C h i l d h o od I m m u n i z a t i o n

1. Childhood Immunization Directed by: Dr.J. Halazoun Presented by : Dr.Y. Abu Zanouna

2. Childhood Immunization • Definitions & General Concepts • Immune Response & Its Determinants • Safety of Immunization • Standards for child and adolescent immunization practices. • Post exposure Immunoprophylaxis. • Passive Immunization.

3. Immunization : WHY ?? • Immunization is a remarkably successful & very cost effective means of preventing infectious diseases. • A leading achievement of public health & pediatrics • It is either to prevent primary infection or secondary consequences of infection

4. Immunization…. • Routine childhood immunization : • Resulted in a decline & global eradication of previously common contagious diseases: • Smallpox • Wild type poliovirus • Hib • Congenital rubella,tetanus, diphtheria • Rubella , measles

5. Recommendations : Want to be Updated?? • Morbidity & Mortality Weekly Report, Published weekly by the Centers for Disease Control & Prevention( CDC ): ACIP • The Red Book: Report of the Committee on Infectious Diseases: AAP

6. Definitions • Vaccination : Administration of any vaccine or Toxoid for prevention of disease. • Immunization: The process of inducing immunity artificially. • Active Immunization: Stimulating the immune system to produce antibodies & cellular elements against an infectious agent. • Passive Immunization: The acquisition of readily formed antibodies ( Transplacental transmission, immunoglobulin administration)

7. Immunizing Agents: • Vaccine: A preparation of proteins , polysaccharides, or nucleic acids that are delivered to the immune system as single entities, part of a complex,or by live attenuated agents or vectors to induce specific responses that inactivate , destroy or suppress the pathogen.

8. Immunizing Agents • Toxoid : A modified bacterial toxin that has been made non-toxic but retains the capacity to stimulate the formation of antitoxin. • Antitoxin : An antibody derived from the serum of humans or animals after stimulation with specific antigens ,used to provide passive immunity.

9. Immunizing Agents • Immunoglobulin: An antibody-containing solution derived from human blood by fractionation of large pools of plasma and used primarily for the maintenance of immunity of immunodefficient persons or for passive immunization.

10. IMMUNIZATION….. • Active immunization: • Live attenuated (M,M,R) • Inactivated,killed • Whole cell ,Hep A • Purified proteins ( HepB, aP ) • Polysaccharides (Meningococcal ) • Conjugated (Hib , pneumococcal) • organism components ( Influenza subunits ) • detoxified (tetanus ,Diphtheria) • Recombinant products (Hep B )

11. Constituents of Vaccines • Preservatives,stabilizers,antibiotics: • Inhibit or prevent bacterial growth,allergic reaction may occur to any of these. • Adjuvants : • Enhance the immune response ( aluminum salts ) • Suspending Fluid : • Sterile water , saline or biologic system in which agent is produced ( egg ag, cell culture ingredients , serum proteins )

12. Determinants of the Immune Response • To vaccinate a whole population efficiently , a vaccine must contain epitopes that are processed & bound to the product of at least one MHC allele in most individuals .

13. Determinants of response: • Genetics • Chemical &Physical state of antigen • Mode of administration • Catabolic rate of antigen • Host factors • Age , nutrition, gender, preexisting immunity • Route of administration

14. Immune response to vaccine agents • Antibody Response : • Inactivating ( antitoxins) • Facilitate phagocytosis ( opsonins) • Interact with Complement (Lysins) • Prevent proliferation ( neutralizing ab) • Antiadhesins • Cellular response : • T – dependant • T- Independent

15. Immune Response ….. • The primary response : • Latent period • Antibodies are detected 7-10 days • Early IgM : complement fixation. • IgG: 2nd week, peaks 2-6 weeks • Oral live vaccines : secretory IgA

16. Immune response…… • Secondary response; • Upon A second exposure to ag • Rapidly within 4-5 days • Immunologic memory : T-dependant • Response is assessed by serum concentration of antibodies • Cellular immunity is difficult to assess • Lack of serum ab does not necessarily mean lack of protection • Immune system stimulation with no antibody production may result in unanticipated response.

17. Safety of Immunization: • Vaccine Factors: • Licensed by FDA • Viral & bacterial contamination • Vaccine administration: • Disposable syringes vs.reusable glass syringes. • 70% alcohol solution • All vaccines containing an adjuvant should be given IM to avoid granuloma or necrosis. • Given in the antlat. Of thigh < 18 months, deltoid or triceps in older children • Aqueous vaccines may be given IM , SQ , ID

18. Vaccine factors • It is safe to administer many combinations of vaccines simultaneously. • Inactivated vaccines can be given together or at any time after different vaccines. • Live-virus vaccines,if not on the same day , should be given at least 30 days apart. • If Ig has been administered , live vaccines should be delayed 6-10 months to avoid interference with immune response

19. Host Factors: • Healthy Children: • Minor acute illnesses,with or without fever , are not contraindications to vaccination. • Moderate to severe febrile illness maybe a reason to postpone vaccination. • Routine P/E and Taking Temp are not necessary in healthy children.

20. Children with Chronic Illnesses • Most chronic diseases are not contraindications to vaccination • Premature Infants should be immunized according to their chronological age ,not gestational age. • Vaccine doses should not be reduced for preterm or LBW infants. • Vaccination May be avoided in those with a progressive CNS disorder.

21. Immunodeficient Children • Congenital Immunodeficient children: Not to be vaccinated with live vaccines • Other vaccines may be safe , yet they may fail to evoke a proper immune response. • Children with cancer,on steroids ,or Immunosuppressive agents are not to receive live vaccines. • Exceptions: • Malignancy in remission, Chemotherapy 90 days prior to vaccine. • Low – moderate dose of steroids < 14 d • Physiologic steroid replacement • topical., inhaled or IA steroids

22. Immunodeficient Children • HIV : MMR are recommended, OPV & varicella are not. • Siblings & contacts of ID patients : • OPV vs. IPV • MMR

23. Breast Feeding • Human milk does not adversely affect the immune response to any vaccine & is not a contraindication to vaccination • Live virus vaccines are not excreted in breast milk • Breast feeding mothers may receive any vaccine safely

24. Allergic or Hypersensitive Children • Hypersensitivity reactions are rare following vaccination. • MMR, IPV ,VZV contain microgram amounts of neomycin,IPV contains polymyxin B. • M &M ,Influenza & yellow fever : contain egg antigens. • MMR ,Varicella , Yellow fever : gelatin. • Skin testing may be done if nature of immune reaction is unknown.

25. List of Revised Standards for Child and Adolescent Immunization Practices • Availability of Vaccines • Vaccination services are readily available. • Vaccinations are coordinated with other healthcare services and provided in a medical home when possible. • Barriers to vaccination are identified and minimized. • Patient costs are minimized.

26. Assessment of Vaccination Status • Healthcare professionals review the vaccination and health status of patients at every encounter to determine which vaccines are indicated. • Healthcare professionals assess for and follow only medically indicated contraindications.

27. Effective Communication about Vaccine Benefits and Risks • Parents/guardians and patients are educated about the benefits and risks of vaccination in a culturally appropriate manner and in easy-to-understand language. • Persons who administer vaccines and staff who manage or support vaccine administration are knowledgeable and receive ongoing education. • Healthcare professionals simultaneously administer as many indicated vaccine doses as possible.

28. Proper Storage and Administration of Vaccines and Documentation of Vaccinations • Healthcare professionals follow appropriate procedures for vaccine storage and handling. • Up-to-date, written vaccination protocols are accessible at all locations where vaccines are administered.

29. CONTINUE…. • Vaccination records for patients are accurate, complete, and easily accessible. • Healthcare professionals report adverse events following vaccination promptly and accurately to the Vaccine Adverse Events Reporting System (VAERS) and are aware of a separate program, the National Vaccine Injury Compensation Program (NVICP). • All personnel who have contact with patients are appropriately vaccinated.

30. Implementation of Strategies to Improve Vaccination Coverage • Systems are used to remind parents/guardians, patients, and healthcare professionals when vaccinations are due and to recall those who are overdue. • Office- or clinic-based patient record reviews and vaccination coverage assessments are performed annually. • Healthcare professionals practice community-based approaches.

31. Post exposure Immunoprophylaxis • For certain Infections,active or passive immunization shortly after exposure can prevent or ameliorate disease. • Rabies : Rabies Vaccine & RIG • Varicella: VZIG & vaccine • Measles :Vaccine & IG • Tetanus,Hep a , Hep B

32. Passive Immunization • Ig : IV , IM . • Hyperimmunoglobulins • VZIG • RIG • HBIG • CMVIG • RSV- IGIV • Hep A

33. THANK YOUALL !