Zac 2013 Immunization Immunization A process whereby a person is made immune or resistance to an infectious disease, typically by administration of a vaccine.

Innate immunity resistance (immunity) of epithelial surfaces to invasion, is a characteristic which is present from birth prevents entry of microorganisms into tissues or, once they have gained entry, eliminates them prior to the occurrence of disease. Non-specific - acts on many organisms and does not show specificity. Does not become more efficient on subsequent exposure to same organisms Biochemical (complement, lysozyme, interferons) Cellular components (neutrophils, monocytes, macrophages, natural killer cells)

Acquired immunity Not present during fetal development Require exposure to antigen for antibody production Respond to a variety of antigens, each in specific manner. Discriminate between foreign antigen and self antigen of the host. Respond to a previously encountered antigen by initiating memory response. Active induction of immunity by infection or with a vaccine naturally Develop primary immune response due to exposure of antigen with the production of the immunological memory (B-cell) artificially Induce by vaccine which contain antigen Stimulate primary response against antigen without cause any symptom of disease tetanus toxoid (against tetanus). Passive the transfer of antibody from one individual to another, naturally happens when a mother transfer antibodies to her offspring via placental route during pregnancy and via colostrum during brea stfeeding artificially injecting antibodies or se nsitized lymphocytes to an organism via a vaccination. measles, hepatitis, rubella, mumps, diphtheria, snake venom

After genuine attack from the pathogen. eg : chickenpox, mumps, measles A long lasting immunity It takes time (usually several weeks) to develop

immediate protection lasts only for a few weeks or months

Vaccine A vaccine is any preparation intended to produce immunity to a disease by stimulating the production of antibodies. Eg: suspensions of killed or attenuated microorganisms, or products or derivatives of microorganisms. 3 main substances used for production of vaccines are: o LIVE microorganisms, (eg : weaken measles, polio virus/ tuberculosis bacteria) o KILLED microorganisms (eg : pertussis microorganism used in DPT o TOXOIDS (eg: inactivated toxins such as tetanus toxoid and diphtheria toxoid vaccines stored in the clinic? -using 2-door refrigerator/ top loading with temperature within 2-8 c -monitored twice a day ( early morning and before closing premise) using the minimax and dial thermometer. -readings are recorded on a chart (to ensure a safe temperature is maintained). 1
Disclaimer: NOT INTENDED FOR PROFIT. FOR PERSONAL USE ONLY. Plagiarism not intended. I do not own any of the materials. I only compile various resources. Credits goes to the textbook authors, lecturers and friends. Peer reviews and corrections are encouraged. These notes are used as a brief insight only and DO NOT REPLACE a good textbook. USE AT YOU OWN RISK. ISAAC 2013

Zac 2013 Immunization Factors That Can Destroy A Vaccine No proper care and handling Reaching the expiry date Exposed to sunlight especially for Polio, BCG and Measles because all these are life vaccine. Too cold and frozen Chemical reagent such alcohol, antiseptic and others The temperature is outside the range between 2C and 8C the importance of immunity 1. To prevent children from getting diseases as the immunity from maternal antibody only lasts till first year of life. 2. To eradicate certain infection eg. Worldwide eradication of smallpox was achieved in 1979. 3. To slow down or prevent the disease outbreak. 4. To reduce prevalence of many other disease. 5. To reduce morbidity and mortality among children. 6. To reduce the cost in health management. It is cheaper to prevent a disease than to treat it. 7. To produce herd immunity. 8. To protect the health of our community, especially those who cannot be immunized (eg children <1y/o cannot receive measles vaccine but can be infected by the measles virus), those who cannot be vaccinated for medical reasons (eg leukemia), and those who cannot make an adequate response to vaccination. Herd immunity Also known as community immunity: A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community. Definition Description Vaccine Any suspesnsion of antigen which is intended to induce protective immunity in the host after administration Adjuvant or Haemophilus Compound linked to a vaccine to increase the immunity conjugate influenza type This vaccines develop by linking the bacterial capsular polysaccharide to carrier protein to enhance immunogenicity. B vaccines. Polysaccharide coatings disguise a bacteriums antigens so that the immature immune systems of infants and younger Pneumococcal children cant recognize or respond to them. vaccine So, after linking it, the immunogenicity will increase and the immune system able to recognize it and immune response develop Live Live suspension of microorganisms which have been rendered non-virulent but retain their infectivity and immunogenicity in Measles attenuated the host. Mumps Rubella Advantage Disadvantage Chickenpox 1. Protection against illness 1. Possibility cause illness that they try to protect against 2. Elicit both cellular and antibody responses and often (immunosuppressed) confer lifelong immunity with only one or two doses. 2. People who have damaged or weakened immune systems because theyve undergone chemotherapy or have HIV, for examplecannot be given live vaccines. 3. May cause mutation of microbe that cause it to revert to a virulent form and cause disease. Killed Purified extracts fromn live organisms which are incapable at replication and therefore non-infectious Polio Hepatitis A Advantage Disadvantage Influenza 1. Safe no possibility to turn virulent 1. Stimulate a weaker immune system response than do 2. Stable and long lasting. live vaccines. 3. Does not cause mutation or reversion of virus. 2. take several additional doses, or booster shots, to 4. Dont require refrigeration, easily stored and maintain a persons immunity. transported 3. This could be a drawback in areas where people dont have regular access to health care and cant get booster shots on time. Toxoid Modified biological toxin which is rendered non toxic but maintain its ability to provoke an immune response Tetanus Diphtheria Botulism Cholera Subunit Hepatitis B introduce a fragment of the microorganism (specific parts of the antigen that best stimulate immune response). Human Identifying which antigens best stimulate the immune system is a time-consuming process. Once scientists do that, papillomavirus however, they can make subunit vaccines in one of two ways: Produced: Culturing microbe in the lab, then use chemicals to break apart, harvest the antigens Manufacture antigen molecules using recombinant DNA technology (known as recombinant subunit vaccines) DNA Influenzae, microbes genetic material especially those that code for antigens. DNA that is administered directly into the body. Vaccine Herpes When give vaccine, cells of recipients take up DNA The cells secrete the antigens and display them on their surfaces. Creating the antigens necessary to stimulate the immune system. Malaysia Immunization Schedule - 2008 Age Immunization 0 1 1 1 2 1 1 2 2 3 3 2

(mo nth) 3

6 3

10

12

15

18

2- 3

4-6

BCG Hepatitis B DTaP Hib

Age (year) 7 If no

13

15

DTB B

TB 2

Disclaimer: NOT INTENDED FOR PROFIT. FOR PERSONAL USE ONLY. Plagiarism not intended. I do not own any of the materials. I only compile various resources. Credits goes to the textbook authors, lecturers and friends. Peer reviews and corrections are encouraged. These notes are used as a brief insight only and DO NOT REPLACE a good textbook. USE AT YOU OWN RISK. ISAAC 2013

Zac 2013 Immunization Polio (IPV) Measles JE MMR HPV Suggested Vaccines = USA Immunization 0 Rotavirus Pneumococcal Influenza Varicella Hep A Meningococcal 1 Age 2 rot PCV (mo nth) 3 rot PCV Age (year) 7 1 2 3 SBH SWK 1 2 B 3 dose B

4 rot PCV

10

12 PCV

15

18

2- 3

4-6

12

15

PPSV high risk Vari MCV 4

Influenza (yearly) Varicella Hep A 2 doses

Why is it so important so follow the schedule? Interval between doses of vaccines: In the recommended time will increase antibody response to the second dose Shorter than the recommended time will decrease the immune response and vaccine efficacy Longer than the recommended time will inhibit immune response to the second dose

ALL Vaccines are killed except MMR, BCG and OPV Contraindications True 1. General a. Postpone during acute febrile illness b. Minor infections without fever or systemic upset are NOT contraindication c. Do not give vaccine within 2 weeks of elective surgery 2. Live vaccines a. Immunosuppressed i. Malignancy ii. Irradiation iii. Leukaemia, lymphoma iv. Primary immunodeficiency syndromes (NOT asymptomatic HIV) b. On chemotherapy (< 6 months after last dose) c. High dose steroid use i. Prednisolone 2mg/kg/day for more than 7 days or low dose more than 2 weeks delay vaccination for 3 months ii. If tropical or inhaled steroids or low dose systemic less than 2 weeks allow vaccination d. If another LIVE vaccine was given less than 3 weeks ago either give simultaneously or wait 3 weeks e. Within 3 months of IV immunoglobulin except for yellow fever or oral polio Kawasaki 11 months f. Pregnancy 3. Killed a. Generally safe b. Unless SEVERE local reaction induration > 2/3 of limbs c. Severe generalized reaction I previous dose i. > 39 C ii. Anaphylaxis iii. Persistent screaming iv. convulsions False 1. Mild illness without fever 2. Asthma, eczema, hay fever, impetigo, heat rash 3. Treatment with antibiotics 4. Breastfed child 5. Neonatal jaundice BUT SHOULD REFER to MO if PROLONGED JAUNDICE (Dr. Doris) 6. Underweight or malnourished 7. Past history of pertussis, measles or rubella unless confirmed medically 8. Non progressive, stable neurological conditions CP, downs simple febrile convulsions, controlled epilepsy 9. Family hx of comvulsions 10. Hx of heart disease 11. Prematurity

3
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Zac 2013 Immunization

Vaccine BCG Type Dose 0,1,6 Birth 1 month (up till 2 months) 6months (no earlier than 24 weeks) Special Consideration Birth At 6 years if no scar Preterm infants (< 33weeks) and low birth weight infants usually not given until the infant is 34 week old or weight is 1800-2000g Rationale Cases of TB have increasing steadily since 1995 Primary TB infections are most common in children and may spread to meninges, bloodstrea m and bones Highly protective against meningeal and miliary TB (80%) Major complicat ions such as liver cirrhosis and HCC infants that become infected by perinatal transmiss ion are 90% at risk of getting chronic infection and 25% risk of dying from HCC children younger than 5 years old living with a Hepatitis B +ve person can become infected via horizonta l transmiss ion and are at a higher likelihood of getting chronic infection, cirrhosis and subseque ntly HCC in early adulthoo d Hep B vaccine provides adequate protection to majority of the recipients and prevents both vertical and horizonta l transmiss ion Side Effect 1. Local reaction papule at site of vaccination occurs within 2 to 56 weeks reaction =papule(2-3 weeks),ulceration(6-8 weeks),scar(end of 3 months). grows and flattens with scaling and crusting with discharging ulcer and heals to leave a scar of at least 4mm 2. 2ndary infection 3. BCG axillary and cervical lymphadenitis 4. Systemic infection 5. BCG osteitis and osteomyelitis Contraindications Symptomatic HIV

Hepatitis B

1st dose : within 48 hours of birth 0, 1, 6

Monovalent If mother is HBsag (+) o administer HepB vaccine and 0.5 ml of HBIG within 12 H or birth, ) should be given simultaneously at different sites, ASAP o check for HBsag and antibody to HBsag 1to 2 months after complete at least 3 doses 1-3 months after completing the vaccine series. at 9 18 months of well child visit o Those that have antiHepB level < 10mIU/ml and HBsAg - ve, should be given another 3 doses at 0, 1, 6 months followed by testing anti-HepB one month after the 3rd dose Preterm infants weighing <2kg, the initial dose should not be counted(receive total of 4 doses) If Mothers HepB status is unknown, administer HepB within 12 hours of birth For immunocompetent children, routine booster doses are not recommended Routine post-immunization testing for anti-HepB level is not necessary However, it is indicated 1-2 months after the 3rd immunization for : o - hemodialysis o - HIV +ve o - occupational risk of exposure to sharp injuries o - babies born to HepBsAg +ve mothers o immunocompromised pt with risk of exposure to Hep B o - regular sexual contacts of Hep BsAg +ve persons

1. 2. 3. 4. 5.

6. 7.

Transient soreness/redness at injection site Low grade temperature Nausea,dizzyness,malaise,ras h Influenza like syndrome Arthritis,Athralgia,Myalgia(l ess frequent in infant and children than adulthood. Rare: Allergy reaction and anaphylaxis These symptoms usually resolve 24-48 hrs after vaccine administration and frequency of reaction decrease with subsequent doses of vaccine.

Severe hypersensitive to aluminium or thiomersal

DTT

1. 2. 3. 4.

DTaP

Primary: 2,3,5,18

Precaution with 1. Moderate or severe acute illness

DIPHTERIA effective, Primary

1.

Swelling, redness, pain Small painless nodule at injection site Transient fever, headaches, malaise, Rarely anaphylaxis and neurological symptoms Local swelling and redness within 24 to 72 hours lasting

1.

1.

Severe hypersensitivity to aluminium and thiomersal

4
Disclaimer: NOT INTENDED FOR PROFIT. FOR PERSONAL USE ONLY. Plagiarism not intended. I do not own any of the materials. I only compile various resources. Credits goes to the textbook authors, lecturers and friends. Peer reviews and corrections are encouraged. These notes are used as a brief insight only and DO NOT REPLACE a good textbook. USE AT YOU OWN RISK. ISAAC 2013

Zac 2013 Immunization

months 2. Booster: 6 and 12 yrs 3. with or without fever Infant weighing less than 2000 grams Guillain-Barr syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoidcontaining vaccine immunization stimulates the production of Ab in considerable excess of the minimum protective level(0.01mIU/ml ), Provides immunity for 310 years Tetanus reduce case Pertusis cause significant morbidity to those between 3 months to 6 years of age 2. 1 to 2 weeks Fever(24 hrs after vaccination,if persits>24 hrs ,not due to DTP). high fever ( >40.5oC) within 48 hours, Drowsyness, Fretfulness Anorexia. unexplained by other cause, Persistent,inconsolable crying >3 hours or more (within 48 hrs of vaccination) collapse or shock-like episodes( within 48 hrs) short-lived convulsions (usually febrile)within 3 days Acute encephalopathy Anaphylaxis shock, hypotension, SOB 2. 3. Progressive neurological disease like infantile spasm, tuberous sclerosis Severe reaction to previous dose a. Anaphylaxis b. Collapse or shock like states c. Hyporesponsive states d. Fits and fever within 72 hours e. Fever > 40.5 C within 48 hours f. Encephalitis within 7 days g. Severe local reaction involving 2/3 of limbs Static neurological diseases, developmental delay, hx of fits are NOT contraindications Severe hypersensitive to aluminium or thiomersal

3. 4. 5. 6. 7.

8. 9. 10. 11.

Pertussis

aP acellular contains only endotoxin less risk of local reaction and s/e

4.

5. HiB 2,3,5 1. Most of the cases of HiB meningitis occur < 12 months old and rarely among children < 3 months or > 5 years old 1st dose must be given at 6/52 after birth and not earlier because possible immune tolerance to HiB vaccine 1. Local swelling, redness and pain lasting up to 24 hours in 10% Malaise, headaches, fever, irritability, inconsolable crying Rarely seizures 6.

2.

3.

2.

Japanese Encephalitis

Polio

OPV live IPV inactivate d

9, 10, 18 months Then every 3 years (5, 8, 11 yo) 2, 3, 5 months Booster at 18 months Supplementar y: 6 years old

Immunodeficiency and malignancy, diabetes, acute exacerbation of cardiac, hepatic and renal conditions Poliovirus infection can result in paralysis with permanent disability Adults that have contracted paralytic poliomyelitis in childhood can develop postpolio syndrome 30-40yrs later, characterized by muscle pain, exacerbation of weakness and/or new paralysis/weaknes s 1. 1. 2. 3. Vaccine associated paralytic polio (OPV) Local reaction at injection side Neurological disorder, hypertension and allergy reaction. More serious side effects but rare: persistent crying, febrile seizure, apyretic seizure, uneasiness,shock.

PV started in 2008 because wild type no longer endemic in Malaysia. Risk of infection if OPV through GI excretion after vaccination

4.

MMR

For HIV infected children : o first dose given at 12 months and second dose may be given after 28 days of the first dose o If there is an outbreak of measles, vaccination with monovalent measles or MMR may be given to infants as young as 6 months old when exposure is considered likely Patients on steroid(prednisolone>2mg/kg/day)

2.

Hypersensitivity to neomycin, polymyxin or anaphylaxis to egg ingestion

5
Disclaimer: NOT INTENDED FOR PROFIT. FOR PERSONAL USE ONLY. Plagiarism not intended. I do not own any of the materials. I only compile various resources. Credits goes to the textbook authors, lecturers and friends. Peer reviews and corrections are encouraged. These notes are used as a brief insight only and DO NOT REPLACE a good textbook. USE AT YOU OWN RISK. ISAAC 2013

Zac 2013 Immunization

should avoid MMR vaccine until one month after the cessation of the therapy Mumps 1. Occurs primarily in children with peak incidence at 5-9 yrs of age 2. Two doses of MMR vaccine will effectively deal with all the cases of primary vaccine failure that are at risk of getting mumps later in life Vaccine induced antibody is shown to persists for at least 16 years and protection against clinical rubella appears ro be long term 1. Highly infectious and major health issue Mortality is highest among children <2 yrs Efficacy is 95% for those vaccinated at 12 months and 98% for those vaccinated at 15 months Failure rate would be higher if vaccine is given<12 months Provides lifelong immunity in majority of vaccinated individual s Vaccinate d individual s develop milder disease 1. 2. Rarely transient rash, pruritic and purpura Parotitis in 1 % of vaccines, 3 or more weeks after vaccination Orchitis and retrobulbar neuritis very rare Menignoencephalitisis mild and rarely occur Severe reaction to eggs or neomycin Non-HIV related immunodeficiency

3. 4.

Rubella

1.

2.

3. 1. 2.

Measles

2.

3. 4. 5. 6.

3.

Rash, fever, lymphadenopathy, thrombocytopenia, transient peripheral neuritis Arthritis and arthralgia occurs in up to 3% of children Polyneuropathy GuillainBarre syndrome like Transient rash in 5% Fever between D5 to D12 post vaccination lasting for 1 to 3 days URTI symptoms Febrile convulsions D6 to D14 Encephalopathy within 30 days Subacute sclerosing panencephalitis

Hypersensitivity to neomycin, polymyxin or anaphylaxis to egg ingestion Pregnancy

Hypersensitivity to neomycin, polymyxin or anaphylaxis to egg ingestion

4.

5.

6.

HPV Varicella zoster

Minimum 9 yo

Quadrivalent HPV vaccine HPV 4 Bivalent HPV HPV2 70 90 % effectiveness. From 12 months to 12 years: single dose. > 12 years old : 2 doses at least 28 days apart. Two vaccines are currently available in Malaysia: -Varivax (MSD) -Varilrix (GSK) Children who have not had chicken pox by 12 years of age are encouraged to receive the vaccine as the illness is more severe in older age groups. HIV infection; two doses with a 3 month interval are recommended. Children with leukaemia & are in remission for at least 1 year, & have > 700/ml circulating lymphocytes may receive vaccination under supervision of the attending paediatrician

1. 2. 3. 4. 5.

Soreness or swelling where the shot was given High Fever(over 39C) Mild rash, up to a month after vaccination Seizure (jerking or staring) caused by fever (very rare). Pneumonia (very rare)

Immunocompromised, anaphylactic reactions to any component of the vaccine , pregnancy , ongoing severe illness, advanced immune disorders of any type,individuals with blood dyscrasias, leukemia, lymphomas of any type, or other malignant neoplasms affecting the bone marrow or lymphatic systems, receiving immunosuppressive therapy

Rota virus

2,4, 6 rotarix

1.

2. 3.

generally well tolerated. Reactions to the rotavirus vaccine are much less frequent. fever diarrhoea (in the week after

6
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Zac 2013 Immunization

4. 5. PCV conjugate vaccine PPSV polysaccharide vaccine Pneumococcal polysaccharide vaccine Protective efficacy ranges from 56 - 81%. Not recommended for children < 2 years old as vaccine is not effective in this group Conjugate vaccine is immunogenic in these infants but currently not widely available. Single dose. Booster 3 - 5 years only for high risk persons. Category A (specialist prescription) 6. 1. 2. 3. rotavirus vaccination) vomiting (in the week after rotavirus vaccination) anaphylaxis (severe allergic reaction) intussusception Drowsy Temporary loss of appetite Redness,tenderness,and swelling at the site of injection Mild fever Very rare life threatening allergic reaction(difculty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness. ) Fussy or irritable

Pneumococal

Children <2 years age, patient that will undergo chemotheraphy/radiotheraphy 10 days prior to starting such therapy, pregnancy

4. 5.

6. Meningococc al MCV4 A , C, Y & W-135 (Does not cover B) Polysaccharide vaccine : Immunogenic in children 2 years or older. Single dose. Immunity up to 3 years. Category C (medical officers) Killed whole cell vaccine : 2 doses 4 weeks apart (minimum 1 week). Booster every 6 months. Not highly effective & short duration of protection < 6 months. First dose given SC/IM; second dose and boosters given ID to reduce systemic side effects. Protects only 50% of vaccines (for 3 6 months). Vaccine is not recommended for infants < 6 months of age. Category B (MO IM/SC (available in KKM as HDC-human diploid cell vaccine) Pre-exposure immunization: 3 doses at Day 0, 7 and 28. Then boosters every 2-3 years. Post-exposure treatment: Fully immunized: 2 doses at Day 0 and Day 3 or 7. Rabies specific Ig unnecessary. Unimmunized: 6 doses at Day 0, 3, 7, 14 and 30. Rabies specific Ig (20 IU/kg given half around the wound and the rest IM). Category B ) Vi polysaccharide vaccine : - Single dose. Seroconversion in > 90% of vaccines - Confers 60 80% protection commencing within 14 days from vaccination. - Boosters every 3 years. Immunogenicity < 2 years of age has not been established. b)Oral typhoid vaccine(Ty21a vaccine)* - Three doses two days apart and whole cell typhoid vaccines are also available. Category B

Cholera

Rabies

Typhoid

routes of immunisation Route Vaccine Oral Oral polio vaccine, cholera vaccine, live typhoid vaccine, rotavirus vaccine Intranasal live attenuated influenza vaccine

Intradermal Subcutaneous

BCG MMR

Intramuscular

DTaP, Hib and Hep B, IPV

Administer the liquid slowly down one side of inside of the cheek( between cheek and gum) towards the infants back of mouth. Care should be taken not to go far back enough to initiate gag reflex Patient seated upright with head tilted back.breathe normally, tip of nasal sprayer inserted slightly into naris Half of content sprayed into nostril and repeat procedure in the other nostril Deltoid area of upper arm BCG usually injected on left deltoid anterolateral aspect of thigh (infant) upper outer tricep ( older children /adult) administered into the fatty tissue which is found below the dermis and above muscle tissue. Pinch the fatty tissue above the muscle by supporting the tissue between the thumb n fingers Needle is inserted in the skin fold at 45 degree angle 1) anterolateral thigh ( middle of vastus lateralis muscle)- in infant 2) Mid deltoid muscle in older children/adult 3)Gluteal region- best avoided- risk of injury to sciatic nerve - bunch up the muscle between forefinger and thumb - insert needle fully into muscle at 90 angle

What are the ingredients? Preservatives. They keep the vials from getting contaminated with germs. E.g. thimerosal. Adjuvants. They help the body create a better immune response. These are aluminum salts. Additives. They help the vaccine stay effective while being stored. Additives include gelatin, albumin, sucrose, lactose, MSG and glycine. 7
Disclaimer: NOT INTENDED FOR PROFIT. FOR PERSONAL USE ONLY. Plagiarism not intended. I do not own any of the materials. I only compile various resources. Credits goes to the textbook authors, lecturers and friends. Peer reviews and corrections are encouraged. These notes are used as a brief insight only and DO NOT REPLACE a good textbook. USE AT YOU OWN RISK. ISAAC 2013

Zac 2013 Immunization Residuals of the vaccine production process. Although these ingredients are removed, tiny (residual) amounts are left in the final product. Depending on how the vaccine is made, it may include tiny amounts of antibiotics (neomycin), egg protein or yeast protein. Thimerosal organic mercury-based (contains ethyl mercury) preservative used in some vaccines, including MMR and some influenza vaccines.

Treatment Febrile convulsions o Give Paracetamol 120 mg prophylaxis after immunization 4 hourly for 48 hours regardless of whether the child is febrile or not o Rectal diazepam given for patients with previous febrile convulsions Local Reactions o Self-limiting. o Relieved by cold compress and paracetamol. o Abscesses drainage till the wounds heal. o Antibiotics if secondary bacterial infection Anaphylaxis o Ensure ABC o Oxygen, -agonist nebulizer if wheezing o IM Adrenaline 0.01ml/kg body weight o Fluid resuscitation (NS) o Antihistamine (IV Chlorpheniramine maleate) o Corticosteroids (IV Hydrocortisone) o -agonist inhalation (Salbutamol) o Adrenaline/Dopamine infusion Disease Definition Epidemiology Causes Pathophysio Classification Clinical course Symptoms Complication Differential Investigation Sign

Management Details Prevention Rehabilitation

8
Disclaimer: NOT INTENDED FOR PROFIT. FOR PERSONAL USE ONLY. Plagiarism not intended. I do not own any of the materials. I only compile various resources. Credits goes to the textbook authors, lecturers and friends. Peer reviews and corrections are encouraged. These notes are used as a brief insight only and DO NOT REPLACE a good textbook. USE AT YOU OWN RISK. ISAAC 2013