IMMUNIZATION
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