Immunisation schedule and some basic facts about them

1. IMMUNIZATION
POOJA SANALKUMAR

2. NATIONAL IMMUNISATION SCHEDULE FOR
INFANTS

3. VACCINE WHEN TO GIVE MAX.AGE DOSE ROUTE SITE
BCG At birth Till 1 yr
0.1ml (0.05 ml
till 1 mth)
Intra-dermal L. Upper arm
Hepatitis B At birth In 24 hrs 0.5ml I.M.
Anterolateral aspect
of L. Mid thigh
OPV₀ At birth In 1st 15 days 2 drops Oral
OPV₁₂₃ At 6,10, 14w Till 5 yrs 2 drops Oral
Rota virus vaccine 6, 10, 14w Till 1 yr 5 drops Oral
IPV 14w Upto 1 yr 0.5ml i.m.
Anterolateral aspect
of R. mid thigh
Pentavac₁₂₃ 6, 10,14w Till 1 yr 0.5ml I.M.
Anterolateral aspect
of l. Mid thigh
Measles ₁ 9-12 months Till 5 yrs 0.5ml S.C. R. Upper arm
Japanese
encephalitis
9-12 months Till 15 yrs 0.5ml s.c. L. Upper arm
Vitamin A 9 compltd mths Till 5 yrs 1 lakh IU Oral

4. NATIONAL IMMUNISATION SCHEDULE FOR
CHILDREN

5. VACCINES WHEN TO GIVE MAX. AGE DOSE ROUTE SITE
DPT booster 16-24 months 7 yrs 0.5 ml I.M.
Anterolateral
aspect of l. Mid
thigh
Measles 2nd 16-24months Till 5 yrs 0.5 ml s.c. R. Upper arm
OPV booster 16-24 months Til 5 yrs 2 drops Oral
Japanese
encephalitis
16-24 months 0.5 ml s.c. L. Upper arm
Vitamin A 2nd -
9th dose
16 months.1
dose every 6 m
Till 5 yrs 2 lakh IU Oral
DPT 2nd booster 5-6 yrs 7yrs 0.5 ml i.m. l. Upper arm
TT 10 & 16 yrs 0.5ml i.m. Upper arm

6. IAP IMMUNIZATION SCHEDULE
AGE VACCINES
BIRTH
BCG
OPV0
HEP B1
6 WEEKS
DTwP1
IPV1
HEP B2
HIB 1
ROTAVIRUS 1
PCV1

7. Age Vaccine
10 weeks DTwP₂ , IPV₂ , Hib₂ , Rotavirus₂ , PCV₂
14 weeks DTwP ₃ , IPV₃ , Hib₃ , Rotavirus₃, PCV₃
6 months OPV₁ , Hep B₃
9 months OPV₂ , MMR₁
9-12 months Typhoid conjugate vaccine
12 months Hep-A₁
15 months MMR₂ , Varicella 1, PCV booster
16-18 months DTwP B1/DTaP B , IPV B₁ , Hib B1

8. Age Vaccines
18 months Hep-A₂
2 years Booster of typhoid conjugate
4-6 years
DTwP B2/DTaP B₂ , OPV₃ , Varicella 2 ,
MMR₃
10-12 years HPV

9. COMMONLY USED VACCINES
BCG VACCINE
• Dose, Route
• Site
• Adverse reactions
• Contraindication
• Storage
‒ 0.1ml, intradermal
‒ Left upper arm at insertion of deltoid
‒ Local ulceration or discharging sinus, axillary
lymphadenitis, disseminated infection, osteomyelitis.
‒ Cellular immunodeficiency, symptomatic HIV
‒ 2-8°C; sensitive to heat & light; discard unused
vaccine after 4 hr

10. • 2-3w after correct intradermal inj. of potent vaccine, paule develops at
the site .
• Slowly increases in size (diameter=4-8mm in 5w)
• Subside or breaks into shallow ulcer, usually covered by crust.
• Healing: spontaneous, within 6-12w leaving permanent, tiny, round scar of
4-8mm.
• Patient becomes mantoux positive in 8w.

11. POLIOMYELITIS
OPV
• Dose, Route
• Adverse reactions
• Contraindications
• Storage
‒ 2 drops; oral
‒ Vaccine derived polio virus, VAPP
‒ Inherited or acquired immunodeficiency,
symptomatic HIV
‒ 2-8˚C ; sensitive to heat ; use vaccine vial
monitor

12. IPV
• Dose, Route
• Adverse reactions
• Contraindication
• Storage
‒ 0.5ml; i.m. or s.c.
‒ Local pain, swelling
‒ Known allergy
‒ 2-8˚C sensitive to light

13. Diphtheria Toxoid, Tetanus Toxoid & Killed Whole Cell Pertussis or
Acellular Pertussis Vaccine
• Dose , Route
• Site
• Adverse
reactions
• Contraindication
‒ 0.5ml; i.m.
‒ Anterolateral aspect of mid thigh
‒ Local pain, swelling, fever
‒ Progressive neurological disease, anaphylaxis after
previous dose , encephalopathy within 7 days of
previous dose

14. • Precautions
• Storage
‒ Previous dose associated with
(i) fever >40.5˚C within 48hr
(ii) collapse within 48hr
(iii) persistent inconsolable crying for more than 3hr
within 48hr
(iv) seizures within 72hr
‒ 2-8ºC ; sensitive to light

15. MEASLES VACCINE
• Dose, route
• Site
• Adverse reactions
• Contraindications
• Storage
‒ 0.5ml, sc
‒ Right upper arm or anterolateral thigh
‒ Fever, transient macular rash 5-10 days later.
‒ (i) immunosuppressive therapy eg:alkylating
agents, high dose corticosteroids (ii) malignancy
(iii) immunodeficiency eg: advanced HIV (iv)
untreated TB
‒ 2-8°C;sensitive to heat and light; use within 4-6
hrs of reconstitution

16. MMR VACCINE
• Dose, route
• Site
• Adverse reactions
• Contraindications
• Storage
‒ 0.5ml;s.c.
‒ Right upper arm or anterolateral thigh
‒ Fever, transient rash, arthralgia, aseptic meningitis,
lymphadenopathy
‒ (i) immunosuppressive therapy eg: alkylating
agents, high dose corticosteroids (ii) malignancy
(iii) severe immunodeficiency eg: advanced HIV
(iv) untreated TB
‒ 2-8ºC;sensitive to heat and light; use within 4-6 hrs
of reconstitutional

17. HEPATITIS B VACCINE
• Dose, route
• Site
• Schedule
IAP 2012
‒ 0.5ML, i.m.
‒ Anterolateral thigh; avoid gluteal region
‒ At birth, 6 weeks & 6 months; may give 3-4 doses in
an alternative schedule while ensuring that
‒ Doses 1& 2 are ≥4weeks apart
‒ Doses 2&3 are≥8weeks apart
‒ Final dose is at ≥6mo of age &≥16weeks beyond
1st dose

18. • Catch up
• Adverse reactions
• Contraindications
• storage
‒ Complete 3 doses series; 2nd dose is given
≥4weeks & 3rd dose ≥8weeks after previous dose
‒ Local soreness, fever, fatigue
‒ Anaphylaxis after previous dose
‒ 2-8˚c ;do not freeze

19. VARICELLA VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
• Catch up
‒ 0.5ml s.c.
‒ Anterolateral thigh or upper arm
‒ Not included
‒ 2 doses at 15-18mo & 4-6yr; 2nd dose maybe
given >3mo after 1st dose
‒ Complete 2 dose series with minimum interval of
3mo between the doses

20. • Adverse reactions
• Contraindications
• Storage
‒ Fever , rash, local pain or redness
‒ Anaphylaxis after previous dose, lymphopenia,
immunodeficiency ,during immunosuppressive
therapy
‒ 2-8ºC; protect from light; use within 3omin of
reconstitution.

21. TYPHOID VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
Catch up
• Adverse reactions
• Contraindications
• Storage
‒ 0.5ml, sc or i.m.
‒ Anterolateral thigh
‒ Not included
‒ 1 dose at 2yr ; repeat every 3yr
‒ 1 dose beyond 2yr
‒ Local pain, swelling, redness, fever
‒ Anaphylaxis after previous dose
‒ 2-8˚c ;do not freeze

22. HEPATITIS A VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
• Catch up
‒ 0.5ml; i.m.
‒ Deltoid
‒ Not included
‒ 2 doses beyond 1yr of age given 6 months apart
‒ Complete 2dose series with interval of ≥6mo;
if≥10 yr old, screen for HAV antibody 1st,
administer vaccine only if seronegative; use adult
vaccine if≥ 13yr old.

23. • Adverse reactions
• Contraindications
• Storage
‒ Local pain, nausea, anorexia, malaise
‒ Anaphylaxis after previous dose
‒ 2-8ºC;protect from light; use within 3omin of
reconstitution.

24. ROTAVIRUS VACCINE
• Dose, route
• Schedule
National program
IAP 2012
‒ RV1: 1ml (lyophilized) or 1.5ml(liquid) ;
RV5: 2ml(liquid);oral
‒ Not included
‒ RV1: 2doses; RV5: 3 doses; at 6-14 weeks ≥ 4weeks
apart; maximum age <15weeks for the 1st dose &
<8mo for the final dose; do not begin schedule
at≥15weeks

25. • Adverse reactions
• Contraindications
• Precaution
• storage
‒ Intussusception
‒ Past history of intussusception; severe
immunodeficiency
‒ Postpone vaccination during ongoing diarrhoea
or moderate illness
‒ 2-8˚c ;do not freeze; protect from light; use
immediately after reconstitution or opening

26. HAEMOPHILUS INFLUENZA B VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
• Catch up
‒ 0.5 ml; i.m.
‒ Anterolateral thigh
‒ Introduced in some states as pentavalent vaccine with
DPT & hepatitis B
‒ 3 doses at ≥6 weeks given≥ 4 weeks apart; 1 booster at
15-18 mo
‒ At 6-12mo:2doses≥ 8weeks apart with 1 booster at 15-
18 mo; at 12-15mo: 1 dose and 1 booster at 15-18 mo;
15-60 mo:1 dose ; not recommended > 5yr old.

27. • Adverse reactions
• Contraindications
• storage
‒ Fever, rash, local pain or redness
‒ Hypersensitivity to previous dose
‒ 2-8˚c

28. PNEUMOCOCCAL VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
Catch up
‒ 0.5ml s.c./i.m.
‒ Anterolateral thigh
‒ Not included
‒ 3 doses at ≥ 6 weeks given ≥ 4 weeks apart and 1
booster at 15-18 mo;
‒ At 7-11 mo: 2doses ≥ 4 wks apart & one booster
dose at 15-18 mo; 12-23mo; 2 doses ≥ 8 wks
apart; 24-59 mo; one dose; >60 mo: one dose
only if in high risk category.

29. • Adverse reactions
• Contraindications
• storage
‒ fever, local pain, soreness, malaise.
‒ Anaphylaxis after previous dose
‒ 2-8˚C; do not freeze.

30. HPV VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
• Catch up
• Adverse reactions
• Contraindications
• storage
‒ 0.5ml; i.m.
‒ Upper arm (deltoid)
‒ Not included
‒ Girls 11-12 yr old
‒ HPV4: at 0, 2 & 6 mo;HPV2: 0, 1 & 6 mo
‒ Before initiation of sexual activity
‒ fever, local pain, erythema, swelling.
‒ Anaphylaxis after previous dose
‒ 2-8˚C; protect from light.

31. JAPANESE B ENCEPHALITIS VACCINE
• Dose, route
• Site
• Schedule
National Program
IAP 2012
Catch up
• Adverse reactions
‒ 0.5ml; s.c.
‒ Anterolateral thigh or upper arm
‒ Only in endemic areas; 1 dose at 9 mo.
‒ Only in endemic areas.
‒ 1 dose in susceptible children up to 15 yr old.
‒ Fever, malaise

32. INFLUENZA VACCINES
• Dose, route
• Site
• Schedule
National program
IAP 2012
• Adverse reactions
• Contraindications
• storage
‒ 0.5ml; i.m.
‒ Anterolateral thigh or upper arm
‒ Not included
‒ Only in high risk categories; 1st time vaccination: 2
doses ≥ 4 wks apart if 6 mo-9 yr old and 1 dose if > 9
yr; annual revaccination with 1 dose; best
administered before rainy season
‒ Local pain, redness, anaphylaxis.
‒ Anaphylaxis after previous dose
‒ 2-8˚C; do not freeze.

33. MENINGOCOCCAL VACCINE
• Dose, route
• Site
• Schedule
National program
IAP 2012
• Adverse reactions
• Contraindications
• Storage
‒ 0.5 ml; s.c./i.m.
‒ Anterolateral thigh or upper arm
‒ Not included
‒ Single dose in high risk categories older than 2 yrs;
repeat after 3-5 yrs if required.
‒ Fever, local pain or redness
‒ Anaphylaxis after previous dose
‒ 2-8˚C; protect from light; use within 30 min of
reconstitution

34. Cold chain
• System for storage and transport of vaccines at low temperature from
manufacturer to the actual vaccination site.
• To prevent vaccine failure (sensitive to temperature).
• Potency of the vaccine decreases when exposed to inappropriate
temperatures.
• Heat sensitive vaccine: OPV > Influenza > IPV, MMR > Cholera,
Pentavac, Rotavirus > BCG, HPV > Hep B, Hib

35. Deep freezer:
•Temperature b/w -15° to -25°C.
•Used for storing OPV vaccine and for
freezing ice packs
Ice lined refrigerator:
•Temperature b/w +2° to +8°C.
•2 parts:
•upper part :DPT, TT, HepB, IPV &
pentavalent vaccines
•Lowe part: OPV, BCG, measles, JE

36. THANKYOU