Immunization

• Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own immune system to protect the person against subsequent infection or disease.

  Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert between 2 and 3 million deaths each year. It is one of the most cost-effective health investments, with proven strategies that make it accessible to even the most hard-to-reach and vulnerable populations. It has clearly defined target groups; it can be delivered effectively through outreach activities; and vaccination does not require any major lifestyle change.

  Passive and active immunization

  Immunization can be achieved in an active or passive manner: vaccination is an active form of immunization.

  Active immunization

  : Active immunity

  Active immunization can occur naturally when a person comes in contact with, for example, a microbe. The immune system will eventually create antibodies and other defenses against the microbe. The next time, the immune response against this microbe can be very efficient; this is the case in many of the childhood infections that a person only contracts once, but then is immune.

  

  Medical student participating in a polio vaccine campaign in Mexico

  Artificial active immunization is where the microbe, or parts of it, are injected into the person before they are able to take it in naturally. If whole microbes are used, they are pre-treated.

  The importance of immunization is so great that the American Centers for Disease Control and Prevention has named it one of the “Ten Great Public Health Achievements in the 20th Century”.^[1] Live attenuated vaccines have decreased pathogenicity. Their effectiveness depends on the immune systems ability to replicate and elicits a response similar to natural infection. It is usually effective with a single dose. Examples of live, attenuated vaccines include measles, mumps, rubella, MMR, yellow fever, varicella,rotavirus, and influenza (LAIV).

  Passive immunization

   Passive immunity

  Passive immunization is where pre-synthesized elements of the immune system are transferred to a person so that the body does not need to produce these elements itself. Currently, antibodies can be used for passive immunization. This method of immunization begins to work very quickly, but it is short lasting, because the antibodies are naturally broken down, and if there are no B cells to produce more antibodies, they will disappear.

  Passive immunization occurs physiologically, when antibodies are transferred from mother to fetus during pregnancy, to protect the fetus before and shortly after birth.

  Artificial passive immunization is normally administered by injection and is used if there has been a recent outbreak of a particular disease or as an emergency treatment for toxicity, as in for tetanus. The antibodies can be produced in animals, called “serum therapy,” although there is a high chance of anaphylactic shock because of immunity against animal serum itself. Thus, humanized antibodiesproduced in vitro by cell culture are used instead if available.Immunizations, or vaccines as they’re also known, safely and effectively use a small amount of a weakened or killed virus or bacteria or bits of lab-made protein that imitate the virus in order to prevent infection by that same virus or bacteria.

  When you get an immunization, you’re injected with a weakened form of (or a fragment of) a disease. This triggers your body’s immune response, causing it to either produce antibodies to that particular ailment or induce other processes that enhance immunity.

  Then, if you’re ever again exposed to the actual disease-causing organism, your immune system is prepared to fight the infection. A vaccine will usually prevent the onset of a disease or else reduce its severity.

   

  Why Should Someone Get Immunized?

  The goal of public health is to prevent disease. It’s much easier and more cost-effective to prevent a disease than to treat it. That’s exactly what immunizations aim to do.

  Immunizations protect us from serious diseases and also prevent the spread of those diseases to others. Over the years immunizations have thwarted epidemics of once common infectious diseases such asmeasles, mumps, and whooping cough. And because of immunizations we’ve seen the near eradication of others, such as polio and smallpox.

  Some vaccines need to be given only once; others require updates or “boosters” to maintain successful immunization and continued protection against disease.

  Which Immunizations Do My Children Need?

  Because proof of immunization is often a prerequisite for enrollment in school or day care, it’s important to keep your children up to date on their vaccines. The benefit of doing so is that your children will be protected from diseases that could cause them serious health problems. The recommended immunizations for children 0-6 years of age include:

  • Hepatitis B
  • Rotavirus
  • Diphtheria, tetanus, pertussis
  • Haemophilus influenzae type B
  • Pneumococcal
  • Poliovirus
  • Influenza
  • Measles, mumps, rubella
  • Varicella (chickenpox)
  • Hepatitis A
  • Meningococcal (for certain high-risk groups)

  At one time or another, each of the diseases addressed by these vaccines posed a serious health threat to children, taking their lives by the thousands; today most of these diseases are at their lowest levels in decades, thanks to immunizations.

  It’s important to keep your child’s immunizations on schedule and up to date, but if your child misses a scheduled dose he or she can “catch up” later.The complete updated schedule of immunizations for children ages 0-18 can be 

  What About Immunization Side Effects?

  Today, vaccines are considered safe. As with any medication, they can have side effects. In most cases these are usually mild. Most common minor reactions to an immunization are:

  • Soreness or redness around the injection site
  • Low-grade fever

  Side effects like these usually disappear in a few days. In extremely rare instances a high fever, in excess of 104 F, can occur with a vaccine.Fevers like this will not harm your children, but they can make them uncomfortable and upset.

  Children have also been known to have serious allergic reactions to a vaccine. These usually happen very soon after getting the vaccine, and doctors’ offices are well equipped to handle such reactions. If you think your child has or may have an allergy to any component in a vaccine, be sure to share that information with your doctor.

   

  Medical providers agree that the proven preventive benefits of vaccines far outweigh the risks of the minimal side effects associated with them. More information about vaccine side effects and precautions can be found in the CDC’s brochure Parents Guide to Childhood Immunizations.

  How Effective Are Immunizations?

  Vaccines are very effective at preventing disease, but they don’t work all the time. Most of the recommended childhood immunizations are 90%-100% effective, according to the CDC.

  However, for reasons that are not completely understood, sometimes a child will not become fully immunized against a disease after receiving a vaccine. This is all the more reason to get children vaccinated. Children in whom the vaccine is 100% effective protect those few who have not been completely immunized — lessening everyone’s chance of exposure to the disease.

  Even in cases where a vaccine has not given your child 100% immunity, the symptoms — if your child is exposed to an infectious disease — will still usually be milder than if he or she had not been immunized at all.

  Vaccine Myths and Misinformation

  Here are important answers to three common misconceptions about vaccines.

  Misconception #1: “We don’t need to vaccinate against rare diseases.”

  Few parents today have even heard of all of the diseases we vaccinate against, let alone seen a case of the measles, diphtheria, or whooping cough.

  Vaccine Myths and Misinformation continued…

  This leads some to ask, “Why am I giving my child a vaccine against a disease that doesn’t even exist?”

  The answer is that it’s the vaccines that keep these diseases so rare. Avoiding having your child immunized because of myths and misinformation about vaccine safety puts your child — and public — at risk. In communities where vaccine rates have dropped, these infectious diseases have quickly returned.

  Misconception #2: “The preservative thimerosal makes vaccines risky.”

  Another concern about vaccines involves the use of a mercury-based preservative called thimerosal.

   

   

   

   

   

  IMMUNIZATION SCHEDULE

   

  Introduction

  The purpose of this review is to revise and update on the evolving immunization schedule at national and at global level. Good vaccination practices begin shortly after birth. The WHO estimated that immunization currently averts an estimated 2 to 3 million deaths every year apart from societal burden & medical costs. For each birth cohort vaccinated in the United States, approximately 20 million illnesses are prevented, along with 40,000 deaths. 
  The Advisory Committee on Vaccines and Immunization Practices (ACVIP) of the Indian Academy of Pediatrics (IAP) has recently (2014) updated immunization schedule for children aged 0 through 18 years. This was based on recent evidences for licensed vaccines that are incorporated in our clinical practices in India (Table 1). 
  
  Table 1: Recommendation for IAP Immunization – updated 2014 Schedule
  

  Age	Vaccines	Comments
  Birth dose	BCG, OPV-zero , HepB1	these vaccines given to all newborns before hospital discharge
  6 weeks	DTwP1, IPV1, Hib1, PCV1, HepB2	DTaP combinations should preferably be avoided for the primary series.
  10	DTwP2, IPV2, Hib2, PCV2, Rota1	If RV1 is chosen, the first dose should be given at 10 weeks. Only 2 doses of RV1 are recommended at present
  14	DTwP3, IPV3, Hib3, PCV3, Rota2	(2nd dose Rotarix –final)
  6 months	OPV1, HepB3
  9 months	OPV2 , MMR1	Measles-containing vaccine ideally should not be administered before completing 270 days or 9 months of life. The 2nd dose must follow in 2nd year of life.
  9-12 months	Conjugated Typhoid vaccine	Currently, two typhoid conjugate vaccines, Typbar-TCV and PedaTyph available in Indian market. Should follow a booster at 2 years of age
  12 months	HepA1	One of the 2 doses of inactivated now or a-single dose for live attenuated H2-strain HepA vaccine now recommended
  15 month	MMR2, varicella1 , PCVb	The risk of breakthrough varicella is lower if given 15 months onwards
  16 to 18 months	DTwP b1 or DTaP b1  IPV b1 , Hib b1	DTwP or DTaP booster (4th dose) may be administered as early as age 12 months, provided at least 6 months have elapsed since the third dose. Considering a higher reactogenicity of DTwP, consider DTaP for the boosters.
  18 months to 2yrs	HepA2, Typhoidb	Also suggesting only single dose for live attenuated H2- strain HepA vaccine
  4 -6 yrs	DTwP b2 or DTaP b2 ; OPV3 Varicella2 and Typhoid b	2nd dose varicella can be given at any time 3 months after the 1st dose
  10 -12 years	Tdap or Td,  HPV series to begin	Tdap is preferred to Td ,followed by every 10 years HPV : 2 or 3 doses > 9 yrs. & older

  
  
  One should follow and adhere to the regional health authority & Institutional immunization policy that are principally derived from the Centers for Disease Control and Prevention (CDC &P) and the WHO. The immunization schedules are intermittently revised and updated; these programs are supported by the Global Alliance for Vaccines and Immunization (GAVI) at the global level. 
  The Advisory Committee on Immunization Practices (ACIP) of the CDC & P, has now updated to reflect the 2016 immunization schedules for the use of vaccines for children and adolescents. The schedules are approved by the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AFP), and the American College of Obstetricians and Gynecologists (ACOG). (Table 2) 
  
  Table 2: General Recommendation from ACIP/CDC from Newborn to 18 yrs. of age
  

  Vaccines	Birth	2 mons	4 mons	6 mons	9 mons	12 mons	15 mons	18 mons	2 -3 yrs.	4-6 Yrs.	11-12Yrs.
  HepB	1st	2nd		3rd ?	3rd	3rd	3rd	3rd  ?
  Rota oral RV1 or Rv5		Rv1 or Rv5	Rv1 or RV5
  DTaP		1st	2nd	3rd			4th  ?	4th  ?		5th	Tdap Q 10 yrs.
  Hib		1st	2nd			3rd or 4th	3rd or 4th
  Pneumo		1st	2nd	3rd		4th	4th
  Polio: IPV <18y		1st	2nd		3rd	3rd				4th
  Influenza (IIV)				yearly
  MMR						1st  ?	1st  ?			2nd
  Varicella						1st  ?	1st  ?			2nd
  HepA									2 dose series
  Meningo(MCV4)											2 dose
  HPV											3 dose series

  
  

  Combination vaccines

  Combination vaccines are necessary and important for the continuing success of our immunization program, especially when more vaccines are added to the already crowded immunization schedule. However, the multiplicity of competing vaccine products, with various overlapping antigen menu and subtle immunologic differences, may be confusing to the busy practitioner. Combining vaccines that target children immunization may expand immunization opportunities and effectiveness. However, offering new choices may not necessarily translate into simpler solutions at the practical level. The combo’s aspects of immunization schedules is not included in this review.
  

   

Stay hydrated. If you don’t, you may strain during a bowel movement and make hard stools, which further irritate the swollen veins. Drink water, and remember that you also get H2O from foods such as fruits and vegetables.

What Are the Treatment Options for Hemorrhoids?Treatment for hemorrhoids can occur at home or at a doctor’s office.

Pain Relief

To minimize pain, soak in a warm tub of water for at least 10 minutes every day. You can also sit on a warm water bottle to relieve the pain of external hemorrhoids. If the pain is too much to bear, you can use an over-the-counter medicated suppository, ointment, or cream to relieve the burning and itching.

Dietary Fiber

Home treatment can also include increasing your dietary fiber intake. Consuming foods that are high in dietary fiber can minimize the risk of developing hemorrhoids in the future. 

Good dietary fiber sources include:

• whole wheat
• brown rice
• oatmeal
• pears
• carrots
• buckwheat
• bran 

Dietary fiber helps create bulk in the intestines, which softens the stool, making it easier to pass.

If you’re constipated, you can also use an over-the-counter fiber supplement to help soften your stool.

Medical Procedures

If home treatments aren’t helping your case of hemorrhoids, your doctor might recommend getting a rubber band ligation. This procedure involves the doctor cutting off the circulation of the hemorrhoid by placing a rubber band around it. This causes loss of circulation to the hemorrhoid, forcing it to shrink. You shouldn’t try this at home, however.

If rubber band ligation isn’t an option in your case, your doctor can inject a chemical into the blood vessel directly. This causes the hemorrhoid to reduce in size. This treatment is known as injection therapy or sclerotherapy.

Treatments for hemorrhoids

In the majority of cases the patient can take some simple measures which will alleviate symptoms while the problem gets better on its own. However, medicines and even surgery may sometimes be needed.

Medicines

Most hemorrhoid medicines are OTC (over-the-counter); this means you do not need a doctor’s prescription to get them. They include ointments, pads or suppositories. Such active ingredients as hydrocortisone and witch hazel are known to relieve itching and pain. These medicines should not be used for more than about seven days (unless your doctor has told you otherwise).

Simple incisions

Your doctor may carry out a simple incision if a clot has formed around an external hemorrhoid. These incisions are usually effective. More continuous bleeding may require rubber band ligation, sclerotherapy (injection) or coagulation.

Surgery to treat hemorrhoids

Specialist ultrasonic device for hemorrhoid surgery.

Surgery is recommended if the patient has not benefited from the simple procedures, or if the hemorrhoids are very large. In some cases the patient may go home straight after the procedure, while in others they may have to be hospitalized. Surgery may involve hemorrhoidectomy or stapling.

The method shown on the right is a gentle method of hemorrhoidal ligation (HAL: Hemorrhoidal Artery Ligation, or RAR: Recto Anal Repair). It locates the main branch of the artery by means ofultrasound loops, with a curved needle tightly threading around the artery and pulling it together. This is called a minimally invasive treatment method and is described as being painless.

What you can do on your own

There are things you can do to relieve the symptoms. Bear in mind that they will not eliminate the hemorrhoids.

• Topical creams and ointments – you can apply an OTC cream or suppository which contains hydrocortisone. There are also pads which contain witch hazel, or a topical numbing agent
• Bathing the affected area – bathe gently with warm water. Do not use soap if you think it will make the problem worse. Dry the area gently with a hair drier after bathing
• Ice packs and cold compresses – if you apply these to the affected area it may help with the swelling
• Sitz bath. Use warm water – the sitz bath is placed over the toilet. Some pharmacies sell them
• Use moist towelletes – dry toilet paper may aggravate the problem
• Analgesics – some painkillers, such as aspirin, ibuprofen and paracetamols (Tylenol) may alleviate the pain and discomfort.

Preventing hemorrhoids

If your stools are always soft your chances of developing hemorrhoids are greatly reduced. You can help prevent hemorrhoids in the following ways:

Including plenty of fruits and vegetables in your diet will help keep your stools soft.

• Nutrition: if you eat lots of fruits and vegetables, as well as whole grains, your stools will nearly always be soft. If you drink plenty of fluids your stools are more likely to be soft (this does not include alcohol)
• Straining: when you go to the toilet try not to strain or hold your breath, as this creates pressure in the veins in the lower rectum
• Go when you need to: if you have the urge to go to the toilet, go. Do not wait. The longer you wait, the drier the stools will be
• Be physically active: physical inactivity, sitting or standing still for long periods puts pressure on the veins
• Keep your bodyweight down: obesity an overweight significantly raise a person’s risk of having hemorrhoids.
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