VACCINES
Immunization :
IMMUNIZATION is the process of inducing immunity by administering a
vaccine prior to natural exposure to infectious agent(active
Immunization)or preformed antibodies soon after exposure,in order to
suppress disease (passive immunization).
Vaccination:
Vaccination is the process of administering a vaccine .This elicits
predominantly humoral immune response,cellular immunity or both
responses
Types of vaccines :
• Live attenuated
• Killed or inactivated
• Toxoid
• Subunit
Vaccination schedules :
Types of Vaccination Schedules:
1. National Immunization Schedule (NIS) [India] – Provided by the
Government of India under the Universal Immunization Programme (UIP). It
includes essential vaccines given free of cost to all eligible children and pregnant
women.
2. Indian Academy of Pediatrics (IAP) Schedule – Recommended by
the IAP, this schedule includes additional vaccines like influenza, HPV, and newer
combination vaccines for broader protection.
3. World Health Organization (WHO) Expanded Programme on
Immunization (EPI) – A global guideline adapted by countries to develop their
national schedules
Types of Immunization programs:
Universal Immunization Programme (UIP) (India) – Ensures free
vaccination against major infectious diseases.
• Mission Indradhanush – Aims to improve immunization
coverage in India.
• Pulse Polio Immunization Programme – Successfully
eradicated polio in India.
• Global Vaccination Initiatives – WHO-led programs to
eradicate diseases like polio and measles worldwide
Principles of immunisation
• a minimum interval of 4 weeks between two dose of same vaccine is required to ensure adequate
immune response
• A live and an inactivated vaccine can be administered simultaneously or at any interval of time.
• A delayed or lapse in the administration of a dose doesnot require the scheduled to be repeated , the
missed dose is administered and the course is resumed at the point it is interrupted .
• Patients should be observed for allergic reaction for 15-20 min after receiving vaccine .l
• Live vaccines are contraindicated in acquired immunodeficiency.
•
Commonly used vaccines :
BCG:
• Dose, Route
• Site
- 0.1ml, intradermal
- Left upper arm at insertion of deltoid
• Adverse reactions - Local ulceration or discharging sinus, axillary
lymphadenitis, disseminated infection, osteomyelitis.
• Contraindication - Cellular immunodeficiency, symptomatic HIV
• Storage -2-8°C; sensitive to heat & light; discard unused vaccine after 4 hr
POLIOMYELITIS
OPV-
• Dose-2 drops
• Route- Oral
• Adverse reactions-VDPV,VAPV
• Contraindications-Inherited or acquired immunodeficiency and
symptomatic HIV
• Storage-2-8°C; sensitive to heat ; use vaccine vial monitor
IPV
• Dose, Route- 0.5ml; i.m. or s.c.
• Adverse reactions - Local pain, swelling
• Contraindication - Known allergy
• Storage - 2-8°C sensitive to light
Diphtheria Toxoid, Tetanus Toxoid & Killed Whole Cell Pertussis or
Acellular Pertussis Vaccine
• Dose-0.5 ml
•Route-IM
• Site-Anterolateral aspect of mid thigh
• Contraindication - Progressive neurological disease, anaphylaxis after
previous dose, encephalopathy within 7 days of previous dose
• Precautions - Previous dose associated with
(i) fever >40.5°C within 48hr (ii) collapse within 48hr
(iii) persistent inconsolable crying for more than 3hr within 48hr
(iv) seizures within 72hr
• Storage
- 2-8°C; sensitive to light
PNEUMOCOCCAL VACCINE
• Dose -0.5 mL
• Route-IM
• Site-Anterolateral thigh
• Schedule -6 and 14 weeks
• Adverse effects -pain ,redness ,swelling at the injection site,fever,irritability
• Contraindications:.severe allergic reaction to a previous dose or vaccine
component and moderate or severe acute illness
Mild: Pain, redness, swelling at the injection site, fever, irritability.
• Rare: Allergic reactions, febrile se
Mild: Pain, redness, swelling at the injectAllergic reactions, febrile seizures
MEASLES VACCINE:
• Dose, route- 0.5ml, sc
• Site- Right upper arm or anterolateral thigh
• Adverse reactions - Fever, transient macular rash 5-10 days later.
• Contraindications - (i) immunosuppressive therapy eg:alkylating
agents, high dose corticosteroids (ii) malignancy (iii) immunodeficiency eg:
advanced HIV (iv)untreated TB
• Storage-2-8°C;sensitive to heat and light; use within 4-6
hrs of reconstitution
-
HBV(r DNA technology)
• Vaccine contains surface antigen HBsAg produced by rDNA technology and
adsorbed on aluminium salt adjuvant .
• Seroconversion rates exceeds95% after three HBV doses.an antibody
titre>10mI/ml is considered protective . Vaccination induces long term
immunity.
• DOSE 0.5 ML I/M ALT- L or deltoid avoid gluteal region
• CONTRAINDICATION ; anaphylaxis after previous dose..
• Adverse reaction : fever ,fatigue and local sore throat .
• If mother is known to be HBsAG positive the child should receive vaccine within
few hours of birth and hepatitis b immunoglobulins within 24 hours at separate
site ‘ if HBIG IS not given then accelerated rate 0 1 and 2 month with
additional dose at 9-12 month
Rotavirus vaccine
• Rota virus is the chief cause of diarrhoea in infants and toddler
accounting for 6-45% of diarrhoea related hospitalization in Indian
children .
• Natural infection doesnot protect against reinfection or severe cases.
• Available vaccine Rota Teq ;Rotarix ,Rotasiil and Rotavac.
• Rotavac is an indigineous monovalent human bovine recombinant live
attenuated vaccine based on the 116E strains.
• The vaccine has 49-54% efficacy against rotaviral diarrhoea in first 2
year of life,
116E human bovine monovalent
• 5 drops, oral
• given 3 dose at 6 ,10and 14 weeks
• Contraindications : past history of intussusception ;severe
immunodeficiency
• Postpone during ongoing diarrhoea or moderate illness
Varicella vaccine(attenuated live virus of oka
strains)
• Varicella vaccine not included in NIS.
• Varicella is benign self limiting illness except when it affects adults or
immunocompromised children leads to serious complications
include bacterial superinfection,pneumonia,laryngitis,cerebellar
ataxia, encephalomyelitis,thrombpcytopenia.
Influenza vaccine( not in NIS)
• Influenza has 3 antigenic types A to C and several subtypes based on
its surface antigens hemagglutinin and neuraminidase.
• Mutation due to antigenic drift and antigenic shifts results in frequent
change in circulating strains
• Inactivated influenza vaccine and live attenuated intra nasal vaccine
• 0.5 ml I/m ALT or upper arm
• ADVERSE reaction ; local pain, fever, nausea, anaphylaxis or Guillain –
Barre syndrome
• C/I anaphylaxis after previous dose
Meningococcal vaccine
• Neisseria meningitidis account for 30-40% cases of bacterial meningitis
• Invasive infection is caused by serogroup A<BC Y
W135and X are reported chiefly in either pre school
child or adolescent .
• Conjugate vaccine are preffered over polysaccharide
vaccine
yellow fever(17D-204 or17DD strains)
• Neutralizing antibodies develop in 90% vaccinees by 10 days and in1
for 100% by 3 week and persist for three decades.
• A single dose is administered at least 10 days before planned to
endemic areas.
Rabies vaccine:
• Route : IM/ID
• Site : Deltoid or anterolateral thigh infants ( never given in gluteal region)
• Dose and schedule:
• PrEP- IM -0.5ml or 1ml doses on days 0,7,21 or 28 and ID- 0.1 mL at two sites on days 0,7 and
21 or 28
• PEP-IM Regimen (ESSEN)-0.5 mL or 1mL Doses on days 0,3,7,14,28
• Zareb regimen -Two 0.5ml and 1ml doses on day 0 and followed by one dose on days 7 and 21
• Rabies immunoglobulin-
• For category III exposure
• Infiltration around the wound and remaining volume should be given IM
• Adverse effects- pain, swelling at the site of injection ,fever and headache
AEFI
• Can be categorised into following category
• (1) vaccine induced : event caused or precipitated by the active
components of vaccine. eg: paralytic poliomyelitis
• (2) vaccine potentiated; event precipitated by vaccine but may have
occurred without vaccine. eg :first febrile seizure.
• (3)injection reaction: anxiety ;pain due to injection,syncope after
vaccination
• (4) programme or immunization errors; event occurs due to error in
vaccine preparation, handling error
• (5) coincidental ; temporally linked by chance or due to unrelated
illness
