Vaccination of special groups

Vaccines are usually administered to healthy individuals and  a deal of infection has been indicated that many a times  individuals with some pathological and physiological condition approach the clinicians regarding immunization against infections diseases .some  of these conditions are

1-pregnancy 2- allergy 3- lactation  4- diabetic mellitus 5- nephropathies

6-elderly person 7- patients with AIDs

Pregnancy

Immunization of a pregnant women is often fraught with the risk of causing abnormalities in the fetus .Some vaccine are not perfectly safe during pregnancy .Hence as far as possible immunization should be performed before gestation .pregnant women require vaccination in following conditions

1. travel to endemic areas 2- epidemic  3- bite by rabid animals  4- tetanus

the vaccine which can be administered to pregnant women

1. safe : tetanus ,influenza ,IPV ,cholera and hepatitis B
2. only under special circumstance BCG ,Pertussis ,Diphtheria ,Measles ,meningitis ,pneumococcal ,pneumonia ,yellow fever and rabies
3. Avoid OPV ,Rubella and small pox .

Rubella vaccine

Rubella virus is known teratogen  and vaccine against this viral infection prevents .congenital anomalies in the child ,women of childbearing age  can only be vaccinated against rubella if conception can be avoided during the two months following the injection of vaccine  

Yellow fever vaccine

This is mandatory for women when they travel to yellow fever endemic areas of the world .this is also one of the essential requirements of international travel,

Rabies vaccine

This is recommended in case of definite exposure to rabies virus through the bite of rabid animal .If nervous tissue anti rabies vaccine is to be administered during advanced stage of pregnancy ,anterior abdominal wall may not be asuitable site for inoculation .instead anterolateral part of thigh should be ideal site .tissue culture vaccine are administered in deltoid region .

OPV

oral poliovaccine has also been shown to be safe both for the mother as well as fetus .However its general use in pregnancy is not advocated

pertussis and diphtheria vaccines

both these vaccines are relatively poorly tolerated by adults since their indications for use in adults in developing countries are rare ,their use should be restricted to emergency situations of sever epidemics 

administered of polysaccharide vaccine against meningitis is absolutely safe for pregnant women .

Allergy

Allergic person during the active phase of disorder should not be vaccinated ,Allergy to antibiotics is common and many vaccine contain antimicrobial agents ,vaccine containing antibiotics should be administered with caution to allergic individuals if possible ,sensitivity can be assessed using a diluted solution of the vaccine ,the relationship of vaccines with allergy is available phenomenon

Vaccines causing allergy

Never                     rarely                          commonly 

IPV                        Rubella                         Influenza

OPV                       Rabies                          yellow fever

                               Measles

                                Mumps

                               Typhoid                            

Sever complications may occur in children with a personal of familial history of allergy ,following immunization against pertussis .these complications are mainly of anaphylactic type and may be due to histamine sensitivity factor present in Bortedella pertussis .

Diabetes mellitus

Infectious diseases are frequent in diabetics and contrary to common belief ,these individuals must be regularly vaccinated .this is more so true for viral infections which are common in diabetics and because of the absence of any specific chemotherapy may cause tremendous morbidity in this vulnerable groups .The immunocompetence of patients with diabetes is comparable to that in normal individuals and they respond satisfactory to many vaccines provided that have controlled diabetes in such patients all vaccine except typhoid vaccines can be administered

Lactation

This has assumed importance because of the excretion of rubella vaccine virus in the milk of the mother and it is possible potentiality to cause infection in neonate no clinical disease  has been recorded in infants breast fed by mother excreting rubella virus in their milk.  

Nephropathy

During the active phase of chronic nephropathies all vaccines  are contraindicated .all vaccines given to these patients except typhoid vaccines because typhoid vaccines tend to aggravate renal pathology .

Elderly people

Immunological ageing in elderly people led to

• susceptible to bacterial and viral aggressions
• increased frequency of auto immune diseases
• increased frequency of cancers

hence they need special immunoprophylactic attention ,immunization is rarely for the elderly and only vaccinated when travel to endemic areas

vaccination of patients with AIDs

patients with HIV positive infection ,whether symptomatic or not should be given all the vaccines (measles ,mump rubella ,polio , rabies) but not the BCG and yellow fever.