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Preventive Pediatrics

Preventive Pediatrics. Celia T. Sy, M.D. Pediatric Pulmonologist Department of Pediatrics Fatima Medical Center. Immunization Vaccinations Type of vaccine Route of administration Immune response Post- exposure drug prophylaxis. Immunization.

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Preventive Pediatrics

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  1. Preventive Pediatrics Celia T. Sy, M.D. Pediatric Pulmonologist Department of Pediatrics Fatima Medical Center

  2. Immunization • Vaccinations • Type of vaccine • Route of administration • Immune response • Post- exposure drug prophylaxis

  3. Immunization • Denotes the process of inducing or providing immunity artificially by administering an immunologic substances • Active • Passive

  4. Active Immunization • When it produces the desired beneficial effects by stimulation of endogenous antibody production by the patient • Tetanous toxoid • MMR • BCG

  5. Passive Immunization • Administration of preformed human or animal antibodies to individuals already exposed or about to be exposed to certain infectious agents • Tetanus antitoxins • Immune globulins

  6. Vaccination • Denotes the physical act of administrating any vaccine or toxoids

  7. Immunobiologic Substances • Vaccine - a suspension of live or inactivated microorganism or fractions thereof administered to induce immunity and prevent infectious disease or its sequela • Toxoid – modified bacterial toxin that has been made nontoxic but retains the ability to stimulate the formation of antitoxins

  8. Antitoxins – a solution of antibodies derived from the serum of animals immunized with specific antigens • Passive immunization • Diphtheria antitoxin • Tetanus antitoxin

  9. Immune globulin (IG) - a sterile solution containing antibodies from human blood. Intended for IM use • for passive immunization • Measles immune globulin • hepatitis b immune globulin

  10. IV IG – a product derived from blood plasma from the donor pools similar to the IG pool but prepared for IV used • Used in primary antibody-deficiency disorders • Kawasaki disease • ITP • Hypogammaglobulinemia

  11. Immunologic Constituents • Suspending fluids – sterile water, saline • Preservatives, Stabilizers, Antibiotics • used to inhibit or prevent bacterial growth • Stabilize the antigens or antibodies • albumin, phenols, neomycin, mercurial • Adjuvants – evoke suboptimal immunologic response • To enhance immunogenicity • Al hydroxide, Al phosphate

  12. Live vaccines BCG MMR Oral polio Varicella Oral typhoid Killed antigens Toxoids DPT Tetanus Vaccines & Toxoids

  13. Killed antigens Inactivated Virus IPV (inactived polio virus) Influenza Rabies Hepatitis A Hepatitis B Killed antigens Bacterial polysaccharide Hib

  14. Intramuscular (IM) DPT IPV (as DPT-IPV-HIB combination)* Hep A & B HiB Influenza Pneumococcal Meningococcal Typhoid Subcutaneous (SC) Measles Mumps Rubella MMR Varicella IPV Pneumococcal Meningococcal Route of Administration

  15. Oral OPV Typhoid Intradermal BCG Route of Administration

  16. Where to inject? General rules: • For children < 1 year old – lateral thigh • For children > 1 year old - deltoid • Buttocks should not be used for active vaccinations because of the potential risk of injury to the sciatic nerve • If the buttocks are to used – use only the upper outer quadrant

  17. Fever:To give or not to give? • Minor febrile illness or malnutrition is not a contraindication to immunization • Immunization is deferred in the presence of severe febrile illness

  18. Vomiting:What to Do? • Regurgitated oral vaccine • If the child vomit or regurgitate within 5 – 10 mins after giving OPV – another dose should be given at the same visit • If repeated dose is not retained, re-administered at the next visit

  19. Diarrhea:Could OPV be given? • Diarrhea should not be considered as a contraindication for OPV but to ensure full protection, doses given to children with diarrhea SHOULD NOT BECOUNTED as part of the series

  20. Need to give 2 or more vaccines:How to give? • Multiple vaccinations • Administer each vaccine at a different site using different needles and syringes • If > 1 vaccine is to be used in a single limb, use the thigh muscle and given at 1 -2 inches apart

  21. Interruption of ScheduleWhat to do? • Interruption with a delay between doses does not interfere with the final immunity achieved • No need to start the series again

  22. Contraindications? • Live attenuated vaccines is contraindicated in: • Pregnant woman • Immunocompromised person – leukemia, lymphoma, malignancy, therapy with steroids, alkylating agents, antimetabolites • Radiotherapy

  23. Trivia • Which of the following are live vaccines? DPT Measles TOPV Pneumococcal IPV Meningococcal BCG Oral Typhoid Hep B MMR

  24. Guidelines for Giving Live vaccines and killed Antigens • 2 or more killed antigens – may be administered simultaneously or at any interval between doses • Example: • DPT and Hep B • DPT and Hib • Hep A and Hep B

  25. Killed and live antigens – may be administered simultaneously or at any interval between doses • Example: • DPT and OPV • Hep b and MMR • DPT and Measles • DPT and varicella

  26. 2 or more live antigens – may administered simultaneously or at 4 week minimum interval if not given simultaneously • Example: • Measles and varicella • MMR and varicella ** OPV can be administered at any time before, with or after MMR if indicated

  27. Guidelines for administration of IG & Vaccines • Simultaneous administration • IG and killed antigen – given at the same time or at any time between doses • Hepatitis B immune globulin and hepatitis B vaccine • Tetanus antitoxins and anti-tetanus vaccine • IG and live antigen – should generally NOTBE ADMINISTERED simultaneously

  28. Guidelines…IG & Vaccines • Non-simultaneous administration First Second IG Killed Ag No interval needed IG Live Ag dose related Killed Ag IG No interval needed Live Ag IG 2 weeks

  29. Interval between IG & Live Measles Vaccine • IVIG Interval • ITP 400 mg/kg 8 month • ITP 1000 mg/kg 10 months • Kawasaki 11 months • Blood transfusion • Whole blood & packed RBC 6 months • Plasma/platelets 7 months

  30. Interval…IG & live measles vaccine • IG measles prophylaxis • Normal contact 0.25ml/kg 5 mons • Immunocompromised 0.50ml/kg 6 mons

  31. Trivia • Which of the following vaccines can be given simultaneously? • Hep B & Measles • BCG & DPT • Oral polio & measles • DPT & MMR • Measles & MMR • DPT & IPV + HiB

  32. Immune Response • Immune response to one live virus vaccine might be impaired if administered within 30 days of another live virus vaccine • Only OPV and MMR can be administered at anytime before, with or after each other

  33. Immune Response • Live virus vaccines can interfere with the response to a tuberculin test • Tuberculin testing can be done either on the same day that live virus vaccines are administered or 4 – 6 weeks later

  34. Special Conditions…Special Considerations • Persons with hemophilia • Increased risk of hepatitis B & hematomas • Assess the patient’s bleeding risk • Use fine needle & apply pressure to the site

  35. Special considerations… • Altered immunocompetence • Killed or inactivated vaccines can be administered to all immunocompromised patients • OPV should not be given to any household contacts of an immunocompromised patient • IPV can be given

  36. Special considerations…. • Altered immunocompetence • MMR is not contraindicated to close contacts of immunocompromised persons • MMR vaccine is recommended for all asymptomatic HIV-infected persons and should be considered for all symptomatic HIV-infected persons

  37. Special consideratios… • Preterm infants • Regardless of birth weight should be vaccinated at the same chronological age and according to the same schedule • Use full recommended dose except BCG • OPV should be deferred until discharge from the nursery

  38. Special considerations… • Pregnancy • Combined tetanus and diphtheria toxoids ARE THE ONLY vaccine indicated

  39. Vaccines • BCG (Bacille-Calmette-Guerin) • Attenuated bovine strains of tubercle bacilli • Route: intradermal • Dose: 0.05 ml preterm 0.1 ml term • Complications • Abscess • Indolent ulcer • lymphadenopathy

  40. Normal course Wheal diappear in 30 mins Induration – after 2-3 wks Pustular formation – after 4 – 6 wks Full scarification – after 6 – 12 wks Accelerated reaponse – 91-100% correlation with TB infection Induration – after 2 – 3 days Pustular formation – after 5 – 7 days Scar – after 2 -3 wks BCG

  41. OPV – live attenuated vaccine IPV – inactive polio virus Combination vaccine: DPT + IPV + Hib Polio vaccine

  42. DPT • Toxoids of diphtheria & tetanus; inactivated pertussis component adsorbed into aluminum salts • Dose: 0.5 ml • Route: IM • Side effect: swelling at injection site

  43. DTaP • Diphtheria, tetanus, acellular pertussis component • Decrease risk of neuroparalytic reactions due to component of pertussis

  44. Measles • Live attenuated vaccine • Freeze dried • Dose: 0.5 ml SQ • Side effects: fever between 5th-14th day after injection, rashes, arthritis • Prophylaxis: may be given within 72 hours after measles exposure • Measles IG – 0.25 ml/kg IM may be within 6 days of exposure

  45. Hepatitis B Vaccine • Infant born to HBs Ag-positive mother should received: • Hep b Vaccine + Hep B immune globulin (HBIG) within 12 hours of birth at different site • Next dose: Hep B at 1-2 months of age and 3rd dose at 6th month of age • Schedule: 0, 1, 6

  46. Hepatitis B Vaccine • Infant born to mother whose HBsAg status is unknown: • Hep B vaccine within 12 hours of birth • Request for mother’s HBsAg status – if (+) Infant should received HBIG Asap (no later than 1 week of age)

  47. BCG DPT, TOPV, IPV, Hib Hepatitis B Measles At birth or anytime after birth 2, 4, 6 month of age 0, 1, 6 month of age 0, 1, 3 month of age (endemic country) 9 month of age ( can be given at 6 month of age) Recommended Schedule

  48. MMR Hepatits A Pneumococcal (IPD 7 valent) Pneumococcal (23-valent) Meningococcal Typhoid 15 month of age After 1 year of age 2, 4, 6 months up to 9 years of age 2 years of age 2 years of age 3 years of age Schedule….

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