prevention and vaccine pediatrics

Dr Hussein Abdeldayem

Alex University

Family Medicine TrainingDentist Training

PAEDIATRICSPREVENTION AND

VACCINEDr Hussein Abdeldayem

Prof of PediatricsAlex University

Dr Hussein Abdeldayem

Alex University

PREVENTION

Dr Hussein Abdeldayem

Alex University

Prevention

• Primary Prevention• Secondary Prevention• Tertiary Prevention• Quaternary Prevention

Dr Hussein Abdeldayem

Alex University

Prevention

• Primary Prevention prevent the occurrence

of the disease as: by immunization by Genetic counseling

NO DISEASE

AR disordersInfectious Disease as MMR, polio,etc

Dr Hussein Abdeldayem

Alex University

Prevention

• Secondary Prevention early detection of the

disease for stopping or reversing its progress

as: by prenatal diagnosis by newborn screening

DISEASENO or MILD CP

PKU, Cong Hypothyroidism

Dr Hussein Abdeldayem

Alex University

Prevention • Tertiary Prevention stop the development of

complication of the previously diagnosed disease

as: by EIP, by treating ABM with

corticosteroid AND follow up for complications (ABR) DISEASE

NO ComplicationEIP, ABM

Dr Hussein Abdeldayem

Alex University

Prevention • Quaternary Prevention set of health activities

that diminish or avoid the consequences of unnecessary or excessive interventions in the health system

costSwine Flu

Dr Hussein Abdeldayem

Alex University

AR Inheritance

Dr Hussein Abdeldayem

Alex University

Prevention and Neurologic disorders• Down syndrome• PKU• Congenital

hypothyroidism• galactosemia

Dr Hussein Abdeldayem

Alex University

Down syndrome1ry (no DS baby)• Translocated mother (4%)Risk 10%Risk 100% (21/21)Prevention: genetic counseling

(prevent conception)• Non-Disjunction (95%)Risk: 1/1000 increase by: age or has a DS

babyPrevention: avoid late age or

frequent conception Recent: Pre-implantation

selection?? Folic acid supplementation

Dr Hussein Abdeldayem

Alex University

Down Syndrome2ry Prevention ( DS baby)

• 9-12 wks GA:21- neck US2- Blood: hCGTH, PaPPa, fetal RBC3- Villous biopsy• 12 -16 wks GA:1- triad: AFP. UOstriol, hCGTH 2- tetrad: triad + inhibin• > 16 wks GA:Amniocentesis

Dr Hussein Abdeldayem

Alex University

DS 3ry Prevention• EIP• Echocardiography• Visual acuity/y• Thyroid function/y

(TSH,T4)• Tympanometry/y• Neck X ray at 3-5 yrs*

*Neutral view, flexion & extension

Dr Hussein Abdeldayem

Alex University

Galactosemia

Failure to thrivevomitingGalactusuria (sugar in urineAAuria, proteinuria

Dr Hussein Abdeldayem

Alex University

Galactosemia

• Milk lactose G + Gal Gal G

• AR• galactosemia 1: (classic) GALT Def (galactose 1p uridyl

transferase)

• Galactosemia 2: GALK (Galactase=galactokinase)

• Galactosemia 3: GALE (uridyl diphosphogalactose- 4 –

epimerase)

Sugar excretion in infancy

Leloir 1970Nobel prize

3 genes

Dr Hussein Abdeldayem

Alex University

Prevention

• 1ry: Genetic counseling AR• 2ry: early Screening- blood and urine: increased gal and Gal 1 P

- decreazed enzymes (UT, Galactokinase,

epimerase) Lactose free milk• 3ry: rehab, treat cataract

Dr Hussein Abdeldayem

Alex University

PKU

– AR – Gene on chromosome 12– Enzyme deficiency:

phenylalanine hydroxylase– Types:1- classic2- cofactor BH4

(tetrahydrobiopterin )3- mixed* : mild ( no disease)

Dr Hussein Abdeldayem

Alex University

PKU• Classic: P Hydroxylase deficiency - blood: severe

hyperphenylalaninemia >20 mg/dl • Cofactor BH4 deficiency - normal phenylalanine in blood or

mild raised - BH4 Cofactor for phenylalanine,

tyrosine and tryptophan - diagnosis: A- measure neopterin and biopterin in

urineB- loading test: oral BH4 (20 MG/KG)

then measure phenylalanine C- enzyme assay• mixed

Dr Hussein Abdeldayem

Alex University

PKUPREVENTION• 1ry: genetic counseling

AR• 2ry: a- neonatal screening then low phenylalanine

milk• 3ry: rehabilitation , diet

resriction

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

C/P

Some CNS effects of untreated PKU include:

• mental retardation• behavior problems,

autism• hyperactivity• restlessness or irritability• seizures

1- fair hair and skin2- a “musty” or

“mousy” body odor3- Eczema

Dr Hussein Abdeldayem

Alex University

maternal PKU syndrome

• Pregnancy in women with PKU (“Maternal PKU”) Women with PKU who are not on the low-Phe diet when they become pregnant have a high chance of having babies with

• birth defects as congenital HD

• mental retardation • microcephaly (recurrent)• SGA

Dr Hussein Abdeldayem

Alex University

Maternal PKU syndrome / PreventionDuring pregnancy, they

need to:• stay on the low-Phe diet• visit their PKU clinic on a

regular basis• have their blood Phe

levels checked often

Dr Hussein Abdeldayem

Alex University

Prevention

• MR PREVENTION:1- 1ry : vaccine of all females

against (at least 3 mo preconception) of GM

2- 2ry: screening of congenital hypothyroidism, PKU and Galactosemia

3- 3ry: rehabilitation and early intervention program as in DS

Dr Hussein Abdeldayem

Alex University

Prevention • Infectious disease prevention:1- 1ry : (as ABM , H1N1flu

disease) a- Vaccine b- Anti-organism prophylaxis c- isolation of infected persons d- Eradication of factors

transmit the infection2- 2ry: early treatment of

infective organism (AB)3- 3ry: early detection of

sequelae as ABR ( for ABM)

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

Immunity

Passive AcquiredFrom mother: a- transplacental, b- breast milk

Vaccine or toxoids

Antibodies administration: a- gamma globin, b- antitoxin

Active infection (clinical or subclinical) = Natural

Dr Hussein Abdeldayem

Alex University

Natural infection is better than immunization

• Actual Infection usually does cause better and longer immunity than vaccination.

• Measles, GM, mumps, & chicken pox produce long life immunity

• However, the price paid for natural disease can cause morbidity ( complications) up to death

Dr Hussein Abdeldayem

Alex University

Vaccination is better than passive immunity

• vaccination cause better and longer immunity than passive immunity ( from mother or injection of IG).

Dr Hussein Abdeldayem

Alex University

Vaccine better than infection

• Safe• Mass protection• ?? cost

• Not solid immunity

• S/E• ?? cost

DiisadventagesAdvantages

Dr Hussein Abdeldayem

Alex University

Vaccines are safe

• Vaccines are easier and safer to administer than ever before.

• Being immunized is much safer than risking infection and disease.

Dr Hussein Abdeldayem

Alex University

Immunization can protect the unprotected

• When immunization coverage is high, it can prevent viruses and bacteria from circulating.

• The more children in a community that are fully immunized, the more everyone is safe.

Dr Hussein Abdeldayem

Alex University

Immunization can save money

• Immunization is one of the most cost-effective health interventions.

• Investing in vaccines SAVES more money than it costs.

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

Age of Infant/Child

Type of vaccine

At birth Zero Dose

1st (OPV) oral polio

OPV: live attenuated (LA) 2-3 drops

0-1 mo: (1st contact of child with health authority)

BCG: against tuberculosis by

BCG: live attenuated (LA) (intra dermal injection over insertion of left deltoid, 0.1ml)

Immunization Schedule

Ist month: all LA

Dr Hussein Abdeldayem

Alex University

Immunization Schedule

Age of Infant/Child

Type of vaccine

2nd Month of age

2nd dose: Polio (OPV), DPT & Hepatitis B 1

4th Month of age

3rd dose: Polio (OPV), DPT & Hepatitis B 2

6th Month of age

4th dose: Polio (OPV), DPT & Hepatitis B 3

OPV: 3 oral dropsDPT: IM 0.5 mlHBV: IM 0.5 ml

DT: killedP: toxoid

HBVRecomb Ag

OPV: Ki oral2-3DT: toxoid IMP: ki IM

HBV: recomb Ag IM

Dr Hussein Abdeldayem

Alex University

Age of Infant/Child

Type of vaccine

9th mo of age

Measles SC LAVitamin A Capsule (100.000

units) polio(5th dose) ORAL LA

Immunization Schedule

Measles: SCMMR :SC

Measles/MMR LA

12 MONTHS

MMR sc LA2 Vitamin A Capsule (200.000

units) polio(6th dose) ORAL LA

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

Immunization ( Booster)

18 – 24 mo Booster of DTP (0.5 ml IM) 7th OPV (3 drops)2 capsules Vit A (200,000 units)

4 – 6 yrs of age (preschool)

MMR 2nd dose(0.5 ml SC)

6 – 12 yrs of age(start schooling)

Booster dose of OPV, DT,BCG ± MMR (if not given at 4-6 yrs)

Dr Hussein Abdeldayem

Alex University

Immunization: non obligatory

HIB: Hemophilus Influenzae type B

3 doses ( 2, 4 ,6 mo) and booster at 18 – 24 mo

IMConjugated polysaccharide vaccine

HAV:Hepatitis A

1st : +12 mo2nd: after 6 – 12 mo

IMInactivated

Dr Hussein Abdeldayem

Alex University

Immunization: non obligatory

Varicella + 12 mo – 13 yr: one doseBooster: 4- 6 yrs ≥ 13yr: 2 doses with 6 wk apart

LA

Meningococcal ACWY

Over 2 ysEvery 3 ys

SCInactivated

Dr Hussein Abdeldayem

Alex University

Immunization: non obligatory

Flu vaccine (>6 mo age)

Every year (septemper/ october)

Recombinant Antigen

???? ????? ?????

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

• Polio vaccine: 1- LA: Oral Sabin 2- killed: IM salk

Dr Hussein Abdeldayem

Alex University

• BCG : intradermal • Measles: SC• MMR: SC

Dr Hussein Abdeldayem

Alex University

Side Effects (Adverse reactions)

• 1- general : fever, allergy, anaphylaxis • 2- local: pain, redness, swelling, sterile

abscess• 3- specific:

Dr Hussein Abdeldayem

Alex University

Side Effects (Adverse reactions)

3- specific:i- BCG: TB ulcer, TB lymphadenitis with cold

abscess and sinus/ suppurative lymphadenitis/ miliary TB

ii- OPV: paralysis

Dr Hussein Abdeldayem

Alex University

Side Effects (Adverse reactions)

iii- Pertussis ( DTP): a. Encephalopathy: within 7 daysb. Convulsions: within 2-3 days,c. Persistent high – pitched cry: for 3 hrs

within 2 daysd. Persistent fever: for 2 days ( >40.5ₒC) e. shock or drowsiness, or somnolence:

within 2 days

Dr Hussein Abdeldayem

Alex University

Side Effects (Adverse reactions)

iv- measles: rash, arthralgia

V- GM: rash, arthralgia, lymphadenopathy, allergy

Vi-mumps: mild parotitis

Dr Hussein Abdeldayem

Alex University

Dr Hussein Abdeldayem

Alex University

Don’t immunize if there is:1-Anaphylactic reaction to a

vaccine2-Seizure or fever > 40 .5 C

within 48 hr of pertussis vaccine

3-True Egg Allergy (MMR)4-Neomycine allergy (MMR)5-Immunocompromized patient

(OPV)6-Untreated moderate to severe

illness + fever

contraindication

Dr Hussein Abdeldayem

Alex University

contraindication

• Pertussis vaccine (DTP)1- history of fits 2- abnormal neurological

child as CP2- S/E of vaccine

Give: DT الثنائى or D T (a)P

Dr Hussein Abdeldayem

Alex University

Vaccine of immunodeficiency child

• immunodeficiency child as AIDS, NS (steroid tt)

• Not GIVE: BCG/ OPV/ MEASLES/MMR• not give Oral OPV to his

HOUSEHOLD contacts (siblings)

Dr Hussein Abdeldayem

Alex University

Cold Chaintransportation - storage

• OPV not yet used: at freezer (-20C)

• ( 0-8C): all vaccine and diluents• On top shelf (under

freezer) : opened OPV, measles

• On 2nd shelf: BCG, DTP, DT, TT

Dr Hussein Abdeldayem

Alex University

Cold Chaintransportation - storage

• In vaccine clinic: keep the vaccine in a cup containing ice

• Sensitive to strong light: BCG, measles, MMR

• Away from HEAT, and direct SUNLIGHT

• DISCARD any vaccine remained in opened vials