immunization

Immunization?

 Is a remarkable successful and very cost effective means of preventing infectious diseases. ?

 Vaccination= is administration of any vaccine or toxiod for preventing the diseases ?

 Immunization=is processes of induction of vaccine (active ) or by Ab(passive) ?

 Active=celluler+Ab=long term protection ?

 Passive=temporary protection, by exogenous Abs(IgM)or by Tran placental (natural)=give protection in the 1st several months of life.

 In general vaccine are indicated at younger age group at which significant risk of diseases and its complication exist and at which protective immune response can be expected.

 Immunizing agents ?

 Vaccine=preparation of protein, polysaccharide, , or nuculer acid of pathogen. either attenuated (live) or killed M.O to induce specific response that inactivate , destroy, and suppress the pathogen. ?

Live=MMR, oral polio(Sabin), typhoid ,BCG. ? Is more antigenic , looks like natural infection ?

 Killed inactivated)=less antigenic, need booster doses to build good immunity. either whole MO(whole cell pertusis, HAV), detoxefied(tetenus and diphtheria), purified protein derivative a cellular type,HBV) , polysaccharide capsular meningococcal vaccine), capsular polysaccharide conjugated to the protein (Hib and pnuemoccocal ) ?

 Toxiod= modified bacterial toxin that had been not toxic but remain had capacity to produce immunity . ? Immunoglobulin(Ig)=Ab-containing solution, derived from human blood ?

Anti-toxin= Ab-containing solution, derived from serum of human or animal after stimulation of sp. Antigen 

. Factors affect the response of vaccine ? 1- chemical and physical state of Ag ? 2- the mode of administration of Ag(i.m, s.c, i.d)i.e(parental polio vaccine not induce mucosal Abs (IgA)where the oral polio vaccine are likely to do so. ? 3- the catabolic rate of Ag ? 4- host factor(age, nutrition, gender, preexisting Abs. ? 5- genetic determent of host . ? 6- the presence of high level of maternal Abs in the 1st few months of life and relative immaturity of immune system early in life will impair the initial response of certain vaccine(measles and MMR). ? 7- 2 types of Ag ?

A-thymus-dependent Ag =need interaction of B and T lymphocyte to produce immune response and is more immunogenic and can be given in the 1st 2years of life. ?

 B- thymus-independent Ag= generally no need of effect of thymus(T lymphocyte to produce immune response and is less immunogenic and can not be given in the 1st 2years of life Immunological reaction after vaccin ? Serum Abs can be detected after 7-10 days(IgM) then replaced by IgG, the secondary immune response become strong and heightened in 4-5days Expanded program of immunization(EPI 

? Is type of schedule of immunization used in developing country including our country. as follow ? 1st week BCG, zero dose of oral polio(OPV), and1st dose of hepatitis B

 ? 2ND month 2nd dose of hepatitis B, 1st dose of DTP, 1st dose ?

 4TH month 2nd dose of OPV, 2nd dose of DTP ?

 6TH month 3rd dose of OPV, 3rd dose of DTP,3rd dose of hepatitis B ?

 9TH month measles vaccine ?

 15th month MMR(measles, mumps, rubella) ?

 18-24th month 1st booster dose of OPV, and DTP ?

 4-6th year 2nd booster dose of OPV, and DTP, 1st booster dose of MMR ?

 11-12th year Td ,then every 10 year ? In USA, Rota virus vaccine(2,4,6 month), conjugated pnuemoccocal vaccine, hemophilius influenza type B, varicella, HAV, influenza vaccine ? In U.K, and Canada use meningococcal C vaccine, are routinely recommended, while BCG is not. BCG(Bacelli-Callmette-Guerine)= ?

 BCG vaccine

 is a lyophilized preparation of live, attenuated organisms of the Calmette-Guérin strain of Mycobacterium bovis that is used to stimulate active immunity to tuberculosis. ? In developing countries where tuberculosis is epidemic and short-term prophylaxis with ant tuberculosis agents (e.g., isoniazid) or tuberculin skin test screening is not possible, BCG vaccine is used routinely to attempt tuberculosis control. The World Health Organization currently recommends that BCG vaccine be administered by intradermal injection in the left deltoid region), and can be given in any time during infancy. and give protection for about 5-7years(it prevent military TB, and TB meningitis in about 50-80%and pulmory TB in about 50%)

 Natural history ? The lesion is characterized by a small red papule at the site of injection; the papule reaches its maximum diameter of approximately 8 mm within 5 weeks after administration of the vaccine. The top of the papule scales, ulcerates, and dries, and the entire lesion gradually shrinks to a smooth or scaly pink or bluish scar approximately 3 months following immunization; the lesion then becomes a smooth or pitted white scar in approximately 6 months.

 Site effect ? Local ulceration, regional supportive adenitis in 0.1-1%, and this is not indicate underlying host immune defect and dose not effect the level of protection and mostly mild and resolve spontaneously but chemotherapy is needed occasionally, Surgical excitation rarely indicated. Ostiomylits in1 in million, Disseminated BCG infection, which can be fatal, occurs only rarely (1–10 cases per 10 million vaccines. Fever, , and irritability are uncommon

 Contraindication ? 1-immune compromised patient ? 2- burn ? 3 hypersensivity reaction to vaccine ? Revaccination of BCG, indicated in some country either depend on the absence of scar, or negative Tuberculin test (indurations less than 8 mm) DPT(diphtheria, pertusis, tetanus)

 ? Killed vaccine, given I.M in the anterolateral aspect of the thigh, ?

Contraindication ? 1-sever allergic reaction to previous vaccine or to its preservative ? 2-encepholopathy (coma, decrease level of consciousness, prolonged fitting within ? 7days) ? 3-progressive neurological distress, infantile spasm, uncontrollable epilepsy, and progressive encephalopathy. ?

 In all of these above , we give only

 DT Precaution ? 1- fever more than 40.5 of less than 2days ? 2-collapse or shocked like state(hypo responsiveness syndrome) of less than 2days ? 3- fit less than 3days ? 4- persistent cry more than 3hours oh less than 2days ? 5- moderate to severe illness with or without fever. ?

 Most of these above complications are due to pertusis vaccine whole cell pertusis vaccine) but now a days acelluler vaccine is available, so that these complications were reduced dramatically.

 Site effect ? Mild Problems (Common) ? Fever (up to about 1 child in 4) ? Redness or swelling where the shot was given (up to about 1 child in 4) ? Soreness or tenderness where the shot was given (up to about 1 child in 4) ? These problems occur more often after the 4th and 5th doses of the DTaP series than after earlier doses. ? Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, for 1 to 7 days (up to about 1 child in 30). ? Other mild problems include: ? Fussiness (up to about 1 child in 3) ? Tiredness or poor appetite (up to about 1 child in 10) ? Vomiting (up to about 1 child in 50) ? These problems generally occur 1 to 3 days after the shot. ?

 Moderate Problems (Uncommon) ? Seizure (jerking or staring) (about 1 child out of 14,000) ? Non-stop crying, for 3 hours or more (up to about 1 child out of 1,000) ? High fever, 40 (about 1 child out of 16,000) ?

 Severe Problems (Very Rare) Serious allergic reaction (less than 1 out of a million doses) Several other severe problems have been reported after DTaP vaccine. These include: ? Long-term seizures, coma, or lowered consciousness ? Permanent brain damage

. Measles vaccine and MMR(measles, mumps, rubella) ? Live attenuated vaccine, given S.C,not given in earlier age (vaccine failure) ?

 Site effect ? fever (one out of six) ? mild rash (one out of 20) ? swollen glands (rare) ? seizure (one out of 3,000) ? pain and joint stiffness (one out of 20) ? low platelet (one out of 30,000) ? serious allergic reaction (less than one out of 1,000,000)

 Hepatitis B vaccine ?

 Killed vaccine, I.M, in the anterolateral aspect of thigh, according to the HBsAg status if it is +ve, given 0.5ml IG, and zero dose of vaccine immediately after birth then 1st dose at age of one month, 2nd at 2 month, 3rd dose at 4th month, 4th dose at 6th month, at the age of 9-18 month do serological test of HBsAbs +ve ,or HBsAg +ve(repeat the above schedule , if still +ve refer to hepatologist. ?

 If HBsAg is unknown or –ve , give the 1st dose at age of 1-2month, 2nd dose at age of 4-6month, 3rd dose at age of 9-18month.

 Site effect ? Fever ? Soreness at the site of injection ? Allergy ?

 Contraindication ? premature baby and the BW,less than 2KG ? allergic reaction of previous vaccine

 oral polio vaccine(sabin type)(1961) ? Live attenuated vaccine, orally , A single dose of oral polio vaccine (usually two drops) contains 1,000,000 infectious units of Sabin 1 (effective against PV1), 100,000 infectious units of the Sabin 2 strain, and 600,000 infectious units of Sabin 3. One dose of OPV produces immunity50% of recipients to all three poliovirus serotypes in approximately.] 

Three doses of live-attenu OPV produce protective antibody to all three poliovirus types in more than 95% of recipients. And also give a good mucosal immunity and this is very important in region .where poor sanitation.incontrast to

 PPV(Salk) used in USA, less antigenic, ? Sabin Salk ?

 Oral parental ? More antigenic less antigenic, ? Mucosal immunity(intestine) circulatory immunity (blood) ? Cheep costy ? By no trained personnel By trained personnel ? VAP 1in 26 million non ? Developing country developed country Meningococcal vaccine(MPSV)

, ? killed vaccine, I.M, indicated in the following= ? 1- functional and anatomical asplenia ? 2- terminal complement defect ? 3- outbreak ? 4-treveling to the endemic area.

 Pnuemoccocal poly sacharide vaccine(MPSV) ? killed vaccine, I.M, indicated in the following ? 1- nephrotic syndrome ? 2- functional and anatomical asplenia ? 3-

 Influenza vaccine ? Annually was given, i.m, indicated in the(more than 6 month) ? 1- CHD ? 2- CPD ? 3- renal failure ? 4- diabetes mellitus ? 5- long term aspirin therapy

 NOTE ? Premature baby was dialed like full term baby(regadind doses and timing)exept HBv