posted by sadam khan achakzai

1. Childhood
Immunization
Dr ali achakzai

2. 2
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.

3. 3
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

8. 8
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.

11. 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)
11

12. DTP continue
Pertussis 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 age
DT 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
12

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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 & OPV
All 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 & Rubella
The 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.

17. Contraindications:
 Immunodef.,immunosupppresive therapy ,HIV
infection.
 Pregnancy
 Severe allergic reaction after previous dose
or to vaccine component.
 Precautions:
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 thrombocytopenia & hx of TP.
 History of receipt of antibody containing bld products <
11 months

18. Varicella Vaccine
Live 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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19. 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
19

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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 vaccine
Contraindications :
 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 Vaccine
Children 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 Immunization
Preexposure:
 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

33. THANK YOU
Special thanks :
Dr ali achakzai