Vaccination (Immunisation) gives immunity to fight against various infections by building immunity. Vaccines may be containing either live or inactivated organisms (attenuated vaccine) organisms
One has to be very careful during early neonatal and infancy as child is more susceptible for some diseases due to inadequate immunity. Breast-fed infants have better immunity as they get antibodies from mother
Vaccination is very important in prevention of childhood diseases and some vaccines give lifelong immunity against certain diseases. Some vaccines need booster doses after a certain interval. Certain vaccines are live while others are inactive.
BCG- Bacille Calmitte Guerine
This gives protection against tuberculosis ( TB). TB is a very common health problem in developing countries like India. It is said that almost every Indian gets exposed to TB organisms (mycobacterium tuberculosis). It affects lungs & possibility of any other organ involvement is there (like kidney, skin, etc). If organ other than lung is involved, its called as extra-pulmonary TB. So this vaccine is given as early as possible after birth preferably within 1st 2 days when delivered lady is still hospitalized. In spite of Vaccination, person can develop TB in future life
MMR
It consists of 3 vaccines- Mumps, Measles, Rubella
Mumps -
This is caused by a virus. It is manifested as epidemic parotitis ( Painful swelling of the salivary glands). Mumps virus was the leading cause of viral meningoencephalitis earlier.
Fever, headache, parotitis(salivary gland inflammation in which cheeks appear swollen), malaise and anorexia are other constitutional symptoms.
Generally it will subside slowly but sometimes it may cause complications like
1. Orchitis ( inflammation of testes in which testes appear swollen) in a male baby which may lead to infertility..
2. Viral meningoencephalitis
Live, attenuated mumps virus vaccine is used as it gives a longterm immunity. The vaccine may be given separately or as part of the MMR . The mumps vaccine has helped a lot in achieving a decrease in the incidence of mumps
Measles –
Measles comes in the category of “ exanthematous fevers”.
The word "exanthem" is a Greek word meaning “ skin rash”. Measles is a highly contagious viral disease that primarily affects children.
It is characterized by fever, cough, cold,, red eyes and a generalized, maculopapular, erythematous rash.
3 “C”s help in diagnosing measles- Cough, coryza , Conjunctivitis.
Koplik's spots are seen inside the mouth . These are pathognomonic for measles but are not seen commonly.
Measles can lead to serious complications sometimes like
Complications Of Measles
1.“ Subacute sclerosing panencephalitis ( SSPE)”
2. Corneal ulceration leading to corneal scarring
Thanks to the efforts of UNICEF, measles deaths worldwide have dropped by 74 percent since 2000. UNICEF is the global leader in vaccine supply, supplying 50% of the world’s need.
Rubella-
This is given at 9 months of age.
In US and UK, rubella vaccine is given compulsorily for all adolescent girls. If girl affected by rubella gets pregnant, child can develop some serious congenital anomalies called as “ Congenital Rubella Syndrome”. This vaccine gives protection.
“ Congenital Rubella Syndrome”
Child develops various abnormalities like
1. Cardiac ( heart related)- Patent ductus arteriosus
2. Defective dentition
3. Deafness
4. Salt pepper fundus or Rubella retinopathy – an abnormality of retina
American Academy of Pediatrics recommends administration of MMR vaccine at the age of 12-15 months and at 4-6 years.
Efficacy of the vaccine is usually around 80%.
Reye's syndrome
Aspirin use is discouraged in young children with viral fever due to chances of Reye’s syndrome. In this syndrome, many abnormalities are seen like brain related abnormalities, mental retardation. Paracetamol, acetaminophen or ibuprofen can be used.
Chicken Pox
This is caused by the varicella-zoster virus (VZV) also known as human herpes virus 3 (HHV-3). It is very contagious from about 2 days before the rash appears and lasts until all the blisters are crusted over. It is acquired by the inhalation droplets from an infected host.
Vaccine
American Academy of Pediatrics (AAP) recommends the vaccine for all children and adults with no history of the disease
From 12 months to 12 years of age – 1 dose.
13 years and above – 2 doses with an interval of 6-10 weeks.
How the vaccine is given
The vaccine is given subcutaneously.
When the vaccine should not be given? What information to be given to doctor
1. Immuno-compromised people
2. Anybody suffering from acute severe febrile illness.
3. Pregnant women
4. Any reaction to previous vaccine
5. If one is taking any drugs like steroids, inform doctor.
OPV ( Oral Polio Vaccine )
Pulse polio programme is going on all over the world to eradicate this disease. India is participating actively in this. Generally OPV is given in December or Jan months on selected days at the same time all over India.
In earlier days, polio used to be seen commonly and it used to make children handicapped. We see many children with lower limb (leg) abnormalities. Nowadays with aggressive vaccination, polio is almost eradicated.
Hepatitis B vaccine
Hepatitis B virus ( HBV) causes hepatitis. This can lead to liver cirrhosis and cancer.
HBV is transmitted very easily through blood and this is an important cause of morbidity and mortality. As HBV can survive adverse atmospheric conditions, this is a of more concern than HIV. This HBV is more dangerous than HIV as death can occur within a few days due to
“ fulminant hepatic failure”
Doses are given at 0, 1 , 6 months. 0 means the day when 1st dose is given. Booster doses are recommended after every 1 year
It is available as
3. Genetically engineered vaccine
4. Derived from human sera of infected people
Genetically engineered vaccine is preferable as it doesn’t have the risk of transmitting infection from 1 person to the other.
It is available with following brand names
1. Engerix
2. Shanvac
.
Tetanus toxoid
Tetanus
This is caused by Clostridium tetani, an anaerobic organism. Unhealthy wound is a risk factor. Tetanus means lock jaw due to muscle spasm. This is an acute fatal disease.
CLOSTRIDIUM TETANI And PATHOGENESIS
Organism enters the body through wound and produces toxin which reaches
central nervous system . This leads to muscle spasms and other signs and symptoms.
Incubation period
Ranges from 3 days to 3 weeks.
Complications
1. Asphyxia
2. Laryngospasm
3. Convulsions related injuries- fractures
4. Death
Tetanus toxoid
It is a formaldehyde treated toxin. Adsorbed toxoid is preferred as it gives long lasting immunity.
This is given to all children between 2 months and 6 years of age to protect (immunize) against tetanus infection .
Schedule For DtaP primary vaccination
1st at 2 months
2nd at 4 months
3rd at 6 months
4th 15 – 18 months
Booster Doses
May be needed at the time of injury
Where It is Given
Upper arm intramuscular deltoid muscle is the commonest site.
What adverse effects can occur?
These are generally mild.
Local adverse effects
1. Irritation
2. Swelling,
3. Redness
4. Bruising with pain
5. Lump at the injection site
6. Itching
Systemic side effects
1. Malaise
2. Low grade fever
3. Itching.
DPT Vaccine
Diphtheria
Pertussis
Tetanus
DTaP Vaccine
Diphtheria
Acellular Pertussis
Tetanus
Management Of Tetanus
1. Wound cleaning and surgical debridement is extremely important.
2. Metronidazole and penicillin treatment are useful to some extent.
Rx Of Mild tetanus
1. Tetanus immuno-globulins IV ( intravenous) or IM ( intramuscular)
2. Tetanus toxoid
3. Metronidazole intravenous
4. Sedation to prevent injuries due to convulsions
Rx Of Severe tetanus
1. Hospitalisation
2. Tetanus immuno-globulins intrathecally
3. Tracheostomy and artificial ventilation
4. Sedation
Myths About Tetanus
Laymen often think that rust on an iron surface causes tetanus if one gets injured with such an object. Actually any injury whether it is due to a rusty nail or normal nail can cause tetanus as it breaches the skin and anaerobic organisms can get penetrated.
Read more about vaccines at
Hepatitis-B-vaccine
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