Vaccina&on in childhood. Agnieszka Wegner MD, PhD Department of Pediatric Neurology Medical University of Warsaw
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1 Vaccina&on in childhood Agnieszka Wegner MD, PhD Department of Pediatric Neurology Medical University of Warsaw
2 Vaccina&on 1. VaccinaCon - accve immunizacon, synthecc, consiscng of the insercon into the body biologicals containing ancgens of pathogens which scmulate produccon of specific humoral or cellular immunity 2. ImmunisaCon is one of the most effeccve and economic public health measures to improve the health of both children and adults. 3. The most notable success has been the worldwide eradicacon of smallpox achieved in The prevalence of many other diseases has been dramaccally reduced. 5. Differences exist in the composicon and scheduling of immunisacon programmes in different countries.
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5 Types of vaccines InacCvated include whole inaccvated microorganisms of fragments or their metabolitestoxoids, which are significantly cleaned. In order to strengthen response immune oren added aluminum hydroxide. - Vaccine against hepaccs B - Influenza vaccine - DTP vaccine - Vaccine against polio - IPV
6 Types of vaccines Live, avenuated - including capable to reproduccon microorganisms with reduced virulence or avirulent. They mimic natural infeccon and therefore they lead to longer lascng immunizacon. - BCG - Vaccine against measles, mumps, rubella - Vaccine against smallpox - Vaccine against rotavirus - Vaccine against polio- OPV
7 Type of vaccine Two or more inaccvated InacCvated and living Two or more living Recommended shortest interval between doses different vaccines Administered at the same Cme or any Cme interval Administered at the same Cme or any Cme interval Administered at the same Cme or 4 weeks apart if they weren t given at the same Cme The Cme interval between two doses of the same vaccinacon min. 4 weeks, opcmal 6-8 weeks
8 Types of vaccined Viral Bacterial Obligatory Recommended Risk groups
9 Types of vaccines Monovalent - contain ancgens one type of micro-organism, immunize against a disease Polivalent - contain several ancgens / types or strains of a single species, immunize against a disease Combined - contain ancgens of combined microorganisms of different species immunize against several diseases
10 Contraindica&ons * A history of adverse reaccons * Allergies immediate (Type I) components of vaccines against ( eg. chicken egg protein - flu, neomycin - measles ) * Primary and secondary immunological deficiency * Acute infeccons with fever > 38 degrees Celsius * steroids
11 It is not a contraindica&on * Mild respiratory tract infeccon * ancbioccs * Fever * Local reaccons to vaccinacon * Non-progressive disease of CNS * Cancer in remission, HIV
12 Side effects of vaccina&on Swelling and discomfort at the injeccon site Mild fever and malaise Measles and rubella vaccinacon- may be followed by a mild form of the disease 7 10 days later Anaphylaxis- may occur but are very rare VaccinaCon should be postponed if the child has an acute illness; however, a minor infeccon without fever or systemic upset is not a contraindicacon. Live vaccines should not be given to children with impaired immune responsiveness (except in children with HIV infeccon in whom MMR vaccine can be given)
13 General recommenda&ons 1. Every healthy child should be carried out in accordance with vaccinacon schedule 2. Before each vaccinacon doctor is obliged to provide pacent informacon relacng to: benefits resulcng from the proteccve vaccinacon type vaccines the duracon of immunity to vaccinacon the necessity to provide doses reminding the possible side effects 3. Every child before vaccinacon must be carefully examined 4. If possible, use a combined vaccine 5. In any case, check the expiracon date on the packaging of the vaccine and method of storage
14 General recommenda&ons 6. Carried out vaccinacon should be documented saving series numbers 7. You should instruct parents carefully to observe vaccinated child for 3 consecucve days 8. When side effects appear the doctor should immediately nocfy Department of Health, PharmaceuCcal CommiVees and / or competent authorices
15 Vaccina&on schedule- part 1 Age Vaccina;on obligatory Vaccina;on recommended 1 st 24 h Hep B, BCG > 6 weeks - 2 mo Hep B, DTP (DTPwc)/ DTPa, Hib Pneumococcus, Rotavirus, Men C, Men B 3 / 4 mo DTP/ DTPa, Hib, Polio- IPV Pneumococcus, Rotavirus, Men C, Men B 5 / 6 mo DTP/ DTPa, Hib, Polio- IPV Pneumococcus, Men C, Men B 7 mo Hep B > 6 mo Influenza mo MMR > 9 mo Varicella, > 12 mo Mec A, C, Y, W -135, Pneum., Men C, Men B mo DTP/ DTPa, Hib, Polio- IPV
16 Vaccina&on schedule part 2 Age Vaccina;on obligatory Vaccina;on recommended 6 yr DTPa, OPV-> IPV (from ) IPV, TBE 10 yr MMR HPV 14 yr dtpa 19 yr dt
17 DTP ( diphtheria, tetanus, pertussis ) D - diphtheria: - InacCvated toxin C.diphteriae with preserved ancgenicity (toxoid) - DTP ( diphtheria toxoid 30 IU ) - d (2 IU ) - Td ( 2 or 5 IU ) - The duracon of immunity for about 10 years - The recovery from naturally acquired diphtheria usually result in immunity to diphtheria
18 DTP ( diphtheria, tetanus, pertussis ) T- tetanus - InacCvated toxin C. tetani with preserved ancgenicity (toxoid) - Adsorbed toxoid of Clostridium tetani Post-exposure prophylaxis Tetanus toxoid can be given in case of a suspected exposure to tetanus. In such cases, it can be given with or without tetanus immunoglobulin (also called tetanus ancbodies or tetanus anctoxin).
19 Vaccina;on status Clean, minor wounds All other wounds Unknown or less than 3 doses of tetanus toxoid containing vaccine 3 or more doses of tetanus toxoid containing vaccine AND less than 5 years since last dose 3 or more doses of tetanus toxoid containing vaccine AND 5 10 years since last dose 3 or more doses of tetanus toxoid containing vaccine AND more than 10 years since last dose Tdap and recommend catch-up vaccinacon No indicacon No indicacon Tdap preferred (if not yet received) or Td Tdap and recommend catch-up vaccinacon Tetanus immunoglobulin No indicacon Tdap preferred (if not yet received) or Td Tdap preferred (if not yet received) or Td
20 DTP ( diphtheria, tetanus, pertussis ) P- pertussis - Pwc - the whole pertussis cells - Pa ( acellular pertussis ) - contain components ancgens - the pertussis toxin, hemaglucnin, pertaccn and fimbriae ancgens - Resistance vaccinacon 3-12 years - ContraindicaCons: metabolic or inflammatory CNS disease - progressive - It is not contraindicacon: epilepsy, seizures
21 Poliomyeli&s Acute anterior poliomyelics vertebra Contains live or killed virus types 3 : 1, 2, 3 OPV ( P.O. ) - "Live " vaccine IPV (s.c. ). - " Killed " vaccine Resistance arer vaccinacon- about 10 years ARer oral vaccinacon for 4-6 weeks - in feces live viruses are excreted
22 Haemophilus influenzae t. B vaccine Type of capsular bacteria Vaccine contains a polysaccharide capsule Very important vaccinacon for children up to 5 yr!!! Rotavirus vaccine Rotarix is a monovalent, human, live avenuated rotavirus vaccine containing one rotavirus strain of G1P specificity. 2-dose series in infants and children Cll 24 week od age
23 Flu vaccina&on Flu - an inaccvated vaccine containing 2 subtypes A and B virus Include: whole virus- so-called split virus, or viral subunits- hemaglutynin and neuraminidase IndicaCon- clinical and epidemiological
24 HepaCCs B - Vaccine contains surface ancgens virus ( HBsAg) - 0, 1, 6 month HepaCCs A - An inaccvated vaccine, immunogenic, well tolerated - Two doses protect - for about 10 years
25 Vaccina&on against S.pneumoniae Prevenar conjugate vaccine The sugar molecules from the outside of the bacteria have been avached to a special protein to make them bever at scmulacng the immune system. Young infants respond well to this type of vaccine. Prevenar 13 is against 13 types of pneumococcal bacteria. Pneumo 23 protects against 23 types of pneumococcal bacteria. Contains the capsular polysaccharides. They are not effeccve in children under 2 years of age
26 Vaccine against N. meningi&dis Meningococcal group A, B, C, Y, W Poland dominated the group B and C - The current polysaccharide vaccine against Meningococcal group C ( NeisVac - C ) and B- Bexsero - Nimenirix- Meningococcal group A, C, Y, W 135
27 - Vaccine against chickenpox ( Varilrix ) > 9 months of age 2 doses TBE Tick bone encehalics - From 2 years of age - 3 doses ( 0, 1-3, 9-12) - Scheme shortened ( 0, 14 days 12m ) - Booster arer 3-5 years - Does not protect against Lyme disease!!!
28 HPV vaccina&on In Poland there are two different vaccine against human papilloma viruses: Cervarix against 2 types of HPV, cancer-causing viruses : HPV16 and HPV18 Silgard against 4 types of HPV, cancer-causing viruses HPV16 and HPV18 and HPV6 and HPV11 responsible for genital warts ( warts ). Both vaccines require a 3 doses
29 Refferences and literature Nelson textbook of Pediatrics, 19 th EdiCon, Kliegman, Behrman, Schor, Stanton, St. Geme Pediatria, Kawalec, Grenda, PZWL, Warszawa 2013 Illutrated textbook of Pediatrics, 4 th EdiCon hvp:// hvp:// hvp://gis.gov.pl/images/ep/akt-1pso2016.pdf Google.com Slideshare.net
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