Updates in Iraq national

program of immunization 2012

ROTA VIRUS

ROTA VIRUS
First identified in 1973 by Bishop (wheel-shaped).
There are six species of this virus, referred to as A - F.
Responsible for 5% to 10% of all gastroenteritis episodes
among children < 5 years of age.
Most common cause of severe diarrhea in under 5 years.
Responsible for up to 500.000 diarrheal death each year
worldwide.

Rota virus Epidemiology

All children has at least 1 infection by age 5 years.
Highest infection rates between 3months-3years.

Rotavirus Epidemiology
Reservoir:

Human

Transmission: Fecal-oral
Temporal pattern: Fall and winter (temperate areas)
Communicability: 2days before to 10days
after onset

1999-2009 over 5 million children died

from Rotavirus disease

Local harm induced by

rotavirus in the gut

Normal Intestinal
Villi

Rotavirus-infected
Microvilli Tips

Rotavirus Immunity
First infection usually dose not lead to
permanent immunity.
Reinfection can occur at any age.
Subsequent infections generally less severe.

Rotavirus Clinical Features

Incubation period 1-3 days.
Variable clinical presentation
asymptomatic to severe diarrhea.
Confirmation requires laboratory testing (
enzyme immunoassay or RT-PCR).

Rotavirus vaccines
There are two rotavirus vaccines.
RV5 (RotaTeq), is a live oral
vaccine manufactured by Merck
and licensed by the FDA in 2006

RV1 (Rotarix), a live oral vaccine

manufactured by GlaxoSmithKline,
was licensed by the FDA in 2008

Rotavirus vaccine (Rota teq)

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Rotavirus vaccine
storage and handling
12

Provided as a single 2ml oral dose

In a buffered stabilizer solution.
Store at (2- 8 C).
Shelf life of properly stored
vaccine is 24 months.
Do not freeze.
Administer as soon as possible
after being removed from
refrigeration.

Rotavirus vaccine
recommendations
Routine immunization of all infants without
contraindications .
Administered at 2, 4 , 6 months of age.
First dose should be administered between
6 and 12 weeks of age (until age 13
weeks).
Do not initiate series after 12 weeks of
age.
3 doses better to be completed within 26
weeks of age

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Rotavirus vaccine
recommendations
Minimum interval between doses is 4
weeks.
Do not administer ANY dose on or after
age 32 weeks , even if fewer than
three doses have been administered.
Do not repeat dose if infant spits out
or regurgitates vaccine.
Administer simultaneously with all
other indicated vaccines.

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Rotavirus vaccine
Contraindications

Severe combined immune deficit

disease (SCID)
Severe allergic reaction to a
vaccine component or following a
prior dose of vaccine
Patient with problem of glucosegalactose or sucrose
malabsorption

Rotavirus vaccine
precautions
Recent receipt of blood product.
Altered immunity (child & household
contact).
Acute, moderate to severe
gastroenteritis or other acute illness.
pre- existing chronic GI disease.
Preterm infants
Infants with history of intussusceptions.
Infants of HIV mother
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14:09 //

Intussusception & Rota teq

vaccine
The phase 3 clinical trials to study the
occurrence of intussusceptions in Rota teq
More than 69,000 infants, of whom half
received vaccine and half received a
placebo.
In the 42 days after vaccination 6 cases of
intussusceptions were diagnosed among
the vaccinated infants and 5 cases were
diagnosed among the placebo recipients.

HAEMOPHILUS INFLUENZA

Haemophilus Influenza, history

In 1892 it was first described by PFIEFFER
In 1920 WINSLOW give name Haemophilus
Gram negative coccobacillus

Enter through nasopharynx and colonize and

may remain only transiently or for several
months in the absence of symptoms
(Asymptomatic carrier)

Haemophilus Infleunza (Hib)

Reservoir:
Only human (asymptomatic carrier)

Transmission:
Respiratory droplet, Hib doesnt survive in the
environment.

Clinical features
Invasive disease
A-Common
1. Meningitis 50-65%
2. Pneumonia
3. Epiglottitis
4. Arthritis
5. Cellulitis

Clinical features,

cont.

B- less common
1. Osteomyelitis
2. Pericarditis
3. Acute bronchitis
4. Otitis media (5-10% due to Hib)

Global Burden of Hib diseases

1. Mortality:
400,000 deaths/year out
of 2 million deaths /year
due to ARI
The case-fatality rate in Hib meningitis
is 2%5%, despite appropriate
antimicrobial therapy.

Haemophillus influenza type-bvaccines

Hib polysaccharide vaccine.

Available in 1985.
Not effective in children younger than
18 months of age.

Haemophilus influenza type-bvaccines, cont`d

Hib polysaccharide conjugated vaccine.
Available in 1987.
conjugation:
chemical bonding process of the polysaccharide
to carrier protein, immune response will be: Effective below 18 months of age.
Repeated doses elicit booster response.

Vaccination schedule
All infants, including those born prematurely ,
should receive a primary series of conjugate Hib
vaccine.
Primary series is 3 doses 2,4,6 months of age.
The recommended interval between primary series
doses is 8 weeks with a minimum interval is 4
weeks.

Booster dose is recommended at 12-15

months.

Vaccination schedule
Conj-Hib Vaccine given before 6 weeks
of age may induce immunological
tolerance to subsequent doses of Hib
vaccine.
((Hib vaccine should never be given to a
child younger than 6 weeks of age))

Vaccination schedule
Use in older children and adults:
Generally not recommended for persons
older than 59 months of age.
Consider for high risk persons:
Asplenia.
Immune-deficiency.
HIV.

Hib vaccine precaution and

contraindication
Anaphylactic reaction to previous
dose.
Moderate or severe acute illness.
Age younger than 6 weeks.

Vaccine Storage and

Handling
All Hib conjugate vaccines
should be stored at 2-8 c
must not freeze.
Should be used within 24
hours of reconstitution.


10
20
30
40

0
-10
-20

DTP
) (

The recommended schedule of immunization

in Iraq 2011
Age

Vaccines

Rout

1 week

B.C.G+POLIO(0)+HB1

ID+ORAL+IM

2 Months

D.P.T(1)+POLIO(1)+HB2

IM+ORAL+IM

4 Months

D.P.T(2)+POLIO(2)

IM+ORAL

6 Months

D.P.T(3)+POLIO(3)+HB3

IM+ORAL+IM

9 Months

MEASLES+VIT A

SC+ORAL

15Months

M.M.R

SC

18-24
Months

FIRST.B00STER
POLIO+D.P.T

ORAL+IM

4-6 Years

2nd..B00STER
POLIO+D.P.T

ORAL+IM

The new recommended schedule of

immunization in Iraq 2012
Age

Vaccines

Rout

1st 24 hours

B.C.G+POLIO(0)+HB1

ID+ORAL+IM

2 Months

Penta(1)+POLIO(1)+Rota(1)

IM+ORAL+ORA
L

4 Months

Tetra(1)+POLIO(2)+Rota(2)

IM+ORAL+ORA
L

6 Months

Penta(2)+POLIO(3)+Rota(3)

IM+ORAL+ORA
L

9 Months

MEASLES+VIT A(100000IU)

SC+ORAL

15Months

M.M.R

SC

18-24 Months FIRST.B00STER POLIO+Tetra+ ORAL+IM+ORA

20000IU VIT. A
L
4-6 Years

2nd..B00STER POLIO+D.P.T+
MMR

Penta=DPT+HB+HiB Tetra=DPT+HiB

ORAL+IM+SC