Vaccination in
pediatrics
By
Dr Usama Alkholy
Professor Of Pediatrics
Zagazig University
Immunization
Immunization is the process of inducing immunity against a specific disease.
Compulsory vaccines in Egypt
Time Type of vaccine Dose
✓ At birth • Polio Sabin (zero dose) o 2 drops oral
• BCG o 0.1 ml ID at the left deltoid
• Hepatitis B (zero dose) o 0.5 ml IM
✓ 2, 4, & 4 months • Polio Sabin o 2 drops oral
• DPT o 0.5 ml IM:3 doses
• Hepatitis B vaccine o 0.5 ml IM: 3 doses
• Hemophilus influenza Hib o 0.5 ml IM: 3 doses
✓ 9 months • Oral polio and vitamin A o 2 drops oral
✓ 12 months • Polio Sabin (OPV) o 2 drops oral
• MMR o 0.5 ml IM first dose
✓ 18 months • Polio Sabin o 2 drops oral
• DPT o 0.5 ml IM
• MMR o 0,5 ml IM 2nd dose
• Hemophilus influenza Hib o 0.5 ml IM: 4th dose
✓ 4 – 6 months • Oral polio o 2 drops oral
• DT vaccine o 0.5 ml IM
General contraindications of vaccine
Moderate or sever illness (GE, Pneumonia,…) with or without fever.
Anaphylactic reaction to vaccine or its constitute.
Live attenuated vaccines
o Pregnant women
o Immunocompromised children
o Within 3 months of IVIG
BCG
• Preparation:
o Live attenuated strain of Bovine type.
o Usually, two weeks after vaccination, small papule
develops which, over a period of 6 weeks, enlarges
and ulcerates → It heals with a scar
• Dose:
o 0.05 ml for neonates & 0.1 ml for older individuals
intradermal in left upper arm.
o Given in the 1st 2 months
o May be given only to tuberculin -ve reactors at the
beginning of every school period.
• Advantages
o It forms a localized focus of infection that stimulates the immune system.
o It prevents severe disease (70- 80%) e.g., miliary TB and TB meningitis.
o The protection from the BCG vaccine can last up to 15 years
• Disadvantages
o Limited protective value → but it is the only proved method for protection.
o Axillary lymphadenopathy if given S.C → BCG oma which may need anti TB therapy
o Poor healing or ulceration may occur at the site of injection
o Disseminated T.B. if given to immunocompromised child
o Osteomyelitis
Complications of BCG vaccine
Polio vaccine: Sabin
• Preparation: Live attenuated vaccine containing the 3
polio strains.
• Precautions
o Cold chain system for keeping and transporting the
vaccine
o The killed vaccine (Salk vaccine) may be used instead.
o Not to be given during GE, acute infections,
immunocompromised babies
o In breast -fed infants, give the vaccine 2 hour before
or after feeding
Failure of the vaccine can result Advantages
from: • Cheap.
• Failure of refrigeration • Gives local GIT immunity and
humoral immunity.
• Vomiting or diarrhea
• High long lasting protective value
• Breast feeding after oral polio 95%
• No booster doses
Disadvantages: easily inactivated.
DPT
• Preparation
o Diphtheria and tetanus toxoid plus killed Pertussis bacteria.
o This combination → decreases the number of injections
• Precautions: not to be given in:
o Febrile states > 40 Co
o History of convulsions or epilepsy
o Children more than 6 years, give only DT
o Severe forms of reactions
• Advantages → High protective value
• Disadvantages
1. Minor reaction: local tenderness and slight fever.
2. Moderate reaction
o Irritability.
• N.B.: Diphtheria and tetanus
o High fever
toxoids and acellular pertussis
o Shock like syndrome
(DTaP) vaccine has a lower
o Protracted cry
incidence of complications
3. Severe reaction.
o Simple convulsions (if it occurs, the infant should
receive only DT in further vaccinations).
o Rarely encephalitis
• N.B.: Infants to HBS Ag +ve
Hepatitis B vaccines
mothers are given:
• Preparation: Recombinant DNA vaccine
o Hepatitis B Ig at birth (0.5 ml)
prepared from coding of Hbs Ag.
o The 1st dose of vaccine in
• Advantages → High protective value.
another site.
• Dose: 0.5 ml IM for children < 10 years (in the
o The other doses of the vaccine
thigh) and 1 ml IM for those > 10 years (in the
are given at 1 & 6 months.
thigh or the deltoid)
• Disadvantages:
o Transient erythema and induration at the
injection site.
o Mild fever and headache
MMR (measles, rubella and mumps).
• Preparation: Live attenuated vaccine containing the 3 types
• Dose: 0.5 ml SC at age of 12 and 18 months
• Disadvantages:
o Reaction: local pain & joint stiffness.
o Fever and coryza may occur 6-10 days after injection (generally safe vaccine).
Hemophilus influenza Hib
• Preparation: Capsular polysaccharide vaccine • Disadvantages:
• Advantages: it protects against meningitis, epiglottitis, and o Low grade fever.
septicemia o Local reaction
• Dose: 4 doses at 2-, 4-, 6-, and 18-months IM o Hyper-sensitivity.
• Value:
o Prevention of Hemophilus influenza type b infections especially
meningitis, septicemia, cellulitis, arthritis and epiglottitis.
o It is particularly important in infants and young children below the
age of 5 years where the incidence of infection with Hemophilus
influenza type b is most prominent
Other vaccines
➢RSV vaccine
➢Yellow fever vaccine
➢Cholera vaccine
➢Plague vaccine
■ General indications of non-compulsory vaccines:
• High risk groups.
• Household contacts to a case.
• During epidemics.
• Travelers to endemic areas.
• Before splenectomy (Hib., pneumococcal & meningococcal vaccines).
