Immunization

IMMUNIZATIONNAVAS SHAREEF.P.PKMCT MED COLLEGE;CALICUT;INDIAEmail:nasmbbs@gmail.com

IMMUNIZATION

• Immunisation is the process by which acquired

immunity is induced.Acquired Immunity• Protection from disease

• Provided by introduction antigens or premade

antibodies into the body

Acquired Immunity

Active immunity

• In response to stimulus by an

antigen characterized by the

production of antibodies by the

host.

Passive immunity

• Immunity transferred in ready

made form.ie,no role of

immunesystem of the recipient.

Active immunity

Naturally acquired

• Repeated clinical &

subclinical infection

in childhood give

immunity.

• Eg:chicken pox

Artificially acquired

• Immunity induced

by vaccination

Passive immunity

Naturally acquired

• Transfer of maternal

antibodies

• Eg:

– Through placenta=Ig G

– Through colostrum=Ig A

Artificially acquired

• Following

administration of

Immune globulin or

antiserum

• Eg:Anti tetanus

serum(ATS)

Immunizing agents

• vaccines

• immunuglobulins

• antisera

VACCINATION

• A vaccine is an immuno-biological

substance(Ag) designed to produce specific

protection against a given disease.

• A vaccine is “antigenic” but not “pathogenic”.

Types of vaccines

• Attenuated live vaccines

• Inactivated killed vaccines

• Toxoids

• Polysaccharide and polypeptide (cellular fraction) vaccines

• Surface antigen (recombinant) vaccines.

Live Vaccines

Advantages • Single dose enough• Produce local immunity• lnduce cell mediated immunity• More convenient for mass immunization

Disadvantages• Reversion to virulence• Difficulty in storage

Killed Vaccines

Advantages• No danger of spread• Stability and safety

Disadvantages• Multiple injection may be required• May be contaminated with• dangerous infectious agent

LiveAttenuated vaccines

KilledInactivated vaccines

Toxoids Cellular fraction vaccines

Recombinant vaccines

•BCG•Typhoid oral•Plague•Oral polio•Yellow fever•Measles•Mumps•Rubella•IntranasalInfluenza•Typhus

•Typhoid•Cholera•Pertussis•Plague•Rabies•Salk polio•Intra-muscular influenza•Japanise encephalitis

•Diphtheria•Tetanus

•Meningococcal polysaccharide vaccine•Pneumococcal polysaccharide vaccine•Hepatitis B polypeptide vaccine

•Hepatitis B vaccine

Route

Intradermal BCG

Subcutaneous Measles, MMR, Meningococcal, Varicella

Intramuscular DTwP / DTaP, Hib, Hep A, Hep B, DTwP-Hep B-Hib, DTwP-Hep B, DTwP-Hib, Hep A-Hep B

VACCINE ADVERSE REACTIONS• Local

– Pain, swelling, redness at site of injection

– Common with inactivated vaccines

– Usually mild and self-limited

• Systemic

– Fever, malaise, headache

– Nonspecific

– May be unrelated to vaccine

• Allergic

– Due to vaccine or vaccine component

– Rare

VACCINE COLD CHAIN

• The system of transporting, storing and distributing vaccines in

a potent state at the recommended temperature from the

point of manufacture to the point of use is the Cold Chain.

• Vaccine potency once lost cannot be restored.

VACCINE COLD CHAIN

Vaccine vial monitor

• Whole cell vaccine– Contains suspension of whole bacterial cells

that have been killed. Eg: DTwP– More effective but less safe

• Acellular vaccine– Cell free vaccine prepared from purified

antigenic component of cell free microorganism.

– ie,doesnot have complete cell but contains fragments of cell best suited to stimulate immune response. Eg: DTaP

– Less effective than DTwP but more safe

Vaccine Failure

• Primary = administration of recommended dose of vaccine

doesnot result in adequate protection against disease.

• Secondary = disease occur inspite of immunsiation.

INDIVIDUAL VACCINES

BCG VACCINE

• Live attenuated vaccine (Bacille Calmettee – Guerin strain)

• Dose: 0.05ml in neonates & 0.1ml in others

• Intradermal injection in to left hand on deltoid area.

• Controls hematogenous spread thus preventing Miliary TB,

Disseminated TB, TB Meningo encephalitis(80%)

• Reconstitute with 1 ml of Sodium Chloride Inj. IP.

• Complications:ulceration ,lymphadenitis...

• C.I ---immunocompromised

Oral Polio Vaccine

• OPV – Live attenuated Polio virus

– Type I - Type II - Type III

• Dose – 2 drops oral at birth,6,10, 14 weeks, 16-24 months

• Contraindication-in immunocompromised, diarrhea, infectious fever

• MgCl2 is the stablizing agent

• Pulse polio immunization -- giving 2 doses 1month apart

• Complications: Vaccine associated paralytic polio--VAPP (due to type

2)

Injectable Polio Vaccine

• Formaldehyde killed and purified poilio virus– Type I-40– Type II-8 D antigen units– Type III-32

• Immunity – humoral, local pharyngeal, intestinal

• Safe • 6,10,14 weeks according to IAP

DTwP / DTaP vaccines• DTaP has been licensed in India for private use

• Current recommendations for use of DTaP

– For infants who had severe reaction to 1st dose of DTwP

– For adolescents and adults

– For infant immunized abroad with DTaP

• DTaP adult formulation has now been recommended as booster by

WHO for adolescents and adults.

• Absolute contra indications for DTwP

– Anaphylaxis to previous dose

– Progressive neurological disorder

– Hypotensive hyporesponsive episodes

MEASLES VACCINE

• Live attenuated vaccine (Edmonston-Zagreb strain)

• Given IM or SC

• Given at 9 months (because at that time maternal antibody

wean off)

• Contraindications

– Malignancy

– Therapy with alkylating agent/ corticosteroid

– Immune deficiency

• Side effect -- TSS (toxic shock syndrome) due to bacterial

contamination.

MMR vaccine

• Measles---Edmonston-Zagreb strain

• Mumps-Jeryl Lynn strain

• Rubell--RA 27/3 strain

• Dose is 0.5 ml (2 dose one at 15 month and another 8 weeks

later) (S / C).

• Contraindication--pregnancy,immunosuppression

HEPATITIS B VACCINE

• Recombinant DNA vaccine (in yeast)

• 0.5 mL IM in <1 year and 1 mL > 1 year

• 3 doses at 0, 1, 6 months

• HBIG gives passive immunity

• HBIG should be given preferably within 48 hours of exposure.

TYPHOID VACCINE

• 2 doses• 0.5 mL SC 1 month interval (killed vaccine)• Typhoral-- oral live vaccine (stable mutant S. typhi strain type 2

Ia)• Typhim-- give SC or IM single dose

Hib VACCINE

• Capsular polysaccharide used as antigen

• Given particularly prior to splenectomy

• 3 dose below six months

• 2 dose between 6-12 months

• 1 dose between 12-15 months

• And a booster dose should be in this children at 18

months

• >15 months--only one dose

HPV Vaccine

• 0.5 mL IM deltoid

• Recommended age for initiation of vaccine is

10-12 years

• 3 doses at 0,2,6 months

Chickenpox Vaccine

• Dose--0.5 mL S /C or IM 2 doses 4-8 weeks apart

>13 years

Pentavalent vaccine

• Trail in Kerala,Tamil Nadu

• Contains D , P , T , Hib , Hep B.

• Schedule-6,10, 14 week

National Immunization ScheduleAge Vaccines

Birth BCG, OPV0 (for institutional deliveries)

6 weeks DTwP1, OPV1, HepB1, Hib1$$ (BCG if not given at birth)

10 weeks DTwP2, OPV2, HepB2, Hib2

14 weeks DTwP3, POV3, HepB3, Hib3

9-12 months Measles

16-24 months DTwP B1, OPV4, MMR

5-6 years DTwP

10 years TT

16 years TT

Pregnant women TT1 (early in pregnancy)TT2 (1 month later)TT booster (if vaccinated in past 3 years)

IAP recommended vaccines for routine use

Vaccines under special circumstances

BCG, OPV IPV DTwP/DTaP DTTd TdapMeaslesTyphoidHibHep BMMRHPVPCVHepatitis AChicken PoxRotavirus vaccine

RabiesInfluenza PPSV23Japanese Encephalitis Meningococcal Cholera Yellow Fever

IAP Immunization Time Table (recommended vaccines for routine use)

Age (completed weeks/ months/years) Vaccines

Birth BCGOPV0HepB 1

6 weeks DTwP1/DTaP1OPV1*/ OPV1 + IPV1Hib1HepB2Rotavirus 1 *#PCV 1

10 weeks DTwP2/ DTaP2OPV2*/ OPV2 + IPV2Hib 2Rotavirus 2PCV 2

14 weeks DTwP3/ DTaP3OPV3*/ OPV3 + IPV3Hib3Rotavirus 3HepB3**PCV 3

9 months Measles

12 months Hepatitis A 1

15 months MMR1VaricellaPCV booster

16 to 18 months DTwP B1/ DTaP B1OPV4*/ OPV4 + IPVB1Hib B1

18 months Hepatitis A 2

2 years Typhoid 1

5 years DTwP B2 / DTaP B2OPV5MMR2Typhoid 2Varicella 2

10 to 12 years Tdap/TdHPV^

vaccination schedule for an unimmunized childVisit Suggested vaccines

First Measles (MMR if more than 12 months)DTwP1/DTaP1 (Tdap if 7 years or more)OPV1/IPV1 (only if less than 5 years)Hib 1 (Only if less than 5 years)Hep B 1

Second visit(after 1 month of first visit)

BCG (only in less than 5 years)DTwP2/ DTaP2 (Td if 7 years or more)OPV 2 (if OPV given earlier)Hep B 2Hib 2 (if less than 15 mths

Third visit (after 1 month of second visit)

OPV3/IPV2MMR (if more than 12 months)Typhoid (if more than 2 years)

Fourth visit(6 months after first visit)

DTwP3/DTaP3 (Td if 7 years or more)OPV4/IPVB1HepB3

Do’s and Don'ts After Vaccine Administration

• Do not rub the site vigorously.• Gentle pressure at the site for a few seconds will suffice. • If blood oozes do not blot. Just apply gentle pressure

with cotton swab.• No Heat, Ice or Cold Water fomentation is advocated.• The wet cloth soaked in ordinary portable water can be

applied at the site of swelling or tenderness for about 5 – 10 minutes.

• Repeat the procedure, if necessary, 3-4 times a day.

THANK YOU