Describing the achievements of immunization globally and in Sri Lanka and providing the immunization schedule used in Sri Lanka in 2016

1. Dr.Murali Vallipuranathan
MBBS, PGD (Population Studies), MSc, MD (Community Medicine), FCCP
Consultant Community Physician

3.  A significant breakthrough came in 1796 when British physician
Edward Jenner discovered that he could immunize patients against
smallpox by inoculating them with material from cowpox sores.

4. A mosaic from the early 14th century shows a man infected with smallpox, a once-
common disease that killed millions during the Middle Ages. The mosaic is located
inside Kariye Mosque, also known as Church of Christ the Savior in Chora, in Istanbul,
Turkey.

7.  In 1885 Louis
Pasteur created
the first successful
vaccine against
rabies.

8.  1798 Smallpox
 1885 Rabies
 1897 Plague
 1923 Diphtheria
 1926 Pertussis
 1927 Tuberculosis (BCG)
 1927 Tetanus
 1935 Yellow Fever

9.  After World War II
 1955 Injectable Polio Vaccine (IPV)
 1962 Oral Polio Vaccine (OPV)
 1964 Measles
 1967 Mumps
 1970 Rubella
 1981 Hepatitis B

10.  In 1954 Jonas Salk introduced an injectable vaccine containing an
inactivated virus to counter the epidemic of poliomyelitis.

11. Poliomyelitis is an infectious viral disease that sometimes results in paralysis of the
muscles involved in breathing. In the early half of the 20th century, paralytic patients
were treated using an iron lung, or respirator, a large cylinder that encased the patient in
an airtight seal. Motors in the iron lung forced air in and out of the patient’s lungs,
providing lifesaving support until recovery and rehabilitation restored the ability to
breathe unaided. There is still no cure for polio, although effective vaccination programs
have virtually eradicated polio in most industrialized nations.

12.  Subsequently, Albert Sabin developed an oral vaccine containing a live
weakened virus.
 Since the introduction of the polio vaccine, the disease has been
nearly eliminated in many parts of the world.

13. 1979
Worldwide Vaccinations Eliminate Smallpox
After two years without a reported case, the World Health
Organization announces that smallpox is eradicated. Smallpox is
an often-fatal, highly contagious, viral disease once fairly
prevalent around the world.

14. Year Milestone
1802 Vaccination against smallpox was introduced
1886 Vaccination against smallpox re-introduced under
the Vaccination Ordinance
1949 BCG vaccination introduced against tuberculosis
1961 Triple vaccination introduced against diphtheria,
whooping cough and tetanus
1962 Oral Polio Vaccine introduced
1963 BCG vaccination of newborn introduced

15. Year Milestone
1969 Tetanus Toxoid administration to pregnant mothers introduced
1978 Launching of the Expanded Programme on Immunization (EPI)
1981 Revision of the immunization schedule and the introduction of a
modified list of contraindications
1984 Measles vaccination introduced
1985 Strengthening of cold chain and logistics in EPI

16. Year Milestone
1989/90 Achievement of Universal Childhood Immunization
(UCI) with 80% coverage of all infants with the
vaccines of EPI
1991 Revision of Tetanus Toxoid schedule
1995 First National Immunization Days (NIDs)
1996 Immunization against rubella commenced
2000/01 Revision of immunization schedule and introduction
of Measles Rubella vaccine
2003 Introduction of Hepatitis B vaccine
2008 Introduction of Hib containing Pentavalent vaccine

17. • Last case of polio in 1993
• Near elimination of tetanus and neonatal
tetanus cases
• Zero incidence of diphtheria since 1995
• Near elimination of measles cases
• Reduction of incidence of whooping
cough
• Near elimination of Congenital rubella
syndrome

20.  Global Eradication of smallpox
 Eradication of poliomyelitis in several countries and elimination in
other countries.
 Reduction of morbidity and mortality due to vaccine preventable
diseases.

22.  Identification of specific tumor antigens provide immune
targets for which immunogenic vaccines may conceivably
be designed. Examples:
 Leukemia
 Breast cancer
 Melanoma
 Prostate cancer
 Colon cancer
 Vaccines against autoimmune diseases
22

23. 1.Immunization programme will be continuously overburdened with
 newer and efficient vaccines added against more diseases
 coverage of increasing population
2. Health care systems of the developing countries will be finding it more difficult to
maintain the immunization programmes
3. Global effort and peaceful atmosphere is needed to achieve eradication
4. Global effort and newer strategies are needed to reduce the cost of the vaccines
and to control diseases more effectively

24. 0-4 weeks BCG Before leaving hospital,
preferably within 24 hours of
birth.
If a scar is not present 2nd dose
could be offered after
6months, up to 5 years
Red indicates mandatory vaccines used in the
government sector
Blue indicates optional vaccines used in the
private sector

25. On completion of
2nd Month Polio & Pentavalent (DTP-
HepB-Hib) (1st dose)
Pneumococcal Vaccine
Rota virus vaccine
For a defaulter or for an un-
immunized child minimum of
6-8 weeks gap between doses
is adequate
4th Month Polio & Pentavalent (DTP-
HepB-Hib) (2nd dose)
Pneumococcal Vaccine
Rota virus vaccine
Preferably 6-8 weeks after
1st dose
6th Month OPV & Pentavalent (DTP-
HepB-Hib) (3rd dose)
Pneumococcal Vaccine
Rota virus vaccine
Preferably 6-8 weeks after
2nd dose

26. 9th Month MMR ( 1st Dose ) On completion of 9 months
IN SECOND YEAR OF LIFE
At 12 months A dose of Live JE Vaccine On completion of 1st year
At 18 months Polio & DTP (4th dose)
Hepatitis B + Hib
Chicken Pox (2 doses)
Hepatitis A (2 doses)
On completion of 18th month

27. PRE SCHOOL GOING AGE
At 3 years MMR (2nd Dose)
Typhoid
On completion of 3rd year
SCHOOL GOING AGE
At 5 years Polio & DT (5th dose) On completion of 5th year
In School
At 12 years aTd (adult Tetanus diphtheria)
Human Papilloma Virus (3
doses)
On completion of 11th year

28. PREGNANT WOMEN
A. 1st Dose Tetanus Toxoid During 1st pregnancy, after 12 weeks of POA
B. 2nd Dose Tetanus Toxoid During 1st pregnancy,6-8 weeks after the
1stdose
C. 3rd Dose Tetanus Toxoid During 2nd pregnancy, after 12 weeks of POA
D. 4th Dose Tetanus Toxoid During 3rd pregnancy, after 12 weeks of POA
E. 5th Dose Tetanus Toxoid During 4th pregnancy, after 12 weeks of POA
F. One booster dose of Tetanus
Toxoid (TTb)
Tetanus Toxoid During 1st pregnancy with a written evidence
of previously being immunized with 6 doses
of Tetanus Toxoid as per National EPI
schedule (3 doses of DPT in infancy + DPT at
18 months + DT at 5 years + aTd at 12 years)
during childhood and adolescent and a gap of
10 years or more after the last Tetanus Toxoid
containing Immunization.

29. FEMALES IN THE CHILD-BEARING AGE GROUP
15-44 years Rubella containing vaccine
(MMR)
One dose of MMR vaccine
should be given to all females
between 15 and 44 years of age,
who have not been immunized
with rubella containing vaccines
earlier.