3. The immune system • is a complex system of interacting cells whose primary purpose is to identify foreign (“non-self”) substances referred to as antigens. • The immune system develops a defense against the antigen. • This defense is known as the immune response and usually involves the production of protein molecules, called antibodies (or immunoglobulins), and of specific cells (also known as cell-mediated immunity) whose purpose is to facilitate the elimination of foreign substances.

4. The task of immuneprophylaxis • management of immunological answer to prevent the disease between separate persons and groups of the population.

5. There are two basic mechanisms for acquiring this protection • active and passive.

6. Active immunity Active immunity are defenses developed by the body that last many years or even a life time. 1. Active-natural immunity – means invasion of the body by microorganisms resulting in development of antibodies and sensitized lymphocytes. Examples: childhood diseases - chicken pox, measles. 2.Active-artificial immunity is attained by inoculation or immunization with antigen of live or killed vaccines that are less virulent than contacting the disease.

7. Passive immunity is temporary, trasmitted from another source that has developed immunity through previous disease or immunization. • Passive-natural immunity is trasplacental and colostrum transfer from mother to child of antibodies. Immunity does not last. • Passive-artificial immunity is injections with Gamma Globulin.

8. Classification of vaccine • Vaccines, which include complete killed microorganisms (pertussis, typhoid, cholera) or inactivated viruses (influenza, poliomyelitis Salk vaccine) • Anatoxins, which contains inactivated toxin of the bacteria (diphtheria, tetanus) • The vaccines from alive attenuated viruses (measles, mumps and others.) • Vaccines, which contains crossing alive microorganisms (BCG) • Chemical vaccines from fraction of killed microorganisms (pneumococcal, meningococcal) • Gene-engineering recombinant, chemical synthesized (hepatitis В, influenza) • Associated (in composition of which enters several vaccines)

9. Composition of vaccines • Active or immunizing antigens • Fluid base • Preservatives, stabilizers, antibiotics • Auxiliary facilities

10. Provide active life long immunity against disease IMMUNIzation programs 1. Recommended immunization Schedule for Healthy Infants and Children

11. The recommended childhood vaccination schedule (Ukraine)

12. Ways of the vaccination • 1. Intramuscular (DTP, DT, DT-M, antirhabic, meningococcal B) • 2. Subcutaneous (measles, mumps, rubella, meningococcal A+C) • 3. Intracutaneous (BCG) • 4. On skin (plague, tularemia, brucellosis) • 5. Peroral (poliomyelitis) • 6. Intranasal (Influenza, inactivated)

13. Vaccination for tuberculosis prevention could not be done in the same day with other vaccines or other parenteral manipulations Vaccines are injected to all newborns, which has no contraindications. Immunization is done by a vaccine to prevent tuberculosis (BCG). For vaccination of premature infants weighing ≥ 2000 g should be used TB vaccine with reduced antigen content (BCG-M).

14. Mantoux test Mantoux test before vaccination against TB should be done for babies elder than 2 months. A negative test result allows making vaccination

15. Immunization by monovalent hepatitis B vaccine • If mother of a newborn is HBsAg "-" (negative), the child may begin vaccination during the first months of life, or combined with vaccination against pertussis, diphtheria, tetanus, polio. The recommended scheme is: 3-4-5-18 months, or: 3-4-9 mo. • Newborns weighing <2000 g born by HBsAg negative mothers, vaccination is done when the child’s weight will be 2000 g or at the age of 1 mo. • If the newborn child is in critical condition, the child immunization should be done when he will be better before hospital discharge. • Vaccination against viral hepatitis B of newborns, whose mothers are carriers of HBsAg, is necessary to do by the accelerated scheme: 0-1-2 and 12 mo.

16. Vaccinations for the prevention of diphtheria, tetanus and pertussis • in the age 3, 4 and 5 months by diphtheria-tetanus-pertussis vaccine (DTP), or vaccine with acellular pertussis component (DTaP) • The interval between the first and second, second and third vaccination is 30 days, the interval between the third and fourth vaccination should be not less than 12 months. • The first booster at 18 months is done by DTaP. • The second and third booster at 6, 14 years is done by DT. • The first adult booster vaccination should be made by DT-M at interval of 5 years after the last vaccination. Further booster vaccinations for adults by DT-M with a minimum 10 years interval from the previous vaccination.

17. For the prevention of diphtheria, tetanus, pertussis, polio, hepatitis B and infections caused by bacteria Haemophilus influenza type b (Hib), you can use the combined vaccine

18. Inactivated vaccine to prevent polio (IPV) is used for the first two immunizations oral polio vaccine (OPV) is used for 3 - 6th vaccination (third vaccination and age revaccination) with no contraindications to OPV. After the OPV is proposed to restrict injections, parenteral intervention, routine operations for 40 days, exclude contact with HIV-infected

19. Vaccination to prevent Hib-infection • can be done by mono- and combined vaccines containing Hib- components. • It is advisable to use combined Hib-vaccines for primary vaccination.

20. Vaccination to prevent measles, mumps and rubella • by the combined vaccine (hereafter - MMR) at the age of 12 months. • The second vaccine to prevent measles, mumps and rubella - in 6 years. • Kids who were not vaccinated vaccination can begin at any age before 18 years (2 doses with the minimum spacing between them). • Children age 15 who received 1 or 2 vaccinations against measles, but not vaccinated against rubella and mumps and didn’t ill with these infections, vaccinations against mumps (guys) or rubella (girls) is scheduled. • 18-teens or older who have not previously been vaccinated can be vaccinated with one dose before 30 years.

21. Recommended vaccinations • Varicella zoster • Hepatitis A • Hepatitis B • Flu • Pneumococcal infection

22. Passive immunization is indicated • To children with insufficient antibodies syntheses as a result of congenital or acquired cellular defects of В-lymphocytes. • At absence of vaccines against infection, when single way of protection is introduction of ready antibodies. • If required immediate preventive maintenance of the disease for epidemiological causes (the contact with sick on measles, preventive maintenance of rabies, tetanus). • For neutralization of the antigen-toxin by specific antitoxic antibodies. • With medical purpose at the beginning of the diseases (at diphtheria, botulism, tetanus).

23. Vaсcinal process • is a change of homeostasis, which appears in organism in response to introduction of vaccinal preparation and include the complex of reactions to which belongs: formation of antibodies, adaptation and postvaccinal reactions, postvaccinal complications.

24. Vaccinal reactions • appear in response to entering the vaccines, are characterized by appearance of clinical manifestations typical to this type of vaccine, which have a round-robin duration, are short, do not cause serious changes of vital activity in the organism.

25. Vaccinal reactions • Increased temperature to 39˚ C. • Increased temperature over 39˚ C (severe total reaction). • Temperature, which is not registered in medical documentation. • Pain, soft tissue swelling > 50 mm, hyperemia in the place of injection > 80 mm, infiltration > 20 mm (severe local reaction). • Lymphadenopathy. • Headache. • Irritability, sleep disturbance. • Non allergic rash. • Anorexia, nausea, abdominal pain, indigestion and diarrhea. • Catarrhal phenomena. • Myalgia, arthralgia.

26. Postvaccinal complications • - all pathological phenomena, which appear after vaccination and are not inherent to the usual vaccinal process, but obvious, their relationship with performed vaccination: • 1. Postvaccinal unusual reactions and complications, caused strictly by vaccine ("true"). • 2. Joining of intercurrent infections in postvaccinal period. • 3. Exacerbation of chronic diseases and primary manifestations of latent diseases.

27. Complication of vaccination

28. Angioneurotic edema (Quincke’s edema)

29. urticaria(hives)

30. Stevens-Johnson’s syndrome

31. Lyell’s syndrome

32. DTP-vaccine

33. OPV-vaccine

34. MMR vaccine

35. BCG-Vaccination

36. Main rules of vaccination • Take allergic history • Take life history • Take history of vaccination • Take family history • Do objective exanimation of the child • Take temperature of the body • Do vaccination at special room • Follow the instruction of vaccine • Supervise the vaccinated person for 30 days

37. CONTRAINDICATIONS TO THE VACCINATION by all vaccines and toxoids • Severe complications from the previous dose in the form of anaphylactic shock. • Allergy to any vaccine component. • Progressive diseases of the nervous system, hydrocephalus in decompensation stage, epilepsy, epileptic syndrome with convulsions 2 times a month and more often. • Acute illness or chronic disease exacerbation

38. CONTRAINDICATIONS TO THE VACCINATION by all live vaccines Congenital combined immune deficiency, primary hypogammaglobulinemia (entering the vaccine is not contraindicated in selective Ig A and Ig M immunodeficiency), transitional hypogammaglobulinemia malignant tumors, pregnancy, AIDS, immune suppression therapy

39. CONTRAINDICATIONS TO THE BCG-VACCINATION • baby weight less than 2000 g: • 1500 - 1999 g vaccinations are not done up to 1 month. • 1000 - 1499 g - up to 2 months. • Complicated reactions to previous vaccine (adenitis, cold abscess, skin ulcers over 10 mm in diameter, kelloid scar, osteomyelitis, generalized BCG infection). • Tubinfection. • Defects of phagocytosis

40. CONTRAINDICATIONS TO THE VACCINATION • OPV • Children whom live vaccine is contraindicated, as well as to members of their families is recommended vaccination by polio inactivated vaccine (IPV) • DTP • A history of convulsions (instead DTP vaccine - DTaP vaccine or DT toxoid is injected)

41. CONTRAINDICATIONS TO THE VACCINATIONS By living vaccine against measles, living mumps vaccine, vaccine against rubella or trivaccine (measles, mumps, rubella) • Allergic reactions on Aminoglucosides • Anaphylactic reactions on eggs protein