The document outlines various aspects of immunization including its history, mechanisms, types of vaccines, and the National Immunization Schedule in India. Key achievements in immunization programs include the eradication of smallpox and the elimination of wild poliovirus. It emphasizes the importance of maintaining a cold chain for vaccine efficacy and details specific vaccination protocols and recommendations.

1. IMMUNIZATION
Dr Lipilekha Patnaik
Professor, Community Medicine
Institute of Medical Sciences & SUM Hospital
Siksha ‘O’ Anusandhan deemed to be University
Bhubaneswar, Odisha
Email- lipilekhapatnaik@soa.ac.in

6. SESSION OUTLINE
• History
• What is immunization
• Why immunization
• How vaccine works
• Types of Vaccines
• Universal Immunization Programme
• National Immunization schedule
• Cold chain and vaccines
• Mission Indradhanush
• Achievements

8. BEGINNING OF VACCINATION

9. • Six Killer disease
• • Poliomyelitis, • Tuberculosis, • Diphtheria,
• • Pertussis, • Tetanus
• Measles
• In 1796, Jenner took pus from the hand of a
milkmaid with cowpox, scratched it into the arm
of an 8-year-old boy.
• Six weeks later inoculated the boy with
smallpox, afterwards observing that he did not
catch smallpox.
• Jenner extended his studies and in 1798
reported that his vaccine was safe in children
and adults.
Contd..

11. 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

12. ACTIVE VS PASSIVE IMMUNIZATION
Active
§ Killed or live attenuated
organism injectedwhich
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 of antibodies
• Short term
• No role of immune system
• Ex- Anti Tetanus, serum,
Anti Rabies
immunoglobulin etc

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

18. HOW VACCINE WORKS
• Development of active immunity,Humoral or cell mediated or
both.
• Humoral immunity - by secretion of antiobodies from B- cells.
• Cell mediated immunity - mediated byT- cells. Eg. In BCG,CMI &
Delayed type of hypersensitivity.
• Education of reticuloendothelial system of body and production
of memory cells or primed cells by both B & T cells.That is
devolopment of immunobiological memory.

19. COMMUNICABLE DISEASES AND
VACCINES AVAILABLE
• TB – BCG
• Measle, Mumps, Rubella - MMR
• Chicken Pox - Varicella
• Diptheria, Tetanus, Pertussis (aka Whooping Cough) - DPT
• Hepatitis (A and B) – HepA, HepB
• Polio – OPV, IPV
• Rotavirus – RVV
• Pneumoccus– PCV
• Haemophilusinfluenzae B- Hib

20. TYPES OF VACCINES
• Live, attenuated vaccines
• Inactivated vaccines
• Subunit vaccines
• Toxoids

21. 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 and chickenpox

22. INACTIVATED VACCINES
• Scientists produceinactivated vaccines by killing
the disease-causing microbe 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-causing state.
• Example:Vaccines against influenza, inactivated
polio vaccine, hepatitis A etc.

23. 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

24. SUBUNIT VACCINE
• Instead of the entire microbe, subunit vaccines
include only 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 the microbe.
• Example: Plague immunization.

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

26. 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 & B etc.

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

28. 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 EPI program, 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.

30. 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

31. 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 yearsand 16 years
• Primary course 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.

32. BCG
¨ WHO recommended Danish 1331 strain to be used.
¨ 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.

33. 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. Mostly used 0,1,6 m schedule.

34. 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

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

36. ROTAVIRAL VACCINE
• 3 doses given in 6th, 10th and 14th weeks.
• Can be given till one year of age
• G9P human strain.
• Dose - 5 drops/0.5 ml orally
• for prevention of diarrhoea among infants due to rotavirus.

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

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

39. MR VACCINE
• Bivalent Live atteunated against measles and rubella.
• Given 0.5 ml SC at 9-12 and 16-24 months.
• Stored 2-8 deg C
• Strain- Measles-Edmonstorn-zagreb, Rubella- Wilstar RA27/3
• Reactions- Fever, Resp. symp.s, Lymphadenitis or parotitis

40. 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

41. 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 withVitamin A solution

42. Vaccines
and
Cold Chain

43. VACCINES
¨ Live attenuated – BCG,Measles and OPV
¨ Inactivated killed –Whole–cell pertussis,hepatitis B
¨ Toxoid – Diphtheria,Tetanus
¨ All vaccines should be stored at plus 2 to plus 8 degrees
ideally in Ice Lined Refrigerators.
¨ BCG and Measles vaccines are in powder form and
come with diluents. Reconstitution is needed before
use.
¨ Use reconstituted BCG and Measles vaccines within 4
hours of reconstitution and JE within 2 hours of
reconstitution if kept at +2 to +8 degrees

44. Cold
WHY HAVE THE COLD CHAIN?
If vaccines are exposed to excessive
they may lose their potency or effectiveness.
Heat
Light

45. HEAT DAMAGE
• Heat damage is cumulative effect
• Reconstituted vaccine is most sensitive to heat
and light.
• Measles and BCG vaccines should not be used 4
hrs after reconstitution and JE 2 hrs after
reconstitution
• Temperature of diluents & vaccine must be same
during reconstitution

46. HEAT SENSITIVITY
• BCG (after reconstitution)
• OPV
• Measles (before and after reconstitution)
• DPT
• BCG (before reconstitution)
• DT
• TT
• HepB
LEAST SENSITIVE
MOST SENSITIVE

47. SENSITIVITY FROM FREEZING
• Hep B
• DPT
• DT
• TT
LEAST SENSITIVE
MOST SENSITIVE

48. COLD CHAIN
• System of storage & transport of vaccines at low temp. from the manufacturer to the
actual vaccination site.
Manufacturer
Airport
State/Region
District store
Health centre
Outreach
Subcentre

49. COLD CHAIN
• Walk-in-cold rooms-at regional levels.
• Deep freezers-for making ice packs and storage of OPV.
• Ice-lined refrigerators-at PHC level.

50. REMEMBER
• All vaccines tend to lose potency on exposure
to heat above +80 C
• Some vaccines (Hep B,TT,DPT) lose potency
when exposed to freezing temperatures
• Some vaccines are sensitive to light (BCG, Measles).
• The damage is irreversible
• Physical appearance of the vaccine may remain
unchanged but potency might be lost.

51. VACCINE CARRIERS
• Used for carrying vaccines (16-20
vials) and diluents from PHC to the
outreach session sites.
• With 4 conditioned icepacks maintain
inside temperature of 2-80C for 12
hours.
• Close the lid of the carrier tightly.
• Never use any day carriers with 2
icepacks or thermos flask for
carrying vaccines.

52. USABLE AND UNUSABLE STAGES OF VVM

54. MISSION INDRADHANUSH
• The Government of India launched Mission Indradhanushon
25th December 2014,to cover children who are either
unvaccinatedor partially vaccinated against seven vaccine
preventable diseases,i.e., diphtheria,whoopingcough,tetanus,
polio,tuberculosis,measles and hepatitis B.
• The goal is to vaccinate all less than 2 years and under-fiveson
demand by the year 2020.
• The drive was througha “catch-up” campaign mode. The
mission was technically supported byWHO,UNICEF, Rotary
International and otherdonorpartners.

56. ACHIEVEMENTS:
• The biggest achievementof the immunization program is the
eradication of small pox.
• One more significant milestoneis that India is free of
Poliomyelitis caused by Wild Polio Virus (WPV) .
• Vaccination has contributedsignificantly to the declinein the
cases and deaths due to the Vaccine Preventable Diseases (VPDs).

57. OPTIONAL VACCINES
• Pneumococcal vaccine
• Typhoid vaccine
• MMR vaccine
• Hepatitis A vaccine
• Chicken pox vaccine
• Flu vaccine
• Meningococcal vaccine

58. VACCINES FOR ADULTS
• HepatitisA
• Hepatitis B
• Chicken pox vaccine
• Human Papilloma Virus vaccine
• Flu vaccine
• Pneumococcalvaccine
• Meningococcalvaccine