IMMUNIZATION
Presenter:
Ahmad Tahir
Siti Nurul Farahah
Supervised by : Dr Muhaireen
OUTLINE
• Definition and introduction
• Type of immunity and vaccines
• Importance of vaccines
• Contraindications of vaccines
• Vaccine refusal and it’s challenges
DEFINITION
• Immunisation : process where the body induces
immunity to a disease as a result of a vaccine.
• Vaccine is a product made from killed or live,
weakened strains of viruses or bacteria.
• Vaccination : the act of giving a vaccine to a
person it triggers an immune response in
your body protects you if you come into
contact with strains of that disease again in the
natural environment
IMMUNISATION PROGRAMMES IN MALAYSIA
• Included in the Maternal & Child Health Programmes
(MCH)
• Since 1950s
• Vaccination is given free under the NIP for all children.
• 2015 onwards - Non Malaysian had to pay a minimal fee
for vaccination.
• Few vaccines delivered through School Health Service:
7yo: MR, DT, tOPV (stopped), BCG revacc (stopped)
13yo: HPV
15yo: Tetanus
TYPE OF VACCINES
• Natural Immunity – at birth (skin, mucosa,
phagocytes, lymphocyte and eosinophils)
• Specific Immunity – expose to microorganism
• Active immunization – administration of vaccine
or toxoid (inactivated vaccine)
• Passive immunization- transplacental transfer of
maternal antibodies and administration of
antibody (immunoglobulinor monocloncal
antibobody)
Vaccines of this type on U.S. Recommended
Vaccine type Childhood (ages 0-6) Immunization Schedule
Measles, mumps, rubella (MMR combined vaccine)
Live, attenuated Varicella (chickenpox)
(weakened or altered so that it Influenza (nasal spray)
will not cause illness) RotavirusZoster (shingles)
Yellow fever
Polio (IPV)
Inactivated/ Killed Hepatitis ARabies
Toxoid
(Inactivated toxin: These are used Diphtheria, tetanus (part of DTaP combined
for diseases which are caused by immunization)
toxins produced by bacterias, but
not bacterias themselves.)
Hepatitis B
Influenza (injection)
Subunit/ conjugate Haemophilus influenza type b (Hib)
(only segments of the pathogen) Pertussis (part of DTaP combined immunization)
Pneumococcal
MeningococcalHuman papillomavirus (HPV)
• Optional Vaccination
• Children might receive other optional
vaccinations based on doctor’s advice.
• > 6 weeks : Rotavirus
• > 2 months : Pneumococcal
• > 6 months : Influenza
• > 10 months : Hepatitis A
• > 12 months : Chicken pox
ROUTE OF ADMINISTRATION
Why shall children receive vaccination
• 1. Vaccination had proven to reduce disease
occurrence and death rates tremendously!
Before vaccines were After residents received
Disease developed vaccination
Nearly everyone in the U.S. got Almost no measles occur in the
Measle it. Hundreds of them died each U.S today.
year.
Diphtheri More than 15,000 Americans Only 2 cases have been reported
a died in 1921. to CDC between 2004 to 2014.
12.5 million Americans were
infected at 1964-1965. It killed Only 15 cases have been reported
Rubella 2,000 babies, and caused to CDC since 2012.
11,000 miscarriages.
Source: Centers of Disease Control and Prevention (CDC)
• 2. Vaccines protect children and others as well
Why do we need high immunisation rates???
• Herd immunitiy
• To protect non responder
• To protect those who have contraindications
to immunization
HERD IMMUNITY = COMUNITY IMMUNITY
• ‘Herd immunity is a form of immunity that occurs when the
vaccination of a significant portion of a population provides a
measure of protection for individuals who have not developed
immunity.’
Contraindications
• Absolute
- severe anaphylaxis reactions to previous
vaccine/component of vaccine
Live vaccine : absolute contraindication
- Immunosuppressed children (malignancy, post transplant)
- Pregnancy
- May be given together
Killed vaccine: mostly are safe
- Severelocal induration
- Severe generalised reactions in previous dose
These are not contraindications to
vaccination
• Mild illness without fever: mild diarrhea,
cough, runny nose
• Asthma, eczema, hay fever, impetigo
• Neonatal jaundice
• Underweight or malnourished
• Stable neurological conditions: cerebral palsy,
mental retardation, febrile convulsions
Immunocompromised child
• (Maligancy: leukemia, lymphoma, post transplant)
• BCG is contraindicatd
• Non –live vaccine can be give may need repeated
• Patient on chemotheraphy
- avoid live vaccine two weeks before, during and 6
months after completion of chemotheraphy
- Safe to give influenza and pneumococcal if indicated
Post hematopoietic stem cell (HSCT) and
solid organ transplant (SOT)
• Non live vaccine can be given 6 months after
HSCT and SOT
• Live vaccine givenat lease 2years after HSCT
(no graft versus hist disease and not on
immunosuppresive theraphy
• Live vaccine contraindicated in SOT (on
immunosuppresive theraphy)
Corticosteroid theraphy
Duration of steroid Vaccine administration
High dose steroid: Delay live vaccine at least
prednisolone > or equal to 1months
2mg/kg/day for >14 days
Low dose systemic steroid: Can be given live vaccine on
1mg/kg/day <2weeks or EOD low dose steroid
>2weeks
Any dose for 28 days or longer Delay at least 1 month
SIDE EFFECT
Adverse event following immunization (AEFI) :
any untoward medical occurrence which follows
immunization and which does not necessarily
have a causal relationship with the usage of the
vaccine.
Type of reaction Exampl es
Vaccine product related the inherent properties of the vaccine product.
reaction Example: Extensive limb swelling following DTP
vaccination.
Vaccine related defect quality defects of the vaccine product including its
related reaction administration device as provided by the manufacturer.
Example: Failure by the manufacturer to completely
inactivate a lot of inactivated polio vaccine leads to cases
of paralytic polio.
Immunization error inappropriate vaccine handling, prescribing or
related reaction administration and thus by its nature is preventable.
Example: Transmission of infection by contaminated
multidose vial.
Type of reaction Examples
Immunization anxiety related reaction anxiety about the immunization.
Example: Vasovagal syncope in an
adolescent during/following vaccination.
Coincidental event other than the vaccine product,
immunization error or immunization
anxiety.
Example: A fever occurs at the time of the
vaccination but is in fact caused
by another infectious disease
Minor reactions
• Usually occur within a few hours of injection.
• Resolve after short period of time and pose little danger.
• Local : (includes pain, swelling or redness at the site of injection).
• Systemic : (includes fever, malaise, muscle pain, headache or loss
of appetite).
Severe reactions
• Usually do not result in long-term problems.
• Can be disabling.
• Are rarely life threatening.
• Include seizures and allergic reactions caused by the body's
reaction to a particular component in a vaccine.
VACCINE HESITANCY:
A GROWING CHALLENGE
FOR IMMUNIZATION
PROGRAMMES
SCENARIO VACCINE REFUSAL IN MALAYSIA
• Started 2012-2013 (initially small movement)
• Recently very significant in Social Media
• There is an increasing number of refusals
based on data from government clinics and
hospitals. Data does not include private clinics
and hospitals.
• The consequences of drop in uptake resulted
in increase outbreaks of VPDs.
ANTI-VAXXERS ON THE NET
Vaccine refusal 2013-2016
REASON FOR REFUSAL, 2013-2016
MANAGEMENT FLOW FOR
IMMUNIZATION REFUSAL
RE-EMERGENCE OF VACCINE PREVENTABLE
DISEASES (PVD)
Incidence Diphtheria, Measles and Pertusis in
Malaysia 1980-2016
NUMBER OF DIPHTHERIA CASES, 1975 – 2017
(ew1-35))
Measles Incidence in Malaysia (per 1 million);
1980 –2017 (August)
• CDC: https://www.cdc.gov/vaccines/vac-gen/whatifstop.htm
• Infomed: http://infomed.com.my/vaccination-in-malaysia
• Myhealth KKM:
http://www.myhealth.gov.my/en/immunisation-schedule/
• The College of Physicians of Philadelphia:
• https://www.historyofvaccines.org/content/articles/different
-types-vaccines
• http://hsi.moh.gov.my/2018/02/04/vaccination-for-children-
in-malaysia/
• https://vaccine-safety-training.org/home.html
• Dr Faridah Kusnin, Vaccinology 2017 – III International
Sympossium for Pacific Expert, Hanoi Vietnam
