the ppt describes the pentavalent and trivalent according to the national immunisation program,india in an easy to understand and interactive form.useful for students and tutors. also has a FAQ section.

2.  A pentavalent vaccine is a combined
vaccine with five individual vaccines
conjugated into one, to protect people from 5
potentially deadly diseases.
 Haemophilus Influenza type B (a bacterium
that causes meningitis, pneumonia and otitis),
 whooping cough,
 tetanus,
 hepatitis B and
 diphtheria.

4. Diphtheria toxoid
 a sub-unit antibacterial vaccine, made
from the modified toxin (poison)
produced by the bacteria
Corynebacterium diphtheriae.
 vaccine protects against diphtheria, a
serious bacterial infection causing a
sore throat, high fever and serious
complications which can be fatal.

5. Pertussis vaccine
 an inactivated antibacterial vaccine,
 contains killed whole bacterial
cells,protects against pertussis (also
known as whooping cough), a highly
contagious, acute respiratory infection
caused by the bacteria Bordetella
pertussis

6. Tetanus toxoid (TT)
 a sub-unit antibacterial vaccine, made
from the modified toxin produced by the
bacteria Clostridium tetani.
 Tetanus is a disease that is acquired
through exposure to the spores of these
bacteria, which are universally present
in the soil. TT vaccine is also given on
its own as a ‘booster’ to women of
childbearing age

7.  a conjugate antibacterial vaccine, protects against
pneumonia and meningitis caused by the bacteria
Haemophilus influenzae type b.
 most common cause of bacterial meningitis in children
under five years of age in countries where Hib vaccine is
not routinely given to all infants.
 Meningitis refers to severe infection of the membranes
surrounding the brain and spinal cord, which can rapidly
lead to high fever, paralysis and death.
 Haemophilus influenzae type b bacteria are also the
second most common cause of bacterial pneumonia in
children.
 Pneumonia is a severe infection in the lungs, which causes
the air sacs to fill with fluid and pus; this makes breathing
painful and difficult, and reduces the oxygen getting into the
body.
Haemophilus influenzae type b
(Hib)

8. Storage, dosage and
schedule of pentavalent
vaccine
 Pentavalent vaccine comes in single-dose
glass bottles called vials, which should be
stored at between +2°C and +8°C. It
should never be frozen, or allowed to
become warmer than +8°C, as this will
destroy its effectiveness.
 If it is allowed to stand for a long time, fine
particles settle to the bottom of the vial
leaving a cloudy liquid above them. This is
normal. Shake the vial to mix the vaccine
with the liquid before using it.

9.  Number of doses- Three (referred to as Penta1, Penta2 and
Penta3
 Schedule At 6, 10 and 14 weeks of age
 Booster None in males; boosters of tetanus toxoid
vaccine are given to women of childbearing age
 Contraindications Severe allergic reaction or encephalopathy to a
previous pentavalent immunization
 Adverse events Mild local reactions are common (see Section
2.2.5); rarely, injection-site abscess
 Special precautions Usually not given after six years of age
because of the
increased risk of serious adverse reactions
 Dosage 0.5 ml
 Injection site Upper outer left thigh
 Injection type Intramuscular (IM
 Storage Store between +2°C and +8°C. Never freeze

10. Adverse events following
pentavalent immunization
and how to treat them The possible adverse events following immunization with
pentavalent vaccine are generally mild: serious reactions are
very rare
The mild reactions are:
 Soreness. Some children may develop mild soreness,
redness, or swelling at the injection site, but this
will go away within 1–3 days.
 Fever. Some children may develop a mild fever (a
temperature of around 37.3oC to 38.4oC,
measured with a thermometer in the child’s armpit,
is termed a low-grade fever). It should disappear
within a day. Fever that begins more than 24 hours
after a pentavalent injection unlikely to be a
reaction to the vaccine and should be
investigated.
 Crying for more than three hours, mostly because of pain,
occurs in up to 1% of infants.

11.  A serious but rare adverse event is an
abscess, which may develop a week or
more after immunization (Figure 2.5),
usually because an unsterile needle or
syringe was used, or the vaccine was
not correctly injected into the muscle.
The management of these adverse
events at Health Post level is
summarised in Table 2.4.

12. TREATMENT
 Low-grade fever (37.3oC to 38.4oC)Paracetamol
syrup, 5 ml as required, up to a maximum of four
doses
 Pain and soreness at the injection siteParacetamol
as above; warm compress (a warm cloth or
another warm material) applied under pressure to
the sore area of skin and held in place for some
time
 Abscess at the injection site Amoxicillin syrup
orally three times daily

13. OPEN VIAL POLICY
GUIDELINES
 The WHO multi-dose vial policy states
that vials of liquid DTP, TT, HepB and
OPV opened in a fixed clinic may be
used at more than one immunization
session provided that:
 A) The expiry date has not passed.
 B) The vaccines are stored under
appropriate cold chain conditions.

15. FAQ’s
What is Hib? What diseases does it cause?
 Haemophilus influenzae type b
 a bacterium that causes severe infections, as listed below
 Bacterial meningitis – inflammation of the membranes that
cover and protect the spinal cord and
brain. It is a serious infection.
 Pneumonia – inflammation of the lungs.
 Septicaemia – presence of pathogenic bacteria in the
blood.
 Septic arthritis – inflammation of the joints.
 Epiglottitis – inflammation of the area around
the vocal cords and obstruction of the
airway. Hib disease is not the same as
hepatitis B (Hep B), which is a viral
disease that affects the liver.

16.  DPT is given in the antero-lateral mid-thigh and not the
gluteal region to prevent damage to the sciatic nerve.
 Moreover, the vaccine deposited in the fat of gluteal
region does not invoke the appropriate immune response.
Q. What should one do if the child is found allergic to DPT
or develops encephalopathy after DPT ?
 A. A child who is allergic to DPT or develops
encephalopathy after DPT should be given the DTaP/DT
vaccine instead of DPT for the remaining doses, as it is
usually the P (whole cell Pertussis) component of the
vaccine which causes the allergy/encephalopathy. It may
be purchased with locally available resources.

17. How does the Hib infection spread?
 Hib bacteria are passed from child to child through
droplets of saliva expelled when an infected child
coughs or sneezes.
 Hib also spreads among children when they share
toys and other things that they have put in their
mouths.
 Hib mostly affects children under five years of age;
children between four months and 18 months of age
are most at risk.
 By age of five years, most children have developed
antibodies against the disease, hence serious
diseases from Hib are uncommon in older children
and adults

18. Do antibiotics work against Hib infections?
 Antibiotics are used for treatment of Hib
disease, but they are not always
effective. Even with antibiotics and the
best medical care, 3% to 5% of
meningitis patients die. Some strains of
Hib are now resistant to antibiotics,
making treatment even more difficult.

19. Who should be immunized with Hib
vaccine?
 Generally, all children aged up to 1 year
(after 6 weeks and less than 1 year)
should receive Hib vaccine as part of
routine immunization.

20. How many doses are needed? When should
they be given?
 Three doses are given.
 The first dose is given as pentavalent
vaccine only after a child is 6 weeks old.
 The second and third doses are given at 10
and 14 weeks of age respectively also in
the form of pentavalent vaccines.
 There is no booster dose recommended
under UIP.

21. Why is Hib given as a pentavalent vaccine
and not separately?
 The schedule for DPT, Hep B and Hib is
the same at 6, 10 and 14 weeks.
 Therefore, if these three vaccines are
given separately, a child gets three
pricks at the same time.
 Giving a pentavalent vaccine will
reduce the number of pricks

22. Till what age can pentavalent vaccine be
administered?
 Pentavalent vaccine can be given to any
child aged more than 6 weeks and up to
1 year of age.

23. What are the side effects of pentavalent
vaccine?
 Pentavalent vaccine has not been
associated with any serious side effects.
 However, redness, swelling, and pain may
occur at the limb site where the injection
was given. These symptoms usually
appear the day after the injection has been
given and last from one to three days. Less
commonly, children may develop fever for
a short time after immunization.

24. Is there any reason why a child should not be given
Pentavalent Vaccine?
 Age-a child below 6 weeks of age should not be
given Pentavalent Vaccine.
 Vaccination history-a child whose vaccination
schedule has been initiated with DPT/hepatitis B
vaccine will continue to receive subsequent doses of
DPT/hepatitis B and not Pentavalent Vaccine
 Severe allergic reactions-although serious side
effects have not been reported, a child who has had
a severe reaction to Pentavalent Vaccine earlier
should not be given another dose.
 Children with moderate or severe acute illness
should not be administered Pentavalent Vaccine
until their condition improves. Minor illnesses,
however, such as upper respiratory infections(
URIs)are not a contraindication to vaccination.

25. MMR Vaccine (Measles, Mumps
and Rubella Vaccine)

26.  The measles, mumps, and rubella
(MMR) vaccine is recommended for all
children.

27.  Measles
 fever
 Rash
 Cough
 runny nose
 red, watery eyes.
 Complications can include ear infection, diarrhea,
pneumonia, brain damage, and death

28.  Mumps
 fever,
 headache,
 muscle aches,
 tiredness,
 loss of appetite,
 swollen salivary glands.
 Complications can include swelling of the
testicles or ovaries, deafness, inflammation of
the brain and/or tissue covering the brain and
spinal cord (encephalitis/meningitis) and,
rarely, death

29.  Rubella,
 fever,
 sore throat,
 rash,
 headache,
 red, itchy eyes.
 If a woman gets rubella while she is
pregnant, she could have a miscarriage or
her baby could be born with serious birth
defects

31. Who should get MMR vaccine
and when?
Children should get 2 doses of MMR
vaccine:
 First Dose: 09 to 12 months of age
 Second Dose: 5 years of age (may be
given earlier, if at least 28 days after the
1st dose)
 Some infants younger than 12 months
should get a dose of MMR if they are
traveling out of the country.

32.  The MMR vaccine can sometimes be given to babies from
six months of age if they may have been exposed to the
measles virus, or during a measles outbreak.
 Babies under six months old are not routinely given the
MMR vaccine. This is because the antibodies to measles,
mumps and rubella passed from mother to baby at the time
of birth are retained and can work against the vaccine,
meaning that the vaccine is not usually effective.
 These maternal antibodies decline with age and are almost
all gone by the time MMR is normally given – around the age
of one.
 MMR vaccination is recommended for six- to nine-month-old
babies if they are at high risk of becoming infected in certain
circumstances, such as during a measles outbreak.
 However, these children may not have enough protection
from this early dose, so they will still need the standard MMR
doses at 12-13 months and 40 months of age.
 The MMR vaccine is given as a single injection into the
muscle of the thigh or upper arm.

33. MMR for women planning pregnancy
 it's a good idea to check that you are fully
protected against measles, mumps and rubella.
Rubella infection in pregnancy can lead to serious
birth defects and miscarriage.
 If you're not sure whether you've had two doses of
the MMR vaccine, ask your GP practice to check.
 If you haven't had both doses or there's no record
available, you can have the vaccinations at your
GP practice.
 should avoid becoming pregnant for one month
after having MMR vaccination.
 Be aware that the MMR vaccine is not suitable for
women who are already pregnant.

34. MMR for older children
 Children up to the age of 18 who
missed, or only partially completed, their
earlier MMR vaccination can have a
"catch-up" MMR vaccination
 If you know or suspect your child hasn't
been fully immunised, arrange with your
GP for them to have a catch-up MMR
vaccination

35. How the MMR vaccine works
 The MMR vaccine contains weakened
versions of live measles, mumps and rubella
viruses. The vaccine works by triggering the
immune system to produce antibodies against
measles, mumps and rubella.
 If you or your child then comes into contact
with one of the diseases, the immune system
will recognise it and immediately produce the
antibodies needed to fight it.
 It's not possible for people who have recently
had the MMR vaccine to infect other people.

36. Some people should not get
MMR vaccine or should wait.
 Anyone who has ever had a life-threatening
allergic reaction to the antibiotic neomycin, or
any other component of MMR vaccine, should
not get the vaccine. Tell your doctor if you
have any severe allergies.
 Anyone who had a life-threatening allergic
reaction to a previous dose of MMR or MMRV
vaccine should not get another dose.
 Some people who are sick at the time the shot
is scheduled may be advised to wait until they
recover before getting MMR vaccine.

37.  Pregnant women should not get MMR vaccine. Pregnant
women who need the vaccine should wait until after giving
birth. Women should avoid getting pregnant for 4 weeks
after vaccination with MMR vaccine.
 Tell your doctor if the person getting the vaccine:
 Has HIV/AIDS, or another disease that affects the immune
system
 Is being treated with drugs that affect the immune system, such
as steroids
 Has any kind of cancer
 Is being treated for cancer with radiation or drugs
 Has ever had a low platelet count (a blood disorder)
 Has gotten another vaccine within the past 4 weeks
 Has recently had a transfusion or received other blood products
 Any of these might be a reason to not get the vaccine, or
delay vaccination until later

38. What are the risks from MMR
vaccine?
 A vaccine, like any medicine, is capable
of causing serious problems, such as
severe allergic reactions.
 The risk of MMR vaccine causing
serious harm, or death, is extremely
small.
 Getting MMR vaccine is much safer than
getting measles, mumps or rubella.
 Most people who get MMR vaccine do
not have any serious problems with it.

39. Mild problems
 Fever (up to 1 person out of 6)
 Mild rash (about 1 person out of 20)
 Swelling of glands in the cheeks or neck
(about 1 person out of 75)
 If these problems occur, it is usually
within 6-14 days after the shot. They
occur less often after the second dose.

40. Moderate problems
 Seizure (jerking or staring) caused by
fever (about 1 out of 3,000 doses)
 Temporary pain and stiffness in the
joints, mostly in teenage or adult women
(up to 1 out of 4)
 Temporary low platelet count, which can
cause a bleeding disorder (about 1 out
of 30,000 doses)

41. Severe problems (very rare)
 Serious allergic reaction (less than 1 out of
a million doses)
 Several other severe problems have been
reported after a child gets MMR vaccine,
including:
 Deafness
 Long-term seizures, coma, or lowered
consciousness
 Permanent brain damage
 These are so rare that it is hard to tell
whether they are caused by the vaccine.

42.  Why give the measles vaccine only on
the right upper arm ?
 A. The measles vaccine is given on the
right upper arm to
 maintain uniformity and to help
surveyors in verifying
 the receipt of the vaccine.