This document provides an overview of immunization and vaccination. It discusses the basics of active and passive immunization. It describes different types of vaccines including live attenuated, inactivated, toxoid, polysaccharide, conjugate, recombinant, and subunit vaccines. Key concepts in vaccinology like herd immunity, vaccine efficacy, and vaccine failure are explained. The principles, technique, and schedule of immunization administration are outlined. Adverse events following immunization and vaccine storage requirements are also summarized.

1. IMMUNIZATION
(PART 1)
DR NARAYANA LUNAVATH,
ASST. PROF, PAEDIATRICS
NTAGI ACVIP
SAGE

2. PART 1
• BASICS
• TYPES OF VACCINES
• TECHNIQUE AND PRINCIPLES OF
IMMUNIZATION
• AEFI
• VACCINE STORAGE AND COLD CHAIN
• IMMUNIZATION IN SPECIAL CONDITIONS
• SCHEDULE

3. PART 2
• INDIVIDUAL VACCINES
• PASSIVE IMMUNIZATION
• NEWER VACCINES
• CATCH UP VACCINATION
• NATIONAL PROGRAMMES

4. IMMUNIZATION
• It is a process of inducing immunity by
administering
o A vaccine prior to natural exposure to
infectious agent (Active Immunization) OR
o Preformed antibodies soon after exposure
(Passive Immunization)
• In order to suppress disease

5. VACCINATION
Process of administering vaccine
VACCINE
• It is an inactivated or attenuated pathogen or
a component of a pathogen(nucleic acid,
protein) that when administered to the host ,
stimulates a protective response of the cells in
the immune system.

6. Key terminologies in vaccinology
• Active immunity
• Passive immunity
• Innate or natural immunity
• Adaptive or acquired immunity
• Primary immune response
• Secondary or booster immune response
• Seroconversion
• Seroprotection

7. Innate immunity Adaptive immunity
Antigen independent Its response is antigen dependent
Immediate response Lag time between exposure and
maximal response
Not antigen specific Antigen specific
Exposure does not result in
induction of memory cells
Exposure results in induction of
memory cells
Epithelial and mucosal barriers,
neutrophils, monocytes,
macrophages, NK cells, dendritic
cells
T-cells, B-cells

8. FEATURE PRIMARY RESPONSE SECONDARY
RESPONSE
Type of B-cell
involved
Naive B-cell Memory B-cell
Time lag 5-10 days 1-3 days
Peak response Smaller Larger
Antibody Isotype IgM predominates IgG predominates
Antibody affinity Lower Higher (Affinity
maturation)
Inducing agent All immunogens Only protein antigens

9. VACCINATION
LOCAL INFLAMMATORY RESPONSE
(INNATE IMMUNITY RESPONSE)
ANTIGEN UPTAKE BY APCs ( ID > IM > SC )
HOW DOES A VACCINE WORK?

10. Live attenuated
vaccine
Inactivated vaccine Polysaccharide vaccine
Inactivated subunit vaccine - long chain of sugar
molecules found in surface of certain bacteria
Immune response-
similar to natural
infection
Immune response is
mostly humoral, no
cellular immunity
Pure PS vaccine is T-cell independent, not
immunogenic in children<2 years.
Produces
immunity in most
with 1 dose
Require multiple
doses
Repeat dose does not cause a booster response
Affected by
circulating
antibody (Measles;
OPV & rotavirus)
Least affected by
circulating antibody
Predominant antibody produced is IgM
Could revert to its
original pathogenic
form (OPV)
Antibody titre
against IV diminish
with time
Conjugation with a protein changes immune
response to T-cell dependent-increased
immunogenicity & booster response
TYPES OF VACCINES

11. Toxoid
• A toxoid is a bacterial toxin (usually an
exotoxin)whose toxicity has been inactivated
or suppressed either by chemical (formalin) or
heat treatment, while immunogenicity
retained.
• Examples – Tetanus , Diptheria

12. Recombinant vaccines
• The vaccines are produced using recombinant
DNA technology or genetic engineering.
• Recombinant vaccines are those in which
genes for desired antigens of a microbe are
inserted into a vector.
• Hepatitis B vaccine and HPV vaccines

13. TYPES OF VACCINES
VACCINES
LIVE
ATTENUAT
ED
BACTERIAL BCG
VIRAL RVV, OPV, MMR,
VARICELLA
INACTIVAT
ED
WHOLE
INACTIVAT
ED
BACTERIAL wP
VIRAL IPV, HAV, RABIES
FRACTION
AL
INACTIVAT
ED
POLYSACH
HARIDE
UNCONJUGAT
ED
PPSV
CONJUGATED TCV, PCV, MCV
PROTEIN TOXOID TT, DT
SUBUNIT HBV, FLU, aP
VACCINE LIKE PARTICLES HPV
DNA

14. • Vaccine Efficacy
It is the percentage reduction in disease
incidence attributable to vaccination [usually]
• Calculated by following equation:
VE (%) = (RU – RV)/RU × 100
Where RU = The incidence risk or attack rate
in unvaccinated people and
RV = The incidence or attack rate in vaccinated
people.

15. Vaccine failure
• When a person who has been fully vaccinated
develops the disease against which they have
been vaccinated, it is referred to as vaccine
failure.
• It is of two types:
A) Primary vaccine failure
B) Secondary vaccine failure

16. Herd immunity:
• It is defined as the resistance of a group or
a community in total, against the invasion and
spread of an infectious agent as a result of a
large proportion of individuals in the group
being immunized.
• The level of herd immunity can be assessed
through cross-sectional and longitudinal
serological surveys.

17. TECHNIQUE OF VACCINE
ADMINISTRATION
• Hands to be cleaned
• Separate needle and syringe for each injection
• Correct dose, Correct site
• Discard needle and syringe safely
• Avoid gluteal region for IM injection
• Gentle pressure at vaccination site for a few
seconds after vaccination

19. PRINCIPLES OF IMMUNIZATION
• Different live vaccines may be given
simultaneously or at an interval of 4 weeks.
• A minimum interval of 4 weeks between two
doses of same vaccine to ensure adequate
immune response
• 2 vaccines can be given in same limb, vaccines are
adminitered atleast 1 inch apart
• If dose is missed, course is resumed at the point it
was interrupted
• Immunization is NOT c/I in minor illness,
prematurity, malnutrition, antibiotic therapy

20. ERRORS OF ADMINISTRATION
• Syringes should be filled only before
administration because several vaccines look
similar in appearance when filled in syringe
• Vaccine should be inspected for expiry date.
• For reconstitution of lyophilized vaccines, only
vaccines specific supplied diluents should be
used.
• Change of brand is usually not recommended
unless there is non availability of same brand.

21. DOCUMENTATION AND RECORD
KEEPING
The ideal vaccination record should have following:
• Date of vaccination
• Product administered
• Manufacturer’s name or brand name
• Batch number
• Expiry date
• Site and route of administration
• Name, address and title of the health-care
provider administering the vaccine.

22. ADVERSE EVENTS FOLLOWING
VACCINATION AND PREPAREDNESS
• Ideally, the vaccinee should be observed for at
least 15–20 minutes following vaccination for
any allergic reactions.
• Each health-care facility offering vaccination
program should have a functional
resuscitation place.

23. Resuscitation place should be equipped with:
• Suction
• Airway
• Oxygen
• Bag and mask
• Intubation equipment
Intravenous access and
• Medications necessary for treating
anaphylaxis (adrenalin, normal saline and
hydrocortisone)

24. Adverse Events Following
Immunization
Adverse event following immunization is any
untoward medical occurrence which follows
immunization and which does not necessarily
have a causal relationship with the usage of
the vaccine

25. Types of vaccine reactions
• Minor AEFI : These are common, self-limiting
reactions E.g. pain, swelling at the injection
site, fever, irritability, malaise etc.
• Severe AEFI : disabling and, rarely, life
threatening events. However not leading to
long-term problems. Eg. : Non-hospitalized
recovered cases of anaphylaxis, high fever
(>102-degree F), hypotonic-hyporesponsive
episodes, cellulitis, sepsis, etc.

26. • Serious AEFI:
(1) results in death, hospitalization, or
persistent or significant disability/incapacity,
(2) occurs in clusters,
(3) causes parental/community concern, or
(4) results in congenital anomaly/birth defect.

27. TYPE OF AEFI DEFINITION EXAMPLE
Vaccine product-related
reaction- Vaccine induced
precipitated due to one or
more of the inherent
properties of the vaccine
product.
Extensive limb swelling
following DTP vaccination.
Vaccine quality defect-
related reaction
caused or precipitated by a
vaccine that is due to one or
more quality defects of the
vaccine product including
its administration device as
provided by the
manufacturer
Vaccine associated
paralytic poliomyelitis
Immunization error-related
reaction
Inappropriate vaccine
handling, prescribing or
administration
Transmission of infection
by contaminated
multidose vial

28. TYPE OF AEFI DIFINITION EXAMPLE
Immunization anxiety-
related reaction
arising from anxiety about
the immunization
Vasovagal syncope
Coincidental event caused by something other
than the vaccine product,
immunization error or
immunization anxiety
A fever occurs at the time
of the vaccination
(temporal association) but
is in fact caused by
malaria.

29. • Serious / severe AFEI to be reported by
medical officer of PHC to district medical
officer through case reporting Format (CRF)

30. SERIOUS ADVERSE EVENTS FOLLOWING
COMMONLY USED VACCINES
VACCINE REACTION
1. BCG FATAL DISSEMINATION OF BCG INFECTION
2. OPV VACCINE ASSOCIATED PARALYTIC POLIOMYELITIS
3. DTwP PROLONGED CYRING AND SEIZURES
HYPOTONIC HYPORESPONSIVE EPISODE
4. MEASLES FEBRILE SEIZURES
THROMBOCYTOPENIA
ANAPHYLAXIS
TSS (S aureus contamination)
5. ROTAVIRUS
6. RUBELLA
INTUSSUSCEPTION
CHRONIC ARTHRITIS

31. VACCINE STORAGE
• Effectiveness of vaccines depends on the
proper storage and proper handling during
transportation, distribution and use.

32. COLD CHAIN
- Storage and transportation of vaccines and
vaccine products
- in recommended conditions and acceptable
temperature ranges
- from point of manufacture until it is
administered to the beneficiary

33. • Vaccines can be heat sensitive, freeze sensitive
and light sensitive.
most heat sensitive OPV
IPV, Measles, MR , MMR , Rotavirus
DTP, DTP- Hep B, DTP – Hib, YF
BCG, JE
Hib, DT
Td, TT, Hep B
least heat sensitive

34. • Aluminum adjuvanted vaccines should not be frozen. If frozen it
desiccates, leads to decrease in potency and causes sterile
abscess.
• Hep B most freeze sensitive, freezes at – 0.50C
• DPT, TT ,DT freezes at ‐30C.
• Do not keep these vaccines on ice pack.
Most freeze sensitive Hep B, Pentavalent
PCV, HPV, Cholera
DTP, DTP- Hep B, DTP – Hib
YF, IPV
DT , Td
TT
Least freeze sensitive

36. EQUIPMENT TEMPERATURE STORAGE LEVEL
1. WALK IN FREEZER -20 C OPV, FROZEN
WATER PACKS
NATIONAL AND
SUBNATIONAL
LEVEL
2. WALK IN COOLER +2 TO +8 C BULK VACCINES
LIKE PENTAVALENT,
BCG,PCV, ROTA,
MEASLES
NATIONAL AND
SUBNATIONAL
LEVEL
3. DEEP FREEZER -15 TO -25 C OPV AND WATER
PACKS
DISTRICT AND SUB
DISTRICT LEVEL
4. ICE LINED
FREEZER
+ 2 TO +8 C BCG, HEP B, DPT,
DT, TT, MEASLES
DISTRICT AND SUB
DISTRICT LEVEL
5. DOMESTIC
REFRIGERATOR
+ 2 TO +8 C VACCINES OUTREACH SITE

37. EQUIPMENT TEMPERATURE STORAGE CAPACITY
COLD BOX +2 TO +8 C ALL VACCINES STORED
FOR TRANSPORT OR IN
CASE OF POWER
FAILURE
VACCINE CARRIER +2 TO + 8 ALL VACCINES CARRIED
FOR 12 HOURS

38. Walk in freezer

42. Vaccine Vial Monitor

43. • TEMPERATURE MONITORING DEVICES USED:
1. Fixed dial thermometer
2. Alcoholic stem thermometer
3. Electronic data logger
4. Vaccine Vial monitors

44. Immunization in Special Circumstances

45. Immunization in Premature Babies
• At same chronological age
• At same doses
• According to same schedule as for full term
infants
• Ex: Hep B- if preterm <2kg, postpone by 1
month if mother is HBsAg negative.

46. VACCINATION IN CHILDREN WITH PID
PID TYPE VACCINATION GUIDELINES
SEVERE B CELL DEFECT All live vaccines contraindicated
Killed vaccines can be given but
ineffective
Close contacts – no live vaccines ( OPV)
MILD TO MODERATE B CELL DEFECT Only OPV contraindicated
SCID AND OTHER SEVERE COMBINED PID Live vaccines – contraindicated
Killed vaccines – ineffective
PHAGOCYTIC DEFECTS Live bacterial vaccines (BCG)
contraindicated
COMPLEMENT DEFECTS All vaccines can be given
Recommended vaccines: Pneumococcal,
HiB, Meningococcal

47. Vaccination in children taking
chemotherapy
• Live vaccines contraindicated during and 6
months after completing therapy
• Killed vaccines can be given but could be
ineffective
• Inactivated influenza vaccine should be given
once intensive phases are over.

48. Immunization in CKD Patients
VACCINES RECOMMENDATIONS
LIVE VACCINES All indicated.
Avoided only if on immunosuppressive
therapy
KILLED AND TOXOID VACCINES Indicated
INFLUENZA VACCINE Annual inactivated vaccines
recommended. Live Attenuated Influenza
vaccine contraindicated
HEPATITIS B Routine schedule
PNEUMOCOCCAL VACCINE Recommended

49. Vaccination post solid organ transplant
• Primary immunization to be completed before
transplant.
• Vaccination to be completed 2 weeks prior to
transplant.
• Post transplant, vaccination to be started after
withdrawing immunosuppressive therapy.
• Inactive vaccines can be used but efficacy is
less.

50. Vaccination in hematopoeitic stem cell
transplant
Post HSCT, considered immunocompetent after 24 months if not
on immunosuppressive therapy and no graft vs host disease
23-PPS 12 and 24 months
HiB 12,14,24 months
Varicella vaccine Contraindicated
Influenza vaccine Yearly for lifelong after >6 months post
HSCT
Td, Hep B, Inactivated Polio 12,14,24 months
Hepatitis A
Meningococcal
Not recommended
MMR >24 months if immunocompetent

51. Vaccination in asplenia or hyposplenia
• Vaccination with pneumococcal (both conjugate
and polysaccharide),Hib, meningococcal, and
typhoid vaccines is indicated
• Planned splenectomy – start immunization 2
weeks prior to surgery
• After emergency splenectomy – 2 weeks post
surgery

52. Vaccination in HIV infected children

55. DIFFERENCES BETWEEN IAP AND UIS
UIS IAP
BIRTH BCG, OPV , HEPATITIS B BCG, OPV , HEPATITIS B-1
6 WEEKS PENTAVALENT-1, fIPV
ROTAVIRUS -1*
PCV -1*
IPV 1, DTP, HEPATITIS B-2, HIB,
PCV, ROTAVIRUS
10 WEEKS PENTAVALENT-2,
ROTAVIRUS-2 *
IPV, DTP, HIB, HEP-3
PCV, ROTAVIRUS
14 WEEKS PENTAVALENT-3, fIPV
ROTAVIRUS -3*
PCV -2*
IPV, DTP, HIB, HEP-4
PCV, ROTAVIRUS
6 MONTHS INFLUENZA 1
7 MONTHS INFLUENZA 2

56. 6-9 MONTHS TCV
9 MONTHS MR-1
PCV-3*
JE-1*
MMR-1
JE-1
12 MONTHS HEPATITIS A
15 MONTHS PCV B-1
MMR 2
VARICELLA 1, JE-2
16-18 MONTHS
16-24 MONTHS DPT B1, OPV B1, MR-2,JE-2*
DTP B1, HIB BI, IPV B 1
18-19 MONTHS HEP A2(If inactivated),
VARICELLA 2
4-6 YEARS DPT B-2 DTP B2, IPV B2, MMR3
9-14 YEARS
10 YEARS Td
Tdap, HPV 1 AND 2
15-18 YEARS
16 YEARS Td
Td, HPV 1,2,3

57. References
• IAP GUIDEBOOK ON IMMUNIZATION
• PG TEXTBOOK OF PIYUSH GUPTA
• OP GHAI’S ESSENTIALS OF PEDIATRICS

58. QUESTIONS ?

59. THANK YOU