CLASS FOR MBBS STUDENTS

1. Immunization

2. Objectives
 Introduction
 Types of vaccination
 Contraindications
 Discussion of individual vaccines
 Preparations
 Administration
 Precautions and contraindications
 Side effects

3. INTRODUCTION
- Administration of all or part of micro
organism or modified product.
- Resulting in protection against the
disease.
What is Immunization?

4. Importance of immunization
 Prevention and control of disease is important for
their healthy growth.
 They must be provided with the opportunity of
healthy growth and development.
 Routine immunization also provides a chance of a
health visit
 Gives further chance for preventive services and
health counseling.

5. Why adolescents should be immunized?
 Success of Immunization Program has resulted in the
decrease in incidence of the vaccine preventable
diseases.
 But unimmunized adolescents have become more
susceptible.

6. Active Immunization
Types
 Live attenuated
 Virus Measles, mumps, rubella
 Bacteria BCG
 Killed
 Virus Hepatitis B
 Bacteria
 Whole Pertussis
 Toxoid Tetanus
 Polysaccharide Meningoccocal

7. Human Immune Serum Globulin
 Specific
 IM Hepatitis B (HBIG)
Rabies (RIG)
Tetanus (TIG)
Varicella (VZIG)
 IV CMV (CMV-IG)
RSV (RSV-IG)

8. Human Immune Serum Globulin
 Non-specific
 IM Immune serum globulin(ISG)
 Hepatitis A
 Measles
 IV Intravenous immune globulin(IGIV)
 Antibody deficiency disorders
 ITP
 Kawasaki syndrome

9. Passive Immunization (Cont)
 SPECIFIC EQUINE ANTIBODIES (IM)
 BOTULISM ANTITOXIN
 DIPHTERIA ANTITOXIN
 TETANUS ANTITOXIN
 SNAKE & SPIDER ANTI-VENOM
 MONOCLONAL ANTIBODIES (IV)
 ANTI-ENDOTOXIN ANTIBODIES

10. Recommended Immunization
Schedule

11. RECOMMENDED AGE VACCINE(S)
BIRTH BCG, Hepatitis B (HBV)
2 MONTHS [DTP, HIB, HBV]
Injectable Polio Vaccine (IPV)
4 MONTHS [DTP, HIB, HBV]
Oral Polio Vaccine (OPV)
6 MONTHS [DTP, HIB, HBV]
Oral Polio Vaccine (OPV)
9 MONTHS Measles vaccine (mono)
12 MONTHS Oral Polio Vaccine (OPV)
MMR
Varicella
1 8 MONTHS Oral Polio Vaccine (OPV)
DTP, HIB
Hepatitis A
24 MONTHS Hepatitis A
4 – 6 YEARS Oral Polio Vaccine (OPV)
DTP
MMR
Varicella

12. General Contraindications
 Moderate or severe illness with or without fever
 Anaphylactic reaction to vaccine or vaccine
constituent
 Live attenuated vaccines
 Pregnant women
 Immunocompromised / Immunosuppressed
children
 within 3-11 months of immunoglobulin
administration

13. Invalid Contraindications
 Mild to moderate local reaction
 Mild acute illness with or without low grade fever
 Current antimicrobial therapy
 Convalescent phase of illnesses
 Prematurity and low birth weight
 History of penicillin or other nonspecific allergies
 Malnutrition

14. Immunization Of Special Groups
IMMUNOCOMPROMISED HOSTS
 Avoid MMR, measles (may be used in HIV)
 Avoid OPV; use IPV for these children and their
household contacts
PRETERM INFANTS
 Treat as term babies
 Avoid OPV in hospital
 Influenza vaccine in BPD
 may delay HBV if <2 kg & mother is HBsAG negative

15. Compulsory Vaccines

16. Bacillus Calmette-Guerin Vaccine
(BCG)
 INDICATIONS
 All newborns
 All tuberculin negative infants
 PRECAUTIONS & CONTRAINDICATIONS(CI):
 Give only to PPD negative children
 CI in persons with immunodeficiencies
 CI during pregnancy

17. Bacillus Calmette-Guerin Vaccine
(BCG)
SIDE EFFECTS
 Local
 Skin ulceration, regional lymphadenitis
 Subcutaneous abscess
 Generalized
 Anaphylaxis, generalized BCG infection
 (rare): osteitis

18. Hepatitis B
 PREPARATIONS
 ENGERIX-B
 RECOMBIVAX HB

19. Hepatitis B
 ADMINISTRATION:
 0.5 -1 ML, anterolateral thigh or deltoid
 IM injection
 at 0,1 and 6 months
 SIDE EFFECTS:
 Pain
 Arthralgia

20. Poliomyelitis Prophylaxis
 PREPARATIONS
 (A) Oral (OPV) SABIN (Live attenuated)
 (B) Inactivated (eIPV) SALK (killed)
 ADMINISTRATION
 OPV 2 drops orally
 eIPV SC injection
 PRECAUTIONS & CONTRAINDICATIONS(CI)
 (a) OPV pregnancy, immunodeficiency
 (b) IPV neomycin hypersensitivity
 ADVERSE REACTIONS
 OPV paralytic disease (rare)

21. Diphtheria, Tetanus & Pertussis (DTP)
 PREPARATIONS
 < 7 years : DTP, DT, DTaP (acellular
pertussis vaccine)
 > 7 years : Td, TdaP
 ADMINISTRATION
 IM

22. Diphtheria, Tetanus & Pertussis (DTP)
 CONTRAINDICATIONS (CI)
 Encephalopathy within 7 days
 Progressive or unstable neurological disorders
 Anaphylactic reaction to a previous dose
 PRECAUTIONS
 severe systemic reactions such as
 Temp > 40.50C
 persistent inconsolable crying > 3 hours
 Collapse episodes
 Convulsions

23. Measles, Mumps & Rubella (MMR)
 PREPARATIONS:
 MEASLES.
 MMR.
 ADMINISTRATION:
 SC.
 INDICATIONS:
 Primary immunization at 1 & 6 years.

24. Measles, Mumps & Rubella (MMR)
PRECAUTIONS & CONTRAINDICATIONS
 Pregnancy
 Anaphylaxis to eggs
 Immunodeficiency and
immunosuppression
 Immunoglobulins within 3-11 months

25. Measles, Mumps & Rubella (MMR)
 ADVERSE REACTIONS
 Fever ,rash (7 days post vaccination)
 Arthralgia , arthritis (rubella)
 Encephalitis [rare] (measles, mumps)
 Suppression of PPD skin test (measles)
 Convulsions in prone children(measles)
 Thrombocytopenia

26. Haemophilus Influenzae Type B
 ADMINISTRATION
 IM
 2,4,6 months, booster at 15 months
 INDICATIONS
 Children under 5 years of age
 High risk children
 SIDE EFFECTS:
 Local pain and erythema
 Mild fever

27. Varicella Prophylaxis
 PREPARATIONS:
 Varivax vaccine (MSD)
 ADMINISTRATION:
 0.5 ml IM
 12 months and above……..2 doses

28. Varicella Prophylaxis
 INDICATIONS:
 All children 12 months-18 years: (if no
history of varicella)
 EFFICACY:
 70-90%

29. Varicella Prophylaxis
 PRECAUTIONS & CONTRAITNDICATIONS:
 Immunocompromised patients
 Within 5 months of IG
 Children on long term salicylates
 SIDE EFFECTS:
 Fever , rash
 Zoster

30. Hepatitis A
 NATURE OF VACCINE:
 Killed formalin inactivated vaccine.
 PREPARATIONS:
 Various preparations available
e.g. Havrix 720 Junior, Havrix 1440 etc.

31. Hepatitis A
 INDICATIONS:
 children 1 year and above
Susceptible children in endemic areas
Chronic liver disease
Hemophilia

32. Hepatitis A
 ADMINISTRATION:
 IM injection
 2 doses, at least 6 months apart
 ADVERSE REACTIONS:
 Local reactions, fever
 Rare: anaphylaxis

33. Additional Vaccines

34. Pneumococcal Prophylaxis
 PREPARATIONS:
 Purified capsular polysaccharide of 23
serotypes of Streptococcus pneumoniae
 7 valent conjugated vaccine
 ADMINISTRATION:
 IM / SC
 1 dose/booster 5 years

35. Pneumococcal Prophylaxis
 INDICATIONS:
 Primary vaccination (conjugate vaccine)
 children 2 yr. or older with
 Anatomical or functional asplenia
 Sickle cell disease
 Nephrotic syndrome
 Immunosuppression

36. Pneumococcal Prophylaxis
 SIDE EFFECTS:
Soreness , erythema, fever, myalgia
Anaphylactic reactions (rare)

37. Meningococcal Prophylaxis
 PREPARATIONS:
 monovalent (A or C)
 bivalent (A & C)
 quadrivalent (A,C,Y & W-135)
 quadrivalent conjugate quadrivalent
 ADMINISTRATION:
 SC

38. Meningococcal Prophylaxis
 INDICATIONS:
 Control of outbreaks
 Children with complement deficiencies
or asplenia
 SIDE EFFECTS:
 local erythema and discomfort
 transient fever

39. Influenza Virus
 Nature of vaccine:
 Killed vaccine.
 Live attenuated
 Preparations:
 whole and “split virus” vaccines.
 “split virus” vaccines are recommended for
children 6 months and older.
 composition of the vaccine is changed
annually.

40. Influenza Virus
 ADMINISTRATION:
 IM (killed).
 Live attenuated (intranasal).
 1 dose during influenzae season.
 Children 6months-9 years should receive an
additional dose, 4 weeks after the 1st dose, if
not previously immunized.

41. Influenza Virus
 Indications:
 chronic cardio-respiratory disease
 asthma
 cystic fibrosis
 bronchopulmonary dysplasia

42. Influenza Virus
 Indications:
 Sickle cell anemia.
 Chronic salicylate therapy.
 Diabetes mellitus.
 Chronic renal disease.
 Chronic metabolic disease.
 immunosuppressive conditions: cancer, HIV etc.
 Hospital personnel with significant patient
contact.

43. Influenza Virus
 Contraindication:
 Anaphylaxis to previous dose.
 Hypersensitivity to eggs.
 Adverse Reaction:
 Soreness at injection site.
 Allergic response.
 Guillain-Barré Syndrome.

44. New Vaccines
 Rota virus vaccines
 Human papilloma virus vaccine

45. THANKS