General

Vaccination in children (1)

Vaccination in children (1)

The microorganisms (bacteria and viruses) that make up the disease are rendered harmless and applied to the body to provide antibody production that will protect the disease is called vaccination.
Considering that approximately 12000 babies die every year due to vaccine-preventable diseases in our country, the importance of vaccination and follow-up of the vaccines that need to be repeated becomes more important.
Vaccines produce a cellular or humoral immune response by stimulating the immune system with the weak and / or dead microorganisms contained therein, or with their demineralized products. In such a way, a resistance is formed in the body against the disease before the disease occurs. It should be kept in mind that no vaccine (active immunization) can produce as effective an immune response as having acquired that disease (natural immunization).

1) Basic Principles of Vaccination:

• If the child is moderately or severely ill at the time of vaccination, vaccination is postponed.
• Infants with a good general condition may be vaccinated if they have a fever below 38.2 ºC, such as mild diarrhea or upper respiratory infection.
• No matter how early in premature infants; vaccination is not necessary in the appropriate months, as in the case of infants born on the day of birth, and vaccination doses do not need to be reduced (2 kg for hepatitis B vaccine, 3 kg for pertussis and tuberculosis vaccines).
• Pregnancy of the mother or anyone in the family does not prevent vaccination; live vaccines (such as oral polio) are not recommended only if there are individuals with immune system disease or immunosuppressed individuals due to cancer treatment or other diseases in the environment.
• A history of an allergy of unknown cause in the child to be vaccinated or close relatives does not prevent the vaccination.
• Children who need to have pertussis and measles vaccination can also be vaccinated if their families have a referral history.
• Multiple vaccinations can be administered at 2 cm intervals at the same time without an increased risk of side effects.
• If there is a delay in vaccines that need to be repeated more than once in a certain period (mixed, polio, pneumonia) to ensure adequate immunity, the vaccine will be resumed.
• Children whose vaccination status is unknown are considered to have never been vaccinated. There is no harm in re-administering vaccines against measles, rubella, mumps and polio to those already immunized.
• Breastfeeding does not prevent vaccination.
• Vaccines can be given to babies who are receiving antibiotic treatment or whose disease is improving.
• People with kidney, heart, sugar, nervous system, cancer and blood diseases and immune system disease should always consult a specialist for vaccination.
• During pregnancy:
a) harmless vaccines: tetanus, influenza, dead polio (IPV), cholera, hepatitis
b) Vaccines only required if necessary: ​​TB (BCG), whooping cough, diphtheria, measles, meningococcal, pneumococcal, rabies and mumps vaccines.
c) vaccines that should not be given: live polio (OPV) and rubella vaccines.

2) General Information About Vaccines

Hepatitis B Vaccine:
It is the first vaccine that can be administered after the child is born. In the newborn and infant age group, who are exposed to hepatitis B virus and are not immune, there is a high probability of developing cirrhosis and liver cancer (hepatocellular carcinoma) when the disease develops.
Therefore, early vaccination with hepatitis B vaccine is of great importance. All newborns should be vaccinated immediately after delivery without hospital discharge. Second dose of vaccine 1-2. months, the earliest dose should be completed after the earliest 24 weeks. If not, 3 doses of vaccine should be given to older children.
Carrier of hepatitis B virus (HBsAg positive) babies should be given 0.5 ml of Hepatitis B Immunoglobulin within the first 12 hours following the birth together with Hepatitis B vaccine.

It is not necessary to look at the antibody level after vaccination, but those who are found to be negative by chance should continue to be vaccinated until the antibody is positive. There is no harm in continuing the vaccination with the products of different companies.
The vaccine has few side effects. Fever and pain at the vaccination site may occur in 1% of children vaccinated.

Tuberculosis vaccine (BCG):
Tuberculosis vaccine is the most effective method for the prevention of tuberculosis in developing countries. Its protection is 0-80%. Vaccination should be given at 2 or 3 months because of the less side effects and higher immunization efficacy. At the age of six, the second dose of vaccine is administered by PPD skin test control. After 6 years of age, PPD is performed in negative cases. The BCG vaccine can be administered in combination with diphtheria, tetanus, whooping cough and polio vaccines. PPD control is recommended 3 months after vaccination and should be re-immunized if negative. The vaccine is always given into the skin on the muscles of the left shoulder and should not be bathed for 3 days after vaccination. At the vaccination site, a reddish, slightly fluffy rash occurs within 2-3 weeks, then the wound crusts and leaves a small scar.

Mixed vaccine (diphtheria, whooping cough, tetanus vaccine):
It is a three-in-one vaccine developed against life-threatening diphtheria, pertussis and tetanus disease, especially in childhood. In our country 2-4-6. months, 18 months and 4-6 years of age in total, 5 times in childhood. Mixed vaccines containing the whole cell pertussis vaccine are administered by the health ministry in health centers. However, it may be recommended to use cell-free (acellular) whooping cough vaccine in some special cases. These are:

>> Children with reactions at the vaccination site or throughout the body (swelling, restlessness, high fever, and persistent crying at the vaccination site) after administration of a full-cell vaccine.
>> Children undergoing treatment due to remittance or who have feverish remittance

Children over six years of age do not receive pertussis vaccine, but diphtheria tetanus toxoid (Td) vaccine is given. The TD vaccine should be repeated every 10 years.

Fever, drowsiness, vomiting, loss of appetite are common after vaccination. Fever should be reduced with antipyretic drugs and physical cooling methods. If the vaccination site, redness, hardness, sensitivity, such as reactions can be seen.

Since it is known that these side effects in mixed vaccine are mostly related to whole cell pertussis vaccine, acellular pertussis vaccine is given to patients who are economically feasible and the physician deems appropriate. Polio vaccine (IPV) and meningitis vaccine (HIB) vaccines together with the same vial (five vaccine: DtaB-IPV-HIB) and the addition of Hepatitis B vaccine (six vaccine: DtaB-IPV-HIB-HBV) immunization can also be performed.

Polio Vaccination:
In 17 countries including Turkey, polio disease has not been eradicated; In recent years, new polio disease is not seen in our country thanks to successful vaccination programs. There are two types of polio vaccine: live (oral) and inactive. The immune status (secretory IgA) that occurs after oral vaccination does not develop after intramuscular vaccination. Therefore, in countries where polio cannot be eliminated, oral live polio vaccination is recommended or it is stated that the last 1-2 doses are important in the case of the first doses of inactive polio vaccine.

Polio vaccine; It is administered together with the mixed vaccine at 2,4 and 6 months, 18 months and 4 years. For better absorption; breast milk, milk, chlorinated water and formula should not be given for 2 hours after oral polio vaccination.
Paralytic disease, the most serious vaccine-related side effect, occurs in oral polio vaccines and one in 2.4 million doses. In immunocompromised adults, the risk of vaccine-induced paralytic disease increases in unvaccinated adults. Live vaccine is not recommended for pregnant women.

Meningitis Vaccine (HIB):
Hemophilus influenzae type B (HIB) is one of the most common causes of severe microbial infections in children under 5 years of age. In addition to causing meningitis in children under 3 years of age, it also causes life-threatening diseases such as throat, ear, sinus and eye infections and pneumonia in infants and older children. The vaccine developed against this germ is popularly known as the meningitis vaccine.

The HIB vaccine can be administered at 2, 4 and 6 months in combination with mixed and polio vaccines (single or five doses). Repeat at 18 months. When it is done for the first time after the sixth month, 2 doses until 1 year of age and 3 doses after 1 year, 2 doses after 1 year of age, and a single dose after 2 years of age.
Side effects of the vaccine are not common. Reactions such as fever, swelling, redness, and pain at the vaccination site usually last for 12-24 hours.

Measles, Rubella, Mumps Vaccine:
It is thought that 1.5 million children die from measles in the world. Maternal protective antibody protects the baby against measles in the first 6 months. Then the antibody level gradually decreases. For this reason, measles vaccine is given in the 9th month in the developing countries and it is repeated in the 15th month. In our country, the first dose of measles rubella and mumps vaccine was started in the 12th month since 01.01.2006. The second dose is given in the first grade of primary school (between the ages of 4-6).

The triple MMR vaccine has no significant side effects. Rather, mild fever due to measles vaccine and a rash may occur 7-10 days after the vaccine.

Chickenpox Vaccine:
Microbial skin diseases, liver involvement, pneumonia and brain can be seen as side effects after chicken pox. Chickenpox in the first 5 months of pregnancy can cause serious disability in the baby. In children vaccinated, chickenpox is either absent or mild, and fever does not exceed 38 ºC and the number of rashes is relatively small compared to the actual disease.

1 dose of vaccine is recommended for children who have not had chickenpox and who have not been vaccinated between 12 months and 13 years. For people after the age of 13, two doses of vaccine are recommended at intervals of 1-2 months if the disease has not occurred before.

The vaccine has little side effects. Mild varicella-like rashes may occur in 7% of children vaccinated within 1 month of vaccination.