Vaccines and Immunoglobulins

Vaccines and Immunoglobulins

Vaccines are special preparations of antigenic materials that can be used to stimulate the development of antibodies and thus confer active immunity against a specific disease or a number of diseases. 

Vaccines may be single component or mixed combined vaccines.

Types of Vaccines

Live Attenuated Vaccines: These vaccines contain live microbes that have been weakened (attenuated). Live attenuated vaccines usually confer immunity with a single dose which is of long duration. They may be dangerous in recipients who are immunocompromised because these patients are unable to mount an effective immune response.

Examples:

  • Mumps vaccines
  • Measles vaccines
  • BCG vaccines
  • Rubella vaccines
  • Chickenpox vaccines

Killed or Inactivated Vaccines: This type of vaccine contains whole inactivated microbes. Inactivated vaccines may require a series of injections in order to produce an adequate body response and in most cases booster doses are required.

Examples:

  • Polio vaccines

Toxoids: Toxoid vaccines use bacterial toxins that have been rendered harmless. Administration of the toxoid causes the recipient’s immune system to manufacture antitoxins directed against the bacterial toxins.

Examples:

  • Tetanus toxoid

Immunity

Immunity is the body’s ability to resist infections afforded by the presence of circulating antibodies and white blood cells.

Types of Immunity

  • Active Immunity: Active immunity is induced by the administration of microorganisms or their products which act as antigens to induce the body to produce antibodies.
  • Passive Immunity: Passive immunity is obtained by injecting preparations made from the plasma of immune individuals with adequate levels of antibodies to the disease for which protection is sought. Treatment should be given as soon as possible after exposure for effective results. This type of immunity lasts for only a few weeks.
Poliomyelitis Vaccine

Available Preparations:

  • Oral suspension of live attenuated poliomyelitis virus

Indications:

  • Active immunization against poliomyelitis

Contraindications:

  • Hypersensitivity to any of the ingredients
  • Patients with diarrhea or vomiting
  • Immunocompromised patients
  • Pregnancy

Dosage:

  • 2 drops at birth
  • 2 drops at 6 weeks
  • 2 drops at 10 weeks
  • 2 drops at 14 weeks

Side Effects:

  • Rarely seen

Drug Interactions:

  • Concomitant administration with immunosuppressant drugs

Key Issues to Note:

  • Live polio vaccine loses potency once the container has been opened; therefore, discard any unused preparation
  • Breastfeeding does not interfere with immunization even though polio antibodies may be excreted in breast milk
  • If the vaccine is vomited, repeat the dose immediately
  • A child who has previously had polio should nevertheless be immunized to offer complete protection
Measles Vaccine

Available Preparations:

  • Injection powder for solution (live attenuated measles virus)

Available Brands: Sii® measles vaccine live

Indications:

  • Active immunization against measles

Contraindications:

  • Hypersensitivity to any antibiotic present in the vaccine
  • Hypersensitivity to eggs

Dosage:

  • 0.5 ml SC at 9 months (left upper arm)

Side Effects:

  • Fever
  • Malaise
  • Thrombocytopenia
  • Headache
  • Rashes

Key Issues to Note:

  • Vaccination is recommended in all children at the age of 9 months
  • Maternal antibodies may interfere with an effective immune response to the vaccine if given in the first 6 months of life
  • The vaccine may be given at 6 months in case there is an outbreak in the community
  • Vaccination should not be given to patients with untreated active tuberculosis
Measles, Mumps, and Rubella Vaccine (MMR Vaccine)

Available Preparations:

  • Injection of live attenuated measles, mumps, and rubella virus

Available Brands: Sii® measles, mumps, and rubella vaccine, Trimovax®, Priorix®

Indications:

  • Active immunization against measles, mumps, and rubella

Contraindications:

  • Pregnancy
  • Hypersensitivity to any antibacterial such as neomycin or kanamycin used in the manufacturing process
  • Immunosuppressed patients

Dosage:

  • By deep SC or by intramuscular injection 0.5 ml (12-15 months)

Side Effects:

  • Fever
  • Parotid swelling
  • Malaise
  • Rash

Drug Interactions:

  • Concomitant administration with immunosuppressant drugs
BCG Vaccine

Available Preparations:

  • Powder for injection of live bacteria of a strain derived from the bacillus of Calmette and Guerin

Indications:

  • Active immunization against tuberculosis

Contraindications:

  • Generalized edema
  • Immunosuppressed patients
  • Antimycobacterial treatment
  • Previous TB infections

  • Generalized skin diseases

  • Tuberculin reaction > 5 mm

Dosage:

  • 0.05 ml intradermally in the right upper arm (infants less than 12 months)
  • 0.1 ml intradermally on the right upper arm (adults and children greater than 12 months)

Side Effects:

  • Keloid formation
  • Lymphadenitis
  • Localized necrotic ulceration
  • Anaphylaxis
  • Disseminated BCG infection in immunosuppressed patients

Drug Interactions:

  • Concomitant administration with immunosuppressant drugs
DPT Vaccine

Available Preparations:

  • Powder for injection

Available Brands: TriPacel®, Infanrix®

Indications:

  • Active immunization against diphtheria, tetanus, and pertussis

Dosage:

  • Infant: 0.5 ml by intramuscular or deep SC injection at 6, 10, and 14 weeks

Side Effects:

  • Irritability
  • Restlessness
  • Limb swelling
  • Malaise
  • Peripheral neuropathy
  • Myalgia
  • Urticaria
  • Headache
  • Fever
  • Loss of appetite
Tetanus Toxoid Vaccine

Available Preparations:

  • Injection

Available Brands: Sii® tetanus toxoid vaccine, Tetavax®

Indications:

  • Active immunization against tetanus and neonatal tetanus

Dosage:

  • Women 15-45 years of age including pregnant women: 0.5 ml deep SC or intramuscular injection at first contact or as early as possible during pregnancy (TT1)
  • TT2 (0.5 ml) at least 4 weeks after TT1 or during subsequent pregnancy
  • TT3 (0.5 ml) at least 6 months after TT2 or during the subsequent pregnancy
  • TT4 (0.5 ml) at least 1 year after TT3 or during subsequent pregnancy
  • TT5 (0.5 ml) at least 1 year after TT4 or during subsequent pregnancy

Note: To achieve lifelong protection against tetanus, 5 doses of TT are required.

Side Effects:

  • Peripheral neuropathy
Anti-Tetanus Immunoglobulin

Available Preparations:

  • Injection 1500 IU

Available Brands: Tetanea®

Indications:

  • Passive immunization against tetanus as part of the management of tetanus-prone wounds

Dosage:

  • Adult and Children: 1 ml by IM injection. Give additional dose if wound is older than 12 hours or heavily contaminated

Side Effects:

  • Local reactions
  • Fever
  • Pain and tenderness at the site of injection
  • Headache
Yellow Fever Vaccine

Available Preparations:

  • Injection powder + solvent of live attenuated virus

Available Brands: Stamaril®

Indications:

  • Active immunization against yellow fever

Contraindications:

  • Immunosuppressed patients
  • Known hypersensitivity to any of the ingredients
  • Infants under 4 months of age
  • Hypersensitivity to eggs

Dosage:

  1. Infants at 9 months: 0.5 ml by SC injection
  2. Immunization of travelers and others at risk:
  • Adult and Children over 9 months: 0.5 ml
  • Infants 4-9 months: 0.5 ml only if the risk of yellow fever is unavoidable

Side Effects:

  • Headache
  • Fever
  • Weakness
  • Diarrhea
  • Myalgia
  • Influenza-like symptoms
  • Nausea

Drug Interactions:

  • Concomitant administration with immunosuppressant drugs
  • Cholera vaccine should not be given together with yellow fever vaccine
Typhoid Vaccine

Available Preparations:

  • Injection VI capsular polysaccharide typhoid 25 mcg/0.5 ml

Available Brands: Typhim Vi®, Typherix®

Indications:

  • Active immunization against typhoid

Contraindications:

  • Immunosuppressed patients
  • Febrile illness
  • Known hypersensitivity to any of the ingredients

Dosage:

  • Adult and children over 2 years: By deep SC (subcutaneous) or intramuscular 0.5 ml with booster doses every 3 years for those at continued risk

Side Effects:

  • Headache
  • Allergic reaction
  • Myalgia
  • Fever
  • Nausea
  • Malaise
  • Swelling and pain

Key Issues to Note:

  • Typhoid fever prevention becomes effective after 2-3 weeks after injection
  • Typhoid is rare in children under 2 years; therefore, to immunize in this age group should be based on the risk of exposure
  • The vaccine offers protection for a minimum duration of 3 years
Pneumococcal Vaccine

Available Preparations:

  • Injection in form of 23-valent polysaccharide vaccine 25 mcg/0.5 ml

Available Brands: Pneumo 23®

Indications:

Immunization against pneumococcal infections in:

  • Sickle cell disease in children over 2 years of age
  • Immunocompromised patients over 5 years at increased risk of pneumococcal infection

Contraindications:

  • Severe allergic reaction to any of the ingredients

Dosage:

  • Adult and children over 2 years: 0.5 ml deep SC or IM as a single dose

Side Effects:

  • Fever
  • Myalgia
  • Pain and erythema at injection site

Key Issues to Note:

  • Revaccination is recommended every 5-10 years in high-risk patients
Meningococcal Vaccine

Available Preparations:

Injection

  • Bivalent vaccine from group A and C
  • Tetravalent vaccine from groups A, C, Y, and W135

Available Brands: Meningo A + C®, Mencevax ACWY®

Indications:

  • Active immunization against Neisseria meningitidis infections such as meningitis and septicemia

Contraindications:

  • Allergy to diphtheria toxoid
  • Febrile conditions

Dosage:

  • Bivalent: 0.5 ml deep SC or IM injection as a single dose
  • Tetravalent: 0.5 ml deep SC injection as a single dose

Side Effects:

  • Allergic reaction
  • Anaphylaxis
  • Erythema

Key Issues to Note:

  • Do not use in children under 2 years except in epidemic situations
Cholera Vaccine

Available Preparations:

  • Oral vaccine containing live attenuated or inactivated

Available Brands: Dukoral®

Indications:

  • Immunization for travelers over 2 years of age at high risk of cholera infections

Contraindications:

  • History of hypersensitivity to any of the ingredients
  • Acute GIT or febrile

Dosage:

  • Children 2-6 years: 3 doses given at intervals of at least 1 week. Give a booster after 6 months if still at risk
  • Adult and Children over 6 years of age: 2 doses given at 1-week intervals. Give a booster after 2 years if still at risk

Side Effects:

  • Abdominal discomfort
  • Headache
  • Diarrhea
  • Fever

Key Issues to Note:

  • Avoid food and drinks 1 hour before and after taking the vaccine
Rabies Vaccine

Available Preparations:

  • Injection 2.5 IU/dose

Available Brands: Sii rabivax®, Lyssavac berna®, Verorab®

Indications:

  • Active immunization against rabies
  • Post-exposure treatment to prevent rabies in patients who have been bitten by rabid animals
  • Pre-exposure prophylaxis in persons at high risk of being bitten by rabid animals

Contraindications:

  • Known hypersensitivity to any of the ingredients

Dosage:

  • Pre-exposure prophylaxis: 1 ml by deep subcutaneous or intramuscular injection on days 0, 7, and 28
  • Post-exposure treatment: 1 ml by deep subcutaneous or intramuscular injection on days 0, 3, 7, 14, and 30

Side Effects:

  • Pain at injection site
  • Fever
  • Erythema at injection site
  • Malaise
  • Nausea
  • Myalgia
  • Headache
  • Hypersensitivity reaction
Hepatitis B Vaccine

Available Preparations:

  • Injection containing inactivated hepatitis B surface antigen

Available Brands: Euvax B adult®, Euvax B paed®, Engerix B®

Indications:

  • Active immunization against hepatitis B infection

Contraindications:

  • History of hypersensitivity

Dosage:

  • Adult and Children over 15 years: 1 ml with an interval of 1 month between the 1st and 2nd dose and 5 months between the 2nd and 3rd doses. Total of 3 doses
  • Children below 15 years: 0.5 ml with 1 month between the 1st and 2nd dose, and 5 months between the 2nd and 3rd dose
  • Infants: 0.5 ml intramuscular injection at 6 weeks, 10 weeks, and 14 weeks of age

Side Effects:

  • Abdominal pain
  • GIT disturbance
  • Sleep disturbance
  • Lymphadenopathy
  • Muscle and joint pains
  • Dizziness
  • Peripheral neuropathy

  • Myalgia

Key Issues to Note:

  • Immunocompromised patients may need further doses

Anti-D (Rho) Immunoglobulin

A Rhesus-negative mother may develop antibodies against Rho antigen red cells when she carries a Rhesus-positive fetus and fetal red cells enter her circulation during childbirth, abortion, or miscarriage. Rho immunoglobulin is used to prevent non-sensitized mothers from producing antibodies which may cause hemolytic disease of the newborn.

Available Preparations:

  • Injection

Indications:

  • Prevention of Rhesus D sensitization in females who are Rhesus D negative

Contraindications:

  • Rhesus-positive individuals
  • Isolated immunoglobulin A deficiency

Dosage:

  • Following birth of Rhesus-positive infant: 500 units deep IM immediately or within 72 hours
  • Following stillbirth: 250 units per episode immediately or within 72 hours
  • Antenatal prophylaxis: 500 units given at 28 and 34 weeks of pregnancy. A further dose is still needed immediately or within 72 hours of delivery

Side Effects:

  • Local tenderness and stiffness
  • Fever
  • Nausea
  • Vomiting
  • Back pain
  • Abdominal pain
  • Myalgia
  • Malaise
  • Sweating
  • Skin rash

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