This document discusses immunization and vaccination. It begins with the objectives of studying the history of immunization and describing different types of vaccines and schedules. It then discusses key topics like the beginning of immunization with Edward Jenner, introduction to vaccination, types of vaccines including live attenuated, inactivated, toxoid, and subunit vaccines. It provides details on common vaccines, administration techniques, storage requirements, and the importance of maintaining the cold chain to ensure vaccine efficacy. Nursing responsibilities in recording immunizations and ensuring proper vaccine handling and administration are also summarized.

1. PRESENTED BY :
MS.NEHA JAISWAL
YEAR:BSC(N) 4 YR
ERA COLLEGE OF NURSING
Immunization
schedule
GUIDED BY :
DR.ANJALATCHI
VICE PRINCIPAL
ERA COLLEGE OF NURSING

2. World immunization day

3. objective
To study about the history of immunization.
 To study about what is immunization.
To study about how to describe vaccine.
To study about types of vaccine .
To study the various immunization
schedules.

4. Beginning of history
 EDWARD JENNER (1749 – 1823)
used the term vaccination
 Cow pox virus provided
immunity in prevention
of small pox.

5. INTRODUCTION
IMMUNIZATION is
a process of artificially
inducing immunity
or providing
Protection from
disease .

6. VACCINE
VACCINE is a
immuno-biological
substance designed
to produce specific
Protection against a given
disease.

8. Types of Vaccines
 Scientists decide the best approach to design a
vaccine depending on the disease-causing agent, how
it infects the cell and how the immune system
responds to it. The following are the main type of
options that currently exist:

9. Type of vaccine

10. World wide report

11. Attenuated (Live) Vaccines
 Live, attenuated vaccines currently recommended as part
of the U.S. Childhood Immunization Schedule include
those against measles, mumps, and rubella (via the
combined MMR vaccine), varicella (chickenpox), and
influenza (in the nasal spray version of the seasonal flu
vaccine). In addition to live, attenuated vaccines, the
immunization schedule includes vaccines of every other
major type—see the table above for a breakdown of the
vaccine types on the recommended childhood schedule.
 Examples of live vaccines include: The varicella-zoster
vaccine, oral poliovirus (OPV) vaccine and yellow fever
virus vaccine.

12. Charateristic

13. Live, Attenuated Vaccines
 Attenuated vaccines can be made in several different ways. Some of
the most common methods involve passing the disease-causing
virus through a series of cell cultures or animal embryos (typically
chick embryos). Using chick embryos as an example, the virus is
grown in different embryos in a series. With each passage, the virus
becomes better at replicating in chick cells, but loses its ability to
replicate in human cells. A virus targeted for use in a vaccine may be
grown through—“passaged” through—upwards of 200 different
embryos or cell cultures. Eventually, the attenuated virus will be
unable to replicate well (or at all) in human cells, and can be used in
a vaccine. All of the methods that involve passing a virus through a
non-human host produce a version of the virus that can still be
recognized by the human immune system, but cannot replicate well
in a human host.
 When the resulting vaccine virus is given to a human, it will be
unable to replicate enough to cause illness, but will still provoke an
immune response that can protect against future infection.

14. Common vaccine

15. Sub-Unit (acellular) Vaccines
 These vaccines do not contain any whole bacteria or
viruses at all. Instead they contain some components,
such as polysaccharides (sugars) or proteins, from
bacteria or viruses. These are the parts that our immune
system recognizes as foreign, they are the antigens that
trigger an immune response. Even though the vaccine
might only contain a few of the thousands of proteins in a
bacterium they are enough in themselves to trigger an
immune response which can protect against the disease.
This method of creating vaccines is used for the
Haemophilus influenzae type b vaccine and the acellular
pertussis (whooping cough) vaccine.

16. Difference between live and killed vaccine

17. Inactivated (Killed) Vaccines
 To produce this type of vaccine, bacteria or viruses are
killed or inactivated by a chemical treatment or
heat. Inactivated vaccines are suitable for healthy
individuals, as well as people with weakened immune
systems as they do not contain live forms of the
microorganism which they are designed to protect
against. Inactivated vaccines do not always create a
strong or long-lasting immune response, in the same way
as live vaccines, so they usually require repeated doses or
booster doses. Examples of inactivated vaccines include:
inactivated poliovirus (IPV) vaccine, whole cell pertussis
(whooping cough) vaccine, rabies vaccine and the
hepatitis A virus vaccine.

18. Toxoid Vaccines
 Some bacteria release toxins (poisonous proteins)
when they attack the body. The immune system
recognises these toxins in the same way it recognises
the antigens on the surface of bacteria. Some
vaccines are made with inactivated versions of these
toxins. They are called “toxoids” because they look
like toxins but are not poisonous. Examples of
vaccines utilising this approach include the diptheria
and tetanus vaccine.

19. Types of vaccine
 Live, attenuated
 Measles, mumps, rubella (MMR combined vaccine)
Varicella (chickenpox)
Influenza (nasal spray)
Rotavirus

20. 2. INACTIVATED VACCINE
Inactivated/Killed
 Rabies
 Hepatitis –A
 Influenza
 Polio (IPV)
 Hepatitis A

21. 3. TOXOID VACCINE
Toxoid (inactivated toxin)
 Diphtheria, tetanus
 (part of DTaP combined immunization)

22. Subunit/conjugate
 Hepatitis B
Influenza (injection)
Haemophilus influenza type b (Hib)
Pertussis (part of DTaP combined immunization)
Pneumococcal
Meningococcal

23. Other available vaccines
 Live, attenuated-Zoster (shingles), Yellow fever
 Inactivated/Killed-Rabies
 Subunit/conjugate-Human papillomavirus (HPV)

24. Combination of vaccine
 The aim is to – simplify administration. - reduce
costs -minimise the no. of contacts with the
health system.
 Eg. DPT, DT, MMR, DPT& Hep.B, Hep B & Hib,
Hep A & B etc.

25. TETANUS TOXOID
 Intramuscular– upper arm – 0.5 ml
Pregnancy – 2 doses - 1st dose as early as
possible and second dose after 4 weeks of
first dose and before 36 weeks of pregnancy
TT booster for both boys and girls at 10
years and 16 years .

26.  The booster dose should be
given a year after the initial
doses.
 It should be stored between
4 and 10 deg C.

27. BCG
 Initial dose birth or as early as
possible till one year of age ¨ 0.1 ml
(0.05ml until one month of age) ¨
 Intra-dermal ¨ Left upper arm ¨
Freeze dried is more stable. Diluent
is Normal saline and injected within
hrs.
 BCG Vaccine should be administered
with a syringe of 1 ml .

28. HEPATITIS B
 Birth dose – within 24 hours of birth
 0.5 ml Intramuscular
 Antero-lateral aspect of mid-thigh
 Rest three doses at 6 weeks, 10
weeks and 14 weeks
 It should be stored at 2 to 8 deg C.
 1 ml in adults, 05ml in children <10 yrs,
given IM.

29. ORAL POLIO VACCINE
 Zero dose – at birth 2 drops
 Oral
 First, second and third doses at 6,10
and 14 weeks with Pentavalent-1, 2
and 3
 OPV booster with DPT booster at
16-24 months

30. PENTAVALENT VACCINE
 Simultaneous immunization
against diphtheria, Pertuisis &
Tetanus, Hep B, Hib.
 Stored at 4-8 degree C.
 Given 0.5 ml IM at antero lateral
aspect of thigh.
 Primary 3 doses with a booster in
16 -24 months. DT 5-6 yrs
 C/I –progressive neurological
diseases.

31. ROTAVIRAL VACCINE
 3 doses given in 6th, 10th and
14th weeks.
 It Can be given till one year
of age.
 Dose - 5 drops/0.5 ml orally for
prevention of diarrhoea among
infants due to rotavirus.

32. IPV
 2 fractional doses given in 6th and
14th weeks.
 Dose – 0.1 ml
 Given intradermally in Right upper
arm

33. MR VACCINE
 Bivalent Live atteunated against
measles and rubella.
 Given 0.5 ml SC at 9-12 and
16-24 months.
 Stored 2-8 vial.

34. DPT
 Primary doses were in
pentavalent vaccine.
 One booster at 16-24 m with
OPV booster (antero-lateral side
of mid-thigh) and second
booster at 5-6 years (upper arm)
 0.5 ml
 Intra-muscular

35. VITAMIN A
 1st dose – 1 ml (1 IU) - along-
with Measles first dose - Oral
 Subsequent 8 doses (2 ml or 2
lakh IU) every six months till 5
years of age starting with DPT
first booster at 16-24 months
 Use only plastic spoon provided
with Vitamin A solution

36. Japanese encephalitis vaccine

37. IPV vaccine

38. IMMUNIZATION SCHEDULE

39. Preparation of Client and mother
 Welcomes patient/family and establishes rapport.
 Explains what vaccines will be given and which
type(s) of injection(s) will be given.
 Answers questions and accommodates language or
literacy barriers and special needs of
patient/parents to help make them feel
comfortable.

40. Medical protocols
 Identifies the location of the medical protocols (e.g.,
immunization protocol, emergency protocol,
reporting adverse events to the Vaccine adverse
Event Reporting system [VAERS], reference
material).
 Identifies the location of epinephrine, its
administration technique, and clinical situations
where its use would be indicated.
 Maintains up-to-date CPR certification.

41.  Demonstrates knowledge of proper
vaccine handling (e.g., maintains and
monitors vaccine at recommended
temperature and protects from light).

42. Preparation of vaccine
 Performs proper hand hygiene prior to preparing
vaccine.
 When removing vaccine from the refrigerator or freezer,
looks at the storage unit’s temperature to make sure it is
in proper range.
 Checks vial expiration date. Double-checks vial label
and contents prior to drawing up.
 Prepares and draws up vaccines in a designated clean
medication area that is not adjacent to areas where
potentially contaminated items are placed.
 Selects the correct needle size for IM and Subcut based
on patient ageand/or weight, site, and recommended
injection technique

43.  Maintains aseptic technique throughout, including
cleaning the rubber septum (stopper) of the vial with
alcohol prior to piercing it.
 Prepares vaccine according to manufacturer
instructions. Inverts vial and draws up correct dose
of vaccine. Rechecks vial label.
 Prepares a new sterile syringe and sterile needle for
each injection. Checks the expiration date on the
equipment (syringes and needles) if present.
 Labels each filled syringe or uses labeled tray to keep
them identified

44. Preparation of Article
 A clean tray containing –
 Kidney tray for collect wet waste .
 Paper bag for collect dry waste.
 Alcohol.
 A bowl containing cotton ball.
 Syringe.
 Sterile needle .
 Vaccination card.
 Inchtape.

45. VVM

46. Administering vaccine
 Verifies identity of patient. Rechecks the provider’s
order or instructions against the vial and the
prepared syringes.
 Utilizes proper hand hygiene with every patient
and, if it is office policy, puts on disposable gloves.
(If using gloves, changes gloves for every patient.)
 Demonstrates knowledge of the appropriate route
for each vaccine.
 Positions patient and/or restrains the child with
parent’s help.

47.  Correctly identifies the injection site (e.g., deltoid,
vastus lateralis, fatty tissue over triceps).
 Locates anatomic landmarks specific for IM or Subcut
injections.
 Prepare the site with an alcohol wipe, using a circular
motion from the center to a 2" to 3" circle. Allows
alcohol to dry.
 Controls the limb with the non-dominant hand; holds
the needle an inch from the skin and inserts it quickly
at the appropriate angle (90º for IM or 45º for
Subcut).

48.  Injects vaccine using steady pressure; withdraws needle at
angle of insertion.
 Applies gentle pressure to injection site for several seconds
(using, e.g., gauze pad, bandaid).
 Uses strategies to reduce anxiety and pain associated with
injections.
 Properly disposes of needle and syringe in “sharps”
container.
 Properly disposes of vaccine vials

49. RECORD AND REPORTING
 Fully documents each vaccination in patient chart:
date, lot number, manufacturer, site, VIS date,
name/initials.
 If applicable, demonstrates ability to use state/local
immunization registryor computer to call up patient
record, assess what is due today, and update
computerized immunization history.
 Ask for and updates patient’s vaccination record and
reminds them to bring it to each visit.

50. IF A DOSE IS MISSED…
 Give the dose at the next
opportunity irrespective of the time
gap
 Do not start the schedule all over
again

51. IMPORTANCE OF IMMUNIZATION
 Immunization has helped to reduced
the impact of communicable disease on
health and wellbeing.
 Stop vaccine may again lead to
epidemic .
 Save money and time.
 Immunization is a proven tool for
controlling and even eradicating disease.

52. COLD CHAIN

54. DEFINITION
 The ‘cold chain’ is the system of transporting and storing vaccines at
recommended temperature from the point of manufacture to the point
of use.

55. IMPORTANCE
 Obtaining the vaccines from the manufacturers
 Storing and transporting the vaccines
 Maintaining the supply of vaccines
 Having information about essential equipments, supply of
electricity etc
 Keeping the vaccine at low temperature
 Protecting the vaccine from sunlight exposure
 Maintaining the potency of vaccines

56. TYPES OF EQUIPMENTS
 Vaccine carriers
Cold packs
 Day carriers
 Refrigerators
 Walk in cooler

65. METHOD OF CONTROLLING COLD
CHAIN
 Keep the vaccine in appropriate conditions as suggested by
manufacturer
 Follow all the precautions while transporting vaccines
 Record the temperature of storage place twice a day and
preparing the temperature chart
 Maintain the equipment of cold chain and the appropriate
functioning of its components, conducting potency tests from
time to time
 Keep communication system effective and latest

66. NURSING RESPONSIBILITIES
Maintenance of cold chain system at immunization
centre or during transportation of vaccines to home or
clinics with necessary precautions to preserve the
efficacy and potency of the vaccines. Care of cold chain
equipment and maintenance of recommended
temperature for vaccines are crucial aspects of the
success of immunization program.

68. VVM monitor

69. References
 Sources
 Plotkin, S.A., Mortimer, E. Vaccines. New York:
Harper Perennial; 1988.
 Plotkin, S.A., Orenstein, W.A., Offit, P.A.,
eds. Vaccines. 6th. ed. Philadelphia: Elsevier; 2013.
