Paediatric immunization

1. CHILDHOOD IMMUNISATION

3. BACKGROUND
 On May 14, 1796, Edward Jenner, a British physician, made
2 small cuts on the arm of an 8-year-old boy.
 Jenner injected the boy with cow pox extract and later
injected him with the small pox virus.
 The recipient did not contract smallpox
 This experiment→ Jenner to discover inoculation
 Vaccinia---Vaccination

4. Edward Jenner

5. DEFINITIONS
 IMMUNITY - ability of the body to tolerate
material(s) indigenous to it & eliminate foreign
material(s).
 IMMUNE SYSTEM - comprises of organs &
specialised cells that protect the body by
identifying harmful substances (antigens)
and destroying them using antibodies & other specialised
substances & cells.

6. DEFINITIONS contd
 VACCINES
-are substances derived from infection -causing- micro
organisms, which through different types of manipulations
have been made to lose their virulence
(i.e. pathogenicity) and
acquire the ability to stimulate immune response by
antibobodies or sensitised cells.

7. Definition contd
 VACCINATION
- The process of introducing vaccines into a host
with the aim of stimulating an immune response
(the response will depend on factors e.g.: age, immune
status, potency, route of administration, type etc)

8. Definition Cont’d
 IMMUNISATION
-Process of of antibody production or production of
sensitised cells due to the introduction of vaccines into a
host.

9. TYPES OF IMMUNITY
Active immunity &
- Passive immunity.
 Active immunity
- developed by a person’s own immune system
through:
- exposure to a dz
or from vaccination.
- lasts for many yrs & may be permanent.

10.  Passive immunity results when
-Abs are transferred from one person to another
eg
-during pregnancy (transplacentally).
-through blood & blood products,
-through immune or hyper-immune globulin
-Disappears over time,

11. Live microorganisms or antigens
produce most effective immune
responses.

12. TYPES OF VACCINES
 Live attenuated vaccines
- derived from dz-causing viruses or bacteria
- grow in a vaccinated individual
- cause either no dz or only a mild form of disease
- one dose usually provides life-long immunity,
- exception OPV - requires multiple doses.

13. Examples of live attenuated vaccines
 Whole-cell vaccines
- made of an entire bacterial or viral cell.
Viruses e.g., oral polio vaccine (OPV), measles, yellow
fever
– Bacteria e.g. BCG
.

14. LIVE VACCINE

15. Inactivated vaccines
- produced by growing viruses or bacteria and inactivating
them with heat or chemicals.
- the organisms cannot grow in a vaccinated individual and
cannot cause the disease.
- Not as effective as live vaccines & multiple doses are
required.
May be whole – Virus e.g., inactivated polio vaccine (IPV)
– Bacteria e.g., whole-cell pertussis

16. Fractional inactivated vaccines
- composed of only part of a cell,
 - either protein- or polysaccharide-based.
 – Protein-based – Subunit, e.g., acellular
pertussis
– Toxoid, e.g., diphtheria and tetanus

17. Polysaccharide-based inactivated vaccines
- composed of long chains of sugar molecules from the
surface capsule of the bacteria.
-
Conjugation process is needed for effectiveness in children
under the age of 2yrs.
Pure Polysaccharide-based e.g. meningococcal
- Conjugated e.g., Hib
 Recombinant e.g., hepatitis B(HbV)

18. Recombinant inactivated vaccines
- inserting genetic material from a dz-causing organism
into a harmless cell,
- replicates the proteins of the disease-causing organism.
-The proteins are purified & used as vaccine.

19. KILLED VACCINE

21. GOOD IMMUNISATION COVERAGE CAN
ALSO PROTECT THE UNVACCINATED

22. HERD IMMUNITY
 Both populations have been exposed to a hypothetical
disease that is 100% contagious
.
 The first group has no immunity to the disease and,
therefore, the disease spreads to everyone.

24. ADVERSE EFFECTS FOLLOWING
IMMUNISATION
 Most vaccines are safe and effective but none is
completely safe and effective for every person.
 Aim of immunisation is to achieve maximum
protection with minimal risk.
 Adverse effects could be programme error or vaccine
reaction.

25. Programme error
 Wrong preparation, handling or administration
 eg overdosage, wrong route of admin., use of wrong
diluent/wrong volume of diluent

26. VACCINE REACTIONS
 These may be:
 Reaction to Antigens, components of the micro
organism, preservatives, stabilisers, or the antibiotics
in the vaccine .
 May be local, systemic, allergic, neurologic,
provocative or coincidental
 local---eg pain, redness, rarely abscess formation at
inj. site.
 not usually due to inactivated vaccines.
Eg accelerated BCG reaction

27.  systemic--- usually mild and mimics actual
infection eg fever, malaise, anorexia, allergic,
neurologic, coincidental etc. commoner with live
attenuated vaccines.
 Allergic---most severe but rare. Usually due to
abn reaction to a component of the vaccine. May
sometimes be life-threatening.
 Neurologic---eg post vaccine encephalitis with
anti rabies vaccine, seizures with pertussis
vaccine etc.

28.  Provocative--- a disease unrelated to immunisation
occurring after the immunisation eg paralytic polio
with DPT inj
 Coincidental---would have occurred without the
vaccine administration.

29. IMMUNISATION IN SPECIAL
CIRCUMSTANCES
 Premature infants---based on chronological but not
gestational age. Hepatitis B vaccine after 2/12 or at
2kg. No OPV to those on admission.
 Immunodeficient individuals
 Asplenic patients---polyvalent pneumococcal
vaccine and quadrivalent meningococcal vaccine to
all under 2 yrs.
 Personal and Family hx of seizures
 Chronic diseases
 Previous vaccine reaction

31. OTHER VACCINES REQUIRED
AGE VACCINES
12 to 15 MONTHS MEASLES, MUMPS & RUBELLA
(MMR)
CHIKEN POX
PNEUMOCCOCAL CONJUGATE
VACCINE (PCV)
18 MONTHS DPT & OPV BOOSTER
FROM 2 YEARS TYPHOID FEVER
MENINGITIS

32. RI FOR HIV INFECTED CHILDREN
Vaccine Asymptom
atic HIV
Infection
Symptoma
tic HIV
infection
Optimal timing of
immunisation
BCG YES NO At birth
DPT YES YES 6, 10, 14 weeks
OPV/IPV YES YES/NO 0, 6, 10, 14
/14weeks
MV YES YES/NO 9 months
HBV YES YES 0, 6, 14 weeks
YF YES NO

33. RI FOR WOMEN
Dose When to give Period of
protection
TT1 At first contact with woman
of childbearing age; or as
early as possible in
pregnancy.
None
TT2 At least 4 weeks after TT1 3 years.
TT3 At least 6 months after TT2 5 years.
TT4 At least 1 year after TT3 10 years.
TT5 At least 1 year after TT4 All childbearing
years.

34. Routine immunisations
 Effective in reducing overall mortality in young
children in an area of high mortality
STRATEGIES
Fixed facility: regular delivery of vaccinations in a health
facility on specified days of the wk & hrs of the day.
Larger facilities may give vaccinations whenever eligible
clients come.
 Outreach
-The delivery of services to people who cannot get to health
facilities .

35. EXPANDED PROGRAMME ON IMMUNISATION
(EPI)
 The EPI originally aimed to protect children against 6 dzs→
adopted globally.
 Launched in Nigeria in 1978

36. EPI LOGO

37. IMMUNISATION PROGRAMME IN NIGERIA
 By 1990, a high level of coverage of 80% had been achieved.
 This level of coverage not maintained b/c of
- continuing economic recession,
- political instability & poor funding
- withdrawal of foreign donors from the programme
- inadequate, irregular supply of vaccines &
- poor utilisation of immunisation services.

38. NATIONAL PROGRAMME ON IMMUNISATION
(NPI)
 In 1996, the FGN organised a review of the immunisation
programme & re-launched EPI as the NPI, to reflect
national commitment & ownership.
 The National Programme on Immunisation was established
by Decree 12 of August 1997 and became operational in
November 1998.

39. NPI STRATEGIES
 Routine Immunisation-RI
- Immunisation given to children b4 they complete 1yr of
age .
Women of Child bearing Age - Periodically at the
designated Health Facilities
 Immunisations (Booster doses) given to special or target
populations
 to achieve set goals & objectives @ a specified period
(elimination, Interruption, Eradication)

40. Missed opportunities
 Children eligible to receive immunisation in health
facilities may miss the opportunity for
unacceptable reasons
 Eg not ill enough to be admitted
 Unconfirmed previous vaccine reaction
 Too few children to spend multiple dose vaccines
 Industrial actions
 Absenteeism of healthcare providers.

41. ELEMENTS OF IMMUNISATION
 Vaccine/Supplies
 Cold Chain/Logistics
 Service Delivery
 Data Mgt
 Advocacy/Communication
 Surv/Monitoring/Evaluation
 Finance
 Coordination

42. Immunisation Plus Days
 Involves delivery of several antigens (OPV, DPT, Measles,
TT) & other child survival interventions (ITNs,
antihelminthics, Vitamin A, soap, ORS…..etc)
 Combination of fixed posts and house-to-house activities
 Immunisation cards to be issued

49. Diphtheria Pertussis
Varicella Measles
Polio Neonatal tetanus

54. KOPLIK SPOTS OF MEASLES

60. MUMPS

61. THANKS FOR
YOUR
ATTENTION