Prevention and vaccine pediatrics

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Prevention and vaccination for Egyptian children . For Medical student , postgraduate, FM doctors and Pedo doctors

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<ul><li> 1. Family Medicine TrainingDentist TrainingPAEDIATRICS PREVENTION ANDVACCINEDr Hussein AbdeldayemProf of Pediatrics Alex UniversityDr Hussein Abdeldayem</li></ul> <p> 2. PREVENTIONDr Hussein Abdeldayem 3. Prevention Primary Prevention Secondary Prevention Tertiary Prevention Quaternary PreventionDr Hussein Abdeldayem 4. Prevention Primary Prevention prevent the occurrence of the disease as: by immunization by Genetic counselingNO DISEASEAR disordersInfectious Disease as MMR, polio,etcDr Hussein Abdeldayem 5. Prevention Secondary Prevention early detection of thedisease for stopping orreversing its progressas: by prenatal diagnosisby newborn screeningDISEASENO or MILD CPPKU, Cong HypothyroidismDr Hussein Abdeldayem 6. Prevention Tertiary Preventionstop the development of complication of the previously diagnosed disease as: by EIP, by treating ABM with corticosteroid AND follow up for complications (ABR)EIP,DISEASEABM NO ComplicationDr Hussein Abdeldayem 7. Prevention Quaternary Preventionset of health activities that diminish or avoid the consequences of unnecessary or excessive interventions in the health systemSwine Flucost Dr Hussein Abdeldayem 8. AR InheritanceDr Hussein Abdeldayem 9. Prevention and Neurologicdisorders Down syndrome PKU Congenital hypothyroidism galactosemiaDr Hussein Abdeldayem 10. Down syndrome1ry (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 babyPrevention: avoid late age or frequent conceptionRecent: Pre-implantation selectionDr Hussein Abdeldayem ?? Folic acid supplementation 11. Down Syndrome2ry Prevention ( DS baby) 9-12 wks GA:21- neck US2- Blood: hCGTH, PaPPa, fetal RBC3- Villous biopsy 12 -16 wks GA:1- triad: AFP. UOstriol, hCGTH2- tetrad: triad + inhibin &gt; 16 wks GA:AmniocentesisDr Hussein Abdeldayem 12. DS3ry Prevention EIP Echocardiography Visual acuity/y Thyroid function/y (TSH,T4) Tympanometry/y Neck X ray at 3-5 yrs**Neutral view, flexion &amp; extensionDr Hussein Abdeldayem 13. GalactosemiaFailure to thrivevomitingGalactusuria (sugar in urineAAuria, proteinuriaDr Hussein Abdeldayem 14. Galactosemia Milk lactose G + GalGal G Sugar excretion in infancy AR 3 genesLeloir 1970Nobel prize galactosemia 1: (classic)GALT Def (galactose 1p uridyltransferase) Galactosemia 2:GALK (Galactase=galactokinase) Galactosemia 3:GALE (uridyl diphosphogalactose- 4 epimerase) Dr Hussein Abdeldayem 15. 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 Dr Hussein Abdeldayem 16. PKU AR Gene on chromosome 12 Enzyme deficiency: phenylalanine hydroxylase Types: 1- classic 2- cofactor BH4 (tetrahydrobiopterin ) 3- mixed* : mild ( no disease)Dr Hussein Abdeldayem 17. PKU Classic: P Hydroxylase deficiency- blood: severehyperphenylalaninemia &gt;20 mg/dl Cofactor BH4 deficiency- normal phenylalanine in blood ormild raised- BH4 Cofactor for phenylalanine,tyrosine and tryptophan- diagnosis:A- measure neopterin and biopterin inurineB- loading test: oral BH4 (20 MG/KG)then measure phenylalanineC- enzyme assay mixedDr Hussein Abdeldayem 18. PKUPREVENTION 1ry: genetic counseling AR 2ry: a- neonatal screeningthen low phenylalaninemilk 3ry: rehabilitation , dietresrictionDr Hussein Abdeldayem 19. Dr Hussein Abdeldayem 20. C/PSome CNS effects ofuntreated PKU include: 1- fair hair and skin mental retardation 2- a musty or mousybody odor behavior problems, autism3- Eczema hyperactivity restlessness or irritability seizures Dr Hussein Abdeldayem 21. maternal PKU syndrome Pregnancy in women with PKU(Maternal PKU)Women with PKU who are noton the low-Phe diet when theybecome pregnant have a highchance of having babies with birth defects as congenital HD mental retardation microcephaly (recurrent) SGA Dr Hussein Abdeldayem 22. Maternal PKU syndrome /PreventionDuring pregnancy, theyneed to: stay on the low-Phe diet visit their PKU clinic on aregular basis have their blood Phe levelschecked oftenDr Hussein Abdeldayem 23. Prevention MR PREVENTION:1- 1ry : vaccine of all femalesagainst (at least 3 mopreconception) of GM2- 2ry: screening ofcongenital hypothyroidism, PKU and Galactosemia3- 3ry: rehabilitation andearly intervention programas in DS Dr Hussein Abdeldayem 24. 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 infection2- 2ry: early treatment of infective organism (AB)3- 3ry: early detection of sequelae as ABR ( for ABM) Dr Hussein Abdeldayem 25. Dr Hussein Abdeldayem 26. Dr Hussein Abdeldayem 27. Immunity PassiveAcquiredFrom mother: Vaccine or toxoidsa- transplacental,b- breast milkAntibodies Active infection (clinicaladministration:or subclinical) = Naturala- gamma globin,b- antitoxin Dr Hussein Abdeldayem 28. Natural infection is better thanimmunization Actual Infection usually doescause better and longerimmunity than vaccination. Measles, GM, mumps, &amp; chickenpox produce long life immunity However, the price paid for naturaldisease can cause morbidity( complications) up to death Dr Hussein Abdeldayem 29. Vaccination is better than passiveimmunity vaccination cause better andlonger immunity than passiveimmunity ( from mother orinjection of IG). Dr Hussein Abdeldayem 30. Vaccine better than infection DiisadventagesAdvantages Safe Not solid immunity Mass protection S/E ?? cost ?? costDr Hussein Abdeldayem 31. Vaccines are safe Vaccines are easierand safer to administerthan ever before. Being immunized ismuch safer than riskinginfection and disease.Dr Hussein Abdeldayem 32. Immunization can protect theunprotected Whenimmunizationcoverage ishigh, it canprevent virusesand bacteriafrom circulating. The morechildren in acommunity thatare fullyimmunized, themore everyoneis safe. Dr Hussein Abdeldayem 33. Immunization can save money Immunization isone of the mostcost-effectivehealthinterventions. Investing invaccines SAVESmore moneythan it costs.Dr Hussein Abdeldayem 34. Dr Hussein Abdeldayem 35. Immunization ScheduleAge of Infant/ChildType of vaccineAt birth Zero1st (OPV) oralOPV: live attenuated (LA) 2-3Dose polio drops0-1 mo: BCG: against BCG: live attenuated (LA)(1st contact of child tuberculosis by(intra dermal injection overwith healthauthority) insertion of left deltoid, 0.1ml)Ist month: all LADr Hussein Abdeldayem 36. OPV: 3 oral dropsImmunization Schedule DPT: IM 0.5 mlHBV: IM 0.5 mlAge of Type of vaccineDT: killedInfant/ P: toxoidChild2nd 2nd dose: Polio (OPV), DPT &amp;OPV: Ki oral2-3Month Hepatitis B 1ofDT: toxoid IMage P: kiIM4th 3rd dose: Polio (OPV), DPT &amp;HBV: recombMonth Hepatitis B 2ofAgage IM6th 4th dose: Polio (OPV), DPT &amp;Month Hepatitis B 3HBVof Recomb AgageDr Hussein Abdeldayem 37. Immunization ScheduleAge of Infant/Child Type of vaccine9th mo of Measles SC LAage Vitamin A Capsule (100.000 Measles: SCunits) MMR :SCpolio(5th dose) ORAL LA Measles/MMR LA12MMR scLAMONTHS2 Vitamin A Capsule (200.000 units)polio(6th dose) ORAL LA Dr Hussein Abdeldayem 38. Dr Hussein Abdeldayem 39. Immunization ( Booster)18 24 moBooster of DTP (0.5 ml IM)7th OPV (3 drops)2 capsules Vit A (200,000 units)4 6 yrs ofMMR 2nd dose(0.5 ml SC)age(preschool)6 12 yrs of Booster dose of OPV,age DT,BCG MMR (if not(startgiven at 4-6 yrs)schooling)Dr Hussein Abdeldayem 40. Immunization: non obligatoryHIB:3 doses ( 2, IMHemophilus4 ,6 mo) and ConjugatedInfluenzaebooster at 18polysaccharidetype B 24 movaccineHAV:1st : +12 mo IMHepatitis A 2nd: after 6 Inactivated12 mo Dr Hussein Abdeldayem 41. Immunization: non obligatoryVaricella + 12 mo 13 yr: LAone doseBooster: 4- 6 yrs 13yr: 2 doseswith 6 wk apartMeningo Over 2 ysSCcoccal Every 3 ysInactivatedACWY Dr Hussein Abdeldayem 42. Immunization: non obligatoryFlu Every yearRecombinant Antigenvaccine (septemper/(&gt;6 mooctober)age)????????? ?????Dr Hussein Abdeldayem 43. Dr Hussein Abdeldayem 44. Polio vaccine: 1- LA: Oral Sabin 2- killed: IM salk Dr Hussein Abdeldayem 45. BCG : intradermal Measles: SC MMR: SCDr Hussein Abdeldayem 46. Side Effects (Adverse reactions) 1- general : fever, allergy, anaphylaxis 2- local: pain, redness, swelling, sterileabscess 3- specific: Dr Hussein Abdeldayem 47. Side Effects (Adverse reactions)3- specific:i- BCG: TB ulcer, TB lymphadenitis with cold abscess and sinus/ suppurative lymphadenitis/ miliary TBii- OPV: paralysis Dr Hussein Abdeldayem 48. Side Effects (Adverse reactions)iii- Pertussis ( DTP):a. Encephalopathy: within 7 daysb. Convulsions: within 2-3 days,c. Persistent high pitched cry: for 3 hrs within 2 daysd. Persistent fever: for 2 days ( &gt;40.5C)e. shock or drowsiness, or somnolence: within 2 daysDr Hussein Abdeldayem 49. Side Effects (Adverse reactions)iv- measles: rash, arthralgiaV- GM: rash, arthralgia, lymphadenopathy, allergyVi-mumps: mild parotitisDr Hussein Abdeldayem 50. Dr Hussein Abdeldayem 51. contraindicationDont immunize if there is:1-Anaphylactic reaction to avaccine2-Seizure or fever &gt; 40 .5 C within48 hr of pertussis vaccine3-True Egg Allergy (MMR)4-Neomycine allergy (MMR)5-Immunocompromized patient(OPV)6-Untreated moderate to severeillness + fever Dr Hussein Abdeldayem 52. contraindication Pertussis vaccine (DTP)1- history of fits2- abnormal neurologicalchild as CP2- S/E of vaccineGive: DT orD T (a)PDr Hussein Abdeldayem 53. Vaccine of immunodeficiencychild immunodeficiency child asAIDS, NS (steroid tt) Not GIVE: BCG/ OPV/ MEASLES/MMR not give Oral OPV to hisHOUSEHOLD contacts(siblings) Dr Hussein Abdeldayem 54. Cold Chaintransportation - storage OPV not yet used: atfreezer (-20C) ( 0-8C):all vaccine and diluents On top shelf (under freezer): opened OPV, measles On 2nd shelf: BCG, DTP, DT,TTDr Hussein Abdeldayem 55. Cold Chaintransportation - storage In vaccine clinic: keep thevaccine in a cupcontaining ice Sensitive to strong light:BCG, measles, MMR Away from HEAT, anddirect SUNLIGHT DISCARD any vaccineremained in opened vialsDr Hussein Abdeldayem</p>

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