Immunisation

IMMUNISATIONIMMUNISATION
Mr. Shivakumar chawanMr. Shivakumar chawan

DEFINITIONDEFINITION
 Protection from preventableProtection from preventable
diseases,disabilities and deaths.diseases,disabilities and deaths.
 Birth right of every childBirth right of every child
 Most costeffective healthcare interventionMost costeffective healthcare intervention
 Greek word ‘ímmune’ means ‘ to be protectedGreek word ‘ímmune’ means ‘ to be protected
’.’.

 Acquired immunity: protection offered byAcquired immunity: protection offered by
introduction of various antigens or antibodiesintroduction of various antigens or antibodies
 The process by which this is obtained isThe process by which this is obtained is
known as immunisationknown as immunisation
 Active immunisation: SpecificActive immunisation: Specific antigensantigens evokeevoke
the needed immune responsethe needed immune response
 Passive immunisation:Antibodies are suppliedPassive immunisation:Antibodies are supplied
readymade as immunoglobulins and sera.readymade as immunoglobulins and sera.

Some definitionsSome definitions
 Vaccination: Process of inoculating theVaccination: Process of inoculating the
vaccine or the antigenvaccine or the antigen
 Immunisation: Process of inducing immuneImmunisation: Process of inducing immune
response, humoral or cell mediated.response, humoral or cell mediated.
 Seroconversion: Change from antibodySeroconversion: Change from antibody
negative state to antibody positive state.negative state to antibody positive state.
 Seroprotection: The state of protection (fromSeroprotection: The state of protection (from
disease) due to presence of humoral immunitydisease) due to presence of humoral immunity
or antibody detectable in serumor antibody detectable in serum

HistoryHistory
 Jenner: Cowpox vaccine – 1796Jenner: Cowpox vaccine – 1796
 Pasteur: Rabies prophylaxis – 1885Pasteur: Rabies prophylaxis – 1885
 EPI: WHO 1974, India – 1978EPI: WHO 1974, India – 1978
 UIP: India – 1985UIP: India – 1985
 Child vaccine initiative: with support from severalChild vaccine initiative: with support from several
international agencies – 1991international agencies – 1991
 Global programme on vaccines: WHO – 1993Global programme on vaccines: WHO – 1993
 Global alliance for vaccine and immunisation - 1999Global alliance for vaccine and immunisation - 1999

ACHIEVEMENTSACHIEVEMENTS
Small pox eradicated in 1977Small pox eradicated in 1977
EPI coverage of > 80% by 1990EPI coverage of > 80% by 1990
Certification for polio eradication by 2005Certification for polio eradication by 2005
Over 3 million lives saved globally, annuallyOver 3 million lives saved globally, annually

Types of vaccinesTypes of vaccines
 Live bacteria- BCG, Ty 21 aLive bacteria- BCG, Ty 21 a
 Live virus – OPV, MMRLive virus – OPV, MMR
 Killed bacteria – Pertussis, S.typhiKilled bacteria – Pertussis, S.typhi
 Killed virus – IPV, Rabies, HAVKilled virus – IPV, Rabies, HAV
 Toxoid – DT, TTToxoid – DT, TT
 Capsular polysaccharide – HiB, Pneumo, MeningoCapsular polysaccharide – HiB, Pneumo, Meningo
 Viral subunit - HBsAgViral subunit - HBsAg
 Bacterial subunit – Acellular pertussisBacterial subunit – Acellular pertussis

National ImmunisationNational Immunisation
ScheduleSchedule
AgeAge VaccineVaccine
BirthBirth BCG, OPV – 0BCG, OPV – 0
6 wks6 wks DPT –1, OPV –1DPT –1, OPV –1
10 wks10 wks DPT – 2, OPV – 2DPT – 2, OPV – 2
14wks14wks DPT – 3. OPV – 3DPT – 3. OPV – 3
9 months9 months MeaslesMeasles
15-18 months15-18 months DPT – 4, OPV –4DPT – 4, OPV –4
5 years5 years DTDT
10 years10 years TTTT
16 years16 years TTTT
Pregnant womenPregnant women 2 TT at 4 wks interval2 TT at 4 wks interval

IAP immunisation timetableIAP immunisation timetable
AgeAge VaccineVaccine
Birth – 2 wksBirth – 2 wks BCGBCG
Birth, 6, 10, 14 wks, 16-18Birth, 6, 10, 14 wks, 16-18
mo, 5 yrsmo, 5 yrs
OPVOPV
mo, 5 yrsmo, 5 yrs
DPTDPT
Birth., 6, 14 wks / 6, 10, 14Birth., 6, 14 wks / 6, 10, 14
wkswks
Hepatitis BHepatitis B
momo
HiB ConjugateHiB Conjugate
9 mo plus9 mo plus MeaslesMeasles
15 months15 months MMRMMR
2 years2 years TyphoidTyphoid
10., 1610., 16 TT / dTTT / dT
Pregnant womenPregnant women 2 doses of TT2 doses of TT

Additional vaccinesAdditional vaccines
 Varicella – above 1 yrVaricella – above 1 yr
 Hepatitis A – above 2 yrHepatitis A – above 2 yr

Cold chainCold chain
 The system of transporting, distributing andThe system of transporting, distributing and
storing vaccines from the manufacturers right upstoring vaccines from the manufacturers right up
to the point of use under refrigeration using anyto the point of use under refrigeration using any
convenient method is referred to as cold chainconvenient method is referred to as cold chain
 Vital link in immunisationVital link in immunisation
 If not maintained, vaccine efficacy will grosslyIf not maintained, vaccine efficacy will grossly
suffersuffer
 Safe temp. zone – mandatory to maintain potencySafe temp. zone – mandatory to maintain potency
 Safe zone for short term storage (1-2 months)is 2-Safe zone for short term storage (1-2 months)is 2-
8 deg C. For long term storage –20 degC is used8 deg C. For long term storage –20 degC is used
only for BCG,OPV,Measles/MMRonly for BCG,OPV,Measles/MMR
 The T series of vaccine(DPT,DT,TT),typhoidThe T series of vaccine(DPT,DT,TT),typhoid
Vi,Hep B should not be frozen as once frozen theVi,Hep B should not be frozen as once frozen the
aluminium salts used as adjuvant will bealuminium salts used as adjuvant will be
desiccated and will act as irritantdesiccated and will act as irritantsterile abcesssterile abcess

NAMENAME BCG-LAV.Danish bovine strainBCG-LAV.Danish bovine strain
CONTENTCONTENT BCG strain of bovine mycobacterium-BCG strain of bovine mycobacterium-
3-10 million bac/dose3-10 million bac/dose
PREPARATNPREPARATN LyophilisedLyophilised
INITIATIONINITIATION At birth/first contactAt birth/first contact
SCHEDULESCHEDULE Single doseSingle dose
BOOSTERBOOSTER NilNil
DOSEDOSE 0.05 ml(newborn)0.1 ml(infants and0.05 ml(newborn)0.1 ml(infants and
childrenchildren
ADMNSTRNADMNSTRN Intra dermal left deltoidIntra dermal left deltoid
EFFICACYEFFICACY 0-80%0-80%
C/IC/I ImmunodeficiencyImmunodeficiency
S/ES/E Axillary adenitisAxillary adenitis

NAMENAME DPT-killed pertusis+toxoidDPT-killed pertusis+toxoid
diph&tetanusdiph&tetanus
OPV-LAVOPV-LAV
CONTENTCONTENT Diph tox 20 Lf,Tet tox 5Diph tox 20 Lf,Tet tox 5
Lf.Pertusis 6 IU(40,000Lf.Pertusis 6 IU(40,000
million killed bacteriamillion killed bacteria
+ALPO+ALPO44-3 mg-3 mg
SABIN, type 1-SABIN, type 1-
101066
(CCID 50),type-2-(CCID 50),type-2-
101055
(CCID 50),type-3-(CCID 50),type-3-
101055
(CCID50(CCID50
PREPARATNPREPARATN LiquidLiquid LiquidLiquid
INITIATIONINITIATION 6 wks6 wks BirthBirth
SCHEDULESCHEDULE 3 doses 6,10,14 wks3 doses 6,10,14 wks Birth,6,10,14 wksBirth,6,10,14 wks
BOOSTERBOOSTER 15- 18 mo,5 yrs15- 18 mo,5 yrs 15- 18 mo,5 yrs15- 18 mo,5 yrs
DOSEDOSE 0.5 ml0.5 ml 2 drops2 drops
ADMNSTRNADMNSTRN I/M lat thighI/M lat thigh OralOral
EFFICACYEFFICACY P80%D80%T100%P80%D80%T100% 80-90%80-90%
C/IC/I Prog neuro dis,uncontrolledProg neuro dis,uncontrolled
cry,convulsion, severe rxncry,convulsion, severe rxn
for 1for 1stst
dosedose
ImmunoImmuno
defeciency,HIVdefeciency,HIV

NAMENAME Hepatits B(HBsAg)Hepatits B(HBsAg) Measles(LAV)Measles(LAV)
CONTENTCONTENT Plasma derived/yeast derivedPlasma derived/yeast derived
r-DNA/CHO cells derived r-r-DNA/CHO cells derived r-
DNADNA
1000TCID50.Schwarz or1000TCID50.Schwarz or
Edmonston Zagreb strainEdmonston Zagreb strain
1000 TCID/CCID1000 TCID/CCID
PREPARATNPREPARATN LiquidLiquid LyophilisedLyophilised
INITIATIONINITIATION Birth w/ I 48 hrsBirth w/ I 48 hrs6 wks6 wks >9 mo>9 mo
SCHEDULESCHEDULE Birth,6,14 wks/0,1,6 monthsBirth,6,14 wks/0,1,6 months 1 dose at 9-12 mo.21 dose at 9-12 mo.2ndnd
doseafter 3 mo if 1doseafter 3 mo if 1stst
dose<9 modose<9 mo
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 10 microgram,0.5 ml(<1010 microgram,0.5 ml(<10
yrs), 1 ml(>10 yrs)yrs), 1 ml(>10 yrs)
0.5 ml0.5 ml
ADMNSTRNADMNSTRN I/M deltoidI/M deltoid S/C deltoidS/C deltoid
EFFICACYEFFICACY 90%90% 95%95%
C/IC/I NoneNone Imm def,anaphylaxis,eggImm def,anaphylaxis,egg
protein allergyprotein allergy
S/ES/E Local pain,erythemaLocal pain,erythema Fever ,rash after a weekFever ,rash after a week

NAMENAME MMR(LAV)MMR(LAV) Mumps(LAV)Mumps(LAV)
CONTENTCONTENT Measles asMeasles as
above,Mumps5000 TCID ofabove,Mumps5000 TCID of
Urabe AM-9,Rubella 1000Urabe AM-9,Rubella 1000
TCID of Wistar RA/3MTCID of Wistar RA/3M
L-Zagreb/Jerry LynnL-Zagreb/Jerry Lynn
strain 5000TCIDstrain 5000TCID
PREPARATNPREPARATN LyophilisedLyophilised LyophilisedLyophilised
INITIATIONINITIATION 15 mo15 mo 15 mo with M&R or at15 mo with M&R or at
11 yrs11 yrs
SCHEDULESCHEDULE Single doseSingle dose Single doseSingle dose
DOSEDOSE 0.5ml0.5ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC deltoidSC deltoid SC deltoidSC deltoid
EFFICACYEFFICACY 95%95% 90-95%90-95%
C/IC/I As in measles+pregnancyAs in measles+pregnancy Imm defImm def
S/ES/E As in measlesAs in measles FeverFever

NAMENAME H Infl b(conjugate)H Infl b(conjugate)
PRPD/PRPT/HBOCPRPD/PRPT/HBOC
TYPHOID(KILLED)TYPHOID(KILLED)
CONTENTCONTENT H.Infl capsularH.Infl capsular
oligosaccharide –boligosaccharide –b
S.typhi 1000 millionS.typhi 1000 million
killed/mlkilled/ml
PREPARATNPREPARATN Liquid/freeze driedLiquid/freeze dried LiquidLiquid
INITIATIONINITIATION 6 wks6 wks 2 yrs2 yrs
SCHEDULESCHEDULE 6,10,14 wks/2,4,6 mo6,10,14 wks/2,4,6 mo 2 doses 4 wks apart2 doses 4 wks apart
BOOSTERBOOSTER After 1 yrAfter 1 yr Every 3 yrsEvery 3 yrs
DOSEDOSE 0.5 ml.10 mcg0.5 ml.10 mcg 0.25 ml<10yrs,0.50.25 ml<10yrs,0.5
ml>10 yrsml>10 yrs
ADMNSTRNADMNSTRN SC/IM-deltoid/ant lat thighSC/IM-deltoid/ant lat thigh SC deltoidSC deltoid
EFFICACYEFFICACY 90-100%90-100% 57-75%57-75%
C/IC/I NoneNone NoneNone
S/ES/E Local rxn,feverLocal rxn,fever Local rxn,feverLocal rxn,fever

NAMENAME TYPHOID(ViTYPHOID(Vi
polysaccharidepolysaccharide
TYPHOID oralTYPHOID oral
CONTENTCONTENT Vi capsular polysachVi capsular polysach
S.typhiS.typhi
Ty 21a strAin(10Ty 21a strAin(1099
organisms)organisms)
PREPARATNPREPARATN LiquidLiquid CapsuleCapsule
INITIATIONINITIATION >2 yrs>2 yrs >6yrs>6yrs
SCHEDULESCHEDULE Single doseSingle dose 3 doses on alternate3 doses on alternate
daysdays
BOOSTERBOOSTER Every 3 yrsEvery 3 yrs Every 3 yrsEvery 3 yrs
DOSEDOSE 25-50 mcg(0.5 ml)25-50 mcg(0.5 ml) 1 capsule1 capsule
ADMNSTRNADMNSTRN I/MI/M OralOral
EFFICACYEFFICACY 70%70% 70%70%
S/ES/E Fever,pain,induratnFever,pain,induratn AbdominalAbdominal
pain,vomiting, loosepain,vomiting, loose
stoolsstools

NAMENAME PneumococcalPneumococcal HEP-A (inactivatedHEP-A (inactivated
vaccine)vaccine)
CONTENTCONTENT Capsular poly saccharideCapsular poly saccharide HM 175 of HAVHM 175 of HAV
720 ELU antigen/ml720 ELU antigen/ml
PREPARATNPREPARATN LyophilisedLyophilised LiquidLiquid
INITIATIONINITIATION >2 yrs>2 yrs >2 yrs>2 yrs
SCHEDULESCHEDULE Single doseSingle dose 2 doses 0, 6 mo2 doses 0, 6 mo
BOOSTERBOOSTER Every 3-5 yrsEvery 3-5 yrs NilNil
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC/IM over Ant. LatSC/IM over Ant. Lat
thighthigh
IM antero lat thighIM antero lat thigh
EFFICACYEFFICACY 85-90 %85-90 % 99%99%
C/IC/I First trimester pregnancyFirst trimester pregnancy NoneNone

NAMENAME Varicella vaccineVaricella vaccine Meningococcal A+CMeningococcal A+C
CONTENTCONTENT OKA strain of varicellaOKA strain of varicella
zoster10zoster1033
(3 PFU)(3 PFU)
N.meningitidisN.meningitidis
groupA,C 50 mcg eachgroupA,C 50 mcg each
PREPARATNPREPARATN LyophilisedLyophilised LyophilisedLyophilised
INITIATIONINITIATION >1 yr>1 yr For use only in endemicFor use only in endemic
areas duringareas during
epidemics.>2 yrsepidemics.>2 yrs
SCHEDULESCHEDULE 1-12 yrs(single dose),>131-12 yrs(single dose),>13
yrs 2 doses 1 mo apartyrs 2 doses 1 mo apart
Single doseSingle dose
BOOSTERBOOSTER NilNil 5 yrs5 yrs
ADMNSTRNADMNSTRN SC deltoidSC deltoid SC/IM-deltoid/Ant latSC/IM-deltoid/Ant lat
thighthigh
S/ES/E Varicella type rash after 1Varicella type rash after 1
wk with feverwk with fever
Local rxn, mild feverLocal rxn, mild fever

NAMENAME Japanese encephalitis(killedJapanese encephalitis(killed
monovalent)monovalent)
InfluenzaInfluenza
vaccine(inactivated-splitvaccine(inactivated-split
virion)virion)
CONTENTCONTENT Mouse brain(Nakayama/NIHMouse brain(Nakayama/NIH
strain) or Baby hamsterstrain) or Baby hamster
kidney(P-3) or Recombinantkidney(P-3) or Recombinant
DNA vaccineDNA vaccine
1.5 mcg hemaglutinin of1.5 mcg hemaglutinin of
each of the chosen straineach of the chosen strain
as suspensionas suspension
PREPARATNPREPARATN Freeze dried /liquidFreeze dried /liquid LiquidLiquid
INITIATIONINITIATION Same as meningo cocciSame as meningo cocci All agesAll ages
SCHEDULESCHEDULE 2 doses 1-2 wks interval2 doses 1-2 wks interval Single doseSingle dose
BOOSTERBOOSTER After 3-4 yrsAfter 3-4 yrs Every year with currentEvery year with current
strainstrain
DOSEDOSE 1 ml1 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC-deltoid/ant lat thighSC-deltoid/ant lat thigh SC/IMSC/IM
EFFICACYEFFICACY 60-80%,100% after booster60-80%,100% after booster 80-90%80-90%
C/IC/I NoneNone Egg protein allergyEgg protein allergy
S/ES/E Local swelling,fever,malaiseLocal swelling,fever,malaise Local reaction,feverLocal reaction,fever

NAMENAME DPT wc+HB combinationDPT wc+HB combination DPT wc+HibDPT wc+Hib
CONTENTCONTENT D and T toxoid+PWC+D and T toxoid+PWC+
yeast derived r-DNAyeast derived r-DNA
HBsAgHBsAg
D &T toxoidD &T toxoid
PWC+capsularPWC+capsular
polysaccharide of Hibpolysaccharide of Hib
PREPARATNPREPARATN LiquidLiquid Lyophilised/liquidLyophilised/liquid
INITIATIONINITIATION 6 weeks6 weeks 6 wks6 wks
SCHEDULESCHEDULE 6,10,14 wks6,10,14 wks 6,10,14 wks6,10,14 wks
ADMNSTRNADMNSTRN IMIM IMIM
C/IC/I Same as DPTSame as DPT NoneNone
S/ES/E Fever,pain,local indurationFever,pain,local induration Mild fever,localMild fever,local
indurationinduration

NAMENAME Rabies (tissue culture)-inactivatedRabies (tissue culture)-inactivated
CONTENTCONTENT 1.1. HDCV(virus grown in Human DiploidHDCV(virus grown in Human Diploid
fibroblasts)fibroblasts)
2.2. PCEC (Chick embryo cells)PCEC (Chick embryo cells)
3.3. Vero cell(vervet monkey kidney cell)Vero cell(vervet monkey kidney cell)
PREPARATNPREPARATN LyophilisedLyophilised
INITIATIONINITIATION Any age-/after dog biteAny age-/after dog bite
SCHEDULESCHEDULE Pre expo:0.7,21 days.PostPre expo:0.7,21 days.Post
expo:0,3,7,14,28.Re expo0,7(<5 yrs), fullexpo:0,3,7,14,28.Re expo0,7(<5 yrs), full
course(>5 yrs)course(>5 yrs)
BOOSTERBOOSTER First after 1 year then every 3 yrsFirst after 1 year then every 3 yrs
DOSEDOSE 0.5 ml/1ml depending on preparatn0.5 ml/1ml depending on preparatn
ADMNSTRNADMNSTRN S/C deltoid/ ant lat thighS/C deltoid/ ant lat thigh
EFFICACYEFFICACY 90-100%90-100%
C/IC/I NoneNone
S/ES/E Local pain,rarely encephalopathyLocal pain,rarely encephalopathy

BCG VaccineBCG Vaccine
 Attenuated M. Bovis developed in 1921Attenuated M. Bovis developed in 1921
 Protects against TB meningitis ,Miliary T BProtects against TB meningitis ,Miliary T B
 Maternal antibodies do not interfere as CMI notMaternal antibodies do not interfere as CMI not
transplacentally transferredtransplacentally transferred
 Induces long term protectionInduces long term protection
 Supplied freeze dried and stored frozen orSupplied freeze dried and stored frozen or
refrigeratedrefrigerated
 Reconstituted vaccine to be used w/I 4-6 hrsReconstituted vaccine to be used w/I 4-6 hrs
 Dose 0.05 ml(infants),0.1 ml(infants and children)Dose 0.05 ml(infants),0.1 ml(infants and children)
 Intra-dermal over left deltoidIntra-dermal over left deltoid
 Local lesion due to bacterial multiplication whichLocal lesion due to bacterial multiplication which
heals leaving a scar in 12 wks(repeat if no scar)heals leaving a scar in 12 wks(repeat if no scar)
 C/I- Immune deficiencyC/I- Immune deficiency
 Side effect-Axillary adenitisSide effect-Axillary adenitis

OPVOPV
 Live attenuated polio virus types1,2&3-developed byLive attenuated polio virus types1,2&3-developed by
sabin ,1961sabin ,1961
 Temperature sensitive store frozen or refrigeratedTemperature sensitive store frozen or refrigerated
 Can be given simultaneous with any other vaccineCan be given simultaneous with any other vaccine
 Multiple doses necessary to ensure vaccine virus takeMultiple doses necessary to ensure vaccine virus take
and response to all three types of virusesand response to all three types of viruses
 IAP recommends additional doses of opv as a part ofIAP recommends additional doses of opv as a part of
pulse polio program every year till age of 5 yrspulse polio program every year till age of 5 yrs

Why PULSE POLIO?Why PULSE POLIO?
 On national immunisation days(NIDs) pulse doses ofOn national immunisation days(NIDs) pulse doses of
oral polio vaccine has to be administered asoral polio vaccine has to be administered as
simultaneous feeding of vaccine to all susceptibles issimultaneous feeding of vaccine to all susceptibles is
neede to produce immunity, by preventing wild polioneede to produce immunity, by preventing wild polio
viruses from multiplying in the gutviruses from multiplying in the gut
 It is mandatory to give all reccomended doses inIt is mandatory to give all reccomended doses in
NIDs so that no wild virus remains in circulationNIDs so that no wild virus remains in circulation
 OPV is contraindicated inOPV is contraindicated in
immunodeficiency,HIV,active viral infectionsimmunodeficiency,HIV,active viral infections
 No side effectsNo side effects

IPVIPV
 Formaldehyde killed polio virus grown inFormaldehyde killed polio virus grown in
monkey kidney or human diploid cellmonkey kidney or human diploid cell
 Contains 20,8,32 D antigen units against typeContains 20,8,32 D antigen units against type
1,2,3 polio viruses respectively1,2,3 polio viruses respectively
 Seroconversion 90-95% after 2 doses,99%Seroconversion 90-95% after 2 doses,99%
after 3 dosesafter 3 doses
 Thermo stable and indicated inThermo stable and indicated in
immunocompromised and HIVimmunocompromised and HIV

DPTDPT
 Diphteria toxoid(Ramon &Glenny,1923)Diphteria toxoid(Ramon &Glenny,1923)
 Killed Bordetella pertusis(Madsen ,1923)Killed Bordetella pertusis(Madsen ,1923)
 Tetanus toxoid(Ramon & Zoeller,1927)Tetanus toxoid(Ramon & Zoeller,1927)
 Toxoids adjuvated (Aluminium hydroxide/Toxoids adjuvated (Aluminium hydroxide/
phosphate)phosphate)
 Vaccine supplied as liquid, stored refrigeratedVaccine supplied as liquid, stored refrigerated
 Aluminium adjuvated vaccine must not be frozenAluminium adjuvated vaccine must not be frozen
 0.5 ml injected IM on anterolateral asoect of thigh.0.5 ml injected IM on anterolateral asoect of thigh.

 Parents must be alerted about local reactionParents must be alerted about local reaction
and fever(PCT given)and fever(PCT given)
 IAP recommends 2IAP recommends 2ndnd
booster at 5 yrsbooster at 5 yrs
 H/O convulsion not contradictionH/O convulsion not contradiction
 Progressive neurological disease or seriousProgressive neurological disease or serious
adverse reaction to earlier dose areadverse reaction to earlier dose are
contraindications for DPT(replace with DT)contraindications for DPT(replace with DT)

MeaslesMeasles
 Live attenuated vaccine developed by Enders-Live attenuated vaccine developed by Enders-
19601960
 Vaccine further attenuated by Schwarz,Vaccine further attenuated by Schwarz,
Edmonston-ZagrebEdmonston-Zagreb
 Supplied freeze dried- store frozen or refrigeratedSupplied freeze dried- store frozen or refrigerated
 Use reconstituted vaccine in 4-6 hrs(refrigerate doUse reconstituted vaccine in 4-6 hrs(refrigerate do
not freeze)not freeze)
 0.5 ml injected S/C preferably right upper arm0.5 ml injected S/C preferably right upper arm
 Age at which recommended 9 monthsAge at which recommended 9 months
 During outbreak>6 monthsDuring outbreak>6 months
 If given < 9 mo repeat dose after 3 moIf given < 9 mo repeat dose after 3 mo
 Possibility of fever for 5-10 daysPossibility of fever for 5-10 days
 MMR-0.5ml S/C over deltoid(15 mo)MMR-0.5ml S/C over deltoid(15 mo)

TyphoidTyphoid
 WHOLE CELLWHOLE CELL::
 Killed S.typhi often with S.paratyphi A(TA)Killed S.typhi often with S.paratyphi A(TA)
 Developed by Wright ,1896Developed by Wright ,1896
 Liquid,store refrigerated,inject S/CLiquid,store refrigerated,inject S/C
 Primary course:2 doses 4 wks apart at 6-9 mo of agePrimary course:2 doses 4 wks apart at 6-9 mo of age
or at any ageor at any age
 Boosters once in 3-5 yrsBoosters once in 3-5 yrs
 Dose :0.25-0.5 ml S/C for primary,0.1ml for boosterDose :0.25-0.5 ml S/C for primary,0.1ml for booster

 Vi POLSACCHARIDEVi POLSACCHARIDE::
 Developed by Robbins,1984Developed by Robbins,1984
 Liquid, adjuvated,store refrigeratedLiquid, adjuvated,store refrigerated
 Inject IM at or after 2 yrs of age(0.5 ml)Inject IM at or after 2 yrs of age(0.5 ml)
 Booster after 3 yrsBooster after 3 yrs

 ORALORAL::
 Live attenuated S.typhi developed byLive attenuated S.typhi developed by
Germanier,1975Germanier,1975
 Strain name:Ty 21aStrain name:Ty 21a
 Enteric coated capsules,store refrigerated,Enteric coated capsules,store refrigerated,
administer orally 3 doses on alternate daysadminister orally 3 doses on alternate days
 Repeat 3-5 yrs laterRepeat 3-5 yrs later
 Recommende age7 yrs or aboveRecommende age7 yrs or above

Hib vaccineHib vaccine
 H . Influenza B-capsular polysaccharideH . Influenza B-capsular polysaccharide
 Liquid or freeze driedLiquid or freeze dried
 Age of initiation 6 wksAge of initiation 6 wks
 3 doses 6,10,14 wks/2,4,6 mo3 doses 6,10,14 wks/2,4,6 mo
 Booster 1 yr after primary doseBooster 1 yr after primary dose
 Dose 0.5 ml SC/IM over deltoid orDose 0.5 ml SC/IM over deltoid or
anterolateral aspect of thighanterolateral aspect of thigh

ADDITIONAL VACCINESADDITIONAL VACCINES
 Varicella vaccineVaricella vaccine::
 Developed by Takahashi in 1971,JapanDeveloped by Takahashi in 1971,Japan
 Live attenuated Oka strain.Live attenuated Oka strain.
 Vaccine available as lyophilized powderVaccine available as lyophilized powder
 Dissolve in 0.5 ml diluentDissolve in 0.5 ml diluent
 SC 0.5 mlSC 0.5 ml
 Single dose 1-12 yrsSingle dose 1-12 yrs
 >13 yrs 2 doses at 1 mo interval>13 yrs 2 doses at 1 mo interval

Hepatitis AHepatitis A
 Inactivated vaccine containing H M 175 strainInactivated vaccine containing H M 175 strain
grown in MRC5 cell line.grown in MRC5 cell line.
 Pediatric formulation 720 ELU IM; 2 doses 6Pediatric formulation 720 ELU IM; 2 doses 6
mo apart between 2-18 yrsmo apart between 2-18 yrs
 >19 yrs 1440 ELU 2 doses 6 months apart>19 yrs 1440 ELU 2 doses 6 months apart
 Efficacy 94-100%Efficacy 94-100%
 No boostersNo boosters

Vaccines recommended duringVaccines recommended during
epidemicsepidemics
 Japanese B Encephalitis vaccineJapanese B Encephalitis vaccine
 Meningococcal A&CMeningococcal A&C

Vaccines for high risk groupVaccines for high risk group
 PNEUMOCOCCAL VACCINEPNEUMOCOCCAL VACCINE::
 Polysaccharide vaccine(23 valent)Polysaccharide vaccine(23 valent)
 7 Valent conjugated with CRM 197 diphtheria7 Valent conjugated with CRM 197 diphtheria
toxintoxin
 23 valent effective after 2 yrs of age23 valent effective after 2 yrs of age
 Single dose 0.5 ml IM with booster every 3-5Single dose 0.5 ml IM with booster every 3-5
yrsyrs

IndicationsIndications
 Sickle cell diseaseSickle cell disease
 Nephrotic syndrome in remissionNephrotic syndrome in remission
 Congenital or acquired asplenia/splenic dys functionCongenital or acquired asplenia/splenic dys function
 HIVHIV
 Chronic cardiac/pulmonary diseaseChronic cardiac/pulmonary disease
 Immunodeficient conditionsImmunodeficient conditions
 CSF leakCSF leak
 Diabetes mellitusDiabetes mellitus

Combination vaccinesCombination vaccines
 DPT/HiB/HepBDPT/HiB/HepB
 Benefits:Benefits:
 1. Reduced number of injections1. Reduced number of injections
 2. Reduced pain and parental anxiety2. Reduced pain and parental anxiety
 3. High compliance, low drop out rates,enhanced3. High compliance, low drop out rates,enhanced
coveragecoverage
 4. Reduced no: of visits4. Reduced no: of visits
 5. Less storage space5. Less storage space
 6. Less burden on cold chain6. Less burden on cold chain

Vaccination schedule forVaccination schedule for
unimmunised childunimmunised child
<5 yrs<5 yrs >5 yrs>5 yrs
First visitFirst visit BCG,OPV,DPT,BCG,OPV,DPT,
HBHB
TT/Td,HBTT/Td,HB
22NDND
visit(1 movisit(1 mo
later)later)
OPV,DPT,HBOPV,DPT,HB TT/Td,HBTT/Td,HB
33RDRD
visit(1 movisit(1 mo
later)later)
OPV,DPT,MMOPV,DPT,MM
R/Measles,TyphR/Measles,Typh
MMR,TyphMMR,Typh
1 yr later1 yr later OPV,DPT,HBOPV,DPT,HB HBHB
Every 3 yrsEvery 3 yrs Typh boosterTyph booster Typh boosterTyph booster

Newer vaccinesNewer vaccines
 Live attenuated varicella(oka)strainLive attenuated varicella(oka)strain
 Killed hep A virus vaccineKilled hep A virus vaccine
 23 valent pneumococcal vaccine23 valent pneumococcal vaccine
 Influenza virus vaccineInfluenza virus vaccine
 Combination vaccinesCombination vaccines

Vaccines available in otherVaccines available in other
countriescountries
 Conjugated pneumococcal vaccine(7 valent)Conjugated pneumococcal vaccine(7 valent)
 Conjugated S.typhi Vi vaccineConjugated S.typhi Vi vaccine
 Rota virus vaccineRota virus vaccine
 Combination vaccinesCombination vaccines

ADVERSE EFFECTSADVERSE EFFECTS

ADVERSEADVERSE
EVENTEVENT
VACVAC
CINCIN
EE
SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
AnaphylaxisAnaphylaxis anyany W/I minutes,acuteW/I minutes,acute
decompensation ofdecompensation of
circ.circ.
System,hypovolemicSystem,hypovolemic
shock,laryngealshock,laryngeal
spasm/edema.Acutespasm/edema.Acute
respiratory distressrespiratory distress
Adrenaline,CPR,IVAdrenaline,CPR,IV
volume expandersvolume expanders
oror
dopamine/dobutamdopamine/dobutam
ine, hydrocortisoneine, hydrocortisone
Hypotensive,Hypotensive,
hyporesponsihyporesponsi
ve episodesve episodes
DPTDPT Within 12 hrs.AcuteWithin 12 hrs.Acute
paleness.Transientpaleness.Transient
decreased levels/lossdecreased levels/loss
of consciousness.Decof consciousness.Dec
muscle tonemuscle tone
IV fluids,IV fluids,
dexamethasone,oxdexamethasone,ox
ygenygen

ADVERSEADVERSE
EVENTEVENT
VACCINEVACCINE SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
Incessant cryIncessant cry DPTDPT Within 48-72Within 48-72
hrs.Excessivehrs.Excessive
inconsolableinconsolable
cryingcrying
Sedation withSedation with
triclofos-triclofos-
50mg/kg/day+PC50mg/kg/day+PC
T+feeding adviceT+feeding advice
Toxic shockToxic shock
syndromesyndrome
MeaslesMeasles
contaminaticontaminati
on by S.on by S.
AureusAureus
Within 30 min-Within 30 min-
few hrs.few hrs.
MountingMounting
fever,vomiting,fever,vomiting,
diarrhoea,septicdiarrhoea,septic
shockshock
IV fluids,antiIV fluids,anti
microbials,cloxacilmicrobials,cloxacil
lin 50-100lin 50-100
mg/kg/day,mg/kg/day,
steroids,antipyretisteroids,antipyreti
cs,supportivecs,supportive
therapytherapy

ADVERSEADVERSE
EVENTEVENT
lymphadenitislymphadenitis BCGBCG Within 2-6Within 2-6
months firm-softmonths firm-soft
axillaryaxillary
lmphadenitis1.5-lmphadenitis1.5-
3 cm with/3 cm with/
without sinuswithout sinus
If firm noIf firm no
treatment.Iftreatment.If
soft&fluctuantsoft&fluctuant
HR3.Aspiration ifHR3.Aspiration if
needed.Steroid ifneeded.Steroid if
sinus presentsinus present
BacterialBacterial
abcessabcess
AnyAny
vaccinevaccine
Within 72Within 72
hrs,fluctuant orhrs,fluctuant or
firm abcess withfirm abcess with
or without feveror without fever
Antibiotics, AntiAntibiotics, Anti
pyretics,drainagepyretics,drainage
if neededif needed

ADVERSEADVERSE
EVENTEVENT
Sterile abcessSterile abcess DPT,DT,TTDPT,DT,TT
,Typhoid &,Typhoid &
HEP BHEP B
By 72 hrsBy 72 hrs
,minimum,minimum
inflamation, noinflamation, no
feverfever
Drainage if neededDrainage if needed
Moderate toModerate to
severe localsevere local
reactionreaction
AnyAny
vaccinevaccine
Non fluctuantNon fluctuant
swelling/rednessswelling/redness
3-10 cm in size3-10 cm in size
at injection siteat injection site
ParacetamolParacetamol

ADVERSEADVERSE
EVENTEVENT
SeizuresSeizures
withwith
fever(rare)fever(rare)
DPT,DPT,
measlesmeasles
AlwaysAlways
generalisedgeneralised
simple/complexsimple/complex
Anticonvulsant,antAnticonvulsant,ant
ipyretic,IV fluidsipyretic,IV fluids
(if needed)(if needed)

IAP recommendations onIAP recommendations on
Immunisation,2003Immunisation,2003
 The IAPCOI-Indian Academy of PediatricsThe IAPCOI-Indian Academy of Pediatrics
Committee On Immunisation,has formulatedCommittee On Immunisation,has formulated
several scientific recommendations to otherseveral scientific recommendations to other
agencies pertaining to Immunisationagencies pertaining to Immunisation

Recommendation to federation ofRecommendation to federation of
OBG societies of IndiaOBG societies of India
 To adopt routine testing of all pregnant womenTo adopt routine testing of all pregnant women
for HBV infection and if mother is positivefor HBV infection and if mother is positive
baby should be given HBIG+HB vaccine soonbaby should be given HBIG+HB vaccine soon
after birthafter birth

Recommendations to MinistryRecommendations to Ministry
of Health, Govt of Indiaof Health, Govt of India
1.1. The academy should be represented on NationalThe academy should be represented on National
Technical Advisory Group on ImmunisationTechnical Advisory Group on Immunisation
2.2. At 5 yrs booster immunisation with DPT rather thanAt 5 yrs booster immunisation with DPT rather than
DT.DT.
3.3. Inactivated polio vaccine should be licensed andInactivated polio vaccine should be licensed and
gradually introduced in phased mannergradually introduced in phased manner
4.4. Hep B and MMR vaccine should be included inHep B and MMR vaccine should be included in
national immunisation schedule immediatelynational immunisation schedule immediately
5.5. Govt. should consider inclusion of typhoidGovt. should consider inclusion of typhoid
vaccine(Vi polysaccharide/whole cell inactivated) invaccine(Vi polysaccharide/whole cell inactivated) in
the national immunisation schedulethe national immunisation schedule
6.6. Another vaccine to be included is HibAnother vaccine to be included is Hib
7.7. Ensuring adequate supply of chick embryo/ tissueEnsuring adequate supply of chick embryo/ tissue
culture rabies vaccineculture rabies vaccine

Immunisation

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