IMMUNIZATION AND

PROPHYLAXIS
BY
DR SAIMA
Objectives

 Types of vaccination
  Contraindications
  Discussion of individual vaccines
 Preparations
 Administration
 Precautions and contraindications
 Side effects
Active Immunization
Types
 Live attenuated
 Virus Measles, mumps,
rubella
 Bacteria BCG 
 Killed
 Virus Hepatitis B
 Bacteria
 Toxoid Tetanus
 Polysaccharide Meningoccocal
Human Immune Serum Globulin

 Specific
 IM Hepatitis B (HBIG)
Rabies (RIG)
Tetanus (TIG)
Varicella (VZIG)
 
 IV CMV (CMV-IG)
RSV (RSV-IG)
 Human Immune Serum Globulin

 Non-specific
 IM Immune serum globulin(ISG)
 Hepatitis A
 Measles
 IV Intravenous immune globulin(IGIV)
 Antibody deficiency disorders
 ITP
 Kawasaki syndrome
 Passive Immunization (Cont)

 SPECIFIC EQUINE ANTIBODIES (IM)

 BOTULISM ANTITOXIN
 DIPHTERIA ANTITOXIN
 TETANUS ANTITOXIN

 MONOCLONAL ANTIBODIES (IV)

 ANTI-ENDOTOXIN ANTIBODIES
Recommended Immunization
Schedule
RECOMMENDED AGE VACCINE(S)

BIRTH BCG, Hepatitis B (HBV)

2 MONTHS [DTP, HIB, HBV]
Polio Vaccine
4 MONTHS [DTP, HIB]
Oral Polio Vaccine (OPV)
6 MONTHS [DTP, HIB, HBV]
Oral Polio Vaccine (OPV)
9 MONTHS Measles vaccine (mono)
12 MONTHS Oral Polio Vaccine (OPV)
MMR,Hepatitis A
Varicella
1 8 MONTHS Oral Polio Vaccine (OPV)
DTP, HIB

24 MONTHS Hepatitis A
4 – 6 YEARS Oral Polio Vaccine (OPV)
DTP
MMR
General Contraindications

 Moderate or severe illness with or without

fever
 Anaphylactic reaction to vaccine or
vaccine constituent
 Live attenuated vaccines
 Immunocompromised /
Immunosuppressed children
 within 3-11 months of immunoglobulin
administration
Invalid Contraindications

 Mild to moderate local reaction

 Mild acute illness with or without low
grade fever
 Current antimicrobial therapy
 Prematurity and low birth weight
 History of penicillin or other nonspecific
allergies
 Malnutrition
 Compulsory Vaccines
Bacillus Calmette‑Guerin
Vaccine (BCG)
 INDICATIONS
 All newborns
 All tuberculin negative infants
 PRECAUTIONS &
CONTRAINDICATIONS(CI):
 Give only to PPD negative children
 CI in persons with immunodeficiencies 
Bacillus Calmette‑Guerin
Vaccine (BCG)
SIDE EFFECTS
 Local
 Skin ulceration, regional lymphadenitis
 Subcutaneous abscess
 Generalized

 Anaphylaxis, generalized BCG infection

 (rare):
Hepatitis B

 PREPARATIONS
 ENGERIX‑B
 RECOMBIVAX HB
 ADMINISTRATION:
 0.5 ‑1 ML, anterolateral thigh or deltoid
 IM injection
 at 0,1 and 6 months 
 SIDE EFFECTS:
 Pain
 Arthralgia
Poliomyelitis Prophylaxis

 PREPARATIONS
 (A) Oral (OPV) (Live attenuated)
 (B) Inactivated (IPV) (killed)
 ADMINISTRATION
 OPV 2 drops orally
 IPV SC injection
 PRECAUTIONS & CONTRAINDICATIONS(CI) 
 (a) OPV immunodeficiency
 (b) IPV neomycin hypersensitivity
 ADVERSE REACTIONS
 OPV paralytic disease (rare)
Diphtheria, Tetanus &
Pertussis (DTP)
 PREPARATIONS
 < 7 years : DTP, DT, DTaP (acellular
pertussis vaccine)
 > 7 years : Td
 ADMINISTRATION
 IM
Diphtheria, Tetanus &
Pertussis (DTP)
 CONTRAINDICATIONS (CI)
 Encephalopathy within 7 days
 Progressive or unstable neurological disorders
 Anaphylactic reaction to a previous dose
 PRECAUTIONS
 severe systemic reactions such as
 Temp > 40.50C
 Collapse episodes
 Convulsions
Measles, Mumps & Rubella
(MMR)
 PREPARATIONS:
 MEASLES.
 MMR.
 ADMINISTRATION:
 SC.
  INDICATIONS:
 Primary immunization at 1 & 6 years.
Measles, Mumps & Rubella
(MMR)
PRECAUTIONS & CONTRAINDICATIONS
 Immunodeficiency and
immunosuppression
 Immunoglobulins within 3-11 months
Measles, Mumps & Rubella
(MMR)
 ADVERSE REACTIONS
 Fever ,rash (7 days post vaccination)
 Arthralgia , arthritis (rubella)
 Encephalitis [rare] (measles, mumps)
 Suppression of PPD skin test (measles)
 Convulsions in prone children(measles)
 Thrombocytopenia
Haemophilus Influenza Type
B
 ADMINISTRATION
 IM
 2,4,6 months, booster at 15 months
 INDICATIONS
 Children under 5 years of age
 High risk children
 SIDE EFFECTS:
 Local pain and erythema
 Mild fever
Varicella Prophylaxis

 PREPARATIONS:
 Varivax vaccine
 ADMINISTRATION:
 0.5 ml IM
 12 months and above……..2 doses 
 
Varicella Prophylaxis

 INDICATIONS:
 All children 12 months‑18 years: (if
no history of varicella)
 EFFICACY:
 70‑90% 
Varicella Prophylaxis

 PRECAUTIONS &
CONTRAITNDICATIONS:
 Immunocompromised patients
 Within 5 months of IG
 Children on long term salicylates 
 SIDE EFFECTS:
 Fever , rash
 Zoster
Hepatitis A

 NATURE OF VACCINE:
 Killed formalin inactivated vaccine.
 PREPARATIONS:
 Various preparations available
e.g. Havrix 720, Havrix 1440 etc
Hepatitis A

 INDICATIONS:
 children 1 year and above
 Susceptible children in endemic areas
 Chronic liver disease
Hepatitis A

 ADMINISTRATION:
 IM injection
 2 doses, at least 6 months apart
 ADVERSE REACTIONS:
 Local reactions, fever
 Rare: anaphylaxis
 Additional Vaccines
Pneumococcal Prophylaxis

 PREPARATIONS:
 Purified capsular polysaccharide of 23
serotypes of Streptococcus pneumoniae
 7 valent conjugated vaccine

 ADMINISTRATION:
 IM / SC
 1 dose/booster 5 years
Pneumococcal Prophylaxis

 INDICATIONS:
 Primary vaccination (conjugate
vaccine)
 children 2 yr. or older with
 Anatomical or functional asplenia
 Sickle cell disease
 Nephrotic syndrome
 Immunosuppression
Pneumococcal Prophylaxis

 SIDE EFFECTS:
 Soreness , erythema, fever, myalgia
 Anaphylactic reactions (rare)
Meningococcal Prophylaxis

 PREPARATIONS:
 monovalent (A or C)
 bivalent (A & C)
 quadrivalent (A,C,Y & W‑135)
 quadrivalent conjugate quadrivalent
 ADMINISTRATION:
 SC
Meningococcal Prophylaxis

 INDICATIONS:
 Control of outbreaks
 Children with complement
deficiencies or asplenia
 SIDE EFFECTS:
 local erythema and discomfort
 transient fever
Influenza Virus

 Nature of vaccine:
 Killed vaccine.
 Live attenuated
  Preparations:
 whole and “split virus” vaccines.
 “split virus” vaccines are recommended for
children 6 months and older.
 composition of the vaccine is changed
annually.
Influenza Virus

 ADMINISTRATION:
 IM (killed).
 Live attenuated (intranasal).
 1 dose during influenzae season.
 Children 6months-9 years should receive
an additional dose, 4 weeks after the 1st
dose, if not previously immunized.
Influenza Virus

 Indications:
 chronic cardio-respiratory disease
 asthma
 cystic fibrosis
 bronchopulmonary dysplasia
Influenza Virus

 Indications:
 Sickle cell anemia.
 Chronic salicylate therapy.
 Diabetes mellitus.
 Chronic renal disease.
 Chronic metabolic disease.
 immunosuppressive conditions: cancer, HIV
etc.
 Hospital personnel with significant patient
contact.
Influenza Virus

 Contraindication:
 Anaphylaxis to previous dose.
 Hypersensitivity to eggs.
 Adverse Reaction:
 Soreness at injection site.
 Allergic response.
 Guillain-Barré Syndrome.
New Vaccines:

 Rota virus vaccines:

 age 2, 4, 6months
 Minimum age 6 wks, administer first dose
at age of 6 to 12 wks
 Do not start the series later than age 12
weeks.
 Human papilloma virus vaccine
Human papilloma virus
vaccine
 Minimum age is 10 years.
 1st dose of HPV vaccine series at age 11 years
 2nd dose after 2 months of the 1st dose and the
3rd dose 6 month after the 1st dose.
THANK YOU!