IMMUNIZATION
Musaed Alharbi
Pediatrics Infectious Diseases Consultant
King Abdullah Specialized Children's Hospital (KASCH)
CONTENTS
Overview
General Principles of Immunization
Types and Biology
Routes
Schedule
Contraindications
Special Cases
• The "Ten Great Public Health Achievements in the 20th Century".
LESSONS FROM HISTORY
LESSONS FROM HISTORY
Are there any enemies for such achievement?
GENERAL PRINCIPLES OF
IMMUNIZATION
Passive Immunization
• Pre-formed antibodies to a person to provide them
limited immunity.
• Provide immediate protection for short period.
I. Natural: Transplacental maternal antibodies.
II. Artificial:
Immunoglobulin:
• Is a preparation derived from a large pool of human
plasma that contains antibodies to a variety of
common infectious diseases
Antitoxins
Active Immunization
• To stimulate a protective antibody or a cell- mediated response
in a person.
• Acquired when the antigen is introduced to the host .
• Takes time to induce the protection effect but of longer
duration
I. Natural : eg: previous Infection .
II. Artificial : with Vaccine:
A suspension of either whole or part of an organism .
Toxoid ( a modified microbial toxin ) .
BIOLOGY OF VACCINES
• The immune response-similar to natural infection.
• Capable to replicate, provide longer duration of
immunity .
• usually no need for booster except for oral dose
Live attenuated • can produce disease in immunocompromised
children.
vaccines :
• Live attenuated viral vaccines: measles,
mumps, rubella, varicella, rotavirus, OPV &
intranasal influenza
• Live attenuated bacterial vaccines: BCG &
typhoid (oral)
BIOLOGY OF VACCINES
• Not Capable to replicate, provide shorter
Inactivated duration of immunity .
vaccine • Require multiple doses(boosters)
(Killed): • Could not cause disease even in an
Produced by immunodeficient person
growing the • Inactivated whole virus vaccines: IPV and
Hep-A
microorganism in
• Inactivated whole bacterial vaccines: Pertusis
culture media,
• Fractional vaccines: subunits-Hep B,
inactivated with
inactivated influenza, vaccine, acellular
heat and/or pertussis, HPV; toxoids-Diptheria & tetanus
chemicals
BIOLOGY OF VACCINES
Polysaccharide
vaccine: A type of
inactivated subunit • e.g. pneumococcal, meningococcal & typhoid
vaccine composed polysaccharide vaccines
of long chain of • Conjugation of PS vaccine with a protein molecule
sugar molecules increases immunogenicity & booster response; Hib,
that make up the Pneumococcal & Meningococcal conjugate vaccine
surface of certain
bacteria
ROUTS
SITE OF IM
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BCG
• Contains a live attenuated strain of Mycobacterium bovis.
• It does not prevent primary infection.
• Has a documented protective effect against meningitis and
disseminated TB in children.
• Intradermal route in the deltoid region of the left upper arm .
Adverse reaction :
Superficial irritation
Abscess at injection site
Regional lymphadenopathy
Disseminated BCGitis (in patients with immunodeficiency)
DTaP
• Upper case “D” and “P” means there is more diphtheria and pertussis in DTaP
than in Tdap .
• (acellular) pertussis vaccines that are associated with fewer side effects .
• For younger than 7 years .
Tdap
T = contains tetanus toxoid .
d = reduced diphtheria toxoid .
ap = acellular pertussis vaccine = more purified = less side effect .
• For older than 7 years .
• Every 10 years in US .
HEPATITIS B
• HBsAg-positive mother — Infants of such mothers should receive
hepatitis B immune globulin (HBIG) shortly after birth and should be
immunized with HepB vaccine, preferably within 12 hours of age .
PNEUMOCOCCAL VACCINE
• There are two types on pneumococcal vaccines :
1- Pneumococcal Conjugated
• PCV13 ( Prevnar13 )
• A 13-valent vaccine contains polysaccharides of the capsular antigens
of 13 pneumococcal serotypes.
• For primary immunization series starting from age of 2months
PNEUMOCOCCAL VACCINE
2- Pneumococcal polysaccharide vaccine , PCV23 ( Pneumovax23 )
• For more than 2 years with special situation :
Chronic Lung illness .
Anatomic or functional asplenia , SCA .
Immunocompromised patients , Nephrotic syndrome .
HIV infection
Cochlear implant .
CSF leaks .
MENINGOCOCCAL VACCINE
• Meningococcal disease occurs in the form of epidemics in sub-saharan
Africa and in large gatherings as in Hajj or Umrah.
• N. Meningitidis has several sero-groups ( include sero- groups A, B, C, Y
and W-135 ) .
• 90% of all disease is caused by these .
• Most epidemics in the “meningitis belt” in Africa are caused by sero-
group A, whereas B and C are more common elsewhere in the world.
• However, recent reports of W-135 meningococcal disease in Saudi Arabia
and Y- group in the US are evidence of shifting trends.
MENINGOCOCCAL VACCINE
• There are two types of meningococcal vaccines available:
Polysaccharide and Conjugate.
• The quadrivalent Vaccine covered (A, C,Y and W-135).
MENINGOCOCCAL VACCINE
• Booster doses after primary vaccination are important for persons
with :
1. Prolonged increased risk (persons with asplenia, or with
complement component deficiencies )
2. Travel to endemic area (Hajj)
CONTRAINDICATION & PRECAUTION
• Situation which makes a • Situation which makes a
particular treatment or particular treatment or
procedure absolutely procedure relatively inadvisable
inadvisable. • Doesn't rule it out .
• Benefits Vs Risks
CONTRAINDICATION
Permanent contraindications:
1- Severe (anaphylactic) allergic reaction to a vaccine .
2- Encephalopathy not due to another identifiable cause occurring within
seven days of pertussis vaccination;
3- Severe combined immunodeficiency (SCID) to Live vaccine .
4- History of intussusception as contraindications to rotavirus vaccine.
Temporary contraindications to vaccination with live vaccines:
Pregnancy and immunosuppression.
PRECAUTIONS
Permanent Precautions
To further doses of pediatric DTaP are
1- Temperature of 105°F or higher within 48 hours of a dose,
2- Collapse or shock-like state (hypotonic hyporesponsive episode)
within 48 hours of a dose,
3- Persistent inconsolable crying lasting 3 or more hours occurring
within 48 hours of a dose, or a
4- Seizure, with or without fever, occurring within 3 days of a dose.
PRECAUTIONS
Temporary precautions :
• 1- Moderate or severe acute illness (all vaccines),
• 2- Recent receipt of an antibody-containing blood product.
only to MMR and varicella-containing vaccines.
TIMING AND SPACING OF VACCINES
NON-SIMULTANEOUS ADMINISTRATION
ANTIBODY-VACCINE INTERACTIONS
• The presence of circulating antibody to a vaccine antigen may reduce or
completely eliminate the immune response to the vaccine.
THANK YOU
