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
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
 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
 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
wks after TT2 immunization
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 • induration: 2-3 days
• pustule formation: 5 • pustule formation: 5-7
– 7 wks days
• scar formation: 2 – 3 • scar formation: 2-3
months 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,
 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
 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
 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
 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!