Universal immunization program National immunization schedule.Community Medicine FAQS on inmmunization schedule

1. Universal Immunization Program
Presented by:Dr. Bilkish Nabilal Patavegar
JR II ,Department of community Medicine,Integral Institute of
medical sciences ,Lucknow(UP).

2. National Immunization Schedule
,fIPV 3

4. National Immunization Schedule
Vaccine When to give Dose Route Site
For pregnant women
Tetanus &
adult
Diphtheria
(Td)- 1
Early in
Pregnancy
0.5 ml Intramuscular Upper Arm
Td 2 4 weeks after
Td 1
0.5 ml Intramuscular Upper Arm
Td Booster If received 2
TT/Td doses in
a pregnancy
within the last
3 years
0.5ml Intramuscular Upper Arm

5. Vaccine When to give Dose Route Site
For Infants
Bacillus
Calmette Guerin
(BCG)
At birth or as early as
possible till one year
of age
0.1ml (0.05ml
until 1 month age)
Intra-dermal Left Upper
Arm
Hepatitis B -
Birth dose
At birth or as early as
possible within 24
hours
0.5 ml Intra-
muscular
Antero-
lateral side
of mid thigh
Oral Polio
Vaccine (OPV)-0
At birth or as early as
possible within the
first 15 days
2 drops Oral Oral
OPV 1, 2 & 3 At 6 weeks, 10 weeks
& 14 weeks (OPV can
be given till 5 years of
age)
2 drops Oral Oral
Pentavalent 1, 2
& 3
At 6 weeks, 10 weeks
& 14 weeks (can be
given till one year of
age)
0.5 ml Intra-
muscular
Antero-
lateral side
of Left mid
thigh

6. Vaccine When to give Dose Route Site
For Infants
Pneumococcal
Conjugate
Vaccine(PCV)
Two primary doses at
6 and 14 weeks
followed by Booster
dose at 9-12 months
0.5 ml Intra-
muscular
Antero-lateral
side of right
mid thigh
Rotavirus (RVV) At 6 weeks, 10
weeks & 14 weeks
(can be given till one
year of age)
5 drops
(liquid vaccine)
2.5 ml (lyophilized
vaccine)
Oral Oral
Inactivated
Polio Vaccine
(IPV)
3 fractional dose at 6
and 14 weeks ,9
months
0.1 ml Intra
dermal
Intra-dermal:
Right upper
arm
Measles
Rubella (MR)
1st dose
9 completed months-
12 months. (Measles
can be given till 5
years of age
0.5 ml Sub-
cutaneous
Right upper
Arm

7. Vaccine When to give Dose Route Site
For Infants
Japanese
Encephalitis (JE)
- 1
9 completed months-
12 months.
Cab be given till 15
yrs of age.
0.5 ml Sub-
cutaneous
(Live
attenuated
vaccine)
Left upper
Arm
Vitamin A (1st
dose
At 9 completed
months with
measles-Rubella
1 ml ( 1 lakh IU) Oral Oral
For Children
Diphtheria,
Pertussis &
Tetanus (DPT)
booster-1
16-24 months 0.5 ml Intra-
muscular
Antero-lateral
side of mid-
thigh
MR 2nd dose 16-24 months 0.5 ml Sub-
cutaneous
Right upper
Arm

8. Vaccine When to
give
Dos
e
Route Site
OPV Booster 16-24
months
2
dro
ps
Oral Oral
JE-2 16-24
months
0.5
ml
Sub-cutaneous (Live
attenuated vaccine)
Intramuscular(Killed vaccine)
Left upper Arm (Live
attenuated vaccine)
Anterolateral aspect
of mid thigh (Killed
vaccine)
Vitamin A (2nd
to 9th dose)
16-18
months.o
ne dose
every 6
months till
5 yrs
2
ml
(2
lakh
IU)
Oral Oral
DPT Booster-2 5-6 years 0.5
ml
Intra-muscular Upper Arm
Td 10 years &
16 years
0.5
ml
Intra-muscular Upper Arm

9. Tetanus and adult diphtheria VACCINE
TYPE KILLED – TOXOID
DOSE
0.5ml
Vial-10 dose
ROUTE OF ADMINISTRATION DEEP INTRA-MUSCULAR
SITE OF INJECTION Upper Arm
IMMUNIZATION SCHEDULE 10 And 16 yrs,Pregnancy
COMPOSITION
Each single 0.5 ml human dose
contains
Diphtheria Toxoid ≤ 5 Lf (≥ 2 IU)
Tetanus Toxoid ≥ 5 Lf (≥40 IU)
Adsorbed on Aluminium
Phosphate, Al+++ ≤ 1.25 mg
Preservative: 0.005% Thiomersal

10. Bacille Calmate Guerin (BCG) VACCINE
TYPE
LIVE ATTENUATED – FREEZE
DRIED POWDER
DANISH 1331 STRAIN
DOSE
0.1ml
Vial-10 doses
ROUTE OF ADMINISTRATION INTRADERMAL
SITE OF INJECTION
Just above insertion of Deltoid
LEFT SIDE
IMMUNIZATION SCHEDULE SINGLE DOSE @ BIRTH
REMARKS
DILUENT IS NORMAL SALINE
RECONSTITUTED VACCINE
SHOULD BE USED WITHIN 4
HOURS
VACCINE BOTTLE IS DARK BROWN
SPECIAL TUBERCULIN SYRINGE

11. Normal reaction after BCG vaccination
• Immediately after a satisfactory injection— wheal of 5 mm in diameter which later
subsides.
• After 2–3 weeks—a papule develops which gradually grows in size till 4-8 mm.
• After 5 weeks—the papule subsides or breaks down into a shallow ulcer, usually
covered with a crust.
• Within 6–12 weeks—healing occurs, leaving a permanent scar, 4–8 mm in diameter.
• Mantoux positivity develops usually after8weeksof injection.
If no scar appears after administering BCG, should one re-vaccinate the child?
There is no need to re-vaccinate the child even if there is no scar.

12. • Complications-
– Prolonged or severe ulceration,Suppurtive
lymphadenitis,Tubercular osteomyelitis,Disseminated BCG
infection
• Contraindications
– Generalized eczema,Infective dermatosis,Pregnancy
– Immunocompramised
states(Hypogammaglobenemia,AIDS,congenital
immunodeficiency,leukemia,lymphoma,generalized
malignancy under chemotherapy)
• Protective efficacy_
• For 15-20 years, partial protection.
• Prevents severe form of childhood tuberculosis such as
military tuberculosis and meningitis
• It gives predominantly cell mediated(delayed-type
hypersensitivity) type of immunity

13. ORAL POLIO (SABIN) VACCINE
TYPE
LIVE ATTENUATED
TRIVALENT – ALL 3 STRAIN TYPES
BIVALENT – TYPE 1 & 3
DOSE 2 DROPS
ROUTE OF ADMINISTRATION ORALLY
IMMUNIZATION SCHEDULE 6 – 10 – 14 WEEKS
BOOSTER @ 16 – 24 MONTHS
PROTECTIVE EFFICACY 70 – 80%
REMARKS
MOST HEAT SENSITIVE
KEPT @ 2 – 8 d CELCIUS

14. HEPATITIS – B VACCINE
TYPE KILLED – RECOMBINANT
DOSE 0.5ml
ROUTE OF ADMINISTRATION INTRA-MUSCULAR
SITE OF INJECTION
INFANTS: ANTERO-LATERAL MIDTHIGH
ADULTS: DELTOID
IMMUNIZATION SCHEDULE
INFANTS: 0 DOSE @ BIRTH
6 – 10 – 14 WEEKS
-----------------------------------------------------
ADULTS: 0 – 1 – 6 MONTHS
PROTECTIVE EFFICACY 98 – 99%

15. LIQUID PENTAVALENT VACCINE (LPV)
INTRAMUSCULAR @ LEFT ANTERO-LATERAL MID THIGH – 0.5ml

16. LPV
• Protection:85-95%.Protection for at least 15 years
or life long
• Adverse reaction:
– Local inflammation, mild fever
• Contraindications:
– Severe allergic reaction to previous dose
– Moderate or severe acute illness
• Special precaution:
• Storage:2-80C
• Availability:5 ml vial (10 doses)

17. • What are the side effects of pentavalent vaccine?
• Pentavalent vaccine has not been associated with any serious side
effects. However, redness, swelling, and pain may occur at the limb
site where the injection was given. These symptoms usually appear
the day after the injection has been given and last from one to
three days. Less commonly, children may develop fever for a short
time after immunization
• Is there any reason why a child should not be given pentavalent
vaccine?
• Although serious side effects have not been reported, a child who
has had a severe reaction to pentavalent vaccine earlier should not
be given another dose.
• What types of pentavalent vaccine are available?
• The pentavalent vaccine is available in various forms of liquid and
lyophilized. However, under the UIP in India, the vaccine will be
available as a liquid formulation only.

18. Pneumococcal Conjugate vaccine(Prevnar 13)
TYPE
KILLED, CONJUGATE VACCINE
13 SEROTYPES STREPTOCOCCUS
PNEUMONIAE ARE INDIVIDUALLY
CONJUGATED TO A NONTOXIC VARIANT
OF DIPHTHERIA TOXIN.
DOSE
0.5 ml
Vial-4 dose
ROUTE OF
ADMINISTRATION
Intramuscular
SITE OF INJECTION
Right mid - thigh in infants
IMMUNIZATION SCHEDULE
Two primary doses at 6 & 14 weeks of
age
booster dose at 9 months of age
REMARKS
Protective efficacy:80%
PCV protects children against severe
forms of pneumococcal disease, such as
otitis media, pneumonia and meningitis.

19. • Side Effects
• Injection site reaction,fever (
39ºC),irritability,drowsiness, restless sleep,
decreased appetite, vomiting, diarrhoea, and
rash
• Contraindications:
• Those who have had severe allergic reactions to a
prior dose.
• Those who are known to have had a severe reaction
to another vaccine containing diphtheria toxoid.
• Those who have a severe illness; vaccination should
be delayed until the condition improves.

20. ROTAVIRUS VACCINE(Rotavac)
TYPE
LIVE ATTENUATED Monovalent
Liquid frozen
Strain
116E prepared in Vero cells
NLT 105.0 FFU of live Rotavirus
116E.
DOSE
5 DROPS(0.5)
Vial -10 dose
ROUTE OF ADMINISTRATION ORAL
IMMUNIZATION SCHEDULE 6 weeks,10weeks,14 weeks
REMARKS Once opened should be used within 4
hours
Protective efficacy
Preventing Severe rotavirus
gastroenteritis 54-60 %

21. The vaccine is in a liquid or frozen form. In liquid form, the vaccine is
generally pink in colour and may sometimes change to orange or light yellow
in colour. This change in colour does not impact the quality of the vaccine. Š
The vaccine is supplied with a pink coloured dropper that is longer and wider
than the dropper used for OPV.

22. Contraindications to Rotavirus Vaccine
• Š
Known or documented allergic reaction to the vaccine.
• History of documented intussusception or abdominal
surgery or intestinal malformation. Š
• Known case of immunodeficiency.
• Administration of Rotavirus vaccine should be postponed in
infants suffering from moderate to severe diarrhea or
vomiting requiring rehydration therapy. In such cases the
vaccine can be administered after recovery from illness
• What are the common side-effects of Rotavirus vaccine?
Mild and transient symptoms include Vomiting,
Diarrhoea,Cough, Runny nose, Fever,Irritability and Rash

23. Inactivated Polio Vaccine
TYPE KILLED POLIO VIRUS VACCINE TYPE 1,2,3 ANTIGENS
FORMULATION
IPV MAY CONTAIN FORMALDEHYDE,TRACES OF STREPTOMYCIN,NEOMYCIN OR
POLYMYXIN,2-PHENOXYETHANOL
COMPOSITION
POLIOVIRUS TYPE 1 STRAIN MAHONEY(INACTIVATED)-40D ANTIGEN UNIT
POLIOVIRUS TYPE 2 STRAIN MEF-1(INACTIVATED)-8 D ANTIGEN UNIT
POLIOVIRUS TYPE 3 STRAIN SAUKETT(INACTIVATED)-32 D ANTIGEN UNIT
DOSE & STORAGE 0.1 ml,+2 TO +8 0C Vial-2.5 ml
ROUTE OF
ADMINISTRATION
Intradermal
SITE OF INJECTION Right upper arm
IMMUNIZATION
SCHEDULE
6 weeks,14 weeks and 9 month
Protective efficacy More than 90 percent

24. Contraindications for IPV
1. Known or documented allergy to vaccine components:
a. Streptomycin
b. Neomycin
c. Polymixin – B
2. History of allergic reaction to previous IPV injection
3. Thrombocytopenia
4. Any other bleeding disorder
5. Temporarily taking immunosuppressant, as this can suppress the
immune response to the vaccine.
• Postpone the vaccination until the end of the treatment to ensure full
protection by the vaccine
What are the common side-effects of IPV?
IPV is one of the safest vaccines
Infrequently reported side effects:
• Swelling, redness and pain at injection site,
• Fever and
• Discomfort

25. • Why was the need felt to introduce IPV in the National
immunization schedule?
1. Though OPV offers effective protection against polio, but in
very rare cases it can itself lead to paralysis
a. Vaccine virus can spontaneously change and become
capable of causing disease (Vaccine Associated Paralytic Polio
or VAPP)
A large proportion of this is from type 2 OPV
b. Rare outbreaks are caused by person-to-person spread of
vaccine strain, which mutates/changes to a highly
transmissible form capable of causing disease (Circulating
Vaccine Derived Poliovirus or cVDPV)
97% of these outbreaks are from type 2 OPV virus
c. On the other hand WILD type 2 poliovirus has been
eliminated since 1999

26. • To solve the problem of VAPP and cVDPV, a step is being taken to ‘SWITCH’
from trivalent Oral Poliovirus Vaccine (t OPV) to bivalent Oral Poliovirus
Vaccine (b OPV) at the global level.
This switch will solve the problem of VAPP & VDPV to a great extent but at
the same time
o The immunity of the subsequent birth cohorts against strain 2 will
plummet due to the absence of the same from the vaccine and
o There is a risk of outbreaks of cVDPV type 2 as it is circulating in the
population due to use of t OPV in the national programme.
The strategy to tackle this threat is simultaneous introduction of IPV in the
immunization schedules because:
o It does not have potential to cause VAPP or VDPV (as it is a killed
vaccine) and
o It will maintain the immunity level of the population against all the three
strains of the virus (since it has all 3 strains
• Will IPV (injection) replace OPV (drops)?
No, IPV will not replace OPV, since IPV is recommended to be
administered in addition to OPV.

27. DPT(Diphtheria-Pertusis-Tetanus
Vaccine)
• Type-Triple antigen
– Diphtheria toxoid+Tetanus toxoid+Killed whole cell of pertusis
• Composition:
– Each 0.5 ml contains
– Diphtheria toxoid-20Lf(Limit of flocculation)
– Tetanus toxoid-0.5 Lf
– Pertusis killed-20,000 million
– Adjuvant:Aluminium phosphate-2.5mg
– Preservative:Thiomersal-0.01%
• Schedule
– Primary:6,10 and 14 week of age
– Booster:16-24months and 5 years.
– Protective efficacy
Diphtheria: Almost 100%
Tetanus: Almost 100%
Pertussis: 75%

28. DPT
• Administration
– Dose-0.5 ml
– Route-Deep intramuscular
– Site-Outer left mid thigh
• Adverse reactions
– Mild local(pain ,redness),fever,rarely convulsions,encephalitis/encephalopathy,infantile
spasms and Reyes syndrome
• Contraindications
– Serious illness requiring hospital admission
• Presence of a progressive neurological disorder
• Convulsions
• A severe reaction to one of the previously given DPT, e.g.,
- Shock or collapse
- Persistent crying episode
- Anaphylactic reaction
• High temperature: >40°C (104°F)
• Other neurological manifestations

29. DPT
• Special precautions
– Never freeze
– Shake the vial to mix before vaccination
– DPT not given over 7 year of age
• Storage:
– 2-8 0C.Not kept over a long time at room temperature
• Protective value-
– Durable
– Antibody level >1IU/ml is maintained up to 10 year of age

30. Side effects of DPT and Td
• Side effects
• Fever
• Local swelling ,pain
• Neurological:Encephalitis,convulsions,infantile
spasms, Reye’s syndrome

31. • Why give the DPT vaccine in the antero-lateral mid thigh and
not the gluteal region (buttocks)?
– DPT is given in the antero-lateral mid-thigh and not the gluteal
region to prevent damage to the sciatic nerve. Moreover, the
vaccine deposited in the fat of gluteal region does not invoke
the appropriate immune response.
• What should one do if the child is found allergic to DPT or
develops encephalopathy after DPT?
– A child who is allergic to DPT or develops encephalopathy after
DPT should be given the DTaP / DT vaccine instead of DPT for
the remaining doses, as it is usually the P (whole cell Pertussis)
component of the vaccine which causes the
allergy/encephalopathy. It may be purchased with locally
available resources.

32. • Why should there be a minimum gap of 4 weeks
between two doses of DPT?
• This is because decreasing the interval between two
doses may not obtain optimal antibody production for
protection.

33. Open vial policy
guidelines(DPT,TT,LPV,HBV,OPV,IPV,P
CV)
• Vaccines opened in a fixed or outreach session can be used at more
than one immunization session for up to 4 weeks provided:
– The expiry date has not been reached
– VVM has not reached the discard point
– Vaccines are stored in appropriate cold chain conditions, both
during transportation and in the cold chain storage point
– Vaccine septum has not been submerged in water or
contaminated in any way
– No case of AEFI has been reported.

34. MEASLES and RUBELLA VACCINE
TYPE
LIVE ATTENUATED LYOPHILIZED
1000 TCID 50 EDMONSTON – ZAGREB STRAIN
1000 TCID50 Wistar RA 27/3
DOSE 0.5ml VIAL-10 DOSE
ROUTE OF ADMINISTRATION SUB-CUTANEOUS
SITE OF INJECTION RIGHT UPPER ARM
IMMUNIZATION SCHEDULE
1ST DOSE @ 9 – 12 M
2ND DOSE @ 16 – 24 M
ADVERSE REACTIONS
Mild fever ,rash,rarely toxic shock
syndrome,encephalitis,anaphylaxis
CONTRAINDICATIONS
Severe reaction to previous
dose,untreated active
tubeculosis,immune
disorder,(Symptomatic HIV)
REMARKS
DILUENT USED IS DISTILLED WATER
Use within 4 hours of reconstitution
PROTECTIVE EFFICACY: 95 – 100%

35. • Storage:2-80c,may be frozen during long
storage
• Reconstituted measles vaccine is sensitive
to heat and light.
• It is always stored in coloured glass vials.
• Since it does not contains the
preservative,there is risk of contamination
with staphylococcus aureus leading to
TSS(severe watery diarrhoea,vomiting
and high fever.Death within 48 hrs)
• It should not be used beyond 4 hrs after
reconstitution.

36. • Side effects:
• Fever and rash
• Contraindications
• Immunocompramised host
• Severe egg allergy
• Pregnancy

37. JAPANESE ENCEPHALITIS VACCINE
Nakayama Strain

38. JE VACCINE
• Diluent:
STERILIZED PHOSPHATE BUFFER
SOLUTION
• If a child above 2 years (24 months) of age has
not received the JE vaccine through either RI
or an SIA, should s/he be given the JE vaccine?
• Yes, the child is eligible to receive a dose of
the JE vaccine, through RI, till the age of 15
years.

39. • Side effects
• Transient fever
• Rash
• Irritability
• Local reaction at injection site(induration
and tenderness)
• Contraindications
• Fever or malnutrition
• Acute infectious diseses
• Active untreated tuberculosis
• Allergy, convulsions
• Immunocopramized state

40. RETINOL PALMITATE (VITAMIN ‘A’) SYRUP
TYPE
NUTRITIONAL INTERVENTION
RETINOL – 1,00,000 IU/ml
DOSES & SCHEDULE
1ST DOSE @ 9 M – 1ml
8 MORE DOSES OF 2ml @ 6 M GAP
TILL 5 YEARS OF AGE
ROUTE OF ADMINISTRATION ORALLY BY MARKED SPOON
REMARKS
DARK COLORED BOTTLE
KEPT AWAY FROM SUNLIGHT

41. • What is the treatment schedule for children with
clinical signs of vitamin A deficiency?
• Administer 200,000 IU of Vitamin A immediately
after diagnosis, followed by another dose of
200,000 IU, 1-4 weeks later.
• What are the storage guidelines for un-opened
bottles of Vitamin A solution?
• Vitamin A solution must be kept away from direct
sunlight and can be used until the expiry date.
• How long can a bottle of Vitamin A be used, once
opened?
• A Vitamin A bottle, once opened, should be used
within 6-8 weeks. Write the date of opening on the
bottle.

45. • If the mother/caregiver permits
administration of only one injection during an
infant’s first visit at 9 months of age, which
vaccine should be given?
• At 9 months of age, the priority is to give
measles vaccine with OPV and Vitamin-A.

46. • Which vaccines can be given to a child
between 1-5 years of age, who has never been
vaccinated?

47. Vaccines which can be given to a child between 1-5 years of age, who has
never been vaccinated
DPT1, OPV-1, MR-1 and 2ml of Vitamin A JE
One month later-DPT-2, OPV-2,MR-2
One month later-DPT3, OPV-3
JE-3months after 1st dose
DPT 1st & OPV Booster minimum of 6 months after administering OPV3/DPT
3.Vitamin A 2ml
Vitamin A at 6 month interval till 5 years of age.
DPT Booster at 5 years

48. • Which vaccines can be given to a child
between 5-7 years of age, who has never been
vaccinated?

49. Vaccines which can be given to a child between 5-7 years of age, who has
never been vaccinated
DPT-1 on 1st visit
One month later-DPT-2
One month later –DPT-3
DPT 1st Booster minimum of 6 months after administering DPT- 3 up to 7
years of age

50. • Why is it not advisable to clean the
injection site with a spirit swab before
vaccination?
• What is meaning of left out and drop out?
• When we will say that child is fully
immunized?

51. Situations
• What is your advice regarding immunization under the
following situations ?
1. Unimmunized child 11 months comes to OPD for the first
time
2. A Child 11 months old comes to OPD with history of only
OPV1/Pentavalent-1/rota-1/PCV-1/fIPV-1 immunization at
3 months
3. A child, 13 months old, has not been immunized at all
presents to OPD for the first time
4. A child, 25 months comes to OPD with a previous history
of BCG, OPV2/Panta-2/Rota-2 immunization
5. A child, 4 years old, not immunized at all earlier comes for
vaccination.

52. Terminology
• Primary immunization
• Fully immunized
• Partially immunized
• Unimmunized
• Reverse cold chain
• 30 cluster survey for immunization coverage
evaluation

53. Auto-disabled Syringes
• Pre-sterilized in sealed pack with fixed needle
• 0.1 and 0.5 ml capacity
• Designed to prevent reuse of non-sterile syringes
• Reduces blank space in syringe that waste vaccine
• Eliminates chances of entry of air bubbles
• Dose-specific-ensures the correct dose
• The plunger can go back and forward only once
• The plunger gets locked after compete dose of vaccine
is pushed in.