Dr Solis - Midterms - Preventive Pediatrics 1&2 & Handouts

SUBJECT : PEDIA TOPIC : Preventive Pediatrics 1.2 LECTURER : DR. Pauline R. Solis, DPPS, DPIDSP

INFO Source : PPT OUTLINE

CSU MD 2018B [email protected]

III. CHARACTERISTICS OF AN IDEAL VACCINE  SAFE VACCINE : it will not induce the disease into the recipient  No serious reaction or adverse effect  ____- recipient should be able to produce specific antibodies  EFFICACIOUS & EFFECTIVE

I. PRINCIPLES OF VACCINATION A. ACTIVE IMMUNIZATION B. PASSIVE IMMUNIZATION

A. ACTIVE IMMUNIZATION  Refers to stimulation of a person’s own immune system thru the administration of ANTIGENS  Usually before natural exposure to an infectious agent.  Stimulation of the immune system to PRODUCE  Antigen-Specific Humoral (antibody)  Cell-Mediated Immunity By active immunizing agents known as vaccines  VACCINE either CONTAIN 1 or more Antigen which will interact With the immune system such that the response would be similar to a Natural infection without subjecting the recipient to the Disease & its Complications.

B. PASSIVE IMMUNIZATION  Refers to administration of preformed human or animal Antibodies to Persons Before or soon after exposure to certain infectious agents.  Administration of products containing human or animal-derived Antibodies to another person.  Provides only Temporal Protection against some infections as Antibodies will degrade during a period of weeks to months.  SOURCES OF ANTIBODIES :  ENDogenous Ab  Transplacental transfer of maternal antibodies to the infant  EXogenous Ab  Blood products used for transfusion (wholeblood, red cells, platelets);  Immuneglobulins derived from plasma or human donors or produced in animals (horse or equine derived Ab)

II. FACTORS THAT INFLUENCE THE IMMUNE RESPONSE TO VACCINATION 1. Presence of maternal antibody 2. Nature & Dose of antigen 3. Route of administration 4. Presence of an Adjuvant  To improve the immunogenicity of the vaccine 5. Host factors  Age  Nutritional factors  Genetics  Coexisting disease

 EFFICACY – How effective the vaccine in inducing protective immunity under ideal circumstances, measured in RCTS.  EFFECTIVENESS – Measures how well a vaccine perform DURING its actual routine use in community.  INDUCE Long-Lasting if not permanent immunity against disease.  Cost-Effective

IV. CLASSIFICATION OF VACCINES A. LIVE ATTENUATED VACCINES B. INACTIVATED VACCINES

A. LIVE ATTENUATED VACCINES  MODIFIED Virus or Bacteria that are WEAKENED BUT  Retain the ability to Replicate & Produce immunity Without causing illness.  PRODUCE Immunologic memory Similar to acquiring a Natural Infection  May have interference of antibody from any source  Exposure to Heat & Light MAY  Damage antigen  Prevent replication of vaccine organism  Poor immune response or vaccine failure  Cold chain practice  All vaccines are stored in 8 - 10o C.

B. INACTIVATED VACCINES  Composed of KILLED Microorganisms or contain INACTIVATED components  Toxoids  Subunit  Subvirion products  Cell wall polysaccharides  DO NOT contain Live virus or bacteria  LESS AFFECTED BY  Circulating Antibody Maybe given in the presence of maternal antibodies or after receiving Ab-containing products.  PRODUCE  Mostly Humoral response  With little or no cellular immunity  Multiple doses & Periodic supplemental doses are needed TO  Increase or boost antibody titers.

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VACCINES FOR CHILDREN LOCALLY AVAILABLE IN THE PH Vaccine classification

Type

Available vaccines

Route

DTwP

IM

DTaP, Tdap

IM

Toxoids

Tetanus, Td

IM

Polysaccharide protein conjugate

Hib,PCV, MCV4 PPV, MPSV4 Typhoid

Toxoids & whole cell bacteria Toxoids & inactivated bacterial components

Inactivated bacterial

polysaccharide

 MINIMUM INTERVAL BETWEEN DOSES  Minimum interval recommended to ensure that a protective immune response against the disease is achieved

Inactivated virus

Poliovirus(IPV), Rabies, Hepa A

IM

Recombinant subunit

Hepa B

IM

Recombinant viral Ag

HPV

IM

Inactivated viral components

Influenza

IM

Live viral

Live attenuated virus

Live bacterial

IM,SC Oral

Live bacteria

DPT-based combinations: DTaP-IPV-Hib; DTap-IPV-Hib-HepB; DTaP-IPV; DTwP-Hib-HepB Measles, MMR, Varicella, MMRV, Yellow fever BCG

IM

SC ID

 Two or More Inactivated or Live vaccines can be administered Simultaneously at the same visit BUT at Different sites.  Inactivated + Inactivated  Inactivated + Live  Live + Live  However, If two or more live, injectable vaccines were not administered Simultaneously, THEN an Interval of at least 4 weeks Between doses is recommended

 Two or more inactivated OR inactivated & live vaccines CAN BE GIVEN At any Interval between doses  EXCEPTIONS :  Tdap & MCV4 (both inactivated) Must be separated by at least 4 weeks If not given simultaneously  Cholera (inactivated) & Yellow fever (live vaccine) Should be separated by at least 3 weeks ≥2 INACTIVATED INACTIVATED & LIVE ≥2 LIVE INJECTABLE

May be administered simultaneously or at any interval between doses May be administered simultaneously or at any interval between doses 28 days minimum interval, if not administered simultaneously

 VACCINE DOSES  Should NOT be administered at intervals less than The minimum interval or earlier than the minimal age  Vaccine doses Administered up to 4 days before The minimum interval or minimum age can be counted as valid  E.g. Baby received 1st dose of DPT at 5 wks & 3 days old-valid ROTAVIRUS VACCINE (RV1/RV5)  Maximum age of 1st dose  ACIP: 14weeks & 6days  RV5 : 12 weeks

V. VACCINE SCHEDULING

 Live, Orally administered vaccines MAY BE GIVEN  Simultaneously  or At any interval With another  live oral  live parenteral  Inactivated vaccine

 MULTIPLE-DOSE VACCINE  should follow a schedule based on the Minimum age & Minimum interval between doses  MINIMUM AGE  Age at which a significant risk for the disease exists

Cholera

Toxoids, inactivated bacterial components, Recombinant viral Ag, Polysaccharideprotein conjugate

 Recommended ages & intervals between doses of the same antigen/s are those that  Provide optimal protection  or have the Best evidence of efficacy

IM

Inactivated (“killed”) whole bacteria

Combination inactivated bacterial & viral

VACCINE SCHEDULING, INTERVALS, SPACING

 Minimum interval between doses: 4weeks  Dose Maximum age for any dose  ACIP: 8months 0days  RV1: 24weeks  RV5: 32 weeks HEPATITIS B VACCINATION  Administer to all Newborns Before discharge  Use Monovalent vaccine < 6weeks old  2nd dose  should be given 1-2 months after 1st  Administer 3rd dose  At Least 8 weeks after the 2nd  & At Least 16 weeks after the 1st  Final (3rd or 4th)  should not be given Earlier than 24 weeks old ACCELERATED SCHEDULE  For people travelling on short notice who face imminent exposure  For emergency responders to disaster areas  Hepatitis B given at days 0, 7 ,21-30 with booster at 12months

SIMULTANEOUS VACCINATION  It is recommended to provide immediate protection to infants During the most vulnerable months of their lives  Simultaneous vaccination Reduces clinic visits, costs, time  It is safe, effective & has no adverse effects to the normal Childhood immune system  No evidence suggests that childhood vaccines can “overload” the immune system  Children receive 14v accines in the 1st year of life -> Exposure to160 immunologic components

By : Arianne Tamaray, Gianne Orlanda, Krisha Turingan, Karessa Rivera, Karizza Parez, Milka Maddara Edited By: @SamioTounsi ;) | [email protected]

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 Infants are exposed to many bacteria & viruses daily  Exposure to one bacterium from the environment can contain Up to 6000 immunologic components

MISSED/ LAPSED IMMUNIZATIONS  Delayed doses or interruption of schedule does not reduce response to The vaccine but immunization series must be completed  It is NOT necessary to restart series or give additional doses Regardless of time elapsed between doses  Rabies Vaccination is an exception

CATCH- UP IMMUNIZATIONS  Recommended for patients who have misses out on previously Scheduled vaccines or have been delayed in receiving subsequent Doses of multi- dose vaccine  Ensures that these children receive protection quickly as possible By providing missing dose/s  Must be based on available, & preferably written documentation of previous vaccination  When records are not available or immunization status is uncertain, The schedule of vaccination appropriate for patient’s age Must be administered  If more than one vaccine is overdue, all appropriate vaccines maybe given at the same time following the general principles of simultaneous administration of multiple vaccines.

VI. VACCINE INTERCHANGEABILITY  Ideally, vaccination series should be completed with the SAME VACCINE BRAND  If a brand is not available or unknown, ANOTHER BRAND of the SAME VACCINE type / dose can be used to complete the series  Rabies Vaccine are Exceptions  “if you change the brand, you have to restart all over again”  For multiple vaccine doses, the number of doses & schedule for the last administered vaccine should be followed.  “you should consider the date/time, same vaccine that was administered, usually, interval is 4 weeks”

VII. VACCINE CONTRAINDICATIONS  A condition in a recipient that significantly increases the chance of a serious adverse reaction or death if the vaccine is given  Do not administer a vaccine if the contraindication is present

PERMANENT CONTRAINDICATION  Anaphylaxis / severe allergic reaction to a vaccine component or prior dose of the vaccine  Encephalopathy not due to another identifiable cause occurring within 7 days of pertussis -containing vaccine  Severe combined immunodeficiency (SCID) – for Rota Virus Vaccine

TEMPORARY CONTRAINDICATIONS TO LIVE VACCINE  Pregnancy  Immunosuppression :  Chemotherapy  High dose  Long term steroid therapy

VIII. VACCINE PRECAUTION  A condition in a person that May  Increase the chance or severity of a serious adverse reaction  might compromise the ability of the vaccine to produce immunity  Vaccines should be deferred when precaution is present unless the benefit of protection outweighs the risks for adverse events

PERMANENT PRECAUTIONS FOR FURTHER DOSES OF PEDIATRIC PERTUSSIS CONTAINING VACCINES  TEMPERATURE  >= 40.5ᵒC within 48 hours of a dose  Collapse or shock - like state  (hypotonic hyporesponsive episode)  within 48 hours of a dose  Persistent inconsolable crying lasting 3 or more hours  occurring within 48 hours of a dose  Seizure with or without fever  occurring within 3 days of a dose (Associated with whole cell pertussis containing vaccine)

TEMPORARY PRECAUTIONS  History of Guillain-Barre syndrome (GBS)  Tetanus containing  Influenza & Meningococcal conjugate vaccines  Unstable progressive neurological problem  Moderate or severe illness – all vaccines  Recent receipt of Ab -containing blood product – live injectable vaccines

IX. INVALID CONTRAINDICATIONS TO VACCINE 1. Prematurity 2. Mild illness 3. Breastfeeding 4. Allergies that are not anaphylaxis in nature 5. A stable neurological disorder  including seizure unrelated to vaccination 6. Family history of adverse events 7. Family history or seizure or neurological condition 8. Antibiotic therapy 9. Disease exposure or convalescence (ex. Tetanus patient and knowing that the child didn’t completed yet the vaccination – even if the child has a tetanus, you can vaccinate still the child after during the convalescence period/recovery, and should still complete the tetanus immunization of the pt even if he acquired the dsebectheres no assurance that the disease will cause a life time immunity)

X. VACCINE SAFETY  Ensuring the safety of vaccination in foremost in any national immunization program  Development of vaccines requires years of testing & clinical trials before any vaccine can be licensed  Continuous surveillance after licensure & while in use allows Safety & efficacy monitoring  Global advisory committee on vaccine safety (GACVS) – an independent body established by WHO in 1999  Advisory committee on immunization practices (ACIP) – under centers for disease control and prevention (CDC)  (monitor adverse reactions to the vaccine)

By : Arianne Tamaray, Gianne Orlanda, Krisha Turingan, Karessa Rivera, Karizza Parez, Milka Maddara Edited By: @SamioTounsi ;) | [email protected]

Page 3 of 3 PEDIA – Preventive Pediatrics 1.2

 Vaccine safety adverse reactions are commonly related to local reactions such as pain on injection site.  Occasionally fever or rash & is usually mild.  Case series on 12 children where the investigators were not blinded.  MMR vaccines cause Autism through a gut reaction (Ileocecal lymphoid nodular hyperplasia) that release brain damaging peptides which increased ASD risk.  Many studies thereafter which included thousands of subject proved that there is really no link between MMR vaccines & ASD.  Lancet retracted the Wakefield study in 2010. Wakefield was stripped of his medical license in 2010.

VACCINES & STEROIDS  Corticosteroid therapy usually is not a contraindication to administering live-virus vaccine when :  Short term (