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Vaccines in children
Vaccines in children
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  1. 1. TERMENOLOGY IMMUNITY: The resistance offered by host to the harmful effects of pathogenic microbial infection is called immunity. INNATE IMMUNITY: the basic immunity which is generally passed on from one generation to other. So, it is present in individual by birth. ACQUIRED IMMUNITY: immunity acquired during life time from exposure to the invading agent either a bacteria, virus or toxin. ACTIVE IMMUNITY: A state where immune bodies are actively formed against specific antigen, either naturally by exposure to any infection or by by introducing the antigen artificially.
  2. 2. PASSIVE IMMUNITY: Temporary immunity acquired by infusion of immunoglobulin either artificially like serum and antibodies from actively immunized donors or naturally from mother to foetus through placenta IMMUNIZTION: The process of inducing or providing active or passive immunity to a person just to prime his immune system against the infectious agent. ANTIBODY: A protein mostly found in serum formed in response to exposure to specific antigen. ANTIGEN: A variety of foreign substances stimulating the formation of antibodies like bacteria, virus, toxins and foreign proteins.
  3. 3. ATTENUATE: Reducing the virulence of any pathogenic micro organism by certain measures like treating with heat or chemicals TOXOIDS: A modified bacterial toxin that has been made non- toxic but retaining the ability to stimulate the production of antitoxin.
  4. 4. • Immunization is the process of protecting an individual from a disease through introduction of live, killed or attenuated organisms . • The immunization is essential to reduce child mortality, morbidity and handicapped conditions. • It is a healthy choice that saves lives. Immunization has saved lives of children more than any other medical intervention in last 50 years. • The recommended age for beginning primary immunization of infants is within 2 weeks of birth or at birth. • Children born preterm should receive the full dose of each vaccine at appropriate chronologic age. • Children who began primary immunization at recommended age but fail to receive all the doses do not need to begin the series again but instead receive only the missed doses. INTRODUCTION TO IMMUNIZATION
  5. 5. INTRODUCTION …… Contd: • Immunization work by stimulating the immune system, the natural disease-fighting system of the body. • The healthy immune system is able to recognize invading bacteria and viruses and produce substances (antibodies) to destroy or disable them. Immunizations prepare the immune system to prevent against a disease. • To immunize against viral diseases, the virus used in the vaccine is weakened or killed (Attenuation). • To immunize against bacterial diseases, small portion of the dead bacteria is used to stimulate the formation of antibodies against the whole bacteria. • The effectiveness of immunizations can be improved by periodic repeat injections or "boosters."
  6. 6. DEFINITION Immunization is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen ). “WIKIPEDIA” (OR) Immunization is the process of inducing or providing active or passive immunity to a person just to prime his immune system against the infectious agent.
  7. 7. BACKGROUND OF IMMUNIZATION: • In 2012, the WHO estimated that vaccination prevents 2.5 million deaths each year. With 100% immunization, and 100% efficacy of the vaccines, one out of seven deaths among young children could be prevented, mostly in developing countries, making this an important global health issue. Four diseases were responsible for 98% of vaccine-preventable deaths: measles, Haemophilus influenza serotype b, pertussis, and neonatal tetanus. • The Immunization Surveillance, Assessment and Monitoring program of the WHO monitors and assesses the safety and effectiveness of programs and vaccines at reducing illness and deaths from diseases that could be prevented by vaccines.
  8. 8. • World immunization week 21st April ,2016 celebrated over the theme set by WHO as “close the immunization gap”, immunization for all through out life. Immunization averts 2-3 million deaths annually. However an additional 1.5 million deaths could be avoided , if global immunization improves. Today, nearly 1 in 5 children world wide are still missing routine immunizations for preventable diseases.
  9. 9. LIST OF VACCINE- PREVENTABLE DISEASES The WHO lists 25 diseases for which vaccines are available
  11. 11. • NEED OF IMMUNIZATION: • Immunizations are definitely less risky and an easier way to become immune to a particular disease than risking a milder form of the disease itself. Through the use of immunizations, some infections and diseases have almost completely been eradicated throughout the United States and the World. Polio in the U.S. is eradicated since 1979.
  12. 12. Polio is still found in other parts of the world like Pakistan & Afghanistan so certain people could still be at risk of getting it  This includes those people: I. who have never had the vaccine II. Those who didn't receive all doses of the vaccine III. Those travelling to areas of the world where polio is still prevalent.
  13. 13. IMMUNIZING AGENTS: These consists of V A C C I N E S I M M U N O GLOBULIN A N T I S E R A
  14. 14. VACCINES: • Active immunizing agents are known as vaccines. These are immuno biological substances which produce specific protection against a given disease. Vaccines stimulate active production of protective antibody and other immune mechanisms. Vaccines are of various types like:
  15. 15. LIVE ATTENUATED VACCINES: Prepared from live organisms that has lost their ability to produce full blown disease. INACTIVATED OR KILLED VACCINES: Suspension of inactivated or killed organisms TOXIODS: Exotoxin produced by certain organisms like diphtheria bacilli and tetanus bacilli are detoxicated and used in preparation of vaccine. CELLULAR FRACTIONS: Extracted cellular fragments e.g meningococcal vaccine produced from polysaccharide cell wall of antigen. V. COMBINATION VACCINE: More than one kind of immunizing agents are included in a vaccine e.g DPT, MMR & DT etc.
  16. 16. TYPE OF VACCINE VACCINE AGAINST BACTERIA VACCINE AGAINST VIRUS LIVE ATTENUATED VACCINE  BCG  Cholera  Typhoid oral  Oral polio vaccine  Mumps  Measles  Rubella  Rotavirus. INACTIVATED OR KILLED VACCINE  Diphtheria  Pertusses  Pneumococcal  Typhoid.  Rabies  Polio  H. Influenza  Hepatitis B  Measles. TOXOIDS  Diphtheria  tetanus
  17. 17. IMMUNOGLOBULIN: Passive immunizing agents obtained from humans. WHO “ Gamma globulin” synonym for “immunoglobulin”. • Human immunoglobulin consists of 5 major classes IgG, IgM, IgA, IgD AND IgE. • IgG constitutes 85% of total serum immunoglobulin and is the only Ig which is transported across placenta. • IgA constitutes approximately 15 % and in present in body secretions like saliva, tears, milk, colostrums, prostatic secretions and vaginal secretions. • The available human Ig’s are: diphtheria, hepatitis A and B, Measels, mumps and tetanus. ANTISERA: passive immunizing agents obtained non human sources like horses e.g; Bacterial: diphtheria, tetanus, botulism Viral: Rabies.
  18. 18. NOTE: Interval between two doses should not be less than one month. Minor cough, colds and mild fever or diarrhoea are not a contraindication to vaccination. In some states hepatitis B vaccine is given as routine immunization. If the child misses the any dose ,the whole schedule need not to be repeated
  20. 20. BENEFICIARIES AGE VACCINE DOSE ROUTE AMOU NT I N F A N T  At Birth (for Institutional deliveries) * BCG Single Intradermal 0.05ml * OPV Zero dose Oral 2 drops  At 6 weeks  BCG (if not given at birth) Single Intradermal 0.1 ml  DPT-1  OPV-1  Hepatitis 1st 1st 1st Intramuscular Oral Intramuscular 0.5 ml 2 drops 0.5 ml  At 10 weeks  DPT-2  OPV-2  Hepatitis B-2 2nd 2nd 2nd Intramuscular Oral Intramuscular 0.5 ml 2 drops 0.5 ml  At 14 weeks  DPT-3  OPV-3  Hepatitis B-3 3RD 3RD 3RD Intramuscular Oral Intramuscular 0.5ml 2 drops 0.5 ml  At 9 months  Measles Single Subcutaneous 0.5 ml C H I L D R E N  At 16-24 months  DP T Booster Intramuscular 0.5 ml  OPV Booster Oral 2 drops  At 5-6 Years  DT Single Intramuscular 0.5 ml Second dose of DT should be given after 4 weeks, if not vaccinated previously with DPT  At 10-16 years  TT Single Intramuscular 0.5 ml second dose of TT should be given if not vaccinated previously a) PREGNANT WOMEN  Early in pregnancy  One month after  TT-1  TT-2 1ST 2ND Intramuscular Intramuscular 0.5 ml 0.5 ml
  22. 22. S. NO VACCINE DISEASE DOSE/ROUTE AGE 1 HIB Meningitis & pneumonia 1.5ml /IM 6,10,14 WEEKS 12-14MONTHS---BOOSTER 2 Varicella Chicken pox 0.5ml/ SC 12-24 MONTHS 2 DOSES FOR ADULTS 2-4 WEEKS APART 3 Typhoid Typhoid 0.5ml/ SC 0.25ml /SC >10year For younger kids > 1year( 2 doses at 4-6 weeks interval 4 RRV- TV(Rotavirus) Diarrhoeal diseases 1-1.5ml / PO 6-26weeks, 3-doses at 4weeks internal 5 MMR Measles, Mumps and Rubella 0.5ml /SC 16-24 Months 6 Rubella Congenital Rubella syndrome 0.5ml /SC Females 12-15 months and women of child bearing age
  23. 23. PENTAVALENT VACCINE: • Pentavalent vaccine is given to those children who are coming for first dose of DPT. Infants who have already received either the first dose or the 2nd dose of DPT and Hep B will complete the schedule with DPT and Hep B only. • Pentavalent vaccine has been introduced in 8 states/ UTs. Tamil Nadu, Kerala, Haryana, J and K, Gujarat, Karnataka, Goa and Pondicherry
  24. 24. AGE CURRENT SCHEDULED VACCINE AFTER INTRODUCTION OF PENTAVALENT VACCINE. At Birth BCG, OPV-O, Hep B- Birth Dose. BCG, OPV-0, Hep B- Birth Dose. 6 weeks OPV-1, DPT-1, Hep B 1ST Dose. OPV-1, Pentavalent-1. 10 Weeks OPV-2, DPT-2, Hep B 2ND Dose. OPV-2, Pentavalent-2 14 Weeks OPV-3, DPT-3, Hep B 3RD Dose OPV-3, Pentavalent-3 9 Months Measles – 1st Dose Measles – 1st Dose 16-24 Months Measles – 2nd Dose DPT- Booster, OPV Booster. Measles – 2nd Dose DPT- Booster, OPV Booster. 5 Years DPT Booster 2 DPT Booster 2 10 Years TT TT 16 Years TT TT
  25. 25. 1.BCG: VACCINATION:  BCG (Bacillus of Calmette and Guerin) is produced by “Dannish-1331” strain of tubercle bacilli.  It is a live attenuated bacterial vaccine  It produces active immunization to children to protect children against tuberculosis  It is heat stable and available in freeze dried form  It should be kept away from direct sunlight and stored at 2o-8o C  Normal saline is recommended as its diluents for reconstituting the vaccine.  Reconstituted vaccine is used upto 3 hours then the left over vaccine should be discarded  Vaccine is given by a special tuberculin syringe in intradermal route
  26. 26. BCG ……Contd Satisfactory route produces a wheel of 5mm in diameter. After BCG vaccination, a papule appears in 2-3 weeks at the site of injection, in 4-5 weeks it grows in size and then subsides into shallow ulcer which can be covered or covered with crust. The ulcer heals in 8-12 weeks leaving a small scar. Reconstituted vaccine is used upto 3 hours then the left over vaccine should be discarded
  27. 27. COMPLICATIONS OF BCG: Deep ulceration. Local abscess formation Enlargement of axillary lymph node. Osteomyelitis or Keloid formation.
  28. 28. CONTRAINDICATIONS of BCG • It is contraindicated in children with  Eczema.  Infective dermatosis  Hypogammaglobulinemia.  Immunodefiency and HIV with symptoms of AIDS. DURATION OF PROTECTION: 15-20 years.
  29. 29. POLIO VACCINATION • Salk polio vaccine is administered in IM or SC route. It is expensive and produce short lived immunity. So, it is not recommended in National Immunization Schedule. • Government of India conducted pulse polio immunization (PPI) campaign towards the goal of eradication of poliomyelitis by oral administration of polio vaccine (OPV). • Oral polio vaccine was first described by Sabin in 1957. • Vaccine potency can be monitored by Vaccine Vial Monitors (VVM)
  30. 30. OPV…… CONTD OPV contains live attenuated polio virus of three strains( type 1,2 and 3), so administered as trivalent. Recent OPV is heat stabilized and is store at 4oC. for a year and at room temperature for a month. It induces both humoral and intestinal immunity. It is very safe vaccine without any side effects
  31. 31. CONTRAINDICATIONS OF OPV Acute infectious disease Fever Diarrhoea, dysentery Leukaemia, malignancy. Steroid therapy.
  32. 32.  DPT is a combined vaccine consists of diphtheria toxoid, tetanus toxoid and killed B Pertussis bacilli. The potency of Diphtheria toxoid is enhanced by Pertussis component of DPT vaccine.  The WHO recommends that only adjuvant DPT vaccine to be utilized immunization programme. The plain DPT vaccine can be used as a booster.  Stored at 4 – 8 C and should not be frozen. It loses potency if kept at room temperature for longer period of time.
  33. 33. DPT…..CONTD • DPT vaccine is given lateral aspect of thigh (vastus lateralis muscle) in infant s and in older children it can be given in gluteal muscle.
  34. 34. COMPLICATIONS OF DPT Mild Fever (2-6 %) Swelling or indurations (5- 10 %) Pain for 48 hours. • Severe complications of DPT ARE: Encephalitis, Encephalopathy, prolonged convulsions, infantile spasms and Reyes syndrome. These problems are thought to be due to Pertussis component of DPT
  35. 35. CONTRAINDICATIONS OF DPT Progressive neurological problems Severe reaction to first dose of DPT like shock and convulsions. cough, cold and mild fever are not contraindicated but seriously ill hospitalized children with these complications should not be immunized with DPT
  36. 36. MEASLES VACCINATION:  Measles vaccine is available as freeze dried powder. Heat stable measles and its diluting fluid should be stored at 2o - 8o C to maintain their potency.  The freeze dried vaccine after reconstitution with diluting fluid must be kept on ice and then used within one hour. Left out vaccine should be discarded and never used after 4 hours of opening the vial.
  37. 37. COMPLICATIONS OF MEASELS Fever and rash after 5th to 10th day of immunization. Fever and rash can persist for 1-3 days Induces mild measles illness (15- 20% cases) • Severe complications can developed if recommended temperature is not maintained and necessary precautions are not followed like Toxic shock syndrome.
  38. 38. CONTRAINDICATIONS OF MEASELS Acute illness Convulsions and allergies Malnutrition and tuberculosis. Immunodeficiency states and malignancy Immuno-suppressive therapy like steroids.
  40. 40. HEPATITIS B….CONTD Hepatitis B vaccine is available in two forms: plasma derived vaccine (HBsAg) and yeast derived vaccine.  Plasma derived Hep B vaccine gives protection for about 3-5 years  Hep B vaccine is used in pre- exposure or post- exposure prophylaxis.  Booster immunizations are required Stored at 2o-8o C and should not be frozen It is recommended the dose be doubled in patients on haemolysis, immuno-compromised individuals and those with malignancies. • Recommended DNA (RDNA) Yeast derived vaccine is alternative to plasma derived vaccine but it is costly • RDNA gives protection for 9 years • Booster immunization is not recommended.
  41. 41. TYPHOID VACCINATION: It does not give 100% protection but it reduces incidence and severity of infection. It can be given at any age after one year Stored at 2o-8o C temperature and should not be frozen Oral typhoid vaccine (Typhoral) induces the local gut immunity. It is recommended for children above 6 years of age.
  42. 42. T Y P E S Monovalent anti-typhoid vaccine containing killed S. typhi Bivalent anti-typhoid vaccine containing S. typhi and S. paratyphi TAB vaccine containing S. typhi and S. paratyphi A and S. paratyphi B The efficacy of all types of typhoid vaccines ranges from 50-70% Primary immunization with anti-typhoid vaccine develops immunity in 10-21 days after inoculation and gives protection for about 3 years. So, booster dose in every 3 years.
  43. 43. TYPHOID ….CONTD •COMPLICATIONS: It includes fever, local pain, malaise and swelling •CONTRAINDICATIONS:  Antibiotics are contraindicated in case of oral typhoid vaccines between 3 days before to 7 days after the vaccine administration as their use may compromise the vaccine “take”.  Immunodeficiency states and immunosuppressive therapy  Febrile illness  Acute intestinal infections  Anti-malarial therapy
  44. 44. COLD CHAIN: • Cold Chain is a system of storing and transporting vaccine at the recommended temperature range from the point of manufacture to point of use. This cold chain is needed because vaccines are very sensitive to heat and may lose their potency if not stored and transported at optimum temperature. • Among all vaccines the oral polio vaccine is the most sensitive vaccine requiring storage at -20oC
  45. 45. India has built a vast cold chain infrastructure to ensure that only potent and effective vaccines reach millions of beneficiaries across the country. LAST COLD CHAIN POINTS I.E PHCS & CHCS DISTRICT STORES DIVISIONAL VACCINE STORES STATE AND REGIONAL VACCINE STORES. 4 GOVT. MED. STORE DEPOTS (AT KARNAL, MUMBAI, CHENNAI AND KOLKATA) MANUFACTURERS
  46. 46. • Transportation of vaccines from States/Regional stores to divisions and districts is done in cold boxes using insulated vaccine vans. Vaccines carriers with icepacks are used to transport vaccines from PHCs to the outreach sessions in the village.
  47. 47. COLD CHAIN…..CONTD • At regional, divisional and district levels, there are cold chain technicians whose responsibility is to maintain and repair cold chain equipment for maintaining the recommended temperatures for storage of vaccines. • At the PHCs and CHCs, cold chain handlers, who are health personnel maintain Ice Lined Refrigerators (ILRs) and Deep Freezers (DFs) including temperature charting. • Cold chain technicians have been provided with trainings and tool kits for performing installation, maintenance and repair activities. For maintenance of cold chain equipment, Govt. of India provides funds to the state under NRHM.
  48. 48. For successful cold chain system, three elements are essential, i.e  Cold chain equipment.  Transportation system and  Motivation and training of workers for maintenance of cold chain link
  49. 49. A.Vaccines to be stored in freezer ( -15 TO -25 C)  OPV  Measles B. Vaccines to be stored in cold part of refrigerator and never allowed to freeze (2-8 C)  DPT  DT  BCG  TT  TYPHOID  All vaccine diluents C. Vaccines stored at room temperature (25C)  TT
  50. 50. VACCINE HEAT LIGHT FREEZING OPV Live attenuated Sensitive Sensitive. OK to freeze BCG Live attenuated Sensitive Sensitive OK to freeze before reconstitution Measles Live attenuated Sensitive Sensitive OK to freeze before reconstitution DPT Toxoid, Killed Relatively stables -- Freezes at -3oC Discard if frozen HEPATITIS B recombinant Relatively stables -- Freezes at -5oC Discard if frozen TETANUS Toxoid Relatively stables -- Freezes at -3oC Discard if frozen
  52. 52. LIST OF COLD CHAIN EQUIPMENTS • Walk in cold rooms: • Deep freezers: • Ice Lined Refrigerators (ILR): • Cold boxes: • Vaccine carriers: • Day carrier: • Ice packs:
  53. 53. 1. Walk in cold rooms: They are located at regional level and are meant to store vaccines for up to 3 months. They are used to store vaccines of 4-5 districts.
  54. 54. D E E P . F R E E Z E R S:
  55. 55. Two types of ILR are available, one with ice tubes (Electrolux ) and others with ice packs (vest frost) as the ice lining.
  56. 56. ……
  57. 57. Available at all peripheral health centres.Fully frozen ice packs are placed at bottom and walls of it before placing vaccines in it. The vaccines are first placed in polythene bags then to be kept in cold boxes. DPT, DT, TT and all diluents should not placed in direct contact with the frozen ice packs.
  58. 58. It is used to carry 16- 20 vials of vaccines to out-reach sites to the sub centres, village, vaccination clinic or camp.
  59. 59. Day carrier: It is used for nearby areas and only for few hours period with two fully frozen ice packs. It is used to carry 6- 8 vials only
  60. 60. • Ice pack is prepared in deep freezers and contains water, filled up to the level marked on the side. No salt is added to it. Leaking ice pack should not be used.
  61. 61. NURSES RESPONSIBILITIES FOR CHILD IMMUNIZATION • Nursing personal is mostly responsible for administration of immunization 1. Motivation of general public regarding the immunization and its benefits. 2. Estimation of beneficiaries of area and identification of non-participants and drop- outs of immunization. 3. Assessment of problems and reasons for non acceptance of immunization and intervening to solve problem. 4. Information, health education and communication about immunization session, time, place and available vaccines 5. Organization of immunization clinics at different health institutions, immunization camps and home based services. 6. Arrangement and maintenance of required amount of vaccines and other necessary equipments for particular immunization centre.
  62. 62. 7. Maintenance of cold chain at centre or during transportation of vaccines to home or clinics with necessary precautions to preserve efficacy and potency of vaccines. 8. Care of cold chain equipments and Maintenance of optimum temperature of vaccines. 9. Administration of vaccine with basic skill of aseptic techniques and check checking the vaccine vials or ampoules. Selection of proper site, position of child, maintenance of six rights and steps of medication should be followed. 10. Observation of possible reaction after vaccination and providing necessary instructions about the care of child to parents and family after immunization. 11. Nurses give information about the next dose of immunization as per the schedule. 12. Maintenance of immunization card with required information and date of next visit 13. Maintenance of clinical records, registers, stocks and vaccines used 14. Reporting about immunization coverage and problems of particular area 15. Participation in research activities and new approaches related to immunization programme 16. Updating own knowledge and developing skill regarding advancement of immunization practices and changing attitudes
  63. 63. CONCLUSION • Prevention of disease is one of the most important goals in child care. Immunization is less risky and better way to immune the body against some disease. It is a healthy choice that saves lives. As we know prevention is better than cure, so, complete immunization as per the universal immunization schedule prevents and protects us from various vaccine preventable diseases. Nurses play a vital role in immunization and in maintaining cold chain. Cold chain plays a key role in making the immunization effective
  64. 64. THANK YOU