IMMUNIZATION SCHEDULES

INTRODUCTION
Immunization is a process of protecting an individual from a disease through introduction of live, or killed
or attenuated organisms in the individual system. It is one of the ‘best buys ‘in community health and one of
the most cost-effective health interventions. Immunization against vaccine-preventable disease is essential to
reduce the child mortality, morbidity and handicapped conditions. It is mass means of protecting the largest
number of people from various diseases. It gives resistance to infectious diseases by producing or
augmenting the immunity. Artificially acquired immunity is developed by the immunization.

Immunity is the security against a particular disease and no susceptibility to the invasive or
pathogenic effects of foreign microorganisms or to the toxic effect of antigenic substances. Acquired
immunity can be active or passive.

 Active Immunity is produced by stimulating immunological defence mechanism through

administration of antigen usually prior to natural exposure to infection. Active immunizing agents
are known as vaccines.
 Passive immunity is produced temporarily by supplying preformed exogenous animal or human
antibody to suppress the disease, given soon after or prior to exposure of an infection. It is
readymade antibodies. Passive immunity agents are antiserum and immunoglobulin.
 THE WORLD'S LARGEST VACCINATION REMINDER SERVICE

IAP-Immunize India is the world's largest vaccination reminder service, and is available free of cost to
parents anywhere in India. It is a national non-profit initiative under the aegis of Indian Academy of
Paediatrics. The initiative is supported by Vodafone, our national telecom partner.
The program was launched in March 2014 at a function in Delhi by Chief Guest Shri C K Mishra,
Additional Secretary, Ministry of Health and Family Welfare, Government of India.
IAP-Immunizeindia aims to prevent a hundred thousand child deaths and disabilities by 2020.
IAP Immunizeindia mission is to enrol 20 million children by 2020. To achieve this ambitious target, IAP
has expanded the SMS service in November 2017 by launching the IAP Immunize India mobile application,
available in 12 Indian languages. IAP Immunizeindia sends free of cost reminders to parents according to
the IAPCOI prescribed immunization schedule for 12 years.

VACCINE PREVENTABLE DISEASES:-

Some infectious diseases can be prevented by vaccines. The diseases against which vaccines are currently
available:

a) Six-killer vaccine preventable diseases, i.e.Poliomyelitis,Tuberculosis,Diphtheria,Pertusis,Tetanus

and Measles.
b) Other vaccine preventable diseases include Hepatitis “B”,Mumps,Rubella,Hemophilus influenza
type B(Hib)infections,
c) Typhoid,
d) Meningococcal meningitis,
e) Japanese encephalitis,
f) Influenza,
g) Pneumococcal pneumonia,
h) Chickenpox,
i) Rotavirus diarrhoea Yellow fever,
j) Cholera,Malaria,Hepatitis ‘A’,
k) Plague and Rabies.

IMMUNIZING AGENTS:-The immunizing agents may be classified as vaccines,immunoglobulins and

antisera.
Vaccines
Vaccines are immunobiological substances which produce specific protection against a given disease. It
stimulates active production of protective antibody and other immune mechanisms. Vaccines are prepared
from live attenuated organisms, or inactivated or killed organisms, extracted cellular fractions, toxoid,
toxoids or combination of these. The following immunizing agents are currently used:
Live Attenuated Vaccines
 Bacterial-BCG,Typhoid(oral),Plague.
 Viral-Oral polio,Measles,Mumps,Rubella,Yellow fever,Influenza.
 Rickettsial-Epi.typus.
Killed or Inactivated Vaccines
 Bacterial-Pertusis,Typhoid,Cholera,Plague,CS meningitis.
 Viral-Rabies,Hepatitis “B”,Influenza,Salk polio,Japanease encephalitis.
Toxoids - Bacterial-Diptheria and Tetanus.
Cellular fractions - Meningococcal and pneumococcal vaccines.
Combinations - DPT(Diphtheria, Pertussis,Tetanus)
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MmR(Mumps,Measles,Rubella)
DT(Diphtheria,Tetanus)
Hib-Hep.B(H.influenzar ‘B’, Hepatitis ‘B’

The human immunoglobulin(Ig)system is composed of 5 major classes(IgG,IgM,IgA,IgD and IgE)and

subclasses within them.The various classes and subclasses of Igs represent different functional groups that
are required to meet different functional groups that are required to meet different types of antigenic
challengers.All antibodies are immunoglobuins,but it is still an open question whether all immunoglobulins
areantibodies.The WHO recommends that the term “gamma globulin”should not be used as a synonym for
“immunoglobulin”.
Two types of immunoglobulin preparations are available for passive immunization .These are normal
human immunoglobulin and specific(hyperimmune) human immunoglobulin.They are used in the
prophylaxis of viral and bacterial infections and in replacement of antibodies in immunodeficient
patients.The available human immunoglobulins are:-
 Normal Human Ig-Hepatitis ‘A’,Measles,Rabies,Tetanus and Mumps.
 Specific H
 human Igg-Hepatitis
Various vaccines in immunization schedules
Bacillus Calmette-Guerin (BCG) Vaccine-
BCG vaccine provides immunity or protection against tuberculosis (TB). The vaccine may be given to
persons at high risk of developing TB. It is also used to treat bladder tumors or bladder cancer.
Roadmap of vaccine introduction (Since 2010 several new vaccines introduced in country UIP
Rotavirus vaccine Expansion Plan in India
Criteria for State selection for RVV introduction
 Diarrheal disease burden
 AEFI preparedness
 Routine immunization coverage and system preparedness
 State willingness to introduce RVV
 Till March’ 19, around 6.49 crore doses of Rotavirus vaccine have been administered to
children.
 Expansion of Rotavirus vaccine under ‘POSHAN Abhiyaan’ to be done in all states in 2019-
20 as per the directions of PMO
Measles Rubella (MR) Campaign

• WHO-SEARO goal of achieving Measles elimination by 2020, also reiterated by Hon’ble Finance
Minister in the budget speech of 2017.
• Measles-Rubella vaccination campaign launched in Feb’17 targeting approx. 41 crore children aged
9 months-15 years across the country.
• Campaign has been completed in 31 states/UTs and ongoing in 1 state (Meghalaya).
• Subsequent to the completion of campaign, MR vaccine introduced in Routine Immunization
replacing Measles vaccine at 9-12 months and 16-24 months of age.

Inactivated Polio Vaccine

 • Launched on 30th November 2015, initially in 6 states.
• Expanded to all states by April 2016.
• 2 doses of fractional IPV (fIPV) given at 6 and 14 weeks of age of child.
• Till March ’19, around 8.89 crore doses of IPV vaccine have been administered to children across
country.
Japanese Encephalitis (JE)

• JE vaccination: One time campaign strategy à single dose JE vaccine targeting all children from 1
to <15 years of age àJE vaccination is included into RI in endemic districts.
• 268 JE endemic districts (including 37 identified in April’18) identified across 21 states – campaigns
completed in 230 districts à JE now part of RI.
• Around 15.5 crore children immunized during the campaign
 • 35 high burden districts (including 4 identified in April’18) identified in 3 states for Adult JE
vaccination in endemic blocks (Assam, UP, West Bengal).
• Adult JE vaccination campaign completed in 31 districts; more than 3.3 crore beneficiaries aged 15-
65 years were vaccinated.
Tetanus & adult Diphtheria (Td) vaccine

• Increase in immunization coverage in children led to shift in age-group of diphtheria cases to school
going children and adults.
• Tetanus and adult Diphtheria (Td) vaccine has been recommended by National Technical Advisory
Group on Immunization (NTAGI) in 2016.
• TT vaccine has been replaced by Td vaccine and will provide protection against both Tetanus and
Diphtheria in adults.
• Td vaccine will replace 2 doses of TT or single booster dose of TT given to pregnant woman and
booster doses at 10 and 16 years of age.

Bacillus Calmette–Guérin (BCG) vaccine-

 BCG is a vaccine primarily used against tuberculosis (TB).

 It is named after its inventors Albert Calmette and Camille Guérin. In countries where tuberculosis
or leprosy is common, one dose is recommended in healthy babies as soon after birth as possible.
 In areas where tuberculosis is not common, only children at high risk are typically immunized, while
suspected cases of tuberculosis are individually tested for and treated.
  Adults who do not have tuberculosis and have not been previously immunized but are frequently
exposed may be immunized as well.
 BCG also has some effectiveness against Buruli ulcer infection and other nontuberculous
mycobacterium infections. Additionally it is sometimes used as part of the treatment of bladder
cancer.

Tuberculosis
Tuberculosis (TB) is a potentially serious infectious disease that mainly affects the lungs. The bacteria that
cause tuberculosis are spread from person to person through tiny droplets released into the air via coughs
and sneezes.

Once rare in developed countries, tuberculosis infections began increasing in 1985, partly because of the
emergence of HIV, the virus that causes AIDS. HIV weakens a person's immune system, so it can't fight
the TB germs. In the United States, because of stronger control programs, tuberculosis began to decrease
again in 1993. But it remains a concern.

Many tuberculosis strains resist the drugs most used to treat the disease. People with active tuberculosis
must take many types of medications for months to get rid of the infection and prevent antibiotic resistance.

Oral poliovirus vaccines 

OPV are the predominant vaccine used in the fight to eradicate polio. There are different types of oral
poliovirus vaccine, which may contain one, a combination of two, or all three different serotypes of
attenuated vaccine. Each has their own advantages and disadvantages over the others.

Polio, or poliomyelitis, is a crippling and potentially deadly disease. It is caused by the poliovirus. The virus
spreads from person to person and can invade an infected person’s brain and spinal cord, causing paralysis
(can’t move parts of the body).

Polio can be prevented with vaccine. Inactivated polio vaccine (IPV) is the only polio vaccine that has been
given in the United States since 2000. It is given by shot in the arm or leg, depending on the person’s age.
Oral polio vaccine (OPV) is used in other countries.

CDC recommends that children get four doses of polio vaccine. They should get one dose at each of the
following ages:

 2 months old
 4 months old
  6 through 18 months old
 4 through 6 years old

Almost all children (99 out of 100) who get all the recommended doses of polio vaccine will be protected
from polio.

The first polio vaccine was available in the United States in 1955. Thanks to widespread use of polio
vaccine, the United States has been polio-free since 1979. But poliovirus is still a threat in some countries. It
takes only one traveller with polio to bring the disease into the United States. The best way to keep the
United States polio-free is to maintain high immunity (protection) in the U.S. population against polio
through vaccination.

Before taking this medicine

 You should not receive this vaccine if:

 you have moderate or severe illness with a fever;

 you have ever had a life-threatening allergic reaction to any vaccine containing live or inactivated
polio virus; or
 you are allergic to 2-phenoxyethanol, formaldehyde, neomycin, streptomycin, or polymyxin B.
 You should not receive a booster vaccine if you had a life threatening allergic reaction after the first
shot.
 To make sure polio vaccine is safe for you, tell your doctor if you have:

 a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or
receiving cancer treatments; or
 a history of Gillian Barré syndrome (or if this was a reaction to a previous vaccine).
 You can still receive a vaccine if you have a minor cold. In the case of a more severe illness with a
fever or any type of infection, wait until you get better before receiving this vaccine.

How is polio vaccine administered?

This vaccine is given as an injection (shot) under the skin or into a muscle. You will receive this injection in
a doctor's office or other clinic setting.

Polio vaccine is recommended for all children. It is also recommended for adults in the following situations:

 people who have never been vaccinated against polio;

 people who travel to areas where polio is common;
 people who handle polio virus in a laboratory or other setting; or
 people who treat patients who have polio.
Polio vaccine is given in a series of shots. Children should receive a total of 4 shots. The first shot is usually
given when the child is 2 months old. The booster shots are then given at 4 months, 6 to 18 months, and then
at 4 to 6 years of age.

Adults who have never been vaccinated against polio should receive a total of 3 shots. Booster shots should
be given 1 to 2 months after the first shot, and then 6 to 12 months after the second shot.

Adults who may have received prior polio vaccine should receive 1 or 2 shots, no matter how long it has
been since the first vaccination.
Your individual booster schedule may be different from these guidelines. Follow your doctor's instructions
or the schedule recommended by the health department of the state you live in.

Vitamine A Vaccination
Vitamin A enhanced the antibody response to measles vaccine given at 9 months of age significantly,
especially in boys. The effects were sustained over time; the children who had received vitamin A with their
measles vaccine were more protected against measles at 6-8 years of age.

Vitamin A supplements for young children aged 6–59 months

The World Health Organization (WHO) recommends that all children aged 6–59 months should receive
supplements if they live in a community where VAD is a public health problem. These are communities
where the prevalence of night blindness is ≥ 1% in children aged 24–59 months, or where the prevalence of
VAD is ≥ 20% in infants and children aged 6–59 months.

Vitamin A supplements for newborns and children aged 1–5 months

Vitamin A supplementation of newborns and children aged 1–5 months is not yet recommended by WHO.
Exclusive breastfeeding of infants is encouraged for the first six months of life, to help achieve optimal
growth, development and health.

Vitamin A supplements for pregnant women are not routinely recommended

Although women are highly susceptible to VAD during pregnancy, vitamin A supplementation during
pregnancy is not recommended, as high-dose vitamin A from supplements may cause harm to the
developing baby. Instead, pregnant women are encouraged to meet their increased requirements by eating
enough vitamin A-rich foods (see pages 65 and 72); this is unlikely to harm the developing foetus.
The only circumstance in which vitamin A supplementation during pregnancy may be considered is when
women live in an area where VAD is a severe public health problem (i.e. ≥5% of pregnant women in that
area have night blindness). It is very important to note that far lower doses are needed for pregnant women
than for children, and doses need to be given on a more frequent basis.
HEALTH EDUCATION