IMMUNIZATION

Beginning of Vaccination

Vaccination ( Latin ;

Vacca- Cow )

Edward Jenner used

the

term Vaccination

Cow pox virus provided

immunity in prevention

of Small pox

Edward Jenner Vaccinating

Scientific Era of Vaccination.

Louis Pasteur adopts the

principles of Vaccination

For his scientific work.

Vaccination for prevention of

Rabies creates

awareness on

Immunization with

scientific fundamentals

1974:Expanded program of Immunization (EPI) organized by WHO

In 1985, The Universal Immunization Program (UIP) was introduced to improve coverage of immunization

Immunization strengthening project introduced by Govt. of India

TERMINOLOGY

VACCINATION: administration or inoculation of

vaccine

IMMUNIZATION: induction of an immune response

SEROCONVERSION: change from Ab-negative to

Ab-positive state

SEROPROTECTION: state of remaining protected

from the disease

VACCINE FAILURE: if disease occurs despite

immunization

HERD EFFECT: immunization of large number of

susceptible individuals, thereby preventing further

spread

IMMUNIZING AGENTS

VACCINES

IMMUNOGLOBULINS

ANTISERA OR ANTITOXINS

Types of Vaccines

Live vaccines

Killed vaccines

Toxoids

Subunit vaccines

Live Vaccines

Contains attenuated form of wild virus or bacteria. Must replicate to provide immunity

Produce local immunity.

More convenient for mass immunization

Single dose is sufficient usually

Unstable & severe reactions are possible

May get interfered by circulating antibodies egmaternal antibodies

Eg: Bacterial-BCG, Oral typhoid

Viral-OPV, MMR, Varicella

Killed Vaccines

Organisms are killed or inactivated by heat or

chemicals but remain antigenic.

Vaccines are stable

Immunity induced is not permanent

Multiple doses are required

Eg: Bacterial-DTPw, whole cell killed typhoid

Viral- IPV, Rabies, Hep A vaccine

Toxoids

Toxoids are modified toxins.

Primary immunization is in the form of multiple divided doses in order to decrease the adverse effects.

Booster doses are required to sustain the protection.

Eg: TT, diphtheria

Subunit Vaccines

Contains bacterial capsular polysaccharide

Eg: Hib, meningococcal, pneumococcal,

S.typhi(Vi)

Or contains viral surface antigens Eg: Hep B

Produce only IgM antibodies.

Combined Vaccines

More than one kind of immunizing agent is

included.

Aim:

To simplify administration

Reduce costs

Minimize the number of contacts of the patient

with health system

Eg: DTP, MMR, DT, DP

Route of Immunization

Intradermal - BCG

Subcutaneous - Measles, MMR, Meningococcal,

Varicella

Intramuscular -DTP, Hep A, HepB, Hib

SITE OF ADMINISTRATION

Deltoid- BCG

Triceps(Posterior skin fold)-Measles, MMR,

Meningococcal,

Varicella

Vastus lateralis(Anterolateral aspect of thigh in

infants) –

Principles of Immunization

A minimum interval of 4wks is essential between administration of 2 live vaccines.

2 or more killed antigens can be administered simultaneously or at any interval

If any relapse in administration occurs, the missed can be given to resume the course

If immunization status of child is unknown he may be given age appropriate vaccines

Do not mix vaccines in the same syringe

Contraindications

Congenital immunodeficiency, therapy with high

dose steroids, illness with immunosuppression,

severe allergic reaction to vaccines

The following are not contraindications :

Minor illness like URT infections & diarrhea, mild

fever, prematurity, allergy to penicillin, h/o allergies,

malnutrition, recent exposure to infections, current

antibiotic therapy

National Immunization

Schedule

Age Vaccine

Birth BCG, OPV – 0,Hep B0

6 wks DPT –1, OPV –1, Hep B1,Hib1

10 wks DPT – 2, OPV – 2, Hep B2, Hib2

14wks DPT – 3. OPV – 3, Hep B3, Hib3

9 months Measles, vitamin A1

16-24 months DPT – 4, OPV –4, vitamin A2

5 years DT

10 years TT

16 years TT

Pregnant women 2 TT at 4 wks interval

IAP Recommendation

Age Vaccine

Birth BCG,OPV-0,Hep B1

6 Wks DTP-1,IPV-1,Hep B2,Hib-1,

rotavirus1,PCV1

10 Wks DTP-2, IPV-2, Hib-2, rotavirus2,PCV2

14Wks DTP-3,IPV-3, Hib-3, rotavirus3, PCV3

6 months OPV1/Hep B3

9 months OPV2, measles

12 months Hep A1

15 months MMR1,Varicella1, PCV-B1

16-18 months DTP B1, IPV B1, Hib B1, Hep A2

2 Years Typhoid 1

5 years DTP-B2,OPV3,MMR2, Varicella2,

Typhoid2

10 Years TT , HPV

Cold Chain

It is the system of transporting, storing & distributing vaccines in a potent state at the recommended temperature from point of manufacture to point of use.

Consist of

Walk in rooms

Deep freezers

Ice lined refrigerators

Cold boxes

Ice packs

Commonly Used Vaccines

BCG (Bacillus Calmette Guerin)

Vaccine

Live attenuated

Common strains- Copenhagen (Danish 1331),

Pasteur,

Glaxo

Administered 0.1 ml i.d. on left shoulder at insertion

of deltoid.

Protection against miliary TB & tubercular

meningitis

Complications- ulceration, lymphadenitis

CI – cellular immunodeficiency, symptomatic HIV

Storage- 2-8 deg C, discard unused vaccine after 4

BCG VACCINATION

OPV

Live attenuated polio virus types1,2 & 3-developed by

sabin ,1961

Dose – 2 drops orally

Virus reach the intestine ;infect the mucosal cells to

elicit immune response

Adverse reactions- Vaccine derived poliovirus; Vaccine

associated paralytic poliomyelitis

CI- inherited or acquired immunodeficiency;

symptomatic HIV

IAP recommends additional doses of OPV as a part of

pulse polio program every year till age of 5 yrs

IPV

Formaldehyde killed polio virus grown in

monkey kidney or human diploid cell

Contains 20,8,32 D antigen units against type

1,2,3 polio viruses respectively

Dose- 0.5ml intramuscular or subcutaneous

Administer 3 doses at 6, 10, & 14wks

according to IAP

DTP

Diphteria toxoid, Tetanus toxoid & killed whole cell pertussis/ acellular pertussis vaccine

0.5 ml injected IM on anterolateral aspect of mid thigh.

Progressive neurological disease or serious adverse reaction to earlier dose, encephalopathy within 7 days of previous dose are contraindications for DPT(replace with DT)

Measles

Live attenuated vaccine

Strain – Edmonston Zagreb

0.5 ml injected S/C preferably right upper arm

Given at 9 months

CI- malignancy, immune deficiency, therapy with

alkylating agent/corticosteroid, untreated TB

MMR

Combination of Measles, Mumps, Rubella vaccines

Mumps- Jeryl Lynn strain

Rubella- RA 27/3 strain

Dose is 0.5 ml s/c preferably right upper arm

Adverse reactions- fever, transient rash, arthralgia,

aseptic meningitis,

lymphadenopathy

CI- malignancy, immunodeficiency, untreated

tuberculosis

Varicella Vaccine

Live attenuated Oka strain.

Dose 0.5ml s/c

Two doses given at 15-18m ,second dose given >3m after the first dose

Typhoid

WHOLE CELL:

Killed S.typhi often with S.paratyphi A(TA)

Primary course:2 doses 4 wks apart at 6-9 mo of age

or at any age

Boosters once in 3-5 yrs

Dose :0.25-0.5 ml S/C for primary,0.1ml for booster

Vi POLSACCHARIDE:

Developed by Robbins,1984

Inject IM at or after 2 yrs of age(0.5 ml)

Booster after 3 yrs

ORAL:

Live attenuated S.typhi

Strain name:Ty 21a

Enteric coated capsules administer orally 3

doses on alternate days

Repeat 3-5 yrs later

Recommended age 7 yrs or above

Hepatitis A

0.5ml im deltoid

2 doses beyond 1yr of age, given 6m apart

Aluminium hydroxide – adjuvant

Indication- children with c/c liver ds seronegative for

HA virus, children attending creches & day

care facilities, travellers to endemic areas

Effective if administered to unimmunised household

contacts of pts symptomatic with HAV within 10 days

Hepatitis B vaccine

Recombinant DNA vaccine

0.5ml IM in <1yr & 1ml >1yr

3 doses at 0, 1, 6 months

HBIG gives passive immunity- dose 0.5ml in

newborns & 0.6ml/kg for all other ages . It

should be given within 48 hrs of exposure

Hib vaccine

H . Influenza B-capsular polysaccharide

3 doses 6,10,14 wks

Booster 1 yr after primary dose

Dose 0.5 ml SC/IM over deltoid or

anterolateral aspect of thigh

Pneumococcal vaccine

High risk groups- childern< 2yrs , cogenital

immunodeficiency, HIV, asplenia, hyposplenia,

nephrotic syndrome

0.5ml IM 3 doses 6, 10, 14 wks with a booster

at 15-18m

Rotavirus Vaccine

Two live oral vaccines availiable – Rotarix & RotaTeq

Rotarix – monovalent (RV1) live attenuated vaccine

human rotavirus G1P(8) strain

given orally 1ml in a 2 dose schedule

RotaTeq – pentavalent (RV5) vaccine

strains reassorted between the bovine &

human

WC3 rotaviruses

given orally 2 ml in 3 dose schedule 2, 4 & 6

mo

Adverse reaction -intussusception

HPV vaccine

0.5ml IM at deltoid

Recommended age for initiation of vaccine is

10-12yr

HPV4- at 0, 2 & 6m

HPV2- at 0, 1 & 6m

Vaccines Recommended During

Epidemics

Japanese B Encephalitis vaccine

0.5ml s/c

Site- anterolateral thigh/ upper arm

1 dose at 9 m

Vaccination schedule for

unimmunised child

<7yrs >7 yrs

First visit BCG ,OPV ,DPT,Hep B TT/Td,Hep B

2ND visit(after 1 mo) OPV,DPT,Hep B TT/Td,Hep B

3RD visit(after 2 mo) MMR/Measles,Typhoid MMR,Typhoid

After 6 mo DPT, Hep B Hep B

Every 3 yrs Typh booster Typh booster

Vaccination for special occupations

Health care workers: hepatitis B, influenza, MMR

Public safety personnel (police, fire fighters) and staff of institutions for the developmentally disabled: hepatitis B, influenza

Vets and animal handlers: rabies, plague and anthrax

Sewage workers: DT, hepatitis A, polio, TAB

Food handlers: TAB

Military troops and camp dwellers: pneumococcal, meningococcal, influenza, BCG (for non reactors), tetanus

Vaccinations for special health

status persons

Immuno-compromised persons ( Leukemia,

lymphoma, HIV, malignancy…)

Hemodialysis and transplantation

Should receive the following vaccines according

to their situation:

HBV, Influenza, Pneumococcal vaccines

THANK U