National University of Rwanda Family and Community Medicine

Childhood Immunization
KABERA Ren,MD PGY III Resident Family and Community Medicine National University of Rwanda

Introduction
1. The goal of immunization in any one individual is the prevention of disease. The goal of immunization of populations is the eradication of disease. 2. As a result, poliomyelitis, diphtheria, and tetanus have all but disappeared in developed nations; measles, rubella, and pertussis are now rare. 3. Smallpox has been eradicated, and the World Health Organization has made poliomyelitis the next target for eradication.

Introduction
Expanded Programme on Immunizations :EPIRwanda EPI is comprised of three principal components: routine vaccination, supplemental immunization activities, and surveillance of target diseases. Routine immunization is intended to reach infants 0-11 months of age and pregnant women, during antenatal care visits.

Introduction
Vaccination services delivery in Rwanda The proportion of vaccination coverage of immunized children < 1yr was 85 % for PENTA 3, 88 % for measles vaccine and between 80 and 85 % for the other antigens.2010

Principles of Vaccination
Immunity 1. Self vs. non-self 2. Protection from infectious disease 3. Usually indicated by the presence of antibody 4. Very specific to a single antigen

Principles of Vaccination
Active Immunity 1. Protection produced by the person's own immune system 2. Usually permanent Passive Immunity 1. Protection transferred from another person or animal as antibody

Principles of Vaccination
Antigen 1. A live or inactivated substance (e.g., protein, polysaccharide) capable of producing an immune response Antibody 1. Protein molecules (immunoglobulin) produced by B lymphocytes to help eliminate an antigen

Passive Immunity
1. Transfer of antibody from an exogenous source 2. Transplacental most important source in infancy 3. Temporary protection

Sources of Passive Immunity

1. Almost all blood or blood products 2. Homologous pooled human antibody (immune globulin) 3. Homologous human hyperimmune globulin 4. Heterologous hyperimmune serum (antitoxin)

Antibody for Prevention of RSV

1. RSV-IGIV Human hyperimmune globulin Contains other antibodies

2. Palivizumab (Synagis) Monoclonal Contains only RSV antibody

o Not available in EPI Rwanda

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Vaccination
1. Active immunity produced by vaccine 2. Immunity and immunologic memory similar to natural infection but without risk of disease

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Classification of Vaccines
1. active: administration of an antigen (usually as a modified infectious agent or toxin) for active production of immunity 2. passive: administration of antibody-containing serum or sensitized cells for passive protection of the recipient.

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Inactivated Vaccines
Whole 1. virus 2. bacteria Fractional 1. protein-based subunit toxoid 2. polysaccharide-based pure conjugate
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Principles of Vaccination

General Rule The more similar a vaccine is to the natural disease, the better the immune response to the vaccine.

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Live Attenuated Vaccines

1. Attenuated (weakened) form of the "wild" virus or bacteria 2. Must replicate to be effective

3. Immune response similar to natural infection

4. Usually effective with one dose

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Live Attenuated Vaccines

1. Severe reactions possible 2. Interference from circulating antibody

3.

Unstable

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Live Attenuated Vaccines

1. Viral measles, mumps, rubella, vaccinia, varicella, yellow fever ,oral polio,rotavirus,influenza. 2. Bacterial BCG, oral typhoid

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Inactivated Vaccines
1. 2. 3. 4. 5. 6. Cannot replicate Minimal interference from circulating antibody Generally not as effective as live vaccines Generally require 3-5 doses Immune response mostly humoral Antibody titer falls over time

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Inactivated Vaccines
Whole cell vaccines 1. Viral polio, hepatitis A, rabies (influenza)
2. Bacterial (pertussis) (typhoid)(cholera) (plague)

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Inactivated Vaccines
Fractional vaccines
1. Subunit hepatitis B, influenza, acellular pertussis, typhoid Vi (Lyme) 2. Toxoid diphtheria, tetanus

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Polysaccharide Vaccines
Pure polysaccharide 1. pneumococcal 2. meningococcal 3. Haemophilus influenzae type b Conjugate polysaccharide 1. Haemophilus influenzae type b 2. pneumococcal

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Pure Polysaccharide Vaccines

1. Not consistently immunogenic in children <2 years of age 2. No booster response 3. Antibody with less functional activity 4. Immunogenicity improved by conjugation

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EPI Rwanda
At birth :Polio 1- BCG 1Mo1/2: Polio 2, Diphteria, Coqueluche, tetanos, hemophilus influenzae b ,Hepatitis b, pneumococcal 2mo1/2: polio 3, Diphteria, Coqueluche, tetanos, hemophilus influenzae b ,Hepatitis b, pneumococcal 3mo1/2: polio 4,Diphteria,Coqueluche,tetanos,hemophilus influenzae b ,Hepatitis b, pneumococcal 9mo : measles, Vit A

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The end

thank you
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