Immunization protects individuals from disease by introducing weakened or killed pathogens. The World Health Organization launched the Expanded Program on Immunization in 1974 to protect children worldwide from six diseases using vaccines. India launched its Universal Immunization Programme in 1985 with the goal of providing universal coverage of eligible populations against tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles by 1990. The national immunization schedule outlines the vaccines, doses, and ages that vaccines should be administered to both children and adults in India.

1. IMMUNIZATION

2. IMMUNIZATION
• Immunization is a process of protecting an
individual from a disease through introduction of
live attenuated, killed or organisms or antibodies in
the individual system.
• Immunization is the process of protecting an
individual by active or passive method.
• The immunizing agents are
Vaccines, Immunoglobulins and antisera

4. Expanded Pr ogr am on
Immunisation
4
 WHO launch a global immunization program,
known as Expanded Program on
Immunization (EPI) in May 1974.
 To protect all children of the world against six
vaccine-preventable diseases, namely -
diphtheria, whooping cough, tetanus, polio,
tuberculosis and measles by the year 2000.
 EPI was launched in India in January 1978 .

5. U
ni ver sal I m
m
uni sat i on
Programme
5
 The Indian version, the Universal
Immunization Programme, was launched on
November 19, 1985.
 The National Health Policy aimed at achieving
universal immunization coverage of the
eligible population by 1990.

6. ACTIVE VS PASSIVE IMMUNIZATION
Active
 Killed or live attenuated
organism injected which
can induce immune
response
 Long term
 Immune system plays role
 Ex-Hepatitis B vaccine,
DPT, Inactivated polio
vaccine, Measles-rubella
(MMR) combined vaccine
Passive
• Transfer ofantibodies
• Short term
• No role of immune system
• Ex-Anti Tetanus, serum,
Anti Rabies
immunoglobulin etc

7. UNIVERSAL IMMUNIZATION PROGRAMME
• In 1974, Expanded program of Immunization (EPI)organized
by WHO
• It was called Expanded because:
• Adding more disease controlling antigens of vaccination
schedules.
• Extending coverage to all corners of a country.
• On 19 November 1985, GOI renamed EPIprogram, modifying
the schedule as‘Universal Immunization Program’
• ‘Universal’ immunization is, therefore, best interpreted as
implying the ideal that no child should be denied immunization
against tuberculosis, diphtheria, whooping cough, tetanus,
polio and measles.

8. WHY IMMUNIZATION
• Prevention of deadly and debilitating
diseases.
• Keeps child from suffering through a
preventable illness.
• Less doctor visits
• No hospitalization

9. LIVE VACCINES
• Live, attenuated vaccines contain a version of the
living microbe that has been weakened in the lab
so it can’t cause disease.
• Because a live, attenuated vaccine is the closest
thing to a natural infection, these vaccines are
good “teachers” of the immune system.
• Example: Vaccines against polio (OPV),
measles, mumps, rubella andchickenpox

10. INACTIVATED VACCINES
• Scientists produce inactivated vaccines by killing
the disease-causingmicrobe with chemicals, heat,
or radiation. Such vaccines are more stable and
safer than live vaccines.
• Because dead microbes can’t mutate back to their
disease-causingstate.
• Example: Vaccinesagainst influenza, inactivated
polio vaccine, hepatitisAetc.

11. TOXOIDS
• For bacteria that secrete toxins, or harmful
chemicals, a toxoid might be the answer.
• These vaccines are used when a bacterial toxin is
the main cause of illness.
• Scientists have found that they can inactivate toxins
by treating them with formalin. Such “detoxified”
toxins, called toxoids, are safe for use in vaccines.
• Example: Diphtheria,Tetanus toxoid

12. SUBUNIT VACCINE
• Instead of the entire microbe, subunit vaccines
includeonly the antigens that best stimulate the
immune system.
• Because subunit vaccines contain only the
essential antigens and not all the other molecules
that make up themicrobe.
• Example: Plagueimmunization.

13. CELLULAR FRACTIONS
• Meningococcal vaccine from the polysaccharide
antigen of the cell wall.
• Pneumococcal vaccine from the polysaccharide
capsule of the organism.

14. COMBINATIONS
The aim is to
– simplify administration.
- reduce costs
-minimise the no. of contacts with the health
system.
Eg. DPT, DT, MMR, DPT& Hep.B, DPT, Hep B &
Hib, Hep A & Betc.

15. MAJOR CONSTITUENTS OF VACCINE
1) Active immunizing antigens-
• Live virus, killed bacteria,Toxoids
2) Suspending fluid-
• Sterile water,saline or tissue culturefluid.
3) Preservatives, stabilizers, & antibiotics-
• Thiomersal. Neomycin,kanamycin.
4) Adjuvants- Al salts frequently used.

16. BCG
16
At birth or as early as
possible till one year of
age
Hepatitis B At birth or as early as
possible within 24 hour
OPV 0 At birth or as early as
possible within the first
15 days
NATIONAL IMMUNISATIONSCHEDULE
VACCINE WHEN TOGIVE
Forinfants

17. NATIONAL IMMUNIZATION SCHEDULE
OPV 1,2 &3
At 6 weeks , 10 weeks & 14 week
ROTA VIRUS1,2&3 At 6 weeks , 10 weeks & 14 week
PENTAVALENT 1,2 &3
At 6 weeks , 10 weeks & 14 week
FRACTIONAL- IPV 1&2 At 6 weeks & 14 week
MEASLES AND RUBELLA 1 9 completed months-12month
( givenup to 5years if not received
at 9-12 monthage)
JAPENESE ENCEPHALITIS 1 9-12months
Vitamin A ( 1st dose) At 9 month with measles
17

18. NATIONAL IMMUNISATIONSCHEDULE
For children When to given
DPT booster 16-24month
OPV Booster 16-24 month
Measlesand Rubella2 16-24 month
Japanese Encephalitis 2 16-24 month with DPT / OPV
Booster
Vitamin A 16 month with DPT/OPV
booster.Then one dose every 6
month up to the age of 5 year
DPT booster 5-6 years
TT 10 years & 16 years

19. NATIONAL IMMUNISATION SCHEDULE
FORPREGNANTWOMEN
TT-1
TT-2
TT-Booster
Early in pregnancy
4 weeksafterTT-1
If received 2 TT dosesin
a pregnancy within the
last years

20. IAP S
C
H
E
D
U
LE
Birth - 15 days BCG + OPV (zero dose) +HepB1
6 weeks - 8 weeks
10 weeks- 12 weeks
14 weeks - 16 weeks
6 months
9months (complete
d)
OPV1 +IPV1 + DPT1+ HepB2 + Hib1 +
Rotavirus1 + PCV1
OPV2 + IPV2 + DPT2+ Hib2 + Rotavirus2 +
PCV2
OPV3 + IPV3 + DPT3 + Hib3 + Rotavirus3# +
PCV3
HepB3 + OPV1
Measles+OPV2

21. IAP SCHEDULE
12months
15months
18 months
2years
5years
10 - 12years
HepatitisA1
MMR1 +Varicella+PCV
booster
OPV4 + IPV booster1 +
DPT*booster1 + Hib booster1 +
HepatitisA2
Typhoid1 (give repeat shots
every 3years)
OPV5 + DPT* booster2
+MMR2^ +Varicella2$$
Tdap/Td (Every 10 yearsthen
give Td)+HPV**

22. 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
• Primarycourse of immunization consists of 2 doses of tetanus
toxoid at intervalsof 1-2 months.
• The booster dose should be given a year after the initial doses.
• It should be stored between 4 and 10 deg C.

23. BCG
¨ WHO recommended Danish 1331 strainto be used.
¨ Initial dose birth or as earlyas possible tillone year of age
¨ 0.1 ml(0.05ml untilone month of age)
¨ Intra-dermal
¨ Left upper arm
¨ Freezedried is more stable. Diluent is Normal saline.

24. HEPATITIS B
• Birth dose – within24 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 at2 to 8 deg C.
• 1 mlin adults, 05ml in children <10 yrs, given IM. Mostly used 0,1,6 m schedule.

25. ORAL POLIO VACCINE
¨ Zero dose – atbirth
¨ 2 drops
¨ Oral
¨ First, second andthird doses at6, 10 and 14 weeks withPentavalent-1, 2 and 3
¨ OPV booster with DPT booster at16-24 months

26. PENTAVALENT VACCINE
• Simultaneous immunization against diphtheria, Pertuisis & Tetanus,
Hep B, Hib.
• Stored at 4-8 degreeC.
• Given 0.5 ml IM at anterolat. aspect of thigh.
• Primary 3 doses with a booster in 16 -24 months. DT5-6 yrs.
• C/I –progressive neurologicaldiseases.

27. ROTAVIRAL VACCINE
• 3 doses given in 6th, 10th and 14th weeks.
• Can be given tillone year of age
• G9P humanstrain.
• Dose - 5 drops/0.5ml orally
• for preventionof diarrhoea among infants due to rotavirus.

28. IPV
• 2 fractional doses givenin 6th and 14th weeks.
• Dose – 0.1ml
• Given intradermallyin Right upper arm

29. JAPANESE ENCEPHALITIS
• SA 14-14-2vaccine
• 0.5 ml,2 doses
• 9 months and16-24 months
• Subcutaneous
• Left upper arm

30. MR VACCINE
• Bivalent Live atteunated against measles and rubella.
• Given 0.5 ml SC at9-12 and 16-24 months.
• Stored 2-8 deg C
• Strain- Measles-Edmonstorn-zagreb, Rubella-Wilstar RA27/3
• Reactions-Fever
,Resp. symp.s, Lymphadenitisorparotitis

31. DPT
• Primary doses were in pentavalent vaccine.
• One booster at 16-24 m with OPV booster (antero-lateralsideof mid-thigh)and
second booster at5-6 years (upperarm)
• 0.5 ml
• Intra-muscular

32. VITAMIN A
• 1st dose – 1 ml (1 IU) - along-withMeasles first dose -Oral
• Subsequent 8 doses (2 ml or 2 lakh IU) every six months till 5 years of agestarting
withDPT first booster at 16-24 months
• Use only plastic spoon provided with Vitamin A solution

33. OPTIONAL VACCINES
• Pneumococcal vaccine
• Typhoid vaccine
• MMR vaccine
• Hepatitis Avaccine
• Chicken pox vaccine
• Flu vaccine
• Meningococcal vaccine

34. VACCINES FOR ADULTS
• HepatitisA
• HepatitisB
• Chicken pox vaccine
• Human Papilloma Virusvaccine
• Flu vaccine
• Pneumococcalvaccine
• Meningococcal vaccine