Seminar on Childhood Immunization

1. Welcome to CME
On
Childhood Immunization

2. Childhood Immunization
DEPARTMENT OF GENERAL PAEDIATRICS
MU- 07, BSH&I

3. PRESENTER
• DR. MD. MOSTAFIZAR RAHMAN
• DR. KALYANMAY DEB DIP
• DR. FAHMIDA FERDOUS
• DR. MUNEEBUR RAHMAN
• DR. SUVRA ROY
• DR. SAMSUD DOHA ULFAT

4. DR. MD. MOSTAFIZAR RAHMAN
MD RESIDENT(PHASE-B)
BSH&I

5. TOPICS
• Immunization
• History of Vaccination
• Vaccine and Vaccination

6. Immunization
It is the process of inducing immunity
artificially by administering antigenic
substances or preformed antibody against
a particular disease.
It is of 2 types-
‘‘Current Diagnosis & Treatment: Pediatrics, 24th, 2018”

7. Active Immunization
• It is a process of inducing antibody
production or to activate immunologically
competent cell against an infectious agent
through stimulating body’s own immune
system.
• It induces immunity by
- Vaccines or
- Toxoid
‘‘Current Diagnosis & Treatment: Pediatrics, 24th, 2018”

8. Passive Immunization
• It is the process of providing temporary
protection through administration of
exogenously produced antibody.
• It includes-
- Immunoglobulin ( IGIM, IGIV OR IGSC)
- Specific or hyperimmune IG
- Monoclonal antibodies(Palivizumab for RSV).
‘’Current Diagnosis & Treatment: Pediatrics, 24th, 2018”

9. Immunoglobulin and Antiserum
Immunoglobulin Antiserum
1. It is a highly purified
preparation of immunoglobulin
antibodies prepared from adult
plasma donors using alcohol
fractionation.
1. Purified and
concentrated
preparation of serum of
horses actively
immunized against a
specific antigen.
2. Human normal IG
Human specific IG
- Hepatitis B, Diphtheria, Varicella
2. Diphtheria antitoxin,
Heptavalent Botulinum
antitoxin
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st Edition. New Delhi: Elsevier;“2020”

12. Discovery of Vaccine
• Discovered in 1796 by Dr. Edward Jenner
• He found out people infected with cow pox
were immune to small pox.
• Scratching liquid from cowpox sores into the
boy’s skin
– full protection against smallpox.
‘’World Health Organization@2023”

13. 10th century from Central Asia, Smallpox  Africa - Europe
1721, Lady Mary brought smallpox inoculation to Europe
as she had observed practice in Turkey.
1798, Edward Jenner prepared vaccine first time against
smallpox
1885, Louis Pasteur prepared the vaccine against Rabbies
‘’World Health Organization@2023”

14. 1969, MMR(Measles, Mumps and Rubella)
1981, Hepatitis B
1985, Haemophilus Influenza B(Hib)
1955, Salk vaccine against poliomyelitis
1927, BCG (Bacillus Calmette-Guerin)

15. • Vaccine: An antigen used to stimulate the
production of antibodies and to provide
immunity against one or several diseases.
• Vaccination: Administration of antigenic
material to stimulate an individual’s
immune system to develop adaptive
immunity to a pathogen.
15
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st Edition. New
Delhi: Elsevier;“2020”

16. Difference Between Immunization &
Vaccinations
Vaccination Immunization
1. It is a process/ way to achieve
immunization.
1. It is a final result.
2. Suspension , killed micro-
organism or protein antigen
injected or administered orally
into our body.
2. It is a resistance/ immunity
which is developed against
antigen.
3. Producing antibodies through
the body's own immune system.
3. It can be achieved by vaccine or
other than vaccination( Breast
feeding, disease development).
4. Vaccine does not guarantee
complete resistance to a disease.
4. Complete immunity occurs
when a person recovers from the
disease.

17. Types of Vaccines
• Live vaccines
• Live attenuated (avirulent) vaccines
• Inactivated or Killed vaccines
• Toxoids
• Polysaccharide and polypeptide (cellular
fraction) vaccines
• Surface antigen (recombinant) vaccines
• Conjugate vaccines.
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st
Edition. New Delhi: Elsevier;“2020”

18. Types of Vaccines
Live
vaccine
Live
Attenuate
d vaccines
Killed
Inactivated
vaccines
Toxoids Cellular
fraction
vaccines
Recombina
nt vaccines
Conjugat
e
vaccines
Small
pox
(variola)
BCG
Typhoid oral
Oral
polio(Sabin)
Yellow fever
Measles
Mumps
Rubella
Influenza
Typhus
Rota virus
Typhoid
Cholera
Pertussis
Rabies
Salk
polio(IPV)
Japanese
encephalitis
Diphtheria
Tetanus
Meningococcal
polysaccharide
vaccine
Pneumococcal
polysaccharide
vaccine
Hepatitis B
polypeptide
vaccine
Hepatitis B
HPV
Hib
PCV
MCV
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st Edition. New Delhi: Elsevier;“2020”

19. Live Vaccines
• Made from live infectious agents without
any amendment.
• The only live vaccine is “Variola” small
pox vaccine.
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st Edition. New Delhi: Elsevier;“2020”

20. Live attenuated (avirulent) vaccines
• Treated for pathogenic organisms and
become attenuated, avirulent but
antigenic.
• Lost their capacity to induce full-blown
disease but retain their immunogenicity.
• Should not be administered to immune
suppressed persons.
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st
Edition. New Delhi: Elsevier;“2020”

21. Inactivated (killed) vaccines
• Organisms are killed or inactivated by
heat or chemicals but remain antigenic.
• Usually safe, less effective than live
attenuated vaccines.
• Need multiple doses to maintain that
immunity.
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st
Edition. New Delhi: Elsevier;“2020”

22. Toxoids
• Bacterial exotoxin modified to be
nontoxic but capable to induce an
active immune response against the
toxin.
• Adjuvant is used to increase the potency
of vaccine.
• Highly efficacious and safe.
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st
Edition. New Delhi: Elsevier;“2020”

23. Polysaccharide and Polypeptide
(cellular fraction) vaccines
• Prepared from extracted cellular fractions
• Efficacy and safety are high.
‘’Kliegman RM et al. Nelson Textbook of Pediatrics, 21st
Edition. New Delhi: Elsevier;“2020”

24. Recombinant Vaccines
• Vaccine produced through recombinant
DNA technology.
• This involves inserting the DNA encoding
of an antigen that stimulates an immune
response into bacterial or mammalian
cells, expressing the antigen in these cells
and then purifying it from them.
‘’Recombinant vaccine articles from across
Nature Portfolio@Wikepedia”

25. Conjugate vaccines
A conjugate vaccine is a type of subunit
vaccine which combines a weak antigen
with a strong antigen as a carrier so that
the immune system has a stronger
response to the weak antigen.
‘‘Ahmad, H. and Chapnick, E.K., 1999. Conjugated polysaccharide
vaccines. Infectious disease clinics of North America, 13(1), pp.113-133.”

26. DR. KALYANMAY DEB DIP
MD RESIDENT(PHASE-B)
BSH&I

27. TOPICS
• Brief History of EPI in Bangladesh
• EPI Schedule in Bangladesh
• Vaccine Preventable disease under EPI
surveillance
• Cold Chain
• Left out & drop out

28. • WHO launch a global immunization
program known as EPI in May, 1974.
• Expanded Program on Immunization(EPI)
in Bangladesh was launched on April 7,
1979.
• EPI service was made available to all target
groups in phases by the year 1990.
Brief History of EPI in Bangladesh
‘’World Health Organization@2023”

29. Cont….
• Polio Eradication and Elimination of
Maternal and Neonatal Tetanus started
in 1995.
• AFP, Measles and Neonatal Tetanus
Surveillance started in 1997.
• Introduced Hepatitis-B vaccination in
2003.
‘’World Health Organization@2023”

30. • AD syringes was introduced for vaccination
from 2004.
• Introduced Hib and Pentavalent vaccine in
2009.
• Incorporated MR vaccine and measles
second dose from 2012.
• Introduced PCV and IPV from 2015.
Cont….
‘’World Health Organization@2023”

31. Cont….
• In 2016 switched from tOPV to bOPV.
• Switched from IPV to fIPV in November
2017.
• In March 2019 switched from TT to Td.
‘’World Health Organization@2023”

32. EPI Vaccination Schedule for Children
Name of
Vaccine
Age of
Vaccination
Dosage Vaccination site Route of
Injection/ Route
BCG After Birth 0.05 ml Outer upper left arm Intradermal
bOPV
6 weeks,
10 weeks
14 weeks
2 drops Oral Mouth
Pentavalent
(DPT, Hep.B, Hib)
6 weeks,
10 weeks
14 weeks
0.5 ml Outer Mid- thigh (left) Intramuscular
PCV
6 weeks,
10 weeks
14 weeks
0.5 ml Outer Mid- thigh (Right)
Intramuscular
f-IPV
6 weeks
14 weeks
0.1 ml Outer upper arm (Right) Intradermal
MR
After 9 months
After 15 months
0.5ml Outer Mid- thigh (Right) Subcutaneous
**bOPV one dose within 14 days of birth will be considered as an additional dose for the children
“MIS, DGHS@2023’’

34. Td schedule for women of 15-49 years age
Dose Starting dose/ dose interval Duration of Protection
Td-1 15 years completed No Protection
Td-2 At least 4 weeks after Td1 3 years
Td-3 At least 6 months after Td2 5 years
Td-4 At least 1 year after Td3 10 years
Td-5 At least 1 year after Td4 Up to Reproductive age
“MIS, DGHS@2023’’

36. Acute Flaccid Paralysis -AFP (<15 years of
Children)
Neonatal Tetanus (birth to 28 days)
Measles (at any age)
Congenital Rubella Syndrome ( < 1 year
children)
Acute Encephalitis Syndrome ( at any age)
Tuberculosis (<5 years)
Diphtheria (at any age)
Pertussis (at any age)
Tetanus after neonatal period ( at any age)
Vaccine Preventable disease under surveillance
“www.cdc.gov/vaccines”

38. The Cold Chain
• The “Cold Chain" is a system of storage
and transport of vaccines at low
temperature from the manufacturer to
the actual vaccination site.
• The cold chain system is necessary
because vaccine failure may occur due to
failure to store and transport under strict
temperature control.
“www.cdc.gov/vaccines”

39. Cold Chain

40. Left out and Drop Out
“www.cdc.gov/vaccines”

41. Measures for Left out and Drop Out
Drop out:
If a child misses a dose, complete the series
of vaccination, no need for starting the
vaccination afresh.
Left out:
1) Immunization schedule 1st time for 1-5
years of age
a. BCG at first visit
b. Immunization with 3 DPT and 3 OPV,
3 Hep B, 1 Hib
“www.cdc.gov/vaccines”

42. Cont….
c. Measles vaccine- up to 2 years of age.
MR can be given at 15-18 months of age.
A second dose MR should be given at 4-6
years or 11-12 years of age.
2) Immunization schedule 1st time after 5
years of age
a. BCG if MT negative
b. 2 doses of OPV, Td, Hep B
c. MR should be given.
“www.cdc.gov/vaccines”

43. DR. FAHMIDA FERDOUS
MD RESIDENT(PHASE- B)
BSH&I

44. TOPICS
Accessible Vaccines apart from
EPI

45. Non EPI Vaccines
• Rotavirus vaccine
• Cholera vaccine
• Typhoid vaccine
• Hepatitis A vaccine
• Meningococcal vaccine
• Chicken pox vaccine
• Influenza vaccine
• Rabies vaccine
• HPV vaccine

46. Rotavirus vaccine
Rotateq: Live attenuated polyvalent
• Dose: 2 ml, oral 3 doses
• Age: 2, 4 & 6 months
Rotarix: Live attenuated monovalent
• Dose: 1 ml per oral 2 doses
• Age: 2 & 4 months
Must start before 15 weeks &
completed within 8 months of age.
“www.cdc.gov/vaccines”

47. Rotavirus vaccination would prevent 4000
deaths, nearly 500,000 hospitalizations and
3 million outpatient visits. So introducing
Rota vaccine in EPI vaccination like 109
other countries would be cost effective.

48. Cholera vaccine
Inactivated cholera vaccine (V.cholerae O139&
O1)
Dukoral:
• Above 2 years
• 2 dose, 2 weeks apart, oral
Shanchol, Euvichol-Plus,:
• >1 year of age
• 2 dose, 2 weeks apart, oral
‘’World Health Organization@2023”

49. Cholera vaccines should be used in
conjunction with improvements in water and
sanitation to control cholera outbreaks and
for prevention in areas known to be high risk
for cholera.

50. Typhoid vaccine
Inactivated (Vi capsular polysaccharide)
vaccine:
• 2 years of age.
• 0.5ml single dose, IM
• Protection: 2 years
Typhoid Conjugate Vaccine:
• 6 months of age
• 0.5ml single dose, IM
• Protection: 2 years
“www.cdc.gov/vaccines”

51. Live attenuated (Ty21) vaccine:
• 6 years and older.
• One capsule is every other day, for a
total of 4 capsules orally on empty
stomach
• Protection: 5 years
“www.cdc.gov/vaccines”

52. Typhoid conjugate vaccine provided 85%
protection to children vaccinated between 9
months and less than 16 years.

53. Hepatitis A
Inactivated Hepatitis A antigen
• Dose:
1 year to 15 years : 0.5ml, IM
>16 years: 1ml, IM
2nd dose after 6 months apart
• Protection: 20 years to lifelong.
“www.cdc.gov/vaccines”

54. Meningococcal vaccine:
Conjugate meningococcal vaccine
• Dose: 0.5 ml IM
• 2–11 months: 2 doses, 2 months apart
1–29 years : Single dose.
“www.cdc.gov/vaccines”

55. Polysaccharide meningococcal
vaccine
• Dose: one dose ≥ 2 years
• A second single dose is
administered for school
children and adults
• Booster dose 3-5 yearly.
“www.cdc.gov/vaccines”

56. Influenza vaccine
• Inactivated vaccine
• 6 months to 8 year:
2 doses(0.5 mL) IM 4 weeks
apart
>9 years: Single dose
• Then yearly single dose with
updated antigen composition.
“www.cdc.gov/vaccines”

57. Chickenpox Vaccine
• Live attenuated vaccine
• 2 doses, 0.5 ml, IM/SC
• First dose at age 12 -15
months
• Second dose at age
4-6 years.
“www.cdc.gov/vaccines”

58. Human papilloma virus vaccine
• Recombinant vaccine
• Ages (9-15 years ): 0.5 ml, IM, 2 dose 6
month apart
• Age 15 years or older : 0.5 ml, IM, 3-dose
6 months apart
“www.cdc.gov/vaccines”

59. Government of Bangladesh has planned to
includes HPV vaccine in EPI Schedule to
vaccinate the child at 10 years to prevent
cervical cancer which is the second most
common cause of death in female due to cancer
in Bangladesh

60. Anti-Rabies Vaccine (ARV)
• Purified chick embryo
cell vaccine
• Purified vero cell
vaccine
• Human diploid cell
vaccine

61. Pre exposure (ARV)
“National Guideline for Animal Bite Management in Bangladesh 2021”
Service providers in Rabies case
management, laboratory professionals and
caregivers for infected dogs and humans.
Dose: 0.1 ml each site Intradermal (ID)
Day: 0,7
Site: Both Deltoid region(>2 yrs) or
Antero-lateral thigh (if ≤ 2 yrs).

62. Post exposure (ARV)
“National Guideline for Animal Bite Management in Bangladesh 2021”
Category ii: Minor scratches or abrasions,
without bleeding
Category iii: Single or multiple transdermal
bites or scratches with active bleeding
Dose: 0.1 ml each site, ID, Day 0,3,7
Both Deltoid region or Antero-lateral thigh.

63. Rabies Immunoglobulin (RIG)
Post exposure, Category iii wound
Dose: 40 IU per kg body weight (maximum
3000 IU) infiltrated as much as possible into
the anatomically feasible sites into and
around the bite wounds.
“National Guideline for Animal Bite Management in Bangladesh 2021”

64. DR. MUNEEBUR RAHMAN
MD RESIDENT(PHASE-B)
BSH&I

65. TOPICS
Adverse Events Following
Immunization(AEFI)
• AEFI definition & types
• AEFI Surveillance & Notification
• Management of AEFI

67. Adverse Events Following
Immunization (AEFI)
AEFI is any medical incident that takes
place after immunization, cause
concern and is believed to be caused
by immunization.

68. Types of AEFI (CIOMS 2012)
Types of AEFI
1. Vaccine product related reaction
2. Vaccine quality defect related reaction
3. Immunization error related reaction
4. Immunization anxiety related
5. Coincidental event

70. Examples of AEFI
a) Common – minor reactions:
• Local reactions – pain, swelling, redness,
scar or keloid.
• Systemic reactions – fever, irritability,
malaise, loss of appetite, rash,
conjunctivitis, diarrhoea, headache,
muscle pain.

71. Rare – serious reactions:
• BCG: suppurative adenitis, BCG
osteitis, disseminated BCG infection.
• Hepatitis B: anaphylaxis
• Measles/MR: febrile seizures,
anaphylaxis, thrombocytopenia.

72. • OPV : vaccine associated paralytic polio.
• Tetanus: brachial neuritis, anaphylaxis,
sterile abscess.
• DPT: persistent inconsolable crying,
seizures, hypotonic hypo-responsive
episode, anaphylaxis/shock

73. AEFI surveillance
AEFI surveilance system is an integral part
of national immunization programme.
The goal of AEFI Surveillance is
• To ensure the quality and safety of NIP.
• To ensure the quality & safety of vaccine
used in NIP.
• To minimize the negative impact of AEFI
on public health.

74. AEFI Surveillance system

75. Reporting & Notification of AEFI
Case detection is the first important step in
AEFI surveillance.
Which events should be reported?
• Serious AEFI, Cluster AEFI, death, caused
by immunization error etc.
• Minor events are common & usually
expected. No need to be reported.

76. List of reportable AEFI
AEFI Onset following immunization
AFP for OPV recipient 4-30 days
Anaphylaxis after any vaccine Within 48 hours
Brachial neuritis after Tetanus 28 days
Disseminated BCG infection Between 1-12 months
Lymphadenitis, Osteitis,
Osteomyelitis after BCG
Between 1-12 months
Encephalopathy after Measles
After DPT
6-12 days
0-2 days
Intussusception after Rota
vaccine
Within 21 days
Sepsis, severe local reaction Within 7 days

77. AEFI Onset following
immunization
Toxic shock syndrome Within 72 hours
Injection site abscess after any
vaccine
within 14 days
Persistent inconsolable
screaming, Hypotonic hypo
responsive episode after
DTP/PVV
Immediately to 48 hours
Thrombocytopenia after
Measels/MR
1-83 Days, median 12-25 days
Death, hospitalization, disability,
other unusual events
Immediately over telephone.

78. AEFI Reporting system
From community
field worker From UHC
From other
health facility
Hospital
surveillance
officer (HSO)
HSO
Supervisor
UH&FPO/MMO
DHIS2
AHO/ZMO

79. AEFI Report Form

80. Verbal Autopsy
• In case of brought dead
• Home dead or
• Insufficient medical record or clinical
diagnosis is not possible.

81. Verbal autopsy form

82. Investigation of the AEFI
Why AEFI reports should be
investigated?
• To find out the cause and
• To implement follow up actions.
When should be investigated?
Started within 24 hours of notification

83. Which should be investigated ?
Only serious reaction or cluster events
should be investigated.

84. Steps of AEFI investigation
Confirm
information in
report
Investigate &
collect data
Assess the
immunization
service
Specimen
collection
Conclude
investigation
about the
patient
about the
event
about the
vaccine
about
other
people
observing
the service
making
enquiries
vaccine &
logistic
from
patient

85. AEFI Investigation form

86. Causality assessment of AEFI
• To enhance the confidence in the NIP.
• Assessment is done by the National AEFI
Expert Review Committee and
representatives from DGHS, EPI, UNICEF
and WHO.

87. Action and follow-up to AEFI
• Patient care
• Follow-up actions on NIP
• Communication with parents and media
• Treatment

88. Treatment of AEFI
Minor events:
• Fever, local reaction, convulsion:
Symptomatic treatment.
• Local abscess: Incision & drainage
• Suppurative lymphadenitis after BCG:
Incision & drainage, anti TB drugs.
AEFI Sueveillance and Operational Guideline 2021

89. Major events:
• AFP: No specific Rx, supportive
• Anaphylactic reaction: Self limiting, anti-
histamine
• Encephalopathy: No specific Rx,
Supportive
• Anaphylaxis: Adrenaline, hydrocortisone
injection

90. AEFI Management Kit
Includes:
• IV fluid: Ringers lactate,
5%DA, 0.9% NS
• Inj. Adrenaline: 2 amps
• Inj. Hydrocortisone: 1
vial
• Paracetamol: 10 tabs
• Disposable syringes, IV
drip, cotton ball,
adhesive tape & AEFI
report forms.

91. DR. SUVRA ROY
MD RESIDENT(PHASE-B)
BSH&I

92. TOPICS
• Vaccination in special situation
• Vaccination for high risk children and
adolescents
• Recommended Immunizations for
International Travel

93. Preterm Low Birth Weight Baby
•Preterm infants >2kg birth weight, should
be vaccinated according to the same
schedule as for full term infants.
•Birth weight <2kg administer 1st dose at
chronological age 1 month or hospital
discharge whichever is earlier.
“Advisory committee on Immunization Practices @ CDC ”

94. Cont….
•BCG vaccine should not administer before
31 weeks of gestational age.
“Advisory committee on Immunization Practices @ CDC ”

95. Baby of HBs Ag Positive mother
The child should be immunized within 12
hours after birth regardless of birth weight.
•Hepatitis B immune globulin (HBIG) 0.5ml
along with
•Hep B vaccine 3 doses (0, 1, 6months) at
separate sites.
“www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.”

96. Cont….
•If HBIG is not administered, the baby
should be vaccinated at 0,1 and 2 months
along with an additional dose at 9-12
months.
•At 12 months blood should be tested for
HBsAg and anti HBs. If anti-HBs is present,
patient is protected.
“www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.”

97. Cont…
•If HBsAg is positive, then the patient is
carrier.
•If none is positive, the baby should be
immunized afresh at 0,1,6 months
schedule.
“www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html.”

98. Immunodeficiency State
• Live attenuated vaccines should not be
given in immunodeficiency state.
• Children getting corticosteroid
<2mg/kg/24 hr can be immunized during
treatment.
98

99. • If steroid dose is 2 mg/kg/24 hr for <14
days, vaccination delayed until end of
steroid therapy.
• If the duration is >14 days, immunization
should be delayed at least 1 month.

100. Protein-Energy Malnutrition
• Same as EPI schedule.
• WHO recommends administering BCG to
malnourished Children in endemic areas.
• WHO also recommends administering
measles vaccine to all hospitalized
severely malnourished children. A second
dose of measles vaccine should be given
before discharge.
‘’Updates on the management of Severe Acute
Malnutrition in infant and Children@WHO 2013”

101. Immunization Chart of SAM

102. Nephrotic Syndrome
• All vaccines should give 1-3 months after
Prednisolone therapy and 6 months of
cyclophosphamide therapy.
• HBV vaccine: Double dose of HBV
recommended.
• Influenza vaccine: Yearly.
• Varicella vaccine: 2 doses 4-12 weeks
apart.
”Bagga A et all.Pediatric Nephrology ,6th edition”

103. • Pneumococcal vaccine :
<2 years : 2-4 doses conjugate vaccine
(PCV13)
2-5 years : 1 dose conjugate vaccine
followed by one dose 23 valent
polysaccharide vaccine
<10 years : 1 dose polysaccharide
vaccine
”Bagga A et all.Pediatric Nephrology ,6th edition”

104. Post-Splenectomy Vaccines
prophylaxis
• Elective splenectomy patients should
be vaccinated at least 14 days prior to
the operation.
• Asplenic or immunocompromised
patients should be vaccinated as soon
as the diagnosis is made.
104

105. Vaccine Recommendation
Pneumococcal
polyvalent
Every 3-5 years
Meningococcal Every 3-5 years
Haemophilus B
conjugate
Yearly
105

106. Vaccination for high risk children and
adolescents
• High risk children : CHD, Asthma, DM,
cochlear implant, sickle cell disease and
other hemoglobinopathies, splenic
dysfunction, HIV infection, CKD, NS,
malignant neoplasms, leukemia,
lymphomas, solid organ transplantation,
congenital or acquired immunodeficiency's
106

107. • There are 8 vaccines PCV13, PPSV23,
MCV4, MenB, Flu, Hib, Hep A, and Hep B
recommended for child and adolescents
at increased risk for complications from
vaccine preventable disease or child who
have an increased risk for exposure to
these diseases.

108. Recommended Immunizations for
International Travel
1. DTaP
2. Poliovirus
3. Pneumococcal
4. Hemophilus inflenze type b
5. MMR
6. Meningoccocal disease
7. Rotavirus
8. Varicella 108

109. 9. Human papillomavirus
10. Hepatitis B
11. Yellow fever
12. Typhoid fever
13. Rabies
14. Japanese encephalitis
15. Cholera

110. DR. SAMSUD DOHA ULFAT
RMO
BSH&I

111. TOPICS
• Newer Vaccines
COVID -19 Vaccine
Dengue Vaccine
Japanese Encephalitis Vaccine
• Success of Vaccination

112. WHO Recommended Vaccines for COVID19
2023:
• AstraZeneca/Oxford vaccine
• Johnson and Johnson
• Moderna
• Pfizer/BioNTech
• Sinopharm
• Sinovac
• COVAXIN
• Covovax
• Nuvaxovid
• CanSino
112

113. • Bangladesh began the administration of
COVID-19 vaccines on 27 January 2021.
• While mass vaccination started on 7
February 2021.
• 8,52,87,956 among the target of
11,78,56,000 has received at least one
dose.
‘’COVID-19 Pandemic in BD@Wikipedia’’

114. COVID-19 Vaccination for BD
‘’DHIS2, MIS, DGHS@2023’’
• AstraZeneca
• Pfizer
• Sinopharm
• Moderna
• Sinovac
• Janssen (Johnson & Johnson)
• Pfizer (Comirnaty).

115. COVID-19 Vaccination for children
• Vaccination campaign for school children
aged 12-17 was started in Bangladesh
from NOV’2021 by Pfizer-BioNTech.
• Then from Aug 2022, Pfizer-BioNTech
vaccine was given for children aged 5-11
years.

116. Children and COVID-19
Vaccination
Age 5–11 years:
• 2-doses series at 0, 3-8 weeks (Pfizer-
BioNTech)
Age 12–18 years:
• 2-doses series at 0, 3-8 weeks (Novavax,
Pfizer-BioNTech)
“www.cdc.gov/vaccines/covid-19”

117. • Tetravalent, live-attenuated vaccine against
four dengue virus serotypes.
• Children and adolescents 9–16 years old
with lab. confirmation of previous dengue
virus infection and living in dengue-
endemic areas.
• Dose: 0.5 ml, S/C at 0, 6 and 12 months(3
doses series)
Dengue Vaccine
1. CYD-TDV(Dengvaxia):
www.cdc.gov/vaccines/Dengue”

118. Dengue Vaccine
2. Qdenga(TAK-003):
• Approved in European union in Dec’2022
• Live attenuated vaccine
• 6- 45 years
• In all dengue patients but not effective
against DENV-2 serotype.
“WIKEPEDIA”

119. Dengue Vaccine
3. TV-003/005:
• Tetravalent admixture of monovalent
vaccines.
• Phase 3 trial in Brazil.

120. Japanese Encephalitis Vaccine
• Purified, inactivated whole vaccine
• 2 months to adult
• Dose: 0.5 ml (> 2 yrs)
0.25 ml(2 month- 2 yrs)
• 2 doses ( 4 wks apart), IM
• ICDDR,B- trial in Bangladesh
.
“www.cdc.gov/vaccines”

121. Success of COVID-19 Vaccination
UNICEF designated Bangladesh as one of
the "Covid-19 Vaccine Success Stories,"
noting that the country's immunization
rate had grown considerably on Nikkei's
COVID-19 Recovery Index for 2022.
“CBGA ISSUE BRIEF 97/2023”

123. Success of COVID-19 Vaccination
Prompt action, early vaccination drives,
effective awareness campaigns and
widespread public involvement have
enabled Bangladesh to bring more than
90% of its population into COVID‐19
vaccination coverage.
“Health Sci Rep. 2023 May; 6(5): e1281”

124. EPI in Bangladesh has been recognized for its sustained
high coverage and great contribution to the reduction
of childhood morbidity and mortality and it received
two ‘GAVI best performance award’ in 2009 and 2012.
“BANGLADESH J CHILD HEALTH 2015; VOL 39 (2) : 93-98 “

125. Success of Vaccination
• EPI has achieved 83.9% valid full
vaccination coverage in 2019 among the
under one-year old children, which was
only 2% in 1985.
• The WHO has certified Bangladesh as a
Polio-free country on 27 March 2014.
https://bmrcbd.org/Bulletin/bulletin_html/4703/4703_Editorial.php”

126. Annual trend in national valid full vaccination coverage
by age of 12 months among 12-23 months old children
from 2001 to 2019
“EPI coverage Evaluation survey(CES)’ 2019”

127. Bangladesh was honoured with GAVI
Alliance Award in 2009 and 2012 for its
outstanding performance in improving the
child immunization status.
Success of Vaccination
https://bmrcbd.org/Bulletin/bulletin_html/4703/4703_Editorial.php”

128. Tremendous strides in immunization, which
has been recognized by GAVI and awarded
Her Excellency Sheikh Hasina, the Prime
Minister of Bangladesh, the Vaccine Hero
Award in 2019.
https://bmrcbd.org/Bulletin/bulletin_html/4703/4703_Editorial.php”
Success of Vaccination

129. Prime Minister of Bangladesh Sheikh Hasina
receive 2019 “Vaccine Hero” Award

130. THANK YOU
10/8/2023 130