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Immunization

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Immunization & cold chain
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Immunization

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Immunization is a process of protecting an individual from a disease through introduction of live attenuated, killed or organisms or antibodies in the individual system.
Immunization is the process of protecting an individual by active or passive method.

The immunizing agents are
Vaccines, Immunoglobulins and antisera
Why vaccination?
Prevention of deadly and debilitating diseases.
Keeps child from suffering through a preventable illness.
Less doctor visits
No hospitalization

Immunization is a process of protecting an individual from a disease through introduction of live attenuated, killed or organisms or antibodies in the individual system.
Immunization is the process of protecting an individual by active or passive method.

The immunizing agents are
Vaccines, Immunoglobulins and antisera
Why vaccination?
Prevention of deadly and debilitating diseases.
Keeps child from suffering through a preventable illness.
Less doctor visits
No hospitalization

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Immunization

  1. 1. IMMUNIZATION Dr Lipilekha Patnaik Professor, Community Medicine Institute of Medical Sciences & SUM Hospital Siksha ‘O’ Anusandhan deemed to be University Bhubaneswar, Odisha Email- lipilekhapatnaik@soa.ac.in
  2. 2. SESSION OUTLINE • History • What is immunization • Why immunization • How vaccine works • Types of Vaccines • Universal Immunization Programme • National Immunization schedule • Cold chain and vaccines • Mission Indradhanush • Achievements
  3. 3. BEGINNING OF VACCINATION
  4. 4. • Six Killer disease • • Poliomyelitis, • Tuberculosis, • Diphtheria, • • Pertussis, • Tetanus • Measles • In 1796, Jenner took pus from the hand of a milkmaid with cowpox, scratched it into the arm of an 8-year-old boy. • Six weeks later inoculated the boy with smallpox, afterwards observing that he did not catch smallpox. • Jenner extended his studies and in 1798 reported that his vaccine was safe in children and adults. Contd..
  5. 5. IMMUNIZATION • Immunization is a process of protecting an individual from a disease through introduction of live attenuated, killed or organisms or antibodies in the individual system. • Immunization is the process of protecting an individual by active or passive method. • The immunizing agents are Vaccines, Immunoglobulins and antisera
  6. 6. ACTIVE VS PASSIVE IMMUNIZATION Active § Killed or live attenuated organism injectedwhich can induce immune response § Long term § Immune system plays role § Ex-Hepatitis B vaccine, DPT, Inactivated polio vaccine, Measles-rubella (MMR) combined vaccine Passive • Transfer of antibodies • Short term • No role of immune system • Ex- Anti Tetanus, serum, Anti Rabies immunoglobulin etc
  7. 7. WHY IMMUNIZATION • Prevention of deadly and debilitating diseases. • Keeps child from suffering through a preventable illness. • Less doctor visits • No hospitalization
  8. 8. HOW VACCINE WORKS • Development of active immunity,Humoral or cell mediated or both. • Humoral immunity - by secretion of antiobodies from B- cells. • Cell mediated immunity - mediated byT- cells. Eg. In BCG,CMI & Delayed type of hypersensitivity. • Education of reticuloendothelial system of body and production of memory cells or primed cells by both B & T cells.That is devolopment of immunobiological memory.
  9. 9. COMMUNICABLE DISEASES AND VACCINES AVAILABLE • TB – BCG • Measle, Mumps, Rubella - MMR • Chicken Pox - Varicella • Diptheria, Tetanus, Pertussis (aka Whooping Cough) - DPT • Hepatitis (A and B) – HepA, HepB • Polio – OPV, IPV • Rotavirus – RVV • Pneumoccus– PCV • Haemophilusinfluenzae B- Hib
  10. 10. TYPES OF VACCINES • Live, attenuated vaccines • Inactivated vaccines • Subunit vaccines • Toxoids
  11. 11. LIVE VACCINES • Live, attenuated vaccines contain a version of the living microbe that has been weakened in the lab so it can’t cause disease. • Because a live, attenuated vaccine is the closest thing to a natural infection, these vaccines are good “teachers” of the immune system. • Example: Vaccines against polio (OPV), measles, mumps, rubella and chickenpox
  12. 12. INACTIVATED VACCINES • Scientists produceinactivated vaccines by killing the disease-causing microbe with chemicals, heat, or radiation. Such vaccines are more stable and safer than live vaccines. • Because dead microbes can’t mutate back to their disease-causing state. • Example:Vaccines against influenza, inactivated polio vaccine, hepatitis A etc.
  13. 13. TOXOIDS • For bacteria that secrete toxins, or harmful chemicals, a toxoid might be the answer. • These vaccines are used when a bacterial toxin is the main cause of illness. • Scientists have found that they can inactivate toxins by treating them with formalin. Such “detoxified” toxins, called toxoids, are safe for use in vaccines. • Example: Diphtheria,Tetanus toxoid
  14. 14. SUBUNIT VACCINE • Instead of the entire microbe, subunit vaccines include only the antigens that best stimulate the immune system. • Because subunit vaccines contain only the essential antigens and not all the other molecules that make up the microbe. • Example: Plague immunization.
  15. 15. CELLULAR FRACTIONS • Meningococcal vaccine from the polysaccharide antigen of the cell wall. • Pneumococcal vaccine from the polysaccharide capsule of the organism.
  16. 16. COMBINATIONS The aim is to – simplify administration. - reduce costs -minimise the no. of contacts with the health system. Eg. DPT, DT, MMR, DPT& Hep.B, DPT, Hep B & Hib, Hep A & B etc.
  17. 17. MAJOR CONSTITUENTS OF VACCINE 1) Active immunizing antigens- • Live virus, killed bacteria, Toxoids 2) Suspending fluid- • Sterile water, saline or tissue culture fluid. 3) Preservatives, stabilizers, & antibiotics- • Thiomersal. Neomycin, kanamycin. 4) Adjuvants- Al salts frequently used.
  18. 18. UNIVERSAL IMMUNIZATION PROGRAMME • In 1974, Expanded program of Immunization (EPI) organized by WHO • It was called Expanded because: • Adding more disease controlling antigens of vaccination schedules. • Extending coverage to all corners of a country. • On 19 November 1985, GOI renamed EPI program, modifying the schedule as ‘Universal Immunization Program’ • ‘Universal’immunization is, therefore, best interpreted as implying the ideal that no child should be denied immunization against tuberculosis, diphtheria, whooping cough, tetanus, polio and measles.
  19. 19. IF A DOSE IS MISSED…….. • Give the dose at the next opportunity irrespective of the time gap • Do not start the schedule all over again
  20. 20. TETANUS TOXOID • Intramuscular– upper arm – 0.5 ml • Pregnancy – 2 doses - 1st dose as early as possible and second dose after 4 weeks of first dose and before 36 weeks of pregnancy • TT booster for both boys and girls at 10 yearsand 16 years • Primary course of immunization consists of 2 doses of tetanus toxoid at intervalsof 1-2 months. • The booster dose should be given a year after the initial doses. • It should be stored between 4 and 10 deg C.
  21. 21. BCG ¨ WHO recommended Danish 1331 strain to be used. ¨ Initial dose birth or as early as possible till one year of age ¨ 0.1 ml (0.05ml until one month of age) ¨ Intra-dermal ¨ Left upper arm ¨ Freeze dried is more stable. Diluent is Normal saline.
  22. 22. HEPATITIS B • Birth dose – within 24 hours of birth • 0.5 ml • Intramuscular • Antero-lateral aspect of mid-thigh • Rest three doses at 6 weeks, 10 weeks and 14 weeks • It should be stored at 2 to 8 deg C. • 1 ml in adults, 05ml in children <10 yrs, given IM. Mostly used 0,1,6 m schedule.
  23. 23. ORAL POLIO VACCINE ¨ Zero dose – at birth ¨ 2 drops ¨ Oral ¨ First, second and third doses at 6,10 and 14 weeks with Pentavalent-1, 2 and 3 ¨ OPV booster with DPT booster at 16-24 months
  24. 24. PENTAVALENT VACCINE • Simultaneous immunization againstdiphtheria, Pertuisis & Tetanus, Hep B, Hib. • Stored at 4-8 degree C. • Given 0.5 ml IM at anterolat. aspect of thigh. • Primary 3 doses with a booster in 16 -24 months. DT 5-6 yrs. • C/I –progressive neurological diseases.
  25. 25. ROTAVIRAL VACCINE • 3 doses given in 6th, 10th and 14th weeks. • Can be given till one year of age • G9P human strain. • Dose - 5 drops/0.5 ml orally • for prevention of diarrhoea among infants due to rotavirus.
  26. 26. IPV • 2 fractional doses given in 6th and 14th weeks. • Dose – 0.1 ml • Given intradermally in Right upper arm
  27. 27. JAPANESE ENCEPHALITIS • SA 14-14-2 vaccine • 0.5 ml, 2 doses • 9 months and16-24 months • Subcutaneous • Left upper arm
  28. 28. MR VACCINE • Bivalent Live atteunated against measles and rubella. • Given 0.5 ml SC at 9-12 and 16-24 months. • Stored 2-8 deg C • Strain- Measles-Edmonstorn-zagreb, Rubella- Wilstar RA27/3 • Reactions- Fever, Resp. symp.s, Lymphadenitis or parotitis
  29. 29. DPT • Primary doses were in pentavalent vaccine. • One booster at 16-24 m with OPV booster (antero-lateral side of mid-thigh) and second booster at 5-6 years (upper arm) • 0.5 ml • Intra-muscular
  30. 30. VITAMIN A • 1st dose – 1 ml (1 IU) - along-with Measles first dose - Oral • Subsequent 8 doses (2 ml or 2 lakh IU) every six months till 5 years of age starting with DPT first booster at 16-24 months • Use only plastic spoon provided withVitamin A solution
  31. 31. Vaccines and Cold Chain
  32. 32. VACCINES ¨ Live attenuated – BCG,Measles and OPV ¨ Inactivated killed –Whole–cell pertussis,hepatitis B ¨ Toxoid – Diphtheria,Tetanus ¨ All vaccines should be stored at plus 2 to plus 8 degrees ideally in Ice Lined Refrigerators. ¨ BCG and Measles vaccines are in powder form and come with diluents. Reconstitution is needed before use. ¨ Use reconstituted BCG and Measles vaccines within 4 hours of reconstitution and JE within 2 hours of reconstitution if kept at +2 to +8 degrees
  33. 33. Cold WHY HAVE THE COLD CHAIN? If vaccines are exposed to excessive they may lose their potency or effectiveness. Heat Light
  34. 34. HEAT DAMAGE • Heat damage is cumulative effect • Reconstituted vaccine is most sensitive to heat and light. • Measles and BCG vaccines should not be used 4 hrs after reconstitution and JE 2 hrs after reconstitution • Temperature of diluents & vaccine must be same during reconstitution
  35. 35. HEAT SENSITIVITY • BCG (after reconstitution) • OPV • Measles (before and after reconstitution) • DPT • BCG (before reconstitution) • DT • TT • HepB LEAST SENSITIVE MOST SENSITIVE
  36. 36. SENSITIVITY FROM FREEZING • Hep B • DPT • DT • TT LEAST SENSITIVE MOST SENSITIVE
  37. 37. COLD CHAIN • System of storage & transport of vaccines at low temp. from the manufacturer to the actual vaccination site. Manufacturer Airport State/Region District store Health centre Outreach Subcentre
  38. 38. COLD CHAIN • Walk-in-cold rooms-at regional levels. • Deep freezers-for making ice packs and storage of OPV. • Ice-lined refrigerators-at PHC level.
  39. 39. REMEMBER • All vaccines tend to lose potency on exposure to heat above +80 C • Some vaccines (Hep B,TT,DPT) lose potency when exposed to freezing temperatures • Some vaccines are sensitive to light (BCG, Measles). • The damage is irreversible • Physical appearance of the vaccine may remain unchanged but potency might be lost.
  40. 40. VACCINE CARRIERS • Used for carrying vaccines (16-20 vials) and diluents from PHC to the outreach session sites. • With 4 conditioned icepacks maintain inside temperature of 2-80C for 12 hours. • Close the lid of the carrier tightly. • Never use any day carriers with 2 icepacks or thermos flask for carrying vaccines.
  41. 41. USABLE AND UNUSABLE STAGES OF VVM
  42. 42. MISSION INDRADHANUSH • The Government of India launched Mission Indradhanushon 25th December 2014,to cover children who are either unvaccinatedor partially vaccinated against seven vaccine preventable diseases,i.e., diphtheria,whoopingcough,tetanus, polio,tuberculosis,measles and hepatitis B. • The goal is to vaccinate all less than 2 years and under-fiveson demand by the year 2020. • The drive was througha “catch-up” campaign mode. The mission was technically supported byWHO,UNICEF, Rotary International and otherdonorpartners.
  43. 43. ACHIEVEMENTS: • The biggest achievementof the immunization program is the eradication of small pox. • One more significant milestoneis that India is free of Poliomyelitis caused by Wild Polio Virus (WPV) . • Vaccination has contributedsignificantly to the declinein the cases and deaths due to the Vaccine Preventable Diseases (VPDs).
  44. 44. OPTIONAL VACCINES • Pneumococcal vaccine • Typhoid vaccine • MMR vaccine • Hepatitis A vaccine • Chicken pox vaccine • Flu vaccine • Meningococcal vaccine
  45. 45. VACCINES FOR ADULTS • HepatitisA • Hepatitis B • Chicken pox vaccine • Human Papilloma Virus vaccine • Flu vaccine • Pneumococcalvaccine • Meningococcalvaccine

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