Transcript CHILDHOOD IMMUNIZATION 2

Dr. Athal Humo
2015-2016
• Passive immunity is achieved by administration of
preformed antibodies to induce transient
protection against an infectious agent.
• Passive immunity also can be induced naturally
through transplacental transfer of maternal
antibodies (IgG) during gestation. Maternally
derived transplacental antibodies can provide
protection during an infant's first months of life
The major indications for passive
immunity are to provide protection to:
1. immunodeficient children with B-lymphocyte
defects who have difficulties making antibodies.
2. persons exposed to infectious diseases or who
are at imminent risk of exposure where there is
no adequate time for them to develop an active
immune response to a vaccine
3. persons with an infectious disease as part of
specific therapy for that disease.
• IG is a sterile antibody-containing solution,
usually derived from adult human plasma.
Indication of IG:
A. IG for i.m injection:
1. Replacement therapy in antibody deficiency
disorders.
2. Hepatitis A prophylaxis
3. Measles prophylaxis
B. IG for i.v injection:
1. Replacement therapy in antibody deficiency
disorders.
2. Kawasaki diseas
3. Pediatric HIV
4. Hypogammaglobulinemia in chronic B-cell
lymphocytic leukemia
5. Bone marrow transplantation
6. May be useful in a variety of other conditions as
Guillain-Barre syndrome, immune mediated
thrombocytopenia,
severe
toxic
shock
syndrome…….
C. Other types of IG:
• Specific Immune Globulin Preparations:
Hyperimmune globulin
preparations are derived from donors with high titers of antibodies to
specific agents and designed to provide protection against those agents
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Hepatitis B immune globulin (IM)
Rabies immune globulin (IM)
Tetanus immune globulin (IM)
Varicella-zoster immune globulin (VZIG) (IM) or IVIG
• Hyperimmune Animal Antisera Preparations:
Animal antisera
preparations are derived from horses. 2 horse antisera preparations are
available for humans: diphtheria antitoxin, which is used to treat diphtheria,
and botulinum antitoxin. Great care must be exercised before administering
animal-derived antisera because of the potential for severe allergic
reactions.
• Monoclonal Antibodies: Monoclonal antibodies are antibody preparations
produced against a single antigen. A major monoclonal antibody used in
infectious diseases is palivizumab, which can prevent severe disease from
respiratory syncytial virus (RSV) among children ≤24 mo of age with
chronic lung disease, with a history of premature birth, with congenital
heart lesions or with neuromuscular diseases.
Adverse reaction to IG
• IGIM:
– Pain and discomfort at the injection site, less
common flushing, headache, chills, and nausea
– Rare & serious: chest pain, dyspnea, anaphylaxis, and
systemic collapse.
• IGIV:
– Fever, headache, myalgia, chills, nausea, and vomiting.
– More serious reactions rarely have been reported,
including anaphylactoid events, thromboembolic
disorders, aseptic meningitis, and renal insufficiency.
Contraindications and special considerations:
• All vaccines: if there is severe allergic reaction
(e.g., anaphylaxis) after a previous vaccine
dose or to a vaccine component
• Live vaccines:
– Immunosuppressed
– Pregnancy
Immunosuppression
Live vaccines can, in some situations, cause
severe or fatal infections in immunosuppressed
individuals due to extensive replication of the
vaccine strain.
For this reason, severely immunosuppressed
individuals should not be given live vaccines .
The following individuals should not receive live
vaccines:
1. patients
with
evidence
of
severe
immunodeficiency, e.g. SCI, or secondary
infection.
primary
as HIV
2. Patients receiving systemic high-dose steroids, until at
least 1 months after treatment has stopped. This would
include children who receive prednisolone, orally or
rectally, at a daily dose (or its equivalent) of 2mg/kg/day
for 2week, or 1mg/kg/day for one month.
3. Patients who have received a solid organ transplant
and are currently on immunosuppressive treatment. At
least 3-6 months after stopping treatment.
4. Patients currently being treated for
malignant disease with immunosuppressive
chemotherapy or radiotherapy, or who
have terminated such treatment within at
least the last 6 months, and disease in
remission.
5. Patients who have received a bone marrow
transplant, until at least 12 months after
finishing all immunosuppressive treatment,
or longer where the patient has developed
graft-versus-host disease.
Pregnancy
• There is a theoretical concern that vaccinating
pregnant women with live vaccines may infect the
foetus. There is no evidence that any live vaccine
(including rubella and MMR) causes birth defects.
• However,
live vaccines should generally be
delayed until after delivery. Termination of
pregnancy following inadvertent immunization is
not recommended
Contraindication & Precaution To Vaccine
Conditions are NOT contraindications to immunization
1.
Mild acute illness ± fever.
2.
Mild –moderate local reaction.
3.
Family history of any adverse reactions following immunization.
4.
Prematurity.
5.
Stable neurological conditions such as well controled convulsion,
cerebral palsy and Down’s syndrome.
6.
History of other non vaccine allergic condition as hay fever,
pencillin allergy, etc. …
7.
Close contact of an
OPV.
immunosuppressed individual, except for
General Principles of Childhood Vaccination
• live-attenuated vaccines (MMR, varicella, LAIV) if not
administered on the same day, should be given at least
1 mo apart.
• IG does not interfere with killed vaccines. However, IG
can interfere with the immune response to measles
and varicella vaccine. Depending on the dose of IG
received, MMR & var vaccine should be deferred for as
long as 3-11 mo.
• IG is not expected to interfere with the immune
response to LAIV or rotavirus vaccines.
• Premature infants should be kept on the same
schedule as full-term infants.
• Children whose vaccination status is uncertain
should be considered unimmunized and
should be given appropriate vaccines.
Good Luck