immunity and immunization fahad al zamil professor & consultant paediatric infectious diseases...

IMMUNITY AND IMMUNITY AND IMMUNIZATIONIMMUNIZATION

FAHAD AL ZAMILFAHAD AL ZAMILProfessor & ConsultantProfessor & Consultant

Paediatric Infectious DiseasesPaediatric Infectious DiseasesKing Khalid University HospitalKing Khalid University HospitalKing Saud University, RiyadhKing Saud University, Riyadh

Keeps Kids Healthy!

IMMUNITY & IMMUNIZATIONIMMUNITY & IMMUNIZATION

I.I. ImmunityImmunity

A.A. Components of the Immune Components of the Immune SystemsSystems

● ● LymphocyteLymphocyte

● ● B. T. KillerB. T. Killer

● ● NeutrophilsNeutrophils

● ● MacrophageMacrophage

● ● ComplementComplement


B.B. Features suggestive of immune Features suggestive of immune

deficiencydeficiency

● ● Increased susceptibility to Increased susceptibility to

infection.infection.

● ● Types of infectionTypes of infection

● ● Skin manifestationSkin manifestation


C.C. Facts and types of Facts and types of immunodeficiency B, T, combined, immunodeficiency B, T, combined, phagocyte and complements.phagocyte and complements.

D.D. Few examples of disorders.Few examples of disorders.

E.E. Evaluations of a patient suspected Evaluations of a patient suspected of having immunodeficiency.of having immunodeficiency.

F.F. Management.Management.

Historical MilestonesHistorical Milestones 1000 years ago:1000 years ago: Chinese inhaled dried crusts from Chinese inhaled dried crusts from

smallpox pustulessmallpox pustules 1721:1721: “variolation” was introduced from Turkey to Britain “variolation” was introduced from Turkey to Britain

by Lady Montaguby Lady Montagu 1796:1796: Edward Jenner: 1Edward Jenner: 1stst scientific attempt of scientific attempt of

immunization (cowpox)immunization (cowpox) 1919thth Century: Century:Anthrax 1881, Rabies 1885, Diphtheria Anthrax 1881, Rabies 1885, Diphtheria

antitoxin 1891, Plague 1895, Cholera 1896, Typhoid 1898antitoxin 1891, Plague 1895, Cholera 1896, Typhoid 1898 Early 20Early 20thth Century: Century: BCG 1921, Diphtheria toxoid 1923, BCG 1921, Diphtheria toxoid 1923,

Pertusis 1926, Tetanus 1927, Yellow fever 1937, Pertusis 1926, Tetanus 1927, Yellow fever 1937, Influenza 1941Influenza 1941

Post World War II:Post World War II: Polio, MMR, Pneumococcal, Polio, MMR, Pneumococcal, Meningococcal, HiB, Hepatitis B, Hepatitis AMeningococcal, HiB, Hepatitis B, Hepatitis A

1980:1980: Eradication of SmallpoxEradication of Smallpox What’s New in the 21What’s New in the 21stst Century?? Century??


II.II. Immunizations:Immunizations:

A.A. Types:Types:

● ● ActiveActive

● ● PassivePassive


Active:Active:● ● Immunizing antigensImmunizing antigens

● ● Site, route and doseSite, route and dose

● ● SchedulingScheduling

● ● Simultaneous administration Simultaneous administration of vaccinesof vaccines


Immunization in special Immunization in special clinical circumstances:clinical circumstances:

● ● PretermPreterm

● ● PregnancyPregnancy

● ● ImmunodeficientImmunodeficient

● ● Asplenic childrenAsplenic children


●● History and family seizuresHistory and family seizures

● ● Children with chronic diseasesChildren with chronic diseases

● ● Foreign travelForeign travel


● ● Lapsed immunizations and unknown Lapsed immunizations and unknown immunization status.immunization status.

● ● ReimmunizationReimmunization

● ● Interference with immunoglobulinInterference with immunoglobulin

● ● Vaccine safety and contraindicationsVaccine safety and contraindications

● ● Immunization after exposure to Immunization after exposure to disease.disease.

ROUTINE ACTIVE IMMUNIZATION ROUTINE ACTIVE IMMUNIZATION

FOR INFANTS & CHILDRENFOR INFANTS & CHILDREN

AgeAge VaccineVaccine

At birthAt birth BCG, HBV 1BCG, HBV 1stst

2 months2 months DPT + HiB + OPV 1DPT + HiB + OPV 1stst, HBV 2, HBV 2ndnd

4 months4 months DPT + HiB + OPV 2DPT + HiB + OPV 2ndnd

6 months6 months DPT + HiB + OPV 3DPT + HiB + OPV 3rdrd, HBV 3, HBV 3rdrd

12 months12 months MMR 1MMR 1stst

18 months18 months DPT + HiB + OPV 1DPT + HiB + OPV 1stst booster booster

4 – 6 years4 – 6 years DPT + OPV 2DPT + OPV 2ndnd booster, MMR 2 booster, MMR 2ndnd

14 – 16 years14 – 16 years Td (Repeated every 10 yrs.)Td (Repeated every 10 yrs.)

Revised Basic Vaccination Schedule Activated in Revised Basic Vaccination Schedule Activated in January 1January 1stst, 2008, 2008

AgeAge VaccineVaccine اللقاحاللقاحAt birthAt birth BCG, HepBBCG, HepB الدرن ، االلتهاب الكبدي

)ب(

2 months2 months IPV (DTP, HepB, Hib)IPV (DTP, HepB, Hib) شلل االطفال المحلل ) الثالثي البكتيري،االلتهاب الكبدي ب،

المستديمة النزلية(

4 months4 months OPV (DTP, HepB, Hib)OPV (DTP, HepB, Hib) شلل األطفال الفموي )الثالثي البكتيري، االلتهاب الكبدي ب،

المستديمة النزلية(

6 months6 months OPV (DTP, HepB, Hib)OPV (DTP, HepB, Hib) شلل االطفال الفموي

9 months9 months Measles (Mono)Measles (Mono) الحصبة المفرد

12 months12 months OPV, MMR, VaricellaOPV, MMR, Varicella شلل االطفال الفموي، الثالثي الفيروسي، الجديري المائي

18 months18 months OPV (DTP, Hib), HepAOPV (DTP, Hib), HepA شلل االطفال الفموي )الثالثي البكتيري،المستديمة النزلية( ،

االلتهاب الكبدي)أ(

24 months24 months HepAHepA االلتهاب الكبدي)أ(

4 – 6 Years4 – 6 Years OPV, DTP, MMR, OPV, DTP, MMR, VaricellaVaricella

شلل األطفال، الثالثي البكتيري، الثالثي الفيروسي،

الجديري المائي

VACCINES AVAILABLE FOR ACTIVE IMMUNIZATIONVACCINES AVAILABLE FOR ACTIVE IMMUNIZATION

VaccineVaccine TypeType RouteRoute

BCGBCG Live bacteriaLive bacteria Intradermal Intradermal (Preferred) or (Preferred) or subcutaneoussubcutaneous

CholeraCholera Inactivated Inactivated bacteriabacteria

Subcutaneous Subcutaneous intramuscular or intramuscular or intradermalintradermal

DTPDTP Toxoids and Toxoids and inactivated inactivated bacteriabacteria

IntramuscularIntramuscular

VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION VACCINES AVAILABLE FOR ACTIVE IMMUNIZATION (cont)(cont)


RubellaRubella Live virusLive virus SubcutaneousSubcutaneous

Tetanus & TD, Tetanus & TD, DTDT

ToxoidsToxoids IntramuscularIntramuscular

TyphoidTyphoid Inactivated Inactivated bacteriabacteria

Subcutaneous Subcutaneous (Boosters may be (Boosters may be intradermal)intradermal)

Yellow feverYellow fever Live virusLive virus SubcutaneousSubcutaneous



MMRMMR Live virusesLive viruses SubcutaneousSubcutaneous

MumpsMumps Live virusLive virus SubcutaneousSubcutaneous

OPVOPV Live virusLive virus OralOral

PlaguePlague Inactivated Inactivated bacteriabacteria

IntramuscularIntramuscular

PneumococcalPneumococcal PolysaccharidePolysaccharide Intramuscular or Intramuscular or subcutaneoussubcutaneous

RabiesRabies Inactivated virusInactivated virus IntramuscularIntramuscular


VaccineVaccine TypeType RouteRouteHep. BHep. B Inactivated viral Inactivated viral

antigenantigenIntramuscularIntramuscular

Haemop. BHaemop. B PolysaccharidePolysaccharide Subcutaneous Subcutaneous intramuscularintramuscular

InfluenzaInfluenza Inactivated virusInactivated virus Intramuscular Intramuscular (Preferred)(Preferred)

or subcutaneousor subcutaneous

IPVIPV Inactivated virusInactivated virus SubcutaneousSubcutaneous

MeaslesMeasles Live virusLive virus SubcutaneousSubcutaneous

MeningococcalMeningococcal PolysaccharidePolysaccharide SubcutaneousSubcutaneous

Immunization & ImmunityImmunization & Immunity

Misconceptions concerning Misconceptions concerning vaccine contraindicationsvaccine contraindications

Mild acute illness with low-grade fever Mild acute illness with low-grade fever or mild diarrhea illness in an or mild diarrhea illness in an otherwise well child.otherwise well child.

Current antimicrobial therapy or the Current antimicrobial therapy or the convalescent phase of illness.convalescent phase of illness.

Immunization & ImmunityImmunization & Immunity

Recent infection to an infectious Recent infection to an infectious

diseasedisease

Breast feedingBreast feeding

A history of non-specific allergies A history of non-specific allergies

or relatives with allergiesor relatives with allergies

Immunization & ImmunityImmunization & Immunity Reaction to a previous DTP dose that Reaction to a previous DTP dose that

involved only soreness, redness, or involved only soreness, redness, or

swelling in the immediate vicinity of the swelling in the immediate vicinity of the

vaccination site or temperature less than vaccination site or temperature less than

105F (40.5 C).105F (40.5 C).

PrematurityPrematurity

Pregnancy of mother or other household Pregnancy of mother or other household

contact.contact.

Immunization & ImmunityImmunization & Immunity Family history of Sudden Infant Death Family history of Sudden Infant Death

Syndrome in children considered for Syndrome in children considered for

DTP vaccination.DTP vaccination.

Family history of an adverse event, Family history of an adverse event,

unrelated to immunosuppression, after unrelated to immunosuppression, after

vaccination.vaccination.

MalnutritionMalnutrition

Immunization & ImmunityImmunization & Immunity Allergies to penicillin or any other Allergies to penicillin or any other

antibiotic, except anaphylactic antibiotic, except anaphylactic

reactions to neomycin or streptomycin.reactions to neomycin or streptomycin.

Allergies to duck meat or duck Allergies to duck meat or duck

feathers.feathers.

Family history of convulsion in persons Family history of convulsion in persons

considered for pertussis or measles considered for pertussis or measles

vaccination.vaccination.

Immunity & ImmunizationImmunity & ImmunizationRecommended Vaccine (s)Recommended Vaccine (s) CommentsComments

11stst visit visit BCG, Td, OPVBCG, Td, OPV Before giving BCG,Before giving BCG,

Tuberculin, skin testing is Tuberculin, skin testing is recommended if feasible.recommended if feasible.

Interval after Interval after 11stst visit visit

1 month1 month MMRMMR

2 months2 months Td, OPVTd, OPV

8 – 14 months8 – 14 months Td, OPVTd, OPV

10 years10 years TdTd Repeat every 10 yrs. Repeat every 10 yrs. throughout lifethroughout life

IMMUNITY AND IMMUNIZATIONIMMUNITY AND IMMUNIZATIONRecommended Vaccine (s)Recommended Vaccine (s) CommentsComments

11stst visit visit BCG, Td, OPVBCG, Td, OPV Before giving BCG,Before giving BCG,

Tuberculin, skin testing is Tuberculin, skin testing is recommended if feasible.recommended if feasible.

Interval after 1Interval after 1stst visit visit

1 month1 month MMRMMR MMR if child > 12 mos.MMR if child > 12 mos.

2 months2 months DTP, OPVDTP, OPV

4 months4 months DTP, OPVDTP, OPV

10 – 16 months 10 – 16 months TdTd

4 – 6 years4 – 6 years DTP, OPVDTP, OPV DT and OPV are not necessary DT and OPV are not necessary

If the 4If the 4thth dose of each were dose of each were given after 4 yrs. of agegiven after 4 yrs. of age

14 – 16 years14 – 16 years TdTd Repeat every 10 yrs. Repeat every 10 yrs. throughout lifethroughout life


Questions to be answered:Questions to be answered:Q.Q. Is it possible to immunize a child with Is it possible to immunize a child with

neurological disorder?neurological disorder?

Q.Q. Is it possible to immunized a child Is it possible to immunized a child during a minor illness?during a minor illness?

Q.Q. My child is having eczema and My child is having eczema and evidence of atopy. Can he be evidence of atopy. Can he be immunized?immunized?


Questions to be answered:Questions to be answered:Q.Q. Is it possible to administer multiple Is it possible to administer multiple

vaccines simultaneously?vaccines simultaneously?

Q.Q. Does the lapse in the immunization Does the lapse in the immunization schedule require re-institution of the schedule require re-institution of the entire series?entire series?

Q.Q. If a child immunization status is If a child immunization status is unknown – what to do?unknown – what to do?


Questions to be answered:Questions to be answered:Q.Q. Is it possible to give vaccines during Is it possible to give vaccines during

immunosuppressive therapy?immunosuppressive therapy?Q.Q. Is it possible to immunize a child who Is it possible to immunize a child who

recently received immune globulins?recently received immune globulins?Q.Q. When to immunize a child born When to immunize a child born

prematurely?prematurely?Q.Q. My child is allergic to egg, can he be My child is allergic to egg, can he be

immunized?immunized?

Further ReadingFurther Reading

http://www.vaccineinformation.org

immunity and immunization fahad al zamil professor & consultant paediatric infectious diseases...

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