Prevention and vaccine pediatrics

Family Medicine Training
Dentist Training

PAEDIATRICS
PREVENTION AND
VACCINE
Dr Hussein Abdeldayem
Prof of Pediatrics
Alex University

PREVENTION


Prevention
• Primary Prevention
• Secondary Prevention
• Tertiary Prevention
• Quaternary Prevention


Prevention
• Primary Prevention
prevent the occurrence of
the disease
as: by immunization
by Genetic counseling

NO DISEASE

AR disorders
Infectious Disease as MMR, polio,etc

Prevention
• Secondary Prevention
early detection of the
disease for stopping or
reversing its progress
as: by prenatal diagnosis
by newborn screening
DISEASE
NO or MILD CP

PKU, Cong Hypothyroidism

Prevention
• Tertiary Prevention
stop the development of
complication of the
previously diagnosed
disease
as: by EIP,
by treating ABM with
corticosteroid AND follow
up for complications (ABR)
EIP, DISEASE
ABM NO Complication

Prevention
• Quaternary Prevention
set of health activities that
diminish or avoid the
consequences of
unnecessary or excessive
interventions in the health
system

Swine Flu cost


AR Inheritance


Prevention and Neurologic
disorders
• Down syndrome
• PKU
• Congenital hypothyroidism
• galactosemia


Down syndrome
1ry (no DS baby)
• Translocated mother (4%)
Risk 10%
Risk 100% (21/21)
Prevention: genetic counseling
(prevent conception)
• Non-Disjunction (95%)
Risk: 1/1000
increase by: age or has a DS
baby
Prevention: avoid late age or
frequent conception

Recent: Pre-implantation selection

Dr Hussein Abdeldayem ?? Folic acid supplementation

Down Syndrome
2ry Prevention ( DS baby)
• 9-12 wks GA:2
1- neck US
2- Blood: hCGTH, PaPPa, fetal RBC
3- Villous biopsy
• 12 -16 wks GA:
1- triad: AFP. UOstriol, hCGTH
2- tetrad: triad + inhibin
• > 16 wks GA:
Amniocentesis


DS
3ry Prevention
• EIP
• Echocardiography
• Visual acuity/y
• Thyroid function/y (TSH,T4)
• Tympanometry/y
• Neck X ray at 3-5 yrs*

*Neutral view, flexion & extension


Galactosemia

Failure to thrive
vomiting
Galactusuria (sugar in urine
AAuria, proteinuria


Galactosemia
• Milk lactose  G + Gal
Gal G Sugar excretion in infancy

• AR 3 genes Leloir 1970
Nobel prize
• galactosemia 1: (classic)
GALT Def (galactose 1p uridyl
transferase)
• Galactosemia 2:
GALK (Galactase=galactokinase)
• Galactosemia 3:
GALE (uridyl diphosphogalactose- 4 –
epimerase)

Prevention
• 1ry: Genetic counseling AR
• 2ry: early Screening
- blood and urine: increased gal and Gal 1 P
- decreazed enzymes (UT, Galactokinase,
epimerase)

Lactose free milk
• 3ry: rehab, treat cataract


PKU
– AR
– Gene on chromosome 12
– Enzyme deficiency:
phenylalanine hydroxylase
– Types:
1- classic
2- cofactor BH4
(tetrahydrobiopterin )
3- mixed* : mild ( no disease)


PKU
• Classic: P Hydroxylase deficiency
- blood: severe
hyperphenylalaninemia >20 mg/dl
• Cofactor BH4 deficiency
- normal phenylalanine in blood or
mild raised
- BH4 Cofactor for phenylalanine,
tyrosine and tryptophan
- diagnosis:
A- measure neopterin and biopterin in
urine
B- loading test: oral BH4 (20 MG/KG)
then measure phenylalanine
C- enzyme assay
• mixed


PKU
PREVENTION
• 1ry: genetic counseling AR
• 2ry: a- neonatal screening
then low phenylalanine
milk
• 3ry: rehabilitation , diet
resriction


C/P
Some CNS effects of
untreated PKU include:
1- fair hair and skin
• mental retardation 2- a “musty” or “mousy”
body odor

• behavior problems, autism 3- Eczema

• hyperactivity
• restlessness or irritability
• seizures


maternal PKU syndrome
• Pregnancy in women with PKU
(“Maternal PKU”)
Women with PKU who are not
on the low-Phe diet when they
become pregnant have a high
chance of having babies with
• birth defects as congenital HD
• mental retardation
• microcephaly (recurrent)
• SGA


Maternal PKU syndrome /
Prevention
During pregnancy, they
need to:
• stay on the low-Phe diet
• visit their PKU clinic on a
regular basis
• have their blood Phe levels
checked often


Prevention
• MR PREVENTION:
1- 1ry : vaccine of all females
against (at least 3 mo
preconception) of GM
2- 2ry: screening of
congenital hypothyroidism,
PKU and Galactosemia
3- 3ry: rehabilitation and
early intervention program
as in DS


Prevention
• Infectious disease prevention:
1- 1ry : (as ABM , H1N1flu disease)
a- Vaccine
b- Anti-organism prophylaxis
c- isolation of infected persons
d- Eradication of factors
transmit the infection
2- 2ry: early treatment of infective
organism (AB)
3- 3ry: early detection of sequelae
as ABR ( for ABM)


Immunity

Passive Acquired
From mother: Vaccine or toxoids
a- transplacental,
b- breast milk

Antibodies Active infection (clinical
administration: or subclinical) = Natural
a- gamma globin,
b- antitoxin


Natural infection is better than
immunization

• Actual Infection usually does
cause better and longer
immunity than vaccination.
• Measles, GM, mumps, & chicken
pox produce long life immunity
• However, the price paid for natural
disease can cause morbidity
( complications) up to death


Vaccination is better than passive
immunity

• vaccination cause better and
longer immunity than passive
immunity ( from mother or
injection of IG).


Vaccine better than infection

Diisadventages
Advantages

• Safe • Not solid immunity
• Mass protection • S/E
• ?? cost • ?? cost


Vaccines are safe

• Vaccines are easier
and safer to administer
than ever before.
• Being immunized is
much safer than risking
infection and disease.


Immunization can protect the
unprotected
• When
immunization
coverage is
high, it can
prevent viruses
and bacteria
from circulating.
• The more
children in a
community that
are fully
immunized, the
more everyone
is safe.


Immunization can save money

• Immunization is
one of the most
cost-effective
health
interventions.
• Investing in
vaccines SAVES
more money
than it costs.


Immunization Schedule
Age of Infant/Child Type of vaccine

At birth Zero 1st (OPV) oral OPV: live attenuated (LA) 2-3
Dose polio drops

0-1 mo: BCG: against BCG: live attenuated (LA)
(1st contact of child tuberculosis by (intra dermal injection over
with health
authority)
insertion of left deltoid, 0.1ml)

Ist month: all LA


OPV: 3 oral drops
Immunization Schedule DPT: IM 0.5 ml
HBV: IM 0.5 ml

Age of Type of vaccine
DT: killed
Infant/ P: toxoid
Child

2nd 2nd dose: Polio (OPV), DPT & OPV: Ki oral2-3
Month Hepatitis B 1
of DT: toxoid IM
age P: ki IM
4th 3rd dose: Polio (OPV), DPT & HBV: recomb
Month Hepatitis B 2
of Ag
age IM
6th 4th dose: Polio (OPV), DPT &
Month Hepatitis B 3
HBV
of Recomb Ag
age

Immunization Schedule
Age of Infant/Child Type of vaccine

9th mo of Measles SC LA
age Vitamin A Capsule (100.000 Measles: SC
units) MMR :SC

polio(5th dose) ORAL LA
Measles/MMR
LA

12 MMR sc LA
MONTHS 2 Vitamin A Capsule (200.000 units)
polio(6th dose) ORAL LA

Immunization ( Booster)
18 – 24 mo Booster of DTP (0.5 ml IM)
7th OPV (3 drops)
2 capsules Vit A (200,000 units)
4 – 6 yrs of MMR 2nd dose(0.5 ml SC)
age
(preschool)

6 – 12 yrs of Booster dose of OPV,
age DT,BCG ± MMR (if not
(start given at 4-6 yrs)
schooling)


Immunization: non obligatory
HIB: 3 doses ( 2, IM
Hemophilus 4 ,6 mo) and Conjugated
Influenzae booster at 18 polysaccharide
type B – 24 mo vaccine

HAV: 1st : +12 mo IM
Hepatitis A 2nd: after 6 – Inactivated
12 mo


Varicella + 12 mo – 13 yr: LA
one dose
Booster: 4- 6 yrs
≥ 13yr: 2 doses
with 6 wk apart

Meningo Over 2 ys SC
coccal Every 3 ys Inactivated
ACWY


Flu Every year Recombinant Antigen
vaccine (septemper/
(>6 mo october)
age)

???? ????? ?????


• Polio vaccine:
1- LA: Oral Sabin
2- killed: IM salk


• BCG : intradermal
• Measles: SC
• MMR: SC


Side Effects (Adverse reactions)
• 1- general : fever, allergy, anaphylaxis
• 2- local: pain, redness, swelling, sterile
abscess
• 3- specific:



3- specific:
i- BCG: TB ulcer, TB lymphadenitis with cold
abscess and sinus/ suppurative
lymphadenitis/ miliary TB

ii- OPV: paralysis



iii- Pertussis ( DTP):
a. Encephalopathy: within 7 days
b. Convulsions: within 2-3 days,
c. Persistent high – pitched cry: for 3 hrs within
2 days
d. Persistent fever: for 2 days ( >40.5ₒC)
e. shock or drowsiness, or somnolence: within
2 days



iv- measles: rash, arthralgia

V- GM: rash, arthralgia, lymphadenopathy,
allergy

Vi-mumps: mild parotitis


contraindication
Don’t immunize if there is:
1-Anaphylactic reaction to a
vaccine
2-Seizure or fever > 40 .5 C within
48 hr of pertussis vaccine
3-True Egg Allergy (MMR)
4-Neomycine allergy (MMR)
5-Immunocompromized patient
(OPV)
6-Untreated moderate to severe
illness + fever

contraindication
• Pertussis vaccine (DTP)
1- history of fits
2- abnormal neurological
child as CP
2- S/E of vaccine

Give: DT ‫الثنائى‬
or
D T (a)P


Vaccine of immunodeficiency
child
• immunodeficiency child as
AIDS, NS (steroid tt)
• Not GIVE:
BCG/ OPV/ MEASLES/MMR
• not give Oral OPV to his
HOUSEHOLD contacts
(siblings)


Cold Chain
transportation - storage
• OPV not yet used: at
freezer (-20C)
• ( 0-8C):
all vaccine and diluents
• On top shelf (under freezer)
: opened OPV, measles
• On 2nd shelf: BCG, DTP, DT,
TT


Cold Chain
transportation - storage
• In vaccine clinic: keep the
vaccine in a cup
containing ice
• Sensitive to strong light:
BCG, measles, MMR
• Away from HEAT, and
direct SUNLIGHT
• DISCARD any vaccine
remained in opened vials


Prevention and vaccine pediatrics

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