Viva Pediatrics MBBS

1. VACCINES FOR VIVA

2. UNIVERSAL IMMUNIZATION PROGRAMME
• Launched on 19 Nov 1985.
• Under the UIP, all vaccines are given free of cost to the beneficiaries as per
the National Immunization Schedule.
• OBJECTIVES
1) To increase immunization coverage.
2) To improve quality of service.
3) To achieve self sufficiency in vaccine production & manufacturing of cold
chain equipment.
4) To establish reliable cold chain equipment and establish a good
surveillance network.
5) To introduce a district wise system monitoring & evaluation
6) To train health personnel.

5. IAP SCHEDULE:
• The Indian Academy of Paediatrics recommends inclusion of more
vaccines in the immunization schedule.
• These vaccines are not included in the UIP because of financial
constraints. The immunization schedule approved by the IAP is as
follows :

7. COMMON VACCINES:
BCG Vaccine
• Live attenuated vaccine.
• Danish 1331 strain used in India.
• Dose, route: 0.1 ml; intradermal, left deltoid.
• Requires cold chain as extremely sensitive to heat
• Adverse effects : persistent ulceration and ipsilateral axillary or cervical
lymphadenopathy - more likely with subcutaneous injection.
Catch up vaccination:
• May be given up to 5 years
• If no scar up to 6 months after vaccination, BCG may be repeated once

8. OPV:
• Dose, route : 2 drops,oral
• Adverse reactions :Vaccine derived poliovirus; vaccine associated
paralytic poliomyelitis.
• Contraindications :Inherited or acquired immunodeficiency;
symptomatic HIV.
• Storage: 2-8°C; sensitive to heat; use vaccine vial monitor.

9. Inactivated Polio Vaccine (IPV)
• Dose, route: 0.5 ml; intramuscular or subcutaneous.
• Catch up: Up to 5 yr; 3 doses at 0, 2 and 6 mo
• Adverse reactions: Local pain, swelling
• Contraindication: Known allergy
• Storage: 2-8°C; sensitive to light

10. Diphtheria Vaccine
• Diphtheria vaccine is a toxoid (DT) - inactivated diphtheria
toxin; adjuvant - aluminum hydroxide.
• DTwP - combination vaccine containing diphtheria toxoid,
tetanus toxin and whole cell killed pertussis.
• Dose,route: 0.5ml,intramuscular
• Site: Anterolateral aspect of mid-thigh (avoid gluteal region:
risk of sciatic nerve injury; inadequate response).
• Adverse effects - chiefly due to the pertussis component.
• Fever, local pain and induration; rarely, incessant crying and
encephalopathy are seen.

11. Pertussis Vaccine
• Two types of pertussis vaccines are available:
• whole-cell (wP) vaccines - killed B. pertussis organisms
• Acellular (aP) vaccines - highly purified, selected components of the agent.
• Booster doses essential for continued protection.
Acellular Pertussis Vaccine (DTaP)
• Contain inactivated pertussis toxin (PT) and one or more additional
pertussis antigens.
• Efficacy of DTaP is similar to DTwP, but the risk of systemic and local
side effects is reduced significantly.
• Not recommended as part of the National Program in India due to its
cost.
• Contraindication for DTaP are the same as for DTwP

12. Tetanus Vaccine
• Immunizing pregnant women - passive immunity to the baby due to
the transplacental passage of IgG antibodies.
• Tetanus toxin is inactivated to make tetanus toxoid (TT) and adsorbed
onto aluminum salts to enhance its immunogenicity.
• Tetanus toxoid is administered with DT and pertussis (killed or
acellular) vaccine in DTP, with 3 doses of the vaccine given 4 weeks
apart, followed by boosters at 18 months and 5 yr.

13. Catch up (IAP 2021)
• Catch up below 7 years: DTwP/DTaP at 0, 1 and 6 months;
• Catch up above 7 years: Tdap, Td, and Td at 0, 1 and 6 months
respectively.
• The 2nd childhood booster is not required if the last dose has been
given beyond the age of 4 years
• Adverse reactions :Local pain, swelling, fever (DTwP>DTaP)
Reduced Antigen Acellular Pertussis Vaccine (Tdap) and Reduced
Antigen Diphtheria Toxoid Vaccine (Td)
• reduced antigen content causes less severe adverse effects while
being sufficient to induce protective response in a previously
immunized individual (booster effect).

14. Contraindications:
• (i) Progressive neurological disease (pertussis is contraindicated) -
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 hr;
• (ii) collapse (hypotonic-hyporesponsive episode) within 48 hr;
• (iii) persistent inconsolable crying for >3 hr within 48 hr;
• (iv) seizures within 72 hr
• Storage 2-8°C; sensitive to light

15. Hepatitis-B Vaccine
• Dose, route: 0.5 ml (1 ml in adults and in children receiving hemodialysis); intramuscular
• Site:Anterolateral thigh (deltoid in adults); avoid gluteal region
Schedule:
Routine vaccination:
• Administer monovalent HepB vaccine to all newborns within 24 hours of birth.
• Hep B vaccine may be given in any of the following schedules:
• Birth, 1, & 6 months,
• Birth, 6 and 14 weeks; 6, 10 and 14 weeks;
• Birth, 6,10 and 14 weeks.
• All schedules elicit similar seroprotection rates.
• There is no recommendation for booster doses
Catch-up vaccination:
• Administer the 3-dose series - 0, 1, and 6 months schedule.
• Contraindication: Anaphylaxis after previous dose
• Storage: 2-8°C; do not freeze

16. Haemophilus influenza B Vaccine
• Dose, route : 0.5 ml intramuscular
• Site : Anterolateral thigh
• Adverse reactions:Fever, rash, local pain or redness
• Contraindication:Hypersensitivity to previous dose
• Storage:2-8°C

17. Rotavirus Vaccine:
• Dose, route: RVl: 1 ml (lyophilized) or 1.5 ml (liquid); RVS: 2 ml (liquid); oral
• Adverse reactions: Intussusception (rare)
• Contraindication: Past history of intussusception; severe immunodeficiency
• The maximum age for the final dose in the series is 8 months
• Precaution: Postpone vaccination during ongoing diarrhea or moderate illness
• Storage: 2-8°C; do not freeze; protect from light; use immediately after
reconstitution or opening

18. Pneumococcal Vaccine
• Dose, route: 0.5 ml subcutaneous or intramuscular
• Site: Anterolateral thigh
Catch up:
• For PCV 13: Catch up in 6-12 months: 2 doses 4 weeks apart and 1 booster; 12-23
months: 2 doses 8 weeks apart; 24 months & above: single dose
• For PCV10: Catch up in 6-12 months: 2 doses 4 weeks apart and 1 booster; 12
months to 5 years: 2 doses 8 weeks apart
• Adverse reactions :Fever, local pain, soreness, malaise
• Contraindication:Anaphylaxis after previous dose
• Storage: 2-8°C; do not freeze

19. Measles Vaccine
• Live attenuated vaccine
• Derived from the Edmonston Zagreb strain of vaccine virus
• Maternal immunity may interfere with the immune response to the
vaccine during infancy (<9months).
• Dose,route: 0.5 ml; subcutaneous
• Site : Right upper arm (at insertion of deltoid) or anterolateral thigh
Catch up: Complete schedule with >4 weeks gap between doses; can
use MMR-V >2 years
• Adverse reactions: Fever, transient macular rash ('measles like' illness)
5-10 days later

20. • CONTRAINDICATIONS:
(i) Immunosuppressive therapy (e.g. alkylating agents, high dose
corticosteroids);
(ii) malignancy;
(iii) severe immunodeficiency (e.g. advanced HN);
(iv) untreated tuberculosis
• Storage : 2-8°C; sensitive to heat and light; use within 4-6 hrs of
reconstitution

21. Measles Mumps Rubella Vaccine:
• The mumps component of MMR vaccine has live attenuated mumps
virus derived from the Jeryl Lynn strain
• The vaccine is contraindicated in pregnant women and in
immunocompromised persons.
• MMR vaccine is recommended for asymptomatic and symptomatic
individuals with HIV if not severely immunocompromised.
• IAP recommends two doses of MMR vaccine, to decrease the risk of
primary vaccine failure to the mumps and rubella components.
• Dose, route: 0.5 ml; subcutaneous
• Site: Right upper arm (at insertion of deltoid) or anterolateral thigh

22. • Catch up >12 mo: Administer 2 doses 24 weeks apart; one dose if
received MMR vaccine previously
• Adverse reactions: Fever, transient rash, arthralgia, aseptic meningitis,
lymphadenopathy
• Contraindications:
(i) Immunosuppressive therapy (e.g. alkylating agents, high dose
corticosteroids);
(ii) malignancy;
(iii) severe immunodeficiency (e.g. advanced HN);
(iv) untreated tuberculosis
• Storage:2-8°C; sensitive to heat and light; use within 4-6 hr of
reconstitution

23. Typhoid Vaccine
• Dose, route : 0.5 ml, subcutaneous or intramuscular
• Site: Anterolateral thigh (deltoid in adults)
• Schedule
• National Program: Not included
• IAP 2021: Both Vi-PS conjugate and Vi-PS (polysaccharide) vaccines are available
• Minimum ages:
• Vi-PS conjugate: 6 months
• Vi-PS (polysaccharide) vaccines: 2 years
• Vaccination schedule:
• Typhoid conjugate vaccines (Vi-PS):
• Single dose at 6-9 months
• Vi-PS (polysaccharide) vaccines: Single dose at 2 years; revaccination every 3 years
• Catch up :One dose beyond 2 yr
• Adverse reactions: Local pain, swelling, redness; fever
• Contraindication: Anaphylaxis after previous dose
• Storage: 2-8°C; do not freeze

24. Japanese B Encephalitis Vaccine
• Dose, route: 0.5 ml subcutaneous
• Site: Anterolateral thigh or upper arm
Schedule
• National Program & IAP:Only in endemic areas; minimum age 8
months till 18 years of age
• Catch up:One dose in susceptible children up to 15-yr-old (during
disease outbreak or in campaign)
• Adverse reactions: Fever, malaise

25. Hepatitis A Vaccine
• Dose, route: 0.5 ml, intramuscular
• Site: Deltoid
Schedule
National Program : Not included
IAP 2021: Two doses beyond 1 yr of age, given 6 mo apart
Catch-up vaccination:
• Either of the two vaccines can be used in 'catch-up' schedule beyond 2 years of
age
• Administer 2 doses of inactivated vaccine at least 6 months apart to unvaccinated
persons
• Only single dose of live attenuated H2-strain vaccine
Adverse reactions: Local pain; nausea, anorexia, malaise
Contraindication: Anaphylaxis after previous dose
Storage:2-8°C; protect from light; use within 30 min of reconstitution

26. Meningococcal Vaccine
• Dose, route: 0.5 ml subcutaneous or intramuscular
• Site: Anterolateral thigh or upper arm
• Schedule
• National Program: Not included
• IAP 2021: Single dose in high-risk categories older than 2 yr; repeat
after 3-5 yr if required
• Adverse reactions: Fever, local pain or redness
• Contraindication: Anaphylaxis after previous dose
• Storage: 2-8°C; protect from light; use within 30 min of reconstitution

27. Inactivated influenza vaccine
• Dose, route:0.5 ml (0.25 ml <3 yr); intramuscular
• Site: Anterolateral thigh or upper arm
• National Program: Not included
• IAP 2021:Only in high-risk categories
• First time vaccination: Two doses ≥4 weeks apart if 6 mo to 9-yr-old
and one dose if >9 yr; annual revaccination with one dose; best
administered before rainy season
• Adverse reactions:Local pain, redness; anaphylaxis
• Contraindication:Anaphylaxis after previous dose
• Storage: 2-8°C; do not freeze

28. Yellow fever vaccine
• Dose, route :0.5 mL, subcutaneous
• Site: Anterolateral thigh or upper arm
Schedule
• National program: Not included
• IAP 2021; WHO: Single dose ;≥10 days before travel to endemic areas;
revaccinate after 10 years
• Adverse reactions :Mild (20-30%): Fever, headache and myalgia
Severe (3-18/million doses): Hypersensitivity reactions; neurotropic,
viscerotopic disease
• Contraindication:Age <6months ;symptomatic HIV or CD4<15%; radiation
or chemotherapy;anaphylaxis after previous dose.
• Precaution:Age 6-9 months or >60 years; pregnancy and lactation;
asymptomatic HIV or CD4≥15%; family history of vaccine associated
adverse effects.
• Storage: 2-8°C; use within 30 minutes of reconstitution.

29. Varicella Vaccine
• Dose, route: 0.5 ml subcutaneously
• Site: Anterolateral thigh or upper arm
• National Program: Not included
• IAP 2021: All children, especially high-risk categories: Two doses >3
months apart; preferably at 15-18 months (minimum 12 months) and
4-6 years
• Catch up:Complete two dose series with minimum interval of 3 mo
between the doses (≥4 weeks if ≥12-yr-old)
• Adverse reactions : Fever, rash, local pain or redness
• Contraindications: Anaphylaxis after previous dose; lymphopenia;
immunodeficiency; during immunosuppressive therapy
• Storage: 2-8°C; protect from light; use within 30 min of reconstitution

30. Human Papillomavirus (HPV) Vaccine
• Dose, route:0.5 ml intramuscular
• Site:Upper arm (deltoid)
Schedule
• National Program:Not included
IAP 2021:
• Girls 9-14 years old: 2 doses of HPV4; or HPV2 ≥6 months apart ;
• Girls ≥15years ,immunocompromised: 3doses HPV4: 0,2 and 6months; or
HPV2:0,1 and 6months.
• Catch up: Before initiation of sexual activity
• Adverse reactions:Local pain, swelling, erythema; fever
• Contraindication:Anaphylaxis after previous dose
• Storage: 2-8°C; protect from light

31. Rabies Vaccine
• Three types of vaccines are available against the virus.
• The purified duck embryo vaccine (PDEV);Modern tissue culture
vaccines include purified chick embryo cell (PCEC) vaccine (Rabipur),
human diploid cell vaccine (HDCV) (Rabivax) ;and purified vero cell
vaccine (PVRV) (Verorab, Abhayrab); these vaccines have similar
efficacy and safety.
• Following an animal bite, the wound should be immediately irrigated
with running water for 10 min, cleaned thoroughly with soap and
coated with povidone iodine, 70% alcohol or tincture iodine.

34. • Following an animal bite, the wound should be immediately irrigated
with running water for 10 min, cleaned thoroughly with soap and
coated with povidone iodine, 70% alcohol or tincture iodine.
• The dose of RIG is 20 U /kg for human (HRIG) and 40 U /kg for equine
(ERIG) immunoglobulin.
• PEP : Modern tissue culture vaccines are recommended for all
category II and III bites.
• Dose: 1.0 mL IM in anterolateral thigh or deltoid (never in gluteal
region) for human diploid cell vaccine (HDCV), purified chick embryo
cell (PCEC) vaccine, purified duck embryo vaccine (PDEV); 0.5 mL for
purified Vero cell rabies vaccine (PVRV).

35. • Schedule: 0, 3, 7, 14, and 30 with day “0” being the day of
commencement of vaccination.
• A sixth dose on day 90 is optional and may be offered to patients with
severe debility or those who are immunosuppressed.
• Rabies immunoglobulin (RIg) along with rabies vaccines are
recommended in all category III bites.
• Equine rabies immunoglobulin (ERIg) (dose 40 U/kg) can be used if
human rabies immunoglobulin is not available.

36. Combination Vaccines
• A combination vaccine consists of multiple immunogens physically
combined in a single preparation, including antigens or serotypes of
the same pathogen (trivalent polio vaccine) or different pathogens
(pentavalent or DTP vaccines.
• This is distinct from simultaneous administration of multiple separate
vaccines at the same time at separate sites.
• The immune system of an infant can respond to a large number of
antigens simultaneously, and the efficacy of most vaccines is not
altered by concurrent administration.
• With the requirement of vaccination against several infections, a child
needs to be administered more than 20 antigens in the first 2yrs.

38. DRUGS FOR VIVA

39. INJ SODIUM BICARBONATE
• Available in 7.5% and 8.4% strengths
• Indications
• Severe metabolic acidosis( inborn errors of metabolism, diabetic
ketoacidosis, salicylate poisoning)
• TOF with cyanotic spell
• Hyperkalemia
• Dilute 1:1 with sterile water or Normal saline and administer as
slow IV(1 meq/kg/minute).

40. INJ CALCIUM GLUCONATE
• Clinical indications
• Symptomatic hypocalcemia (tetany/seizures)
• Hyperkalemia: Protects the heart from the arrhythmogenicity of
potassium
• What precautions should be taken while giving IV ?
• It is a vesicant drug. So patency of IV line should be verified before
giving it. Also, it should be given very slowly after dilution with
normal saline, monitoring heart rate. Stop infusion if there is
bradycardia < 60/min.

41. INJ POTASSIUM CHLORIDE
• To treat hypokalemia : Severe vomiting, diarrhea, continuous naso-
gastric aspiration, during treatment for diabetic ketoacidosis.
• Dangers : Sudden IV push can cause cardiac arrest.

42. INJ DEXTROSE
• Clinical indications:
• Symptomatic hypoglycemia
• concentrations available:
• 5%, 10%, 25%.
• Up to 10%, we can give through peripheral line. Beyond that we have to
use central line.

43. IV FLUID: RINGER LACTATE
• It is a crystalloid. Used as volume expander in severe dehydration,
acute hemorrhage, shock etc.
• What is the concentration of sodium in this?
Sodium 130meq/l (other contents are potassium 4, calcium 3,
chloride 109, lactate 28 meq/l)

44. IV FLUID: NORMAL SALINE
• Uses are same as that of Ringer Lactate.
• More preferred fluid to treat shock.
• Sodium 150meq/L

45. IV FLUID: ISOLYTE P
• This is the pediatric maintenance fluid. Given when oral intake is
not possible or is contra indicated.
• Calculation of fluid is by Holliday Segar formula.
• Up to 10kg: 100ml/kg/day.
• 11-20kg: 1000ml+ 50ml/kg for each kg above 10kg.
• More than 20kg: 1500ml+20ml/kg for each kg above 20kg.

46. INJ PHENYTOIN SODIUM
• Anticonvulsant (especially IV phenytoin is the drug of choice in status
epilepticus beyond neonatal age group), antiarrhythmic action is also
there.
• It should be diluted and given IV at a rate not more than
1mg/kg/minute
• If administered rapidly, Cardiac Arrhythmias may occur
• Long term use : Gum hypertrophy, hirsutism.

47. INJ PHENOBARBITONE
• Anticonvulsant
• Caution : Monitor respirations while giving it IV.
• Other uses : It can increase the excretion of bilirubin by increasing
liver metabolism, so used in neonatal jaundice as well as some
cholestatic liver diseases like neonatal hepatitis syndrome.

48. INJ DIAZEPAM
• Dose : 0.3 mg/kg/dose
• Care should be taken while giving iv : Risk for respiratory depression
is there ,so it should be monitored. The rate of IV push should not be
more than 4 mg/minute.

49. INJ ADRENALINE
• Clinical uses: Anaphylaxis, cardiac arrest, shock, croup
syndrome, as local vasoconstrictor.
• Doses & routes (1amp (1ml)-1:1000 solution)
• Usual dose: 0.01ml/kg subcut
• in anaphylactic shock, give IM,
• in croup: < 6 months 2.5ml and > 6 months 5ml undiluted
adrenaline nebulized.
• In cardiac arrest use IV 0.01ml/kg (diluted 1:10)or intra
tracheally 0.1ml/kg(undiluted)

50. INJ ATROPINE
• Preparation – 0.6mg/ml & 6mg/ml - IV
• Clinical uses: Resucitation, Pre anaesthetic medication, OP
Poisoning.
• Side effects : Dry mouth, constipation, urine retention, fever,
tachycardia, psychosis

51. DIGOXIN
• Indications :
• Congestive cardiac failure
• Supraventricular tachycardia
• Contraindications:
• Constrictive pericarditis
• Hyperkalemia
• side effects:
• Vomiting
• Cardiac arrythmias

52. INJ AMINOPHYLLIN
• Indications :
• Acute severe asthma,
• Apnea of prematurity
• What are the side effects?
• Arrhythmia,
• Convulsions

53. INJ HYDROCORTISONE
• USES
• Acute severe asthma
• Anaphylaxis
• Hypo-adrenalism
• Shock

54. PREDNISOLONE
• 4 times more potent than hydrocortisone
• USES
• Nephrotic syndrome
• Collagen vascular diseases : SLE, JIA
• Severe bronchial asthma
• Some TB associated conditions

55. INJ DEXAMETHASONE
• 25 times more potent than hydrocortisone
• USES
• To decrease cerebral edema
• Septicemia
• Dexamethasone suppression test

56. INJ AMPICILLIN
• What class of antibiotic is ampicillin?
Beta lactam antibiotic(semisynthetic penicillin)
• What is the dose in pneumonia treatment?
50mg/kg/dose 6 hrly
• If it produces a rash in a child with fever, what are the possibilities?
Ampicillin allergy or the patient may be having infectious mononucleosis.

57. INJ CLOXACILLIN
• Penicillinase resistant Penicillin
• Specific indication to use Cloxacillin in child with pneumonia -
Staph. Pneumonia
• Dose of Cloxacillin is recommended by the ARI control
programme - 50mg/kg/dose 6 hrly

58. INJ CEFTRIAXONE
• Belongs to third generation of cephalosporins
• Indications:
1. Meningitis
2. Septicemia
3. Enteric fever