The document discusses various vaccines including their administration, effectiveness, and side effects. It notes that vaccines for diphtheria, pertussis, and tetanus (DPT) are given in a 3-dose series at 6-10-14 weeks and provide protection for 10 years. The measles vaccine is highly effective but needs to be given after 6 months of age to avoid interference from maternal antibodies. The mumps and rubella vaccines are part of the combined MMR vaccine. Rare side effects of the MMR include febrile seizures and deafness.

5. EDWARDEDWARD
JENNERJENNER
May 14May 14
17961796

6. Opisthotonos: body is bent backwardOpisthotonos: body is bent backward

7. LGF, toxic, pseudomembrane, bull neckLGF, toxic, pseudomembrane, bull neck

8. v. severe cough,v. severe cough,
vomiting, ribbon likevomiting, ribbon like
tenacious sputumtenacious sputum

11. Immunisefirsttohugme!Immunisefirsttohugme!
Immunisefirsttohugme!Immunisefirsttohugme!

12. WELCOME ALLWELCOME ALL

13. ““Few things give more benefitsFew things give more benefits
for child survival thanfor child survival than
immunization”immunization”

14. At the end …. you will learnAt the end …. you will learn
• Immunization is an essential part of child-careImmunization is an essential part of child-care
• .. has a.. has a greatgreat role in reducing IDs, NMR, IMRrole in reducing IDs, NMR, IMR
• .. is.. is cost effectivecost effective
• Vax.Vax. varyvary in efficacy, dosing, safety, stabilityin efficacy, dosing, safety, stability
• It addresses allIt addresses all susceptiblesusceptible personspersons
• SchedulesSchedules varyvary among countriesamong countries
The best Vax. for a newbornThe best Vax. for a newborn
is BMis BM

15. Vaccines: the BasicsVaccines: the Basics
• Vax. contain the same germs that cause d. ButVax. contain the same germs that cause d. But
they are either killed/weakenedthey are either killed/weakened: no sickness: no sickness
• Some vax. contain only aSome vax. contain only a partpart of germof germ
• Vax. stimulates immune sys. to make AB, exactlyVax. stimulates immune sys. to make AB, exactly
like it would do to the d.like it would do to the d.
Vax. are powerful medicines. But unlike mostVax. are powerful medicines. But unlike most
medicines, vax.medicines, vax. preventprevent the d.the d.

16. Why vaccinate ?Why vaccinate ?
 Immunization prevents vax.-preventable d.:Immunization prevents vax.-preventable d.:
110 million110 million illnessesillnesses areare preventedprevented
 3.5 million lives3.5 million lives areare saved every yearsaved every year
 Uptake of new and underused vax. is increasingUptake of new and underused vax. is increasing
 But 18.7 million infants worldwide are still missing outBut 18.7 million infants worldwide are still missing out
on basic vaccineson basic vaccines

17. ImmunisationImmunisation ReducesReduces
MortalityMortality
MorbidityMorbidity
MalnutritionMalnutrition
VADXVADX
Drop out from schoolDrop out from school
Childhood strokeChildhood stroke

18. Successes Story of ImmunisationSuccesses Story of Immunisation
Small pox eradicatedSmall pox eradicated
Polio… soonPolio… soon
Measles… nextMeasles… next
Dramatic fall in IDDramatic fall in ID
Dramatic rise in child survivalDramatic rise in child survival
Significant fall in malnutritionSignificant fall in malnutrition
Economic upliftEconomic uplift

19. 10 myths and facts about vax.10 myths and facts about vax.
1.1. Better hygiene-sanitation will make ds. disappearBetter hygiene-sanitation will make ds. disappear
–– No need of vax.No need of vax. FALSEFALSE
2. Vax. have damaging SE; can even be fatal2. Vax. have damaging SE; can even be fatal. FALSE. FALSE
3. DTP and polio vax. cause3. DTP and polio vax. cause SIDS.SIDS. FALSEFALSE
4. Vax. Target Ds. are almost eradicated in my country4. Vax. Target Ds. are almost eradicated in my country
-- No need of vax.-- No need of vax. FALSEFALSE
5. Vax.-preventable ds. are just a fact of life.5. Vax.-preventable ds. are just a fact of life. FALSEFALSE

20. 6.6. >1 vax. at a time can increase risk and overload the>1 vax. at a time can increase risk and overload the
child’s immune systemchild’s immune system. FALSE. FALSE
7.7. Flu is just a nuisance, the vax. isn’t v. effective.Flu is just a nuisance, the vax. isn’t v. effective. FALSEFALSE
8.8. Better to be immune by disease than by vax.Better to be immune by disease than by vax. FALSEFALSE
9.9. Vax. containVax. contain mercurymercury which is dangerous.which is dangerous. FALSEFALSE
10.10. Vaccines cause autismVaccines cause autism FALSEFALSE
10 myths and facts about vax. …10 myths and facts about vax. …
Thiomersal: organic, mercury added to some vax. As preservative; most widely-used
preservative in multi-dose vials; no evidence to suggest it poses a health risk

21. ImmunityImmunity
…… body'sbody's ability toability to self-protectself-protect
ActiveActive
PassivePassive

22. Sensitizing with anSensitizing with an germ/antigen togerm/antigen to
make Abmake Ab
naturalnatural :: infectioninfection
artificialartificial :: vax.vax.
Memory remains in immune sys.Memory remains in immune sys.
Active immunityActive immunity

23. Passive ImmunityPassive Immunity
A.A. From mother:From mother:
B.B. External sources:External sources:
TIGTIG
VZIGVZIG
HBIGHBIG
ADSADS
RIGRIG
AGSAGS
AntivenomsAntivenoms
Antibotulin, etc.Antibotulin, etc.
Mainly forMainly for RxRx
BBy givingy giving Antibody:Antibody: ((TemporaryTemporary effecteffect))

24. Transplacental AntibodiesTransplacental Antibodies
• DPT, Polio, MMR, Influenza, HBVDPT, Polio, MMR, Influenza, HBV
• Transferred from 2Transferred from 2ndnd
TMTM. Only IgG. Only IgG
• These can inhibit vax. response in 1These can inhibit vax. response in 1stst
y of life: usuallyy of life: usually
overcome by booster dosesovercome by booster doses
Transfer of IgA in BM for gut of the babyTransfer of IgA in BM for gut of the baby
Fetus starts IgM at 20wFetus starts IgM at 20w

25. What isWhat is immunisationimmunisation??
Giving a vax.Giving a vax. for immunityfor immunity

26. Target DiseasesTarget Diseases
1010 EPI diseasesEPI diseases
OthersOthers
AnthraxAnthrax
Chicken poxChicken pox
CholeraCholera
HAVHAV
HPVHPV
JB encephalitisJB encephalitis
InfluenzaInfluenza
MeningoccusMeningoccus
Mumps, rubellaMumps, rubella
PneumococcusPneumococcus
RabiesRabies
Rota virusRota virus
TyphoidTyphoid
Yellow fever, etc.Yellow fever, etc.

27. Vax. in BangladeshVax. in Bangladesh
• BCGBCG
• DPTDPT
• PolioPolio
• HBVHBV
• HIBHIB
• HAVHAV
• HPVHPV
• MMRMMR
• MeningococcusMeningococcus
• RabiesRabies
• Rota virusRota virus
• TyphoidTyphoid
• VaricellaVaricella
• CholeraCholera
• PneumococcusPneumococcus
• InfluenzaInfluenza

28. Future vax. sFuture vax. s
MalariaMalaria
LeprosyLeprosy
Dengue, ChikungunyaDengue, Chikungunya
Improved BCGImproved BCG
HCVHCV
HEVHEV
AIDSAIDS
EbolaEbola
MERSMERS

29. 3 types of vaccine3 types of vaccine

30. Characteristics of Live Vax.Characteristics of Live Vax.
SingleSingle shot.shot. DurableDurable immunityimmunity
…… of Killed Vax.of Killed Vax.
Multiple shotsMultiple shots ((1y1y series)series) followed byfollowed by booster(s)booster(s)
…… of Extract/toxoidof Extract/toxoid
• 1y1y series followed byseries followed by booster(sbooster(s))
∀ ⇑⇑ immunogenic withimmunogenic with adjuvantadjuvant

31. Live vax. : BCGLive vax. : BCG
ImmediatelyImmediately after birthafter birth
One i.d. doseOne i.d. dose
ConflictingConflicting reports of efficacyreports of efficacy
Protects fromProtects from lethal TBlethal TB

32. Advantages DisadvantagesAdvantages Disadvantages
 One shot.One shot. Very safeVery safe
 Expertise for i.d. inj.Expertise for i.d. inj.
 Does not prevent TBDoes not prevent TB
 Light sensitiveLight sensitive
 Generalized vacciniaGeneralized vaccinia
 not stable at room temp.not stable at room temp.
 UlcerUlcer nn scarscar

33. ‘‘Bull neck’Bull neck’

36. Diphtheria Pertussis TetanusDiphtheria Pertussis Tetanus
DPTDPT
3x3x 0.5ml i.m. at 6-10-14w0.5ml i.m. at 6-10-14w
Booster 6-12mo laterBooster 6-12mo later
Protects forProtects for 1010 yy

37. Advantages DisadvantagesAdvantages Disadvantages
• DTDT very effectivevery effective
• Whole cell pertussis:Whole cell pertussis: 60%60% effectiveeffective
• Acellular pertussis (aP/Pa) is superiorAcellular pertussis (aP/Pa) is superior
F, restlessF, restless,, inconsolable cryinconsolable cry
Redness swelling at prick siteRedness swelling at prick site
• Anaphylaxis febrile fit may occurAnaphylaxis febrile fit may occur

38. Pertussis Deaths, USA: 2000-2009Pertussis Deaths, USA: 2000-2009

39. A young girl with bulbar polio with tripod sign attempts to sitA young girl with bulbar polio with tripod sign attempts to sit

42. Poliomyelitis:Poliomyelitis: 3 strains3 strains
• OPV (live)/IPV (killed)OPV (live)/IPV (killed)
• 3 doses: 6-10-14w (with DPT)3 doses: 6-10-14w (with DPT)
• 44thth
with measles vax.with measles vax.
• PulsePulse dosing for developing countriesdosing for developing countries

43. Advantages DisadvantagesAdvantages Disadvantages
• OPV is easy, cheap, rapid;OPV is easy, cheap, rapid; herdherd immunityimmunity
• Permanent protectionPermanent protection
• No OPV in immunocompromised (Give IPV)No OPV in immunocompromised (Give IPV)
• Breast milk may killBreast milk may kill
• Change to wild virus (VAPP:Change to wild virus (VAPP: 1/2.5million doses)1/2.5million doses)
VAPP: vax. Assoc. polio paralysisVAPP: vax. Assoc. polio paralysis

48. Measles vax.Measles vax.
AttenuatedAttenuated live viruslive virus
• 0.5ml s.c. at 9mo; better as MMR0.5ml s.c. at 9mo; better as MMR
• 2 doses: 22 doses: 2ndnd
at 15at 15thth
momo
– no primary vax. failureno primary vax. failure
– permanent immunitypermanent immunity
• LastingLasting protectionprotection

49. Advantages DisadvantagesAdvantages Disadvantages
Measles vax. isMeasles vax. is veryvery effective, safeeffective, safe
Sensitive to heatSensitive to heat
NotNot effective <effective <6 mo6 mo age (maternal antibody)age (maternal antibody)
schedule varies among countriesschedule varies among countries

52. MUMPS vax.MUMPS vax.
• Live-attenuatedLive-attenuated
• MMR preferredMMR preferred
• 0.5 ml s.c. +/- other vax.0.5 ml s.c. +/- other vax.
• >95% with>95% with singlesingle dosedose
• 2 doses: 100%2 doses: 100%
Must immunize before pubertyMust immunize before puberty

53. Measles
German measles

54. "blueberry muffin (ecchymoses)"

56. Newborn with CRS

57. Rubella vax.Rubella vax.
• 2 doses2 doses
• MMR preferredMMR preferred
• Can protect within 3d of exposureCan protect within 3d of exposure
• 2nd dose before 11y2nd dose before 11y
• No conception within 28dNo conception within 28d

58. Adverse Reactions: MMRAdverse Reactions: MMR
• Common:Common: F, rash, lowF, rash, low
plateletsplatelets
• LAP, arthralgia,LAP, arthralgia, arthritis inarthritis in
adult femalesadult females after 1-3wafter 1-3w
(reactive)(reactive)
• Rare:Rare: orchitis, LGF,orchitis, LGF,
parotitis, limb painparotitis, limb pain
• Very rare:Very rare: febrile fit,febrile fit,
deafness, meningitis,deafness, meningitis,
encephalitis, pruritusencephalitis, pruritus

59. MMR contraindicationsMMR contraindications
• Administration of IG, blood transfusion:Administration of IG, blood transfusion:
• Altered immunity (live vax):Altered immunity (live vax):
• Corticosteroids (live vax):Corticosteroids (live vax):
• Pregnancy (live vax):Pregnancy (live vax):

60. • Ig in high doses (Kawasaki, GBS) can inhibitIg in high doses (Kawasaki, GBS) can inhibit
responseresponse
– push 2w before or 3mo after Ig/BTpush 2w before or 3mo after Ig/BT
Ig and BTIg and BT

61. • NoNo live vax.live vax. inin
– malignancy, chemotherapymalignancy, chemotherapy
– pregnancypregnancy
– HD steroid, radiation,HD steroid, radiation, AIDSAIDS
• Vax. mumps virusVax. mumps virus do notdo not transmittransmit
• Risk of mumps/rubella in immunodeficient can beRisk of mumps/rubella in immunodeficient can be ⇓⇓ byby
vax. for close contactsvax. for close contacts
ImmunodeficienciesImmunodeficiencies

62. GlucocorticosteroidsGlucocorticosteroids
• At 2mg/kg/d or >20mg/d x2w:At 2mg/kg/d or >20mg/d x2w: wait for 1 mowait for 1 mo
• Postpone steroids if vax. is essentialPostpone steroids if vax. is essential

63. PregnancyPregnancy
• No conception for 4w after live vax.No conception for 4w after live vax.
• Vax. virus infects placenta (2%), not the fetusVax. virus infects placenta (2%), not the fetus
• Accidental vax. in preg.: no cong. defects:Accidental vax. in preg.: no cong. defects:
– not an indication for terminationnot an indication for termination
Vax. before pregnancy?Vax. before pregnancy? Any vax.Any vax.
• It's the best to have a medical CU before preg.It's the best to have a medical CU before preg.

64. Vax. in pregnancy: principlesVax. in pregnancy: principles
• Generally: no live vax.Generally: no live vax.
• Toxoids, inactivated vax., Ig are safeToxoids, inactivated vax., Ig are safe
• Start in 2Start in 2ndnd
TM (except flu): miscarriage, fetal anomalyTM (except flu): miscarriage, fetal anomaly
• Post-exposure Ig anytime:Post-exposure Ig anytime: HA&B, measles, rabies,HA&B, measles, rabies,
tetanus, varicellatetanus, varicella
• TT, HBV, DTP, flu, pneumococcusTT, HBV, DTP, flu, pneumococcus
• Vax. can protect both mom and fetusVax. can protect both mom and fetus
TM: trimester. HA&B: hepatitis A and BTM: trimester. HA&B: hepatitis A and B

65. • If no prior Tdap, get it before preg. Td is better (safety ofIf no prior Tdap, get it before preg. Td is better (safety of
pertussis part Is not fully known)pertussis part Is not fully known)
• Hib: prior splenectomy, menigococcal anytimeHib: prior splenectomy, menigococcal anytime
• Inactive Typhoid, HBV. Rabies: if exposedInactive Typhoid, HBV. Rabies: if exposed
• Cholera, plague, J. encephalitis: if high riskCholera, plague, J. encephalitis: if high risk
• Anthrax: post-exposure prophylaxis and vax.Anthrax: post-exposure prophylaxis and vax.
None of these are live vax.None of these are live vax.
Vax. in pregnancy …Vax. in pregnancy …

66. Recommendations for TdapRecommendations for Tdap
• Age: 11y or older sAge: 11y or older specially forpecially for
• adults in contact with young children, padults in contact with young children, pregnant womenregnant women
• healthcare professionalshealthcare professionals
• grandparents (including those >65ygrandparents (including those >65y
• 10 yearly Td booster for those who got 1 Tdap10 yearly Td booster for those who got 1 Tdap
– 5 years for wound management5 years for wound management

67. Vax avoided in pregnancyVax avoided in pregnancy
• Nasal spray flu vax. (flu shot is killed virus)Nasal spray flu vax. (flu shot is killed virus)
• MMR, Varicella, BCG: postpone pregnancy for 4wMMR, Varicella, BCG: postpone pregnancy for 4w
• Little info. about other vax.: Polio, HA, Anthrax, J.Little info. about other vax.: Polio, HA, Anthrax, J.
encephalitis, Typhoid, smallpox, Yellow Fencephalitis, Typhoid, smallpox, Yellow F
• Some of these vax. contain live viruses. Carefully weighSome of these vax. contain live viruses. Carefully weigh
the risks and benefits and decidethe risks and benefits and decide
No HPV in preg.: under studyNo HPV in preg.: under study

68. Postpartum vaccination:Postpartum vaccination: ACIPACIP
• All EXCEPT smallpox are safe during lactationAll EXCEPT smallpox are safe during lactation
• MMR for rubella nonimmuneMMR for rubella nonimmune
• Varicella dose 1 in hospital and 2Varicella dose 1 in hospital and 2ndnd
in 4-8win 4-8w
• Tdap: if not given (Tdap: if not given (prevents pertussis to NB)prevents pertussis to NB)
• Anti-D if baby is Rh+veAnti-D if baby is Rh+ve
• If <26y: HPVIf <26y: HPV

69. HPVHPV>130 strains>130 strains
• Double stranded DNA virusDouble stranded DNA virus
– Non-oncogenic/oncogenicNon-oncogenic/oncogenic
• ~ everyone will be infected at least once in life~ everyone will be infected at least once in life
– Most unaware when infectedMost unaware when infected
– Most common STD in M and FMost common STD in M and F
STD: sexually transmitted diseaseSTD: sexually transmitted disease

70. HPVHPV
• Ca cervix kills 275,000 women, mostly in 3WCCa cervix kills 275,000 women, mostly in 3WC
• Prevents also vulval, vaginal, penile, colorectal,Prevents also vulval, vaginal, penile, colorectal,
head-neck and some skin cancershead-neck and some skin cancers
• 2 types. Premarital vax. are 100% effective in2 types. Premarital vax. are 100% effective in
preventing precancerpreventing precancer
• Age: 9y and aboveAge: 9y and above
• Very safeVery safe

71. HPVHPV
• Females: Routine: 9-26yFemales: Routine: 9-26y
– Either HPV4 or HPV2Either HPV4 or HPV2
• Males: Routine: at 11yMales: Routine: at 11y
– HPV4 is recommendedHPV4 is recommended
• 22ndnd
dose 1-2 mo of 1dose 1-2 mo of 1stst
and 3and 3rdrd
6 mo after 16 mo after 1stst

72. HIV and Adult VaccinationHIV and Adult Vaccination
Vaccines are esp. critical for people with chr. d. like HIVVaccines are esp. critical for people with chr. d. like HIV
If CD4 count is ≥200:If CD4 count is ≥200:
• fluflu,, TdapTdap ,, Pneumo-Pneumo-, HB, HPV (man/woman up to 26y), HB, HPV (man/woman up to 26y)
• MMR (born in 1957/later or not have immunity)MMR (born in 1957/later or not have immunity)
• Varicella (born in 1980/later and have not gotten 2Varicella (born in 1980/later and have not gotten 2
doses or have no immunity)doses or have no immunity)
CD4 count is <200:CD4 count is <200: flu, Tdap, Pneumococcal, HB, HPVflu, Tdap, Pneumococcal, HB, HPV

73. Asplenia and Adult VaccinationAsplenia and Adult Vaccination
Vax. are esp. critical for chr. d. like aspleniaVax. are esp. critical for chr. d. like asplenia
• Flu, Tdap, Hib (if not vaccinated)Flu, Tdap, Hib (if not vaccinated)
• Pneumo- , Meningococcal, Zoster (if 60y or older), HPVPneumo- , Meningococcal, Zoster (if 60y or older), HPV
• MMR (not vaccinated or no immunity)MMR (not vaccinated or no immunity)

75. Title
•

76. Flu vax: inactivated virusFlu vax: inactivated virus
• UniversalUniversal
• High risk:High risk: children, elderly, immunodeficient, preg.,children, elderly, immunodeficient, preg.,
chr. Illnesschr. Illness
• Dose: initial 2 shots; i.m.; then single dose annuallyDose: initial 2 shots; i.m.; then single dose annually
for new strainfor new strain
• Age 6-36 mo: half the adult doseAge 6-36 mo: half the adult dose

77. Yellow fever
• Ac. viral hemorrhagic F (mosquitoes)Ac. viral hemorrhagic F (mosquitoes)
• 2013: in routine imm. in 35/44 countries/territories at risk2013: in routine imm. in 35/44 countries/territories at risk
in Africa and Americas (cov.41%)in Africa and Americas (cov.41%)
• Single dose is sufficient‡. At 9-12mo (measles), s.c.Single dose is sufficient‡. At 9-12mo (measles), s.c.
• CI: in <6 mo and immunodeficientCI: in <6 mo and immunodeficient
• Mass vaccination for inhabitants at riskMass vaccination for inhabitants at risk

78. Bangladesh EPIBangladesh EPI
1979: launched1979: launched
1995: Polio eradication; elimination of1995: Polio eradication; elimination of
maternal and NTmaternal and NT
2003: Introduced HBV2003: Introduced HBV
2009: HIB2009: HIB
2012: rubella2012: rubella
Next: pneumococcus, HPVNext: pneumococcus, HPV

79. Objectives of EPI:
• Disease reduction
• vax. coverage

80. Targets
 Eliminate NT (<1 /1000) 2005√
 Measles ⇓ 95% 2005√
Vax. coverage 90% 2005√
 Polio eradication 2007√
 ⇓ HBV 80% in U5 2010

81. ImmunisationImmunisation ScheduleSchedule
• At birthAt birth BCGBCG
HBV 1HBV 1
• 6-10-14 weeks6-10-14 weeks DPT 1,2,3DPT 1,2,3
OPV1,2,3OPV1,2,3
HIB 1,2,3HIB 1,2,3
HBV 2,0,0HBV 2,0,0
• 6 months6 months HBV 3HBV 3
• 9 mo:9 mo: (270d)(270d) MR.MR. OPV 4OPV 4

82. Pulse dosing of OPVPulse dosing of OPV
• 22 doses ondoses on 22 occasions (6mo) foroccasions (6mo) for U-5U-5 (up to(up to 1010
doses)doses)
• Repeat OPV replacesRepeat OPV replaces wild viruswild virus in thein the
environmentenvironment

83. YesYes!!
 Benefits far outweigh risksBenefits far outweigh risks
 Exception: if severe reaction to DPT (fits) theException: if severe reaction to DPT (fits) the
pertussispertussis isis omittedomitted
Our body can handleOur body can handle 15000 Ag15000 Ag at a timeat a time!!
A child who does not need hospitalization canA child who does not need hospitalization can
get the shotget the shot
Can aCan a sicksick child be immunized?child be immunized?

84. Missed DatesMissed Dates
Give as soon as possibleGive as soon as possible
Longer gap? Still theLonger gap? Still the nextnext dosedose
Only complete doses requiredOnly complete doses required
For remote areas altered schedules, NIDsFor remote areas altered schedules, NIDs
are usedare used

86. EPI gives no boosterEPI gives no booster
After 7y: pertussis is omittedAfter 7y: pertussis is omitted
In Mid- East measles vax. is given at 6 moIn Mid- East measles vax. is given at 6 mo
Schedule varies among countriesSchedule varies among countries
MoreMore InfoInfo

87. Every nonimmune is targetedEvery nonimmune is targeted
Consider susceptibilityConsider susceptibility
Age or weight not importantAge or weight not important
A child should be fully immunized by 9moA child should be fully immunized by 9mo
EPI targets children and CB womenEPI targets children and CB women
WhoWho be immunized?be immunized? AgeAge??

88. WomenWomen
 2 TTs for NT2 TTs for NT
 5 TTs5 TTs ⇒⇒ protectprotect all futureall future babiesbabies
 Woman with 3 DPTs need 2Woman with 3 DPTs need 2
 MRMR
Hygienic cord Rx is less effective than immunizingHygienic cord Rx is less effective than immunizing
the motherthe mother

89. Principles of ImmunisationPrinciples of Immunisation
 Follow a schedule; but not strict!Follow a schedule; but not strict!
 Schedule variesSchedule varies
 Date flexibleDate flexible
 4w = 1mo4w = 1mo
 No Vax in 3mo ofNo Vax in 3mo of IgIg
11stst
polio as IPVpolio as IPV
After DTP diseases,After DTP diseases,
Vax is still requiredVax is still required
2 TT in 12 TT in 1stst
preg. (4-7preg. (4-7
mo) 1 shot for latermo) 1 shot for later

90. Not a ContraindicationNot a Contraindication
 A child needingA child needing
no admissionno admission
 Mild RTIMild RTI
 DVDV
 AsthmaAsthma
 EczemaEczema
 AB TherapyAB Therapy
 Chr. Lung DsChr. Lung Ds
 Heart diseaseHeart disease
 Febrile fitFebrile fit

91. ContraindicationsContraindications
 Ac. IllnessAc. Illness
 Severe reactionsSevere reactions
 Hypersensitivity to a component of VaxHypersensitivity to a component of Vax
(neomycin, polymyxin B, egg protein)(neomycin, polymyxin B, egg protein)
 Progressive neuropathy for pertussis VaxProgressive neuropathy for pertussis Vax

92. All not equal;All not equal; depends ondepends on
immune systemimmune system
immunogenecityimmunogenecity
• All not equally stableAll not equally stable
Most stable is TTMost stable is TT
• Best herd immunity with OPV; none with toxoidBest herd immunity with OPV; none with toxoid
or inactivated vax.or inactivated vax.
• The most effective is the TTThe most effective is the TT
Effectiveness of vax. sEffectiveness of vax. s

93. Essential Cold ChainEssential Cold Chain
• Once opened dispensed within coupleOnce opened dispensed within couple
of hours e.g. BCGof hours e.g. BCG

95. 5 Adverse Reactions5 Adverse Reactions
• vax. reactionsvax. reactions
• Program errorProgram error
• Injection reactionInjection reaction
• CoincidentalCoincidental
• UnknownUnknown

96. vax.vax. ReactionsReactions
Most vax. are safeMost vax. are safe
 MMRMMR ⇒⇒mildmild disease.disease. None with extractNone with extract
 Serious:Serious:⇐⇐ pertussis Vx.:pertussis Vx.: inconsolable cry, fever,inconsolable cry, fever,
irritability a few hours later, febrile fitirritability a few hours later, febrile fit
 Rare anaphylaxis, GBSRare anaphylaxis, GBS with some vax. swith some vax. s
To minimize reactions:To minimize reactions: do not rub prick site, givedo not rub prick site, give
paracetamolparacetamol

97. SafeSafe InjectionInjection
No harm to recipientNo harm to recipient
No harm to you! me!No harm to you! me!
Correct pushCorrect push ⇒⇒ no abscessno abscess
No dangerous wasteNo dangerous waste
Dispo-syringe and needle: rDispo-syringe and needle: rememberemember
1 child: 1 syringe 1 needle!1 child: 1 syringe 1 needle!

99. Not in buttocksNot in buttocks
IM at right angle into AL thighIM at right angle into AL thigh
No IM in bleeding disordersNo IM in bleeding disorders
S.c. Vax is given in thigh, forearmS.c. Vax is given in thigh, forearm
Jet gunsJet guns not used for vaccinationnot used for vaccination
‘‘ZZ track’track’ inj.inj. ⇒⇒less leakage, infiltrationless leakage, infiltration
SitesSites of Administrationof Administration

100. ID push needs expertiseID push needs expertise
Deltoid area for BCG, not very up or low.Deltoid area for BCG, not very up or low.
Avoid thighAvoid thigh
SC routeSC route
MMR, Varicella, MeningitisMMR, Varicella, Meningitis
IM routeIM route
DTP, Typhoid, HBV, HAV, RabiesDTP, Typhoid, HBV, HAV, Rabies

102. ImmuneImmune ResponseResponse
• Primary responsePrimary response
Traceable AB:Traceable AB: 1-2 weeks: IgM1-2 weeks: IgM
• Secondary responseSecondary response
High titre:High titre: 4-5d mainly IgG4-5d mainly IgG

103. MCQMCQ
• EPI targets only childrenEPI targets only children
• BCG is highly effectiveBCG is highly effective
• Pertussis vax. has more SEPertussis vax. has more SE
• TT is very stableTT is very stable
• Herd immunity can be achieved by IPVHerd immunity can be achieved by IPV

104. MCQMCQ
• Vaccinating NB with TT can prevent NTVaccinating NB with TT can prevent NT
• Cold or cough is a CI for vaccinationCold or cough is a CI for vaccination
• TT in pregnancy is started during 3TT in pregnancy is started during 3rdrd
TMTM
• DTP vax. can cause febrile fitDTP vax. can cause febrile fit
• Having pertussis excludes immunizationHaving pertussis excludes immunization

105. MCQMCQ
• TT gives herd immunityTT gives herd immunity
• Strict immunization schedule is essentialStrict immunization schedule is essential
• Having tetanus gives natural immunityHaving tetanus gives natural immunity
• Having diphtheria gives natural immunityHaving diphtheria gives natural immunity
• Parenteral typhoid vax is CI in AIDSParenteral typhoid vax is CI in AIDS
• Typhoid vax. is protective against all EFsTyphoid vax. is protective against all EFs

106. MCQMCQ
• MMR OPV are recommended in HIVMMR OPV are recommended in HIV
• BCG is CI in HIVBCG is CI in HIV
• In bleeding disorder an IM vax is given SCIn bleeding disorder an IM vax is given SC
• GBS may follow after some vaccinationGBS may follow after some vaccination
• Hygienic cord Rx is as equally effective to preventHygienic cord Rx is as equally effective to prevent
tetanus as immunizing the mothertetanus as immunizing the mother

109. NEXT LECTURENEXT LECTURE::
AGN and NSAGN and NS

110. THANK YOU