Transcript CHILDHOOD IMMUNIZATION

Immunization
and
Vaccine Preventable
Diseases
Department of Child Health, Medical School,
Padjadjaran University
Learning Objectives
At the end of the presentation , students will be able to:
1. Describe the difference between active and passive immunity
2. List some group of vaccine-preventable diseases
3. List group of live attenuated and inactivated vaccines
4. For each vaccine-preventable disease, identify those for
whom routine immunization is recommended
5. For each vaccine-preventable disease, describe the
characteristics of the vaccine used to prevent the disease
INTRODUCTION

WHO & UNICEF:
preventable infectious diseases cause
two-thirds of child deaths worldwide
 Without vaccines : epidemics of many
preventable diseases could return
 increased - and unnecessary - illness,
disability, and death among children
INTRODUCTION
 Immunization saves the lives of
approximately 3 million people each
year, all over the world
 Immunization is among the safest of
modern medical interventions
 Immunization is one of the most costeffective health interventions
IMMUNIZATION GOAL
 IMMEDIATE GOAL: PREVENTION
OF DISEASE IN INDIVIDUAL OR
GROUPS
 ULTIMATE GOAL: ERADICATION
PRINCIPELS OF VACCINATION
Active Immunity
 Protection produced by the person's own
immune system
 Usually permanent
Passive Immunity
 Protection transferred from another person
or animal
 Temporary protection that wanes with time
Vaccination
 Active immunity produced by vaccine
 Immunity and immunologic memory
similar to natural infection but
without risk of disease
IMMUN RESPONS
Primary Antigen
Contanct
Primer
respons
Secundary Antigen
Contact
Secundar
respons
VACCINE-PREVENTABLE DISEASES
Anthrax
Japanese Encephalitis
Rabies
Cervical Cancer
(JE)
Rotavirus
Diphtheria
Lyme Disease
Rubella (German
Hepatitis A
Measles
Measles)
Hepatitis B
Meningococcal
Shingles (Herpes
Haemophilus
Mumps
Zoster)
influenzae type b (Hib)
Pertussis (Whooping
Smallpox
Human Papillomavirus
Cough)
Tetanus (Lockjaw)
(HPV)
Pneumococcal
Tuberculosis
H1N1 Flu (((Swine
Poliomyelitis (Polio)
Typhoid Fever
Influenza (Seasonal
Varicella (Chickenpox)
Flu)
Yellow Fever
VACCINE-PREVENTABLE DISEASES
 Most common and serious vaccine-preventable
diseases (WHO) :
- tuberculosis
- diphtheria, pertussis, tetanus
- poliomyelitis
- measles, mumps, rubella
- Haemophilus influenzae type b (Hib)
- yellow fever
 Other common vaccine-preventable diseases :
influenza and pneumococcal pneumonia
EXPANDED PROGRAM IMMUNIZATION (EPI)
TARGET DISEASES
TARGET DISEASES
Diseases
covered by
Traditional EPI
Tuberculosis, Diphtheria; Tetanus: Pertussis; Polio;
Measles
MNT = Maternal and Neonatal Tetanus
EPI + YF
Tuberculosis, Diphtheria; Tetanus (MNT);
Pertussis; Polio; Measles; Yellow Fever
EPI + diseases
Tuberculosis, Diphtheria; Tetanus (MNT);
to be prevented by Pertussis; Polio; Measles
relatively new
Hepatitis B; Haemophilus influenzae type b (Hib)
Vaccines
EPI + diseases
All above plus: Rotavirus acute diarrhoea;
to be prevented by Pneumococcal lower respiratory infections;
vaccines in
Human papilloma virus (for cervical cancer);
the pipeline
Meningitis A, etc.
VACCINE PREVENTABLE DISEASES
EPIDEMIOLOGY
Tetanus—United States,
1947-2006
Diphtheria - United States,
1940-2006
20000
18000
16000
14000
12000
10000
8000
6000
4000
2000
0
1940
600
500
Cases
Cases
700
400
300
200
100
1950 1960
1970 1980
1990 2000
Year
0
1950
1960
1970
1980
1990
2000
Poliomyelitis—United States,
1950-2006
25000
Measles – United States,
1950 - 2006
Inactivated vaccine
900
15000
10000
5000
Cases (thousands)
Cases
20000
800
700
600
Vaccine licensed
500
Live oral vaccine 400
Live oral vaccine
300
Last200indigenous case
100
0
1950 1956 1962 1968 1974 1980 1986 1992 1998 2004
0
1950
1960
1970
1980
1990
2000
Hepatitis A - United States, 1966-2006
70000
Vaccine
Vaccine
Licensed
60000
Licensed
Cases
50000
40000
30000
20000
10000
0
1966
1970
1975
1980
1985
Year
1990
1995
2000
2005
CLASSIFICATION OF VACCINE
Bacteria Vaccine
• Measles
• Mums
• Rubella
• Varicella
• BCG
Live
attenuated
Inactivated
• Diphtheria
• Tetanus
• Pertussis
• Cholera
Virus Vaccine
• Meningo
• Pneumo
• Hib
• Typhim Vi
•
•
•
•
•
• OPV
• Yellow
Fever
Influenza
IPV
Rabies
Hepatitis B
Hepatitis A
THE MAJOR CONSTITUENTS OF
VACCINES
 Active immunizing antigen
- Tetanus or diphtheria toxoid, acellular pertussis
component, varicella, etc.
 Conjugating agents
- Carrier proteins of proven immunologic potential (eg,
tetanus toxoid, nontoxic variant of diphtheria toxin)
 Suspending fluid
- Sterile water, Saline solution, etc
 Presevatives, stabilizers, and antimicrobial
agents
- Thiomersal, Neomycin, Streptomycin sulfate, etc
 Adjuvants : - Alumunium salt
Contraindications and Precautions
Permanent contraindications to
vaccination:
• severe allergic reaction to a vaccine
component or following a prior dose
• encephalopathy not due to another
identifiable cause occurring within 7
days of pertussis vaccination (applies
only to pertussis-containing vaccines)
Contraindications and Precautions
Condition
Allergy to component
Encephalopathy
Pregnancy
Immunosuppression
Severe illness
Recent blood product
Live
C
--C
C
P
P**
Inactivated
C
C
V*
V
P
V
C=contraindication P=precaution V=vaccinate if indicated
*except HPV and Tdap. **MMR and varicella-containing
(except zoster vaccine), and rotavirus vaccines only
Invalid Contraindications
to Vaccination










Mild illness
Antimicrobial therapy
Disease exposure or convalescence
Pregnant or immunosuppressed person in the
household
Breastfeeding
Preterm birth
Allergy to products not present in vaccine or allergy
that is not anaphylactic
Family history of adverse events
Tuberculin skin testing
Multiple vaccines
Screening Questions
 Is the child (or are you) sick today?
 Does the child have an allergy to any medications,
food, or any vaccine?
 Has the child had a serious reaction to a vaccine in
the past?
 Has the child had a seizure, brain or nerve problem?
 Has the child had a health problem with asthma, lung
disease, heart disease, kidney disease, metabolic
disease, such as diabetes, or a blood disorder?
RECCOMENDED IMMUNIZATION
SCHEDULE
 UNITED STATES 2007 AND 2010
 INDONESIAN MINISTRY OF HEALTH
 INDONESIAN PEDIATRICS
ASSOCIATION (IPS)
= IKATAN DOKTER ANAK INDONESIA
(IDAI)
Guidelines for Spacing of Live and
Inactivated Antigens
Antigen
Combination
> 2 inactivated
Recommended minimum
Interval Between Dose
None; can be administtered
simultaneously or at any
interval between dose
Inactivated and live
None; can be administtered
stimultaneously or at any
interval between dose
> 2 live
28-day minimum interval if
not administered at the same
visit
EXPANDED PROGRAM IMMUNIZATION
VACCINE DOSE
ROUTE
BCG
0,05 ml
Intra
dermal
Hep B
0,5 ml
Intra
muscular
DTP
0,5 ml
Intra
muscular
Polio
1-2 gtt
Per oral
Measles
0,5 ml
Sub cutan
NON-EXPANDED PROGRAM IMMUNIZATION
1. MMR
(Measles, Mumps, Rubella)
Prevention: Measles, Mumps and
Rubella
AAP recommended at 12-15
months of age;
Second dose at 4-6 years of age
IDAI recommended as booster at
15 month and 6 years of age
Dose: 0.5 ml subcutan
2. Hib (Haemophilus influenzae tipe b)
Two conjugate vaccines licensed for
use in infants
 PRP-T
ActHIB, TriHIBit
 PRP-OMP
PedvaxHIB, Comvax
Recommended at 2, 4, and 6 month; booster
at 12 – 15 month of age
Dose: 0.5 ml, intramuscular
3. Typhoid Fever
There are 2 type
- Polisacharida vaccine (injection)
- Capsular vi Polisakharida vaccine (oral)
Recommended at 2 year of age and the
booster every 3 year
4. Hepatitis A
-
Schedule: > 2 year (2 dose, interval 6
month)
- Dose: 720 U
5. Varicella
AAP recommended at 12-15 months of age;
Second dose at 4-6 years of age
IDAI recommended at 5-12 years of age
Dose: 0,5 ml subcutan
6. Pnemococcal (PCV7)
Major clinical syndromes include
pneumonia, bacteremia, and meningitis
Doses at 2, 4, 6, months of age, booster
dose at 12-15 months of age.
Dose: 0.5 ml intramuscular
7. Influenza
< 8 years of age: 2 dose (interval min
4 week)
Dose: 0.25 ml (6-35 months of age)
0.5 ml (> 3years of age)
Booster: anually
LAPSED IMMUNIZATIONS
 A lapse in the immunization schedule does not
require reinstitution of the entire series or
addition of doses to the series.
UNKNOWN OR UNCERTAIN
IMMUNIZATION STATUS
□ Many children do not have adequate documentation
□ In general, when in doubt: recommended
immunization should be initiated without delay on a
schedule commensurate with the person’s current
age.