immunization

1. IMMUNIZATION

2. Beginning of Vaccination
Vaccination ( Latin ;
Vacca- Cow )
Edward Jenner used
the
term Vaccination
Cow pox virus provided
immunity in prevention
of Small pox

3. Edward Jenner Vaccinating

4. 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

5.  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

6. 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

7. IMMUNIZING AGENTS
 VACCINES
 IMMUNOGLOBULINS
 ANTISERA OR ANTITOXINS

8. Types of Vaccines
 Live vaccines
 Killed vaccines
 Toxoids
 Subunit vaccines

9. 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 eg
maternal antibodies
Eg: Bacterial-BCG, Oral typhoid
Viral-OPV, MMR, Varicella

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. Commonly Used Vaccines

21. 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

22. BCG VACCINATION

23. 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

25. 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

26. 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)

27. 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

28. 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

29. 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

30. 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

31. 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

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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

38. Vaccines Recommended During
Epidemics
 Japanese B Encephalitis vaccine
 0.5ml s/c
 Site- anterolateral thigh/ upper arm
 1 dose at 9 m

39. 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

40. 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

41. 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

42. THANK U 