IMMUNIZATION
NAVAS SHAREEF.P.P
KMCT MED COLLEGE;CALICUT;INDIA
Email:nasmbbs@gmail.com
IMMUNIZATION
• Immunisation is the process by which
acquired immunity is induced.
Acquired Immunity
• Protection from dise...
Acquired Immunity
Active immunity
• In response to stimulus by an
antigen characterized by the
production of antibodies by...
Active immunity
Naturally acquired
• Repeated clinical &
subclinical infection
in childhood give
immunity.
• Eg:chicken po...
Passive immunity
Naturally acquired
• Transfer of maternal
antibodies
• Eg:
– Through placenta=Ig G
– Through colostrum=Ig...
Immunizing agents
• vaccines
• immunuglobulins
• antisera
VACCINATION
• A vaccine is an immuno-biological
substance(Ag) designed to produce specific
protection against a given dise...
Types of vaccines
• Attenuated live vaccines
• Inactivated killed vaccines
• Toxoids
• Polysaccharide and polypeptide (cel...
Live Vaccines
Advantages
• Single dose enough
• Produce local immunity
• lnduce cell mediated immunity
• More convenient f...
Killed Vaccines
Advantages
• No danger of spread
• Stability and safety
Disadvantages
• Multiple injection may be required...
Live
Attenuated
vaccines
Killed
Inactivated
vaccines
Toxoids Cellular fraction
vaccines
Recombinant
vaccines
•BCG
•Typhoid...
Route
Intradermal BCG
Subcutaneous Measles, MMR, Meningococcal, Varicella
Intramuscular DTwP / DTaP, Hib, Hep A, Hep B, DT...
VACCINE ADVERSE REACTIONS
• Local
– Pain, swelling, redness at site of injection
– Common with inactivated vaccines
– Usua...
VACCINE COLD CHAIN
• The system of transporting, storing and distributing vaccines in
a potent state at the recommended te...
VACCINE COLD CHAIN
Vaccine vial monitor
• Whole cell vaccine
–Contains suspension of whole bacterial cells
that have been killed. Eg: DTwP
–More effective but les...
Vaccine Failure
• Primary = administration of recommended dose of vaccine
doesnot result in adequate protection against di...
INDIVIDUAL VACCINES
BCG VACCINE
• Live attenuated vaccine (Bacille Calmettee – Guerin
strain)
• Dose: 0.05ml in neonates & 0.1ml in others
• I...
Oral Polio Vaccine
• OPV – Live attenuated Polio virus
– Type I - Type II - Type III
• Dose – 2 drops oral at birth,6,10, ...
Injectable Polio Vaccine
• Formaldehyde killed and purified poilio virus
– Type I-40
– Type II-8 D antigen units
– Type II...
DTwP / DTaP vaccines
• DTaP has been licensed in India for private use
• Current recommendations for use of DTaP
– For inf...
MEASLES VACCINE
• Live attenuated vaccine (Edmonston-Zagreb strain)
• Given IM or SC
• Given at 9 months (because at that ...
MMR vaccine
• Measles---Edmonston-Zagreb strain
• Mumps-Jeryl Lynn strain
• Rubell--RA 27/3 strain
• Dose is 0.5 ml (2 dos...
HEPATITIS B VACCINE
• Recombinant DNA vaccine (in yeast)
• 0.5 mL IM in <1 year and 1 mL > 1 year
• 3 doses at 0, 1, 6 mon...
TYPHOID VACCINE
• 2 doses
• 0.5 mL SC 1 month interval (killed vaccine)
• Typhoral-- oral live vaccine (stable mutant S. t...
Hib VACCINE
• Capsular polysaccharide used as antigen
• Given particularly prior to splenectomy
• 3 dose below six months
...
HPV Vaccine
• 0.5 mL IM deltoid
• Recommended age for initiation of vaccine is
10-12 years
• 3 doses at 0,2,6 months
Chickenpox Vaccine
• Dose--0.5 mL S /C or IM 2 doses 4-8 weeks apart >13
years
Pentavalent vaccine
• Trail in Kerala,Tamil...
National Immunization Schedule
Age Vaccines
Birth BCG, OPV0 (for institutional deliveries)
6 weeks DTwP1, OPV1, HepB1, Hib...
IAP recommended vaccines for
routine use
Vaccines under special
circumstances
BCG,
OPV
IPV
DTwP/DTaP
DT
Td
Tdap
Measles
Ty...
IAP Immunization Time Table
(recommended vaccines for routine use)
Age (completed weeks/ months/years) Vaccines
Birth BCG
...
14 weeks DTwP3/ DTaP3
OPV3*/ OPV3 + IPV3
Hib3
Rotavirus 3
HepB3**
PCV 3
9 months Measles
12 months Hepatitis A 1
15 months...
18 months Hepatitis A 2
2 years Typhoid 1
5 years DTwP B2 / DTaP B2
OPV5
MMR2
Typhoid 2
Varicella 2
10 to 12 years Tdap/Td...
vaccination schedule for an unimmunized child
Visit Suggested vaccines
First Measles (MMR if more than 12 months)
DTwP1/DT...
Do’s and Don'ts After Vaccine Administration
• Do not rub the site vigorously.
• Gentle pressure at the site for a few sec...
THANK YOU
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Immunization

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Immunization

  1. 1. IMMUNIZATION NAVAS SHAREEF.P.P KMCT MED COLLEGE;CALICUT;INDIA Email:nasmbbs@gmail.com
  2. 2. IMMUNIZATION • Immunisation is the process by which acquired immunity is induced. Acquired Immunity • Protection from disease • Provided by introduction antigens or premade antibodies into the body
  3. 3. Acquired Immunity Active immunity • In response to stimulus by an antigen characterized by the production of antibodies by the host. Passive immunity • Immunity transferred in ready made form.ie,no role of immunesystem of the recipient.
  4. 4. Active immunity Naturally acquired • Repeated clinical & subclinical infection in childhood give immunity. • Eg:chicken pox Artificially acquired • Immunity induced by vaccination
  5. 5. Passive immunity Naturally acquired • Transfer of maternal antibodies • Eg: – Through placenta=Ig G – Through colostrum=Ig A Artificially acquired • Following administration of Immune globulin or antiserum • Eg:Anti tetanus serum(ATS)
  6. 6. Immunizing agents • vaccines • immunuglobulins • antisera
  7. 7. VACCINATION • A vaccine is an immuno-biological substance(Ag) designed to produce specific protection against a given disease. • A vaccine is “antigenic” but not “pathogenic”.
  8. 8. Types of vaccines • Attenuated live vaccines • Inactivated killed vaccines • Toxoids • Polysaccharide and polypeptide (cellular fraction) vaccines • Surface antigen (recombinant) vaccines.
  9. 9. Live Vaccines Advantages • Single dose enough • Produce local immunity • lnduce cell mediated immunity • More convenient for mass immunization Disadvantages • Reversion to virulence • Difficulty in storage
  10. 10. Killed Vaccines Advantages • No danger of spread • Stability and safety Disadvantages • Multiple injection may be required • May be contaminated with • dangerous infectious agent
  11. 11. Live Attenuated vaccines Killed Inactivated vaccines Toxoids Cellular fraction vaccines Recombinant vaccines •BCG •Typhoid oral •Plague •Oral polio •Yellow fever •Measles •Mumps •Rubella •Intranasal Influenza •Typhus •Typhoid •Cholera •Pertussis •Plague •Rabies •Salk polio •Intra- muscular influenza •Japanise encephalitis •Diphtheria •Tetanus •Meningococcal polysaccharide vaccine •Pneumococcal polysaccharide vaccine •Hepatitis B polypeptide vaccine •Hepatitis B vaccine
  12. 12. Route Intradermal BCG Subcutaneous Measles, MMR, Meningococcal, Varicella Intramuscular DTwP / DTaP, Hib, Hep A, Hep B, DTwP- Hep B-Hib, DTwP-Hep B, DTwP-Hib, Hep A- Hep B
  13. 13. VACCINE ADVERSE REACTIONS • Local – Pain, swelling, redness at site of injection – Common with inactivated vaccines – Usually mild and self-limited • Systemic – Fever, malaise, headache – Nonspecific – May be unrelated to vaccine • Allergic – Due to vaccine or vaccine component – Rare
  14. 14. VACCINE COLD CHAIN • The system of transporting, storing and distributing vaccines in a potent state at the recommended temperature from the point of manufacture to the point of use is the Cold Chain. • Vaccine potency once lost cannot be restored.
  15. 15. VACCINE COLD CHAIN
  16. 16. Vaccine vial monitor
  17. 17. • Whole cell vaccine –Contains suspension of whole bacterial cells that have been killed. Eg: DTwP –More effective but less safe • Acellular vaccine –Cell free vaccine prepared from purified antigenic component of cell free microorganism. –ie,doesnot have complete cell but contains fragments of cell best suited to stimulate immune response. Eg: DTaP –Less effective than DTwP but more safe
  18. 18. Vaccine Failure • Primary = administration of recommended dose of vaccine doesnot result in adequate protection against disease. • Secondary = disease occur inspite of immunsiation.
  19. 19. INDIVIDUAL VACCINES
  20. 20. BCG VACCINE • Live attenuated vaccine (Bacille Calmettee – Guerin strain) • Dose: 0.05ml in neonates & 0.1ml in others • Intradermal injection in to left hand on deltoid area. • Controls hematogenous spread thus preventing Miliary TB, Disseminated TB, TB Meningo encephalitis(80%) • Reconstitute with 1 ml of Sodium Chloride Inj. IP. • Complications:ulceration ,lymphadenitis... • C.I ---immunocompromised
  21. 21. Oral Polio Vaccine • OPV – Live attenuated Polio virus – Type I - Type II - Type III • Dose – 2 drops oral at birth,6,10, 14 weeks, 16-24 months • Contraindication-in immunocompromised, diarrhea, infectious fever • MgCl2 is the stablizing agent • Pulse polio immunization -- giving 2 doses 1month apart • Complications: Vaccine associated paralytic polio--VAPP (due to type 2)
  22. 22. Injectable Polio Vaccine • Formaldehyde killed and purified poilio virus – Type I-40 – Type II-8 D antigen units – Type III-32 • Immunity – humoral, local pharyngeal, intestinal • Safe • 6,10,14 weeks according to IAP
  23. 23. DTwP / DTaP vaccines • DTaP has been licensed in India for private use • Current recommendations for use of DTaP – For infants who had severe reaction to 1st dose of DTwP – For adolescents and adults – For infant immunized abroad with DTaP • DTaP adult formulation has now been recommended as booster by WHO for adolescents and adults. • Absolute contra indications for DTwP – Anaphylaxis to previous dose – Progressive neurological disorder – Hypotensive hyporesponsive episodes
  24. 24. MEASLES VACCINE • Live attenuated vaccine (Edmonston-Zagreb strain) • Given IM or SC • Given at 9 months (because at that time maternal antibody wean off) • Contraindications – Malignancy – Therapy with alkylating agent/ corticosteroid – Immune deficiency • Side effect -- TSS (toxic shock syndrome) due to bacterial contamination.
  25. 25. MMR vaccine • Measles---Edmonston-Zagreb strain • Mumps-Jeryl Lynn strain • Rubell--RA 27/3 strain • Dose is 0.5 ml (2 dose one at 15 month and another 8 weeks later) (S / C). • Contraindication--pregnancy,immunosuppression
  26. 26. HEPATITIS B VACCINE • Recombinant DNA vaccine (in yeast) • 0.5 mL IM in <1 year and 1 mL > 1 year • 3 doses at 0, 1, 6 months • HBIG gives passive immunity • HBIG should be given preferably within 48 hours of exposure.
  27. 27. TYPHOID VACCINE • 2 doses • 0.5 mL SC 1 month interval (killed vaccine) • Typhoral-- oral live vaccine (stable mutant S. typhi strain type 2 Ia) • Typhim-- give SC or IM single dose
  28. 28. Hib VACCINE • Capsular polysaccharide used as antigen • Given particularly prior to splenectomy • 3 dose below six months • 2 dose between 6-12 months • 1 dose between 12-15 months • And a booster dose should be in this children at 18 months • >15 months--only one dose
  29. 29. HPV Vaccine • 0.5 mL IM deltoid • Recommended age for initiation of vaccine is 10-12 years • 3 doses at 0,2,6 months
  30. 30. Chickenpox Vaccine • Dose--0.5 mL S /C or IM 2 doses 4-8 weeks apart >13 years Pentavalent vaccine • Trail in Kerala,Tamil Nadu • Contains D , P , T , Hib , Hep B. • Schedule-6,10, 14 week
  31. 31. National Immunization Schedule Age Vaccines Birth BCG, OPV0 (for institutional deliveries) 6 weeks DTwP1, OPV1, HepB1, Hib1$$ (BCG if not given at birth) 10 weeks DTwP2, OPV2, HepB2, Hib2 14 weeks DTwP3, POV3, HepB3, Hib3 9-12 months Measles 16-24 months DTwP B1, OPV4, MMR 5-6 years DTwP 10 years TT 16 years TT Pregnant women TT1 (early in pregnancy) TT2 (1 month later) TT booster (if vaccinated in past 3 years)
  32. 32. IAP recommended vaccines for routine use Vaccines under special circumstances BCG, OPV IPV DTwP/DTaP DT Td Tdap Measles Typhoid Hib Hep B MMR HPV PCV Hepatitis A Chicken Pox Rotavirus vaccine Rabies Influenza PPSV23 Japanese Encephalitis Meningococcal Cholera Yellow Fever
  33. 33. IAP Immunization Time Table (recommended vaccines for routine use) Age (completed weeks/ months/years) Vaccines Birth BCG OPV0 HepB 1 6 weeks DTwP1/DTaP1 OPV1*/ OPV1 + IPV1 Hib1 HepB2 Rotavirus 1 *# PCV 1 10 weeks DTwP2/ DTaP2 OPV2*/ OPV2 + IPV2 Hib 2 Rotavirus 2 PCV 2
  34. 34. 14 weeks DTwP3/ DTaP3 OPV3*/ OPV3 + IPV3 Hib3 Rotavirus 3 HepB3** PCV 3 9 months Measles 12 months Hepatitis A 1 15 months MMR1 Varicella PCV booster 16 to 18 months DTwP B1/ DTaP B1 OPV4*/ OPV4 + IPVB1 Hib B1
  35. 35. 18 months Hepatitis A 2 2 years Typhoid 1 5 years DTwP B2 / DTaP B2 OPV5 MMR2 Typhoid 2 Varicella 2 10 to 12 years Tdap/Td HPV^
  36. 36. vaccination schedule for an unimmunized child Visit Suggested vaccines First Measles (MMR if more than 12 months) DTwP1/DTaP1 (Tdap if 7 years or more) OPV1/IPV1 (only if less than 5 years) Hib 1 (Only if less than 5 years) Hep B 1 Second visit (after 1 month of first visit) BCG (only in less than 5 years) DTwP2/ DTaP2 (Td if 7 years or more) OPV 2 (if OPV given earlier) Hep B 2 Hib 2 (if less than 15 mths Third visit (after 1 month of second visit) OPV3/IPV2 MMR (if more than 12 months) Typhoid (if more than 2 years) Fourth visit (6 months after first visit) DTwP3/DTaP3 (Td if 7 years or more) OPV4/IPVB1 HepB3
  37. 37. Do’s and Don'ts After Vaccine Administration • Do not rub the site vigorously. • Gentle pressure at the site for a few seconds will suffice. • If blood oozes do not blot. Just apply gentle pressure with cotton swab. • No Heat, Ice or Cold Water fomentation is advocated. • The wet cloth soaked in ordinary portable water can be applied at the site of swelling or tenderness for about 5 – 10 minutes. • Repeat the procedure, if necessary, 3-4 times a day.
  38. 38. THANK YOU
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