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Immunisation

The document discusses immunization and vaccination recommendations for HIV-positive children. It defines vaccines and the differences between active and passive immunization. For HIV-positive children, it recommends vaccination with BCG, DPT, hepatitis B, polio, and measles vaccines according to WHO schedules. It also addresses special considerations for immunizing HIV-positive children, such as using inactivated polio vaccine where available and giving measles immunoglobulin after exposure. The document concludes that immunization plays an important role in preventing illness in both HIV-negative and HIV-positive children.

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109 views

Immunisation

The document discusses immunization and vaccination recommendations for HIV-positive children. It defines vaccines and the differences between active and passive immunization. For HIV-positive children, it recommends vaccination with BCG, DPT, hepatitis B, polio, and measles vaccines according to WHO schedules. It also addresses special considerations for immunizing HIV-positive children, such as using inactivated polio vaccine where available and giving measles immunoglobulin after exposure. The document concludes that immunization plays an important role in preventing illness in both HIV-negative and HIV-positive children.

Uploaded by

Ojambo Flavia
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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IMMUNISATION

Dr. Senkungu Jude Paediatrician

Exposed infant clinic .


Mbarara Regional Referral hospital

LEARNING OBJECTIVES
Define VACCINE and the nature of

ACTIVE vs. PASSIVE IMMUNIZATION


Discuss special issues related to

immunization of HIV+ children


To review the recommended

immunization schedule for HIV+ children

What is a vaccine and how does it work in the body?

DEFINITION: Vaccine
A VACCINE is a suspension of live (usually attenuated/weakened) or inactivated microorganisms (e.g. bacteria, viruses) or fractions thereof administered to induce immunity and prevent an infectious disease or its sequelae.
CDC MMWR, Vol 43, No. RR1, 28 Jan 1994

IMMUNISATION

The ultimate goal of immunization is

eradication of disease in individuals

ACTIVE IMMUNIZATION
A person is stimulated to develop

immunologic defences against future natural exposure It involves administration of all or part of a microorganism or a modified product of that microorganism(e.g toxoid,a purified antigen) Some vaccines can give life long protection, and others partial.

PASSIVE IMMUNIZATION
A person already exposed or, about to be

exposed, is given preformed human or animal antibody

PASSIVE IMMUNIZATION
Use of hyper immune globulins is

recommended for children who have been exposed to particular antigens to prevent infection or shorten disease Examples: HBIG (hepatitis), RIG(rabies), TIG (tetanus),

IMMUNIZATION SCHEDULE
EPI : recommended by WHO in 1970
The UNEPI schedule initially had

vaccines for 6 disease, but since 2002 June has an additional 2(Meningitis and hepatitis B)
Mass immunization is carried out

intermittently in an attempt to achieve herd immunity.

RECOMMENDED IMMUNIZATION SCHEDULES


WHO EPI
At Birth 6 Weeks 10 Weeks 14 Weeks 6 Months 9 Months BCG, OPV, HepB OPV, DTP, HepB OPV, DTP OPV, DTP Measles, HepB Measles, Yellow Fever Measles

UGANDA MOH
BCG, OPV OPV, DTP, HepB, Hib OPV, DTP, HepB, Hib OPV, DTP, HepB, Hib

WHO/UNICEF RECOMMENDATION FOR VACCINATION OF HIV INFECTED CHILDREN AND WOMEN OF CHILD BEARING AGE

VACCINE

ASYMPTOMATIC HIV INFECTION

SYMPTOMATIC HIV INFECTION

OPTIMAL TIMING OF IMMUNIZATION

BCG DPT HEPATITIS B HEAMOPHILUS INFLUENZA -B OPV MEASLES YELLOW FEVER

YES YES YES YES YES YES YES

NO YES YES YES YES YES NO

BIRTH 6,10,14 WKS 6,10,14 WKS 6,10,14 WKS 0,6,10,14 WKS 6MTHS,9MTHS

TETANUS TOXOID YES

YES

**5 DOSES

SPECIFIC IMMUNIZATIONS
Bacille Calmette Guerin (BCG)
Type-Live attenuated vaccine Use BCG in asymptomatic HIV infected

children. After vaccination Papule - appears after 3 weeks Ulceration - after 6 weeks A scar - after 6 months

Complications of BCG
Large pus filled abscess if injection

technique is poor (too deep)


Suppurative lymphadenitis (short term)
Disseminated BCG infection (very rare) Fistula formation at the site of injection

Diphtheria,Pertussis,Tetanus (DPT)
Type-Inactive vaccine.
Not contraindicated for HIV infected

children Side effects Mild - low grade fever,mild irritability,tenderness at site of injection Rx: with paracetamol 15mg/kg 4-6hrly

DPT .cont
Severe Temp > 39.50C
High pitched uncontrollable crying Rarely-febrile seizures with no

consequences. Shock Advise parents to return in case of above.

Hepatitis B vaccine
Type- Inactive vaccine.
Given with DPT

Not contraindicated in HIV infected

children
Adverse effects very rare

Anaphylaxis

Polio vaccine
OPV is live attenuated, while IPV is

inactivated. Eradicated in much of the world


IPV preferred for all the children where it

is available.
Given by s/c injection in upper arm or

thigh

Polio vaccine.cont
Side effects of OPV
Vaccine associated paralytic polio

occurs within 2 months after immunization


Risk is very low 1:7.8 million doses

Measles vaccine
Type-live attenuated vaccine.
Measles is a serious illness in under fives in

developing countries-over 1 million deaths/yr


Severe complications in HIV infected children,

where death rate is 40%


WHO recommends immunization of HIV

infected children at 6 months followed by second dose at 9 months.

Measles vaccine.cont
Mild effects of vaccine Low grade fever 7-14 days after injection cough,nasal drainage,rash,tenderness at site of injection.
Serious side effects Seizures,dyspnoea,severe skin rash

Measles . cont
HIV infected children can receive

prophylactic measles immunoglobulin within 6 days of exposure to measles disease.


Dose - 0.5ml/kg,max.of 15ml

Vaccine handling and storage


Inattention to vaccine storage conditions

can contribute to vaccine failure OPV,measles,varicella, and yellow fever vaccines are sensitive to increased temperatures Diphtheria, tetanus, and pertussis are destroyed by freezing The cold chain must be maintained up to the recipient

The child health card


It is used for maintaining the

immunization schedule, as well as a growth monitoring tool


Adverse events for each immunization

should be noted.
Very important tool in monitoring HIV

infected children

Case Study
An auntie brings Thomas, a 6-year old

HIV+ boy, to you for a consult regarding immunization. Auntie wants to start Thomas in day school, but is required to show proof of measles immunization. Auntie is concerned about immunization, but wants to get Thomas into school.

Case Study (Cont)


Thomas CD4 count is 18% and auntie

reports that he has periodic bouts of diarrhea.


QUESTIONS

Is it safe to administer the measles vaccine to Thomas? How would you counsel Auntie?

Points to Note.
Exclude symptomatic HIV children when

giving BCG. Do not give yellow fever vaccine to symptomatic HIV-infected children; give asymptomatic children at 9mths Give Measles vaccine to children even when HIV symptoms are present at 6 and 9mths. (Ugandan Experience) HIV infected children can receive prophylactic measles immunoglobulin (0.5ml/kg) within 6 days of exposure.

Points to Note.(Cont)
Care providers and patients should be

informed about the benefits of immunization in preventing disease to themselves and the greater community.
Health care providers play a key role in

immunization, patient education and counseling, and serve as frontline advocates in the fight against vaccine preventable diseases.

CONCLUSIONS
Immunizations play an important role in the

prevention of childhood illnesses


HIV positive children have an increased risk of

vaccine preventable diseases


Mortality is very high in un-immunized HIV +VE

children
Immunization is therefore worthwhile !!!!

THANK YOU FOR YOUR ATTENTION !

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