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IMMUNISATIONIMMUNISATION
ANVARAZAD.MANVARAZAD.M
T.D.MedicalT.D.Medical collegecollege
AlappuzhaAlappuzha
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DEFINITIONDEFINITION
ImmunizationImmunization is the process ofinducingimmunityis the process ofinducingimmunityartificially by either vaccinationartificially by either vaccination
( active immunization ) or administration of( active immunization ) or administration ofantibody ( passive immunization ).antibody ( passive immunization ).
ACTIVE IMMUNIZATIONACTIVE IMMUNIZATION
Stimulatesimmune system to produce antibodiesStimulatesimmune system to produce antibodiesand cellularimmune responses that protect againstand cellularimmune responses that protect againstinfectious agent.infectious agent.
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PASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION
Provides temporary protection throughProvides temporary protection through
administration of exogenously produced antibodyadministration of exogenously produced antibodysuch asimmune globulin.such asimmune globulin.
Also occursnaturally throughAlso occursnaturally through transplacentaltransplacentaltransmission of antibodies to a fetus.transmission of antibodies to a fetus.
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VaccineVaccine
::A product of weakened or killedmicroorganismA product of weakened or killedmicroorganism
(bacterium or virus) given for the prevention or(bacterium or virus) given for the prevention or treatrea
tmenttment ofinfectiousdiseasesofinfectiousdiseases
Types of vaccinesTypes of vaccines
11-- Killed or inactivated vaccinesKilled or inactivated vaccines e.g. TAB vaccine fore.g. TAB vaccine for
typhoid and para-typhoid, Salk vaccine for poliomyelitistyphoid and para-typhoid, Salk vaccine for poliomyelitis
and human rabies vaccines.and human rabies vaccines. 22-- living attenuated vaccinesliving attenuated vaccines e.g. Sabin vaccine fore.g. Sabin vaccine for
poliomyelitis BCG vaccine for tuberculosis, 17poliomyelitis BCG vaccine for tuberculosis, 17--D vaccineD vaccine
for yellow fever, MMR vaccinefor yellow fever, MMR vaccine
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33-- ToxoidsToxoids:: These are vaccines prepared byThese are vaccines prepared by
detoxifying the toxins ofsome bacteria, e.g.detoxifying the toxins ofsome bacteria, e.g. toxoidtoxoidvaccines fordiphtheria and tetanusvaccines fordiphtheria and tetanus
44--VaccinesVaccines preparedprepared fromfrom bacterialbacterial oror viralviralcomponentscomponents
a)a) TheThe capsularcapsular polysaccharidepolysaccharide vaccinevaccine ofofMeningococciMeningococci,, pneumococcipneumococci,, andand HH.. influenzasinfluenzastypetype bb..
b)b) AcellularAcellular vaccinevaccine ofof BB.. pertussispertussis containingcontaining thethepurifiedpurified proteinsproteins fromfrom thethe organismorganism
c)c) PurifiedPurified surfacesurface antigensantigens ofof hepatitishepatitis BB virus,virus,
d)d) TheThe splitsplit virusvirus vaccinevaccine ofofinfluenzainfluenza virusvirus containingcontaining
haemagglutininhaemagglutinin andand neuraminidaseneuraminidase..
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55--Recombinant vaccinesRecombinant vaccines prepared by recombinantprepared by recombinant
DNA technology, e.g. hepatitis B virus vaccineDNA technology, e.g. hepatitis B virus vaccine..
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NationalNational ImmunisationImmunisation ScheduleSchedule
VaccineVaccine
BCG, OPVBCG, OPV 00
DPTDPT 1, OPV1, OPV 11
DPTDPT 2, OPV2, OPV 22
DPTDPT 3. OPV3. OPV 33
MeaslesMeasles
DPTDPT 4, OPV4, OPV 44
DTDT
TTTT
TTTT
AgeAge
BirthBirth
6 wks6 wks10 wks10 wks
14wks14wks
9months9months
1515--18 months18 months
5 years5 years
10 years10 years
16 years16 years
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Cold chainCold chain The system of transporting,distributing andstoringThe system of transporting,distributing andstoring
vaccines from the manufacturers right up to thevaccines from the manufacturers right up to the
point ofuse under refrigerationusing anypoint ofuse under refrigerationusing any
convenient methodis referred to as cold chainconvenient methodis referred to as cold chain
Vital linkinVital linkinimmunisationimmunisation
Ifnot maintained, vaccine efficacy will grosslyIfnot maintained, vaccine efficacy will grossly
suffersuffer
Safe temp. zoneSafe temp. zone mandatory to maintain potencymandatory to maintain potency
Safe zone forshort termstorage (1Safe zone forshort termstorage (1--2 months)is 22 months)is 2--88
deg C. For long termstoragedeg C. For long termstorage 2020 degCdegC isused onlyisused only
forfor BCG,OPV,MeaslesBCG,OPV,Measles/MMR/MMR
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The T series of vaccine(DPT,DT,TT),typhoidThe T series of vaccine(DPT,DT,TT),typhoid
Vi,HepVi,Hep B shouldnot be frozen as once frozen theB shouldnot be frozen as once frozen thealuminiumaluminium saltsused as adjuvant will be desiccatedsaltsused as adjuvant will be desiccated
and will act asand will act asirritantirritantsterilesterile abcessabcess
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BCG VaccineBCG Vaccine
Protects against TB meningitis,Protects against TB meningitis,MiliaryMiliary T BT B Induces long term protectionInduces long term protection
SCHEDULESCHEDULE
Single doseSingle dose
DOSEDOSE
DosDosee0.05 ml(infants),0.1 ml(infants and children)0.05 ml(infants),0.1 ml(infants and children)
ADMNSTRNADMNSTRN
IntraIntra--dermal over left deltoiddermal over left deltoid C/IC/I--
Immune deficiencyImmune deficiency
Side effectSide effect
--AxillaryAxillary adenitisadenitis
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OPVOPV
Live attenuated polio virus types1,2&3Live attenuated polio virus types1,2&3--INITIATIONINITIATION -- BirthBirth
SCHEDULESCHEDULE -- Birth,6,10,14 wksBirth,6,10,14 wks
BOOSTERBOOSTER -- 1515-- 18 mo,5 yrs18 mo,5 yrs
DOSEDOSE -- 2 drops2 drops
ADMNSTRNADMNSTRN -- OralOral
C/IC/I -- ImmunoImmuno defeciency,HIVdefeciency,HIV
S/ES/E -- nonenone
part of pulse polio program every year till age of 5 yrspart of pulse polio program every year till age of 5 yrs
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IPVIPV
Formaldehyde killed polio virusgrowninmonkeyFormaldehyde killed polio virusgrowninmonkeykidney or humandiploid cellkidney or humandiploid cell
Contains 20,8,32 D antigenunits against type 1,2,3Contains 20,8,32 D antigenunits against type 1,2,3
polio viruses respectivelypolio viruses respectively SeroconversionSeroconversion 9090--95% after 2 doses,99% after 395% after 2 doses,99% after 3
dosesdoses
Thermo stable andindicatedinThermo stable andindicatedinimmunocompromisedimmunocompromised andHIVandHIV
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DPTDPT DPTDPT--killedkilled pertusis+toxoidpertusis+toxoid diph&tetanusdiph&tetanus ToxoidsToxoids
adjuvatedadjuvated ((AluminiumAluminium hydroxide/ phosphate)hydroxide/ phosphate)
INITIATIONINITIATION -- 6 wks6 wks
SCHEDULESCHEDULE -- 3 doses 6,10,14 wks3 doses 6,10,14 wks
DOSEDOSE -- 0.5 ml0.5 ml
BOOSTERBOOSTER -- 1515-- 18 mo,5 yrs18 mo,5 yrs
ADMNSTRNADMNSTRN -- I/MI/M anterolateralanterolateral thighthighC/IC/I -- ProgProg neuroneuro dis,uncontrolleddis,uncontrolled cry,cry,
convulsion,convulsion,
S/ES/E -- Fever,localFever,local indurn,painindurn,pain
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MMRMMR
Live attenuated vaccineLive attenuated vaccine
Supplied freeze driedSupplied freeze dried-- store frozen or refrigeratedstore frozen or refrigerated
0.5 ml injected S/C preferably right upper arm0.5 ml injected S/C preferably right upper arm
Age at which recommended9monthsAge at which recommended9months
During outbreak>6 monthsDuring outbreak>6 months
Ifgiven < 9mo repeat dose after 3 moIfgiven < 9mo repeat dose after 3 mo
Possibility of fever for 5Possibility of fever for 5--10 days10 days
MMRMMR--0.5ml S/C over deltoid(15mo)0.5ml S/C over deltoid(15mo) C/IC/I -- AsinAsinmeasles+pregnancymeasles+pregnancy,, ImmImm defdef
S/ES/E -- Asinmeasles, FeverAsinmeasles, Fever
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TyphoidTyphoid
WHOLE CELLWHOLE CELL::
KilledKilled S.typhiS.typhi often withoften with S.paratyphiS.paratyphi A(TA)A(TA)
Liquid,storeLiquid,store refrigerated,injectrefrigerated,inject S/cS/c
Primary course:2 doses 4 wks apart at 6Primary course:2 doses 4 wks apart at 6--9mo of age or at9mo of age or at
any ageany age
Boosters once in 3Boosters once in 3--5 yrs5 yrs
Dose :0.25Dose :0.25--0.5 ml S/C for primary,0.1ml for booster0.5 ml S/C for primary,0.1ml for booster
C/IC/I -- NoneNone
S/ES/E -- Fever,painFever,pain,,
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ViPOLSACCHARIDEViPOLSACCHARIDE
Liquid,Liquid, adjuvated,storeadjuvated,store refrigeratedrefrigerated
Inject IM at or after 2 yrs of age(0.5 ml)Inject IM at or after 2 yrs of age(0.5 ml)
Booster after 3 yrsBooster after 3 yrs
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ORALORAL::
Live attenuatedLive attenuated S.typhiS.typhi
StrainStrainname:Tyname:Ty 21a21a
Enteric coatedEnteric coated capsules,storecapsules,store refrigerated,refrigerated,
administer orally 3 doses on alternate daysadminister orally 3 doses on alternate days
Repeat 3Repeat 3--5 yrs later5 yrs later RecommendeRecommende age7 yrs or aboveage7 yrs or above
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HibHib vaccinevaccine H . Influenza BH . Influenza B--capsular polysaccharidecapsular polysaccharide
Liquid or freeze driedLiquid or freeze dried
Age ofinitiation 6 wksAge ofinitiation 6 wks
3 doses 6,10,14 wks/2,4,6 mo3 doses 6,10,14 wks/2,4,6 mo
Booster 1 yr after primary doseBooster 1 yr after primary dose
Dose 0.5 ml SC/IM overdeltoid orDose 0.5 ml SC/IM overdeltoid or anterolateralanterolateral
aspect of thighaspect of thigh
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PneumococcalPneumococcal
Capsular polyCapsular poly saccharidesaccharide
INITIATIONINITIATION -- >2 yrs>2 yrs
SCHEDULESCHEDULE -- Single doseSingle dose
BOOSTERBOOSTER -- Every 3Every 3--5 yrs5 yrs
DOSEDOSE -- 0.5 ml0.5 ml
ADMNSTRNADMNSTRN -- SC/IM over Ant. Lat thighSC/IM over Ant. Lat thigh
C/IC/I -- First trimester pregnancyFirst trimester pregnancy
S/ES/E -- nonenone
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VaricellaVaricella vaccinevaccine
OKA strain ofOKA strain of varicellavaricella zoster10zoster1033
INITIATIONINITIATION -- >1 yr>1 yr
SCHEDULESCHEDULE -- 11--12 yrs(single dose),>13 yrs 212 yrs(single dose),>13 yrs 2
doses 1 mo apartdoses 1 mo apart BOOSTERBOOSTER -- NilNil
DOSEDOSE -- 0.5 ml0.5 ml
ADMNSTRNADMNSTRN -- SC deltoidSC deltoid C/IC/I -- NoneNone
S/ES/E -- VaricellaVaricella type rash after 1 wk withtype rash after 1 wk with
feverfever
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Hepatitis AHepatitis A
Inactivated vaccine .Inactivated vaccine . INITIATIONINITIATION -- >2 yr s>2 yrs
SCHEDULESCHEDULE -- 2 doses 0, 6 mo2 doses 0, 6 mo
DOSEDOSE -- 0.5 ml0.5 ml
No boostersNo boosters
ADMNSTRNADMNSTRN -- IMIM anteroantero lat thighlat thigh
C/IC/I -- NoneNone
S/ES/E -- Mild reactionMild reaction
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MeningococcalMeningococcal
N.meningitidisN.meningitidis groupA,CgroupA,C
INITIATIONINITIATION -- For use only in endemic areasForuse only in endemic areas
during epidemics.>2 yrsduring epidemics.>2 yrs
SCHEDULESCHEDULE -- Single doseSingle dose
BOOSTERBOOSTER -- 5 yrs5 yrs
DOSEDOSE -- 0.5 ml0.5 ml
ADMNSTRNADMNSTRN -- SC/IMSC/IM--deltoid/Ant lat thighdeltoid/Ant lat thigh
C/IC/I -- NoneNone
S/ES/E -- LocalLocal rxnrxn,mild fever,mild fever
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Vaccines for high risk groupVaccines for high risk group
PNEUMOCOCCAL VACCINEPNEUMOCOCCAL VACCINE::
Polysaccharide vaccine(23Polysaccharide vaccine(23 valentvalent))
77 ValentValent conjugated with CRM 197 diphtheriaconjugated with CRM 197 diphtheriatoxintoxin
2323 valentvalent effective after 2 yrs of ageeffective after 2 yrs of age
Single dose 0.5 ml IM with booster every 3Single dose 0.5 ml IM with booster every 3--55yrsyrs
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IndicationsIndications
Sickle cell diseaseSickle cell disease
NephroticNephrotic syndrome in remissionsyndrome in remission
Congenital or acquiredCongenital or acquired aspleniaasplenia//splenicsplenic dysdys functionfunction
HIVHIV
Chronic cardiac/pulmonary diseaseChronic cardiac/pulmonary disease
ImmunodeficientImmunodeficient conditionsconditions
CSF leakCSF leak DiabetesmellitusDiabetesmellitus
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Combination vaccinesCombination vaccines
DPT/DPT/HiBHiB//HepBHepB Benefits:Benefits:
1. Reducednumber ofinjections1. Reducednumber ofinjections
2. Reduced pain and parental anxiety2. Reduced pain and parental anxiety
3. High compliance, low drop out3. High compliance, low drop out rates,enhancedrates,enhanced coveragecoverage
4. Reducedno: of visits4. Reducedno: of visits
5. Lessstorage space5. Lessstorage space
6. Less burden on cold chain6. Less burden on cold chain
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ADVERSEEFFECTSADVERSEEFFECTS
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11--AnaphylaxisAnaphylaxis {any{anyVACCINE}VACCINE}
SYMPSYMP--W/IW/I minutes,acuteminutes,acute decompensationdecompensation of circ.of circ.
System,hypovolemicSystem,hypovolemic shock,laryngealshock,laryngealspasm/spasm/edema.Acuteedema.Acute respiratory distressrespiratory distress
MANAGEMENTMANAGEMENT--
Adrenaline,CPR,IVAdrenaline,CPR,IV volume expanders orvolume expanders ordopamine/dopamine/dobutaminedobutamine, hydrocortisone, hydrocortisone
22 DPTDPT
ADRADR-- Hypotensive,hyporesponsiveHypotensive,hyporesponsive episodesepisodesSYMPSYMP --Within 12Within 12 hrs.Acutehrs.Acute paleness.Transientpaleness.Transient
decreased levels/loss ofdecreased levels/loss of consciousness.Decconsciousness.Dec musclemuscle
tonetone
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MANAGEMENTMANAGEMENT
IV fluids, corticosteroid,IV fluids, corticosteroid, SedationSedation ,oxygen,,oxygen,feeding advicefeeding advice
Measles contamination by S.Measles contamination by S. AureusAureus
ADRADR --Toxic shocksyndromeToxic shocksyndrome
SYMPSYMP--Within 30 minWithin 30 min-- few hrs. Mountingfew hrs. Mounting
fever,vomitingfever,vomiting,,diarrhoea,septicdiarrhoea,septic shockshock
MANAGEMENTMANAGEMENT
IVIV fluids,antifluids,anti microbials,cloxacillinmicrobials,cloxacillin 5050--100100
mg/kg/day,mg/kg/day,steroids,antipyretics,supportivesteroids,antipyretics,supportive therapytherapy
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BCGBCG
ADRADR--lymphadenitislymphadenitis
SYMPSYMP--Within 2Within 2--6 months firm6 months firm--softsoft axillaryaxillary
lmphadenitis1.5lmphadenitis1.5--3 cm with/ without sinus3 cm with/ without sinus MANAGEMENTMANAGEMENT
....AspirationifAspirationifneeded.Steroidneeded.Steroid ifsinus presentifsinus present
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DPT,DT,TT,TyphoidDPT,DT,TT,Typhoid &HEP A&HEP AADRADR--SterileSterile abcessabcess
SYMPSYMP--By 72 hrs,minimumBy 72 hrs,minimuminflamationinflamation,no fever,no fever
MANAGEMENTMANAGEMENT
Drainage ifneededDrainage ifneeded
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measlesmeasles
ADRADR--Seizures with fever(rare)Seizures with fever(rare)
SYMPSYMP--AlwaysAlwaysgeneralisedgeneralised simple/complexsimple/complex
MANAGEMENTMANAGEMENT
Anticonvulsant,antipyretic,IVAnticonvulsant,antipyretic,IV fluids(ifneeded)fluids(ifneeded)
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THANKYOUTHANKYOU