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immunizationn-140429082910-phpapp02.pptx
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- 2. IMMUNIZATION • Immunisation isthe process by which acquired immunity is induced. Acquired Immunity • Protection from disease • Provided by introduction antigens or premade antibodies into the body
- 3. Acquired Immunity Active immunity •In response to stimulus by an antigen characterized by the production of antibodies by the host. Passive immunity • Immunity transferred in ready made form.ie,no role of immunesystem of the recipient.
- 4. Active immunity Naturally acquired •Repeated clinical & subclinical infection in childhood give immunity. • Eg:chicken pox Artificially acquired • Immunity induced by vaccination
- 5. Passive immunity Naturally acquired •Transfer of maternal antibodies • Eg: – Through placenta=Ig G – Through colostrum=Ig A Artificially acquired • Following administration of Immune globulin or antiserum • Eg:Anti tetanus serum(ATS)
- 6. Immunizing agents • vaccines •immunuglobulins • antisera
- 7. VACCINATION • A vaccineis an immuno-biological substance(Ag) designed to produce specific protection against a given disease. • A vaccine is “antigenic” but not “pathogenic”.
- 8. Types of vaccines •Attenuated live vaccines • Inactivated killed vaccines • Toxoids • Polysaccharide and polypeptide (cellular fraction) vaccines • Surface antigen (recombinant) vaccines.
- 9. Live Vaccines Advantages • Singledose enough • Produce local immunity • lnduce cell mediated immunity • More convenient for mass immunization Disadvantages • Reversion to virulence • Difficulty in storage
- 10. Killed Vaccines Advantages • Nodanger of spread • Stability and safety Disadvantages • Multiple injection may be required • May be contaminated with • dangerous infectious agent
- 11. Live Attenuated vaccines Killed Inactivated vaccines Toxoids Cellular fraction vaccines Recombinant vaccines •BCG •Typhoid oral •Plague •Oralpolio •Yellow fever •Measles •Mumps •Rubella •Intranasal Influenza •Typhus •Typhoid •Cholera •Pertussis •Plague •Rabies •Salk polio •Intra- muscular influenza •Japanise encephalitis •Diphtheria •Tetanus •Meningococcal polysaccharide vaccine •Pneumococcal polysaccharide vaccine •Hepatitis B polypeptide vaccine •Hepatitis B vaccine
- 12. Route Intradermal BCG Subcutaneous Measles,MMR, Meningococcal, Varicella Intramuscular DTwP / DTaP, Hib, Hep A, Hep B, DTwP-Hep B-Hib, DTwP-Hep B, DTwP-Hib, Hep A-Hep B
- 13. VACCINE ADVERSE REACTIONS •Local – Pain, swelling, redness at site of injection – Common with inactivated vaccines – Usually mild and self-limited • Systemic – Fever, malaise, headache – Nonspecific – May be unrelated to vaccine • Allergic – Due to vaccine or vaccine component – Rare
- 14. VACCINE COLD CHAIN •The system of transporting, storing and distributing vaccines in a potent state at the recommended temperature from the point of manufacture to the point of use is the Cold Chain. • Vaccine potency once lost cannot be restored.
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- 17. • Whole cellvaccine –Contains suspension of whole bacterial cells that have been killed. Eg: DTwP –More effective but less safe • Acellular vaccine –Cell free vaccine prepared from purified antigenic component of cell free microorganism. –ie,doesnot have complete cell but contains fragments of cell best suited to stimulate immune response. Eg: DTaP –Less effective than DTwP but more safe
- 18. Vaccine Failure • Primary= administration of recommended dose of vaccine doesnot result in adequate protection against disease. • Secondary = disease occur inspite of immunsiation.
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- 20. BCG VACCINE • Liveattenuated vaccine (Bacille Calmettee – Guerin strain) • Dose: 0.05ml in neonates & 0.1ml in others • Intradermal injection in to left hand on deltoid area. • Controls hematogenous spread thus preventing Miliary TB, Disseminated TB, TB Meningo encephalitis(80%) • Reconstitute with 1 ml of Sodium Chloride Inj. IP. • Complications:ulceration ,lymphadenitis... • C.I ---immunocompromised
- 21. Oral Polio Vaccine •OPV – Live attenuated Polio virus – Type I - Type II - Type III • Dose – 2 drops oral at birth,6,10, 14 weeks, 16-24 months • Contraindication-in immunocompromised, diarrhea, infectious fever • MgCl2 is the stablizing agent • Pulse polio immunization -- giving 2 doses 1month apart • Complications: Vaccine associated paralytic polio--VAPP (due to type 2)
- 22. Injectable Polio Vaccine •Formaldehyde killed and purified poilio virus – Type I-40 – Type II-8 D antigen units – Type III-32 • Immunity – humoral, local pharyngeal, intestinal • Safe • 6,10,14 weeks according to IAP
- 23. DTwP / DTaPvaccines • DTaP has been licensed in India for private use • Current recommendations for use of DTaP – For infants who had severe reaction to 1st dose of DTwP – For adolescents and adults – For infant immunized abroad with DTaP • DTaP adult formulation has now been recommended as booster by WHO for adolescents and adults. • Absolute contra indications for DTwP – Anaphylaxis to previous dose – Progressive neurological disorder – Hypotensive hyporesponsive episodes
- 24. MEASLES VACCINE • Liveattenuated vaccine (Edmonston-Zagreb strain) • Given IM or SC • Given at 9 months (because at that time maternal antibody wean off) • Contraindications – Malignancy – Therapy with alkylating agent/ corticosteroid – Immune deficiency • Side effect -- TSS (toxic shock syndrome) due to bacterial contamination.
- 25. MMR vaccine • Measles---Edmonston-Zagrebstrain • Mumps-Jeryl Lynn strain • Rubell--RA 27/3 strain • Dose is 0.5 ml (2 dose one at 15 month and another 8 weeks later) (S / C). • Contraindication--pregnancy,immunosuppression
- 26. HEPATITIS B VACCINE •Recombinant DNA vaccine (in yeast) • 0.5 mL IM in <1 year and 1 mL > 1 year • 3 doses at 0, 1, 6 months • HBIG gives passive immunity • HBIG should be given preferably within 48 hours of exposure.
- 27. TYPHOID VACCINE • 2doses • 0.5 mL SC 1 month interval (killed vaccine) • Typhoral-- oral live vaccine (stable mutant S. typhi strain type 2 Ia) • Typhim-- give SC or IM single dose
- 28. Hib VACCINE • Capsularpolysaccharide used as antigen • Given particularly prior to splenectomy • 3 dose below six months • 2 dose between 6-12 months • 1 dose between 12-15 months • And a booster dose should be in this children at 18 months • >15 months--only one dose
- 29. HPV Vaccine • 0.5mL IM deltoid • Recommended age for initiation of vaccine is 10-12 years • 3 doses at 0,2,6 months
- 30. Chickenpox Vaccine • Dose--0.5mL S /C or IM 2 doses 4-8 weeks apart >13 years Pentavalent vaccine • Trail in Kerala,Tamil Nadu • Contains D , P , T , Hib , Hep B. • Schedule-6,10, 14 week
- 31. National Immunization Schedule AgeVaccines Birth BCG, OPV0 (for institutional deliveries) 6 weeks DTwP1, OPV1, HepB1, Hib1$$ (BCG if not given at birth) 10 weeks DTwP2, OPV2, HepB2, Hib2 14 weeks DTwP3, POV3, HepB3, Hib3 9-12 months Measles 16-24 months DTwP B1, OPV4, MMR 5-6 years DTwP 10 years TT 16 years TT Pregnant women TT1 (early in pregnancy) TT2 (1 month later) TT booster (if vaccinated in past 3 years)
- 32. IAP recommended vaccinesfor routine use Vaccines under special circumstances BCG, OPV IPV DTwP/DTaP DT Td Tdap Measles Typhoid Hib Hep B MMR HPV PCV Hepatitis A Chicken Pox Rotavirus vaccine Rabies Influenza PPSV23 Japanese Encephalitis Meningococcal Cholera Yellow Fever
- 33. IAP Immunization TimeTable (recommended vaccines for routine use) Age (completed weeks/ months/years) Vaccines Birth BCG OPV0 HepB 1 6 weeks DTwP1/DTaP1 OPV1*/ OPV1 + IPV1 Hib1 HepB2 Rotavirus 1 *# PCV 1 10 weeks DTwP2/ DTaP2 OPV2*/ OPV2 + IPV2 Hib 2 Rotavirus 2 PCV 2
- 34. 14 weeks DTwP3/DTaP3 OPV3*/ OPV3 + IPV3 Hib3 Rotavirus 3 HepB3** PCV 3 9 months Measles 12 months Hepatitis A 1 15 months MMR1 Varicella PCV booster 16 to 18 months DTwP B1/ DTaP B1 OPV4*/ OPV4 + IPVB1 Hib B1
- 35. 18 months HepatitisA 2 2 years Typhoid 1 5 years DTwP B2 / DTaP B2 OPV5 MMR2 Typhoid 2 Varicella 2 10 to 12 years Tdap/Td HPV^
- 36. vaccination schedule foran unimmunized child Visit Suggested vaccines First Measles (MMR if more than 12 months) DTwP1/DTaP1 (Tdap if 7 years or more) OPV1/IPV1 (only if less than 5 years) Hib 1 (Only if less than 5 years) Hep B 1 Second visit (after 1 month of first visit) BCG (only in less than 5 years) DTwP2/ DTaP2 (Td if 7 years or more) OPV 2 (if OPV given earlier) Hep B 2 Hib 2 (if less than 15 mths Third visit (after 1 month of second visit) OPV3/IPV2 MMR (if more than 12 months) Typhoid (if more than 2 years) Fourth visit (6 months after first visit) DTwP3/DTaP3 (Td if 7 years or more) OPV4/IPVB1 HepB3
- 37. Do’s and Don'tsAfter Vaccine Administration • Do not rub the site vigorously. • Gentle pressure at the site for a few seconds will suffice. • If blood oozes do not blot. Just apply gentle pressure with cotton swab. • No Heat, Ice or Cold Water fomentation is advocated. • The wet cloth soaked in ordinary portable water can be applied at the site of swelling or tenderness for about 5 – 10 minutes. • Repeat the procedure, if necessary, 3-4 times a day.
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