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《交互式心脏血管和胸部手术》
Q 1. I am putting following queries for clarification:
(i) As per WHO, diluents are vaccine specific. Can we use distilled water in case of accidental breakage of diluent ampoule
(ii) How to immunize thalassemic child who is given regular blood transfusion Can blood transfusion affect his sero-conversion
(iii) WHO recommends AD syringe for immunization. But such syringe is not useful for vaccines, which are to be reconstituted.
Reply
(i) Yes, diluents are not only vaccine specific but of exact quantity also vig 0.5 mL. Now-a-days the diluents are supplied in non-breakable small containers. Distilled water is an irritant to the skin and hence should be avoided.
(ii) A thalassemic child has no immune deficiency, but repeated blood trans-fusions make them prone to blood borne infections. Hepatitis B and Hepatitis C are common among these children(1). Routine immunization schedule can be followed after regular blood transfusions. Blood transfusion does not affect sero-conversion. In fact, low dose intradermal hepatitis B vaccination has been found to be adequately effective in children with thalassemia and sickle cell disease(2). However, if immunoglobulins are to be given, 6 months of interval is needed, in respect of measles or MMR vaccine only(3).
(iii) Agreed. But if a policy decision is taken by the WHO and other professional bodies at individual nation level, considering the risk of blood borne diseases due to the use of recycled syringes and needles, it may be worthwhile and cost effective to use two syringes in case of lyophilized vaccine formulations.
References
1. AI-Faway I, Ramia S. Decline in Hepatitis B infection in Sickle cell Anemia and Beta Thalassaemia Major. Arch Dis Child 1993; 69: 594-596.
2. Mok Q, Zenderhill G, Wonke B. Intradermal Hepatitis B Vaccine in Thalassemia and Sickle Cell Disease. Arch Dis Child. 1989; 64: 535-540.
3. American Academy of Pediatrics. Measles. In: Pickering LK. Ed. 2000 Red Book: Report of the Committee on Infections Diseases. 25th ed. Elk Grove village, II: American Academy of Pediatrics 2000: 390.(Kamlesh R. Lala,)
(i) As per WHO, diluents are vaccine specific. Can we use distilled water in case of accidental breakage of diluent ampoule
(ii) How to immunize thalassemic child who is given regular blood transfusion Can blood transfusion affect his sero-conversion
(iii) WHO recommends AD syringe for immunization. But such syringe is not useful for vaccines, which are to be reconstituted.
Reply
(i) Yes, diluents are not only vaccine specific but of exact quantity also vig 0.5 mL. Now-a-days the diluents are supplied in non-breakable small containers. Distilled water is an irritant to the skin and hence should be avoided.
(ii) A thalassemic child has no immune deficiency, but repeated blood trans-fusions make them prone to blood borne infections. Hepatitis B and Hepatitis C are common among these children(1). Routine immunization schedule can be followed after regular blood transfusions. Blood transfusion does not affect sero-conversion. In fact, low dose intradermal hepatitis B vaccination has been found to be adequately effective in children with thalassemia and sickle cell disease(2). However, if immunoglobulins are to be given, 6 months of interval is needed, in respect of measles or MMR vaccine only(3).
(iii) Agreed. But if a policy decision is taken by the WHO and other professional bodies at individual nation level, considering the risk of blood borne diseases due to the use of recycled syringes and needles, it may be worthwhile and cost effective to use two syringes in case of lyophilized vaccine formulations.
References
1. AI-Faway I, Ramia S. Decline in Hepatitis B infection in Sickle cell Anemia and Beta Thalassaemia Major. Arch Dis Child 1993; 69: 594-596.
2. Mok Q, Zenderhill G, Wonke B. Intradermal Hepatitis B Vaccine in Thalassemia and Sickle Cell Disease. Arch Dis Child. 1989; 64: 535-540.
3. American Academy of Pediatrics. Measles. In: Pickering LK. Ed. 2000 Red Book: Report of the Committee on Infections Diseases. 25th ed. Elk Grove village, II: American Academy of Pediatrics 2000: 390.(Kamlesh R. Lala,)