Galal Hussein Aref

Professor of Pediatrics
Previous Chairman of Pediatrics and
Vice Dean
 Preventive Pediatrics.

The ultimate goal in medicine is not

treatment but prevention of disease.
1.Prevention of Genetic Disorders
Genetic counselling
2. Prevention of Endocrine disease
Neonatal screening
3-Prevention of nutritional disorders:
early vitamin D & iron supplementation after 6
months of age.

4-Prevention of accidents & poisoning.

5-Prevention of handicaps:
Good antenatal & obstetric care (Erb’s palsy, mental
handicap.
Early detection of deafness & visual problems.
6-Prevention of infectious diseases :

Isolation of infected person

Eradication of factors that transmit the

infection
Elimination of infective organism

Increased resistance of host through

Immunization
Anti-microbial prophylaxis
 Edward Jenner 1749-1823

 Hunter. Naturalist (Cuckoo),MD.

 Cowpox and Smallpox
 James Phipps 8 years old
 Vaccinia virus (Horsepox)
 Last case in Somalia 1977
 WHO declared World Free of Smallpox
1980
 Active Immunization
 Preservatives and antibiotics
 Adjuvants (aluminum
hydroxide,thimerosal)
 VIRUSES killed live attenuated
 BACTERIA killed live attenuated
 TOXOIDS
 POLYSACCHARIDES
 Passive Immunization
 1000 donors per lot (pooled blood)
 IgG mainly
 Very little IgM and IgA
 Convalescent serum (history)
 IM immune globulin (0.02ml/kg HA 0.25ml/kg Measles)
 IV immune globulin (replacement, Kawasaki, ITP, GB)


Risk of malformations among
infants of women who contract
rubella in 1st weeks of pregnancy is
almost 100% , 40% during 2nd
month, 10% in 3rd month and 4%
in the 2nd and 3rd trimester .
Chicken pox:
Spread occurs by direct contact
or by droplet.
Patients are infectious from
about 24 hours before
appearance of rash until all
lesions are crusted ( usually 6-7
days after eruption)
 Prevention

Primary prevention: immunization

Secondary prevention: early detection of

disease & stopping its progress.

Tertiary prevention: prevent development

of complications .
Natural passive immunity :
(transplacental)
Not all antibodies cross the placenta.
Whooping cough: no passive immunity.

Full protection in first 4 months.

Partial protection from 4-6 months.

May interfere with vaccination (multiple doses)

Antibodies cross placenta in latter half of last
trimester.
Acquired passive immunity

Already formed antibodies.

Given in emergency situations e.g
contacts of infectious diseases.
Contacts to cases of hepatitis A, B,
diphteria, chicken pox.

Injured person exposed to tetanus

(non-immunized or incomplete
immunization)

Exposure to rabies

Immunosuppressant treatment Anti-

Rh anti D to prevent Rh disease.
We can give: gamma globulins (non
specific) or specific human immune
globulin ( Zoster Ig, Hepatitis B Ig,
Rabies Ig )
Natural active immunity:

Acquiring infection may give life

long immunity as after measles,
german measles infection or
transient as after common cold
 Acquired active immunity:
Immunization or vaccination:
Administration of vaccines or toxoids
that stimulate the body’s immune
system to produce antibodies & cell
mediated responses to protect against
infectious agents.
 Types of vaccines
-live attenuated virus vaccines:
Measles, Mumps, Rubella (MMR), Oral Polio
(Sabin), Varicella.

-live attenuated bacterial vaccines:

BCG

-Inactivated killed virus vaccines:

Salk vaccine, Rabies.
-Inactivated killed bacterial vaccines:
Pertussis, Cholera, Typhoid vaccine.

-Immunological components of viruses

or bacteria:
Pneumococcal, Meningeococcal, HiB vaccine,
Acellular Pertussis.

-vaccines produced by genetic

engineering:
Recombinant HepatitisB vaccine.

-Toxoids: Tetanus & Diphtheria in

 Contraindications to vaccines:
NO CONTRAINDICATION TO VACCINES
Contraindications to live-attenuated vaccines
(Oral Polio, Measles, MMR, BCG)

1. Immuno-deficiency (except HIV infants should be

vaccinated for MMR +IPV instead of OPV)
2. Household contacts of immuno-deficient children
should not receive OPV
3. Immuno-suppressive therapy: give vaccine 3
months after stopping treatment.
 Contraindications to Pertussis
1. Fever > 40.5 within 48 hours of DPT (not due to other
cause).
2. Persistent unusual high pitched cry >3 hours within 48
hours of vaccination
3. Convulsion within 48-72 hours of DPT.
4. 4-History of convulsion.
5. Encephalopathy within 7 days of previous DPT
6. Allergic (anaphylactic) reaction to DPT
For Contraindications to Pertussis Vaccine:

WE GIVE DT OR DTaP INSTEAD OF DPT.

 Adverse reactions to some vaccines:

Pertussis vaccine:

• Serious side effects are very rare.

• Redness, pain & swelling of

injection site.
• Slight to moderate fever.
 Measles, MMR vaccines

• Fever between 6-10 day after vaccination. It

lasts 1-2 days.
• Transient rash.
 BCG

Local lesion:
Small abcesses if vaccine is given in a big dose or SC.

Some abcesses point out and discharge then heal.

Some abcesses discharge and leave an ulcer with clear

cut edge which may take many weeks to heal if not
treated.
Local complications disappear quickly with INH
treatment.
 Regional node abcess:
Especially if vaccine is given SC.

Appears within 3 months.

May suppurate, discharge & leave an ulcer.

It heals quickly with INH therapy.

Disseminated lesion:
uncommon, occurs in severely malnourished
children & immunocompromised children.
 Other Vaccines

HiB vaccine
Prevents Hemophilus influenza B infection
(pneumonia, meningitis, epiglottitis)
Conjugate vaccine containing
immunological component of H.influenza.
It is given at 2, 4, & 6 months then a booster
dose at 15 months.
0.5ml IM.
Meningococcal vaccine

Polysaccharide capsular vaccine.

After 2 years of age. 0.5 ml SC.
In epidemics, soldiers, medical staff, and
crowding situations (Pilgrimage).
 Pneumococcal vaccine

Polysaccharide capsular vaccine.

Should be given especially after
splenectomy, in sickle cell disease,
nephrotic syndrome.

A New Polyvalent (PCV) vaccine is given in

first year in 3 doses at 2, 4, & 6 months then a
booster dose at 15 months.
Chicken pox vaccine
Live-attenuated virus vaccine.
After one year of age
One dose 0.5ml SC.
Hepatitis A vaccine
2 doses IM
1st dose then 2nd after 6 months
New vaccine Hepatitis A & B together
Influenza virus vaccine
Every season different vaccine
(different strains of the virus)

Typhoid vaccine
Active immunization for intimate
contact of case or carrier and/or
outbreak of typhoid.
40% protection, new oral vaccine
 Rota virus vaccine

Previous vaccine intussusception

Now new vaccine:

2 Oral Doses, 1 to 2 months apart before 6
months of age.
 Immunization schedule in Egypt
At birth:
• 0 dose of oral polio

• BCG can be given from birth to 40 days. It is given

0.1ml intradermal at insertion of left deltoid .
At 2, 4 and 6 months:
• Doses 1, 2 & 3 of Oral Polio
• Doses 1, 2 & 3 of DPT

• Doses 1, 2 & 3 of Hepatitis B.

 Immunization schedule in Egypt
At 9 months:
• Dose 4 of oral polio

• Measles vaccine 0.5ml SC.

• First dose of vitamin A 100000IU .

At 18 months:
• Booster dose of polio

• Booster dose of DPT

• MMR vaccine 0.5ml SC

• Second dose of vitamin A 200000IU

 Antimicrobial prophylaxis
Chemoprophylaxis for contacts of
meningococcal meningitis Rifampicin
10mg/kg/dose twice daily for 2 days.
Contacts of whooping cough Erythromycin
50mg/kg for 10-14days + booster DPT if age <
6 years
Contacts to case of diphtheria penicillin or
erythromycin
Contacts to case of TBINH.
Bacterial endocarditis.
Thank you