Immunoprophylaxis and Immunizations Types of Immunity:

Passive Natural From the mother by transplacental antibodies - Maternal Ig G antibodies cross the placenta mainly in latter half of last trimester. - disappear from infants rd circulation by the 3 th 6 month of age. Artificial/Acquired Administration of exogenously produced antibodies ( globulins and antitoxins) - temporary prevention i) Standard human immune serum globulins (Gamma globulins) ii) Specific human serum globulins ( Hepatitis B , Rabies) iii) Animal sera and antitoxins ( Anti-snake serum, Anti-scorpion serum ) Indications of Immune globulins and Antitoxins : - Exposure to Hepatitis A or B. - Exposure to Measles. - Exposure to Rabies. - Exposure to Tetanus (in nonimmunized or incompletely immunized persons) - Chicken Pox (varicella) (in immunosuppressed child) - Diphtheria - Snakes, scorpions and spider bites. -Immunosuppressant therapy: Anti-Rh (D) immune globulin to prevent Rh disease. Natural Acquiring the infection either in its subclinical or overt clinical forms. - may be Life-long immunity as in Measles, German measles, Mumps and Chicken Pox OR - Transient as in common cold Active Artificial (vaccination) Administration of Vaccines or Toxoids

vaccines or toxoids stimulate the bodys immune system to produce antibodies and cellular immune responses that protect against the infectious agents

protect against - Diphteria - Poliomyelitis - Measles - Mumps..etc. *Newborns are not protected against Pertussis

Types of Vaccines: Live Attenuated Virus Vaccine Live Attenuated Bacteria Vaccine Killed Virus Vaccines Killed Bacteria Vaccine Immunological components of Infective agents Toxoids Vaccines produced by genetic engineering

Measles, Mumps, Rubella, Varicella, Rota virus & Oral poliovirus (OPV / Sabin) vaccines BCG ( Bacille of Calmette and Guerin) Rabies , Salk poliovirus (IPV or Salk) and Infuenza virus vaccines Pertussis and cholera Pnemococcal polysaccharide vaccine, Meningococcal polysaccharide , Hemophilus influenza vaccine, Acellular Pertussis vaccines Modified toxins of the offending bacteria as Tetanus and Diphtheria toxoid recombinant Hepatitis B vaccine, Human Papilloma Virus vaccine

Schedule of Vaccination applied by the Ministry of Health in Egypt Age Vaccine Newborn Oral Polio vaccine (zero dose 2 months OPV1 + DPT1 + HBV1 4 months OPV2 + DPT2 + HBV2 6 months OPV3 + DPT3 + HBV3 9 months OPV4 + Vitamin A 12 months MMR 18 months OPV (booster) + DPT (booster) + Vitamin A 4-6 years MMR 2nd dose DT BCG 6 years OPV + DT+ BCG 12 years DT + MMR ( if not given at 5 years) Other Vaccines given for specific diseases (Non-obligatory) Haemophilus Infuenza type b vaccine (HIB) Hepatitis A vaccine Varicella vaccine Rota virus vaccine (ROTARIX) Seven Valent Pneumococcal Vaccine (Prevenar) Meningococcal polysaccharide vaccine Human Diploid Cell vaccine for Rabies (HDCV)

Dose & Route of Administration Oral, 2-3 drops OPV: 2-3 oral drops. DPT: 0.5 ml IM Injection (separate from HBV) HBV: 0.5 ml IM Injection (separate from DPT) ( 100,000 units orally) 0.5 ml Subcutaneous 200,000 units orally 0.5 ml Subcutaneous 0.5 ml Intramuscular 0.1 ml Intradermal

Conjugate polysaccharide vaccine Inactivated hepatitis A virus Live attenuated virus vaccine Lyophilized live attenuated human Rota virus 7- valent Pnemococcal conjugate vaccine Meningococcal polysaccharide vaccine Inactivated Rabies virus grown in human diploid cell culture

Adverse reactions of some vaccines: Local reactions : Irritation, redness, swelling. Systemic reactions: Fever, rash, and allergy. Specific reactions: Measles Fever (usually 9th day) , transient rash, and arthralgia Rubella Fever, transient rash, transient lymphoadenopathy and arthragia Mumps Mild parotid enlargement BCG Persistent ulcer, axillary lymphadenitis, cold abscess and sinus formation. Generalized Tuberculosis in the immunocompromised Sabin (OPV) paralytic polio is extremely rare except if the child is immunocompromised Pertussis Redness, pain, swelling, fever, drowsiness, and somnolence. Convulsions, encephalopathy and shock. These side effects are extremely rare and non- existent with acellular pertussis vaccine Contradications of Vaccination : All infants should be vaccinated as scheduled even if preterm. Live attenuated vaccine like BCG, OPV, MMR, and varicella should NOT be given to immunocompromised infants or to their contacts. Contraindications to Pertussis vaccine: - Encephalopathy within 7 days of previous DPT vaccine. - Persistent unusual high pitched cry - Shock-like state or somnolence. So, we give DT vaccine instead of DPT.

- Convulsions or history of convulsions. - Fever >40.5C unexplained by other causes. - Allergic reaction to vaccine.

Cold Chain in transportation and storage of vaccines Vaccines and vaccine diluents should be refrigerated between 0 C and + 8 C. Oral Polio Vaccine is stored frozen at 20 C. Opened Oral Polio Vaccine vial is kept on top shelf of refrigerator under the freezer. Measles vaccines are kept on top shelf of refrigerator under the freezer. BCG, DPT, DT, TT are kept on the second shelf of the refrigerator. Freezing damages the killed absorbed vaccines and toxoids (DPT, DT, TT). Disinfectants and antiseptics ( alcohol and detergents) can damage the vaccines. Avoid strong light, heat and direct sun light. Even if storage temperatures are always correct, check the expiry dates. For reconstituted vaccines, use only the diluent supplied by the vaccine manufacturer.