Prevention and vaccine pediatrics

Dr Hussein Abdeldayem

Alex University

Family Medicine TrainingDentist Training

PAEDIATRICSPREVENTION AND

VACCINEDr Hussein Abdeldayem

Prof of PediatricsAlex University


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PREVENTION


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Prevention

• Primary Prevention• Secondary Prevention• Tertiary Prevention• Quaternary Prevention


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Prevention

• Primary Prevention prevent the occurrence

of the disease as: by immunization by Genetic counseling

NO DISEASE

AR disordersInfectious Disease as MMR, polio,etc


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Prevention

• Secondary Prevention early detection of the

disease for stopping or reversing its progress

as: by prenatal diagnosis by newborn screening

DISEASENO or MILD CP

PKU, Cong Hypothyroidism


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Prevention • Tertiary Prevention stop the development of

complication of the previously diagnosed disease

as: by EIP, by treating ABM with

corticosteroid AND follow up for complications (ABR) DISEASE

NO ComplicationEIP, ABM


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Prevention • Quaternary Prevention set of health activities

that diminish or avoid the consequences of unnecessary or excessive interventions in the health system

costSwine Flu


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AR Inheritance


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Prevention and Neurologic disorders• Down syndrome• PKU• Congenital

hypothyroidism• galactosemia


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Down syndrome1ry (no DS baby)• Translocated mother (4%)Risk 10%Risk 100% (21/21)Prevention: genetic counseling

(prevent conception)• Non-Disjunction (95%)Risk: 1/1000 increase by: age or has a DS

babyPrevention: avoid late age or

frequent conception Recent: Pre-implantation

selection?? Folic acid supplementation


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Down Syndrome2ry Prevention ( DS baby)

• 9-12 wks GA:21- neck US2- Blood: hCGTH, PaPPa, fetal RBC3- Villous biopsy• 12 -16 wks GA:1- triad: AFP. UOstriol, hCGTH 2- tetrad: triad + inhibin• > 16 wks GA:Amniocentesis


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DS 3ry Prevention• EIP• Echocardiography• Visual acuity/y• Thyroid function/y

(TSH,T4)• Tympanometry/y• Neck X ray at 3-5 yrs*

*Neutral view, flexion & extension


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Galactosemia

Failure to thrivevomitingGalactusuria (sugar in urineAAuria, proteinuria


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Galactosemia

• Milk lactose G + Gal Gal G

• AR• galactosemia 1: (classic) GALT Def (galactose 1p uridyl

transferase)

• Galactosemia 2: GALK (Galactase=galactokinase)

• Galactosemia 3: GALE (uridyl diphosphogalactose- 4 –

epimerase)

Sugar excretion in infancy

Leloir 1970Nobel prize

3 genes


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Prevention

• 1ry: Genetic counseling AR• 2ry: early Screening- blood and urine: increased gal and Gal 1 P

- decreazed enzymes (UT, Galactokinase,

epimerase) Lactose free milk• 3ry: rehab, treat cataract


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PKU

– AR – Gene on chromosome 12– Enzyme deficiency:

phenylalanine hydroxylase– Types:1- classic2- cofactor BH4

(tetrahydrobiopterin )3- mixed* : mild ( no disease)


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PKU• Classic: P Hydroxylase deficiency - blood: severe

hyperphenylalaninemia >20 mg/dl • Cofactor BH4 deficiency - normal phenylalanine in blood or

mild raised - BH4 Cofactor for phenylalanine,

tyrosine and tryptophan - diagnosis: A- measure neopterin and biopterin in

urineB- loading test: oral BH4 (20 MG/KG)

then measure phenylalanine C- enzyme assay• mixed


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PKUPREVENTION• 1ry: genetic counseling

AR• 2ry: a- neonatal screening then low phenylalanine

milk• 3ry: rehabilitation , diet

resriction


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C/P

Some CNS effects of untreated PKU include:

• mental retardation• behavior problems,

autism• hyperactivity• restlessness or irritability• seizures

1- fair hair and skin2- a “musty” or

“mousy” body odor3- Eczema


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maternal PKU syndrome

• Pregnancy in women with PKU (“Maternal PKU”) Women with PKU who are not on the low-Phe diet when they become pregnant have a high chance of having babies with

• birth defects as congenital HD

• mental retardation • microcephaly (recurrent)• SGA


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Maternal PKU syndrome / PreventionDuring pregnancy, they

need to:• stay on the low-Phe diet• visit their PKU clinic on a

regular basis• have their blood Phe

levels checked often


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Prevention

• MR PREVENTION:1- 1ry : vaccine of all females

against (at least 3 mo preconception) of GM

2- 2ry: screening of congenital hypothyroidism, PKU and Galactosemia

3- 3ry: rehabilitation and early intervention program as in DS


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Prevention • Infectious disease prevention:1- 1ry : (as ABM , H1N1flu

disease) a- Vaccine b- Anti-organism prophylaxis c- isolation of infected persons d- Eradication of factors

transmit the infection2- 2ry: early treatment of

infective organism (AB)3- 3ry: early detection of

sequelae as ABR ( for ABM)


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Immunity

Passive AcquiredFrom mother: a- transplacental, b- breast milk

Vaccine or toxoids

Antibodies administration: a- gamma globin, b- antitoxin

Active infection (clinical or subclinical) = Natural


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Natural infection is better than immunization

• Actual Infection usually does cause better and longer immunity than vaccination.

• Measles, GM, mumps, & chicken pox produce long life immunity

• However, the price paid for natural disease can cause morbidity ( complications) up to death


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Vaccination is better than passive immunity

• vaccination cause better and longer immunity than passive immunity ( from mother or injection of IG).


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Vaccine better than infection

• Safe• Mass protection• ?? cost

• Not solid immunity

• S/E• ?? cost

DiisadventagesAdvantages


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Vaccines are safe

• Vaccines are easier and safer to administer than ever before.

• Being immunized is much safer than risking infection and disease.


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Immunization can protect the unprotected

• When immunization coverage is high, it can prevent viruses and bacteria from circulating.

• The more children in a community that are fully immunized, the more everyone is safe.


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Immunization can save money

• Immunization is one of the most cost-effective health interventions.

• Investing in vaccines SAVES more money than it costs.


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Age of Infant/Child

Type of vaccine

At birth Zero Dose

1st (OPV) oral polio

OPV: live attenuated (LA) 2-3 drops

0-1 mo: (1st contact of child with health authority)

BCG: against tuberculosis by

BCG: live attenuated (LA) (intra dermal injection over insertion of left deltoid, 0.1ml)

Immunization Schedule

Ist month: all LA


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Age of Infant/Child

Type of vaccine

2nd Month of age

2nd dose: Polio (OPV), DPT & Hepatitis B 1

4th Month of age

3rd dose: Polio (OPV), DPT & Hepatitis B 2

6th Month of age

4th dose: Polio (OPV), DPT & Hepatitis B 3

OPV: 3 oral dropsDPT: IM 0.5 mlHBV: IM 0.5 ml

DT: killedP: toxoid

HBVRecomb Ag

OPV: Ki oral2-3DT: toxoid IMP: ki IM

HBV: recomb Ag IM


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Age of Infant/Child

Type of vaccine

9th mo of age

Measles SC LAVitamin A Capsule (100.000

units) polio(5th dose) ORAL LA


Measles: SCMMR :SC

Measles/MMR LA

12 MONTHS

MMR sc LA2 Vitamin A Capsule (200.000

units) polio(6th dose) ORAL LA


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http://www.youm7.com/News.asp?NewsID=181137&SecID=245&IssueID=0


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Immunization ( Booster)

18 – 24 mo Booster of DTP (0.5 ml IM) 7th OPV (3 drops)2 capsules Vit A (200,000 units)

4 – 6 yrs of age (preschool)

MMR 2nd dose(0.5 ml SC)

6 – 12 yrs of age(start schooling)

Booster dose of OPV, DT,BCG ± MMR (if not given at 4-6 yrs)


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Immunization: non obligatory

HIB: Hemophilus Influenzae type B

3 doses ( 2, 4 ,6 mo) and booster at 18 – 24 mo

IMConjugated polysaccharide vaccine

HAV:Hepatitis A

1st : +12 mo2nd: after 6 – 12 mo

IMInactivated


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Varicella + 12 mo – 13 yr: one doseBooster: 4- 6 yrs ≥ 13yr: 2 doses with 6 wk apart

LA

Meningococcal ACWY

Over 2 ysEvery 3 ys

SCInactivated


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Flu vaccine (>6 mo age)

Every year (septemper/ october)

Recombinant Antigen

???? ????? ?????


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• Polio vaccine: 1- LA: Oral Sabin 2- killed: IM salk


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• BCG : intradermal • Measles: SC• MMR: SC


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Side Effects (Adverse reactions)

• 1- general : fever, allergy, anaphylaxis • 2- local: pain, redness, swelling, sterile

abscess• 3- specific:


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3- specific:i- BCG: TB ulcer, TB lymphadenitis with cold

abscess and sinus/ suppurative lymphadenitis/ miliary TB

ii- OPV: paralysis


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iii- Pertussis ( DTP): a. Encephalopathy: within 7 daysb. Convulsions: within 2-3 days,c. Persistent high – pitched cry: for 3 hrs

within 2 daysd. Persistent fever: for 2 days ( >40.5ₒC) e. shock or drowsiness, or somnolence:

within 2 days


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iv- measles: rash, arthralgia

V- GM: rash, arthralgia, lymphadenopathy, allergy

Vi-mumps: mild parotitis


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Don’t immunize if there is:1-Anaphylactic reaction to a

vaccine2-Seizure or fever > 40 .5 C

within 48 hr of pertussis vaccine

3-True Egg Allergy (MMR)4-Neomycine allergy (MMR)5-Immunocompromized patient

(OPV)6-Untreated moderate to severe

illness + fever

contraindication


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contraindication

• Pertussis vaccine (DTP)1- history of fits 2- abnormal neurological

child as CP2- S/E of vaccine

Give: DT الثنائى or D T (a)P


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Vaccine of immunodeficiency child

• immunodeficiency child as AIDS, NS (steroid tt)

• Not GIVE: BCG/ OPV/ MEASLES/MMR• not give Oral OPV to his

HOUSEHOLD contacts (siblings)


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Cold Chaintransportation - storage

• OPV not yet used: at freezer (-20C)

• ( 0-8C): all vaccine and diluents• On top shelf (under

freezer) : opened OPV, measles

• On 2nd shelf: BCG, DTP, DT, TT


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Cold Chaintransportation - storage

• In vaccine clinic: keep the vaccine in a cup containing ice

• Sensitive to strong light: BCG, measles, MMR

• Away from HEAT, and direct SUNLIGHT

• DISCARD any vaccine remained in opened vials

Health & Medicine

Prevention and vaccine pediatrics