Vaccination

• "You can have the best vaccines for a woman or her child, but if you can't get her to come and get them then they won't work."

  
• Immunization


  The process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine

  
• Vaccines


  Stimulate the body's own immune system to protect the person against subsequent infection or disease
• Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases
• Immunization is estimated to avert between 2 and 3 million deaths each year
• Immunization is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations
• Immunization has clearly defined target groups, it can be delivered effectively through outreach activities, and vaccination does not require any major lifestyle change
• Types of Immunization


  • Preformed antibodies (immunoglobulin) - Passive immunization
  • Introduction of an antigen - Active Immunization
• Passive Immunization


  • Transfer of maternal Antibodies Through placenta(natural)
  • Transfer of maternal Antibodies Through milk(natural)
  • Following administration of Immunoglobulin or antiserum (acquired)
• Active Immunization


  • Following clinical infection (natural)
  • Following subclinical infection(natural)
  • Following vaccination (acquired)

  
• Aims of Immunization


  • Eradication of disease
  • Elimination of disease
  • Control of disease
  • Protection from preventable diseases, disabilities and deaths
  • Most cost-effective healthcare intervention
• Vaccination


  A method of giving antigen to stimulate the immune response through active immunization

  
• Vaccine


  An immuno-biological substance designed to produce specific protection against a given disease

  
• A vaccine is "antigenic" but not "pathogenic"

  
• Features of effective vaccines

  • Safe
  • Protective
  • Gives sustained protection
  • Induces neutralizing antibody
  • Induces protective T cells
  • Practical considerations (low cost, biological stability, ease of administration, few side-effects)

  
• Types of vaccines


  • Live, attenuated
  • Inactivated/Killed
  • Toxoid (inactivated toxin)
  • Subunit/conjugate

  
• No vaccine is 100% safe

  
• No vaccine is 100% effective

  
• All vaccines have possible side effects, most mild, rarely severe

  
• The risk of disease far outweighs the risk of vaccine

  
• Vaccine Administration


  • IM
  • SC (usually live virus vaccines)
  • Oral
  • ID

  
• The route of administration is specific to each vaccine and it is essential to check and be sure of the route of administration for a given vaccine

  
• BCG vaccine


  Bacillus Calmette-Guérin: a vaccine against tuberculosis prepared from a strain of the attenuated (weakened) live bovine tuberculosis bacillus, Mycobacterium bovis

  
• BCG is given as a single intradermal injection at the insertion of the deltoid and leaves a scar in the left deltoid (85%)
• If BCG is accidentally given subcutaneously, then a local abscess may form (a BCG-oma) that can sometimes ulcerate, and may require treatment with antibiotics
• BCG vaccine


  • 50% effective in preventing pulmonary TB
  • 50-80% effective in preventing dissiminated and meningeal TB

  
• BCG vaccine contraindications


  • Immunocompromised patients - HIV

  
• Normally, a local lesion, papule, appears 2 weeks after BCG vaccination due to bacterial multiplication which heals leaving a scar in 12 weeks (repeat if no scar)
• BCG vaccine side effects

  • Fever
  • Local side effects: pain, redness, swelling, abscess - Discharging ulcer
  • Rare side effects: suppurative axillary lymphadenitis, disseminated BCG infection

  
• Hepatitis B vaccine


  A recombinant DNA HBsAg (Hep B surface antigen) vaccine that is very safe and effective

  
• Hepatitis B vaccine is given by 0.5cc IM route, with the initial dose at 61 days, then at 91 days and third dose after 5 months (usually given at 121 days in children)

  
• Hepatitis B vaccine


  • >95% efficacy
  • Local reaction and minimal fever as side effects, rare anaphylaxis

  
• Hepatitis B vaccine contraindications and precautions

  • Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component
  • Moderate or severe acute illness with or without fever
  • Infant weighing less than 2000 grams (4 lbs, 6.4 oz)

  
• H. Influenza vaccine


  A polysaccharide-conjugated vaccine given to all children less than 5 yrs and for those more than 5yrs at high risk, which is very safe and effective

  
• H. Influenza vaccine is given IM 0.5cc in the anterior thigh on the 61st, 91st & 121st days

  
• H. Influenza vaccine


  • 95-100% efficacy after 2 doses
  • Minimal side effects

  
• H. Influenza vaccine contraindications

  • Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component
  • Age younger than 6 weeks

  
• DTP vaccine


  Diptheria toxoid + Tetanus toxoid + inactivated whole cell Pertusis

  
• DTP is given 0.5cc intramuscularly on the 61st, 91st & 121st days, with booster doses at 18-24 months. DT is given at 6 years and dT after 10 years of DT (16 years)
• DTP vaccine


  • 95-100% efficacy after completion of schedule
  • Mild problems (fever, redness, swelling, soreness, fussiness, tiredness, poor appetite, vomiting) are common, moderate problems (seizure, non-stop crying, high fever, hypotonic-hyporesponsive episodes) are uncommon, and severe problems (serious allergic reaction, long-term seizures, coma, brain damage, brachial neuritis, Guillain-Barre Syndrome) are very rare