prevention and vaccine pediatrics

Dr Hussein Abdeldayem

Alex University

Family Medicine TrainingDentist Training

PAEDIATRICSPREVENTION AND

VACCINEDr Hussein Abdeldayem

Prof of PediatricsAlex University


Alex University

PREVENTION


Alex University

Prevention

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


Alex University

Prevention

• Primary Prevention prevent the occurrence

of the disease as: by immunization by Genetic counseling

NO DISEASE

AR disordersInfectious Disease as MMR, polio,etc


Alex University

Prevention

• Secondary Prevention early detection of the

disease for stopping or reversing its progress

as: by prenatal diagnosis by newborn screening

DISEASENO or MILD CP

PKU, Cong Hypothyroidism


Alex University

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) DISEASE

NO ComplicationEIP, ABM


Alex University

Prevention • Quaternary Prevention set of health activities

that diminish or avoid the consequences of unnecessary or excessive interventions in the health system

costSwine Flu


Alex University

AR Inheritance


Alex University

Prevention and Neurologic disorders• Down syndrome• PKU• Congenital

hypothyroidism• galactosemia


Alex University

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 conception Recent: Pre-implantation

selection?? Folic acid supplementation


Alex University

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, hCGTH 2- tetrad: triad + inhibin• > 16 wks GA:Amniocentesis


Alex University

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


Alex University

Galactosemia

Failure to thrivevomitingGalactusuria (sugar in urineAAuria, proteinuria


Alex University

Galactosemia

• Milk lactose G + Gal Gal G

• AR• galactosemia 1: (classic) GALT Def (galactose 1p uridyl

transferase)

• Galactosemia 2: GALK (Galactase=galactokinase)

• Galactosemia 3: GALE (uridyl diphosphogalactose- 4 –

epimerase)

Sugar excretion in infancy

Leloir 1970Nobel prize

3 genes


Alex University

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


Alex University

PKU

– AR – Gene on chromosome 12– Enzyme deficiency:

phenylalanine hydroxylase– Types:1- classic2- cofactor BH4

(tetrahydrobiopterin )3- mixed* : mild ( no disease)


Alex University

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

urineB- loading test: oral BH4 (20 MG/KG)

then measure phenylalanine C- enzyme assay• mixed


Alex University

PKUPREVENTION• 1ry: genetic counseling

AR• 2ry: a- neonatal screening then low phenylalanine

milk• 3ry: rehabilitation , diet

resriction


Alex University


Alex University

C/P

Some CNS effects of untreated PKU include:

• mental retardation• behavior problems,

autism• hyperactivity• restlessness or irritability• seizures

1- fair hair and skin2- a “musty” or

“mousy” body odor3- Eczema


Alex University

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


Alex University

Maternal PKU syndrome / PreventionDuring 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


Alex University

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


Alex University

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)


Alex University


Alex University

Immunity

Passive AcquiredFrom mother: a- transplacental, b- breast milk

Vaccine or toxoids

Antibodies administration: a- gamma globin, b- antitoxin

Active infection (clinical or subclinical) = Natural


Alex University

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


Alex University

Vaccination is better than passive immunity

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


Alex University

Vaccine better than infection

• Safe• Mass protection• ?? cost

• Not solid immunity

• S/E• ?? cost

DiisadventagesAdvantages


Alex University

Vaccines are safe

• Vaccines are easier and safer to administer than ever before.

• Being immunized is much safer than risking infection and disease.


Alex University

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.


Alex University

Immunization can save money

• Immunization is one of the most cost-effective health interventions.

• Investing in vaccines SAVES more money than it costs.


Alex University


Alex University

Age of Infant/Child

Type of vaccine

At birth Zero Dose

1st (OPV) oral polio

OPV: live attenuated (LA) 2-3 drops

0-1 mo: (1st contact of child with health authority)

BCG: against tuberculosis by

BCG: live attenuated (LA) (intra dermal injection over insertion of left deltoid, 0.1ml)

Immunization Schedule

Ist month: all LA


Alex University


Age of Infant/Child

Type of vaccine

2nd Month of age

2nd dose: Polio (OPV), DPT & Hepatitis B 1

4th Month of age

3rd dose: Polio (OPV), DPT & Hepatitis B 2

6th Month of age

4th dose: Polio (OPV), DPT & Hepatitis B 3

OPV: 3 oral dropsDPT: IM 0.5 mlHBV: IM 0.5 ml

DT: killedP: toxoid

HBVRecomb Ag

OPV: Ki oral2-3DT: toxoid IMP: ki IM

HBV: recomb Ag IM


Alex University

Age of Infant/Child

Type of vaccine

9th mo of age

Measles SC LAVitamin A Capsule (100.000

units) polio(5th dose) ORAL LA


Measles: SCMMR :SC

Measles/MMR LA

12 MONTHS

MMR sc LA2 Vitamin A Capsule (200.000

units) polio(6th dose) ORAL LA


Alex University

http://www.youm7.com/News.asp?NewsID=181137&SecID=245&IssueID=0


Alex University

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 age (preschool)

MMR 2nd dose(0.5 ml SC)

6 – 12 yrs of age(start schooling)

Booster dose of OPV, DT,BCG ± MMR (if not given at 4-6 yrs)


Alex University

Immunization: non obligatory

HIB: Hemophilus Influenzae type B

3 doses ( 2, 4 ,6 mo) and booster at 18 – 24 mo

IMConjugated polysaccharide vaccine

HAV:Hepatitis A

1st : +12 mo2nd: after 6 – 12 mo

IMInactivated


Alex University


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

LA

Meningococcal ACWY

Over 2 ysEvery 3 ys

SCInactivated


Alex University


Flu vaccine (>6 mo age)

Every year (septemper/ october)

Recombinant Antigen

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


Alex University


Alex University

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


Alex University

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


Alex University

Side Effects (Adverse reactions)

• 1- general : fever, allergy, anaphylaxis • 2- local: pain, redness, swelling, sterile

abscess• 3- specific:


Alex University


3- specific:i- BCG: TB ulcer, TB lymphadenitis with cold

abscess and sinus/ suppurative lymphadenitis/ miliary TB

ii- OPV: paralysis


Alex University


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 ( >40.5ₒC) e. shock or drowsiness, or somnolence:

within 2 days


Alex University


iv- measles: rash, arthralgia

V- GM: rash, arthralgia, lymphadenopathy, allergy

Vi-mumps: mild parotitis


Alex University


Alex University

Don’t immunize if there is:1-Anaphylactic reaction to a

vaccine2-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


Alex University

contraindication

• Pertussis vaccine (DTP)1- history of fits 2- abnormal neurological

child as CP2- S/E of vaccine

Give: DT الثنائى or D T (a)P


Alex University

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)


Alex University

Cold Chaintransportation - 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


Alex University

Cold Chaintransportation - 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

Health & Medicine

etcdr hussein abdeldayem

diseasedr hussein abdeldayem

ds dr hussein abdeldayem

abm dr hussein abdeldayem

cataract dr hussein

prevention mr prevention

syndrome2ry prevention

pku classic