IMMUNIZATION

HILDA TEODORO-RABAGO,MD FPPS

MA. PHILOMENA GABRIEL-LOPEZ,MD FPPS
ROSALIA M. BUZON,MD FPPS
 Immunization
• Immunization
– Deliberate provocation of an adaptive immune
response by introducing antigen into the body

• Vaccination
– Deliberate induction of an adaptive immune
response to a pathogen by injecting a
vaccine, a killed or attenuated form of the
pathogen
Vaccination
• The best known and
the most successful
application of
immunological
principles to human
health
Vaccine (from vacca, Latin for cow)
• Dr. Edward Jenner, 1796
• Material from cowpox lesions to vaccine an 8 y/o
boy vs smallpox (1st vaccine)
Rabies Vaccine
• Dr. Louis Pasteur, 1885
• Vaccinated a 9 y/o boy
who had been bitten by a
rabid dog
• Altered preparations of
microbes could be used
to generate enhanced
immunity vs. the fully
virulent organism
Ultimate goal: eradication of disease
Immediate goal: prevention of disease

TYPES OF
PROTECTION INDUCED:
7. Complete protection for life
8. Partial protection (booster doses)
GOALS CAN BE ACHIEVED IN 2 WAYS:

3. ACTIVE immunization

5. PASSIVE immunization
 ACTIVE IMMUNIZATION

• Involves administration of all

or part of a microorganism or
a modified product of that
microorganism (toxoid,
purified antigen, antigen
produced by genetic
engineering, to evoke an
immunologic response
mimicking that of the natural
infection but which usually
presents little or no risk to the
recipient.
PASSIVE IMMUNIZATION

• the administration of
preformed antibody to a
recipient for the
prevention and
amelioration of infectious
diseases ( temporary
protection)
 Immunity

Active Passive

Injection of an Antigen Injection of preformed

Toxoid, Live Attenuated Viral, antibiotics (gammaglobulins)
Killed Bacterial Vaccine

Protection produced by the Protection transferred from

person’s own immune another person or animal
System

Usually permanent Temporary protection that

wanes with time
 Passive Immunity
SOURCES
• Almost all blood or blood products
• Homologous pooled human antibody (immune
globulin)
• Homologous human hyperimmune globulin
• Heterologous hyperimmune serum (antitoxin)
• Transplacental most important source in
infancy
 ACTIVE IMMUNIZATION

- Live attenuated viral vaccine – Measles, MMR, OPV,

Varicella
- Inactivated viral vaccine – Influenza , Hep A, IPV, Hep B
(recombinant DNA)
- Detoxified exotoxin (Toxoid) – Diphtheria, Tetanus
- Purified protein antigens – acellular Pertussis, Hep B
- Whole cell pertussis vaccine – DTP
- Inactivated acellular pertussis vaccine – DTaP
- Capsular polysaccharide – Typhoid
- Protein conjugated polysaccharide vaccine – Hib,
Pneumococcal
- Live attenuated bacterial vaccine – BCG (Bacille Calmette
Guerin)
 ACTIVE IMMUNIZATION - Generalities
• Contraindications to ALL VACCINES:
- serious allergic reaction (anaphylaxis) after a
previous vaccine dose
- serious allergic reaction to a vaccine
component

• Precautions :
- moderate or severe acute
illness with or without fever
 ACTIVE IMMUNIZATION - Generalities

Contraindications to ALL LIVE VACCINES:

3. immunocompromised patients
4. patients given immunoglobulin and blood products for
the past 3 months
5. pregnancy and possibility of getting pregnant within 3
months
6. household contacts of immunocompromised patients*
(OPV)
 ACTIVE IMMUNIZATION - Generalities

Simultaneous administration of Multiple

Vaccines:

• no contraindications for multiple vaccines routinely

recommended
• immune response to one vaccine generally does not
interfere with other vaccines
 ACTIVE IMMUNIZATION - Generalities

• There should be an interval of 28 days between

administration of live vaccines

• After 7th birthday, Td is recommended for both primary

and booster vaccination

• Interchangeability of vaccine products is allowed for

primary and booster doses
 ACTIVE IMMUNIZATION - Generalities

Lapsed immunizations:

• in general, intervals between

vaccine doses that exceed those
that are recommended do not
adversely affect the immunologic
response, provided
immunization series is
completed
 EXPANDED PROGRAM ON IMMUNIZATION (EPI)
by the Department of Health

VACCINE MINIMUM DOSE (NO) ROUTE MINIMUM REMARKS

AGE AND SITE INTERVAL
OF BETWEEN
ADMINIST- DOSES
RATION
BCG 1 Birth; or any 0.05 ml for Intradermal; Vaccine
time after NB; 0.1 ml deltoid R destroyed
birth for infants arm by heat &
(1) sunlight
DTP 6 weeks 0.5 ml (3) IM; upper 4 weeks Vaccine
outer portion damaged by
of thigh heat,
freezing
POLIO 6 weeks 2 drops (3) PO; mouth 4 weeks Vaccine
easily
damaged by
heat
 EXPANDED PROGRAM ON IMMUNIZATION (EPI)
by the Department of Health

VACCINE MINIMUM DOSE (NO) ROUTE MINIMUM REMARKS

AGE AND SITE INTERVAL
OF BETWEEN
ADMINIST- DOSES
RATION
HEP B 6 weeks or at Follow IM; Vaccine
birth manufactur- anterolateral destroyed
er’s aspect of by heat or
instructions thigh freezing
0.5 ml (3) -
0,1 & 6
months
MEASLES 9 months 0.5 ml (1) SC; outer Vaccine
part of the easily
thigh damaged
by heat
 EXPANDED PROGRAM ON IMMUNIZATION (EPI)
by the Department of Health

VACCINE MINIMUM DOSE (NO) ROUTE AND MINIMUM REMARKS

AGE SITE OF INTERVAL
ADMINIST- BETWEEN
RATION DOSES
BCG 2 At school entry, 0.1 ml (1) ID; L deltoid Vaccine
whether or not destroyed by
child has BCG heat or
scar sunlight
TETANUS Women of 0.5 ml (5) IM; deltoid TT1 at 1st Vaccine easily
TOXOID childbrearing region contact damaged by
age TT2 at least 4 heat &
weeks after sunlight; given
TT1 for those not
given primary
TT3 at least 6
immunization
wks after TT2
in infancy and
TT4 at least 1 childhood
year after
TT5 at least 1
year after
 Summary of Rules for Childhood
Immunization

BCG Vaccine:
- live attenuated bacterial vaccine
- at birth or anytime after birth
- 0.05 ml ID from birth to 4 weeks; 0.1 ml ID
beyond 1 month at right upper deltoid
- booster dose given at school entry, 0.1 ml ID at left
upper deltoid

Contraindications: immunodeficiency, progressive

dermatoses

Reaction: abscess at the site; axillary lymphadenopathy

 Summary of Rules for Childhood
Immunization
BCG Vaccine:

Usual reactions: Accelerated Reactions:

• induration: 2 – 4 wks
• pustule formation: 5 – 7
wks
• scar formation: 2 – 3
months
• induration: 2-3 days
• pustule formation: 5-7
days
• scar formation: 2-3 weeks
 Summary of Rules for Childhood
Immunization
Hepatitis B vaccine:
- inactivated viral antigen
- 0, 1 & 6 months
- if mother is HBsAg(+): give HBIg & Hep B #1 within
12 hours of birth, Hep B #2 at 1 month and Hep B #3
at 6 months of age
- children and adolescents who have not been
vaccinated with Hep B may begin series during any
visit
Dosage: up to 19 years of age 10mcg (0.5ml)
19 years and above 20mcg (1 ml)
Contraindication: anaphylactic reaction to previous dose

Reactions: pain and swelling at site, fever

 Summary of Rules for Childhood
Immunization

Diphtheria, Tetanus & Pertussis:

DTaP
– DT are toxoids
– aP is acellular pertussis

DTP or DTwP
– DT are toxoids
– P is killed or inactivated whole cell pertussis
 Summary of Rules for Childhood
Immunization
Diphtheria, Tetanus & Pertussis:

Usual Side Effects:

– fever up to 72 hours (low to moderate grade)
– restlessness and irritability
– local reaction: pain and swelling at the site of injection

Contraindications:
- Continuous high grade fever 39 to 40 °C within 48
hours after administration of the vaccine.
- Ongoing neurologic illness
- Moderate to severe illness with fever
- Previous adverse reaction to a previous dose
Previous adverse reaction to a previous dose
1. Change in sensorium: drowsiness, lethargic,
stuporous, convulsion and coma.
2. Seizure within 3 days of receiving the vaccine,
encephalopathy (coma, prolonged seizure and
decreased level of consciousness) within 7 days of
administration of previous dose.
4. Anaphylactic shock within 48 hours after receiving
the vaccine.
5. Continuous incessant inconsolable crying lasting
3 hours within 48 hours after giving the vaccine.
5. Progressive neurological disorders; infantile
spasm, uncontrolled epilepsy, progressive
encephalopathy.
 Summary of Rules for Childhood
Immunization
Poliomyelitis Vaccine:

2 types of vaccines:
1. Oral Polio Vaccine (OPV)
- live attenuated (Sabin)
- 0.5 ml orally; or 2 drops (using multiple dose)
• Absolute contraindications:
1. altered immune states (malignancies [lymphoma,
leukemia], therapy with alkylating agents, metaboltes,
high dose steroids, radiation, HIV/AIDS)
2. pregnancy
3. household contacts of immunocompromised patients
• Relative contraindications: vomiting and diarrhea
• Adverse Reaction: paralysis
 Summary of Rules for Childhood
Immunization

Poliomyelitis Vaccine:

2. Inactivated or Killed Polio Vaccine (IPV)

- given IM

IPV was recommended to decrease the incidence of

vaccine-associated paralytic polio (VAPP)
 Summary of Rules for Childhood
Immunization
Measles Vaccine:
- live attenuated
- 0.5 ml SC
- given at 9 months but may be given as early as 6
months during epidemics

Adverse reactions:
1. fever with or without rashes (5-12 days after
administration)
2. hypersensitivity reaction

Contraindication: immunocompromised state, pregnancy

Relative Contraindication: untreated active tuberculosis
 Summary of Rules for Childhood
Immunization

Measles, Mumps, Rubella (MMR) Vaccine:

- live attenuated
- 0.5 ml SC
- given at 12-15 months; a booster dose is
recommended at 4-6 years old

Reactions:
1. fever with or without rashes (5-12 days after
administration - measles)
2. fever, swelling of parotid gland (mumps)
3. fever, mild rash, transient arthritis or arthralgia,
post-auricular lymphadenopathy (rubella)
 Summary of Rules for Childhood
Immunization

Measles, Mumps, Rubella (MMR) Vaccine:

Reasons for giving 2 doses of MMR:

1. only 87-90% of children actually receive the
measles vaccine
2. 5% of children who receive the first vaccine won’t
develop immunity
3. children who had an immune response to the first
dose could get a “booster” effect

Contraindications: same as other live vaccines

 Summary of Rules for Childhood
Immunization
Varicella Vaccine:
- live attenuated
- 0.5 ml SC
- routinely given at age 12 to 15 months and up but can
be given as early as 9 months
- can be given within 5 days of exposure
- a patient given varicella vaccine can also develop
shingles although the incidence is less frequent and
less severe as compared to the actual varicella
infection
- varicella vaccine prevents moderate to severe cases
of chickenpox
- Booster at 4-6 years
 Summary of Rules for Childhood
Immunization
Varicella Vaccine:

Recommendations:
1. single dose for ages 1-12 years
2. 2 doses 6-10 wks apart in children >13 years
Safety of Varicella vaccine:
1. the virus is so weak that it is not transferred from
someone who got the vaccine to another person
2. it can be given to children who are living in the
home of someone whose immune system is weak
3. may also be given to patients whose mother is
pregnant
 Summary of Rules for Childhood
Immunization

Varicella Vaccine:

Reactions:
-may develop few varicella-like lesions and fever
about 2 to 3 weeks after vaccination
 Summary of Rules for Childhood
Immunization

Hemophilus influenzae b (Hib) Vaccine:

- polysaccharide protein conjugate
- 0.5 ml IM given at 2, 4, 6 and 12 - 15 months old

Reactions: low grade fever (2%)

pain and swelling (10-15%)
 Summary of Rules for Childhood
Immunization

Pneumococcal Vaccine:
- PCV is given at 2, 4, 6 and 12 -15 months or 1 dose at
2 yrs of age
- PPV is given for children 2 yrs and above
- 0.5 ml IM

Indications:
1. patients undergoing splenectomy
2. sickle cell disease
3. asplenia
4. HIV
5. Routinely for children 2 months and above
 Summary of Rules for Childhood
Immunization

Hepatitis A Vaccine:
- inactivated viral antigen
- given to children 1 year and above in 2 doses:
- first dose: anytime after 1 year
- 2nd dose: (booster) 6-12 months after first dose
- Dose for 1-18 years: 0.5 ml IM (720 U)
for >19 years: 1 ml IM (1440 U)
 Summary of Rules for Childhood
Immunization

Hepatitis A Vaccine:

Indications:
1. persons traveling to areas with high prevalence of
Hepatitis A
2. occupational hazards
3. hemophiliacs – contacts of infected persons

Reactions: pain and local swelling

 Summary of Rules for Childhood
Immunization
Influenza Vaccine:
- inactivated vaccine or killed viral
- dose:
for 3 years and above: 0.5 ml IM or SC
for 6 – 36 months: 0.25 ml IM or SC
- should be administered before the start of flu season (Feb to
June)
- 2 doses administered 1 month apart to those receiving
influenza for the first time

Indications
1. prophylaxis in children older than 6 months and adults
2. over 60 years
3. suffer from disease of cardiovascular system, metabolic
disease, cystic fibrosis, chronic respiratory disease,
chronic renal insufficiency
4. Two dose administered at least one month apart are
recommended for children who are receiving influenza
vaccine for the first time.
 Summary of Rules for Childhood
Immunization
Rotavirus Vaccine:
- inactivated vaccine
- given at 2, 4, and 6 months old
- 0.5 ml IM
- first dose 2 months (6 to 12 weeks to 3 months not later
than 12 weeks or 3 months)
- and should not be administer after age 32 weeks (8
months)
Human Papilloma Virus Vaccine:
- inactivated vaccine
- given from 9 to 26 yrs old at 0, 1, and 4months
- 0.5 ml IM
- 3 doses with the 2nd and 3rd doses
- administer 2 months and 6 months after the 1st dose
- after the 1st dose
- schedule 0, 2, 6 or 0, 1, 3 (alternative dose or 2nd at
least one month from the first or 3rd at least 3 months
after the 2nd )
THANK YOU!