The basic principle of immunization is to administer into a healthy person a vaccine that will prevent that person from getting a certain disease.
Vaccines may be of: Live attenuated (e.g. Rubella, OPV, Measles and BCG), inactivated or killed (e.g. Hib, IPV) micro-organisms and detoxified toxins (e.g. Tetanus).
Generally, several vaccines can be given at the same time. This is important since you do not know when you will see the child again. BCG, OPV, DPT-HeB-Hib and Measles vaccines can be given simultaneously if the child is of the appropriate age and has not received the early immunizations. A critically ill child needing hospital admission must be given the appropriate vaccines upon recovery.
Remember:
• That a slight fever and/or other minor illness should not prevent you from immunizing a child
• To inform mothers/child-caretakers about possible side effects of each of the given vaccines
• To record all vaccinations on tally sheets and on the Child-Health immunization cards and instruct the mothers always to bring the cards along with them when taking children to a health facility
• To instruct mothers to return the child for the next immunization date as indicated on the card
• That vaccines are easily destroyed by heat and rendered ineffective
• To handle the disposal of used sharp syringes appropriately
• To ensure appropriate cold storage of the vaccines and follow the recommended cold- chain instructions for each of the vaccines carefully.
ADVICE TO MOTHERS
Facts about the common vaccine-preventable diseases
Whooping cough (Pertussis): A communicable disease. Spread by droplets. Symptoms include severe cough followed by a whoop and vomiting, leads to malnutrition, can cause death, severe under 1 year old.
Diphtheria: An infectious disease. Spread by droplets. Symptoms include difficulty in breathing, swallowing, enlarged neck. Very severe when it occurs.
Tetanus: [see tetanus] A clinical syndrome involving primarily the central nervous system and resulting from the tetanus toxins. Enters through open wounds, cuts and umbilical stump. Symptoms include stiffness, locked jaw, inability to suckle and muscle spasms. Has a very high mortality (>50%). Immunizing pregnant mothers ensures protection of her new born baby.
Measles (Rubeola): [see measles] Killer disease. Highly infectious. Symptoms include rash, fever, cough, red eyes; is associated with blindness, malnutrition, deafness, pneumonia and death.
Poliomyelitis (Infantile Paralysis): [see poliomyelitis] An acute communicable disease. Spread by droplets and oro-faecal contamination. Symptoms include pain and flaccid paralysis in limbs, fever, vomiting; can lead to permanent deformity and can cause death.
Tuberculosis: [see tuberculosis] A communicable disease. Spread by droplet. Symptoms include fever, wasting, deep chesty cough, night sweats. May have lymphadenopathy. Leads to lowered resistance to other diseases and may be fatal.
Hepatitis B: is a highly infectious disease. Transmitted mainly by parenteral route, also from person to person by close contact through exchange of body fluids such as saliva, secretions from open wounds, blood, vaginal secretions and semen. Transmission between children is common, since they are often more infectious than adults. Transmission from carrier mothers can occur in up to 80% of babies during the perinatal period, the risk being higher in HBsAg. positive mothers. Infection may be transmitted either vertically (transplacentally from mother to unborn baby) or horizontally by close contact. Complications of HBV infection include: acute hepatitis, chronic hepatitis, liver cirrhosis, vascular disease, glomerulonephritis, and primary hepatocellular carcinoma. Haemophilus Influenzae b: is a bacteria recognised as one of the commonest agents causing pneumonia and meningitis in children (see 21.9. pnemonia, 12.4. meningitis)
New Vaccines
The following new vaccines are now recommended to be adopted for universal childhood immunization programmes in developing countries where appropriate.
• Recombinant DNA Hepatitis B vaccine (HepB)
• Haemophilus influenzae type b conjugate vaccine (Hib)
• Yellow Fever viral vaccine (for routine use only; not for outbreak control).
CHILDHOOD IMMUNIZATION SCHEDULE IN KENYA
Vaccine |
Age |
Remarks |
BCG POLIO (OPV O) |
At birth
Birth Dose |
Or at first contact with child |
DPT1-HeB1-Hib1 DOSE POLIO (OPV 1) |
6 weeks
(1 ½ months) |
Or at first contact with child after that age |
DPT2-HeB2-Hib2 DOSE POLIO (OPV 2) |
10 weeks
(2 ½ months) |
4 weeks after DPT 1 and OPV 1 can also be given anytime after this period, when in contact with the child. |
DPT3-HeB3-Hib3 DOSE POLIO (OPV 3) |
14 weeks
(3 ½ months) |
4 weeks after DPT 2 and OPV 2 can also be given any time after this period, when in contact with the child. |
Measles |
9 months |
May be given between 6 and 9 months if child is admitted to hospital for any other illness. Repeat at 9 months as per KEPI schedule. |
IMMUNIZATION SCHEDULE FOR PREGNANT MOTHERS (TT2+)
Tetanus Toxoid (TT) |
Pregnant women |
1st dose with first pregnancy or subsequent pregnancy |
| |
|
2nd dose - 4 wks after first dose |
| |
|
3rd dose - 6 months after 2nd dose |
| |
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4th dose - at least 1 year after the third dose |
| |
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5th dose - at least 1 year after the fourth dose |
Immunizing a pregnant mother ensures protection of her newborn baby.
VITAMIN A SUPPLEMENTATION SCHEDULE
Dosage (in IU) |
When to give |
<6 months - 50,000
6-12 months- 100,000
>12 months-200,000 |
First dose at 9 months then every 6 months (twice per year) up to the age of 60 months. |
VACCINE DOSAGE AND ROUTE OF ADMINISTRATION
VACCINE DOSE
(*=Live vaccines) |
ROUTE OF ADMINISTRATION |
|
BCG*
Child under 1 year, 0.05 ml.
Child over 1 year, full dose, 0.1 ml
|
Intra-dermally into upper outer part of left forearm, at the junction of the upper and middle thirds. If given correctly a small wheal appears at the site of the injection. Inform the mother that a small sore will appear in 2-6 weeks. Let this heal by itself. It will leave a small scar. If no reaction develops, the vaccination should be repeated after 3 months. |
|
POLIO (OPV)*
2 drops by mouth.
Follow manufacturers instructions on dosage
|
Read the instructions on the bottle. Give vaccine by mouth. Use dropper provided. If child spits or vomits repeat the dose. |
Pentavalent vaccine consisting of DPT-HeB-Hib 0.5 ml |
Intramuscularly in the upper outer part of the thigh. |
HB
0.5 ml - child
1.0 ml - adult |
Intramuscularly in the upper outer part of the thigh for child and deltoid (left) for adult |
Measles*
0.5 ml |
Subcutaneously or intramuscularly in upper outer part of the arm (deltoid muscle) |
Tetanus Toxoid (TT)
0.5 ml. |
Intramuscularly in the outer part of the upper-arm (deltoid muscle) |
Notes: Hands should be washed before and after handling vaccines. All the vaccines and diluents must be kept cold. DPT, HB, and TT vaccines are damaged if kept below 0°C and therefore should never be frozen. Always check Vaccine Vial Monitor (VVM).
Contra-indications. A definite severe reaction to a preceding vaccine dose is a contraindication to further doses.
Live vaccines should not be given to individuals with impaired immune response e.g. leukaemia, HIV/AIDS.
The intramuscular route should not be used in patients with bleeding disorders such as haemophilia or thrombocytopaenia.
HIV/AIDS INFECTION AND IMMUNIZATION
Asymptomatic children infected with HIV should receive all standard Kenya Expanded Programme on Immunization (KEPI) vaccines. Non-immunized children with symptomatic HIV infection should receive all standard vaccines except BCG.
Side-effects and adverse reactions to vaccinations
Range from mild to severe for various vaccines.
BCG Vaccine
These include injection abscess, regional or wide-spread lymphadenitis, osteomyelitis and disseminated BCG infection. These should be treated with anti-tuberculosis drugs [see 12.8. TB]
Oral Polio Vaccine
Adverse reactions rarely occur.
Measles Vaccine
Adverse reactions include fever, mild rash and rarely convulsions, encephalitis and sub-acute schlerosing pan-encephalitis (SSPE).
DPT (Diphtheria, Pertussis, Tetanus)
Most adverse reactions are attributed to the pertussis component. Minor reactions include, pain at the site of injection and fever. Major reactions are persistent crying, high pitched cry, excessive somnolescence, convulsions, encephalopathy and coma.
Recombinant DNA Hepatitis B Vaccine
Side effects include pain, fever and swelling at the site of injection.
