Childhood Immunization

Dr ali achakzai

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ROUTINE VACCINES IN CHILDHOOD & ADOLESCENSE

ALL CHILDREN SHOULD BE VACCINATED AGAINST : Diphtheria,Tetanus,Pertussis,Polio Myelitis,Measles,

Mumps, Rubella, Hepatitis B & Varicella , unless contraindicated.

Completion of the vaccination schedule by 18 months of age requires 16-20 injection, in 4-5 visits .

The number of injections is likely to be reduced by the introduction of combination vaccines.

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General Rules for all Vaccines:True Contraindications :

Serious allergic reaction after previous vaccine dose.

Serious allergic reaction to vaccine component.

Precautions: Moderate to severe acute illness with or without

fever.

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Untrue contraindications: Mild acute illness with or without fever. Mild to moderate local reaction (swelling ,

redness) , low grade or moderate fever after previous dose.

Current anti microbial therapy. Convalescent phase of illness Premature birth ( hepB is an exception in certain

circumstances) History of penicillin allergy, other non vaccine

allergies Recent exposure to an infectious disease

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Hepatitis B Vaccine

All infants should receive the first dose soon after birth , before hospital discharge .

Infants born to HBsAg –ve mothers should receive the 2nd dose at least one month after the 1st dose.

The 3rd dose should be given at least 4 months after the second dose, but not before 6 months of age.

Infants of HBsAg +ve mother should receive hepatitis B vaccine and 0.5 ml HepB Ig within 12 hours after birth, at separate sites.

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Hepatitis B Vaccine

The second dose is recommended at 1-2 month of age & 3rd dose at 6 month of age.

Infants of mothers of unknown HBsAg status should receive HBV vaccine within 12 hrs of birth & maternal blood should be drawn at delivery to determine the mother status. If HBs Ag is +ve the infant should receive HB Ig

as soon as possible ( not later than 1/52 of age).

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Hepatitis B Vaccine

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DTaP Vaccine The 4th dose of DTaP may be administered as early

as 12 month of age, provided 6/12 have elapsed since the 3rd dose & if the child is unlikely to return at age 15 – 18 month.

Tetanus & diphtheria toxoids (Td) is recommended at age 11-12 yrs, if at least 5 yrs have elapsed since the last dose.

Subsequent routine (Td) boosters are recommended every 10 yrs.

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Contraindications:Encephalopathy ( coma , decreased level of

consciousness, prolonged seizures ) within 7 days of administration of previous dose.

Progressive Neurologic disorder including Infantile spasm , uncontrolled epilepsy , progressive Encephalopathy, defer DTaP until neurologic status clarified .

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Precautions: Fever of 40.5 cْ or more , within 48 hrs after

vaccination with previous dose of DTP or DTaP .

Collapse or shock like state : Hyporesponsive – Hypotonic episode within 48

hrs after receiving previous dose of DTP or DTaP. Seizures within 3 days of receiving previous

dose of DTP or DTaP. Persistent , inconsolable crying lasting > 3 hrs

& < 48 hrs after previous dose. Guillian- Barre Syndrome within 6 weeks after

previous dose.

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These are not contraindications:

Temperature < 40.5 Fussiness or mild drowsiness after previous

dose. Family Hx of seizures . Family Hx of SIDS Family Hx of adverse reaction after DTP or

DTaP vaccination. Stable neurologic condition ( CP, well

controlled convulsions , developmental delay)

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DTP continuePertussis is common in developing countries and some developed nations ,where immun. Is not provided.Protection is attained with four doses and booster at 4-6 yr of ageDT should be used for children who are younger than 7years and who have contraindication to pertussis vaccine . Pertussis vacc. Has not recommended for persons 7 yr of age or older.Dose and administration:0.5ml in anterolateral thigh.Acetaminophen administered before DTaP or DTP vaccination and thereafter every 4 hours for 24 hours,for children with personal or family Hx of convulsions

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Hib Conjugate Vaccine

Vaccine is administered at 2/12 & 4/12 (a dose at 6/12 not required).

Contraindications : Age below 6 weeks. Precautions :moderate to severe acute illness with or

without fever.

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IPV & OPVAll children should receive 4 doses of

IPV at age 2,4,6-18 months and 4-6 yrs.Two doses of IPV administered at ages

2 & 4 months, followed by two doses of OPV at 12-18 months & 4-6 yr.

IPV is recommended for Immunocompromised persons .

Precaution : pregnancy.

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IPV & OPV cont……… IPV is recommended to reduce the risk

of vaccine associated paralytic poliomyelitis associated with OPV.

OPV is recommended in areas where polio is endemic & in unvaccinated children who will travel within 4 weeks to endemic areas.

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Measles, Mumps & RubellaThe 1st dose at 12 months or after.The 2nd dose of MMR is recommended at 4-

6 yrs and may be given during any visit .Those who have not previously received the

2nd dose should complete the schedule by the visit at 11- 12 yrs.

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Contraindications: Immunodef.,immunosupppresive therapy ,HIV

infection. Pregnancy Severe allergic reaction after previous dose

or to vaccine component. Precautions:

thrombocytopenia & hx of TP. History of receipt of antibody containing bld products <

11 months

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Varicella VaccineLive attenuated Varicella virus vaccine is

recommended at any visit , at or after age 12 months for susceptible children.

Patients on salicylate therapy have a risk of developing Reye syndrome after vaccination.

Persons 13 yrs or older should receive 2 doses, given at least 4 weeks apart.

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Varicella cont….. Varicella should not be given to a member of

family hx of immunodef. Until the immune status documented.

Pregnancy . All children 12 months of age or older ,who

have no hx of varicella vaccination or chicken pox should be vaccinated .

Infants younger than 6 months protected by maternal antibodies.

VZIG is recommended for newborn whose mother had onset of chicken pox within 5 days before to2 days after delivery

Children and adoles. With ALL in remission can receive varicella vaccine

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Pneumococcal Vaccine It is a conjugate vaccine.[PCV] It is recommended for all children aged 2-23 months. It is also recommended for certain children aged 24-59

months Pneumococcal polysaccharide vaccine[PPV] is

recommended in addition to PCV for certain high risk groups: Sickle cell disease Asplenia HIV Congenital ID CRF- nephrotic syndrome Chronic cardiac disease CSF leak

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Hepatitis A Vaccine It is an inactivated vaccine.This vaccine is recommended for use in

selected states & regions.Given in 2 doses

0.5 ml for 2 – 17 yrs of age 1 ml for 18 yrs or older

Protective immunity develops 2-4 weeks after receiving the initial vaccine dose.

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Hepatitis A Vaccine If immediate protection( before 2 weeks) is

necessary , IM Ig can be given

for short protection of 1 – 2 months. 0.02 ml / kg

For long time protection of 3-5 months 0.06 ml / kg ; can be repeated every 5 months if exposure

continues

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Influenza Vaccine

Influenza vaccine is recommended for : persons at increased risk of complications of influenza. The elderly. Children 6 months or older :

Asthma Cardiac disease Sickle cell disease HIV others

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Influenza vaccine Can be given annually from 6 months of age :

6- 35months: 0.25 ml

3yrs or more: 0.5 ml

Children 8 yrs or less who are receiving the vaccine for the first time , should receive 2 doses at least 4 weeks apart.

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Influenza vaccineContraindications :

Severe allergic reaction to egg protein , or other component

Untrue contraindication : Concurrent administration of aminophyllin &

comadine Severe contact allergy to latex

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Meningococcal Vaccine Serogroup A is the most common cause of

meningococcal meningitis. Group C & B are less common. The quadrivalent polysaccharide A/C/Y/W-

135 is available in USA. The vaccine is ineffective against serogroup

A in infants less than 3 months & may be partially effective in children 3 –11months of age.

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Meningococcal VaccineChildren younger than 2 yrs , are not

protected against serogroup C .The meningococcus vaccine(0.5 ml SQ) is

recommended for persons 2 yrs or older.Children vaccinated before 4 yrs of age ,

should be revaccinated after 2 –3 yrs, if they remain in endemic areas.

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Meningococcal Vaccine Indications

Functional or anatomic asplenia

Travel to endemic areas

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Typhoid Vaccine Recommended for persons traveling to endemic

areas. Three typhoid vaccine :

oral vaccine : for 6 yrs & older 4 doses of one enteric coated capsule EOD Repeated every 5 yrs as booster

2 parenteral vaccines : younger than 6 yrs 0.25 ml from 6 months – 10 yrs 0.5 ml for 10 yrs and older

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Rabies Immunization The risk of rabies is currently the highest in

countries where rabies in dogs is uncontrolled.

Children should be considered for pre exposure prophylaxis ,if they will be in an endemic area fore more than 1 month.

There are two available vaccines HDCV: Human Diploid Cell Rabies Vaccine RVA : Rabies Vaccine Absorbed

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Rabies ImmunizationPreexposure:

3 intradermal doses of HDCV: 0.1 ml on days 0,7,28 days.

RVA IM as 3 doses ; 1ml on days 0,7,28 Post exposure:

Rabies IG : given IM as 5 doses of 1 ml on days 0, 3, 7, 14, 28,if previously unvaccinated & 2 doses on days 0, 3 if vaccinated.

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ROTA VIRUS

First dose should not be given before 6 weeks .

C/o hypersensitivity to aminoglicoside,ampho B ,febrile illness ,immunodef. Precaution is acute vomiting or diarrhea

THANK YOU

Special thanks :

Dr ali achakzai