The document provides the schedule for seminars and discussions for post-graduate students in the Department of Community Medicine at Grant Medical College in Mumbai for the month of July 2015. It lists the dates, topics, presenting students, and supervising teachers. Some of the topics included are introduction to vaccinology, cold chain management, the national immunization programme, adverse events following immunization, and future generation vaccines.
WHO - AMR Global Overview and Action Planmarkovingian
Diberikan dan disampaikan pada Seminar "Cegah Resistensi Antibiotik: Demi Selamatkan Manusia", kerjasama Kemenkes, WHO, dan Yayasan Orang Tua Peduli, didukung oleh React, 5 Agustus 2015
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Claudia Llanten, MD, MPH of CMMB describes the importance of immunization in protecting the health of children and adults and how CMMB partners with other organizations to deliver vaccines at the CCIH 2018 conference.
WHO - AMR Global Overview and Action Planmarkovingian
Diberikan dan disampaikan pada Seminar "Cegah Resistensi Antibiotik: Demi Selamatkan Manusia", kerjasama Kemenkes, WHO, dan Yayasan Orang Tua Peduli, didukung oleh React, 5 Agustus 2015
Presentation from the 3rd Joint Meeting of the Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI) Networks, organised by the European Centre of Disease Prevention and Control - Stockholm, 11-13 February 2015
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Claudia Llanten, MD, MPH of CMMB describes the importance of immunization in protecting the health of children and adults and how CMMB partners with other organizations to deliver vaccines at the CCIH 2018 conference.
Antibiotic Guardian Leeds Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
The national flu immunisation programme 2017/18 - training for professionalsPublic Health England
This training slide set about the National Flu vaccination programme 2017-2018 is intended for healthcare practitioners and includes detailed information on:
• the background of the programme
• vaccine handling, administration and constituents
• eligibility and resource
For additional guidance on delivering the programme please visit https://www.gov.uk/government/collections/annual-flu-programme
Antibiotic resistance is one of the biggest threats facing us today!
European Antibiotic Awareness Day (EAAD) is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.
This year, to run in line with EAAD; Public Health England has established the Antibiotic Guardian pledge campaign. It calls on everyone in the UK, the public and healthcare community to become antibiotics guardian by choosing one simple pledge about how they will make better use of these vital medicines.
To ensure that the information and knowledge on Antibiotic Stewardship is disseminated to those practising healthcare across the nation, a series of awareness and educational events have been developed. These educational workshop events, to be held in Leeds, Birmingham and London, will provide guidance, resources and information for practitioners on topics associated with antibiotic awareness. The events will provide an opportunity to understand how you and your organisation can support combat the global challenge faced by antibiotic resistance whilst gaining advice, support and resources to inform patients and staff.
In order to ensure the control, eradication and elimination of diseases, routine immunization is extremely important. Since the Indian climatic condition is extremely disease-prone, one needs to embrace the latest advancements which have ushered into the vaccine and immunization arena. Vaccination initiatives can be made more effective through a routine immunization program in India.
via : https://www.itsu.org.in/
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
How Nutrition Can Help Fight Against the COVID-19 PandemicUN SPHS
By Dr. Randah Miqbil Alqurashi Assistant Professor, King Faisal University, delivered at the Global Forum 2020 Food Safety and Risk Assessment session.
Antibiotic Guardian London Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Tang Min Moon, consultant dermatologist in Kuala Lumpur Hospital, Ministry of Health Malaysia.
Hepatitis A is an under rated infectious disease in children , with high morbidity and a major cause of fulminant hepatitis in children.There has been a longstanding debate between the LIVE VACCINE FOR HEPATITIS A AND THE KILLED INACTIVATED VACCINE FOR HEPATITIS A. Recent CDC guidelines and INDIAN ACADEMY OF PEDIATRICS GUIDELINES and recent references were studied before making these slides. Hope you find these useful.
Antibiotic resistance: causes, consequences and means to limit itGreenFacts
Over the last century, antibiotics have radically changed the
way we treat infections. They are an important tool for modern medicine, but unfortunately their misuse have led to the emergence of bacteria that are resistant to antibiotics.
What has caused it and how can the spread of resistance be limited?
Antibiotic Guardian Leeds Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
The national flu immunisation programme 2017/18 - training for professionalsPublic Health England
This training slide set about the National Flu vaccination programme 2017-2018 is intended for healthcare practitioners and includes detailed information on:
• the background of the programme
• vaccine handling, administration and constituents
• eligibility and resource
For additional guidance on delivering the programme please visit https://www.gov.uk/government/collections/annual-flu-programme
Antibiotic resistance is one of the biggest threats facing us today!
European Antibiotic Awareness Day (EAAD) is part of the UK 5 Year Antimicrobial Resistance Strategy 2013 to 2018, which focuses on antibiotics and sets out actions to slow the development and spread of antimicrobial resistance.
This year, to run in line with EAAD; Public Health England has established the Antibiotic Guardian pledge campaign. It calls on everyone in the UK, the public and healthcare community to become antibiotics guardian by choosing one simple pledge about how they will make better use of these vital medicines.
To ensure that the information and knowledge on Antibiotic Stewardship is disseminated to those practising healthcare across the nation, a series of awareness and educational events have been developed. These educational workshop events, to be held in Leeds, Birmingham and London, will provide guidance, resources and information for practitioners on topics associated with antibiotic awareness. The events will provide an opportunity to understand how you and your organisation can support combat the global challenge faced by antibiotic resistance whilst gaining advice, support and resources to inform patients and staff.
In order to ensure the control, eradication and elimination of diseases, routine immunization is extremely important. Since the Indian climatic condition is extremely disease-prone, one needs to embrace the latest advancements which have ushered into the vaccine and immunization arena. Vaccination initiatives can be made more effective through a routine immunization program in India.
via : https://www.itsu.org.in/
Influenza vaccine is nothing new . However there are lesser known facts about Influenza vaccine. This is just a humble attempt to highlight a few important points about Influenza vaccine, including some updates.
Burden of Influenza disease worldwide.
Importance of Influenza vaccine in Corona virus pandemic.
Influenza vaccine quadrivalent vs trivalent vaccine.
Split virion vs Subunit influenza vaccine
0.5 ml dose of influenza vaccine below 3 yrs age in children
Northern hemisphere or Southern hemisphere influenza vaccine for India, some suggestions
How Nutrition Can Help Fight Against the COVID-19 PandemicUN SPHS
By Dr. Randah Miqbil Alqurashi Assistant Professor, King Faisal University, delivered at the Global Forum 2020 Food Safety and Risk Assessment session.
Antibiotic Guardian London Workshop 20164 All of Us
Antibiotic resistance is one of the biggest threats facing us today.
Why it is relevant to you: without effective antibiotics many routine treatments will become increasingly dangerous. Setting broken bones, basic operations, even chemotherapy and animal health all rely on access to antibiotics that work.
What we want you to do: To slow resistance we need to cut the unnecessary use of antibiotics. We invite the public, students and educators, farmers, the veterinary and medical communities and professional organisations, to become Antibiotic Guardians.
Call to action: Choose one simple pledge about how you’ll make better use of antibiotics and help save these vital medicines from becoming obsolete.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Tang Min Moon, consultant dermatologist in Kuala Lumpur Hospital, Ministry of Health Malaysia.
Hepatitis A is an under rated infectious disease in children , with high morbidity and a major cause of fulminant hepatitis in children.There has been a longstanding debate between the LIVE VACCINE FOR HEPATITIS A AND THE KILLED INACTIVATED VACCINE FOR HEPATITIS A. Recent CDC guidelines and INDIAN ACADEMY OF PEDIATRICS GUIDELINES and recent references were studied before making these slides. Hope you find these useful.
Antibiotic resistance: causes, consequences and means to limit itGreenFacts
Over the last century, antibiotics have radically changed the
way we treat infections. They are an important tool for modern medicine, but unfortunately their misuse have led to the emergence of bacteria that are resistant to antibiotics.
What has caused it and how can the spread of resistance be limited?
Universal Immunization Program is a vaccination program launched by the Government of India in 1985.
It became a part of Child Survival and Safe Motherhood Program in 1992 and is currently one of the key areas under National Rural Health Mission(NRHM) since 2005.
Program consists of vaccination for 12 diseases -
Tuberculosis
Diphtheria
Pertussis
Tetanus,
Poliomyelitis,
Measles,
Hepatitis B,
Diarrhea,
Japanese-Encephalitis,
Rubella,
Pneumonia
Pneumococcal diseases
Vaccinations are essential for maintaining public health and are a cornerstone of contemporary healthcare. Vaccines prime the body to successfully combat a range of infectious diseases by boosting the immune system without generating the illness itself.
Anti-microbial resistance has become a world health issue today. Therefore it is imperative to know about the methods of acquiring resistance and ways to deal with the situation and prevent resistance.
A brief presentation on fish vaccination and its application particularly in Bangladesh. The overall process is described in a nutshell here. The types, procedure of formation, regulation, licensing and use are among them.
Nigeria's National Programme on ImmunisationEsther Ajari
This presentation gives a well-researched overview of Nigeria's National Programme on Immunization. The key areas covered include: Definition of terminologies, history, components, controversies, strategies, and guidelines.
Disclaimer -
The Content belongs to WHO (World Health Organisation). Sharing here is just to spread awareness about Covid-19.
https://www.who.int/docs/default-source/coronaviruse/risk-comms-updates/update37-vaccine-development.pdf?sfvrsn=2581e994_6
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
1. College seminar schedule for month of July 2015
Sr.
No.
Date Name Of PG student Topic PG Teachers
1 02/07/2015 Dr. Santosh Kadle Introduction to Vaccinology
Dr. Lalit Sankhe
Dr. Amit Mohite
2 09/07/2015 Dr. Vinod Chaudhary Cold Chain Management
3 16/07/2015 Dr. Amol Askar National Immunization programme
4 23/07/2015 Dr.Deepanjali Gadgikar Reporting of AEFI
5 30/07/2015 Dr. Santosh Kadle Future Generation Vaccines
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
1
2. Discussion Schedule for month of July 2015
Sr.N
o.
Date
Immuni
zation
Module
Topic PG student PG teachers
1 03/07/15 I
II
Introduction
Vaccine preventable disease & Surveillance Of VPD
Dr . Upadhye
Dr . Dange
Dr. Lalit Sankhe
Dr. Amit Mohite
2 10/07/15
III
IV
Manage cold chain
Plan and implement immunization services
Dr . Pisharodhi
Dr . Kale
3 17/07/15
V
VI
Adverse events following immunization (AEFI)
Special programme for vaccine preventable disease
Dr . Satpathy
Dr . Aatram
4
24/07/15
VII Monitor and evaluate immunization services
Vaccine manufacturing & Trial
Dr . Panigrahi
Dr . Nishant
5 31/07/15 Adult vaccination Dr . Sid
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
2
3. Introduction To Vaccinology
PG Student : Dr.Santosh Kadle
PG Teachers: Dr. Lalit Sankhe
Dr. Amit Mohite
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
3
4. Contents of seminar :
Vaccinology
Achievements
Global immunization vision and strategy (GIVS) goals
Need of Vaccines
Basic Concept of Immunity
Development of vaccine/200 years of revolution
Type of Vaccines
Vaccines currently in use
Major milestones in vaccine developments and licensing in India
List of licensed vaccine manufacturing units in India
Year of start of vaccine manufacturing units in India
Issues of vaccine- efficacy , immunogenicity and safety
Global monitoring of vaccine
Monitoring of vaccine in India
Criteria for selection of vaccines for introduction in NIP
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
4
5. Vaccinology
• The branch of medicine concerned with the development of vaccines.
• The word vaccine comes from Latin word “Vaccinus”- pertaining to cows
• Vaccine is “an immuno-biological substance designed to produce specific
protection against a given disease.” It stimulates the production of protective
antibodies and other immune mechanisms.
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
5
6. What’s so special about vaccines?
-- Vaccines are special !!!
Unlike many other health intervention, they help healthy people stay healthy & in
doing to help to remove a major obstacle to human development.
They benefit not only individual but also communities & even entire population(e.g.
eradication of small pox , elimination of poliomyelitis)
Impact of vaccine on communities &population are more rapid than that of many
other health intervention.
United state –CDC (Centre for disease control & prevention) put vaccine on top of list
of Ten great public health achievements of 20 th century.
Copenhagen Census Center in 2008 put expanded coverage for children in fourth Place
on List of 30 cost effective ways of advancing Global welfare.
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
6
7. • Immunization is key to achieving the Millennium Development Goals (MDGs),especially the
goal to reduce deaths among children under five years old (MDG 4).
• Vaccines prevent more than 2.5 million child deaths a year.
• Available vaccines could prevent additional 2 million deaths a year among children under five
years old.
• The introduction of new vaccines against pneumococcal disease and rotavirus could have a
rapid impact-within 3 to 5 years – on reducing the high toll of sickness , disability, and deaths
among children under five years old.
• Over 100 million children are immunized every year before their first birthday.
• But still issue is--around 24 million children under one year old - almost 20% of the children
born every year- are not being reached with vaccines.
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
7
8. Global immunization vision and strategy (GIVS) goals
By 2010 or earlier:
Increase coverage. Countries will reach at least 90% national vaccination
coverage and at least 80% vaccination coverage in every district.
Reduce measles mortality: Globally, mortality due to measles will have
been reduced by 90% compared to the 2000 level.
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
8
9. Global immunization vision and strategy (GIVS) goals
By 2015 or earlier:
Sustain coverage. vaccination coverage goal reached in 2010 will have been
sustained.
Reduce morbidity and mortality- of vaccine preventable diseases by at least
2/3 of the 2000 level
Ensure access to vaccines of assured quality
Introduce new vaccines
Ensure capacity for surveillance and monitoring
Strengthen systems
Assure sustainability
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
9
10. Why we need vaccines?
• The control of infection is approached from several directions.
• One method of breaking the chain of infection –e.g. in UK , rabies and psittacosis
control by controlling the importation of dogs and parrots respectively.
• Improvements in public health-water supply , sewage systems , and education in
personal hygiene- prevent the spread of cholera and many more diseases.
• And off course when other measures fail we can back on induction of immunity.
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
10
11. What is immunity ?
• Immunity is “ a state of being exemption from penalty ,duty , obligation , injury or
harmful influences.”
• Word -Immunity comes from Latin word – “Immunitos” -exemption from civic duties
afforded to senators, exemption from military services/tax.
• Immunity is basically constitutes of recognition mechanism and self/non-self
mechanism.
• Its of two types-
1]Natural /Innate immunity
2] Acquired/ adaptive immunity
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
11
12. Active immunity -
It is the immunity which an individual develops as a result of infection or by specific
immunization and is usually associated with presence of antibodies or cells having a
specific action on the microorganism concerned with a particular infectious disease or
on its toxin.
• In other words , active immunity depends upon the humoral and cellular responses of
the host.
• The immunity produced is specific for a particular disease.
• Active immunity may be acquired in 3 ways:
a) following clinical infection, e.g. chicken pox, rubella &measles
b) following subclinical or in apparent infection, e.g. polio & diphtheria
c) following immunization with an antigen which may be a killed vaccine , a live
attenuated vaccine or toxoid
16/07/2015
Department of Community Medicine, Grant Medical College
,Mumbai
12
13. Natural immunity is nonspecific, no change with repeat exposure.
While Acquired immunity is specific and memory against exposure.
Humoral immunity Cell mediated immunity
B lymphocyte T-lymphocyte
--Responds to antigen by differentiating
into antibody producing plasma cells.
--Effective against extracellular
pathogens and their products.
-- Antibodies binds their structure and
cause their destructions.
--Effective against intracellular
pathogens(like viruses , bacteria ,
parasite)
--Elimination of intracellular pathogen by
causing the lysis of infected cells and
intracellular destruction of
microorganism.
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14. Passive immunity --
When antibodies produced in one body(human or animal) are transferred to another to
induce protection against disease, it is known as passive immunity.
In other words, the body does not produce its own antibodies but depends upon ready-
made antibodies.
Passive immunity may be induced :
a) by transfer of maternal antibodies across the placenta .Human milk also contains
protective antibodies,(IgA)
b) by administration of an antibody- containing preparation(immune globulin or
antiserum)
Passive immunity differs from active immunity in following respects-
1)immunity rapidly established,
2)immunity produced is only temporary till antibody is eliminated from body and
3)there is no education of the reticuloendothelial system.
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15. Herd immunity -
It is a type of immunity that occurs when the vaccination of a portion of population
(or herd) provides protection to unprotected individuals.
Herd immunity provides an immunological barrier to the spread of disease in the
human herd.
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17. Types of Vaccines
• Approaches to designing vaccines against a microbe are typically based o
n fundamental information about microbe such as how it infects cells
and how the immune system responds to it, as well as practical
considerations.
• Following are types of vaccine depending upon their content and
preparation method :
1] Live, attenuated vaccines
2] Inactivated vaccines
3] Subunit vaccines
4] Combination
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18. 1] Live Attenuated Vaccine:
• Live vaccines(e.g. BCG ,OPV , Measles) are prepared from live or wild organism.
• These organisms have been passed repeatedly in laboratory in tissue culture or chick embryos
and have their capacity to induce full-blown disease but their immunogenicity is there.
• Live vaccines are more potent immunizing agent than killed vaccines , because :
1] Live organism multiply in the host and resulting antigenic dose is larger than what is injected.
2] Live vaccines have all the major and minor antigenic components.
3] Live vaccines engages certain tissues of body ( e.g. intestinal mucosa by OPV)
4] There may be the other mechanisms such as the persistence of latent virus.
• Live vaccines should not be administered to persons with immune deficiency diseases or whose
immune response may be suppressed because of leukaemia ,lymphoma ,malignancy or therapy
with steroids , anticancer drugs or radiation .
• Pregnancy is another contraindication unless the risk of infection exceeds the risk of harm to
foetus.
• When two live vaccines are required they should be given either simultaneously at different site
or with interval of at least 3 -4 weeks apart.
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19. • Protection is generally achieved with single dose of vaccine.
• An additional dose is given to ensure the seroconversion. (e.g. with single dose of measles
there is response up to 95-98%, but the second dose ensures 100% s protection against
measles)
• Live vaccines usually produce durable immunity, but not always as long as that of natural
infection.
• Live vaccines must be properly stored to retain effectiveness. Serious failure of measles and
polio immunization have resulted from inadequate refrigeration prior to use .
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20. 2] lnactivated Vaccine:
• Inactivated vaccines are produced by growing virus or bacteria in culture media and
then inactivating them with heat and chemicals (usually formalin),when injected in
body they stimulate active immunity.
• They are usually safe but less efficacious than live vaccines.(e.g. cholera vaccine offer
50% protection while efficacy of pertussis vaccine is 80% in first three years and almost
NIL in 12 years after immunization.
• Killed vaccines require a primary series of 2 to 3 dose of vaccine to produce an
adequate antibody response and in most cases booster are required.
• The duration of immunity following the use of inactivated vaccines varies from months
to many years.
• A vaccine is inactivated , the infective agent can not grown in immunized so that it can
not cause the disease , even in an immunodeficient person.
• The only absolute contraindication is a severe local or general reaction to a previous
dose.
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21. • Unlike live antigen, inactivated antigens are not affected by circulating antibody.
• They need adjuvant for action and preparation
• Inactivated vaccines are often more stable than attenuated vaccines. So they
have very high stability at room temperature.
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22. 3] Subunit Vaccine:
• A vaccine can be made of single or multiple antigenic components of a microorganism
that are capable of stimulating a specific immune response sufficient to protect from the
relevant pathogen infection or from the clinical manifestation of the disease.
• Depending on the molecular composition of the purified antigen used to prepare the
vaccine and on the techniques applied to obtain the final material used as a vaccine ,
different types of subunit vaccines can be defined.
• Types of subunit vaccines :
1] Toxoid
2] Protein Vaccine
3] Recombinant protein vaccine
4] Polysaccharide based vaccine
5] Conjugated vaccine
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23. 1] Toxoid vaccine
• Certain organisms produce exotoxins,( e.g. diphtheria and tetanus bacilli ).
• The toxins produced by these organisms are detoxicated and used in the preparation
of vaccines.
• The antibodies produced neutralize the toxic moiety produced during infection,
rather than act upon the organisms.
• In general , toxoid preparations are highly efficacious and safe immunizing agents.
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24. 2] Protein vaccine
• single or multiple protein from pathogen used for protein vaccine.
• Purification of protein in vitro culture done before used in the preparation of
vaccines.
• Example –
1] Acellular pertussis vaccine is prepared from 2-4 different purified protein
from B.Pertusis , which is more effective than vaccine from whole organism
2] Influenza subunit prepared from Haem-agglutinin (HA) &
Neuro-aminodase (NA) and purified from inactivated infective virus
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25. 3] Recombinant protein (DNA) Vaccine
• Development of recombinant deoxyribonucleic acid (DNA) technology has made
possible the expression of protective protein antigen in heterologous expression
systems such as E.coli, yeast, mammalian cells, or baculovirus.
• This technology avoids the problems related to growing and manipulating large
amounts of a pathogen from which the antigen is purified.
• As in this ,better purified protein antigen is used, more cleaner vaccine
preparation is there. But this causes decrease in immunogenicity , so need of
adjuvants to enhance immunogenicity.
• Example –
1] Hepatitis vaccine is prepared by inserting segments of Hepatitis B gene into yeast
cell and then modified yeast cell used for preparation of vaccine. As recombinant
Hepatitis B vaccine not contain virus DNA ,it is unable to produce infection.
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26. 4] Polysaccharide based vaccine
• In some bacteria, there is capsular shell of bacteria which constitutes polymeric
glycan and which is act as shield or barrier against host immune response.
• Stimulation of antibody response against this surface polysaccharides of pathogenic
bacteria is main strategy for preparation of vaccine.
• Disadvantage- as chemical structure of surface polysaccharides varies with species
and strains , vaccine is to serotype specific.
• Example –
1] Hib vaccine
2] Pneumococcus
3] Typh.(Vi)
4] Meningococcus
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27. 5] Conjugate Vaccine
• Children under two years of age do not respond well to antigens, such as
polysaccharides , which produce antibodies via a t –cell independent mechanism.
• Polysaccharide antigen are chemically linked(conjugated) to a protein that T–cells
recognize, then these conjugate vaccines can elicit strong immune responses and
immune memory in young children.
• The conjugate vaccines are also sero-type specific , and ,therefore, multivalent
formulations are required to achieve protection against multiple serotypes.
• Examples are S.pneumococcal and meningococcal vaccines.
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28. 4] Combination vaccines:
• In this, more than one kind of immunizing agent used for vaccine preparation.
• Basic aim for this vaccine preparation are- simplify administration , decrease in
cost , decrease in no . of frequency, decrease in storage cost and facilitation of
new addition of vaccines in national immunization programme.
• Example –
1] DPT 2] DT 3] DP 4]DPT a
5]MMR 6]Hepatitis A ,B 7] DTwp
8] DPT , Hep B , Hib
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29. Vaccines currently in use
Live attenuated Killed organism Toxoid/protein Polysaccharide Glyco-conjugate Recombinant
• BCG • Typhoid • Diphtheria Pneumococcus Hib HBV
• Yellow fever • Cholera • Tetanus meningococcus Pneumococcus Lyme disease
• Polio (OPV) • Plague • Acellular Pertussis Hib MenACWY Cholera Toxin B
• Measles • Pertussis • Anthrax Typhoid (Vi) HPV
• Mumps • Influenza • Influenza subunit
• Rubella • Typhus
• Typhoid • Polio (IPV)
• Varicella • Rabies
• Rotavirus • JE
• Cholera • TBE
• Cold adapted
influenza
• HAV
• Rotavirus
reassortants
• Zoster
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30. Major milestones in vaccine developments and licensing in India
1893- Efficacy trails on cholera vaccine conducted in Agra , India
1897- First plague vaccine discovered by Dr.Haffkine
1904-05 first vaccine research institute established at Kasauli , Himachal Pradesh
1907 Pasteur institute of India, Coonoor , manufactured neural tissue anti-rabies vaccine
1920-39 DPT,DT and TT vaccine become available in country
1940 Drugs and cosmetics act enacted
1948 BCG vaccine laboratory set up Guindy , near Madras (Chennai)
1951 Liquid BCG vaccine available in India as part of mass campaigns
1965 Live attenuated freeze dried smallpox vaccine become available
1967 Freeze dried BCG vaccine become available, OPV become available in India
1970 Indigenous OPV trivalent(Sabin) was developed and produced
1980 Indigenous measles vaccine production started
1984 Inactivated polio vaccine first produced in India (later on production stopped)
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31. Major milestones in vaccine developments and licensing in India
1985/1988 AEFI surveillance system established and initial guidelines were released
1989 Indian vaccine company limited (IVCOL) and Bharat immunological and biological limited (BIBCOL)
were set up as public private joint venture companies
1997 First ever recombinant DNA hepatitis B vaccine developed in India
2006 Guideline for clinical trials BY Indian Council of medical research (ICMR)
2009 Three Indian manufacturers developed pandemic flu (Novel H1N1:2009)
2010 National Pharmacovigilance programme of India launched.
Meningitis A vaccine for African Meningitis Belt licensed and successfully used in Africa.
Indigenously researched bivalent oral cholera vaccine developed and licensed in the country
2012 An indigenous Inactivated JE vaccine licensed in country
Indian manufacturer acquired capacity to produce inactivated polio vaccine
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32. List of licensed vaccine manufacturing units in India
Following manufactures has installed capacity and are licensed for production or marketing of at least one or
more vaccine in India
1] BCG vaccine laboratory , Guindy , Madras (Chennai)
2] Serum institute of India ,Pune
3] Pasteur institute of India, Coonoor , Tamil Nadu
4] Central Research Institute , Kasauli , Himachal Pradesh
5] Haffkine Biological product C Ltd. Mumbai
6] Human biological and immunological limited, Hyderabad
6] Panacea Biotec Ltd. Delhi
7] Zydus Cadila , Ahmedabad
8] Bharat Biotech International Ltd. Hyderabad
9] Bio vaccines, Hyderabad.
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33. List of licensed vaccine manufacturing units in India
Following manufactures has installed capacity and are licensed for production or marketing of at least one or
more vaccine in India
10] King institute of preventive medicine ,Chennai
11] Pasteur Institute , Shillong
12] Dano vaccines, Hyderabad
13] Bharat immunological and biological Company limited, Bulandshahar
14] Bio-med (P) , Ghaziabad
15] Sanofi Pasteur India Pvt. limited , Delhi
16] Sanofi (Aventis)Pasteur , New Delhi
17] Chiron Behring vaccine Lab. Ankles war , Gujarat
18] Bharat biotech International (L) , Hyderabad
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34. Year of start of vaccine manufacturing units in India
Year -------------------- Milestone
1832-90 Sporadic research in various setups for development of smallpox vaccine lymph in India
1890 Laboratory in Shillong started producing smallpox vaccine lymph
1897 Plague vaccine produced by Dr.Haffkine in makeshift laboratory of 2 rooms in Grant medical
1898 college , Bombay (Mumbai)
1899 Plague Laboratory ,Bombay: Later on named as Haffkine Institute(1925) Mumbai
1904/05 Central Research Institute , Kasauli , Himachal Pradesh
1907 Pasteur institute of India, Coonoor , Tamil Nadu
1910-30 Additional vaccine institutes established in India , majority of producing smallpox vaccine
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35. Year of start of vaccine manufacturing units in India
Year -------------------- Milestone
1948 BCG vaccine laboratory , Guindy , Madras (Chennai)
1952 Zydus Cadila
1953 Biological E Ltd.
1966 Serum institute of India Ltd.
1982 Indian Immunological Limited
1988 Panacea Biotec
1989 Indian vaccine company limited (IVCOL) and Bharat immunological and biological limited (BIBCOL)
1992 Shantha Biotechnic Ltd.
1996 Bharat Biotech Ltd.
2008 Green Bio-pharma Ltd.
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36. Global monitoring of vaccine :
• In the early 1900s,the United States Food And Drug Administration [FDA] and The Paul Ehrlich
Institute in Germany ,were the first regulatory agencies created to ensure the safety of biological
products, including vaccines.
• World health organization [ WHO]-
- has standard mechanism for assessing the quality of vaccines and that of manufacturing units
which provides prequalification of vaccines for procurement for United Nation supply.
- This prequalification is considered a standard for vaccine quality.
- This prequalification system was developed in 1987
-In order to be included in the list of WHO prequalified vaccines, a vaccine must , inter alia, be
licensed and be under continuous regulatory oversight by an independent , fully functioning
national regulatory authority in country where the vaccine is manufactured.
-Prequalification status normally lasts for two years , after which the vaccine is reassessed to
determine if it- and the manufacturer- still meets the standards required to retain prequalification
status.
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37. • In this Internationally accepted system of testing vaccines for their efficacy, quality and safety,
there are three main testing phases;
1) Preclinical laboratory testing, including animal tests
2) Clinical trials in humans (phase 1-3)
3) post marketing evaluation (phase 4)
• A vaccine that has successfully completed the preclinical and clinical trail stages is ready to be
submitted to a regulatory authority for licensure or approval for human use.
• A regulatory authority will undertake the review if preclinical and clinical tests, also will inspect
the production site and detailed review the vaccine production from raw to finished product, and
will even check the qualification of the manufacturer staff.
• Following licensure, post marketing evaluation involves surveillance for any adverse events. This
stage also includes testing pf vaccines batches for consistency of the production process and
routine inspection of manufacturing process to ensure continuing conformity to standards of
good manufacturing practice(GMP).
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38. • WHO efforts to ensure the safety and quality of vaccines uses a system that- first establishes
international standards of vaccine efficacy, safety and quality and then- monitors the extent to
which a given licensed vaccine meets the standards.
• Setting of International standards is the role of WHOs Expert Committee on Biological
Standardization(ECBS).
• Monitoring of vaccine compliance to these standards is role of the country's National Regulatory
Authority(NRA).
• In 1981, WHOs Expert Committee on Biological Standardization(ECBS) called upon all countries to
have a national regulatory authority.
• In 1997, WHO started initiative of strengthening of national regulatory authority. In 1997, , only
37(19%) of WHOs 190 member states had a reliable fully functioning national regulatory
authority. Out of this, 20(38%) of 52 vaccine producing countries.
• By the end of 2008, only 58(30%) of WHOs 193 member states had a reliable fully functioning
national regulatory authority. Out of this, 33(69%) of 48 vaccine producing countries.
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39. Monitoring of vaccine in India :
• The regulatory control over quality of drugs in country is exercised through the Drugs &
Cosmetics Act, 1940. The “schedule Y ” of this act regulates clinical and preclinical testing of
products.
• As per the Act ,vaccines and other biological products are considered to be “ New drug” and thus
are governed by all rules and regulations applicable to a new drug.
• Central Drug Standards Control Organization [CDSCO],which is national regulatory authority
(NRA) of India monitors vaccine in India.
• The setting up of vaccine manufacturing units and grant of permission of clinical trails and final
licensing and marketing authorization for vaccines is provided by the Central Drug Standards
Control Organization [CDSCO].
• As part of licensing process and as post marketing surveillance, the manufacturers are required to
submit Periodic safety Update Reports (PSURs) for all newly vaccines to CDSCO, initially every six
months in first two years and then annually for next two years.
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40. Monitoring of vaccine in India :
• The vaccine manufacturing and procedures for clinical trials have become systematic in India in
recent years.
• In 2006, The Indian Council Of Medical Research [ICMR] ,New Delhi , India released a new set of
guidelines for conduct of research on human subjects.
• There is section on vaccine research and clinical trials in these guidelines and all vaccine related
trials now need to be registered in clinical trial registry and to be done according to these
guidelines.
• The National Pharmacovigilance Programme in India has been launched in July 2010.
• India has joined the WHO Global Network of Post Marketing Surveillance(PMS)for new vaccines
with aims to provide useful data for global vaccine safety assurance.
• This PMS network of 12 countries from six different regions. In this network ,Maharashtra state
represents India.
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41. Criteria for selection of vaccines for introduction in NIP :
• For the selection of vaccine for possible Introduction in NIP ,the below given criteria may be
considered for an informed decision making about the introduction of new vaccine in UIP.
1) Disease burden (incidence/prevalence, absolute number of morbidity/mortality,
epidemic/pandemic potential);
2) Safety and efficacy of the vaccine under consideration;
3) Affordability and financial sustainability of the vaccination program, even if the initial
introduction is supported by the external funding agency;
4) Program capacity to introduce a new antigen, including cold chain capacity;
5) Availability of a domestic or external vaccine production capacity;
6)The cost effectiveness of the vaccination program and also of the alternatives other than
vaccination.
• The Grades of Recommendation Assessment, Development and Evaluation (GRADE) system is
one such system followed, which allows a systematic and transparent grading of evidence with
deliberate separation of quality of evidence and strength of recommendation.
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42. References:-
1. State of the worlds vaccines and immunization, third ed. Geneva, World Health Organization,2009
2. Vaccines & Biologicals ,Annual Report 2000, Department of Vaccines &Biologicals , Geneva, World
Health Organization,2001
3. Ivan M. Roitt , Book of Essential immunology ,Blackwell scientific Publications, sixth edition,1988
page 173-182
4. William E.Paul (2013), Fundamental Immunology ,Seventh ed.
5. Lahariya C. A brief history of vaccines & vaccination in India , Indian J Med Res 139, April 2014,
pp 491-511
6. Central Drugs Standards Control Organization , Directorate General of Health services , Ministry of
health and family welfare , Government of India, New Delhi, 2012 .Available from
:http://www.cdsco.nic.in /accessed on 20 June 2015
7. World Health Organization. A system for the Prequalification of vaccines for UN
supply.Geneva,WHO,2012.Available from: http://www.who.int/immunization_standards/vaccine
quality/ pq_ system /en /index.html, accessed on 25 June 2015
8. National vaccine policy ,2011 , Ministry of health and family welfare ,GOI ,New Delhi , April 2011
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Unlike many other health intervention, they help healthy people stay healthy & in doing to help to remove a major obstacle to human development.
They benefit not only individual but also communities & even entire population(e.g. eradication of small pox)
Impact of vaccine on communities &population are more rapid than that of many other health intervention.( e.g. Global mortality of measles was reduced by 74% between 2000-2007).It is estimated that the new vaccines against pneumococcal disease, rotavirus will reduce high burden within 3-5 years.
United state –CDC (Centre for disease control & prevention) put vaccine on top of list of Ten great public health achievements of 20 th century.
Copenhagen Census Center in 2008 put expanded coverage for children in fourth Place on List of 30 cost effective ways of advancing Global welfare.
During the preclinical laboratory phase ,a vaccine undergoes biochemical testing and evaluation in laboratory animals for , among other things, characterization of its biochemical components, potency ,purity , genetic and biological stability and safety in animals.
The clinical (human) trial stage covers three phases.
In phase one the vaccine is tested in a few volunteers for safety and efficacy(immunogenicity).and for an initial indication of appropriate dose to be used (dose ranging)
In phase two the vaccine is tested for safety ,immunity stimulating capacity ,dose ranging and efficacy in up to several hundreds volunteers.
In phase three the vaccine is tested for efficacy and safety in several thousands volunteers.
The selection of vaccine for possible introduction in NIP is a complex process.