This document provides information on various rotavirus and measles vaccines. It discusses the burden of rotavirus in India, presenting symptoms, affected age groups, seasonality and transmission. It describes three oral rotavirus vaccines - Rotarix, RotaTeq and Rotavac. For measles, it outlines the disease burden, the rationale for introducing a second dose of MMR vaccine in India's UIP, and details of the MR vaccine including strains, dosage, efficacy and safety. It also briefly mentions Haemophilus influenzae type B and other optional vaccines included in India's immunization program.

1. VACCINES RV/MMR
&
OTHERS
DR RAMKUMAR P

2. ROTA VIRUS
• It is leading cause of severe dehydrating
diarrhea in children aged <5 years.
• In LIC, 80% of primary rotavirus infections - <1-year
• HIC, - 2–5 years
Most common pathogens cause diarrhea
• Rotavirus
• Cryptosporidium,
• Enterotoxigenic Escherichia coli, and Shigella.

3. BURDEN IN INDIA
• 22% of all rotavirus deaths <5yr of age
• An analysis of 51 studies from all over India over last four
decades
Areas stool positivity rate
Hospitalization 22.1%.
In community settings, 18.6%.
 Etiological agent in 16.1% cases of nosocomial diarrhea

4. PRESENTATION
• It occur in the first 2 years of life.
• MC affected age group was 7–12 months of age
• seasonality:
Most common - September to February.
Highest prevalence - December to February (56.4%).

5. PATHOGEN
• It is an RNA virus .
• 7 serogroups (A–G);
• group A rotaviruses cause most human
disease.
• viral outer capsid contains VP7 protein
determines the G serotypes and the VP4
protein the P serotypes. .
• Transmission - fecal-oral spread, close
person-to-person contact, and by fomites.
• other modes - respiratory droplets

6. VACCINES
Human Monovalent Live Vaccine (RV1):ROTARIX
• live attenuated human strain 89-12 [type G1P1A(8)] rotavirus
• provided as a lyophilized powder
• Diluents contain calcium carbonate, sterile water and xanthan.
• stored at 2–8°C

7. Human Bovine Pentavalent Live Vaccine
(RV5):RotaTeq
• It consists of five reassortants between the bovine WC 23 strain and
human G1-4, and P8 rotavirus strains grown in Vero cells
• Each 2 mL vial of vaccine contains approximately 2 × 10*6 infectious
units
• The vaccine viruses are suspended in the buffer solution that contains
sucrose, sodium citrate, tissue culture media etc...
• stored at 2–8°C.

8. Indian Neonatal Rotavirus Live Vaccine,
116E:Rotavac
• Bharat Biotech of India
• It contains monovalent, bovine-human reassortant strain G9P[11],
with the VP4 of bovine rotavirus and all other segments of human
rotavirus origin.
• Asymptomatic infants, with mild diarrhea by Indian researchers in
1985 at AIIMS, New Delhi.
• Childrens are protected against severe rotavirus diarrhea for up to
2 years.

9. ROTAVAC :
• It is a liquid vaccine.
• A single human dose - 5 drops containing not less than 10*5 FFU of
live rotavirus 116E
• Used in selected states like Andhra,odisha,himachal and haryana
extended into 5 more states in Feb 2017.
• 3 doses at 6,10 and 14 weeks.

10. ROTASIIL:
• Bovine rotavirus pentavalent vaccine (BRV-PV)
• developed from five Bovine(UK) X Human Rotavirus Reassortant
strains (serotypes G1, G2, G3,G4 and G9)
• The viruses are propagated in Vero cells.
• Freeze dried form
• Each dose of 2.5 mL containing 10*5-6 FFU per serotype
• It is a thermostable vaccine

11. Oral Rota virus vaccine
Rotarix(RV1) RotaTeq(RV5) Rotavac(116E)
Dose 1.0 ml( lyophilized powder
mix with diluent)
2 ml (available in liquid
form)
5 drops
STRAINS G1P1A(8) WC 23 and human G1-4,
and P1A(8 )
116E
VACCINE EFFICACY 95% 85% 55%
UIP not recommended not recomended selected states
Maximum age(1st dose) -
1 year ,3 doses
6,10 and 14 weeks
IAP 2018-19 2 doses
10 and 14 weeks
(6 and 10 weeks)
3 doses
6,10 and 14 weeks
3 doses
6,10 and 14 weeks

12. cost-Rs.54
Total-162
Cost-Rs.1613
- Trade Name: Hexaxim
- Manufacturer: GSK
- Unit: 1.0ml
Rs.900
Total-Rs.2700

13. Serum institute of india
Rs 400/Piece
Packaging Type :Box
Packaging Size: 2.5 ml

14. ROTA VIRUS VACCINE
Routine vaccination:
• Minimum age: 6 weeks
• An interval of 4 weeks should be maintained between doses.
• Only two doses of RV-1 are recommended
• RV5 should be employed in a three-dose 6, 10, and 14 weeks-schedule.
• If any dose in series was RV5 or vaccine product is unknown for any dose in
the series, a total of 3 doses of RV vaccine should be administered.

15. Catch-up vaccination:
• The maximum age for the first dose is 14 weeks, 6 days.
• Vaccination should not be initiated for infants aged 15 weeks, 0 days
or older.
• The maximum age for the final dose in the series is 8 months, 0
days(32weeks).

16. ADVERSE EFFECTS:
• Fever,diarhoea and vomiting,intussception(rare)
CONTRAINDICATION:
• severe allergic reaction (e.g. anaphylaxis) after a previous dose of rotavirus.
• SCID and history of intussusception.
precautions:
• moderate to severe illness including gastroenteritis (vaccination to be
postponed);
• Preexisting chronic intestinal tract disease.

17. MMR
• Measles elimination contributes significantly in achieving (MDG-4).
'' MDG-4 - proportion of 1-year-old children immunized against
measles''
• Rare - industrialized countries,
• common illness - developing countries
• source of infection- imported from other countries
• Leading cause of death and disability among young children.

18. • vaccine efficacy of 85% at 9 months of age
• UIP of GOI introduced 1 dose between 9 - 12 months of age since
1985
• Approximately 41% (31% unimmunized + 15% of immunized who
failed to seroconvert)
• Due to dropout, left out, and failure to develop immunity.

19. In 2010( Revised routine immunization (RI)
2 doses of measles-containing vaccine:
• 1st dose : 9 - 12 months of age
• 2nd dose :16 - 24 months of age along with DTP booster dose.
• Missed both doses can be given up to 5 years of age with gap of 30
days.
• high coverage >80% is maintained for both doses of measles vaccine
in every district.

20. To control measles
• Needs sustained >95% vaccination coverage.
• States like Kerala, Goa, Sikkim, and Punjab demonstrate almost 90%
coverage,
• UP, Bihar, MP, and Rajasthan - < 70% coverage.
• Least coverage-UP and Bihar with large number of measles cases.

21. Measles Initiative in 2001
• The Measles and Rubella Initiative is a global partnership aimed at
ensuring no child dies of measles or is born with congenital
rubellasyndrome (CRS).
• Measles rubella program - Feb.2017
• 1 Dose - 9 months to 15 yrs - irrespective of immunization status
• IAP Recommended :
MR/MMR at 9 and 16-24 months
MMR at 4 - 6 year of age (Booster dose)

22. MR Vaccine
• Live attenuated strains of Edmonston-Zagreb measles virus and
Wistar RA 27/3 - rubella virus.
• Both measles and rubella viruses are propagated on human diploid
cells (HDCs).
• lyophilized form and is provided with diluent.
• Appearance of a yellowish-white dry cake.
• Diluent (sterile water for injections) supplied is specially designed for
use with the vaccine.

23. It is a freeze-dried vaccine, available as single-dose and multidose vials.
 Dose is 0.5 mL - subcutaneously or IM,
 Site - upper arm/anterolateral thigh.
 shelf life is 24 months at 2–8°C.
 once opened discarded within 4 - 6 hours - Staphylococcal sepsis and TSS

24. IMMUNOGENICTIY
Depends on the age of administration due to interference by pre-existing
maternal antibodies.
Seroconversion rates
 60% - 6 months,
 80–85% - 9 months
 95% -12–15 months.
 In HIV-infected infants, superior seroconversion rates are seen at 6
months as compared to 9 months due to progressive
immunodeficiency with age.
Vaccine efficacy - 60% to 80% when given at the age of 9 months.

25. • If pregnancy is plan - interval of 1 month need after MR vaccination.
• immunize children with malnutrition..
contraindication:
• severely immunocompromised,
• severe allergic reactions to the constituents and in pregnancy.
• vaccine contain traces of neomycin, history of anaphylactic, or anaphylactoid
reactions .
• Rare - hypersensitivity reactions- cows milk allergy
• MR vaccine should not be administered in pregnant women.

26. SIDE EFFECTS of Measles
• SAFE AND EFFECTIVE
• Mild pain and tenderness at the injection site
• A mild fever can occur in 5–15% of vaccinees 7–12 days after
vaccination and last for 1–2 days.
• Rash occurs in approximately 2% of recipients, usually starting 7–10
days after vaccination and lasting 2 days.
• Encephalitis - 1 case / million doses
• Thrombocytopenic purpura - 1/30,000 vaccinees

27. Rubella
• joint symptoms - arthralgias (25%) and arthritis (10%) among
adolescent womens -- Few days to 2 weeks.
• Rare in children and in men receiving MR vaccine (0–3%).
• Non immune individuals: Low-grade fever , rash, lymphadenopathy,
myalgia, and paraesthesia are commonly reported.
• Very rare allergic reactions
urticaria, pruritus, and allergic rash within 24 hours of vaccination.

28. other optional vaccines
• Pneumococcal vaccine
• JE vaccine
• HPV vaccine
• Typhoid vaccine
• Varicella vaccine
• Influenza vaccine
• Rabies vaccine
• Hepatitis-A vaccine
• Meningococcal vaccine
• yellow fever vaccine

29. Haemophilus influenza
• Capsulated Haemophilus influenzae has six serotypes - Type-B is most
important.
• (Hib) is an important invasive pathogen
• meningitis, bacteremia,pneumonia, cellulitis, osteomyelitis, septic
arthritis, and epiglottitis.
• Most of invasive Hib disease occurs in children in the first two years
of life before natural protective immunity.

30. • Noncapsulated Hib disease causing bronchitis, otitis media, sinusitis,
and pneumonia is not amenable to prevention at present and can
occur at all ages.
• Data from the Invasive Bacterial Infections Surveillance (IBIS) Group
from six referral hospitals in India
• Hib is a common cause of pneumonia and meningitis in India

31. BURDEN IN INDIA(1993-1997)
• A prospective surveillance was conducted in 5,798 patients aged 1 month to 50 years
who had diseases likely to be caused by H. influenzae.
• Total - 125 H. influenzae infections detected,
• 97% caused by Hib, 108 (86%) isolates were from children aged <5 years.
• clinical spectrum of these children
 meningitis (70%), pneumonia (18%), and septicemia (5%).
• case-fatality rate was 11% overall and 20% in infants with Hib meningitis.
• (WHO) estimates for the year 2008 show that 1.828 million children under 5 years die
annually
• India - 20.3% mortality is due to pneumonia

32. vaccine
• All Hib vaccines are conjugated vaccines where the Hib capsular
polysaccharide (polyribosylribitol phosphate or PRP) is conjugated with a
protein carrier so as to provide protection in the early years of life when it is
most needed.
• Currently available vaccines:
• HbOC (carrier CRM197 mutant C. diphtheriae toxin protein),
• PRP-OMP (carrier Neisseria meningitidis protein outer membraneprotein
complex) - increase antibody level from 1st dose onwards.
• PRP-T (carrier tetanus toxoid).
• The onset of protection with PRP-OMP is faster.

33. • 3 doses of HbOC and PRP-T are recommended for primary
vaccination,
• 2 doses of PRP-OMP are recommended
• Only HbOC and PRP-T are currently available in India.
• stored at 2–8°C
• Recommended dose is 0.5 mL IM (Anterolateral thigh)
• 90–100% efficacy against culture proven invasive Hib disease for 1
year after vaccination.

35. NATIONAL
PROGRAM
IAP 2018 -19
Pentavalent vaccine
with DTP and hep-B
3 doses -6,10 and 14
weeks
3 doses
> 6 weeks given > 4
weeks apart
one booster at 15-18
months
CATCH UP
TILL 5 years of age
6-12months: 2 doses > 8
weeks apart; 1 booster at
15-18 months
12-15 months: 1 dose
and 1 booster at 15-18
months
15-60 months : 1 dose
> 5 years old except if
hypo/asplenia

36. PNEUMOCOCCAL VACCINE
• Pneumococcal disease (PD) is the world’s number 1 vaccine
preventable cause of death among infants and children < 5
years.
• Streptococcus pneumoniae (Pneumococcus)
• As per WHO, vaccination is the only available tool to prevent
PD
• only 10 serogroups are responsible for most pediatric
infections.
• MC serotypes - 1, 5, 6A, 6B, 14, 19F, and 23F

37. • After introduction of PCV-7 increase in cases due to nonvaccine
serotypes, the “replacement phenomenon”
• Among non-PCV-7 serotypes, 1 and 5 cause significant PD in India as well
as in other developing countries

38. BURDEN OF Pneumoccal disease
• 2-year prospective study at 3 Bengaluru hospitals in south India,
• Incidence of IPD in the 1st year of study among < 2-year old
children - 28.28 / 100,000 population
• pneumonia - 15.91 .
• Acute bacterial meningitis (ABM) - 6.28/1 Lakh
• < 2yr old with highest burden
• 6–11-month-old population (49.85 cases per 100,000) during the
2nd year of the study

39. PNEUMOCOCCAL VACCINE
Currently, two types of vaccines are licensed for use:
1. Pneumococcal polysaccharide vaccine (PPSV)
2. Pneumococcal conjugate vaccines (PCV)
Pneumococcal polysaccharide vaccine (PPSV):
 Purified polysaccharide contain 23 serotypes,
 It is a T-cell independent vaccine
 Poorly immunogenic below the age of 2 years,
 Low immune memory, does not reduce nasopharyngeal carriage,
 No herd immunity.

40. • 0.5 mL dose - IM in the deltoid muscle or subcutaneously.
• Each 0.5 mL dose contains 25 μg of each of the 23 polysaccharide
antigens in normal saline solution with either phenol or thiomerosal
as a preservative.
• It is stored at 2–8°C.
• It is a safe vaccine with occasional local side effects.
• Not > 2 life time doses are recommended,
• Repeated doses cause immunologic hyporesponsiveness.

41. Pneumococcal conjugate vaccines
• conjugate vaccines are using same protein carriers—cross-reactive
material (CRM197); a nontoxic mutant diphtheria toxin, diphtheria
toxoid, tetanus toxoid; or a meningococcal outer membrane protein
complex.
• Three of these vaccines containing (PCV-7, PCV-10 and PCV-13) were
licensed..
• PCV-10 and PCV-13 are currently marketed.

42. Vaccine Compositions
PCV-13:
• Dose: 0.5-mL contains
2.2 μg of polysaccharide from each of 12 serotypes
4.4 μg of polysaccharide from serotype 6B;
Total concentration of CRM197 is approximately 34 μg.
The vaccine contains 0.02% polysorbate 80 (P80),
• 0.125 mg aluminum phosphate (AlPO4) adjuvant,
• 5 mL of succinate buffer,
• No thimerosal preservative.

43. PCV-10

45. TYPE PCV - 10 AND 13 PPSV
UIP/
IAP 2018 - 2019
3 doses - 6 and 14 weeks
> 6wks - 6 months: > 4
weeks apart
Booster - 12-15 months
not recommended
Mininum age : 2 years
high risk category - 1 dose
> 8 wks after primary
course with conjugate
vaccine
CATCH UP 7-11 months: 2 doses > 4
wk apart
1 booster at 15-
18 months
12-23 months : 2 doses >
8 wks
24-59 months : 1
dose(PCV-10) & 2
dose(PCV-13)
> 60 months : 1 dose if
high risk
STORAGE: 2-8 C
ADVERSE:local
pain,soreness,malaise,fev
er
C/I: Anaphylaxis

46. Non-vaccine Pneumococcal Serotypes -IPD(Article-
2017)
• Fatal infections- 10F, 17F, 15C and 33C.
• Higher resistance among NVS was seen against co-trimoxazole
followed by erythromycin.
• Very low resistance was observed against penicillin and all isolates
were susceptible to cefotaxime.
• Serotype 11A and 15B were the only penicillin-resistant S.
penumoniae strains.

47. JE Vaccine
• Japanese encephalitis (JE), a mosquito borne flavivirus disease,
leading form of viral encephalitis in Asia in children below 15 years of
age..
• Case fatality averages 30%
• High percentage of the survivors are left with permanent
neuropsychiatric sequelae.
• Acute encephalitis syndrome has heterogeneous etiology and JE
remains an important contributing agent (5–40%) to AES in our
country.
• Risk - aged 1–15 years in rural areas and in the monsoon or
postmonsoon season.

48. vaccines
• Mouse brain-derived inactivated JE vaccine (JE-VAX).
• Inactivated primary hamster kidney cells with P3—China.
• Live attenuated, cell culture-derived SA 14-14-2.
Newer JE vaccines:
• Inactivated SA 14-14-2 vaccine (IC51; IXIARO® by Intercell and JEEV® by
Biological Evans India Ltd.)
• Inactivated Vero cell culture-derived Kolar strain, 821564XY, JE vaccine
(JENVAC® by Bharat Biotech).
• Live attenuated recombinant SA 14-14-2 chimeric vaccine(JE-CV, IMOJEV® by
Sanofi Pasteur).

49. Live-attenuated cell
culture SA-14-14-2
Inactivated cell culture
derived SA-14-14-2
JEEV (Biological E Ltd)
Inactivated vero cell
culture derived kolar
{Jenvac }
Dose ,Route
SITE: Anterolateral thigh
upper arm
PE
0.5 ml
subcutaneous
88 - 95 %
1-3 year : 0.25 ml
> 3 year : 0.5 ml
IM
> 90 %
0.5 ml ; IM
93 - 98 %
NIP Only endemic areas
2 doses : 9 and 16-18
months
Minimum age: 8 months
not used
Not used
IAP
Recommended in endemic
areas
Not available in private
sector
> 1 Year ; 2 doses - day 0
and 28
> 1 Year ; 2 doses - 4
weeks interval
CATCH UP Upto 15 yrs; 1 dose to
non-immune adults
Upto 15 yrs; Upto 15 yrs;
Adverse effects Fever,
malaise,hypersensitivity
rare
Less common Uncommon

50. Rs 664.6/ Piece
Pack size: 0.5ml
Brand: Bharat Biotech
Manufacturer: Bharat Biotech International Ltd.
Composition: Japanese Encephalitis Vaccine
Inactivated (Adsorbed, Human( I.P
Form: Injection
Rs 985/ Piece
Specifications:
- Trade Name: JEEV
- Manufacturer: Biological E.
- Unit: 0.5ml
- Type: Injection

51. MENINGOCOCCAL VACCINE
• N.meningitis - 30-40 % cases of meningitis.
• serogroupes - A,B,C,Y and W135
• Epidemic - A and W 135
• Endemic - sero-group B
• EFFICACY - 85% (A and C)

52. UNCONJUGATED VACCINE
(Group specific polysaccharide)
CONJUGATED VACCINE
1. T - cell indepedent Prolonged efficacy
2.Dont induce immunological memory Herd effect
3. Poorly immunogenic < 2 years Highly immunogenic
4. Bivalent ( A and C)
Tetravalent ( A,C,Y and W135)
Quadrivalent (A,C,Y and W 135) - diphtheria toxin ; Menactra R ,
MENVEO(Gsk)
Monovalent ( A ) - TT serum institute of India

53. POLYSACCHARIDE QUADRIVALENT CONJUGATE
DOSE ; ROUTE
SITE
0.5 ml ; Subcutaneous or IM
Anterolateral thigh or upper arm
0.5 ml ;IM
Anterolateral thigh or upper arm
IAP
High risk categ : > 2yrs old
outbreaks : > 3 months
1 dose ; repeat after 3-5 yrs
High risk categ : > 2 yrs
ADVERSE EFFECTS Fever,local pain or redness Local pain,sweling or redness; GBS (rare)
C/I Anaphylaxis May interfere with pneumococcal vaccine ;
separate admin by 4 wks
STORAGE 2-8 C
use within 30mins of reconstitution
2-8 C ; Donot freeze

55. Brand: Bio Med
Form: Liquid
Dosage Strength: 0.5 ml
Packaging Type: Box
Type: Bi Meningo
Rs 600/ Piece
Packaging Type: Box
Packaging Size: One Dose
Product Type: Injetion
Brand: Bio-Med
Other Name: Quadri Meningo

56. Rs 3,400/ vial
Packaging Type: Box, Bottle
Brand: Menactra
Packaging Size: 0.5 ml
Menveo Vaccines
Rs 3,100/ Piece
Manufacturer: Gsk

57. HPV
• Cervical cancer -2nd MC cancer in women
• Oncogenic serotype - HPV 16 and 18
• Non oncogenic serotype - HPV 6 and 11 ( 90 % - anal warts)
• Protect 90 % infections
• Gardasil (HPV-4)
• Cervarix (HPV-2)
• nonavalent - HPV 6 + 31,33,45,52,58
• Immunogenic : 9 - 14 yrs of age and protect for 5 years
• Dose - 0.5 ml / IM - Upper arm

58. HPV-Vaccine
WHO;IAP Recommeded age : 9 years
9–14 years: 2 doses > 5 months apart
> 15 YRS:
HPV - 4 : 0,2 and 6 months ; interval b/w 1st & 2nd dose - 5 months
HPV - 2 : 0,1 and 6 months 2nd & 3rd dose - 12weeks
Immunocompromised : Irrespective of age should receive the 3-dose
schedule.
CATCH UP Upto 45 yrs (IAP): preferable before initiation of sexual activity
Adverse Reaction Local pain,erythema,sweeling,fever,syncope
Contraindication Anaphylaxis
Storage 2-8 C
Protect from light

59. HEPATITIS - A
• RNA Virus
• Feco - oral transmission
• Most serious complication - Fulminant hepatic failure
• 50 % seropositive by 5 years of age
• 2 types of vaccines :
• Inactivated vaccine -HM175/GBM strain, aluminium hydroxide (adjuvant),PE- >95%
• Live - attenuated vaccine - H2 and L-A-1 strain:
 PE- 100% in Pre exposure and 95% in post exposure

60. HIGH RISK CATEGORIES :
• Chronic liver disease
• sero -ve travellers to endemic areas
• children attending creches and daycare
• sero -ve adolescents
• Liver and kidney transplant recipients
• POST EXPOSURE PROPHYLAXIS:
within 10 days of exposure

61. INACTIVATED VACCINE LIVE-ATTENUATED VACCINE
DOSE
ROUTE
SITE -Deltoid
0.5 ml (720 U)
IM
0.5 ml
subcutaneous
IAP
2 doses
minimum age(1st dose) : 12months
2nd dose : 6 -18 Months
H2 strain
single dose after age of 12 months
CATCH UP
1- 10 yrs - 2 doses
> 10 yrs - 1st confirm sero -ve
>15 yrs - adult dose 1ml(1440 U)
same as inactivated vaccine
ADVERSE Local pain,headche,malaise soreness,erythema,fever,malaise
C/I Anaphylaxis Hypersensitivity to egg
protein,immunodeficiency,chemo or
radiotheraphy
STORAGE 2-8 C ; protect from light
use within 30mins of reconstitution
2-8 C ; donot freeze
use within 30mins of reconstitution

62. VARICELLA vaccine
• self limiting illness
• Each dose - atleast 1000 PFU of live virus Oka strain attenuated in
human diploid cell culture

63. Population Impact Data
• Till 2015, 24 countries have introduced Varicella in NIP (Europe 8, Americas 10, Eastern
Mediterranean 4, and East Pacific 2).
• The impact studies have been published from 7 countries, which are using either
Variped, Varilrix, or both.
• Breakthrough varicella: It is defined as varicella developing > 42 days after
immunization and usually occurs 2–5 years following vaccination. 1–4% of vaccines per
year.
• Breakthrough disease in 70% is mild, with <50 skin lesions, predominantly
maculopapular rather than vesicular rash, low or no fever, and 4-6 days
• It is contagious, may be severe can result in outbreaks
• occasionally caused deaths in the immunocompromised.

64. High risk groups:
• Chronic cardiac or lung disease
• Asymtomatic HIV with CD4 > 15%
• Leukemia in remission and off chemotherapy > 3months
• Prolonged immunosupression and aspirin therapy
• unimmunised household contacts
POST - EXPOSURE PROPHYLAXIS : within 72hrs of contact
Protective efficacy - 70 %
VZIg for susceptibe individuals

65. DOSE,ROUTE 0.5 ml , subcutaneous
SITE Anterolateral thigh or upper arm
IAP All child,esp high risk : 2 doses - (15 months ) > 3 months apart or 4-6 yrs
minimum age :12 months
CATCH UP If < 13 yr - 2 doses >3 months apart or 4 weeks apart
> 13 yr - 2 doses > 4 weeks apart
High risk groups : 2 doses 4-8weeks apart irrespective of age
ADVERSE Fever,rash,local pain or redness ; mild rash after 2-3 wks
C/I Anaphylaxis,lymphopenia,immunodeficiency,active leukemia or lymphoma,
during immunosuppressive therapy
STORAGE Freeze dried lyophilized;
2-8 C
protect from light ; withiin 30 mins of reconstitution

66. VZIg
• For susceptible individuals and significant contacts
• Neonates born to mothers who develop varicella 5 days before or 2
days after delivery
• neonates < 28 weeks of gestation/with birth weight < 1,000 g
exposed in the neonatal period.
• preterm neonates > 28 weeks of gestation and exposed to varicella
• Pregnant women exposed to varicella.

67. Dosage and Administration Schedule
• VZIg should be given < 96 hours following exposure.
• VZIg reduces risk of disease and complications and duration of
protection lasts for 3 weeks.
• VZIg (Varitect) - dose of 0.2–1 mL/kg diluted NS over 1 hour.
EFFICACY:
• Neonates - 100%
• Other option: uncertain efficacy IVIg at the rate of 200 mg/kg or oral
acyclovir - 80 mg/kg/day beginning from the 7th day of exposure for
7–10 days.

68. Rs 1,560/ Piece
Specifications:
- Trade Name: Varilrix
- Manufacturer: GSK
- Unit: 0.5ml
- Type: Injection

69. INFLUENZA
• 3 antigenic types - A to C
• Several subtypes based on hemagglutinin and neuraminidase
• Flu epidemics - A and B
• Strain-specific humoral response with PE - 30 - 90%
• composition annually changed
1. Inactivated influenza vaccine - Tri or quadrivalent
vaccine - chick embryo
2. Live attenuated intranasal vaccine - passage of virus at
low temperature - sensitive strain 25 C - donot replicate 37-39 C

70. STRAINS - INFLUENZA
Most of the current seasonal influenza vaccines :
• 2 influenza A strains and 1 influenza B strain.
• Globally, trivalent inactivated vaccines (TIVs3) and live attenuated
influenza vaccines (LAIVs)are available.
• The development of quadrivalent inactivated influenza vaccine
(QIIV4) protection against influenza B viruses.

72. INACTIVATED VACCINE LIVE VACCINATED VACCINE
DOSE ; ROUTE 0.5 ml IM 0.25 ml in each nostril
SITE Anterolateral thigh or upper arm Intranasal using Accuspray
IAP only in High- risk categories( 6months to
5 yrs):
1st time vaccination:
6months- 9 yrs : 2 doses > 4wks apart
>9 yrs : 1 dose
Annual Revaccination : 1 dose before rainy
season
Healthy children 2-18 yrs
1st time vaccination:
6months - 9 yrs - 2 doses > 4wks apart
>9 yrs - 1 dose
Annual Revaccination : 1 dose before rainy
season
A/E Mild (10-30%) : Local pain,fever,nausea
Severe : Anaphylaxis
Runny nose,headache,wheeze,myalgia,
fever,sore throat,vomiting
C/I Anaphylaxis ,egg allergy,GBS High risk category
STORAGE 2 - 8 C ; donot freeze 2 - 8 C ; donot freeze

73. High risk categories :
• Age 6 - 24 months
• chronic cardiac or lung disease
• Asthma require steroid therapy
• immunodficiency
• SCD,DM,SLE
• Aspirin theraphy

74. TYPHOID VACCINE
• Three vaccines are available :
1. Typhoid conjugate vaccine
2. Oral Ty21a (not used in india)
3. Vi capsular polysaccharide vaccine

75. Oral Ty21a :
 Mutant strain of S.typhi
 enteric coated capsule
 Induce intestinal mucosal immunity
 PE - 50-60% within 7 days
 Antibiotics are avoided to avoid interfere with response
 Repeated every 3 years

76. Vi capsular polysaccharide :
 S.typhi strain Ty2
 children > 2 yrs
 1 dose develop PE - 50-75%
 Revaccination every 3 years
IN INDIA: 2 conjugate vaccines
 Vi antigen + TT (carrier)
 Vi antigen + Pseudomonas aeurginosa Exotoxin A

77. Vi capsular polysaccharide Typhoid conjugate vaccine
(Typbar-TCV)
Oral Ty21a - Live
DOSE ; ROUTE 0.5 ml ; SC or IM 0.5 ml ; IM Oral ; capsule
SITE Anterolateral thigh or Upper arm Anterolateral thigh or Upper
arm
oral
IAP
> 2 yrs - 1 dose
Repeat every 3 yrs
6-9 months - 1 dose 3 doses (> 6 years)
CATCH UP
> 2 yrs - 1 dose 1 dose upto 18 yrs Any age
ADVERSE Local pain,
redness,swelling,fever
Local pain,
redness,swelling,fever
Abdominal discomfort
fever
C/I
STORAGE
Anaphylaxis
2-8 C ; donot freeze
Anaphylaxis
2-8 C
immunodeficiency
2-8 C

79. RABIES
• Rabies is a viral zoonosis
• Transmission - bites, scratches, and licks on mucous membrane or
nonintact skin by a rabid animal
• Human-to-human transmission occurs almost exclusively as a result
of organ or tissue transplantation (including cornea).
• IP - 4–6 weeks but can range from 5 days to 6 years.
• Fatal and only 6 survivors reported in world literature.
• MC animal - dog , > 96 % cases - 35% of childrens

80. CATEGORY TYPE OF CONTACT TYPE OF EXPOSURE MANAGEMENT
Category I Touching or feeding animals, animal licks
on intact skin (no exposure)
NONE Wound care, no prophylaxis
is required
Category II Nibbling of uncovered skin, minor
scratches, or abrasions
without bleeding (exposure)
MINOR Appropriate wound care +
Immediate PEP
Antirabies vaccine
Category
III
Single or multiple transdermal bites or
scratches, contamination of mucous
membrane or broken skin with saliva from
animal licks
Exposures due to direct contact with bats
(severe exposure)
SEVERE Appropriate wound care
+
Immediate PEP(Anti rabies
vaccine)
+
Rabies immunoglobulin or
MAB

81. WOUND CARE :
• Flushing with soap under running water for 15 minutes.
• povidone iodine or 70% alcohol irrigation
• Antimicrobials and tetanus toxoid should be given if indicated.
• suturing of wound should be avoided
• unavoidable condition - RIG has been infiltrated in the wound prior
to suturing.
• Only stay suturing is advocated initially. Delayed suturing may be
done after 48 hours if needed.

82. HUMAN MONOCLONAL ANTIBODY
• Rabishield (rabies human monoclonal antibody)
• Indian firm Serum Institute of India
• Dose: 3.33 IU/kg
• RMab can be started till 7th day of first dose of vaccine.
• Vial of 2.5 mL, 1 mL containing 40 IU, 100 IU per vial.

83. RABIES Ig (2 Types)
• Human rabies immunoglobulin (HRIg—dose is 20 U/kg body weight,
maximum dose 1,500 IU)
• Equine rabies immunoglobulin (ERIg—dose is 40 U/kg, maximum
dose 3,000 IU).
• Indicated - category III wounds
• It should be infiltrated thoroughly into and around the wound.
Adverse reactions: Include tenderness/stiffness, low-grade fever;
sensitization may occur after repeated injections.

84. Rabies vaccines
• cell culture vaccines (CCVs) :
• purified chick embryo cell vaccine (PCECV),
• purified Vero cell rabies vaccine (PVRV); and
• Purified Duck Embryo vaccine (PDEV).
• CCVs and PDEV potency (antigen content) > 2.5 IU / IM irrespective of
whether it is 0.5 mL or 1.0 mL vaccine by volume.
• Adverse effects : local pain, swelling, and redness and less commonly
fever, headache, dizziness, and GI side effects

85. POST EXPOSURE PROPHYLAXIS
• The standard schedule - 4 dose schedule
• on days 0-3-7-14 to 28 days.
• Dose - 1ml /IM
• The recommended ID schedule for PEP is 2-sites ID on days 0, 3 and 7.
In Immunocompromised :
 category II exposures should receive RIg in addition to a full postexposure
vaccination.
In previously vaccinated children:
 Irrespective of previous vaccination except within 3 months of PrEP and PEP
 Booster - 2 doses - On day 0 and 3

86. PRE-EXPOSURE PROPHYLAXIS
High-risk groups :
Continuous exposure: Lab personnel and production of rabies
biologics.
Source and exposure may be unrecognized.
Frequent exposure: Veterinarians, laboratory personnel involved
medical, and paramedical staff treating rabies patients, dog catchers,
zoo keepers, and forest staff.
Infrequent exposure:
• Postmen, policemen, and courier boys
• Travelers to rabies endemic countries

87. WHO current recommendations
PrEP schedules:
• A 2 sites ID or a 1-site IM vaccine - on days 0 and 7.
• Monitor antibody titres every 6 months - < 0.5 IU/mL - Booster
needed

88. YELLOW FEVER VACCINE
LIVE VACCINE - STRAIN 17D-204 OR 17DD
EFFECTIVENES 90% - 10 Days ; 100 % - 3 weeks
DOSE ; ROUTE ; SITE 0.5 ML ; Subcutaneous ; Anterolateral thigh or upper arm
IAP Single dose > 10 days before travel to endemic area
Revaccinate after 10 years
ADVERSE EFFECTS Mild (20-30%) : Fever,myalgia and headache
Severe : Hypersensitivity reaction; neurotropic and viscerotropic disease
C/I Age < 6 months ; symptomatic HIV or CD4 < 15%
Radiation,chemotheraphy,anaphylaxis
STORAGE 2-8 C
use within 30 min of reconstitution

89. VACCINE EFFICACY
• Similar in RV1 & RV5
• There is no studies conduted in efficay of vaccines in india except
116E
• In Africa - 50-80 % and latin america shows around 80%
• In malawi RV1 - 49% and SA - 77%
• In 2014, 116E - 55%

91. Oral Rota virus vaccine
Rotarix(RV1) RotaTeq(RV5) Rotavac(116E)
Dose 1.0 ml( lyophilized powder
mix with diluent)
2 ml (available in liquid
form)
5 drops
STRAINS G1P1A(8) WC 23 and human G1-4,
and P1A(8 )
116E
VACCINE EFFICACY 95% 85% 55%
UIP not recommended not recommended selected states
Maximum age(1st dose) -
1 year ,3 doses
6,10 and 14 weeks
IAP 2018-19 2 doses
10 and 14 weeks
(6 and 10 weeks)
3 doses
6,10 and 14 weeks
3 doses
6,10 and 14 weeks

93. Reference
1. OP GHAI Text book of paediatrics; 9 th Edition
2. IAP immunization book 2018 - 2019