2. IMMUNIZATION
Immunization is defined as the procedure by which the body is
prepared to fight against a specific disease.
It is used to induce the immune resistance of the body to a specific
disease.
Immunization is of two types:
1. Passive immunization
2. Active immunization.
3. PASSIVE IMMUNIZATION
Passive immunization or immunity is produced without challenging the
immune system of the body. It is done by administration of serum or
gamma globulins from a person who is already immunized (affected by
the disease) to a non-immune person.
Passive immunization is acquired either naturally or artificially
4. Passive Natural Immunization
Passive natural immunization is acquired from the mother before and after birth.
Before birth, immunity is transferred from mother to the fetus in the form of maternal
antibodies (mainly IgG) through placenta.
After birth, the antibodies (IgA) are transferred through breast milk
Passive Artificial Immunization
It is developed by injecting previously prepared antibodies using serum from humans or
animals. This type of immunity is useful for providing immediate protection against acute
infections like tetanus, measles, etc.
5. ACTIVE IMMUNIZATION
Active immunization or immunity is acquired by activating
immune system of the body.
Body develops resistance against disease by producing
antibodies following the exposure to antigens.
Active immunity is acquired either ◦ naturally or artificially.
6. CONT
Active Natural Immunization
Naturally acquired active immunity involves activation of immune
system in the body to produce antibodies. It is achieved in both clinical
and subclinical infections
Active Artificial Immunization
Active artificial immunization is a type of immunization that is achieved
by the administration of vaccines or toxoids.
7. WHY IMMUNIZATION ?
Key strategy to child survival.
Protecting infants from diseases.
Lower morbidity and mortality rates in children.
Indicator of a strong primary health care system.
8. VACCINE
Any preparation of a weakened or killed
bacteria or viruses introduced into the
body to prevent a disease by stimulating
antibodies against it.
VACCINATION is the administration of
antigenic material(the vaccine) to
produce immunity to a disease.
9. HOW VACCINES WORK
The body is exposed
to a weakened or
dead pathogen
The body’s
immune cells
make antibodies
to attack the
pathogen
If the body is
exposed to the
pathogen again,
the body will be
prepared with
antibodies
10. VACCINE DOSING THROUGH THE
LIFESPAN
Some vaccines
provide life-long
immunity from a
single dose
New vaccines are
needed frequently
for pathogens that
mutate often (such
as influenza)
Others provide
greater
protection after
multiple doses
VACCINES AREN’T JUST FOR CHILDREN
– OLDER POPULATIONS NEED
TARGETED PROTECTION FROM
CERTAIN DISEASES
11. VACCINE COMPONENTS:
SAFE AND EFFECTIVE
Provide immunity
Antigens
Adjuvants
Keep vaccines safe and long lasting
Preservatives
Stabilizers
Used during the production of vaccines
Cell culture materials
Inactivating ingredients
Antibiotics
12. CONT
FULL IMMUNIZATION:
• Beneficiary child(12-23 months) -3 doses of DPT and OPV each, 1 dose of
BCG & measles each.
• Mother- two dose or 1 booster dose of tetanus toxoid during her
pregnancy.
PARTIAL IMMUNIZATION
• Child-missed any vaccine or one or more dose Mother- received just one
dose of primary tetanus toxoid during last pregnancy
13. CONT
NON-IMMUNIZATION
Child and/or mother –not received a single dose of vaccine.
RING-IMMUNIZATION
Vaccination of people in close contact with an isolated infected patient
MOP-UP ROUNDS
When the final pockets of polio virus transmission have been identified
standard surveillance, door to door immunization in high-risk districts.
14. TYPES OF VACCINES
Live attenuated: contain weakened pathogen; require 1-2
doses. Ex. MMR, rotavirus, varicella
Subunit: contain killed, antigenic component of pathogen;
require several doses (booster shots). Ex. Hib, HPV,
pneumococcal
Inactivated: contain killed pathogen; require several doses
(booster shots). Ex. Hepatitis A, rabies, inactivated
poliovirus vaccine
Toxoid: contain toxin made by pathogen; may require
booster shots. Ex. Diphtheria, pertussis
15. Types of Vaccine
Vaccine type Vaccines of this type on U.S. Recommended Childhood (ages 0-6) Immunization Schedule
Live, attenuated
Measles, mumps, rubella (MMR combined vaccine)
Varicella (chickenpox)
Influenza (nasal spray)
Rotavirus, OPV
Inactivated/Killed
Polio (IPV)
Hepatitis A
Toxoid (inactivated toxin) Diphtheria, tetanus (part of DTaP combined immunization)
Subunit/conjugate
Hepatitis B
Influenza (injection)
Haemophilus influenza type b (Hib)
Pertussis (part of DTaP combined immunization)
Pneumococcal
Meningococcal
15
16. Routes of Administration
Deep subcutaneous or intramuscular route (most vaccines)
Oral route (oral BCG vaccine)
Intradermal route (BCG vaccine)
Intranasal route (live attenuated influenza vaccine)
17. Scheme of Immunization
Booster vaccination
• To maintain immunity level after it declines after some time has elapsed (DT, MMR
• Short period (months): cholera vaccine
• Multiple dose vaccines (polio, DPT, hepatitis B)
Primary vaccination
• One dose vaccines (BCG, measles, mumps, rubella, yellow fever)
18. INFANTS
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
days
15 2 drops Oral
OPV₁₂₃ At 6,10, w
14 Till 5 yrs 2 drops Oral
Rota virus vaccine 6, 10, 14w Till 1 yr drops
5 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- months
12 Till 5 yrs ml
0.5 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
19. VACCINES WHEN TO GIVE MAX. AGE DOSE ROUTE SITE
DPT booster 16-24 months 7 yrs 0.5 ml I.M.
Anterolateral
aspectof 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 every6 m Till 5 yrs 2 lakhIU 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
20. MILESTONES IN IMMUNIZATION IN INDIA
1978: EPI
1985: UIP, measles vaccine added
1986: Technology mission
1990: Vitamin A
1992: CSSM
1995: Polio National Immunization days
1997: RCH-I
2005: RCH-II and NRHM
28. BCG Vaccine
• Attenuated strain of M. tuberculosis var. bovis Used as live vaccine against tuberculosis Freeze dried( lyophilized)
and stored at 4 C.
• Dose, Route ‒ 0.1ml, intradermal,on left upper arm at insertion of deltoid
• Adverse reactions ‒ Local ulceration or discharging sinus, axillary lymphadenitis, disseminated infection,
osteomyelitis.
• Storage ‒ 2-8°C; sensitive to heat & light; discard unused vaccine after 4 hr
• After 2-3 weeks, a papule develops- heals to scar, local LNs can enlarge.
• Timing- Any time after birth since mother’s immunity is not transferred to fetus.
• Significant protection conferred against ,progressive primary tuberculosis and Disseinated TB including TB
Meningitis.
• BCG does not protect from leprosy and other mibcrobial disease.
29. Immunity to diphtheria
Antibody production against the exotoxin of C. diphtheria
Usually mothers are immune to diphtheria and transplacental passage confers immunity in
first few months
H Influenzae conjugate vaccine containing PRP-D ( diphtheria toxoid) or CRM 197 (
diphtheria toxin variant) can not be substituted for diphtheria toxoid immunization.
Schedule: 4 , 6 or 8th week.
Booster recommended during 18 months
30. Poliomyelitis
OPV
• Dose, Route ‒ 2 drops; oral
• Adverse reactions ‒ Vaccine derived polio virus, VAPP
• Contraindications ‒ Inherited or acquired immunodeficiency, symptomatic HIV
• Storage ‒ 2-8˚C ; sensitive to heat ; use vaccine vial monitor
IPV
• Dose,Route-0.5ml,i.m/s.c
• Adverse reactions-local pain and swelling
• Contraindications- Known allergy
• Storage- 2-8˚C sensitive to light
31. MEASLES VACCINE
• Dose, route ‒ 0.5ml, sc
• Site ‒ Right upper arm or anterolateral thigh
• Adverse reactions ‒ Fever, transient macular rash 5-10 days later.
• Contraindications ‒ (i) immunosuppressive therapy eg:alkylating agents, high
dose corticosteroids (ii) malignancy (iii) immunodeficiency eg: advanced HIV (iv)
untreated TB
• Storage- 2-8°C;sensitive to heat and light; use within 4-6 hrs of reconstitution
32. MMR
• Dose, route ‒ 0.5ml;s.c.
• Site ‒ Right upper arm or anterolateral thigh
• Dose, route ‒ 0.5ml, sc
• Site ‒ Right upper arm or anterolateral thigh
• Adverse reactions ‒ Fever, transient macular rash 5-10 days later.
• Contraindications ‒ (i) immunosuppressive therapy eg:alkylating agents, high
dose corticosteroids (ii) malignancy (iii) immunodeficiency eg: advanced HIV (iv)
untreated TB
• Storage‒ 2-8°C;sensitive to heat and light; use within 4-6 hrs of reconstitution
33. HEPATITIS B
•
•
•
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
35. WHAT SHOULD NOT HOLD ROUTINE
IMMUNIZATION
Minor illnesses such as upper respiratory infections or diarrhoea, mild fever(>38.5 c)
Allergy, asthma
Prematurity, underweight newborn child
Malnutrition
Child being breastfed
Family history of convulsions
Treatment with antibiotics
Chronic disease of heart, lung, kidney and liver
History of jaundice after birth
36. CONTRAINDICATION
A rare condition in a recipient that
increases the risk for a serious adverse
reaction
The only contraindication applicable to all
vaccines is a history of a severe allergic
reaction after a prior dose of vaccine or to
a vaccine constituent
PRECAUTION
A condition in the recipient that may increase
the risk of a serious adverse reaction, might
cause diagnostic confusion, or might
compromise the ability of the vaccine to
produce immunity
Vaccine may be administered if the benefit
from the vaccine is judged to outweigh the
risk
CONTRAINDICATIONS & PRECAUTIONS
Contraindications and precautions are conditions under which vaccines should not be administered. The
majority of these conditions are temporary, so immunizations often can be administered later when the
conditions no longer exists.
37. COLD CHAIN
A system of transporting and storing vaccines at recommended temperature from
the point of manufacture to the point of use
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
Vaccines are able to achieve these benefits by mimicking natural infection, but with lower risk of disease.
When an individual is exposed to pathogens that cause infectious disease through natural infection, the body’s immune system responds by having its immune cells, like white blood cells, replicate and target these pathogens with antibodies, which are blood proteins that bind to pathogens and destroy them (source: https://www.cdc.gov/vaccines/terms/glossary.html).
Once the pathogen has been destroyed, the immune cells disband and immune system activity returns to normal levels, but key cells known as memory cells remain.
If the individual is exposed to the same pathogen in the future, these memory cells are able to identify the pathogen and respond incredibly quickly with the appropriate antibodies – often before an individual can even feel sick from an immune response – and prevent disease.
The differing types of vaccines mean the timing and dosing of vaccines can vary (source: https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-safety/dosing-safety).
Some vaccines are best able to protect the greatest number of people if they are given more than once. The chickenpox, or varicella, vaccine is one example of this: after 1 dose, 78 of 100 adults will be protected, but after a second dose, 99 of 100 adults will be protected. It’s recommended that everyone get a second dose, since it is safe to receive and extends protection to more people.
Some vaccines provide a greater response and higher level of protection after a second dose. Haemophilus influenzae type b or Hib is an example of this.
Some need several doses to produce the strongest immune response. DTaP vaccines are an example of this.
Some vaccines protect against pathogens that mutate so often that older versions of vaccines would not offer protection. Influenza vaccines are an example of this, with new influenza vaccines recommended every year.
It is important that health providers review dosing guidelines for each vaccine to ensure that patients comply with immunization recommendations throughout their entire lives, from birth through adulthood.
Today’s vaccines use only the ingredients they need to be safe and effective.
Each ingredient in a vaccine serves a specific purpose (source: https://www.vaccines.gov/basics/vaccine_ingredients/index.html).
For example, vaccine ingredients may help provide immunity (protection) against a specific disease:
Antigens are very small amounts of weak or dead pathogens that can cause diseases. They help the immune system learn how to fight off infections faster and more effectively. The influenza virus is an example of an antigen
Adjuvants, which are in some vaccines, are substances that help the immune system respond more strongly to a vaccine. This increases the immunity against the disease. Aluminum is an example of an adjuvant (Aluminum is the world’s most abundant metal, found in plants, soil, water and air. The quantities of aluminum present in vaccines are low and highly regulated)
Some ingredients help make sure a vaccine continues to work like it’s supposed to and that it stays free of outside pathogens. For example:
Preservatives protect the vaccine from outside bacteria or fungus. Today, preservatives are usually only used in vials (containers) of vaccines that have more than 1 dose. Most vaccines are also available in single-dose vials and do not have preservatives in them
Stabilizers, like sugar or gelatin, help the active ingredients in vaccines continue to work while the vaccine is made, stored and moved
Sometimes, trace amounts of some ingredients that are needed to produce the vaccine remain in the final product. Examples of these non-harmful ingredients include:
Cell culture (growth) material, like eggs, to help grow the vaccine antigens
Inactivating (germ-killing) ingredients, like formaldehyde, to weaken or kill viruses, bacteria or toxins in the vaccine
Antibiotics, like neomycin, to help keep outside germs and bacteria from growing in the vaccine
Globally-recommended vaccines fall into four main categories (source: https://www.vaccines.gov/basics/types/index.html):
Live attenuated vaccines – use a weakened (or attenuated) form of the pathogen that does not cause illness. These vaccines create a strong and lasting immune response; just one or two doses of most live vaccines can provide a lifetime of protection. Examples of live attenuated vaccines include the measles, mumps, rubella (MMR) vaccine, and the rotavirus and varicella vaccines.
Inactivated vaccines – use a killed form of the pathogen. Inactivated vaccines typically don’t provide protection that is as strong as live attenuated vaccines, so several doses must be administered over time to elicit ongoing immunity. These additional doses are called booster shots. Examples of inactivated vaccines include the Hepatitis A, influenza and rabies vaccines.
Subunit vaccines – like inactivated vaccines, subunit vaccines do not contain live pathogens, but they are distinct in that they contain only select antigenic parts of a pathogen – the parts that are necessary to elicit a protective immune response. They also require booster shots. Examples of subunit vaccines include Hib, HPV and pneumococcal vaccines.
Toxoid vaccines – use a toxin (a harmful product) made by the pathogen that causes disease. This means the immune response is targeted to the toxin instead of the whole pathogen. They may require booster shots. Examples of toxoid vaccines are diphtheria and tetanus vaccines.
There are some circumstances under which vaccines should not be administered, however. It is important that health providers screen patients for contraindications and precautions before giving each dose of vaccine.
A contraindication to immunization is a rare condition in a recipient that increases the risk for a serious adverse reaction. If there is a contraindication, a vaccine should not be administered. Ignoring contraindications can lead to avoidable and adverse reactions that harm an individual’s health (source: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.htmlhttps://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html).
The only contraindication applicable to all vaccines is a history of a severe allergic reaction after a prior dose of vaccine or to a vaccine constituent (the estimated rate of severe allergic reactions to immunization is 1 in 1,000,000 (source: https://www.cdc.gov/vaccines/vac-gen/side-effects.htm)). Health workers administering vaccines should know the signs of allergic reactions and be prepared to take immediate action.
A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion or might compromise the ability of the vaccine to produce immunity (source: https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html).
A precaution is usually a reason to defer vaccine administration, although a health provider may decide the benefit of immunization outweighs the risk of an adverse reaction.
Most contraindications and precautions are temporary, and the vaccine can be administered later.
Health professionals should only diverge from recommended immunization schedules if a patient displays a known contraindication or precaution. Misperceptions about certain conditions or circumstances, or misidentifying contraindications or precautions, can result in missed opportunities to administer recommended vaccines, leaving individuals at greater risk of disease.
A thorough list of contraindications and precautions for each vaccine is included for reference among additional resources at the end of the presentation.
