Immunization is single most important step towards control and elimination of infectious disease. With regards to epidemiology and population demographics, various changes are made from time to time in Immunization Schedule of the National Health Programme. This slide show encompasses the recent changes made by National Health Commission with regards to Immunization Schedule.

1. NEWER VACCINES &
UPDATES IN
IMMUNIZATION
PROGRAMMES
By: Dr. Ronak Javia
Under guidance of: Dr. Rajendra Chauhan MD (PSM)

2. Contents
 Fractionated IPV and tOPV to bOPV switch
 RotaVac
 MR Vaccine campaign
 Pneumococcal Vaccine Introduction (phased)
 Switch from TT to Td for adolescent and pregnant females
 Human Papilloma Virus (HPV) Vaccine
 Intensified Mission Indradhanush
 Guidelines for Medical Officer regarding Immunization

3. Inactivated Polio Vaccine (IPV)
 Developed in 1955 by Dr Jonas Salk.
 Also called the Salk vaccine, IPV consists of inactivated (killed) poliovirus.
 Introduced in India in November, 2015 as single IM dose of 0.5mL in phased
manner as a part of Polio Endgame Strategy.
 In April 2016, fractionated dose IPV was introduced along with National Switch
of tOPV to bOPV.
 Three virulent reference strains,
 Mahoney (type 1 poliovirus),
 MEF-1 (type 2 poliovirus), and
 Saukett (type 3 poliovirus),
 Inactivated with formalin.

4. Inactivated Polio Vaccine (IPV)
 Dosage:
 Intramuscular 0.5 mL – 3 doses (confers IgG mediated immunity)
 As per NIP India
 Intramuscular – 0.5 mL at 14th Week
 Intradermal – 0.1 mL at 6th and 14th week.
 Advantages:
 Carries no risk of VAPP ( Vaccine Associated Paralytic Polio)
 Has excellent immunogenicity in most of the people.
 Disadvantages
 Little to no induction of local IgA mediated intestinal immunity.
 Not useful in epidemic.
 Contraindicated – k/h/o previous anaphylaxis.

5. THE Switch
 Objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018 -
removal of all oral polio vaccines (OPVs) in the long term.
 This will eliminate the rare risks of vaccine-associated paralytic polio (VAPP)
and circulating vaccine-derived poliovirus (cVDPV).
 Therefore, on April 25, 2016, India undertook switch of trivalent OPV to bivalent
OPV removing the OPV2 strain which was associated with most cases of
VAPP.

6. FRACTIONATED IPV
 A fractional dose of IPV is a smaller dose of the same vaccine, equal to 1/5 of
a standard dose.
 Produce an even stronger immune response than a single full IPV dose.
 Advantages
 Stronger immune response
 Comparatively larger population coverage
 Less pain to baby and healthier baby
 Saves time and improves coverage.

7. How to administer fIPV

8. Rotavirus Vaccine
 Rotavirus is responsible for more than 4,50,000 deaths each year in children
younger than five years of age.
 Rotavac® (ORV116E)
 Monovalent vaccine
 Rotavirus 116E (G9P[11])
 Manufactured by Bharat Biotech.
 Given in 3 doses at ages 6 weeks, 10 weeks and 14 weeks.
 Other Rotavirus Vaccine approved by WHO are:
 Rotarix® (GSK): monovalent. 2 doses. At 2nd and 4th month.
 RotaTeq® (Merck) : pentavalent. 3 doses. 2nd, 4th and 6th month.
 India has introduced RotaVac in phased manner, supplied free of cost to all
Govt. Hospitals and health centers in multidose vials.

9. RotaVac®
 Rotavirus vaccine is a live attenuated, oral liquid vaccine and is available in
10 dose vial and does not require reconstitution.
 Open Vaccine Vial Policy is not applicable to RotaVac. Date and time of vial
opening is always noted on vial itself.
 Dose is of 5 drops (0.5ml).
 Liquid frozen form.
 In liquid form, the vaccine is generally pink in colour.
 Supplied with a pink coloured dropper that is longer and wider than the
dropper used for OPV.
 Administered only with the dropper supplied by the manufacturer.
 Rotavirus vaccine has a VVM 2, which is used for the least heat-stable
vaccines.
 Stored along with or just above BCG in cold chain.

10. Administration of RotaVac®
 Administered in 3 doses at 6, 10 and 14 weeks along with the other UIP
vaccines.
 No booster dose of rotavirus vaccine is recommended.
 The maximum upper age limit for giving first dose of Rotavirus vaccine is one
year.
 Mild illness such as upper respiratory tract infection or mild diarrhea is not a
contraindication for Rotavirus vaccine.

12. MR Vaccine – Measles & Rubella Initiative
 Measles is highly infectious, potentially fatal and mostly affects children.
 The mortality burden of measles is high because the un-immunized individuals.
 Rubella disease is a mild viral infection affecting both children as well as adults.
 During pregnancy, if infected with Rubella, it may cause
 Spontaneous Abortion
 IUGR
 Congenital Rubella Syndrome
 GoI has set the goal of measles elimination and rubella/CRS control by 2020.
 WHO currently recommends two doses of measles vaccine or
MEASLES+RUBELLA.
 India has accepted and implemented Measles-Rubella Vaccine in it’s immunization
schedule in 2014 as recommended by NTAGI (National Technical Advisory Group on
Immunization)

13. MR Vaccine
 MR Vaccine is offered to all children in government setup free of cost under
two program implementation strategies
 Routine Immunization. 2 doses. 1st at 9 months. 2nd at 16-24 months.
 Supplemental Immunization Campaign. One dose irrespective of previous
immunization status to all children aged 9 months to 15 years.

14. MR Vaccine
 Strains: Measles – Edmonston. Rubella – RA 27/3
 Amber coloured. Sunlight sensitive.
 Multidose vials.
 Freeze dried for which is to be
 Reconstituted using sterile water provided by manufacturer.
 Stable at 2 to 8 degree Celsius.
 Reconstituted only when it is to be administered.
 OPEN VACCINE VIAL POLICY is NOT applicable.
 Diluent should be kept at 2–8°C at least 24 h before use and thus
should be carried to session site at the same temperature as the vaccine
(Inside vaccine carrier).
 Each MR dose is 0.5 ml (10 dose vial) subcutaneously in the right upper
arm. The site is important for standardization and survey purposes.

15. MR Vaccine
 Adverse Effects following immunization are generally mild and transient
 Pain and tenderness at the site of injection sometimes followed by mild
fever.
 Some rare AEFI:
 A transient rash. Maculopapular.
 Arthralgia (transient)
 Thrombocytopenia (1 in 30000) and Anaphylaxis to measles component (1 in million).
 Contraindications:
 high fever (>102 °F / 38–39 °C)
 Serious disease p
 Pregnancy
 Persons with a history of an anaphylactic reaction
 persons who are severely immune-compromised

16. Fight Pneumoniae – PCV 10/13
A Pneumococcal Vaccine
 A common cause of pneumonia
 The leading cause of vaccine-preventable deaths.
 India has a pneumonia mortality rate of 7 per 1000 live births. Most common
culprit being Streptococcus pneumoniae.
 Vaccination is a safe, effective and cost-effective.
 Currently, three vaccines have the potential to significantly reduce
childhood mortality from and related to pneumonia: PCV, Hib-containing
pentavalent vaccine and measles vaccine.
 First, vaccinations help prevent children from developing infections that directly
cause pneumonia, such as Hib and S. pneumoniae.
 Second, vaccinations may prevent infections that can lead to pneumonia as a
complication, such as influenza, measles and pertussis. This is also called
indirect protection.

17. Pneumococcal Vaccines
 Two types of pneumococcal vaccines are available:
 Pneumococcal polysaccharide vaccine (PPSV): 23-valent polysaccharide vaccine
(PPSV23), available since the early 1980s.
 Pneumococcal conjugate vaccines (PCV): 10-valent (PCV10) and 13-valent (PCV13)
are currently available.

18. PCV – Pneumococcal Conjugated Vaccine
 India has planned for introduction of PCV into its universal immunization
program based on global and Indian evidence and recommendations.
 To be introduced in Phased Manner.
 A dosing schedule:
 2 primary doses at 6 weeks and 14 weeks
 Followed by a booster dose at 9 months is recommended.
 For operational feasibility and cost effectiveness, multi-dose presentation
and compliance with open vial policy, recommended PCV13 (4-dose vial).

19. PCV13
 Dose - 0.5 ml - Intramuscular injection - anterolateral aspect of the right mid
thigh of infants.
 The FIRST DOSE, PCV1, will be administered at 6 weeks of age with the first dose
of pentavalent vaccine, oral polio vaccine (OPV), fractional-dose IPV1 and
rotavirus vaccine.
 The SECOND DOSE, PCV2, will be given at 14 weeks of age, with the third dose of
pentavalent vaccine, oral polio vaccine, fractional-dose IPV2 and rotavirus
vaccine.
 The PCV BOOSTER dose will be administered at 9 months of age with the first
dose of measles-rubella vaccine and first dose of Japanese Encephalitis (JE)
vaccine along with Vitamin A.
 First dose to be given under 1 year of age.

21. PCV 13
 Freeze-sensitive vaccine.
 Stored at +2°C and +8°C in the basket
 Do not freeze PCV.
 PCV can be co-administered with other UIP vaccines. But should not be mixed
within same syringe.
 AEFI
 PCV is a safe vaccine. Severe reactions are extremely rare.
 PCV should not be administered to children with severe allergic reaction to a prior
dose, or to vaccines containing diphtheria toxoid, such as pentavalent vaccine.
 PCV should not be given to a child with severe illness.
 Most common PCV side effects: Irritability, crying, swelling and tenderness at
injection site, transient fever >39°C (102°F).
 PCV is a costly vaccine. Open vial policy is applicable to PCV13 (4-dose vial).
The permissible wastage for PCV is less than 10%.

22. Td - A New Initiative
 The RATIONALE
 Majority of the cases of Diphtheria are occurring in age group 5 years and
above and mostly in unvaccinated.
 Since 1999, there have been more than 80% reduction in tetanus mortality,
however diphtheria outbreaks are increasing which reflect gaps in diphtheria
protection.
 From extensive multicentric trials and studies, it is now well established that
immunity to diphtheria subsides following the primary series of DTP infant
immunization and that booster doses of diphtheria toxoid containing vaccines
are needed for continued protection.
 The use of Td rather TT is recommended during pregnancy to protect
against maternal and neonatal tetanus & diphtheria during prenatal
care.
 Td also boosts decreasing diphtheria immunity in addition to assuring
tetanus protection, and help to curtail diphtheria outbreaks.

23.  Td vaccine will be supplied by
Government of India as is done
for other vaccines under UIP.
 Target Groups:
 Children of 10 and 16 years (school
going)
 Pregnant women
 The storage, package size,
presentation, route of
administration, wastage rate, doses
required, transportation, heat and
freeze sensitivity, cold chain
maintenance is same as TT.
 Td vaccine can be given as a
subsequent dose following TT, and all
previous TT doses will remain valid.
There is no need to re-start the
series.
Td Vaccination
Guidelines

24. “
”
1 + 3 = 6 –> Human Papilloma
Vaccine
Not a part of NIP, but an important aspect of Adolescent
Immunization and immunization against neoplasms.
• The Food and Drug Administration (FDA) has approved three vaccines that
prevent infection with disease-causing HPV types: Gardasil®, Gardasil® 9,
and Cervarix®. All three vaccines prevent infection with HPV types 16 and 18,
two high-risk HPVs contributing to 70% of cervical cancer cases.

25. HPV Vaccines
Gardasil®
 Quadrivalent (6,11,16,18)
 Nonavaent
(6,11,16,18,31,33,45,52,58)
 Protection against cervical, vaginal,
vulval and anal intraepithelial
neoplasm and carcinoma.
 Protection against anogenital warts
and Papillomas due to HPV.
 For both males and females.
 3 doses. 0,2,6 months. To be
completed in 1 year.
Cervarix®
 Bivalent (16,18)
 Protection against cervical
intraepithelial neoplasm amd cancer.
 No protection against other HPV
acquired cancers or neoplasms
 No protection against warts.
 3 doses. 0,1,6 months. To be
completed in 1 year.

27. Mission Indradhanush
 Launched by Union Health Minister J. P. Nadda
 On 25th December 2014
 Aim:
 90% full immunization coverage of India and sustain the same by year 2020
 To be vaccinated against 8 common Vaccine preventable diseases.
 Tuberculosis. Polio. Diphtheria. Tetanus. Pertussis. Measles. Hepatitis B. Influenza B bacteria.
 Ensure full immunization as per UIP to all children below 2 years and pregnant women.
 Seeing the efficiency of program, PM Narendra Modi launched Intensified Mission Indradhanush
on October 7, 2017 to cover the left out at risk population.

28. IMI
 The priority for conducting Intensified Mission Indradhanush should be
areas with weak routine immunization coverage in the district.
 IMI should be taken as an opportunity to improve:
 Complete immunization
 MR Vaccination campaign
 FOCUS AREAS
 Areas with vacant subcenters
 Areas which missed 3 or more routine immunization sessions.
 Areas identified as High risk during pulse polio immunization
 Areas with Vaccine hesitancy or low coverage during previous session
 Nomadic areas
 Brick kilns
 Construction sites

29. IMI
 Schedule for IMI
 One phase of Intensified Mission Indradhanush immunization drive, consisting of
4 rounds of immunization will be conducted in the selected districts and urban
cities.
 Round 1 – 7th October 2017
 Round 2 – 7th November 2017
 Round 3 – 7th December 2017
 Round 4 – 7th January 2018
 Intensified Mission Indradhanush immunization drive will be spread over 7
working days starting from 7th of every month.
 In case the 7th of the month is a Sunday/ holiday, the drive may begin from
the next working day.
 These 7 days do not include holidays, Sundays and the routine immunization
days planned in that week. Such routine immunization sessions should be held
as already planned.

30. IMI
 OPERATIONAL PLANNING
 The following two operational mechanisms will be utilized to reach out to
unreached or poorly reached beneficiaries.
 Fixed and outreach sessions
 Mobile sessions
 KEY FOCUS: Children who have missed vaccinations may belong to one of
the LODOR [Left outs, Dropouts, and Resistant] families/communities.

31. Modified Immunization Schedule
(Pregnant Women)

32. Modified Immunization Schedule
(Infants)

33. Modified Immunization Schedule
(Infants)

34. Modified Immunization Schedule
(Children)

35. Thank You
By: Dr. Ronak Javia
Under guidance of: Dr Rajendra Chauhan MD (PSM)