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Immunisation Guidelines

Active Artificial Immunity

Dr Nabil Sulaiman
Objectives
„ Trends of vaccination in UAE
„ What vaccines to give
„ When to give them
„ Where to give them
„ How to administer
„ Complications
„ Contraindications
Vaccination Coverage in UAE
1985 - 2004
100
Coverage percenta

90

80

70

60

50
1985 1990 1995 2000 2004
Year
OPV&DPT 3 Measles Hep B 3 Hib 3
Immunization Schedule

Age Immunisation Disease


Schedule

Birth BCG Tuberculosis


Hep B Hepatitis B
Imm. Schedule- Cont
End of Oral Polio Vaccine Polio
(OPV 1) Diphtheria/Tetanus/Pertussis
2nd Pentavalent 1 Haemophilus Influenzae B
Hepatitis B
Month
End of OPV 2 Same as above
Pentavalent 2
4th
Month
End of
OPV3
6th Pentavalent 3 Same as above
Month
Imm. Schedule- Cont
End of MMR Measles/Mumps/Rubella
12th Month
End of OPV 4 Polio
Tetravalent DTP
18th Month Hib

*Pentavalent – DPT+Hib+Hep B Vaccine


*Tretravalent – DPT+Hib Vaccine
Vaccine Administration
„ Most Vaccines should be given by
intramuscular (IM) injection.

„ IM are less likely to cause local


reactions
Before immunization ?
Explaining procedure and possible complications

Informed consent must be taken from the parents

Most Vaccines should be given by (IM) injection


Exception:
- BCG vaccine (intradermal injection)
- Oral polio vaccine (by mouth)
Common injection sites
„ For IM : anterolateral aspect of the thigh or
the deltoid area of the upper arm

„ BCG: Intradermal over the insertion of the


left deltoid muscle
Vaccine Administration
Exceptions:

„ BCG vaccine (intradermal injection)

„ Oral polio vaccine (by mouth)

„ No vaccines given intravenously


IM injections – How?
„ IM injections: needle at a 90º angle to the
STRECHED skin
„ Deep SC injections: needle at a 45º angle to the
BUNCHED skin.
„ Needle needs to be sufficiently long
Vaccine Administration
IM injections – Site?
„ For IM and SC: anterolateral aspect of the thigh
or the deltoid area of the upper arm
„ BCG: Intradermal over the insertion of the left
deltoid muscle
„ Not into the buttock, due to sciatic nerve and fat
If not immunized?
WHO estimates that 2.1 million people died in 2002
of vaccines preventable diseases:
„ 610,000 deaths from measles,
„ 600,000 deaths from hep B,
„ 386,000 from Hib,
„ 294,000 deaths from pertussis,
„ 213,000 deaths from tetanus,
„ 36,000 from yellow fever, and other such as
diphtheria and polio.

„ Of the 2.1 million, 1.4 million were children


under the age of five.
Complications?
„ Encephalitis
„ convulsions
„ epilepsy, paralysis, nerve inflammation
„ lymph glands
„ skins disorders
„ allergies
„ arthritis
„ cancer
Complications?
„ The pertussis (whooping cough) vaccine

„ 1 in 13 children had persistent high-pitched crying

„ 1 in 700 had convulsions or shock, which may cause


learning disabilities or brain damage.

„ Additional chemicals such as formaldehyde


Contraindication to vaccination?
„ Anaphylactic reaction to a vaccine
„ Moderate or severe illness +/- fever
„ For live vaccine: if immunoglobulin or
blood transfusion was given recently,
should delay for a minimum of 3
months
„ Immuno-suppressed patients
„ Patients on steroids
„ Pregnant patients

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