TIS

Immunization
• What is the EPI schedule?
Q1. How is the BCG vaccine administered?
Q2. What are the possible adverse affects of the vaccine?
Q3. Can you give BCG vaccine to a 14mo old? Give your reason.
Q4. What is an accelerated BCG reaction?
Q5. What is immune reconstitution inflammatory syndrome?
A1. 0.05ml, intradermal injection.
A2.

A3. Beyond 12mo BCG is not recommended in high endemic areas such as our because the individual
acquires comparable immunity from the environmental exposure by then. Having said that in low endemic
areas, even adults who are TST negative with possibility of exposure to TB are candidates for the vaccine.
A4. If an individual with TB infection receives vaccine they will have an accelerated response with formation
of the papule in 1-2 days and scar within 10-15days.
A5. When HIV immunocompromised pts are started on ART, within 3 months of the immune restoration they
develop local abscesses or regional lymphadenitis but no dissemination. Possibly happens because the
previously compromised immune system is now awake and mounts an dysregulated immune response to
the mycobacterium organism.
• How would you manage a term baby born to HBsAg positive mother?
• How would you manage a baby if mother’s HBsAg status is unknown?
Mother Hep B surface antigen Positive
• 1st dose of Hep B vaccine + HBIG
0.5 ml within 12 hours then do
routine vaccination at 6, 10 and
14 weeks
• Check HBsAg and Anti-HBS at 9-
12 months
• If Anti-HBS positive  the child
is immune.
• If HBsAg positive  treat the
child
• If both negative  re vaccinate
completely and check again the
HepBsAg and antibodies.
Mother’s status unknown
• Give Hep B vaccine within 12
hours
• For HBIG:
- If BW <2 kg give HBIG if the
result is not available within 12
hrs or if the mother tests
positive.
- If BW >2kg you can wait and if
the mother tests positive within
7 days give the HBIG. If at 7 days
the status is still unknown give
the HBIG.
Interpret the following :

Patient Hep BsAg Anti Anti Anti HBS Hep BeAg HBV DNA Interpretation
HBc -IgM HBc-IgG

1 + - - - - + Carrier

2 + + - - + + Acute infection

3 + - + - + - Chronic Infection

4 - - - + - - Immune

5 - - + + - - Resolved
• A 6 Month old child brought from an area of measles out break for an
advice to prevent measles.

• How would you manage the child?

Intervention of choice for a measles outbreak is vaccine and
prevents/modifies disease if given within 72 hours of exposure.
• Age 6 to 11mo:
- Will get a total of 3 doses: 1st dose stat followed by an additional two doses
at 12-15mo of age and the next one 4 weeks later.
• Age 12 to 15mo:
- 2 doses 4 weeks apart.

IMIG or IVIG prevents/modifies disease within 6 days of exposure. It is

recommended for those who cannot receive the live vaccine: infants,
pregnant women, severely immunocompromised hosts regardless of
vaccination history.
• A 18yr old from Tharparkar about to marry in a years time. She heard about certain
tetanus vaccine.
• Give her a tetanus vaccine schedule.
• A 15 years old Presents with a clean wound. He has had 4 doses of
tetanus and received his last Tetanus shot at the age of 4-1/2 years.

• How would you manage the boy?

- Note: the ONLY indication for TIG in a immunocompetent person is a dirty wound in a patient whose vaccination
status is not known or has received less than 3 doses.
Q1. A medical student during general peds clinic asks you if patients on
inhaled/oral steroids can be given live vaccines. What is your answer?
Q2. The same student asks if there are any recommendations in place
for oncology patients on chemotherapy.
Q3. You decided to ask the student to read up on the recommendation
on immunization schedule after receiving IVIG and the reason for that
recommendation. What recommendation will the student come
across?
A1.

A2. Live vaccines cannot be given to immunosuppressed patients. Their household contacts can get
vaccinated with live vaccine EXCEPT OPV and live influenza vaccine ( the nasal mist).
A3. After any immunoglobulin containing product including IVIG, blood products the dose of
MMR/varicella has to be deferred to allow a decrease in passive antibodies so children will have an
adequate response to the vaccine. Post IVIG the delay is 11months.
Q1.A 2 yr old, girl, previously unvaccinated has come to clinic.
Recommend a vaccination schedule.
Q2.An 8 yr old has come to clinic, received birth and 6 weeks vaccine.
Recommend a catch up vaccine schedule.
A1. BCG and rotavirus not indicated.
- Polio: 4 doses of bOPV 4 weeks apart, IPV to be given with the first dose
of bOPV.
- Hep B vaccine 3 dose series, 1st dose stat then 2 more 4 weeks apart.
- DTP: 3 doses with interval of 8 weeks between the first 2 doses
followed by 3rd dose 6-12mo after. Don’t forget to schedule a booster in
adolescence with Td.
- Hib: 1 dose stat only
- PCV: 2 doses 8 weeks apart
- Measles: 2 doses 4 weeks apart
A2. The pt has received BCG, OPV0 and OPV1, Penta 1: DPT, Hep, Hib,
Rota I.
Hib, PCV, Rotavirus not recommended.
- Polio: resume without repeating previous doses to complete 4 dose
series. Give 2 more doses of OPV, 4 weeks apart, IPV to be given with
the stat dose of OPV.
- HepB: resume without repeating previous dose to complete 3 dose
series. Give 2 doses 4 weeks apart.
- Tdap: resume without repeating previous dose. Complete 3 dose series
with acellular pertussis since >6 yrs old using Tdap. So 2 doses of Tdap
8 weeks apart. Don’t forget to schedule a Td booster in adolescence.
- Measles: 2 doses 4 weeks apart.
 Thank you
Feedback/questions: sheripariha@aku.edu