BCG OPV and IPV

1. BCG, OPV, IPV &
CATCH-UP VACCINATION
PRAVEEN RK
NO: 75

2. BCG VACCINE

3. BCG
• Bacillus Calmette Guerin
• Live attenuated vaccine against Tuberculosis
• Protects against TB Meningitis, Miliary TB
• Common strains used- Copenhagen(Danish1331), Pasteur , Glaxo
• Danish 1331- Produced at Guindy, Tamil Nadu, India
• Available as lyophilised (freeze dried) powder
• Reconstituted with sterile normal saline

4. • Induces Cell mediated immunity
• Primary infection is not prevented
• Protects against severe form of TB – miliary TB, TB meningitis
• Protective efficacy – 80%
• Duration of protection – 15 to 20 years
• Maternal antibodies do not interfere as CMI do not transfer transplacentally
• Administration at birth provides – early protection
ensures compliance
convenient to implement

5. • Dose – 0.05ml (neonates) , 0.1ml (infants and children)
• Route of administration – intradermal (26G needle)
• Site – left upper arm at insertion of deltoid

6. PHENOMENA AFTER VACCINATION
Permanent tiny round scar 4-8mm diameter
Healing occurs (6-12 weeks)
Breaks into shallow ulcer with crust
Increases size with diameter of 4-8mm (5-6 weeks)
Papule at site of injection (2-3 weeks)

7. SCHEDULE
• National Immunization Program
• At birth
• Catch up till 1 yr
• IAP 2016
• At birth
• Catch up till 5 yr

8. ADVERSE REACTIONS
• Persistent ulceration at injection site
• Discharging sinus
• Ipsilateral axillary or cervical lymphadenopathy
• Disseminated infection
• Osteomyelitis
• Scrofuloderma (immunodeficient persons)

9. CONTRAINDICATION
• Immunodeficiency (HIV, leukemia, lymphoma)
• Generalized eczema
• Infective dermatosis
• Hypogammaglobinemia

10. STORAGE
• 2-8oC
• Sensitive to heat and light
• Discard unused vaccine after 4h

11. ORAL POLIO VACCINE

12. OPV
• Live attenuated polioviruses (types 1, 2, 3)
• Developed by Sabin
• Each dose (2drops) contain 105 to 106 median cell culture doses of each serotypes
• Stabilizing agent – Magnesium chloride
• Multiple doses are needed to ensure take
• Vaccine of choice for eradication of poliovirus where wild poliovirus is still
circulating
• Given as bivalent OPV (serotypes 1&3)

13. • Included in
• Pulse Polio Immunization
• Supplementary immunization activities
• National Polio Surveillance Project
• National Immunization program

14. DEVELOPMENT OF IMMUNITY
Administration of vaccine
Infect intestinal mucosa
Multiplication in mucosal cells (take)
Provides local as well as systemic immunity

15. • Dose – 2 drops
• Route of administration – Oral
• Method of administration –
Tilt the child’s back and gently squeeze the cheeks or pinch the nose
to make the mouth open. Let the drops fall from the dropper onto the
child’s tongue. Repeat the process if child spits out the vaccine

17. SCHEDULE
• National Immunization Program
• OPV0 at birth or within 15 days
• OPV1 at 6th week
• OPV2 at 10th week
• OPV3 at 14th week
• OPVb at 15-18 months and 5yr

18. • IAP 2016
• OPV at birth, 6mo, 9mo and 5yr (In case of sequential IPV- OPV Schedule)
• Same as in National Program (IPV not available)

19. ADVANTAGES
• Easy to administer
• Induces both humoral and intestinal immunity
• Antibody is quickly produced
• Vaccinee excretes the virus and infects others who are also immunized thereby
• Useful in controlling epidemics
• Relatively inexpensive

20. ADVERSE REACTIONS
• Vaccine associated paralytic polio( type 3 mutation)
• Vaccine derived poliovirus (type 2)

21. CONTRAINDICATIONS
• Immunocompromised individuals (symptomatic HIV, leukemia, malignancy, those
under corticosteroids)
• Active viral infections
• Breast feeding and mild diarrhoea are not contraindications

22. STORAGE
• Stable at 4-80C for 3-4 months
• -20oC for a year
• Potency drops rapidly with temperature fluctuations
• Potency monitored using Vaccine Vial Monitor (VVM)
• Vaccine discarded if color of inner square in vvm is as dark as or darker than color of
outer circle

23. INACTIVATED POLIO VACCINE

24. IPV
• Developed by Salk
• Suspension of formaldehyde killed poliovirus grown in monkey kidney, human
diploid or vero cell culture
• Induces humoral immune response and gives protection from paralysis
• Does not induce local immunity
• Vaccine potency measured by ‘D’ antigen
• Currently used Enhanced potency IPV (eIPV) contain 40D, 8D, 32D units of types
1, 2, 3 polioviruses.

25. • Highly immunogenic
• Seroconversion – 90-95% in infants beyond 8 weeks age administered of two
doses of IPV 2months apart
99% of those given 3 doses 4 weeks apart

26. • Dose – 0.5ml
• Route of administration – intramuscular or subcutaneous

27. SCHEDULE
• National Immunization Program
• At 14 weeks
• IAP 2016
• Sequential IPV-OPV schedule
• 3 doses IPV at 6, 10 and 14 weeks , or
• 2 doses IPV at 8 and 16 weeks (primary) and 1 dose IPV at 15-18 months (booster)
• Also give OPV at 6mo, 9mo, and 5yr and on NIDs and SIAs
• Catchup upto 5yr; 3 doses at 0, 2 and 6months

28. ADVANTAGES
• Efficacy of IPV in preventing poliomyelitis is excellent
• Does not cause Vaccine associated paralytic poliomyelitis
• Vaccine of choice in patients with immunodeficiency
• Can be administered to pregnant women

29. DISADVANTAGE
• Immunity not rapidly achieved
• Injections during epidemic can precipitate paralysis
• Does not produce local immunity , virus can multiply in gut and can be a source
of infection to others

30. ADVERSE REACTIONS
• No serious adverse reactions
• Minor local erythema, induration, swelling and tenderness

31. CONTRAINDICATIONS
• Any known allergy

32. STORAGE
• 2-8oC
• Sensitive to light

33. CATCH UP VACCINATION

34. CATCH UP VACCINATION
• Not infrequently, children who present for immunization have missed out on
previously scheduled vaccines
• To ensure that these ‘overdue’ children can be protected as quickly as possible,
‘catch-up’ vaccination schedules are available
• Every opportunity should be taken to check vaccination status and to provide
missing doses.
• When infants and children have missed scheduled vaccine doses, a catch-up
schedule should be commenced
• Missed immunization does not require restarting of the entire series or addition
of doses to the series for any vaccine in the recommended schedule

35. • Two or more inactivated vaccines can be given simultaneously or at any interval
between doses without affecting the immune response
• An inactive vaccine can similarly be given simultaneously or at any interval with a live
vaccine
• 2 live (intranasal/injectable) vaccines should either be given simultaneously or at least
4 weeks apart
• If a dose of DTP, IPV, Hib, pneumococcal conjugate, hepatitis A, hepatitis B, HPV,
MMR, or varicella vaccine is missed, subsequent immunization should be given at the
next visit as if the usual interval had elapsed

36. • For rotavaccine same principle can be followed, though upper age limit of last
dose should be maintained
• Minimal interval recommendation should be followed for administration of all
doses.

38. THANK YOU