Immunisation Guidelines Immunisation Guidelines Active Artificial ImmunityActive Artificial Immunity

Dr Nabil SulaimanDr Nabil Sulaiman

ObjectivesObjectives

Trends of vaccination in UAE Trends of vaccination in UAE What vaccines to giveWhat vaccines to giveWhen to give themWhen to give themWhere to give themWhere to give themHow to administer How to administer Complications Complications ContraindicationsContraindications

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1985 1990 1995 2000 2004

Year

Cov

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OPV&DPT 3 Measles Hep B 3 Hib 3

Vaccination Coverage in UAE

1985 - 2004

Immunization Schedule

AgeAge Immunisation Immunisation ScheduleSchedule

DiseaseDisease

BirthBirth BCGBCG

Hep BHep BTuberculosisTuberculosis

Hepatitis BHepatitis B

Imm. Schedule- ContEnd of End of 22ndnd

MonthMonth

Oral Polio VaccineOral Polio Vaccine(OPV 1)(OPV 1)

Pentavalent 1Pentavalent 1

PolioPolioDiphtheria/Tetanus/PertussisDiphtheria/Tetanus/PertussisHaemophilusHaemophilus Influenzae BInfluenzae BHepatitis BHepatitis B

End of End of 44thth

Month Month

OPV 2OPV 2Pentavalent 2Pentavalent 2

Same as aboveSame as above

End of End of 66thth

MonthMonthOPV3OPV3Pentavalent 3Pentavalent 3 Same as aboveSame as above

Imm. Schedule- Cont

End of End of 1212thth MonthMonth

MMR MMR Measles/Mumps/RubellaMeasles/Mumps/Rubella

End of End of 1818thth MonthMonth

OPV 4OPV 4TetravalentTetravalent

PolioPolioDTPDTPHibHib

*Pentavalent *Pentavalent –– DPT+Hib+HepDPT+Hib+Hep B Vaccine B Vaccine

**TretravalentTretravalent –– DPT+HibDPT+Hib VaccineVaccine

Vaccine AdministrationVaccine Administration

Most Vaccines should be given by Most Vaccines should be given by intramuscular (IM) injection.intramuscular (IM) injection.

IM are less likely to cause local IM are less likely to cause local reactions reactions

Before immunization ?Before immunization ?

Explaining procedure and possible complicationsExplaining procedure and possible complications

Informed consent must be taken from the parentsInformed consent must be taken from the parents

Most Vaccines should be given by (IM) injectionMost Vaccines should be given by (IM) injectionException:Exception:

-- BCG vaccine (BCG vaccine (intradermalintradermal injection) injection) -- Oral polio vaccine (by mouth)Oral polio vaccine (by mouth)

Common injection sitesCommon injection sites

For IM : For IM : anterolateral aspect of the thighanterolateral aspect of the thigh or or the deltoid area of the upper armthe deltoid area of the upper arm

BCG: Intradermal BCG: Intradermal over the insertion of the over the insertion of the left deltoidleft deltoid musclemuscle

Vaccine AdministrationVaccine Administration

Exceptions:Exceptions:

BCG vaccine (BCG vaccine (intradermalintradermal injection) injection)

Oral polio vaccine (by mouth) Oral polio vaccine (by mouth)

No vaccines given intravenouslyNo vaccines given intravenously

IM injections IM injections –– How?How?

IM injections: needle at a 90IM injections: needle at a 90ºº angle to the angle to the STRECHED skinSTRECHED skin

Deep SC injections: needle at a 45Deep SC injections: needle at a 45ºº angle to the angle to the BUNCHED skin. BUNCHED skin.

Needle needs to be sufficiently long Needle needs to be sufficiently long

Vaccine AdministrationVaccine Administration

IM injections IM injections –– Site?Site?For IM and SC: anterolateral aspect of the thigh For IM and SC: anterolateral aspect of the thigh or the deltoid area of the upper arm or the deltoid area of the upper arm BCG: Intradermal over the insertion of the left BCG: Intradermal over the insertion of the left deltoid muscle deltoid muscle Not into the buttock, due to sciatic nerve and fat Not into the buttock, due to sciatic nerve and fat

If not immunizedIf not immunized??WHO estimates that 2.1 million people died in 2002 WHO estimates that 2.1 million people died in 2002

of vaccines preventable diseases: of vaccines preventable diseases: 610,000 deaths from measles, 610,000 deaths from measles, 600,000 deaths from hep B,600,000 deaths from hep B,386,000 from 386,000 from HibHib,,294,000 deaths from pertussis,294,000 deaths from pertussis,213,000 deaths from tetanus, 213,000 deaths from tetanus, 36,000 from yellow fever, and other such as 36,000 from yellow fever, and other such as diphtheria and polio. diphtheria and polio.

Of the 2.1 million, 1.4 million were children Of the 2.1 million, 1.4 million were children under the age of five. under the age of five.

Complications?Complications?Encephalitis Encephalitis convulsions convulsions epilepsy, paralysis, nerve inflammation epilepsy, paralysis, nerve inflammation lymph glands lymph glands skins disorders skins disorders allergies allergies arthritis arthritis cancer cancer

Complications?Complications?The pertussis (whooping cough) vaccine The pertussis (whooping cough) vaccine

1 in 13 children had persistent high1 in 13 children had persistent high--pitched crying pitched crying

1 in 700 had convulsions or shock, which may cause 1 in 700 had convulsions or shock, which may cause learning disabilities or brain damage. learning disabilities or brain damage.

Additional chemicals such as formaldehyde Additional chemicals such as formaldehyde

Contraindication to vaccination?Contraindication to vaccination?Anaphylactic reaction to a vaccine Anaphylactic reaction to a vaccine Moderate or severe illness +/Moderate or severe illness +/-- feverfeverFor live vaccine: if immunoglobulin or For live vaccine: if immunoglobulin or blood transfusion was given recently, blood transfusion was given recently, should delay for a minimum of 3 should delay for a minimum of 3 monthsmonthsImmunoImmuno--suppressed patientssuppressed patientsPatients on steroidsPatients on steroidsPregnant patientsPregnant patients