1 Intro. To Pediatrics &childhood Immunization

INTRODUCTION
TO PEDUATRICS &
CHILD HOOD
IMMUNIZATUON
Dr .Nigussie [Pediatrician] 1
What is pediatrics
 This is the study of pediatric population from birth
to 18 years.
 Includes both pediatric problems and child health
assessment (normal child evaluation)
 It studies in different age group because different
age group has difference in:
 Etiologic base of disease
 Problems
 Drug metabolism
 Different organ of maturation
 Different need
 Different level of understanding
2
Peculiarities
 Low immunity specially in under five years
 Different in lymph reticular system maturity
 Vulnerable to different indirect and direct abuses
 Passive immunity from mother may hampered
/mask/ disease manifestation.
 They have high metabolic needs
3
Ethiopia in Child Health
 Ethiopia is one of the country which has
high child mortality.
 The leading cause of mortalities
Pneumonia(28%) , neonatal
mortality(23%) , malaria, diarrheal
disease , measles
 To tackle this Ethiopia developed
different strategies to decrease this
(immunization started in 1980 and
progressively increase it coverage). 4
Early Childhood Mortality
 Neonatal mortality: the probability of dying within
the first month of life
 Post-neonatal mortality: the difference between
infant and neonatal mortality

 Infant mortality: the probability of dying before the
1st birthday
 Child mortality: the probability of dying between
the 1st and 5th birthday

 Under-5 mortality: the probability of dying between
birth and the fifth birthday

 All rates are expressed per 1,000 live births, except for
child mortality, which is expressed per 1,000 children

surviving to 12 months of age. 5
Early Childhood Mortality Rates in
Ethiopia(DHS/2011, Preliminary Data)
 Neonatal mortality rate(NMR)= 37
 Post- neonatal mortality rate(PNMR)=22
 Infant mortality rate(IMR)=59
 Child mortality rate(CMR)=31
 Under-five mortality rate(U5MR)=88
 All from 1000 live births NMR +
PNMR=IMR
IMR + CMR= U5MR

6
Ethiopian Immunization
 EPI started in 1980
 The objective was to MR from preventable disease.
 They programmed every year 10% coverage who
need the vaccine.
 Currently EPI coverage of Ethiopia
 In 20
7
8
9
In 2012-13
 Other vaccine was added pneumococcal vaccine .
 In Ethiopia 1 in every 4 death among under 5
children because of pneumonia each year
 100,000 become ill b/s of pneumococcal disease/yr

 Pneumonia accounts about 28% of death of under 5
children
 Case fatality rate :
 18% for pneumonia
 83% for meningitis
10
PCV
 Vaccine introduced in our country 2011
called synflorixTM
 Against 10 common serotypes called

PCV10
 PCV10 serotype contain in PCV cause

approximately 80% of pneumococcal
disease burden in the country
11
In 2013 GC
 Ethiopia also introduce Rota vaccine to decrease
mortality and morbidity from diarrheal disease.
 Other strategies are
 Health education
 Increase health professionals
 Nutritional surveillance
 NGO collaboration
 etc
12
Prevention of Disease
 Immunization
 Infection prevention (standard prequestion )
 Hand hygiene
 Reduction of HAI
13
Current Immunization
Program
14
No Age Type of vaccine
1st birth BCG,OPV0

EPI SCHEDUEL
2nd 6wks Pentavalent1(DPT- Hib
WHO STARTED AT BIRTH
, he-
b) ,OPV1,PCV1,rota 1
3rd 10 wks Pentavalent2,OPV2,
PCV2, rota 2
4th 14wks Pentavalent3 ,
OPV3 ,PCV3
5th  ……………. 9 month measles
15
Catch –up Immunization
 BCG ,PCV <12 MONTH

 OTHERS UNTIL FIVE YEAR(5yrs.) YOU CAN
START AND CONTINUE THE SECHEDUEL AS
MENTIONED
o OPV 0 WILL BE PROVIDED UPTO 14 DAYS
 IF 9 MONTH AND OLDER START WITH

MEASLES.
16
CHILDHOOD IMMUNIZATION
AND VACCINE PREVENTABLE
DISEASE
Dr .Nigussie Berihun(Asst.prof.
of pediatrics and child health
OUTLINE
 Objective
 Introduction
 Immunization and vaccination
 Standard childhood schedule
 Contra indication and precaution
 Immunoprophylaxis guidelines for especial
hosts
 Active and passive immunizing agents
 Cold-chain system
08/17/2022 immunization 18
Objective
 After completing this ;
 Able to define immunization vs.
vaccination
 List some of the contraindications to
immunization
 Describe especial group immunization
 List Pcv vaccine types
 Define cold chain.
Introduction
Passive immunity:
 Acquired passively through the
antibodies which came directly from
Maternal antibodies (through placenta)
or through immunoglobulin given
parentally.
Active Immunity:
 Acquired actively through exposure to
the antigen (Naturally through infection
or artificially by immunization
Introduction
 Immunization is the process of inducing
immunity against a specific disease.
 Vaccination is a process of administering the
vaccine or toxoid for disease prevention.
 Immunity can be induced either Passively
through administration of antibody-containing
preparations or
 Actively by administering a vaccine or toxoid to
stimulate the immune system to produce a
prolonged humeral and/or cellular immune
response
Indication for passive immunity
1) Immunodeficient children with B-lymphocyte
defects who have difficulties in making antibodies
(2) persons exposed to infectious diseases or who are

at imminent risk of exposure where there is not
adequate time for them to develop an active
immune response to a vaccine; and
(3) persons with an infectious disease as part of

specific therapy for that disease
IMMUNOGLOBULINES
 Immune globulin (IG) is a sterile Ab containing
solution
 Derived through cold ethanol fractionation of
large pools of human plasma.
 IG contains 15–18% protein, predominantly IgG,
 IG is not known to transmit infectious agents,
including viral hepatitis and HIV.
 Indications for IG are replacement therapy for
children with antibody deficiency disorders, and for
passive immunization for measles and hepA
ACTIVE IMMUNITY
Vaccines are defined as whole or parts
of microorganisms administered to
prevent an infectious disease.
Vaccines are antigens
 A toxoid is a modified bacterial toxin
that has been made nontoxic but is still

able to induce an active immune
response against the toxin.
08/17/2022
immunization 24
ACTIVE IMMUNIZATION …
Whol
e cell
Parts of
the
Polysacc Live
haride
Polysac
toxoid
attenuated charide
inacti organism with vaccine
vated conjugat
vaccine
ion
Polio( aP,
IPV), HPV,Hep
Hib,pcv, Measles,m MPSV,
mening umps,rube PPSV
Tetanus,
HepA B ococal
lla, Diphtheria
vaccine
varicella,
Rota ,inf.
vaccine
25
08/17/2022 immunization
Passive VS. Active
PASSIVE ACTIVE
Component Antibody Antigen
DURATION Short Long
MEMORY No Yes
Introduction cont…
LIVE KILLED
Virulence Attenuated Non infectious
 Whole Cell  Whole cell
bacteria  Toxoid
 Varient from  Surface
other component
Forms species  Conjugate
 Molecular surface
approach  Molecular
approach
Replication Yes No
Immunity Longer Shorter
duration
Usuallu No Yes
Booster
need
Introduction …
 Vaccination programs are considered to be the
most cost-beneficial health intervention and one of
the few that systematically demonstrate far more
benefits than costs.
 Vaccines are good, there is no reason to suffer if

there is effective way to prevent.
 Only those which are restricted to human are
eradication possible (polio, smallpox, measles)
Ethiopian immunization
 EPI started in 1980
 The objective was MR from preventable
disease.
 They programmed every year 10% coverage
who need the vaccine.
 Currently Ethiopia is working to make

immunization coverage 80% in 2015.
EPI SCHEDUEL
WHO STARTED AT BIRTH
No Age Type of vaccine
1st birth BCG,OPV0
2nd 6wks Pentavalnt 1(DPT-
hib ,he-
b),OPV1,PCV1,rota
1
3rd 10 wks Pentavalant2,OPV2,
PCV2,Rota2
4th 14wks Pentavalant3,OPV3

PCV3
5th
 …………….
9 month Measles
Catch up immunization
 BCG ,PCV LESS THAN 12 MONTH
 OTHERS UNTIL FIVE YEAR(5yrs.)
YOU CAN START AND CONTINUE
THE SECHEDUEL AS MENTIOND
 OPV 0 WILL BE PROVIDED UPTO 14
DAYS
 IF 9 MONTH AND OLDER START
WITH MEASLES.
EPI DELIVERY STRATAGIES
 STATIC
 OUTREACH
 MOBILE
 CAMPAIGN
STANDARD childhood
IMMUNIZATION
STANDARD CHILDHOOD IMMUNIZATIONS
IMMUNIZATION PROBLEMS
 DROPOUT; a child who discontinue the
immunization program.
 A child who discontinued the immunization should

not be re started
 There is no maximum interval b/n two
immunizations
 MISSED OPPORTUNITY; any child at health

facility should be screened for immunization
 08/17/2022 immunization 35
Adverse Reactions
 Local reactions ; swelling or indurations,
tenderness, and redness or erythema at the
injection site.
 More severe, such as inflammatory cellulitis
without bacterial infection (e.g., after DT or DPT-
containing vaccines).
 Systemic reactions may include fever, rash,

joint or muscle pain, fainting, seizures or
other central nervous system symptoms.
 Fainting immediately after immunization usually
due to apprehension and should not be confused
with anaphylaxis.
Adverse Reactions cont…
 Allergic reactions, such as urticaria, rhinitis,
bronchospasm and anaphylaxis, are rare.
 They may be due to a specific allergy to any

component of the vaccine
 If the specific cause of a serious allergic reaction

following immunization can be identified, that
particular component must never be given again.
 If the specific cause is not identified, no

component of the vaccine should be given again
except on the advice and under direct supervision
of an experienced physician
08/17/2022 immunization . 37
True contraindication
General contraindications:
 Anaphylactic reaction to a previous dose of vaccine
 Anaphylactic reaction to a constituent of a vaccine
Specific
 IPV: previous anaphylactic reaction to neomycin.
 MMR: previous anaphylactic reaction to neomycin,
pregnancy and severe immunodeficiency.
 Influenza: known anaphylactic hypersensitivity to
eggs.
 Meningococcal vaccine: Hypersensitivity to any
component of the vaccine
 Pneumococcal vaccine : Hypersensitivity to any
component of the vaccine including diphtheria toxoid.
 Varicella Vaccine : pregnancy and severe
immunodeficiency
Common Misconceptions
Vaccines may be given despite the presence of the
following:
 Mild acute illness, regardless of fever.
 Low-grade fever.
 Convalescent phase of illness.
 Recent exposure to infectious disease.
 Mild to moderate local reaction to
previous dose of vaccine (soreness,
redness, swelling).
 Current antimicrobial therapy.
 Prematurity.
Common Misconceptions cont…
 Malnutrition.
 Allergy to penicillin or other antibiotic
(except
anaphylactic reaction to
neomycin or streptomycin).
 Pregnancy of mother or another household
contact (except varicella vaccine may be
deferred if there is a pregnant, varicella-
susceptible household contact).
 Unimmunized household contact.

IMMUNOPROPHYLAXIS
GUIDELINES FOR SPECIAL HOSTS
PRETERM INFANTS:
 Immunize according to chronologic age

using regular vaccine dosage.
 Hepatitis B virus (HBV): delay until the

child is >2 kg or 2 months of age,
whichever is earlier.
Immunoprophylaxis …
PREGNANCY:
 Immunization of pregnant women with
killed or recombinant vaccine is safe;
however, the use of live, attenuated
vaccines is contraindicated.
 Pregnant women not immunized, or

incompletely immunized against tetanus
should receive TT to prevent neonatal
tetanus.
Immunoprophylaxis cont…
 Live attenuated yellow
fever vaccine may be
administered to pregnant
women only if they will be
exposed to an ongoing
epidemic.
CORTICOSTEROID ADMINISTRATION
AND IMMUNIZATION.
 Only high dose systemic steroids for more than 2

weeks(˃2WKS.) interfere with vaccine induced immune
responses.
 A period of at least 3 months should elapse
between high dose steroid use and administration of
both inactivated or component vaccines (to ensure
immunogenicity) and live vaccines (to reduce the risk
of dissemination).
 Children receiving physiologic replacement doses of

glucocorticoids can follow the routine immunization
schedule without restriction.
 Topical and inhaled steroids have no known impact

on oral or injected vaccines. immunization
08/17/2022 44
immunoprophylaxis cont…
 Children with neurologic disorders can

undergo routine vaccinations.
 For those with seizure disorders that might
be exacerbated by fever, prophylactic doses
of acetaminophen is advised.
……
EGG ALLERGIES:
 MMR vaccine can be given to children with
egg allergies without prior skin testing
provided you observe them for 30.minute
 Yellow fever vaccine and influenza
vaccines that are prepared from viruses
grown in embryonated eggs should
not be given unless the risk of the
disease outweighs the small risk of a
systemic hypersensitivity reaction.
Immunopophylaxis cont…
Immediate hypersensitivity reaction to eggs:
 Influenza vaccine: is contraindicated
 yellow fever vaccine: Skin testing is

recommended before administration.
........
PATIENTS TREATED WITH IG OR OTHER
BLOOD PRODUCTS :
 Passive immunization with products of

human origin can interfere with the immune
response to live viral vaccines.
 For measles vaccine, the recommended

interval between immune globulin (IG)
administration and subsequent
immunization varies from 3 to 10 months.
Pts treated with Ig cont..
 Interval of 3 mo for Mumps and
Rubella vaccine.
 If administration of IG preparation
becomes necessary after MMR vaccine
or its individual component vaccines
have been given, interference can also
occur.
Immunization in patients with
cancer(ca)
 Prevention of infection is important in pts
with impaired immunity.
 Infection in such patients results in high
mortality and morbidity
 Pts with low immunity are unable to
produce protective immunity .
 Immunization with live attenuated vaccine
may end up the patient with cancer by of
spreading of disease
Immunization in ca con…
 Cancer patients should generally be
vaccinated with inactivated vaccines
 Ca pts should not be receiving live
attenuated virus vaccines
 CDC recommend leukemia,lymphoma,and
others can receive if in remission or 3mon
chemotherapy termination .
 All indicated vaccines should be received
before( chemo,radiation,splenectomy or any
immunosuppressive mx)
Immunization ca cont…
 If inactivated vaccines are given during
chemotherapy ,should be readministerd after
recovery.
 Revaccination after chemotherapy is not

recommended if previous vaccination occurred
before.
 Pts with hematopoietic stem cell transplant

should be immunized after.
ACTIVE IMMUNIZING
AGENTS
AND VACCINE
PREVENTABLE
DISEASES
Diphtheria vaccine
 Diphtheria was one of causes of death in children
from 1 to 5 years of age.
 Universal immunization with diphtheria toxoid
throughout life, to provide constant protective
antitoxin levels
 Immunization does not preclude subsequent
respiratory or cutaneous carriage .
 It decreases local tissue spread, prevents toxic
complications, diminishes transmission .
 Provides herd immunity when at least 70–80% of a
population is immunized.
Diphtheria Vaccine cont…
 Diphtheria toxoid is prepared by
formaldehyde treatment of toxin,
standardized for potency, and adsorbed to
aluminum salts, which enhance
immunogenicity
 Two preparations of diphtheria toxoids are

formulated according to the limit of
flocculation (Lf) content, a measure of the
quantity of toxoid
 The pediatric preparation (i.e., DTaP, DT) contains
6.7–25.0 Lf units of diphtheria toxoid per 0.5 mL
dose
 The adult preparation (dT) contains no more than 2
Lf units of toxoid per 0.5 mL dose
 The higher-potency (D) children through 6 yr of
age because of superior immunogenicity and
minimal reactogenicity.
 For individuals 7 years of age or older, dT
adequately immunogenic .
 Increasing the content of diphtheria toxoid
heightens reactogenicity with increasing age.
Recommended Usage:
 Primary immunization of children < 7 years of age:
2,4,6 months then 1.5 , 4-6 years.
 Primary immunization of persons > 7 years of age:
dTap or Td.
 Adult booster dose: Td booster at 10-year intervals
or at least offer vaccine for high risk people (travelers
, close contacts of confirmed diphtheria case)
*Td-tetanus toxoid and reduced diphtheria toxoid
* Tdap – tetanus toxoid-reduced diphtheria toxoid-
and accelullar pertussis vaccine.
Adverse reactions:
 Diphtheria toxoid may cause severe but transient
local and febrile reactions in children and adults,
the frequency increasing with age
 A large proportion of children receiving a booster

dose of DTaP vaccine at 4 to 6 years of age
experience local redness and/or swelling of 5 cm or
more in diameter.
* DTaP –diphtheria toxoid-tetanus toxoid & a
cellular pertussis vaccine.
Tetanus Toxoid
 Tetanus is an acute and often fatal disease caused
by Clostridium tetani. The organism is ubiquitous
in soil, but has also been detected in the intestines
of animals and humans.
 Wounds that are contaminated with dirt, feces or

saliva and that are associated with tissue injury and
necrosis are most frequently associated with
tetanus
Tetanus Toxoid
Recommended Usage:
1- Routine childhood schedule (DtaP)

2- Routine booster doses every 10 years (Td)
3- Adults who have not previously received a
primary tetanus toxoid series require three
doses as part of an adult primary
immunization regimen (dTap or Td).
4- Active immunization against tetanus should
be undertaken for patients who have
recovered from this disease, because
infection does not confer protective
immunity.
………..
 Immunization of women with TT prevents
neonatal tetanus,with at least 2 doses of TT.
 For unimmunized persons >7 yr of age,

the primary immunization series
consists of 3 doses of Td toxoid given
/IM, the 2nd given 4-6 wk after the 1st
and the 3rd given 6-12 mo after the 2nd
WOUND MX
 TT should always be given after a dog or other
animal bite
 All non-minor wounds require human TIG except

those in a fully immunized patient.
 In patients with an unknown or incomplete

immunization history; crush, puncture, wounds
contaminated with saliva, soil, or feces; avulsion
injuries; compound fractures; or frostbite), TIG /
human IGIV/ derived TAT
08/17/2022 63
Tetanus Toxoid
Adverse Reactions:
 Rare but, incidence increases with age.
 Following booster doses, local erythema and

swelling are not uncommon Severe local reactions
occur rarely .Lymphadenopathy may occasionally
occur.
 Fever has been infrequently reported and usually

occurs in cases showing a marked local reaction
Tetanus Toxoid
 Systemic reactions, such as generalized
urticaria, anaphylaxis, serum sickness and
brachial plexus neuropathy, have rarely been
reported.
 Trismus associated with tetanus toxoid
immunization has rarely been reported. Outcomes
have been favourable. The pathogenesis is
unexplained.
Tetanus Toxoid
Contraindications and precautions:
 Tetanus toxoid should not be given if a severe
systemic reaction, including severe
hypersensitivity or a neurologic event, followed a
previous dose.
 People who experience a major local reaction or
high fever following a dose of tetanus toxoid
should not be given another dose for at least 10
years.
 There is no evidence that tetanus toxoid is
teratogenicity, but it is prudent to wait until the
second trimester of pregnancy to administer a
routinely required dose.
Pertussis Vaccine
 Pertussis (whooping cough) is a highly
communicable infection of the respiratory
tract caused by Bordetella pertussis.
 The disease can affect individuals of any

age; however, severity is greatest among
young infants. The goal of pertussis control
is to reduce the incidence and severe
morbidity of pertussis among young
children
 There is no serologic correlate of protection
from B. pertussis
Pertussis Vaccine
 All cellular pertussis(ap) vaccines licensed in
Canada have an estimated efficacy of
approximately 80- 85%.
 The duration of protection afforded by cellular

pertussis vaccines is not known, but the data
seem to indicate that protection does not
decline during the first 4 years of follow-up.
 Dap vaccines have fewer adverse effects than
the vaccines containing whole-cell pertussis
(DTP).
Pertussis Vaccine
Recommended Usage:
 Routine childhood schedule (Dap) at 2,4,6
and 18 months.
 4th dose may be administered as early as

12 mo of age, provided that 6 mo have
elapsed since the 3rd dose.
 5th dose of Dap is recommended for

children at 4-6 yr of age; a
……..
 5th dose is not necessary if the 4th dose in
the series is administered on or after the 4th
birthday.
 Children ≥ 7 years of age who have not
been immunized or for whom the
immunization status is unknown (e.g.,
immigrant children), adolescent/adult dap
should be considered.
 patients who had natural pertussis as per

routine
Pertussis Vaccine
Contacts:
 If received <3 doses--- > a dose after 4 wks.
 If received 3 doses ---- > 4 th dose after 6
months.
 Booster dose if 4th dose was less than 3 years
back.
 Booster dose for >7 years of dap is
considered.
Pertussis Vaccine
Adverse Reactions:
 The rate of reactions to cellular pertussis
vaccines is less than that reported with the
whole-cell preparations.
 Local adverse reactions eg.tenderness
 General reactions of fever, irritability,
drowsiness, persistent crying and hypotonic-
hyporesponsive episode
 Convulsions are unusual and were reported
Pertussis Vaccine
Contraindications and Precautions:
 Anaphylactic reaction to a previous dose or to any
constituent of the vaccine.
Not Contraindications :
 High fever within 48 hours of vaccination, afebrile
convulsions, persistent, inconsolable crying and an
unusual high-pitched cry after prior pertussis
vaccination,
 Hypotonic-hyporesponsive episodes, onset of

encephalopathy temporally related to pertussis
immunization and evolving neurologic conditions.
Haemophilus vaccine
Recommended Usage:
 Routine childhood schedule (pentacel) at
2,4,6 months then 1.5 , 4-6 years.

 Delayed vaccination 12-59 months : one
dose only
 Children in whom invasive Hib disease

develops before 24 months of age should
still receive vaccine as recommended, since
natural disease may not induce protection.
Haemophilus vaccine
Adverse Reactions
 Fever
 Local reaction 25% ,These symptoms are mild and
usually resolve within 24 hours.
 No severe adverse reactions have been noted in
clinical trials, although a few temporally associated
allergic reactions have been reported in older
children receiving the vaccine as part of their
routine immunization program.
Contraindications
 allergy to any component of thevaccine.
Measles vaccine
 Measles vaccine is available as a monovalent or
combined with the rubella (MR) or (MMR)
 MMR is the recommended form in most
circumstances .
 Following the measles resurgence of 1989-1991, a
second dose of measles vaccine was added to the
schedule.
 The current recommendations include a first dose at
12-15 mo followed by a second dose at 4-6 yr of age.
 Seroconversion : (87% at 9 mo, 95% at 12 mo, and
98% at 15 mo)
Measles vaccine CONT…
 Passively administered immune globulin may
inhibit the immune response to live measles
vaccine, and administration should be
delayed for variable amounts of time based
on the dose of immune globulin .
 7 days after exposure to 4-6 daysafter rash is
risk for transmission.
 Children should be isolated in this period.
Recommendations
Category Recommendation
6-11month endemic area Immunize,re immunize(12-15 month)
Histoy of inactivated or unkown Immunize(2x)
Hiv infected Immunize(2x) if no sever

immunosupression
Vaccination given with IG Immunize(2x)
Egg allergy No contraindication
Neomycine C/I if sever anaphylaxis
Immunoglobuline and mv
IG INTERVAL
TETANUS(IG 3month
HEB(IG 3month
RABIES(IG 4month
VARICELLA(IG 5month
MEASLES(IG 5-6month
BIOOD 5/6/7moth respectively.
TRANSFUSION(packed,whole,plasma or
plat late
ITP(IGIV 8month
KWASSAKI 11month
HEP A(IG 3month
Post exposure prophylaxis
for measles
 Susceptible individuals exposed to measles may be

protected from infection by either vaccine or IG.
 The vaccine is effective in prevention or
modification of measles if given within 72 hr of
exposure.
 IG may be given up to 6 days after exposure to
prevent or modify infection
 IG is indicated for susceptible household contacts
of measles patients, especially infants <6 mo of age,
pregnant women, and immunocompromised
persons.
Poliomyelitis vaccine
 Trivalent enhanced-potency vaccine of formalin-inactivated
poliovirus types 1, 2, and 3 grown in human diploid or Vero cells .
 Vaccination is the only effective method of preventing
poliomyelitis
Recommended Usage:
 Routine childhood schedule at 2,4,6 months then 1.5 , 4-6 years.

 Unimmunized or partially immunized individuals who are at
imminent risk of exposure to poliovirus .
 Adults: if they are at risk traveller, household contact, Lab

workers…etc.
STRATAGIES FOR IRRADICATION
 WHO used 4 basic strategies:
 routine immunization
 National Immunization Days (NIDs)
 Acute Flaccid Paralysis surveillance
 “mop-up” immunization.
TYPES
 IPV elicits higher serum IgG antibody titers.
 OPV also induces significantly greater mucosal IgA

immunity in the oropharynx and gastrointestinal tract,
which limits replication
 Transmission of wild poliovirus by fecal spread is

limited in OPV recipients.
 The immunogenicity of IPV is not affected by the

presence of maternal antibodies.
Poliomyelitis vaccine
 Side effects: No serious side effects have
been associated with use of the IPV
vaccine
Contraindications:
 Anaphylaxis to vaccine, vaccine
constituent, streptomycin, polymyxin B,

or neomycin.
HEPATITIS B VACCINE
 Hepatitis B vaccine and hepatitis B
immunoglobulin (HBIG) are available for
prevention of HBV infection.
 Two recombinant DNA vaccines are

available in the United States; both are
highly immunogenic in children.
 The safety profile of HBV vaccine is

excellent.
Hepatitis B Vaccine
.High risk groups:
 Health care and emergency service workers and
other occupational exposure.
 household and sexual contacts of acute HBV cases
and HBV carriers.
 populations or communities in which HBV is
highly endemic;
 travellers to hepatitis B endemic areas.
 hemodialysis patients, patients receiving
repeated infusions of blood or blood
products
Hepatitis B Immunoglobulin
 HBIG is indicated only for specific post
exposure circumstances
 provides only temporary protection (3-6

mo) .
 It plays a pivotal role in preventing

perinatal transmission when
administered within 12 h of birth.
Current HBV vaccination recommendations
 For all medically stable infants >2,000 g at birth

and born to Haig-negative mothers, HBV vaccine
birth, at 1-4 mo and at 6-18 mo .
 Preterm infants weighing <2,000 g at birth and born to

Haig-negative mothers should have their initial dose
delayed until 1 mo of age or before hospital discharge.
 Infants born to Haig-positive mothers, infants

born to Haig-positive women should receive
vaccine at birth, 1-2 mo, and 6 mo of age . The first
dose should be accompanied by HBIG
08/17/2022 88
Pneumococcal vaccine
 Streptococcus pneumonia is a leading cause of
serious illness among children worldwide .
 It was the most frequent cause of bacteremia,
bacterial pneumonia, bacterial meningitis,
sinusitis, and acute otitis media.
 Since pneumococcal conjugate vaccine was
added to the routine childhood immunization
schedule in the United States, the incidence of
invasive pneumococcal disease has declined
by 60 to 90 %.
Pneumococal vaccine CONT…
 The surface capsular polysaccharide of S.
pneumoniae provokes a type-specific
protective immune response and serves as the
basis for serotyping of these organisms.
 More than 90 different pneumococcal
serotypes have been identified.
 Serotypes 4, 6B, 9V, 14, 18C, 19F, and 23F are
the most prevalent in children, accounting for
between 60 and 80 percent of infections,
depending upon the area of the world.
 Polysaccharide vaccines are poorly immunogenic in
children younger than two years
 conjugation of an immunogenic nonpneumococcal
protein (carrier protein) to individual pneumococcal
polysaccharides elicits a T cell-dependent memory
response and increases the effectiveness of the
vaccine during the first two years of life.
 Carrier proteins for pneumococcal conjugate
vaccines include CRM197 (a nontoxic mutant of
diphtheria toxin) and OMP (the outer membrane
protein complex from Neisseria meningitidis).
 PCV that include 7, 9, 10, 11, 13, and 15
serotypes have been develop.
 The 13-valent vaccine is used in the
United States.
 the 10-valent vaccine is used in Europe
and in developing countries .
 The potential efficacy of the 7-, 10-, 11-,
and 13-valent vaccines varies depending
upon the serotypes that are included .
Pneumococcal vaccine CONT…
 In Ethiopia 1 in every 4 death among under 5
children because of pneumonia each year
 100,000 become ill b/s of pneumococcal disease/yr
 Pneumonia accounts about 28% of death of under 5

children
 Case fatality rate :

 18% for pneumonia
 83% for meningitis
PCV
 Vaccine introduced in our country 2011 called
synflorixTM
 Against 10 common serotypes called PCV10
 It is the only liquid vaccine with out
preservants provided in a 2 dose vial
 Sensitive to heat and freezing
 It should be discarded after 6hr from opening
 PCV10 serotype contain in PCV cause
approximately 80% of pneumococcal disease
burden in the country
Cont…
 Schedule:
 At 6,10 ,14 week
 All under 11 month any time
 Along with pentavalent vaccine
Cont…
 Contraindication
 Severe hypersensitivity reaction for the

previous dose of pave
 Child with HIV should get the pave as per

schedule
The following incident should be
reported
1. All injection site abscess
2. All cases of BCG vaccine lymphadenitis.
3. All deaths occur with in 1 month
following vaccination
4. All cases requires hospitalization occur
in 1 month period
5. All medical events occur caused by the
vaccination of the people concern
PCV cont..
 Administration
 Have a look at the VVM

 Shake well to have uniform solution
 IM over the right upper outer thigh
 Dose 0.5 ml using a 0.5 cc syringe gage
 Instruct the mother and clean the site
 Press after injection for few seconds
but donor massage
Rota vaccine
 RV is the most common cause of GE.
 Particularly in the ages of six months and two years.
 Extensive surveys have established rotavirus

as the single most important viral cause of
severe gastroenteritis in children worldwide.
 Universal infant immunization against
rotavirus is recommended by the CDC.
TYPES OF RV VACCINE
 Currently two
 A pentavalent human-bovine rotavirus
reassortant vaccine (RV5, PRV, RotaTeq) is
licensed in the USA and Europe for universal
use in infants younger than six months (Europe)
to eight months (United States) of age.
 A monovalent rotavirus vaccine derived from
the most common human rotavirus strain
attenuated by serial passage (RV1, HRV,
Rotarix) is licensed for use in the all continent.

Ethiopia and RV Vaccine
 Started in 2012-2013 period for all infants with
all eligible children at six weeks and 10 week.
 RV1 can be administered to premature infants
who are clinically stable, at least six weeks old.
 RV1 can be administered to breastfed infants
 The RV1 series should be initiated or
completed in infants who have had rotavirus
GE before completing the two-dose series
because the initial infection frequently
provides only partial immunity

RV1 contraindications
 Who are allergic to any of the ingredients of
the vaccine
 Who had a severe allergic reaction after a
previous dose
 With severe combined immunodeficiency
 With a history of intussusception
 With severe (anaphylactic) allergy to latex
(the applicator contains latex

Passive Immunizing Agents
 Provide immediate protection
Types:
 Standard immune globulin (IG) of human
origin, sometimes referred to as “immune
serum globulin” or “gamma globulin”;
 Special preparations of either human or

animal sera containing high titres of specific
antibodies to a particular microorganism or
its toxin, such as tetanus immune globulin.

Immune Globulin (Human):
 It is obtained from pooled human
plasma and contains mainly IgG with

small amounts of lgA and IgM.
 Maximum plasma levels are reached

about 2 days after intramuscular
injection, and the half-life in the
recipient’s circulation is 21 to 27 days.
1. Measles (Post-exposure Immunoprophylaxis):

 Vaccine prevents or modifies disease if given
within 72 hours of exposure (<1year or <2 vaccine)
 IG can be given to prevent or modify measles in
susceptible people within 6 days after exposure.
 IG should be considered for susceptible contacts of
measles, particularly all children < 1 year of age
and immunologically compromised individuals for
whom measles vaccine is contraindicated.

Specific Immune Globulins:
 Specific immune globulins are derived from

the pooled sera of people with antibody to
the specific infectious agents.
 Human Or Animal Derived
 Before antisera of animal origin is injected,

testing for hypersensitivity to the
preparation should be carried out in
accordance with the manufacturer’s
recommendation.
Specific Immune Globulins
1. Botulism antitoxin (equine)
2. Diphtheria antitoxin (equine)
3. Hepatitis B immune globulin (HBIG)
4. Rabies immune globulin (RIG)
5. RSV immune globulin intravenous (human)
(RSV-IGIV)
6. Tetanus immune globulin (TIG)
7. Varicella-zoster immune globulin (VZIG)

Varicella-zoster immune globulin
High Risk Groups:

 Immunocompromised individuals
without a history of varicella.
 Susceptible pregnant women.
 Newborn infant with onset of varicella
in mother from 5 days before to 2 days
after delivery .
 Hospitalized premature infants
exposed during the first weeks of life.
CONT’D
 How to keep the
efficacy of the
vaccine???

The Cold Chain
Cold chain is
 the system used for keeping &
distributing vaccines in good

condition
 The equipment & people that keep
vaccines cold during their journey

are together
* Vaccines should be kept between 2 to
8 from manufacturer to eligible
COLD CHAIN
Manufacturer
Cold chain = system to ensure Central Cold room

the potency, the safety of
vaccines during distribution to
the point of use.
Région /
Mobile strategy Zone/District
Out reach
strategy
08/17/2022 Health facility

immunization
- -
111
Major Cold chain equipments
1. Cold rooms:
 Refrigeration (2oc – 8oc)
 Freezer (-15 to -25oc)
2. Refrigerator
 Vertical & Chest
 Absorption & Compression
3. Cold boxes
4. Vaccine Carrier
5. Ice-Packs (0.6 lit & 0.4 lit)
6. Foam Pads
Storage Temperature
Vaccine Primary Health Health
Store Post
Region District/ Centre
Zone
6 months 3 months 1 month 1 month Daily
Use
OPV -150C to –250C
BCG WHO no longer recommends that
freeze-dried vaccines to be stored
Measles
at –270C. Storing them at –200C is
Yellow Fever not dangerous & no necessity.
These vaccines must be kept cool &
Hib lyophilised
transported at +20C to 80C
HepB
DTP-HepB-Hib +20C to 80C
Hib- liquid
DTP +20C to 80C
DT
TT
The diluents must NEVER be frozen. If the vaccine is supplied freeze-dried pre-packed
with 08/17/2022 immunization
the diluents, the whole package must 113
be stored at +2 0C to +80C. When supplied
0 0
Vaccine damage due to freezing
Certain vaccines are more at risk from loss of potency

due to freezing than to heat exposure.
most sensitive  HepB

(tetravalent)
DTP
 DT
least sensitive  Td
 TT
Freezing can totally and irreversibly damage the efficacy
of these vaccines and increase the risk of side effects.
Heat sensitivity
Range Vaccine
OPV
Measles, MR, MMR
DTP, DTP-HepB, DTP-Hib,
DTP-HepB+Hib, YF
BCG
Hib, DT
Td, TT, HepB, JE

Light sensitivity
Range Vaccine
BCG
Measles
MR
MMR
rubella

Freeze sensitivity
Range Vaccine
HepB
Hib (liquid)
DTP, DTP-HepB, DTP-Hib,
DTP-HepB+Hib,
DT
Td
TT, Hib lyophilised

Refrigerator temperature chart

Refrigerator location
 Coldest room in a clinic
 Avoid from high temperature
 Lockable room
 Some centimeters away from the wall
 Level the refrigerator (kerosene ones)
 Avoid draught (Kerosene refrigerators)
 Distance to walls 100 mm
 Distance to Roof = 400mm

References
 1)Nelson text Book of pediatrics,18th Edition.
 2)Nelson Text Book of Pediatrics,19th Edition.
 3)Rudolph's Pediatrics, 21st Edition
 4)Introduction to pneumoccocal conjugate vaccine in
ethiopia,june2011GC.
 5)Immunization in practice;FMOH
 6)WHO /CDC Immunization Guide line.
 7)Text Book of pediatric infectious disease,5th Edition.
 8) WHO Technical Report Series No 941, 2007
 9) Up-to-date 21.2 .

MANY THANKS!!!

122

1 Intro. To Pediatrics &childhood Immunization

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1 Intro. To Pediatrics &childhood Immunization

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INTRODUCTION

infant and neonatal mortality

the 1st and 5th birthday

birth and the fifth birthday

child mortality, which is expressed per 1,000 children

IMR + CMR= U5MR

 100,000 become ill b/s of pneumococcal disease/yr

 Against 10 common serotypes called

 PCV10 serotype contain in PCV cause

1st birth BCG,OPV0

 BCG ,PCV <12 MONTH

o OPV 0 WILL BE PROVIDED UPTO 14 DAYS

 IF 9 MONTH AND OLDER START WITH

(2) persons exposed to infectious diseases or who are

(3) persons with an infectious disease as part of

 A toxoid is a modified bacterial toxin

that has been made nontoxic but is still

Component Antibody Antigen

DURATION Short Long

 Vaccines are good, there is no reason to suffer if

 Currently Ethiopia is working to make

4th 14wks Pentavalant3,OPV3

 A child who discontinued the immunization should

 MISSED OPPORTUNITY; any child at health

 Systemic reactions may include fever, rash,

 They may be due to a specific allergy to any

 If the specific cause of a serious allergic reaction

 If the specific cause is not identified, no

 Unimmunized household contact.

 Immunize according to chronologic age

 Hepatitis B virus (HBV): delay until the

 Pregnant women not immunized, or

 Only high dose systemic steroids for more than 2

 Children receiving physiologic replacement doses of

 Topical and inhaled steroids have no known impact

 Children with neurologic disorders can

 Influenza vaccine: is contraindicated

 yellow fever vaccine: Skin testing is

 Passive immunization with products of

 For measles vaccine, the recommended

 Revaccination after chemotherapy is not

 Pts with hematopoietic stem cell transplant

 Two preparations of diphtheria toxoids are

 A large proportion of children receiving a booster

 Wounds that are contaminated with dirt, feces or

1- Routine childhood schedule (DtaP)

 For unimmunized persons >7 yr of age,

 All non-minor wounds require human TIG except

 In patients with an unknown or incomplete

 Following booster doses, local erythema and

 Fever has been infrequently reported and usually

 The disease can affect individuals of any

 The duration of protection afforded by cellular

 4th dose may be administered as early as

 5th dose of Dap is recommended for

 patients who had natural pertussis as per

 If received 3 doses ---- > 4 th dose after 6

 Hypotonic-hyporesponsive episodes, onset of

2,4,6 months then 1.5 , 4-6 years.

 Children in whom invasive Hib disease

6-11month endemic area Immunize,re immunize(12-15 month)

Histoy of inactivated or unkown Immunize(2x)