Preventative Medicine - Immunization Schedules

Immunization

• Definition: Process of making a person resistant to a specific disease via vaccine administration.
• Vaccination: Safe and effective way to protect against harmful diseases before contact.

Classification of Vaccines

• Inactivated vaccines
• Live-attenuated vaccines
• Messenger RNA (mRNA) vaccines
• Subunit, recombinant, polysaccharide, and conjugate vaccines
• Toxoid vaccines
• Viral vector vaccines

Inactivated Vaccines

• Use killed version of the germ.
• Don’t provide immunity as strong as live vaccines.
• Multiple doses needed for long-lasting immunity.
• Examples: Hepatitis A, Flu (shot), Polio (shot), Rabies, Diphtheria, Tetanus, Hepatitis B, Meningococcal, IPV, Pneumococcal Vaccine.

Live Attenuated Vaccines

• Use weakened form of the germ.
• Create strong, long-lasting immune response.
• Need refrigeration.
• Unstable; severe reactions possible.
• Contraindicated in immunocompromised and pregnant patients.
• Examples: BCG, Oral Polio, MMR, Rotavirus, Smallpox, Chickenpox, Yellow fever.

Messenger RNA Vaccines (mRNA)

• mRNA vaccines make proteins to trigger an immune response.
• Benefits: shorter manufacturing time, low risk of causing disease.
• Used against COVID-19.

Subunit, Recombinant, Polysaccharide, and Conjugate Vaccines

• Use specific antigen or element of the germ.
• Strong immune response.
• Low chance of adverse reaction.
• Multiple booster shots needed.
• Examples: Hib, Hepatitis B, HPV, Whooping cough, Pneumococcal disease, Meningococcal disease, Shingles.

Toxoid Vaccines

• Use a toxin made by the germ.
• Create immunity to disease-causing parts, not the germ itself.
• Immune response targets the toxin.
• Booster shots needed.
• Protect against Diphtheria and Tetanus.

Viral Vector Vaccines

• Use modified virus as a vector for protection.
• Examples: influenza, vesicular stomatitis virus (VSV), measles virus, adenovirus.
• Protects against COVID-19.

Routes of Administration

• Oral: OPV, Rotarix
• Intradermal: BCG
• Subcutaneous: MMR, Yellow Fever
• Intramuscular: Pentavalent, IPV, DPT, MMR, Hepatitis B

Principles of Vaccination

• Minimum 4-week interval between live vaccines.
• Killed antigens can be given simultaneously or at any interval.
• Missed doses should be given to resume course.
• Give age-appropriate vaccines if immunization status is unknown.
• Do not mix vaccines in the same syringe.

Side Effects

• Common: Pain, swelling, redness, mild fever, chills, fatigue, headache, muscle/joint aches.

Severe Allergic Reactions

• Difficulty breathing
• Swelling of face/throat
• Dizziness
• Weakness
• Tachycardia
• Generalized rash

Guyana Vaccination Schedule – Non Exposed

• Birth/2 months: BCG, HepB
• 2 months: 1st dose IPV, PCV, Pentavalent, Rotarix
• 4 months: 2nd dose BOPV, PCV, Pentavalent, Rotarix
• 6 months: 3rd dose BOPV, PCV, Pentavalent
• 12 months: MMR, YF
• 18 months: MMR, Booster BOPV, Booster DPT
• 3 years 9 months: Boosters OPV, DPT
• 9-13 years: HPV (0, 6 months)
• 15-17 years: DT Vaccine Booster
• Pregnant Women: Two dT during pregnancy

Guyana Vaccination Schedule – Exposed Infants

• Birth to 2 months: Delay BCG until HIV status known; 1 Hep B
• 2 months: 1st dose IPV, Pentavalent, PCV 13, Rotarix 2
• 4 months: 2nd dose IPV, Pentavalent, PCV 13, Rotarix 2
• 6 months: 3rd dose IPV, Pentavalent, PCV 13
• 12 months: Delay MMR if ill; Do not give Yellow Fever Vaccine
• 18 months: Booster IPV and DPT vaccines; Delay MMR if sick.
• 45 months: Booster IPV, DPT
• 10 – 13 years: HPV – 0, 6 months
• 15 years and over: DT vaccines (adults)

Instructions for Administration of Vaccines

• BCG: 0.05 ml (<3 months) or 0.1 ml (older), Intradermal, Upper left arm
• DPT/DT Pediatric: 0.5mL, IM, Outer thigh (<1 year), Deltoid (older)
• DT Adult: 0.5mL, IM, Deltoid
• IPV: 0.5mL, IM, Anterolateral thigh (infants), Deltoid (older)
• OPV: Entire vial, Oral, Mouth
• Rotarix: Entire vial, Oral, Mouth
• MMR: 0.5mL, Deep SC/IM, Deltoid
• YF: 0.5mL, Deep SC, Deltoid
• Hepatitis B: -, Deep IM, Deltoid
• Pentavalent: 0.5mL, IM, Anterolateral thigh
• HPV: 0.5mL, IM, Deltoid

Immunization for Health Care Workers

• Strongly recommended: Hepatitis B, Tetanus, Diphtheria, Pertussis, MMR.
• May be indicated: Yellow Fever, Varicella – Zoster Virus, Typhoid, Tuberculosis.

Diphtheria Toxoid Adult Vaccine

• Reinforcing dose(s) give(s) lifelong protection.
• Indications: Wound/burn > 6 hours before treatment, significant devitalized tissue, puncture, soil/manure contamination, sepsis.

Yellow Fever Indications

• Protect endemic/epidemic populations.
• Protect travelers.
• Prevent international spread.
• One dose provides lifelong immunity.

COVID 19 Vaccines

• Types: Inactivated/weakened virus, protein-based, viral vector vaccines, RNA and DNA.