Immunization

Dr. Abbas Elsayed

Assistant Professor of Pediatrics
 Learning objectives
• Definition & types of Immunity
• Classification of vaccines
• Principles of active immunization
• National immunization program
• Adverse reaction, precaution & contraindication
of vaccination
 Immunity & immunization
• The term vaccination was used by Louis pasteur in the
19th century to include the physical act of administrating
any vaccine or toxoid
• Immunization is more inclusive term, denoting the
process of inducing immunity by administrating an
immunologic agent which can be active or passive
• Immunity is the ability to tolerate material which is self
antigen to the body and to eliminate material which is
foreign non self antigen
• There is 2 basic mechanisms of acquired immunity,
active & passive
 Overview of Immunity

Fig. 14-11)
 Types of Immunity
• Active immunity : produced by the person’s own immune
system (usually permanent protection)
• Active immunity is produced by immuno-biological
substance designed to produce a specific protection
against specific pathogen
• Passive immunity : protection transferred from another
person or animal by injection or from the mother to her
fetus through the placenta in the last months of pregnancy
• Provide effective but (temporary protection)
 Vaccination
• Vaccination is a method of giving antigen to stimulate the
immune response through active immunization.
• A vaccine is an immuno-biological substance designed to
produce specific protection against a given disease.
A vaccine is “antigenic” but not “pathogenic”.

The ideal vaccine :

-Immunogenic -Long lasting immunity

-Safe -Stable in field conditions

-Combined -Single dose

-Affordable and (accessible) to all

 Types of vaccines
I-Attenuated live vaccines
II-Inactivated killed vaccine which include
A-Whole cell vaccine
B-Fractional vaccine which include
1-Toxoids
2-protein base subunit
3-Polysaccharide and polypeptide (cellular fraction)
vaccines
III-Recombinant vaccines.
 Live attenuated vaccines
• Weakened form of the wild virus or bacterium that may
replicate to produce immune response like natural infection
• Live attenuated vaccine are fragile, must be stored &
handled carefully
• Not given to pregnant women and immunocompromised
hosts
Types
• Viral : Measles, Mumps, Rubella (MMR), Varicella &
rotavirus
• Bacterial : BCG & oral typhoid
 Inactivated or killed vaccines
• Produced by growing the bacterium or virus in culture
media then inactivating it by chemicals or heat
• Cannot replicate, generally not as effective as live vaccines.
Types
A-Whole cell vaccines: hepatitis A, & influenza
B-Fractional vaccine
1- toxoids : modified bacterial toxins that has been made
nontoxic but retain the ability to stimulate the formation of
antibodies to the toxins
2- protein based subunit : Acellular pertussis
3- poly saccharide based : as HIb, PCV13 &MCV4
C- Recombinant vaccines
A recombinant vaccine is a vaccine produced through
recombinant DNA technology.
 Types of vaccines
Type Live Killed Toxoids Polysaccharide Recombinant
Attenuate Inactivated vaccines vaccines
d vaccines vaccines

Examples •BCG -Pertussis •Diphtheria •Meningococcal •Hepatitis B

•Oral polio •Rabies •Tetanus polysaccharide vaccine
•Measles •Salk polio vaccine •HPV vaccine
•Mumps •Intra- •Pneumococcal
muscular polysaccharide
•Rubella vaccine
•varicella influenza
•Hepatitis A •HIB vaccine
•Intranasal
Influenza
 General recommendation
Vaccine administration
• For infant ˂ 1 year : anterolateral surface of the thigh
• For adult & children ˃ 1 year : deltoid area
• The buttock is not recommended for vaccine injection
• More than one injection can be given at the same limb but
spaced with at least 2.5 cm
Routes of administration
• Oral : OPV & Rotavirus vaccine
• Intranasal : live attenuated influenza vaccine (nasal spray)
• Intradermal ( needle inserted 15̊ angle) : BCG vaccine
• Subcutaneous (needle inserted 45˚angle) : MMR & varicella
• Intramuscular (needle inserted 90̊ angle) : DPT, PCV, MCV4
Simultaneous administration of the vaccines
Vaccine cold chain
 National
Immunization
Program
 NATIONAL IMMUNIZATION ROUTE
AGE (new 2019)

Birth -Hep B -Intramuscular

At the thigh

2 months - IPV -All I M at the thigh

- DTaP except rota is
oral
-Hep B
-Hib
-PCV
-Rota

4months - IPV All I M At the thigh

- DTaP except rota is oral
-Hep B
-Hib
-PCV
-Rota

6 momths -IPV BCG:Intraderm.

-DTaP OPV &. Rota are oral
Others I M at the thigh
-Hep B
-HIB
-PCV
-Rota
-OPV
-BCG
 NATIONAL IMMUNIZATION ROUTE
AGE (new 2019)

9 months -Measles Measles-subcutaneous

- MCV4 MCV4- Intramuscular

12months - OPV - Oral

- MMR - SC
- PCV - IM
-MCV4 - IM

18 months -OPV - Oral

- DTaP - IM
- Hib - IM
- Hep A - IM
-MMR - SC
-Varicella - SC

24 months (2y) - Hep A IM injection

6 years Primary -OPV - Oral

(School Entry) - DTaP - IM
- MMR - SC
-Varicella - SC
Age National immunization Route
(New 2019 )

11 years Tdap IM
HPV ( females only) IM

12 years HPV ( females only) IM

18 years MCV4 IM
 Hepatitis B vaccine
• Regardless of the mother HBsAG status all
medically stable infants > 2 kg at birth should
receie the 1 st dose of Hep B vaccine within 24
hours of age i
8
• Hep B vaccine & hepatitis B immunoglobulin must
be given < 12 hours or less after birth if the mother
e
is known to be HBsAG Positive
• Hepatitis A vaccine : Hep A vaccine
• inactivated vaccine
• Given to children > 1 year of age two doses, the
first at 18 months & the Second dose 24 months
 BCG vaccine
8
e

I
 IPV & OPV
• Poliomyelitis (polio) is a highly infectious disease that is caused
when the person is infected by the polio virus that invades the
nervous system. Poliomyelitis can cause paralysis and even death.
There are 3 types of the polio virus ; type 1, type 2, and type 3. The
polio virus usually affects children under 5 years of age who are not
fully vaccinated

1 -Salk vaccine (IPV) ; inactivated killed vaccine

2- Sabin vaccine (OPV)( oral polio vaccine ): live attenuated vaccine

• Taken orally as a drops
• Lifelong immunity & main preventive measures for polio
• Repeat the dose if there is vomiting
• Do not postpone vaccination in case of diarrhea
• Breast feeding has no effect on the vaccine
 Polio vaccines
• Trivalent OPV (tOPV) and IPV protect against all three types
of polio viruses (types 1, 2 and 3). Bivalent OPV (bOPV)
targets type 1 and type 3, but not type 2.
• OPV is very effective against the wild poliovirus, but in very
rare cases the vaccine can lead to paralysis. Vaccine
Associated Paralytic Poliomyelitis (VAPP). For every 1
million children in OPV-only using countries, there are 2-4
cases of VAPP. This translates to an estimated 250- 500
VAPP cases globally per year. Of these, about 40% are
caused by OPV’s type 2 component.
• How to prevent VAPP?
• Use of IPV & the switch from tOPV to bOPV will reduce the
risk of vaccine associated polio and increase protection from
types 1 and 3 polioviruses.
 IPV & OPV
• IPV protects children against polioviruses types 1, 2 and
3. After the switch from tOPV to bOPV, IPV use will help
maintain immunity to poliovirus type 2. This will help
prevent reemergence or reintroduction of wild or
vaccine-derived poliovirus. IPV does not cause VAPP
• OPV is no longer recommended for routine use in USA
because of very small risk of paralytic disease
• OPV which is no longer available in the US is
contraindicated in immunocompromised patients and in
children who live in household with an
immunocompromised or an HIV- infected adults because
of fecal-oral contamination is a concern
DTaP, Tdap, DT
 Rotavirus vaccine
Live attenuated vaccine
• Highly protective against rotavirus diarrhea
• Given at 2, 4 & 6 months & used by Oral route
• Contraindicated in :
• Severe combined immunodeficiency (SCID)
because it can cause prolonged diarrheal
disease in this patients
• History of intussusception
 Pneumococcal vaccine
• In 2000, a pneumococcal conjugate vaccine PCV: 7 strains
was released for all children less than 24 months
• At that time, the 7 vaccine serotypes was responsible for 80%
of invasive pneumococcal disease
• After that, there was increased incidence in invasive
pneumococcal disease caused by non vaccine serotypes
particular19A strain
• In 2010, a 13-valent (PCV13) was approved which include
coverage of 19 A strain
• Protect against pneumonia , meningitis, OM and bacteremia
• Given at 2,4,6, and 12 months
MMR
Varicella
Human papillomavirus vaccine(HPV)
General adverse reaction to vaccination
Specific vaccine adverse reaction
Contraindication & precautions
Specific contraindication
Allergic reaction
 The following are NOT contraindications to
immunization so give vaccines if there is
1. Previous mild to moderate local reaction ( soreness, redness or swelling)
2. Family history of adverse immunization reaction particular DTaP
3. Stable neurological condition, e.g., Down syndrome, epilepsy or cerebral
palsy
4. Influenzas vaccine : 2018-2019 recommendation of AAP and CDC are that
children with egg allergy can receive influenza vaccine without additional
precautions
5. Yellow fever vaccine : consult an allergist for those with any egg allergy
6. Personal or family history of inflammatory bowel disease does not
contraindicate MMR immunization
7. Family history of convulsions
8. Current antibiotic use
9. Previous mild to moderate reaction
10.Current mild acute illness with or without fever
 Revision
• Which vaccines require subcutanous administration ?
• List the routinely administrated live vaccines?
• It is appropriate to give a vaccine to a child with a cold?
• Which vaccine is recommended during the letter part of each
pregnancy?
• Which type of vaccine is not given to pregnant adolescent?
• Which vaccine is recommended at birth?
• Which vaccine is routinely recommended at the age of 11-12
years?
• An MMR is safe with an egg allery?
• What are the contraindication of MMR vaccine?
• What are the contraindication of rota virus vaccine?
 Revision
• MOH schadule (ALL)
• What is the optimum temperature for refrigerated vaccine?
• What are the general contraindication of the vaccine
administration?
• What is the first line for treatment of anaphylaxis after a
given vaccine?
References :-
1-Nelson textbook of pediatrics 21th edition 2020
2-pediatirc Review med-study 9th edition 2021
3-Nelson essential of pediatrics 9th edition 2022

THANK YOU!!!