Paediatric Infectious Disease Presentation

DR. ELHAM BUKHARI

Consultant
Paediatric Infectious Disease
Paediatric Department
King Khalid University Hospital
 Immunization.

-Is the process by which an individual's immune

system becomes fortified against an agent (known
as the immunogen).
 Immunization.
• The most important elements of the immune system that are
improved by immunization are the B cells (and the
antibodies they produce) and T cells.
• Memory B cell and memory T cells are responsible for a
swift response to a second encounter with a foreign
molecule.
• Active Immunization:
Administration of all or part of a microorganism or a
modified product of that microorganism i.e. a toxoid, a
purified antigen, or an antigen produced by genetic
engineering→to evoke an immunologic response
mimicking that of the natural infection but that usually
present little or no risk to the recipient.
 Active Immunization:

• Vaccines incorporating an intact infectious agent may

be either live (attenuated) or killed (inactivated).
what are the advantages of a live attenuated vaccine?
Active Immunization
• Virus:
Hepatitis B
• Bacteria:
• WholePertussis
• ToxoidTetanus
• PolysaccharideMeningoccocal
• Passive immunization

Administration of performed antibody to a recepient

e.i.
1. When persons are deficient in synthesis of antibody as a
result of congenital or acquired B-lymphocyte defects, alone
or in combination with other immunodeficiencies.
2. When a person susceptible to a disease is exposed to or has a
high likelihood of exposure to that infection, especially when
that person has a high risk of complication from the disease
i.e. a child with leukemia exposed to varicella or measles.
• Passive immunization

• Immune globulin (IG)

and specific hyper immune globulin given intramuscularly i.e.
hepatitis B immune globulin (HBIG)

Immunoglobulin intravenous (IGIV)

and specific hyper immune IG given by intravenous (IV) route
i.e. respiratory syncytial virus IGIV-(RSV-IGIV), human plasma
and antibodies of animal origin.
Human Immune Serum Globulin

• Specific
• IMHepatitis B (HBIG)
• Rabies (RIG)
• Tetanus (TIG)
• Varicella (VZIG)
• IVCMV (CMV-IG)
• RSV (RSV-IG)
• Active immunization of persons who recently received
immune globulin

Live-virus vaccines given parenterally can have diminished

immunogenicity when given shortly before or during a
period of several months after receipt of immune globulines

High doses of IG have been demonstrated to inhibit the

response to measles + varicella + rubella vaccine for a
prolonged duration.

In contrast with live-virus vaccine administration of IG has

not been demonstrated to cause significant inhibition of the
immune responses to inactivated vaccines and toxoid.
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• Immunization in special clinical circumstances

• Preterm infants
• Prematurely born infants, including infants of low birth
weight, should be immunized @ the usual chronologic age
in most cases.
• If an infant is still in the hospital @ 2 months of age, the
immunization routinely scheduled at that age including
DPT, H1b and IPV.
• Management of preterm infants born to HBsAg
negative mom

• In low birth weight less than 2kg the sero conversion rate
reported to be lower than rates in preterm immunized at a
later age and in term infant immunized shortly after birth.
• Hence, immunization in preterm infant with birth weight of
less than 2kg whose mothers are HBsAg negative should be
delayed until just before hospital discharge if the infant weighs
2kg or more or until approximately 2 months of age when
immunization are given.
• Pre term infant with birth weight less than 2kg whose
mothers are HBsAg positive should receive hepatitis
immune globulin within 12 hours of birth and concurrent
hepatitis B vaccine at different site (and this dose should
not be counted) .
• if the maternal HBsAg status is unknown, the vaccine
should be given in accordance with recommendation for
the infant of an HBsAg-positive mother.
• HIV Infection

1. MMR
• Should be given to asymptomatic children and those who
are symptomatic but are not severely immune
compromised.
• Why it should be given?
• Because of reports of severe measles in symptomatic HIV
children including fatalities in 40% of cases.
2. Varicella
- should be considered for asymp or mildly symp
with age-specific CD4. T lymphocyte % of 25% or
more.

3. Routinely recommended childhood vaccines,

including DTab, IPV, Hep B, Hib according to the
recommended schedule.
• 4. Annual influenza

• 5. Pneumococcal vaccine based

on the age

• 6. BCG is contraindicated
• Asplenic Children

Surgical Removal
Congenital asplenia
Functional asplenia i.e. SCD

Why→↑ fulminant bactremia

• What type of vaccine?
1 Pneumococcal vaccine @ 2 years and older

2 Hib vaccine @ 2m of age

3 Quadrivalent meningococcal vaccine @ 2 years of age

and older
• Pneumococcal Disease

• Children less than two years are at highest risk,

especially 6-11 months

• 500,000 cases of pneumococcal disease are estimated

to occur every year in Canada

• The number one cause of bacterial pneumonia and

meningitis
• Pneumococcal Disease in Children

• Estimated annual number of cases in children less

than 2 years of age
• Meningitis: 60
• Bacteremia: 1000
• Pneumonia: 3000
• Otitis media: 200000
• Pneumococcal Conjugate Vaccine
97% effective in preventing bacteremia and
meningitis in infants

• Pneumonia
• Clinical diagnosis: ↓11%
• Infiltrate on x-ray: ↓ 33%
• Consolidation “2.5 cm : ↓73%
• Pneumococcal Conjugate Vaccine

• Acute otitis media

• Any episode ↓6%
• Any Pnc otitis ↓34%
• Vaccine serotype ↓57%
• Pnc & ruptured TM ↓65%

Pneumococcal carriage
40-50% ↓ in vaccine serotypes
4-050% ↑ in non-vaccine serotypes
• Pnc Conjugate Vaccine Use

• NACI recommends routine immunization of all infants less

than 2 years of age.

Because attendance at group child care increases risk of

pneumococcal disease, healthy children 24-59 months of
age should be vaccinated.

• Vaccination of healthy children 24-59 months of age not in

group child care should be considered.
• Vaccination Does not Cause
• Autism
• Inflammatory bowel disease
• Asthma and atopic disorders
• SIDS
• Type 1 diabetes
• Multiple sclerosis
• Chronic fatigue syndrome
• AIDS, cancer, ADD, etc.
• MMR and Autism: 1

A large study of children with autism in England

found that there was no association between the
date at which MMR was given and the date when
parents first became concerned about abnormal
behavior in their child.
• MMR and Autism: 2

• The frequency of autism in USA appears to have

increased in recent years.

• This increase occurred long after MMR vaccine was

introduced.

• No increase in autism rates has been observed

following the introduction of MMR vaccine in USA,
Canada, Europe, or Japan.
• MMR and Autism: 3

• All evidence concerning MMR and autism has been

reviewed independently by expert committees of the
Institute of Medicine in the USA, the American Academy
of Pediatrics, and CPS.

• They agree that there is no scientific evidence to support

the theory that MMR causes autism or autistic spectrum
disorders or inflammatory bowel disease.
• Vaccination and Asthma

• A large International study analyzed immunization

rates and rates of asthma and other allergic diseases
from 91 centers in 38 countries in six and seven years
old, and also in 99 centers in 41 countries in children
13 to 14 years old. There was no correlation between
immunization rates and asthma/allergy rates.
• Vaccines and Immune Exhaustion

• Infants estimated to have the capacity to respond to

about 10,000 different antigens at any one time.

• Current vaccines much more highly purified than those in

the past.

• Even though infants now receive more vaccines than they

did 30 years ago, total amount of proteins and
polysaccharides is much lower today than it used to be.