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1. IMMUNISATION

2.  Active and passive immunity
 Definitions
 Types of vaccine
 Principle of immunisation
 National immunisation schedule
 IAP immunisation schedule
 Individual vaccines

5. DEFINITION
 Vaccine : composed of one or more antigens of a
pathogenic agent which, when adminstered to a
previously unexposed individual, will elicit an
immune response but not cause disease.
 Immunisation
process of inducing acquired immunity
by administering
- Live killed or attenuated organism or specific
antigens (active immunisation)
- Preformed exogenous antibodies given soon after,
or prior to exposure (passive immunisation)

6.  Vaccination :
process of administration of a vaccine.
 Seroconversion :
change frm antibody negative to antibody
positive.
 Immunogenecity:
ability of vaccine to elicit an immune response
whether cellular, humoural or both.

7. Types of
vaccine
Live
attenuated
vaccine
Killed or in
activated
vaccine
Toxoids
Subunit vaccines
Capsular polysaccharide
Conjugated
Recombinant

8. Live
attenuated
vaccine:
consist of whole
inactivated
organism
•Elicit both cellular and humoral
response
•Mimic natural infection
•Single dose sufficient to induce
immunity except OPV
•Maternal antibody may interfere with
immune response except BCG and
OPV
•May confer herd immunity
•BCG, oral typhoid, oral polio, MMR,
varicella, rotavirus, influenza
(intranasal)

9. Inactivated
vaccine:
produced by
growing the
microorganism in
culture media,
inactivating with
heat and/or
chemicals
(formalin
•Donot cause infection but elicit
protective immune response
•Minimal interference by maternal
antibodies
•Multiple doses required
•Immunity not permanent booster
doses are necessary
•Pertussis , IPV, rabies, hept A,
influenza

10. Toxoids :
modified and
purified toxins that
are not injurious to
recipients
•Primary immunisation with
multiple divided doses to
decrease adverse effects and to
elicit high antibody titres
•Booster doses required
•Tetanus toxoid ,diptheria toxoid

11. Capsular polysaccharide
vaccine
Conjugate vaccine
component Carbohydrate present in
bacterial cell surface
(capsule)
Polysaccharide attached to carrier
protein tha t is recognised by host
as foreign antigen
Immune cell
stimulated;
response
elicited
B cell ;humoral
immunity, thymic
independent
B and T cell ; humoral and
cellular immunity, thymic
dependent
Antibodies
type and titre
Chiefly IgM, low titre Both IgM and IgG, high titre
Duration of
protection
brief Longer and consisent
Age at which
effective
Poor efficacy <2 yr of age Effective in infancy or older age
Booster
response
poor satisfactory
Subunit vaccine

12. Age Vaccines given
Birth BCG, OPV-0, Hepatitis B Birth dose
6 Weeks OPV-1, Pentavalent-1, fIPV-1, Rota-1 & PCV-1
10 weeks OPV-2, Pentavalent-2 & Rota-2
14 weeks OPV-3, Pentavalent-3, fIPV-2, Rota-3 & PCV-2
9-12 months MR-1, JE1*, PCV-Booster
16-24 months MR-2, JE2*, DPT-Booster 1, OPV- Booster
5-6 years DPT-Booster 2
10 years Td
16 years Td
Pregnant
Mother
Td1, 2 or Td Booster**
* in endemic districts only
** one dose if previously vaccinated within 3 years Being introduced/scaled up
NATIONAL IMMUNISATION SCHEDULE

13. IAP IMMUNISATION SCHEDULE

14. ROADMAP OF VACCINE INTRODUCTION
Vaccin
es
against
6 VPDs-
Measle
s, DPT,
TB,
Polio
Hep. B
vacci
ne
pilote
d
Measles
2nd
dose
intro
(2010-
14)
Hep. B
scaled
up
nationwi
de
Pentavale
nt
(2011-
2015)
JE 2nd
dose
intro
-IPV
introducti
on
(2015-16)
Penta
scaled up
entire
country
Rotavir
us
vacci
ne
Switch
from
tOPV
to
bOPV
MR
PCV
JE
2010
2015
2011
2013
2017
2016
Since 2010 several
new vaccines
introduced in
Country’s UIP
14
2002
1985
2006
JE
vacci
ne
introd
uced

15. PRINCIPLE OF IMMUNISATION
 Adminstration of two live vaccine
 Adminstration of two killed / subunit vaccine
 Adminstration of live and killed vaccine
 Site of vaccination
 Observation for allergic reaction
 Missed dose
 Contraindication to vaccination

16. BCG
 Bacillus calmette –Guerin vaccine
 Strain – danish 1331 ,Diluent – normal saline
 Stored at – 2-8 degree C
Light sensitive
No preservative
 Route -0.1 mL; intradermal
 Site -Left upper arm at insertion of deltoid with 26 guage
needle
 Injection site cleaned with normal saline
 Schedule
National program At birth; catch up till 1-yr (if missed)
IAP At birth; catch up till 5-yr

17. A wheal of 5 mm at injection site indicates successful i.d
adminstration of injection
2-3 week after BCG vaccination – development of papule
End of 5-6 weeks – papule increases to a size of 4-8
mm ;get converted to pustule within few days. pustule
bursts open & again get sealed off
At the end it dries up & a crust is formed. Crust falls off &
a scar is formed by 6-12 weeks

18.  Adverse reaction
Local ulceration; discharging sinus; axillary
lymphadenitis .If immunodeficient disseminated infection,
osteomyelitis; scrofuloderma
 C/I Cellular immunodeficiency; symptomatic HIV

19. BIVALENT OPV
 Dose , route : 2 drop oral
 Storage 2-8 degree c, most sensitive to heat
 Schedule
National progrm: dose at birth or < 2 weeks (zero dose)
3 doses at 6,10,14 weeks
one booster at 16-24 mnth
 IAP schedule : at birth
 Catch up : upto 5 yr , 3 doses 4 wk apart
 Adverse reaction:
vaccine derived poliovirus (cVDPVs)
vaccine assctd paralytic polio (VAPP)
 Contraindication : inherited / acquired immunodeficiency
symptomatic HIV

20. INACTIVATED POLIO VIRUS
VACCINE
 Dose 0.5 ml IM , 0.1 ml intradermal
 Nationl prgrm :
0.1 ml i.d at 6 and 14 week or
one full dose IM at 14 week
 IAP : 3 doses of IPV at6,10,14 week
and 1 booster dose at 15-18 mnth
 Catch up : upto 5 yr : 3 dose at 0,2 ,6 mnth
 Adverse reactn : local pain,swelling
 Advantage : carries no risk of VAPP
excellent immunogenicity in most
 Disadvantage : not useful in epidemic
little/no induction of local IgA mediated intestinal
immunity

21. RECOMMENDATIONS ON
VACCINATION AGAINST
POLIOVIRUS IN INDIA
 Most countries practise sequential IPV-OPV schedule,
advantage – risk of OPV induced VAPP is minimised, and
adequate mucosal immunity to interrupt wild poliovirus
circulation
 WHO recommends that all countries using only OPV
should add at least one dose of IPV to the national
schedule
 INDIA - two fractional (fIPV) intradermal doses at 6 and
14 weeks with b OPV at 6,10,14 week

22. THE SWITCH
 On April 25, 2016, India undertook switch of trivalent OPV to
bivalent OPV removing the OPV2 strain which was associated
with most cases of VAPP
 Objective of the Polio Eradication and Endgame Strategic plan
2013-18 – atleast one dose of IPV in routine immunisation and
withdraw OPV in phased manner, starting with OPV2
1 2
3
1 3

23. FRACTIONATED IPV
 Smaller dose of IPV equal to 1/5 of standard dose
 Two doses produces an even stronger immune response
than a single full IPV dose
 Advantage
Stronger immune response
Comparatively larger population coverage

24. HEPATITIS B VACCINE
 Dose route 0.5 ml (10 mcg ); 1 mL In lmmunosuppressed children,
malignancy or hemodialysis and adult , intramuscular
 Site Antrolateral thigh or deltoid; avoid gluteal region
 Schedule national prgrm At birth, 6 weeks, l0 weeks and 14 weeks
 IAP schedule: birth, 6,10,14 week
 one dose of hepatitis vaccine within 24hrs of birth
 catch up Three doses 0, 1 and 6 months;'
preferred gap between first two doses is >=4 weeks, and doses 2 and
3 is >= 8weeks
 Adverse reaction Local soreness; fever; fatigue
 C/I Anaphylaxis after prl!vious dose
 storage 2-8°C; do not freeze

25. ORAL ROTAVIRUS VACCINES
Rotarix RV1 Rotateq RV5 Rotavac
Dose 1.5 ml 2ml 5 drops
Schedule
national program
Nt included Nt included 3 doses 6, 10 and
14 week
IAP 2016 2 doses 10 and 14
week
3 doses 6,10,14
week
3 doses 6,10,14
week
Adverse reaction: fever, diarrhoea, vomiting , intussusception
rare
C/I past H/O of intussusception , severe immunodeficiency
Precaution postpone vaccination during ongoing diarrhoea or moderate
illness
Storage 2-8 c use within 4 hr of recostitution or opening

26. ROTAVAC
 India has introduced Rotavac in phased manner
 Live attenuated, oral liquid vaccine & is available in 10
dose vial
 No booster dose recommended
 Max uppr age limit for 1st dose -1yr

27. HIB VACCINE
 Dose route 0.5 mL, intramuscular
 Site Anterolateral thigh
 Schedule National programme : Pentavalent vaccine
with DPT and hepatitis B; three doses given at 6, 10 and
14 weeks
 IAP : 3 doses at >6 weeks given >:4 weeks apart; one
booster at 15-18 months
 Catch up At 6-12 months: Two doses >8 weeks apart; one
booster at 15-18 months
 At 12-15 months: One dose and one booster at 15-18
months
 15-60 months: One dose; not recommended >5-year-old
except, if hypo / asplenia
 Adverse reaction Fever, rash, local pain or redness
 C/I Hypersensitivity to previous dose

28. DPT
 Dose, route : 0.5 ml , i.m
 Site Anterolateral aspect of mid thigh
 DTwP is composed of tetanus, diptheria toxoid and killed
whole cell pertussis
 DTaP diptheria tetanus and acellular pertussis
 Tdap tetanus , reduced quantity diptheria and acellular
pertussis
 Td tetanus , reduced quantity diptheria
 DT tetanus and diptheria
 schedule National Progrm :
DTwP at 6, 10 and 14 weeks (primary); at '15-18
months nd 5 yrs (boosters

29.  IAP :DTwP three primary dose at 6,10,14 week two
boosters at 15-18 month and 4-5 yrs;
 Catch up <7 years: DTwP (preferred) or DTaP at 0, l and
6 months
 > 7 yrs Tdap ,Td and Td at 0,1 and 6months
 DTaP may be preferred to DTwP in children with severe
adverse effects after previous doses of DTwP or children
with neurologic disorders
 DT < 7yr where pertussis vaccine is contraindicated
 Tdap – pregnant mothers during each pregnancy (after
27weeks ) regradless of no: of yrs frm prior Td or T dap

30.  Advrs reaction Common: Local pain, swelling, fever
(DTwP > DTaP)
 Rare: Hypotonic hyporesponsive episodes, inconsolable
cry; fever >40 C; seizures; encephalopathy (DTwP=DTaP)
 C/I (i) Progressive neurological disease (administer DT or
dT instead); (ii) anaphylaxis after previous dose; (iii)
encephalopathy within 7 days of previous dose ·
 Precautions: Previous dose associated with (i) fever
>40.5°C within 48 hrs (ii) hypotonic – hyporesponsive
episode <48 hr (iii) persistent inconsolable crying > 3 hrs
(iii) seizures < 72 hrs
 Storage 2-8°C; sensitive to light

31. TETANUS & ADULT DIPHTHERIA VACCINE
 Increase in immunization coverage in children led to shift in age-group
of diphtheria cases to school going children and adults.
 Tetanus and adult Diphtheria (Td) vaccine has been recommended by
National Technical Advisory Group on Immunization (NTAGI) in
2016.
 TT vaccine has been replaced by Td vaccine and will provide protection
against both Tetanus and Diphtheria in adults.
 Td vaccine will replace 2 doses of TT or single booster dose of TT given
to pregnant woman and booster doses at 10 and 16 years of age.

32. PNEUMOCOCCAL VACCINE
 Pneumococcal conjugate (PCV13)
 Dose route 0.5 mL; intramuscular
 Site Anterolateral thigh or deltoid
 Schedule Some states: Three doses at 6 weeks, 14 weeks and
booster at 9 months
 IAP Three doses at 6,10,14 week and one booster at 15- 18
months
 Catch up At 7-11 months: Two doses >4 weeks apart; one booster
at 15-18 months
 At 12- 23 months: Two doses >8 weeks apart
 At 24-59 months: One dose
 >60 months· One dose, if high risk*
 Adverse reaction Fever, local pain, soreness, malaise
 C/I Anaphylaxis after previous dose

33. PNEUMOCOCCAL
 Pneumococcal polysacchride (PPV23)
 0.5 mL; intramuscular or subcutaneous, Deltoid
 Not recommended in national schedule
 High-risk category•; One dose 8 week after primary course
with conjugate vaccine; repeat 5 years later, if risk persists
 S/E Pain, redness
 High risk primary immunodeficiency, HIV,
immunosuppressive therapy and organ transplant recipients;
(ii) sickle cell disease, asplenia or hyposplenia; (iii) chronic
cardiac, liver or pulmonary disease; (iv) chronic kidney
disease and nephrotic syndrome; (v) diabetes mellitus; and
(vi)children with cerebrospinal fistula or cochlear implants.
Pneumococcal
polysacchride (PPV23)
Pneumococcal conjugate
vaccine (PCV 13)

34. MEASLES CONTAINING VACCINE
 Mesales - Edmoston zagreb strain
 Mumps- Jeryl Lynn strain
 Rubella – RA 27/3
 The two doses of measles in immunization progrm are being
replaced by the MR vaccine in a phased manner.
 This follows the nationwide 'measles rubella' program
(launched February 2017) in which one dose of the vaccine
given to all children 9 months -15 yr, irrespective of their
immunization status.
 Dose , route 0.5 ml , S.c, diluent –sterile water
 Site :Right upper arm (at insertion of deltoid) or
anterolateral thigh
 Storage 2-8°C; sensitive to heat and light; use within 4-6
hours of reconstitution to aviod TSS
MR – measles rubella MMR – measles mumps
rubella vaccine

35. MEASLES CONTAINING VACCINE
 Schedule National prgrm At 9-12 and 15-24 mnth MR vaccine
 IAP At 9-12 months, 15-18 months and 4-6 years; preferably as
MMR; avoid MMR-V <2 years
 Catch up Complete schedule with >4 weeks gap between doses;
can use MMR-V >2 years
 Advrs reactn : Local pain, tenderness; febrile seizures (especially
with MMR-V in <2-yr-old)
Measles vaccine: Fever or transient macular rash (after 7-12
days)
MMR vaccine: Transient rash, arthralgia, aseptic meningitis,
lymphadenopathy
 C/I Immunosuppresson; malignancy; immunodeficiency
(symptomatic HIV); recent infusion of, immunoglobulin-
containing blood product .