Immunization
‫الدكتور عبد المهدي عبد الرضا حسن‬
Ph,D, Pediatric & Mental Health Nursing
Lecturer ,college of Nursing, Babylon University
Objectives
Types of vaccination
Contraindications
Discussion of individual vaccines
Preparations
Administration
Precautions and contraindications
Side effects
Active Immunization
Types
Live attenuated
Measles, mumps, rubella
BCG
Bacteria
Killed
Hepatitis B
Virus
Bacteria
Pertussis
Whole
Tetanus
Toxoid
Meningoccocal Polysaccharide
Virus
Human Immune Serum Globulin
Specific
Hepatitis B (HBIG)
IM
Rabies (RIG)
Tetanus (TIG)
Varicella (VZIG)
CMV (CMV-IG)
RSV (RSV-IG)
IV
Human Immune Serum Globulin
Non-specific
Immune serum globulin(ISG) IM
Hepatitis A
Measles
Intravenous immune globulin(IGIV) IV
Antibody deficiency disorders
ITP
Kawasaki syndrome
Passive Immunization (Cont)
SPECIFIC EQUINE ANTIBODIES (IM)
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BOTULISM ANTITOXIN
DIPHTERIA ANTITOXIN
TETANUS ANTITOXIN
SNAKE & SPIDER ANTI-VENOM
MONOCLONAL ANTIBODIES (IV)
ANTI-ENDOTOXIN ANTIBODIES
Recommended Immunization Schedule
for KSA 2008
General Contraindications
Moderate or severe illness with or without fever
Anaphylactic reaction to vaccine or vaccine constituent
Live attenuated vaccines
Pregnant women
Immunocompromised / Immunosuppressed children
within 3-11 months of immunoglobulin administration
Invalid Contraindications
Mild to moderate local reaction
Mild acute illness with or without low grade fever
Current antimicrobial therapy
Convalescent phase of illnesses
Prematurity and low birth weight
History of penicillin or other nonspecific allergies
Malnutrition
Immunization Of Special Groups
IMMUNOCOMPROMISED HOSTS
Avoid MMR, measles (may be used in HIV)
Avoid OPV; use IPV for these children and their household contacts
PRETERM INFANTS
Treat as term babies
Avoid OPV in hospital
Influenza vaccine in BPD
may delay HBV if <2 kg & mother is HBsAG negative
Compulsory Vaccines
Bacillus Calmette‑ Guerin Vaccine (BCG)
INDICATIONS
All newborns
All tuberculin negative infants
PRECAUTIONS & CONTRAINDICATIONS(CI):
Give only to PPD negative children
CI in persons with immunodeficiencies
CI during pregnancy
Bacillus Calmette‑ Guerin Vaccine (BCG)
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SIDE EFFECTS
Local
Skin ulceration, regional lymphadenitis
Subcutaneous abscess
Generalized
Anaphylaxis, generalized BCG infection
(rare): osteitis
Hepatitis B
PREPARATIONS
ENGERIX‑ B
RECOMBIVAX HB
Hepatitis B
ADMINISTRATION:
0.5 ‑ 1 ML, anterolateral thigh or deltoid
IM injection
at 0,1 and 6 months
SIDE EFFECTS:
Pain
Arthralgia
Poliomyelitis Prophylaxis
PREPARATIONS
(Live attenuated)
SABIN
(A) Oral (OPV)
(killed) SALK
(B) Inactivated (eIPV)
ADMINISTRATION
2 drops orally
OPV
SC injection
eIPV
PRECAUTIONS & CONTRAINDICATIONS(CI)
pregnancy, immunodeficiency
(a) OPV
neomycin hypersensitivity
(b) IPV
ADVERSE REACTIONS
paralytic disease (rare)
OPV
Diphtheria, Tetanus & Pertussis (DTP)
PREPARATIONS
pertussis vaccine)
< 7 years : DTP, DT, DTaP (acellular
> 7 years : Td, TdaP
ADMINISTRATION
IM
Diphtheria, Tetanus & Pertussis (DTP)
CONTRAINDICATIONS (CI)
Encephalopathy within 7 days
Progressive or unstable neurological disorders
Anaphylactic reaction to a previous dose
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PRECAUTIONS
severe systemic reactions such as
Temp > 40.50C
persistent inconsolable crying > 3 hours
Collapse episodes
Convulsions
Measles, Mumps & Rubella (MMR)
PREPARATIONS:
MEASLES.
MMR.
ADMINISTRATION:
SC.
INDICATIONS:
Primary immunization at 1 & 6 years.
Measles, Mumps & Rubella (MMR)
PRECAUTIONS & CONTRAINDICATIONS
Pregnancy
Anaphylaxis to eggs
Immunodeficiency and immunosuppression
Immunoglobulins within 3-11 months
Measles, Mumps & Rubella (MMR)
ADVERSE REACTIONS
Fever ,rash (7 days post vaccination)
Arthralgia , arthritis (rubella)
Encephalitis [rare] (measles, mumps)
Suppression of PPD skin test (measles)
Convulsions in prone children(measles)
Thrombocytopenia
Haemophilus Influenzae Type B
ADMINISTRATION
IM
2,4,6 months, booster at 15 months
INDICATIONS
Children under 5 years of age
High risk children
SIDE EFFECTS:
Local pain and erythema
Mild fever
Varicella Prophylaxis
PREPARATIONS:
Varivax vaccine (MSD)
ADMINISTRATION:
0.5 ml IM
12 months and above……..2 doses
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Varicella Prophylaxis
INDICATIONS:
All children 12 months‑ 18 years: (if no history of varicella)
EFFICACY:
70‑ 90%
Varicella Prophylaxis
PRECAUTIONS & CONTRAITNDICATIONS:
Immunocompromised patients
Within 5 months of IG
Children on long term salicylates
SIDE EFFECTS:
Fever , rash
Zoster
Hepatitis A
NATURE OF VACCINE:
Killed formalin inactivated vaccine.
PREPARATIONS:
Various preparations available
e.g. Havrix 720 Junior, Havrix 1440
etc.
Hepatitis A
INDICATIONS:
children 1 year and above
Susceptible children in endemic areas
Chronic liver disease
Hemophilia
Hepatitis A
ADMINISTRATION:
IM injection
2 doses, at least 6 months apart
ADVERSE REACTIONS:
Local reactions, fever
Rare: anaphylaxis
Additional Vaccines
Pneumococcal Prophylaxis
PREPARATIONS:
Purified capsular polysaccharide of 23 serotypes of Streptococcus pneumoniae
7 valent conjugated vaccine
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ADMINISTRATION:
IM / SC
1 dose/booster 5 years
Pneumococcal Prophylaxis
INDICATIONS:
Primary vaccination (conjugate vaccine)
children 2 yr. or older with
Anatomical or functional asplenia
Sickle cell disease
Nephrotic syndrome
Immunosuppression
Pneumococcal Prophylaxis
SIDE EFFECTS:
Soreness , erythema, fever, myalgia
Anaphylactic reactions (rare)
Meningococcal Prophylaxis
PREPARATIONS:
monovalent (A or C)
bivalent (A & C)
quadrivalent (A,C,Y & W‑ 135)
quadrivalent conjugate quadrivalent
ADMINISTRATION:
SC
Meningococcal Prophylaxis
INDICATIONS:
Control of outbreaks
Children with complement deficiencies or asplenia
SIDE EFFECTS:
local erythema and discomfort
transient fever
Influenza Virus
Nature of vaccine:
Killed vaccine.
Live attenuated
Preparations:
whole and “split virus” vaccines.
“split virus” vaccines are recommended for children 6 months and older.
composition of the vaccine is changed annually.
Influenza Virus
ADMINISTRATION:
IM (killed).
Live attenuated (intranasal).
1 dose during influenzae season.
Children 6months-9 years should receive an additional dose, 4 weeks after the 1st
dose, if not previously immunized.
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Influenza Virus
Indications:
chronic cardio-respiratory disease
asthma
cystic fibrosis
bronchopulmonary dysplasia
Influenza Virus
Indications:
Sickle cell anemia.
Chronic salicylate therapy.
Diabetes mellitus.
Chronic renal disease.
Chronic metabolic disease.
immunosuppressive conditions: cancer, HIV etc.
Hospital personnel with significant patient contact.
Influenza Virus
Contraindication:
Anaphylaxis to previous dose.
Hypersensitivity to eggs.
Adverse Reaction:
Soreness at injection site.
Allergic response.
Guillain-Barré Syndrome.
New Vaccines
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