CHILDHOOD VACCINATION

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1 EPI (3) Age of Child How and Where is it given? CHILDHOOD VACCINATION Nicolette du Plessis Block 10 28/02/ weeks DTaP-IPV/Hib (2) Diphtheria, Tetanus, Acellular pertussis, Inactivated polio vaccine, Haemophilus influenzae type b (Combined) Hep B (2) Hepatitis B vaccine Left thigh EPI (1) EPI (4) Age of Child At birth Bacille Calmette Guerin (BCG) Oral Polio OPV (1) How and Where is it given? Right arm Drops by mouth Age of Child 14 weeks RV (2) Rotavirus vaccine DTaP-IPV/Hib (3) Diphtheria, Tetanus, Acellular pertussis, Inactivated polio vaccine, Haemophilus influenzae type b (Combined) Hep B (3) Heptitis B vaccine PCV13 (2) Pneumococcal conjugate vaccine How and Where is it given? Liquid by mouth Left thigh Rotavirus vaccine should NOT be administered after 24 weeks of age EPI (2) EPI (5) Age of Child 6 weeks OPV (2) Oral polio vaccine RV (1) Rotavirus vaccine DTaP-IPV/Hib (1) Diphtheria, Tetanus, Acellular pertussis, Inactivated polio vaccine, Haemophilus influenzae type b (Combined) Hep B (1) Hepatitis B vaccine PCV13(1) Pneumococcal conjugate vaccine How and Where is it given? Drops by mouth Liquid by mouth Left thigh Age of Child 9 months 18 months 6 years 12 years Measles vaccine (1) PCV13 (3) Pneumococcal conjugate vaccine DTaP-IPV/Hib (4) Diphtheria, Tetanus, Acellular pertussis, Inactivated polio vaccine, Haemophilus influenzae type b (Combined) Measles vaccine (2) Td - Tetanus and reduced strength diphtheria vaccine Td - Tetanus and reduced strength diphtheria vaccine How and Where is it given? Left thigh Left arm Right arm Left arm Left arm 1

2 CONTRA-INDICATIONS TO IMMUNISATION: FACT OR FICTION? Cerebral palsy Previous administration of intravenous immunoglobulin Chronic heart and lung disease Inhaled corticosteroids Antibiotic treatment BCG in symptomatic AIDS patients Eczema Previous temperature of 39 o C after DPT History of pollen allergy Family history of convulsions Egg allergy Prematurity Breastfeeding Malnutrition Prolonged steroid treatment Tonsillitis with a temperature of 38.5 o C Pertussis-containing vaccines Previous encephalopathy within 7 days after a previous pertussis-containing vaccine Evolving (undiagnosed) neurological problem CONTRA-INDICATIONS TO IMMUNISATION: FACT OR FICTION Cerebral palsy Previous administration of intravenous immunoglobulin (3mo) Chronic heart and lung disease Inhaled corticosteroids Antibiotic treatment BCG in symptomatic AIDS patients Eczema Previous temperature of 39oC after DPT History of pollen allergy Family history of convulsions Egg allergy(yf/influenza Prematurity Breastfeeding Malnutrition Prolonged steroid treatment (3mo) Tonsillitis with a temperature of 38.5oC Measles, Mumps, Rubella (MMR), Varicella, Yellow Fever, Oral Polio If blood, plasma or immunoglobulin were given in the last 3 months All s Anaphylactic type reaction to a previous dose of that vaccine, or to any vaccine component (not trace element) Influenza, Yellow Fever Anaphylactic reaction to chickens, including eggs, egg protein, feathers etc 2

3 BCG Symptomatic AIDS patients or severe primary immunodeficiencies (SCID) TUBERCULOSIS VACCINE BACILLE CALMETTE-GUÉRIN (BCG) Live-attenuated bacterial vaccine Prepared from attenuated strains of M. bovis. Does NOT lead to primary prevention of infection Protect against most serious forms of tuberculosis, particularly in young children meningitis disseminated disease To newborn babies at birth as part of EPI-SA schedule Intradermally to the upper right arm Safe, well tolerated in immunocompetent children Local reactions common, long term complications rare Swelling or abscesses at the site of injection Risk of BCG-disease in immunocompromised POLIOMYELITIS VACCINE Two types of polio vaccines Live-attenuated oral polio vaccine (OPV) Inactivated polio vaccine (IPV) Both IPV and the OPV contain all three types of polioviruses 3

4 POLIOMYELITIS VACCINE ORAL POLIO VACCINE (SABIN VACCINE) OPV mimics natural infection - induces broad immune response Humoral and mucosal immunity Shedding of vaccine virus Unimmunised persons passively vaccinated In resource-poor settings, is the polio vaccine of choice for the eradication of polio POLIOMYELITIS VACCINE OPV at birth and 6 weeks IPV at 6,10 and 14 weeks, 18 months Side effects OPV causes almost no side-effects, 2-4 cases/million, vaccine virus reverts to neurovirulence - vaccine-associated poliomyelitis paralysis (VAPP) IPV is very safe. Precautions Congenital immune deficiency syndromes (OPV) DIPHTHERIA VACCINE Inactivated diphtheria toxin. Effective POLIOMYELITIS VACCINE INACTIVATED POLIO VACCINE (SALK VACCINE) Induces humoral immunity - prevent the spread of poliovirus to central nervous system Provides individual protection against polio paralysis but, unlike OPV, cannot passively vaccinate unvaccinated individuals Preferred for immunisation of pregnant women, immunocompromised patients and their households Final phases of polio eradication DIPHTHERIA VACCINE Diphtheria toxoid vaccine (DTP) as part of DTaP- IPV/Hib at 6,10,14 weeks, 18 months Diphtheria toxoid vaccine available in combination with tetanus toxoid and pertussis vaccines (both acellular and whole cell) Side effects Mild Pain and swelling at the site of injection Fever that usually disappears within a day Irritability and loss of appetite 4

5 TETANUS VACCINE HAEMOPHILUS INFLUENZAE TYPE B VACCINE Inactivated tetanus toxin Combinations Trivalent in combination with diphtheria and pertussis vaccines (DTP/DTaP) Td TT Tdap Need at least 5 doses Four dose schedule (6, 10, 14 weeks, 18 months) Hib vaccine only confers protection against invasive disease caused by Hib Hib vaccine is safe with no noted serious side effects PERTUSSIS VACCINE Two types of pertussis vaccines: Whole-cell vaccines Acellular vaccines Both vaccines highly efficacious In 4 doses as part of the EPI-SA schedule As part of DTaP-IPV/Hib at 6,10,14 weeks, 18 months HEPATITIS B VACCINE Prevent: HBV transmission (also mother-to-child) Chronic hepatitis B Chronic liver disease Cirrhosis and hepatocellular carcinoma HAEMOPHILUS INFLUENZAE TYPE B VACCINE Reduces meningitis, pneumonia and otitis media Hib conjugate vaccines used in EPI-SA highly effective Efficacy rates from 90% to 100% HEPATITIS B VACCINE Protection rates of between 93% and 100% Most vaccinated individuals remain protected for at least 20 years Immunocompromised individuals and haemodialysis patients Often requires more doses as poor response to the standard schedule Three dose schedule vaccine administered at the same time as DTaP-IPV/Hib 5

6 HEPATITIS B VACCINE Infants with HIV infection vaccinated within the EPI schedule Neonates born to hepatitis B chronic carrier mothers High risk adults Side effects and special precautions Hepatitis B vaccine is highly safe. Mild side-effects Soreness at injection site, fatigue, irritability, headache and fever. Persons who are allergic to yeast-derived products should be given the plasma-derived vaccine Persons who reacted negatively to a previous dose of the vaccine should not be vaccinated PNEUMOCOCCAL VACCINE PCV13, Prevenar is licensed for use (EPI) Polysaccharide from the thirteen most common serotypes Conjugated to CRM197 (a nontoxic mutant of diphtheria toxin) PCV10, Synflorix is licensed for use (Private) PS from 10 serotypes conjugated to Non-typeable Haemophilus protein ROTAVIRUS VACCINE Prevent severe rotavirus diarrhoea Reduce diarrhoeal deaths 30% months Two vaccines licensed RotaTeq RotaRix (SA EPI) ROTAVIRUS VACCINE No data on interchangeability Side effects and special precautions RotaRix Loss of appetite, fever, fatigue, diarrhoea, vomiting, regurgitation of food, flatulence, abdominal pain, crying, disturbed sleep, sleepiness, and constipation RotaTeq Diarrhoea, vomiting, fever, runny nose, sore throat, wheezing or coughing, and ear infection MEASLES VACCINE Live-attenuated viral vaccine 6 months of age, additional dose at 9 months 6

7 MEASLES VACCINE Given at 9 and 18 months of age as part of the EPI-SA schedule Asymptomatic HIV-positive infants should be vaccinated at 6 months of age, with an additional dose at 9 months Side effects Rare - allergic reaction to the vaccine Mild Pain at the site of injection Fever Rash Precautions Should not be given to persons with severe immune deficiency Asymptomatic HIV positive persons can be vaccinated TIME Infanrix Hexa C-pox Hep A Masels MMR HPV MMR MUMPS MUMPS VACCINE Doctor responsible for fabricating the link between the MMR and autism to be erased from the medical register Dr Andrew Wakefield, a British doctor known for his discredited work on MMR will be erased from the medical register by the British General Medical Council for professional misconduct. LANCET RETRACTS AUTISM PAPER Live-attenuated viral vaccine Monovalent; a bivalent in combination with measles or rubella vaccines, MM/MR; or a trivalent in combination with measles and rubella vaccines, MMR Immunocompromised individuals and haemodialysis patients often require more doses as poor response to standard schedule Very efficacious Protective efficacy rate to be 95% Mumps vaccine is NOT AVAILABLE as part of the EPI (SA) schedule Subcutaneously Reactions to mumps vaccine usually mild NOT be given to persons with severe immune deficiency Asymptomatic HIV positive persons can be vaccinated 7

8 RUBELLA VACCINE Live-attenuated viral vaccine Developed from live-attenuated RA 27/3 strain Monovalent Bivalent in combination with measles or mumps Trivalent in combination with measles and mumps Very efficacious 97% of vaccinees remain seropositive up to 15 years following vaccination RUBELLA VACCINE VARICELLA VACCINE Rubella vaccine not available as part of EPI (SA) schedule Persons at increased risk of rubella virus infection Women of childbearing age Adolescents Childcare personnel Health care workers Military personnel Precautions Not for people with severe immune deficiency and active tuberculosis Asymptomatic HIV positive persons can be vaccinated Side-effects usually mild Pain at the site of injection Fever for a day or two Rash lasting two days Allergic reaction (rare) Live-attenuated viral vaccine To prevent Complications Economic effects of disease Highly effective Not available as part of the EPI (SA) schedule Indications Children less than 10 years of age Household contacts of persons infected with varicella Immunocompromised individuals Unvaccinated young adults Schedule One dose to children 9 months to 12 years Two doses to adolescents (>13 years) and adults one month apart Reactions usually mild Not for persons with severe immune deficiency, and pregnant women. Asymptomatic HIV positive persons can be vaccinated provided CD4 count sufficient HEPATITIS A VACCINE Does not prevent hepatitis caused by other hepatitis agents such as hepatitis B virus, hepatitis C virus, hepatitis D virus, etc Inactivated vaccine Highly efficacious in preventing clinically apparent disease Not available as part of the EPI (SA) schedule Persons at increased risk People living under conditions where sanitation is poor Health care workers Food handlers Recipients of blood or blood products, such as haemophiliacs Travellers to HAV endemic countries Children in day-care centres, their families Day-care centre staff Intramuscular injection Two doses at least 6 to 12 months apart for both children and adults Mild side-effects Red Book Online. Available at: 8

9 HPV4 [Gardasil] and HPV2 [Cervarix] Red Book Online. Available at: Red Book Online. Available at: Red Book Online. Available at: 9

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