Vaccination

QUICK RECAP

karim saeed
 Immunization means protection.
The most effective and safe way to protect children from contagious
diseases is by vaccination.

Vaccine Preventable Diseases

• Tetanus
• Diphtheria
• Pertussis (Whooping Cough)
• Hemophilus influenza type b (Hib)
• Polio
• Hepatitis A
• Hepatitis B
• Rotavirus
• Mumps
• Measles
• Rubella (German Measles)
• Varicella (Chickenpox)
• Pneumococcus
• Meningococcus
• Influenza
• Human Papilloma Virus (HPV)

Vaccine Safety
• Vaccination never been proven associated with autism
• In 2010, Lancet retracted the 1998 article was initial paper linking MMR
with autism
• There are multiple web-based sites that have false information
• regarding vaccine risks

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Vaccine Formulation
• All vaccine components undergo a process rendering them incapable of
causing a disease.
• The components that protects against Polio undergo a process to
neutralize the active virus.
• The components that protect against tetanus and diphtheria are proteins
secreted by bacteria (causing symptoms to appear).Toxins, which
undergo decontamination and weakening. This enables the body to
protect itself against diseases, even though those proteins are no longer
toxic.
• The components that protects against pertussis comprise of isolated and
purified antigens of pertussis bacteria and do not contain bacteria
cells.
• The component against haemophilus influenza B comprises of parts of
bacteria membrane that are joined to a protein by conjucation, which
prolong the vaccine's shelf life.

Possible Side-Effects of the Vaccine

• Side-effects are usually mild, are not dangerous and are transient,
and appear in less than 10% of vaccine recipients.
A) Local side-effects
➢ Redness,
➢ Pain and swelling in the region of the injection
➢ swelling along the entire limb.
➢ These side-effects appear a short time after the vaccine is given,
usually within 24 hours.
B) General side-effects:
➢ Nausea, vomiting
➢ Lack of appetite
➢ prolonged crying
➢ diarrhea
➢ restlessness
➢ somnolence and fever.

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 C) Very rare side-effects:
➢ Joint pain
➢ muscle pain
➢ enlarged lymph glands
➢ allergic skin reactions

• Rarely, convulsions appear 2-3 days after the time of the vaccine,
usually accompanied by fever. These convulsions are not considered
to be dangerous, and they do not cause permanent neurological
damage.
• A severe sensitivity reaction anaphylaxis is extremely rare

General Guidelines for All Vaccines

• In case of the appearance of effects that were not described, seek
medical or nursing advice.
• Report to the nurse any side-effects that the child underwent at
previous vaccinations.
• It is important to make sure to carry out the routine vaccination
program for each child, at the recommended times in accordance
with age, with no changes or deviations so far as is possible.
• As a rule, a baby with acute illness with a temperature of over 38
degrees should not receive a vaccine.
• It is important not to withhold a vaccine for the wrong reasons such as:
➢ mild illness with no fever,
➢ with fever of under 38 degrees
➢ A mild infection of the upper respiratory tract (cold)
➢ mild diarrhea
➢ local infection

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DIPHTERIA • Caused by Corynebacterium diphtheriae
• Incubation 2-5 days
• Early: malaise, sore throat, difficulty in swallowing, loss
of appetite, hoarseness, mild fever
• Within 2-3 days :adherent, gray membrane on oral
mucous membranes
• Extensive membrane :life-threatening airway
obstruction.
• Toxin : serious systemic complications including
myocarditis
• Death rate 5%-10%
TETANUS • Spread by contact with soil containing bacterium
Clostridium tetani
• Most infections from contaminated wounds
• incubation 1-2 weeks
• Not contagious
• Produces exotoxin
• 1-2 weeks after infection : progressive muscle
tightening, descending pattern
✓ Trismus (lockjaw)
✓ Neck stiffness
✓ Difficulty swallowing
✓ Abdominal muscle rigidity
• Neonatal tetanus due to no maternal immunity and
cutting the umbilical cord with contaminated
instrument (e.g. bamboo in Haiti)
PERTUSSIS • Symptoms: can last several weeks
✓ Severe coughing
✓ Whooping
✓ Post-tussive vomiting
• 1 in 10 cases develop pneumonia
• 1 in 50 cases develop convulsions
• 1 in 250 cases develop encephalopathy

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 DTaP

Formulation
➢ Diphtheria
➢ Tetanus
➢ Acellular pertussis

Times the vaccine is given

• Primary series
➢ 2, 4, 6 months
➢ 12-18 months (at least 6 months from the 3rd dose)
➢ 4 years
• 12-14 years Tdap
• Then Td boosters every 10 years

Contraindications
Severe allergic reaction
➢ e.g., anaphylaxis
➢ after a previous vaccine dose or to a vaccine component
Encephalopathy
➢ e.g., coma, decreased level of consciousness; prolonged seizures
➢ not attributable to another identifiable cause
➢ within 7 days of administration of previous dose of DTP or DTaP
Progressive neurologic disorder
➢ infantile spasms
➢ uncontrolled epilepsy
➢ progressive encephalopathy
➢
Defer DTaP until neurologic status clarified and stabilized

Capital letter denotes full dose vaccine • Small “a” for acellular •
Compared to Td or Tdap • Small letter denotes half dose vaccine for
booster effect • Diphtheria and Pertussis vaccines only given as
combination with Tetanus

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Situations not to Administer DTaP
• Temperature of <105°F (<40.5°C) after dose
• Fussiness after dose
• Mild drowsiness after dose
• Family history of seizures
• Family history of sudden infant death syndrome
• Family history of an adverse event after vaccine
• Stable neurologic conditions
➢ cerebral palsy
➢ well-controlled seizure disorder
➢ developmental delay

POLIOMYELITIS • Very infectious virus

• Up to 95% of people infected with polio have no
symptoms
• 4-8% minor symptoms –fatigue, myalgias, stiffness
• <1% have paralysis from virus attacking motor
neurons

Polio vaccines

there are two vaccines Sabin (oral polio OPV) and Salk (inactivated
injectable IPV)
For IPV:
• 4 dose series
➢ 2, 4, 6-18 months
➢ Booster at 4 years

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 • Dose 4 must be 6 months after 3rd dose
• If dose 3 is after 4 years old and >6 months from dose 2, a 4th
dose is not needed
• If 4 doses received prior to 4 years old, a 5th dose is required

Hepatitis B vaccine

Vaccine Formulation
contains the viral envelope only, and is produced by a genetic engineering
method.

Times the Vaccine is Given

During the baby’s first year: After birth (in hospital), at the age of one month
and at the age of half a year.

*Possible Side-Effects of the Vaccine

• This vaccine is considered to be one of the safest vaccines.
• For a small proportion of people receiving the vaccine:
A) local side-effects
➢ Redness,
➢ pain and swelling at the injection site.
B) General side-effects
➢ Fever, headache,
➢ muscle and joint pain,
➢ dizziness,
➢ reduce appetite, nausea, abdominal pain,
➢ defective liver function
➢ rash.

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C) Very rare side-effects
➢ Enlarged lymph glands,
➢ disorders of the central and peripheral nervous system.
➢ Disorders of the Production of blood platelets for coagulation,
➢ arthritis.
Must be given for baby of a mother positive for hepatitis B

Pneumococcal vaccine (Prevenar)

The vaccine against pneumococcus bacteria is targeted at the 13 most

widespread strains of pneumococcus bacteria in children.
The vaccine also decreases the size of the pool of infected persons,
thus preventing the bacteria from being passed on to family members.

Vaccine Formulation
The vaccine contains components of the bacterial capsule linked to a
protein by modern methods, effecting long term immunity.

Times the Vaccine is Given

➢ During the first year of the baby’s life
➢ at age two months, four months and one year

Vaccinating Children who Belong to Groups that are at

Particularly High Risk
Some children that are at high risk of developing serious illnesses caused by
pneumococcus, must receive extra doses. The number of doses correlates
with age.
Groups with high risk are:
• Disorders of spleen function, having no spleen, and sickle cell
anemia.
• Chronic Prolonged heart or lung disease.
• Diabetes.
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 • Disorders of the immune system due to:
➢ malignant diseases,
➢ treatment that suppresses the immune system,
➢ AIDS and any condition accompanied by disorders of the immune
system.
• Organ transplants and bone marrow transplants.
• Implant in the inner ear (cochlear implant).
• Leakage of spinal fluid.
•After the Prevenar vaccination is completed, it is recommend that children
who belong to groups that are at risk receive an additional vaccine of
another type against pneumococcus - polysaccharide vaccine. This
vaccine is given from age two years

Hepatitis A vaccine

vaccine Formulation
The vaccine against hepatitis A is produced from killed virus.

Times the Vaccine is Given

•At the age of one and a half years
•At the age of two years

*Possible Side-Effects of the Vaccine

The reactions could appear in the initial days after the vaccine, and they
resolve within a small amount of time (24 hours).
For a small proportion of people receiving the vaccine,:
local side-effects are possible:
➢ Local sensitivity,
➢ redness, swelling and firmness in the region of the injection.
➢ These side-effects resolve within a small amount of time.

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General side-effects(very rare)
➢ fever, fatigue, headache,
➢ muscle pain, joint pain,
➢ nausea, vomiting,
➢ loss of appetite and diarrhea.

Hemophilus •Prior to vaccine, Hib was leading cause of childhood:

influenza B ➢ Bacterial meningitis
(HiB) ➢ Epiglottitis
➢ Pneumonia
➢ Empyema
➢ Pericarditis
➢ Bacteremia
➢ Septic arthritis
2 vaccines available
o 3-dose series (PedvaxHIB)
o 4-dose series (ActHIB)
Vaccines are interchangeable
o If changed at 2 or 4 months of age, need a 6-month dose of
either vaccine
o Either vaccine may be given for the 12-month booster dose
Cannot give any form of Hib to infants less than 6 weeks old
o Have decreased immune response to polysaccharide capsule
(PRP) of Hib
o May also prevent future ability to develop antibodies

*PedvaxHIB
❖ Hemophilus influenza type b vaccine
❖ Antigen conjugated to Meningococcal Group B outer membrane
protein (PRP-OMP)
❖ 2-dose primary series + booster
❖ 2, 4 months primary and 12-15 month booster
❖ Also comes in a combination vaccine with Hepatitis B (Comvax)

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 *Act-HIB
➢ Hemophilus influenza type b vaccine
➢ Conjugated to tetanus toxoid (PRP-T)
➢ 3-dose primary series plus booster
➢ 2, 4, 6 months primary and booster at 12-15 months
➢ Also comes in 2 combination vaccines
• With DTaP, and IPV (Pentacel) Primary series
• With DTaP (TriHibIt) Booster dose only

Vaccine against
Rotavirus

The vaccine against rotavirus is given by mouth, not by injection,

The vaccine is very effective in preventing diarrhea and vomiting due to
rotavirus (the main cause of diarrhea that involves hospitalization),
but does not prevent diarrhea or vomiting due to other causes.
It is worthwhile for all babies to receive the vaccine, including those babies
who have suffered infection caused by rotavirus.
The vaccine has been in use internationally since 2006, and has proved
itself since then to be highly effective and safe.

Vaccine Formulation
➢ The vaccine contains 5 attenuated strains of rotavirus. The strains
have been attenuated (weakened) by passing them through cultures.
➢ The vaccine is called RotaTeq OR ROTARIX

The Times that the Vaccine is Given

The vaccine is given during the first year of the baby’s life at the following
ages:
➢ First dose at the age of two months.
➢ Second dose at the age of 4 months.
➢ Third dose at the age of 6 months.

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 It is important to note:

• The first dose may be given from age 6 weeks, until age 14 weeks
and 6 days.
• The last dose may be given until the age of exactly 8 months. The
time interval between doses must be at least 4 weeks.
• The vaccine can be given together with other vaccines.

*Possible Side-Effects of the Vaccine

• Most babies take the vaccine well, with no side-effects.
• If there are side-effects, they are mild:
➢ restlessness,
➢ mild and transient diarrhea,
➢ vomiting after a dose of vaccine.

Contraindications
➢ A baby with an acquired defect of the immune system (HIV or AIDS) or
a congenital defect of the immune system for other reasons.
➢ A baby who has suffered from intussusception

Influenza vaccine
The Ministry of Health recommends vaccinating the entire population against
Influenza annually, starting six months of age.

Vaccination Guidelines
The vaccination guidelines of the Epidemiology Division is intended to aid in
the implementation of the vaccination plan, and serves as a guide
regarding the practicalities of vaccination, aimed at the medical staff.

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Measles • Measles starts as
➢ fever,
➢ cough,
➢ runny nose, conjunctivitis (pinkeye),
➢ a red, pinpoint rash that starts on the face
and spreads to the rest of the body.
• If the virus infects the lungs, it can cause
pneumonia.
• Measles in older children can lead to
inflammation of the brain, called encephalitis,
which can cause seizures and brain damage.
Mumps • The mumps virus usually causes swelling in
glands just below the ears, giving the
appearance of chipmunk cheeks.
• Before the vaccine, mumps was the most
common cause of both meningitis(inflammation
of the lining of the brain and spinal cord) and
acquired deafness in the U.S.
• In men, mumps can infect the testicles, which can
lead to infertility.
Rubella (German • It can cause
measles) ➢ a mild rash on the face,
➢ swelling of glands behind the ears,
➢ in some cases, swelling of the small joints
➢ low-grade fever.
• Most children recover quickly with no lasting
effects.
• But if a pregnant woman gets rubella, it can be
devastating.
• If she's infected during the first trimester of
pregnancy, there's at least a 20% chance her
child will have a birth defect such as
➢ blindness,
➢ deafness,
➢ a heart defect
➢ intellectual disabilities.
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 MMR Vaccine
➢ Given at 12 months
➢ Booster at 4-6 years

Bacille Calmette-Guerin (BCG)

vaccination became compulsory in all governorates of Egypt in 1974.
It protects against Tuberculosis , given intradermal
Administration of intradermal BCG requires a highly trained staff, and use of
freeze-dried vaccine is preferable to ensure validity.
Independent retesting to evaluate the efficacy of BCG vaccine in
randomly selected groups by determining postvaccination conversion rates
of tuberculin, vaccination scars, and lymphadenopathy is
recommended.
Also suggested is the possibility of vaccinating entrants to primary school.
The medical service could then have more control over the vaccinations
and would be able to monitor more easily the methods used

The chickenpox vaccine

It is a shot that can protect nearly anyone who receives the vaccine from
catching chickenpox. It's also called the varicella vaccine, because
chickenpox is caused by the varicella-zoster virus.
The vaccine is made from a live but weakened, or attenuated, virus.
Viruses that have been attenuated are less virulent than viruses that are
not.
Although the virus in the chickenpox vaccine is generally incapable of
causing a disease, it still stimulates a response from the body's immune
system. That response is what gives someone who's had a shot for
chickenpox immunity or protection from the illness.

TIME FOR VACCINATION

AFTER 12 MONTH ------- booster AT 4-6 Y

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