Referrence from : OP Ghai pediatrics, Eighth edition IAP guidebook on immunization 2018-2019

1. IMMUNIZATION
-Kaviyarasi .m

2.  Administration of all or part of a pathogen or preformed
antibodies to elicit immunological response that protects from
the disease
 Process of inducing acquired immunity by administering
1.Live killed or attenuated organism or specific pathogens usually prior to
exposure to infectious agent(Active immunization)
2.Preformed exogenous antibodies, given soon after or prior to exposure, in
order to suppress disease (Passive immunization)
Immunization

3. TERMINOLOGIES
Seroconversion : change from antibody negative to antibody positive state,
due to induction of antibodies in response to infection or vaccination.
Seroprotection: refers state of protection from disease, due to the presence
of detectable serum levels of antibody.
Herd effect: If a large proportion of susceptible individuals are protected
from infection with an organism by simultaneous vaccination, the
transmission chain of the infectious agent can be broken by reducing
carriage of the causative microorganism by vaccinated individuals, thus
decreasing the risk of disease even among the unimmunized individuals.
***Herd effect is utilized as one of the strategies for eradication of
poliovirus, and potentially, during measles epidemics. Herd immunity refers
to the proportion of immune individuals in a population.

5. LIVE Bacterial BCG, Oral typhoid
Viral OPV, measles, MMR, varicella, rotavirus, yellow fever
KILLED Bacterial DTwP, whole cell killed typhoid
Viral IPV, rabies, hepatitis A, influenza (whole virion)
TOXOIDS Bacterial Diphtheria toxoid, tetanus toxoid Salmonella typhi (Vi),
Hib, meningococcal, pneumococcal
SUB UNIT Bacterial Acellular pertussis
viral Recombinant hepatitis B, influenza (split subunit)
TYPES OF VACCINES

6. PRINCIPLES OF IMMUNIZATION
Compliance with the recommended dose and route of vaccination limits adverse
events and loss of efficacy
Minimum interval of 4 weeks between administration of two live vaccines
Killed vaccines can be administered simultaneously
There is no minimum recommended time interval between two types of vaccines
A delay or lapse in the administration of vaccine does not require whole schedule
to be repeated, missed dose can be administered at the course of point

7. Mixing of vaccines in the same syringe is not recommended
The following are not contraindication for vaccination
*minor illness, pre-maturity, malnutrition, recent
infection, h/o allergy, current therapy with antibiotics
Live vaccines are contraindicated in children with
* inherited or acquired immune deficiency
Immunoglobulins interfere with immune response of vaccines like measles,
MMR
*if Ig are administered within 14 days of vaccine , the
vaccination is repeated after 3-4 months
Active immunisation is recommended following exposure to
* Rabies, Hepatitis B, Varicella, Tetanus, Measles

8. NATIONAL IMMUNIZATION SCHEDULE

10. INDIAN ACADEMY OF PEDIATRICS
RECOMMENDATION 2018

12. COMBINATION VACCINES
BENEFITS IN COMBINING VACCINES :
Number of injections at each site is decreased
Fewer visits are required
Leading to increased compliance
Decreased expenditure on packaging and transportation
Enhanced immunization coverage
Simultaneous vaccination against several disease for children who
have missed previous dose

13. CHALLENGES IN DEVELOPMENT OF COMBINATION
VACCINES :
The antigens combined together in a vaccine should be
compatible with each other
They should be indicated at same time
Some antigen may require an adjuvant to be present in
combination
The total volume of the vaccine should not be excessive and the
product should be stable for atleast 18-34 months

14. VACCINE ADMINISTRATION
Vaccine administrators should inspect the vaccine and diluent
vials for the date of expiry, storage conditions and appearance
Vaccine available as lypophilized powder may require to be
reconstituted
**sterile or distilled water-MMR,MPSV4
**normal saline -Hib vaccines
**another vaccine- combination vaccine

15. ADVERSE EVENTS FOLLOWING
IMMUNIZATION
Vaccine induced
**vaccine associated paralytic poliomyelitis(OPV),
encephalopathy(DPT), adenitis(BCG)
Vaccine potentiated
**first febrile seizure in a pre disposed individual
Programmatic error
** toxic shock syndrome due to bacterial contamination
of measles vaccine
coincidental

16. Common events following vaccination :
Fever
Irritability
Swelling in injection site
Redness in injection site
Reportable events following vaccination:
Anaphylaxis in ≤ 7 days
Adverse events listed as a
contraindication for future
vaccination
Any sequale of reportable events
Any serious or unusual event

17. VACCINE SPECIFIC REPORTABLE EVENTS
VACCINES EEVENTS
OPV Paralytic polio ,1-6 months
MEASLES Thrombocytopenic purpura, 7-30 days
Measles infection , ≤6 months
MMR Encephalitis , < 15 days
TT Brachial neuritis, < 28 days
PERTUSSIS Encephalitis ,< 7 days
ROTAVIRUS Interssusception <30 days
RUBELLA Chronic arthritis < 6 weeks

18. VACCINE STORAGE
Cold chain is a
system of storing and
transporting vaccines
at recommended
temperature from the
point of manufacturer
to the point of use

19. VACCINE SENSITIVITES

20. STORAGE PROTOCOL IN DOMESTIC
FRIDGE

21. VACCINE STORAGE IN COOLER ICE
LINED REFRIDGERATOR

22. VACCINATION OF SPECIAL GROUPS

23. ASPLENIA/HYPOSPLENIA
In patients with planned splenectomy, vaccination should be
initiated 2 weeks before .
In case of emergency splenectomy,
**studies indicate vaccination after 2 weeks shows superior
functional antibody response, when compared to vaccination
immediately following surgery
Hib, meningiococcal, typhoid vaccines are recommended in
addition to routine

24. IMMUNOCOMPROMISED :
All inactivated vaccines can be given
In severe cases, LIVE vaccines are
contraindicated
Antibody titres should be checked,
boosters administered if needed
Household contacts of
immunocompromised should
***not receive OPV, instead use IPV
*** fully immunised
CORTICOSTEROIDS :
High dose live vaccine-not given
2mg/kg/day killed vaccine-less
20mg/day efficacious
Lesser dose all vaccines can be
Inhalational/ given
topical

25. IMMUNODEFICIENCY
severe B-cell immunodeficiency :live vaccine contraindicated
inactivated vaccine - in effective
In sub class, Ig A, Ig G deficiency : OPV contraindicated
inactivated vaccine - ineffective
T-cell immunodeficiency :live vaccine contraindicated
inactivated vaccine - in effective
Phagocyte dysfunction+ :live vaccine contraindicated
Tcell & NK cell dysfunction inactivated vaccine - safe,effective

26. PERSON WITH BLEEDING
DISORDER
• Vaccination planned shortly after
administration of clotting factors
• IM injections can be given in
subcutaneous route, if admissible
• Applying firm pressure without
rubbing for 5-10 mins
PERSON WITH CANCER :
• Live vaccines are contraindicated
• Annual inactivated influenza
vaccine is the only vaccine
recommended during chemotherapy
• Sibling immunization should be
continued except for OPV
• Post treatment immunization
depends on pre chemotherapy
immunization status

27. CIRCUMSTANCES THAT INCREASE
RISK OF ACQUIRING CERTAIN
INFECTIONS
 Congenital or acquired immunodeficiency (including HIV
infection)
 Chronic cardiac, pulmonary•, hematologic, renal
(including nephrotic syndrome), liver disease and
diabetes mellitus
 Prolonged therapy with steroids, other
irnrnunosuppressive agents Radiation therapy
 Diabetes mellitus
 Cerebrospinal fluid leak, cochlear implant
 Malignancies
 Children with functional/ anatomic asplenia/hyposplenia
 During disease outbreaks
 Laboratory personnel and health care workers
 Travelers
HIGH-RISK CONDITIONS IN WHICH
CERTAIN VACCINES MAY BE
NECESSARY
 Influenza vaccine
 Meningococcal vaccine
 Japanese encephalitis vaccine
 Cholera vaccine
 Rabies vaccine
 Yellow fever vaccine
 Pneurnococcal polysaccharide vaccine (PPSV 23)

28. PASSIVE IMMUNIZATION