2009 IMMUNIZATION SMALL POX VACCINE WAS THE FIRST VACCINE TO BE APPLIED IN THE 15th CENTURY, OTHER VACCINES WERE THEN DEVELOPED. IT WAS ANNOUCED FIRST

2009

IMMUNIZATION

SMALL POX VACCINE WAS THE FIRST VACCINE TO BE APPLIED IN THE 15th CENTURY, OTHER VACCINES WERE THEN DEVELOPED. IT WAS ANNOUCED FIRST TIME IN THE OTTOMAN EMPIRE IN 1721 THAT A VACCINE WAS USED BY LADY MONTAGUE,WIFE OF THE BRITISH CONSULATE GENERAL AT THAT TIME. IT WAS EDWARD JENNER, WHO ESTABLISHED THE BASICS OF VACCINATION IN SCIENTIFIC TERMS

1811- STARTED BY SANİZADE ABDULLAH EFENDİ

1847- İSMAİL PAŞA RENEWED THE VACCINE AND FOUNDED AN INSTITUTE.

1887- ZOEROS PAŞA ESTABLISHED THE FIRST RABIES VACCINE FOUNDATION.

1900- SMALL POX, SCARLET FEVER AND DIPHTHERIA VACCINES WERE PREPARED AT ETFAL (CHILDREN’S) HOSPITAL.

1916-1917- BACTERIOLOGY LABORATORIES WERE FOUNDED IN IZMIR,SIVAS AND DAMASCUS, SEVERAL VACCINES WERE PREPARED. AFTER FOUNDATION OF TURKISH REPUBLIC, ANKARA CENTRAL HEALTH PROTECTION INSTITUE (HIFZISHHA ENSTİTÜSÜ) HAS PROVIDED VACCINES AND ANTISERUMS NEEDED.

IMMUNIZATION

ACTIVE IMMUNIZATION INVOLVES ADMINISTRATION OF ALL OR PART OF A MICROORGANISM OR A MODIFIED PRODUCT OF THAT MICROORGANISM TO EVOKE AN IMMUNOLOGIC RESPONSE

WITH ACTIVE IMMUNIZATION, A PERSON IS STIMULATED TO DEVELOP IMMUNOLOGIC DEFENSES AGAINST FUTURE NATURAL EXPOSURE.

PASSIVE IMMUNIZATION ENTAILS ADMINISTRATION OF PREFORMED ANTIBODY TO A RECIPIENT

WITH PASSIVE IMMUNIZATION, A PERSON ALREADY EXPOSED OR ABOUT TO BE EXPOSED, TO CERTAIN INFECTIOUS AGENTS IS GIVEN PREFORMED HUMAN OR ANIMAL ANTIBODY.

THE GLOBAL ERADICATION OF SOME DISEASES IS ACHIEVED BY COMBINING AN EFFECTIVE IMMUNIZATION PROGRAM.

IN MOST DEVELOPING COUNTRIES INFECTIOUS DISEASES REMAIN AS A MAJOR PROBLEM, BECAUSE OF INAPPROPRIATE IMMUNIZATION.

VACCINES INCORPORATING AN INTACT INFECTIOUS AGENT

• LIVE – ATTENUATED (VEAKENED)

• KILLED (INACTIVATED OR DETOXIFED AGENTS)

LIVE ATTENUATED VACCINES (LAV)

• PRODUCED A COMPLEX IMMUNOLOGIC RESPONSE SIMULATING NATURAL INFECTION

• GENERALLY IMMUNITY INDUCED BY ONE DOSE OF LAV IS LONG – LASTING POSSIBLY LIFE LONG

• INDUCTION OF IMMUNITY BY LAV CAN BE INHIBITED BY PASSIVE ANTIBODY (FROM MOTHER’S OR RECCIPT OF IVIG)

INACTIVED OR PURIFIED ANTIGEN VACCINE

• INDUCE RESPONSE ONLY TO THOSE COMPONENTS PRESENT IN THE VACCINE

• GENERALY MULTIBLE DOSES (THREE OR MORE) ARE NECESSARY

NATURE OF RESPONSE

• DEPENDS ON ANTIGEN TYPE

• PROTEIN (AND GLYCOPROTEIN) ANTIGENS USUALLY INDUCE BOTH HUMORAL AND CELLULER IMMUNİTY

• POLY SACCHARIDE ANTIGEN7S INDUCE ONLY HUMORAL ANTİBODY WİTHOUT T LYMPHOCYTE STİMULATİON

• BY CONJUGATION OF POLYO ACCHARIDES TO PROTEIN CARRIERS TO INDUCE STRONGER IMMUN RESPONSE IN YOUNGER CHİLDREN

IMMUN RESPONSE TO ACTIVE IMMUNIZATION

ANTIGEN↓

ANTIGEN PROCESING AND ANTIGEN – PRESENTING CELLS (DENDRITIC CELLS

OR MACROPHAGES)↓

INTERACTION OF LYMPHOCTES↓

T LYMPHOCYTES RESPONSE ↓ ↓

Th1 Th2↓

Assist B cells ın antibody production↓

İmmune response

AFTER VACCINATION IT TAKES SOME TIME UNTIL IMMUNIZATION IS ESTABLISHED

IN THE FIRST TWO WEEKS, FIRST IgM THAN IgG ANTIBODIES ARE MADE

ACCORDING TO THEIR HALF LIVES ANTIBODIES ARE MADE CONTINUOUSLY

IF THE SAME ANTIGEN GETS INTO THE BODY BEFORE DISAPEARANCE OF THE ANTIBODIES, A SMALL AMOUNT OF IgM, BUT A LARGE AMOUNT OF IgG ANTIBODIES ARE MADE

AFTER EACH ANTIGENIC STIMULUS, ANTIBODIES OF IgG CLASS ARE MADE IN LARGE AMOUNTS AND THE PATIENT CAN BE PREVENTED FROM THAT DISEASE

ANTIBODIES PRODUCED IN RESPONSE TOIMMUNIZATION

1) DIRECT MEUTRALIZATION OF TOXIN

2) OPSONIZATION OF ORGANISM BY COMPLEMENT PATHWAY

3) LYSİS SORGANISM OR PROMOTE PHAGOCYTOSIS

4) REACTION WITH NONSENSITIZED LYMPHOCYTES TO PROMOTE PHAGOCYTOSIS

5) SENSITIZATION OF MACROPHOGES TO PROMOTE PHAGOCYTOSIS

THOSE SHOULD BE BORN IN MIND TO ACHIEVE AN EFFECTIVE AND PROTECTIVE VACCINATION:

1. RESPONSE EVOKED BY THE VACCINE IS AFFECTED BY THE TYPE OF THE VACCINE, i.e. DEAD, WHOLE CELL VACCINES etc. AS WELL AS ANTIGENIC TYPE OF THE VACCINE, i.e. SINGLE ANTIGEN OF VIRUSES OR BACTERIA OR ANTIGEN COMPLEXES FORMING THE VACCINE.

2. IMMUNIGENICITY INCREASES AS THE SIZE OF THE ANTIGEN INCREASES. SOLUBLE PROTEINS ARE LESS ANTIGENIC COMPARED TO INSOLUBLE PROTEINS. ADJUVANTS CAN BE

ATTACHED TO SOLUBLE PROTEINS TO MAKE THEM LESS SOLUBLE AND MORE ANTIGENIC.

3. IMMUNOLOGICAL RESPONSE OF THE HOST IS IMPORTANT IN THE EFFECTIVENESS OF THE VACCINE. STARTING FROM THE NEONATAL PERIOD, IMMUNE REACTION IS POSSIBLE. BUT, PASSIVELY ACQUIRED ANTIBODIES CAN INHIBIT SUCH IMMUNOLOGICAL RESPONSES.

THESE PASSIVELY ACQUIRED ANTIBODIES MAY BE PROVIDED TO THE NEONATE:

- THROUGH TRANSFER OF MATERNAL IgG THROUGH PLACENTA, - INFUSION OF SERUM IMMUNOGLOBULINS, SOME PASSIVELY ACQUIRED ANTIBODIES CAN PROVIDE PROTECTION, NEVERTHELESS MAY INTERFERE WITH ACTIVE IMMUNIZATION WITH VIRUS VACCINES INHIBITING ANTIBODY PROTECTION. THIS IS NOT THE CASE FOR THE DEAD VACCINES; DTP MAY BE STARTED AT 2rd OR 3th MONTHS.

SEVERAL IMPLICATIONS TO BE CAREFUL ABOUT

- VACCINES SHOULD BE STORED AND

TRANSPORTED IN APPROPRIATE CONDITIONS

- VACCINES SHOULD BE APPLIED THROUGH

APPROPRIATE ROUTE, i.e. SC, ID OR IM.

- BOOSTER DOSES SHOULD BE APPLIED TO

PROVIDE ADEQUATE RESPONSE

PLEASE NOTE THAT:

1. NOT ONLY THE INGREDIENTS CONTAINED IN THE VACCINE, BUT ALSO THE IMMUNE RESPONSE

OF THE PATIENT CAN INFLUENCE THE EFFECT OF THE VACCINE.

2. IMMUNIZATION CAN BE EVOKED ONLY AFTER A PERIOD OF TIME.

3. GENERALLY, BOOSTER DOSES ARE NEEDED IN ORDER TO MAINTAIN AN EFFECTIVE AND LONG LASTING IMMUNIZATION.

4. IF RABIES AND MEASLES VACCINES ARE DONE AT THE INCUBATION PERIOD OF THE DISEASE, THEY CAN PREVENT THE PATIENT FROM GETTING THESE INFECTIONS.

- PROLONGATION OF BOOSTER INTERVALS DOES NOT

WEAKEN THE RESPONSE, ON THE CONTRARY EARLY

BOOSTER DOSES MAY INTERFERE WITH THE ADEQUATE

RESPONSE.

- MANY VACCINES CAN BE APPLIED SIMULTANOUSLY; e.g.

DTP, OPV AND MMR; HIB AND HBV. THESE ALL PROVOKE

ADEQUATE ANTIBODY PRODUCTION.

- TWO LIVE VIRUS VACCINES SHOULD BE APPLIED WITH

AT LEAST 30 DAY INTERVAL, OTHERWISE IMMUNE

RESPONSE MAY BE INADEQUATE.

- LIVE VIRUS VACCINES CAN BE APPLIED TO PATIENTS ON IMMNUNOGLOBULIN TREATMENT THREE MONTHS AFTER CESSATION OF THE TREATMENT.

- IMMUNOGLOBULINS CAN BE GIVEN AT LEAST THREE WEEKS AFTER THE VACCINATION.

- SUCKLING DOES NOT AFFECT VACCINATION.

- DIFFERENT BRANDS UNDER DIFFERENT FIRM NAMES CAN BE USED IN ROUTINE VACCINATION; e.g. DT, PER ( WHOLE CELL), OPV,IPV, HAV, HBV, RABIES, HIB.

- DOSE REDUCTION IS NOT DONE FOR PREMATURES.

- HBV VACCINE CAN BE APPLIED TO PATIENTS WEIGHTING MORE THAN 2000 g.

- VACCINATION IS NOT APPLIED IN IMMUNE DEFICIENCY STATES. IN CONGENITAL OR ACQUIRED IMMUNE DEFICIENCY STATES, LIVE ATTENUATED VACCINES AND BACTERIAL VACCINES MAY EVOKE SEVERE SIDE EFFECTS. LIVE VACCINES SHOULD NOT BE APPLIED TO THESE PATIENTS.

- VACCINATION SHOULD BE STARTED AFTER THREE MONTHS OF CHEMOTHERAPY, RADIOTHERAPY OR STEROID TREATMENT. BEFORE THIS PERIOD, IMMUNE RESPONSE DOES NOT OCCUR.

CONTENTS OF VACCINES

1. BASIC ANTIGENS CONSIST OF WHOLE BACTERIA OR VIRUSES OR ALL STRUCTURAL ELEMENTS PERTAINING TO THEM.

2. ANTIGENS THAT THE HOST PRODUCES ARE HOST PROTEINS OR PROTEIN DERIVATIVES CARRIED ALONGSIDE WITH THE VIRAL PARTICLES.

3. TRANSFORMED ANTIGENS ARE THE PROTEINS OR PROTEIN DERIVATIVES DENATURED AT THE PLACE OF VIRAL INFECTION

OR REPRODUCTION

4. ANTIBIOTICS ADDED DURING PRODUCTION OF THE VACCINES IN THE MEDIUM.

5. UNKNOWN AND/OR UNWANTED VIRAL OR BACTERIAL PRODUCTS

6. SUSPENSION FLUID: STERILE WATER OR SALINE ( INCLUDES SERUM PROTEINS, EGG ANTIGENS, TISSUE CULTURE

ANTIGENS)

7. STABILIZING PRESERVATIVES; i.e. MERCURY PRODUCTS INHIBITING OTHER BACTERIA FROM GROWTH OR STABILIZING ANTIGENS.

8. ADJUVANTS; i.e. ALIMINUM SALTS PROVOKING HOST RESPONSE BY THE INACTIVATED MICROORGANISMS; e.g. ALIMINUM PHOSPHATES, ALIMINUM HYDROXIDES).

VACCINE TRANSPORT AND STORAGE CONDITIONS CAN CONTRIBUTE TO VACCINE FAILURE. VACCINES SHOULD BE KEPT IN REFRIGERATORS OR FREEZERS ACCORDING TO THE STORAGE RECOMMENDATIONS.

VACCINES SENSITIVE TO INCREASED TEMPERATURE:OPV, MEASLES, VARICELLA, YELLOW FEVER

VACCINES SENSITIVE TO FREEZING:DIPHTHERIA, TETANUS TOXOIDS, PERTUSIS VACCINES, IPV, HiB CONJUGATE, INFLUENZA VACCINES, HEPATITIS A AND B THE STORAGE TEMPERATURE FOR OPV IS 0-4C (FOR OTHER VACCINES :2-8 C). POLIO VACCINE CAN BE FREEZED AND DEFREEZED REPEATEDLY.

DISCARD OPENED MMR VACCINE AFTER 8 HOURS. TOXOID VACCINES CAN BE STORED AT THE REFRIGERATOR FOR 4-5 DAYS.

THE USE OF VACCINES

1. PEOPLE TO DO VACCINATION HAS TO BE FULLY VACCINATED, INORDER TO NOT TO SPREAD THE DISEASE.

2. BEFORE THE VACCINATION HANDS MUST BE WASHED.

3. THE ENJECTORS MUST BE DISPOSIBLE.

4. DIFFERENT SORT OF VACCINES SHOULD NOT BE PLACED IN THE SAME ENJECTOR TO BE USED AT THE SAME TIME.

5. THE VACCINES SHOULD BE APPLIED TO THE SUGGESTED

AREAS. THE ADJUVANT VACCINES ARE TO BE APPLIED IM.

PREFERABLY ON THE ANTEROLATERAL PART OF THE

M.DELTOIDEUS, WITH 2,2-2,5 CM OF ENJECTOR NEEDLE OF AN

22-25 G ENJECTOR. SUBCUTENOUS ENJECTIONS 1,6-1,9 CM

NEEDLE WITH 23-25 G ENJECTOR SHOULD BE USED. THE

INTRADERMAL ENJECTIONS MUST BE APPLIED TO THE VOLAR

FACE OF THE FORE ARM, WITH THE TIP OF THE ENJECTOR

FACING UPWARDS. FOR INTRADERMAL ENJECTIONS 0,95-1 CM

NEEDLE, 25-27 G ENJECTOR SHOULD BE USED. THERE MUST BE

A SMALL HEAP AT THE PLACE OF INTRADERMAL INJECTION. IF

NOT DONE INTRADERMALLY BUT SC, THERE WON’T BE

ANTIBODY REACTION. AFTER SC/ID ENJECTION, LOCAL

IRRITATION, ENDURATION, COLOUR DIFFERENCE,

INFLAMMATION AND GRANULAMATOUS REACTION AT THE SITE

OF INJECTION ON THE SKIN SURFACE CAN BE SEEN.

EXTENDED IMMUNIZATION PROGRAM 2010

A-VACCINATION SCHEDULE:

1- UNDER THE AGE OF 1 YEAR OLD (0-11 MONTHS): NEWBORN HBV-1

AT THE FIRST MONTHS HBV-2

AT THE END OF 2nd MONTHS (8 WEEKS OLD) BCG DaPT-IPV-Hib1

CPV1

AT THE END OF 4th MONTHS (16 WEEKS OLD) DaPT-IPV-Hib2

CPV2

AT THE 6 MONTHS DaPT-IPV-Hib3

CPV3OPVHBV3

AT THE 12 MONTHS MMR1 + CPV4

EXTENDED IMMUNIZATION PROGRAM 2010

2- BOOSTER DOSES

( 18-24 MONTHS OLD) DaPT-IPV-Hib4+ OPV+CPV

SCHOOL TIME VACCINATIONS

3- FIRST YEAR OF PRIMARY SCHOOL KKK2 + DaBT-IPA

4- AT THE 8th PRIMARY SCHOOL dT*

*dT: ADULT TYPE OF DIPHTHERIA- TETANUS (TETANUS) IS APPLIED

A. AŞI TAKVİMİ: (SAĞLIK BAKANLIĞI 2010)

Doğumda 1. Ayın

sonu2. Ayın sonu

4. Ayın sonu

6. Ayın sonu

12. Ay 18-24 ay İlköğretim 1. sınıf

İlköğretim 8. sınıf

Hepatit B I II III

BCG I

DaBT-İPV-Hib

I II III R

KKK I R

DaBT-IPV R

OPV I II(R)

CPV I II III R

12 -18 ay

Td II(R)

Hep B: Hepatit B aşısı

BCG: Bacille Calmette – Guerin aşısı

DaBT-İPA-Hib: Difteri, aselüler boğmaca, Tetanoz, İnaktif Polio, Hemofilus influenza tip B aşısı (Beşli Karma aşı)

KKK: Kızamık, Kızamıkçık, Kabakulak aşısı

OPV: Oral Polio aşısı

Td: Erişkin Tipi Difteri – Tetanoz aşısı

R: Rapel (Pekiştirme)

UNDER 6 YEARS OLD AND NOT VACCINATED

1ST VISIT: DTaP-IPV-Hib,HBV, CPA(IF OLDER THAN 5 YRS OF AGE MAY NOT BE DONE), PPD TEST MAY ALSO BE DONE FOR BCG.

2 DAYS AFTER THE 1ST VISIT: MMR, PPD İS NEGATİVE BCG.

1 MONTHS AFTER THE 1ST VISIT: DTaP-IPV-Hib,HBV, CPA

2 MONTHS AFTER THE 1ST VISIT: DTaP, IPV, Hib

8 MONTHS AFTER THE 1ST VISIT: DTaP-IPV, HBV, OPV

4-6 YEARS: DTaP-IPV, MMR.

11-12 YEARS: Td.

CHILDREN 6 – 12 YEARS WHICH HAVEN’T BEEN VACCINATED

1ST VISIT: DTaP-IPV,HBV, MMR

1 MONTHS AFTER 1ST VISIT: DTaP-IPV,HBV, MMR, OPV

8 MONTHS AFTER 1ST VISIT: DTaP-IPV, OPV, HBV

11-12 YEARS: Td.

TBC VACCINE (1)

* BCG IS A LIVE ATTENUATED VACCINE.

* 5 YEAR PROTECTION RATE AFTER VACCINATION IS 0-80%. AFTER 5 YEARS ITS PROTECTIVE COVER DECLINES.

* THE VACCINES PROTECTIVE DURATION SHOULD BE OVER WATCHED BY PPD CONTROLS.

* THE VACCINE IS APPLIED INTRADERMALLY.

* IT IS APPLIED SINCE NEWBORN.

* IN TURKEİ IT IS APPLIED BEYOND 2 MONTHS AF AGE.

FOR GLOBAL ADMINISTRATION OF BCG VACCINE(2) 1. THE ANNUAL RATE FOR RISK OF INFECTION SHOULD BE

OVER 1/10000.

2. IF THE INCIDENCE OF TBC BACTERIA POSITIVE CASES ARE OVER 5/100000 IN THE LAST 3 YEARS.

3. IF THE INCIDENCE OF THE CASES WITH ACTIVE TBC ISN’T UNDER 10% IN THE LAST DECADE.

4. IF THE TBC MENINGITIS OF THE CHILDHOOD IS OVER THE 1/10000000 OF THE GENERAL POPULATION, VACCINATION SHOULD BE APPLIED.

ALTHOUGH THERE MAY BE TBC MENINGITIS OR MILIER TBCAMONG VACCINATED PEOPLE AND BECAUSE THERE AREN’TTERMS TO PREVENT THE GLOBAL VACCINATION IN TURKEİ,BCG VACCINATION SHOULD BE APPLIED.

TBC VACCINE (3)

* THE VACCINE IS APPLIED TO THE LEFT SHOULDER 0,1 cc ID ON THE 2ND MONTH OF LIFE.

TBC VACCINE (4)

* IF THE VACCINATION IS APPLIED BY THE RIGHT METHODS, A 6-8 mm PAPUL WILL FORM ON THE SKIN SURFACE AND WILL VANISH IN 15 mins. AFTER A MONTH IT WILL HEAL LIVING A SCAR MARK BEHIND.

* THERE MUSN’T BE AN APPLICATION OF IODINE SOLUTION OR BANDAGE ON THE SITE OF ENJECTION.

SIDE EFFECTS

- ULSERATION AT THE SITE OF ENJECTION.- LYMPHADENITIS.- OSTEOMYELITIS.

ORAL POLIO VACCINE (OPV)- (2)

* IT’S LIVE ATTENUATED SABIN VACCINE

* ORAL POLIO VACCINE IS PREFERED BECAUSE OF ITS’ CHEAP COST, INFEST THE PEOPLE USING SAME TOILETS AND PREVENTING INTESTINAL INFECTIONS, FROM 1964.

* THE VACCINES USE IS PROOVED BY, REPORTATION OF 1 NATURAL PARALYTIC POLIO CASE AND POLIO SEEN AS ENFECTION BUT NOT AS VACCINE COMPLICATION IN THE COUNTRIES WHERE THE PARALYTIC POLIO HAS BEEN ERADICATED.

* THE VACCINE PROVIDES LOKAL IGA AND SYSTEMIC IGG TYPE ANTIBODIES.

IN TURKEİIPV + OPV

IS USED AFTER 2ND month DaPT-IPV-Hib1 AFTER 4ND month DaPT-IPV-Hib2 AFTER 6ND month DaPT-IPV-Hib3+OPV

BOOSTER DOSE AT 18-24ND month DaPT-IPV-Hib4 + OPV

SIDE EFFECTS OF THE VACCINE

OPV* PARALYTIC POLIO IN EVERY 1/10,000,000 DOSES.

* THE VACCINE SHOULD BE AVOIDED IN PREGNANCY AND IMMUNCOMPROMIZED.

AFTER VACCINATION, THE BABY SHOULDN’T BE FED AND NO CHLORINATED WATER SHOULD BE DRANK.

IPV• HYPERSENSITIVITY TO STREPTOMISIN, NEOMYCIN, POLYMYXIN B.

TETANOUS VACCINE(1)

* IS A TOXOID VACCINE.

* TETANOUS MICRO ORGANISM IS NATURALLY FOUND IN HORSE, COW AND EVEN HUMAN FEACES. THE MIKRO ORGANISM MAY MAINTAIN SURVIVAL IN THE CONTAMINATED SOIL FOR YEARS. THE DISEASE IS MORE LIKELY IN THE AGRICULTURAL AREAS THAN HIGHLANDS. THE SPREAD FROM HUMAN TO HUMAN IS UNLIKELY. IT IS SPREAD BY CONTAMINATED WOUNDS SUCH AS THE CAUSES OF TRAFIC ACCIDENTS OR CRUSH WOUNDS.

* IN TURKEİ THE TETANOUS VACCINE CAN BE PROVIDED AS DaPT VACCINE.

TETANOUS VACCINE(2)

IN TURKEİ THE VACCİNE IS APPLIED

2ND month of age DaPT-IPV-Hib14ND month of age DaPT-IPV-Hib26ND month of age DaPT-IPV-Hib3

BOOSTER DOSE I- 18-24ND month of age DaPT-IPV-Hib

II- WHILE ATTENDING TO THE DaPT-IPV PRIMARY SCHOOL 1

III- WHILE ATTENDING TO THE dT PRIMARY SCHOOL 8

TETANOUS VACCINE (3)

IN INJURIES IS DEEP AND 5 YEARS OF TIME 1 DOSE OF CONTAMINATED VACCINATED HAD PASSED VACCINE

IF THE WOUND NEVER MORE THAN 5 1 DOSE OFIS DEEP AND VACCINATED YEARS OF TIME VAC.+TIGCONTAMINATED HAD PASSED OR ATS

TETANOUS VACCINE (4)

FOR NEONATAL TETANOUS

FOR THE PREGNANT MOTHER: ALTHOUGH EVEN ONE DOSE IS ENOUGH 3 DOSES ONE AFTER THE OTHER AT ONE MONTH GAP SHOULD BE APPLIED DURING THE 2ND AND 3RD TRIMESTER. SHOULD BE REPEATED AT THE NEXT PREGNANCY.

VACCINE REACTION: ERITEMATOUS REACTION, ENDURATION, SENSITIVITY, RARELY GENERALIZED URTICERIAL RASH, ANAPHYLACTIC REACTIONS AND NEUROPATHY HAS BEEN REPORTED.

DIPHTERIA VACCINE (1)

* IS A TOXOID VACCINE

* SINCE GLOBAL VACCINATION, NO CASES HAVE BEEN REPORTED

IN TURKEİ.

* IT IS APPLIED AS DaPT VACCINE IN TURKEİ.

* IT HAS NO DIRECT PROTECTION ( THE IMMUNIZED PEOPLE

WOULD SUFFER THE DISEASE BUT IN A MILDER FORM.

IMMUNIZATION DOESN’T PREVENT FROM BEING A CARRIER).

* PROTECTION ACCORDS TO THE DOSAGE; 3 DOSES PROTECTS

74,4 %, 4 DOSES PROVIDES A PROTECTION OF 84 %.

DIPHTERIA VACCINE (2)

IN TURKEİ THE VACCİNE IS APPLIED


BOOSTER DOSE I- 18-24ND month of age DaPT-IPV-Hib

II- WHILE ATTENDİNG TO THE DaPT-IPV PRIMARY SCHOOL 1

III- WHILE ATTENDİNG TO THE dT PRIMARY SCHOOL 8

SIDE EFFECTS:

* MILD FEVER.* LOCAL SWELLING AT THE SITE OF ENJECTION.

PERTUSIS VACCINE (1)

* IS A KILLED WHOLE CELL VACCINE. IT IS APPLIED AS MIXT VACCINATION AS DTP.

* IT IS RAISED IN BACTERIAL CULTURE, SANTRIFUGED, KILLED BY SALTY WATER, DETOXIFIED BY USING HEAT OR CHEMICALS THEN BINDED TO ALUMINIUM ADJUVANT BEFORE USED.

* IN TURKEİ ACELLULAR PERTUSIS VACCINE IS APPLEID


* ACELLULAR PERTUSIS VACCINE: THE VACCINE IS PREPEARED BY USING THE BACTERIAS’ AS ANTIGENIC MATERIALS SUCH AS PT, FHA, PERTACTIN. ITS’ PROTECTION IS FINE AND HAS LESS SIDE EFFECTS.


IN TURKEİ THE VACCINE IS APPLIED


BOOSTER DOSE

I- 18-24ND month of age DaPT-IPV-Hib

II- WHILE ATTENDING TO THE DaPT-IPV PRIMARY SCHOOL 1

III- WHILE ATTENDING TO THE dT PRIMARY SCHOOL 8


* SIDE EFFECTS: THE WHOLE CELL VACCINES CONTAIN MANY

TYPES OF TOXIC MATERIALS; THEREFORE REACTIONS

ACCORDING TO THE VACCINE OCCURS. THE SIMILAR

REACTIONS ARE SEEN IN ACELLULAR VACCINES BUT IN MILDER

FORM. LOCAL ERYTHEMA, SWELLING, SENSITIVITY, SYSTEMIC

REACTIONS AS: FEVER OVER 38C, FATIGUE, IRRITABILITY,

CRYING MORE THAN 3 HOURS, HYPOTONIA, HYPOREFLEXIA,

CONVULSIONS. THERE IS NO DIRECT EVIDENCE SHOWN IN

SUDDEN INFANT DEATH.


CAUTIONS WHILE APPLYING PERTUSIS VACCINE

ANAFYLACTIC REACTİON, ENCEPHALOPATY. (CI)

* FEVER OCCURING IN 48 HOURS ( FEVER OVER 40C, COLLAPS,

SHOCK LIKE CLINIC), AFTER INJECTION.

* CRYING EPISODES LASTING MORE THAN 3 HOURS

* FEBRIL OR NON FEBRIL CONVULSIONS SEEN IN THE FIRST 3

DAYS OF ENJECTION.

IN THE FUTURE VACCINATIONS THE OUTCOME OF THE

VACCINATION HAS TO EVALUATED FOR CONTINUATION.

(IF EPIDEMY, DTAB MAY BE USED)

MEASLES VACCINE(1)

* FIRST VACCINE EVER DISCOVERED WAS EDMONSTON B VACCINE.

* THE VACCINE HAS SIDE EFFECTS AS FEVER AND RASH.

* SCHWARZ TYPE WAS LICENCED IN 1965, MOROTEN TYPE WAS IN 1968.

* SCHWARZ TYPE IS USED IN TURKEİ.

* IT IS A HYPER ATTENUATED VACCINE PREPEARED FROM HEN EMBRYO.

* THE VACCINE IS DILUTED BY DISTILATED WATER.

* AFTER DILUTION THE VACCINE IS CLEAR YELLOWISH IN COLOUR.

* THE VACCINE PROTECTION IS AROUND 90-95%.

* IN DEVELOPING COUNTRIES, THE VACCINATION START AT THE AGE OF 9 MONTHS.

MEASLES VACCINE (2)

IN TURKEİ THE VACCINE IS APPLIED AS:

* AT 12 MONTH OF AGE (MMR): 1ST DOSE SC

* AT PRIMARY SCHOOL 8 : 2RD DOSE SC

MEASLES VACCINE (3)

SIDE EFFECTS:

1. COUGH, FEVER.

2. RASH ON 7-14 TH DAYS.

3. RARELY GUILLIAN BARRE SYNDROME, REYE SYNDROME,

OCULOMOTOR PALSY, OPTIK NEUROPATHY, CEREBELLAR

ATAXIA LIKE NEUROLOGICAL COMPLICATIONS.

4. ARTHRALGY, TROMBOCYTOPENY.

5. THE VACCINATION HAS REDUCED THE SSPE INCIDENCE

MEASLES VACCINE (4)

SIDE EFFECTS:

* THE PREGNANT AND IMMUN COMPROMISED PEOPLE SHOULD

BE

AVOIDED FROM VACCINATION.

* PEOPLE ATOPIC AGAINST EGG SHOULD NOT BE VACCINATED.

* REVACCINATION SHOULD BE CONSIDERED IN PATIENTS WHO

HAVE RECEIVED IVIG OR BLOOD PRODUCTS.

* IVIG SHOULD BE GIVEN 2 WEEKS AFTER THE VACCINATION AT

THE EARLIEST.

MUMPS VACCINE (1)

* MUMPS OCCUR 30% AS A SILENT INFECTION, HOWEVER AS

20% RATE, ORCHITIS, MENINGITIS, ENCEPHALITIS AND

RARELY DEAFNESS IS SEEN.

* IT IS A LIVE ATTENUATED VACCINE. IT CAN BE USED AS

SINGLE VACCINE OR AS MMR.

* IT IS REPEATED AT PRIMARY SCHOOL 8 AND HAS A PROTECTION

RATE OF 95 %.

* IT IS APPLIED SC. SHOULD BE STORED AWAY FROM LIGHT AT

THE TEMPERATURE OF 2-8C.

SIDE EFFECTS:

MILD RASH, URTICERIA, SENSITIVITY AT THE SITE OF ENFECTION

CAUSED BY ITCHING.

MUMPS VACCINE (2)

IN TURKEİ

at 12 month of age MMR 1st dose SC

at primary school 8 1st dose SC

RUBELLA VACCINE (1)

* IS A LIVE ATTENUATED VACCINE.

* IT IS USED AS RUBELLA, MR, MMR.

* THE VACCINE MAY BE USED TO EVERYONE AFTER THE AGE OF 12 MONTHS.

* MAY BE APPLIED TO EVERY YOUNG GIRL AND WOMAN WHO GUARANTEE NOT TO GET PREGNANT FOR 3 MONTHS AFTER THE VACCINATION.

RUBELLA VACCINE (2)

IN TURKEİ

* THE VACCINE IS APPLIED AT THE AGE OF 12 MONTHS.

* IT IS REPEATED AT PRIMARY SCHOOL 8

RUBELLA VACCINE (3)

SIDE EFFECTS

*ARTHRITIS, ARTRALGIA.

* RASH.

*POLYNEUROPATHY.

THE VACCINE SHOULD BE AVOIDED FROM THE IMMUNCOMPRAMISED, PREGNANT WOMEN AND PEOPLE SENSITIVE TO NEOMYCINE.

HEPATITIS B VIRUS VACCINE (1)

FULMINATING HEPATIC DISEASE CHRONIC HEPATITISCIRRHOSISHEPATOCELLULAR CARSINOMACHRONIC HEPATITIS B CARRIER STATE

HEPATITIS B VIRUS VACCINE

1. PLASMA DERIVED VACCINE: INDUCES ANTIBODY RESPONSE IN % 90-94 OF CHILDREN

2. RECOMBINANT VACCINE: INDUCES ANTIBODY RESPONSE IN % 98-100 OF CHILDREN


NEWBORN BABIES AND PERSONS OF ALL AGES CAN RECEIVE THE VACCINE. (IM OR sc)

IN NEWBORN BABIES, TODDLERS AND CHILDREN, THE ANTEROLALERAL ASPECT OF THE THIGH IS THE PREFERRED SITE. FOR THE PARENTS, DELTOID MUSCLE IS USED.

SCHEDULING0. MONTH 1.DOSE 0.5 ML1. MONTH 2. DOSE 0.5 ML6. MONTH 3. DOSE 0.5 ML

HEPATITIS B VIRUS VACCINE (3) IN CASE OF VERTICAL TRANSMISSION; AT THE NEWBORN PERIOD 0.5 ML VACCINE +Hepatit B IVIG

AT THE 1 – 2 MONTH 0.5 ML VACCINE

AT THE 6 MONTH 0.5 ML VACCINE

AT THE 12. MONTH 0.5 ML VACCINE


• NO NEED FOR SEROLOGIC INVESTIGATION BEFORE VACCINATION FOR NEONATAL PERIOD ONLY.

• VACCINATION OF PRETERM INFANTS SHOULD BE DELAYED TILL THE INFANT WEIGHS 2 KG OR MORE

• SIX MONTHS AFTER THE THIRD VACCINE, ANTI-HBs TITERS SHOULD BE CHECKED

• THREE DOSES OF VACCINE ARE EFFECTIVE AND THERE IS NO NEED FOR EXTRA BOOSTER DOSES

SIDE EFFECTS:

PAIN, SWELLING, REDNESS, HEADACHE, FATIGUE

HAEMOPHILUS B CONJUGATE VACCINE (HiB CONJUGATE)

HAEMOPHILUS B IS THE MAJOR COUSE OF MENINGITIS INCHILDREN YOUNGER THAN FIVE YEARS OLD.

MENINGITIS, EPIGLOTTITIS, PNEUMONIA, SEPTIC ARTHRITIS,CELLULITIS, SEPSIS AND OTHER INVASIVE INFECTIONS AREMOST COMMON IN CHILDREN 3 MONTHS TO 3 YEARS OF AGE.

CHILDREN AT RISK:

CHILDREN AT DAY CARE CENTERSCHILDREN 3 MONTHS TO 2 YEARS OF AGECHILDREN WITH: ASPLENIA, SICKLE CELL DISEASE,HODGKIN AND HYPOGAMMAGLOBULINEMIA

H. INFLUENZA VACCINES:

1. POLYSACCHARIDE VACCINES: POLYRIBOSYL RIBITOL PHOSPHATE (PRP)

2. CONJUGATE VACCINES ( TETANUS TOXOID PRP-T) THE OUTER MEMRANE OF N. MENINGITIDIS PRP-OMP OR CRM 197 IS ATTACHED TO THE MUTANT TOXIN OF C. DIPTHERIA (HBOC).

* PRP-T AND PRP-OMP VACCINES ARE AVAILABLE IN OUR COUNTRY.

IN TURKEİ

IS USED AFTER 2ND month DaPT-IPV-Hib1 AFTER 4ND month DaPT-IPV-Hib2 AFTER 6ND month DaPT-IPV-Hib3

BOOSTER DOSE AT 18-24ND month DaPT-IPV-Hib4

HAEMOPHILUS B CONJUGATE VACCINE (HiB CONJUGATE)

IF A NEW BORN BABY IS IN A HIGH RISK GROUP, THE FIRST DOSE SHOULD BE A PRP-OMP VACCINE ( BECAUSE OF BETTER ANTIBODY RESPONSE), THE CONSECUTIVE DOSES SHOULD BE DONE WITH PRP-T VACCINE. EVEN CHILDREN WHO ARE YOUNGER THAN 5 YEARS OLD AND ALREADY HAVE HAD THE DISEASE SHOULD BE VACCINATED.

SIDE EFFECTS:

POLISACCHARIDE VACCINES HAVE ONLY A FEW SIDE EFFECTS. 5 % LOCAL REACTIONS (SWELLING, REDNESS), 5-10 % FEVER CAN BE SEEN. OCCASIONALLY, SEAZURES, TROMBOCYTOPENIA AND GUILLAN-BARRE DISEASE IS REPORTED.

PNEUMOCOCCAL VACCINE

PNEUMOCOCCUS COUSING MOST OF THE INFECTIONS IN

CHILDHOOD ARE:

TYPE: 1, 3, 4, 6, 7, 8, 9, 12, 14, 18, 19, 23

PNEUMOCOCCAL VACCINES:

1. THE 23-VALENT PNEUMOCOCCAL VACCINE IS COMPOSED

OF PURIFIED CAPSULAR POLYSACCHARIDE ANTIGENS OF 23

PNEUMOCOCCAL SEROTYPES. IT IS GIVEN SUBCUTANEOUSLY

OR INTRAMUSCULARLY.


2. MULTIVALENT PROTEIN CONJUGATE VACCINES ARE CURRENTLY UNDER EVALUATION IN FIELD TRIALS.

PNEUMOVAX- 14 VALANT( TYPE 1, 2, 3, 4, 6A, 7F, 8, 9N, 12F, 14, 18C, 19F, 23F, 25)

PNEUMOVAX- 23 VALANT( TYPE 1, 2, 3, 4, 5, 6A, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C,19A, 19F, 20, 22F, 23F, 33)

PCV7 (Prevnar) (CPV)(TYPE 4, 6B, 9V, 14, 18C, 19F, 23F)

PCV10 (Synflorix)(TYPE 1, 4, 5, 6B, 7F, 9V,14,18C, 19F 23F)

PCV 13 VALANT TYPE 4, 6B, 9V, 14, 18C, 19F, 23F, 1, 5, 7F, 3, 6A, 19A


RECOMENDATIONS FOR IMMUNIZATION:*SICKLE CELL DISEASE

*FUNCTIONAL OR ANATOMIC ASPLENIA

*NEPHROTIC SYNDROME OR CHRONIC RENAL FAILURE

*CONDITIONS ASSOCIATED WITH IMMUNOSUPRESSION

*HIV INFECTION

*CHRONIC CARDIOVASCULAR DISEASE

*CHRONIC PULMONARY DISEASE

*CHRONIC LIVER DISEASE

***WHEN ELECTIVE SPLENECTOMY IS TO BE PERFORMED, PNEUMOCOCCAL VACCINE SHOULD BE GIVEN APPROXIMATELY 2 WEEKS OR MORE BEFORE THE OPERATION.

IN TURKEİ

2ND month CPV1 4ND month CPV2 6ND month CPV3

12ND month CPV4

ADVERSE REACTIONS:

MILD SIDE EFFECTS, SUCH AS ERYTHEMA AND PAIN AT

THE INJECTION SIDE ARE COMMON.

FEVER, MYALGIA AND SEVERE LOCAL REACTIONS ARE

UNCOMMON.

ANAPHYLAXIS HAS BEEN REPORTED RARELY ( 0.005 %)

A. AŞI TAKVİMİ: (SAĞLIK BAKANLIĞI 2010)

Doğumda 1. Ayın sonu

2. Ayın sonu

4. Ayın sonu

6. Ayın sonu

12. Ay 18-24 ay İlköğretim 1. sınıf

İlköğretim 8. sınıf

Hepatit B I II III

BCG I

DaBT-İPV-Hib

I II III R

KKK I R

DaBT-IPV R

OPV I II(R)

CPV I II III R

12 -18 ay

Td II(R)

Hep B: Hepatit B aşısı

BCG: Bacille Calmette – Guerin aşısı

DaBT-İPA-Hib: Difteri, aselüler boğmaca, Tetanoz, İnaktif Polio, Hemofilus influenza tip B aşısı (Beşli Karma aşı)

KKK: Kızamık, Kızamıkçık, Kabakulak aşısı

OPV: Oral Polio aşısı

Td: Erişkin Tipi Difteri – Tetanoz aşısı

R: Rapel (Pekiştirme)

Documents

2009 IMMUNIZATION SMALL POX VACCINE WAS THE FIRST VACCINE TO BE APPLIED IN THE 15th CENTURY, OTHER VACCINES WERE THEN DEVELOPED. IT WAS ANNOUCED FIRST