DEPARTMENT OF PAEDIATRICS, NIMS MEDICAL COLLEGE, HOSPITAL & RESEARCH CENTRE

Presented by : Dr. Ajeta Gupta

Moderator : Dr. M. L. Gupta
IMMUNISATION - 1
 EDWARD JENNER

Edward Jenner is known as “Father of

Immunology.”
14 May 1796 — Jenner inoculated eight-year-
old James Phipps with cowpox from
dairymaid, Sarah Nelmes.
On July 1, Jenner inoculated the boy with
smallpox matter but James did not develop the
disease as he was immune due to his
vaccination. (vacca = cow)
 IMMUNISATION

Immunisation is the administration of all or part of a pathogen or preformed

antibodies to elicit an immunological response that protects from disease.
 ACTIVE IMMUNITY - Active immunity is the protective response mounted by
the immune system following exposure to an infectious organism (as clinical or
subclinical infection) or after vaccination with live or killed organism, a toxoid
or subunit.
PASSIVE IMMUNITY - Passive immunity refers to protection from disease
provided by introduction of preformed animal or human antibodies into the
body.
1. the passage of IgG from the mother across the placenta to the foetus
2. transmission of secretory IgA in breast milk
3. administration of immunoglobulin or antisera to prevent disease (‘Passive
Immunisation’)
 IMMUNISATION - Immunisation is the process of inducing acquired
immunity, by administering :
(i) live killed or attenuated organisms or specific antigens (active immunisation),
usually prior to natural exposure to infectious agent; or
(ii) preformed exogenous antibodies, given soon after or prior to exposure, in
order to suppress disease (passive immunisation).
VACCINATION - Vaccination is the process of administration of a vaccine.
Humoral Immune Response (e.g. Haemophilus influenza b vaccine),
Cellular Mediated Immunity (e.g. BCG)
Both responses (e.g. most vaccines).
VACCINE - A vaccine is composed of one or more antigens of a pathogenic
agent which, when administered to a previously unexposed individual, will elicit
an immune response but not cause disease.
VACCINE FAILURE - Vaccine failure is the occurrence of disease in an
individual despite vaccination.
Primary vaccine failure - (3 Doses of Oral Polio Virus)
Secondary vaccine failure(BCG, Pertussis, Typhoid Vaccines.)
Vaccine Failure is rare with measles, diphtheria & tetanus vaccines.
VACCINE EFFICACY - Protective efficacy is the vaccine's actual ability to
protect against disease.
Efficacy = (Rate of disease in unvaccinated persons - Rate of disease in the
vaccinated) x 100 % / Rate of disease in unvaccinated persons
VACCINE EFFECTIVENESS - Vaccine effectiveness is the ability of a vaccine
to protect the population from disease, when administered in an immunisation
program.
Vaccine Effectiveness depends on vaccine efficacy, program implementation &
herd effect.
SEROCONVERSION - Seroconversion refers to the change from antibody
negative to antibody positive state, due to induction of antibodies in response to
infection or vaccination.
SEROPROTECTION - Seroprotection refers to the state of protection from
disease, due to the presence of detectable serum levels of antibody.
IMMUNOGENICITY - Immunogenicity is the ability of a vaccine to elicit an
immune response, whether cellular, humoral or both.
ADJUVANTS - Adjuvants are substances unrelated to the organism that, when
added to a vaccine, enhance its immunogenicity. Aluminum hydroxide and
lipids.
 HERD EFFECT - If a large proportion of susceptible individuals are protected
from infection with an organism by simultaneous vaccination, the transmission
chain of the infectious agent can be broken by reducing carriage of the
causative microorganism by vaccinated individuals, thus decreasing the risk of
disease even among the un-immunised individuals.
This phenomenon, termed THE HERD EFFECT.
Herd immunity can be achieved by mass infection or vaccination.
HERD IMMUNITY - Herd immunity refers to the proportion of immune
individuals in a population.
 VACCINE

WHAT MAKES A GOOD VACCINE ? A

good vaccine is one that is easy to
administer, induces permanent immunity, is
free of toxic substances, has minimal side
effects and is relatively stable for prolonged
time.

India celebrates National Immunisation

Day, also known as National
Vaccination Day, every year on March
16.
LIVE ATTENUATED VACCINES - Live vaccines replicate in the host to produce
an immune response mimicking natural infection. Therefore, these vaccines actually
infect the recipient but do not cause disease because the potency of the organism has
been attenuated.
However, the vaccine may cause disease in immuno-compromised hosts.

Usually a single dose of live vaccines is sufficient to induce immunity; OPV is an exception where
multiple doses may be required to infect the intestinal mucosa.
Residual maternal antibody in the infant's serum may neutralise the organism before infection occurs,
hence, vaccines like (MMR) are administered beyond 9 months of age.
BCG where maternally derived antibodies do not interfere with vaccine 'take'. BCG induces cell mediated
immunity that is not transferred from mother to foetus.

KILLED OR INACTIVATED VACCINES -Killed vaccines, prepared by growing

bacteria or viruses in media followed by heat or chemical (e.g. formalin)
inactivation, do not cause infection but elicit protective immune response. (e.g.
Influenza, Typhoid Vaccine, Salk Polio Vaccine, Hepatitis A Vaccine)
TOXOIDS - Toxoids are modified toxins that, if well purified, are not injurious to
the recipient. Primary immunisation is in form of multiple divided doses in order to
decrease the adverse effects at each administration and to elicit high antibody titres
with repeated exposure to the same antigen. Booster doses are required to sustain the
protection. (e. g. Tetanus Toxoid, Diptheria Toxoid)
DNA / RNA / VECTOR VIRUS VACCINES - Genetic material, either DNA or
RNA from the pathogenic bacteria or virus is introduced into the human cells to
produce protein encoded by inserted gene of the pathogens. Our immune system
detects this foreign agent and produces immune response as a whole. (e.g HIV
Vaccine, COVID-19 Vaccine)
SUBUNIT OR CONJUGATE VACCINE - Capsular polysaccharides are
carbohydrate antigens (SUGARS) that elicit humoral response by stimulating B
cells directly, without modulation by helper T cells. Hence, there is no
immunological memory and the antibodies produced are of the IgM class alone,
rather than an IgG response. (e.g. Haemophilus Influenza Type 2 Vaccine,
Pneumococcal Conjugate Vaccine, Meningococcal Conjugate Vaccine)
RECOMBINANT VACCINE - Recombinant or purified protein vaccines consist
of protein antigens that have either been produced in a heterologous expression
system (e.g., bacteria or yeast) or purified from large amounts of the pathogenic
organism. The vaccinated person produces antibodies to the protein antigen, thus
protecting him/her from disease. (e.g. Human Papilloma Virus Vaccine, Hepatitis
B)
 PHASES OF VACCINE TRIALS

Following the phase 3

trials an application is
made for the vaccine
to be licensed for use
on humans by the
appropiate medical
body.
 COLD CHAIN
A cold chain is a temperature-controlled
supply chain that includes all vaccine-
related equipment and procedures.
The cold chain begins with the cold storage
unit at the manufacturing plant, extends to the
transport and delivery of the vaccine and
proper storage at the provider facility, and
ends with administration of the vaccine to the
patient.
Storage and transport equipment such as cold
rooms, refrigerators, freezers, cold boxes and
vaccine carriers must comply with
performance standards defined by the World
Health Organization (WHO).
 REFRIGRATOR VACCINE STORAGE
Place measles, MR, MMR, BCG, OPV, yellow
fever, Japanese encephalitis (SA-14-142),
meningococcal A conjugate, Rotavac* and/or any
other vaccines not damaged by freezing on the top.
Put DTP, DT, Td, TT, Tdap, HepB, DTP+HepB,
DTP+HepB+Hib, Hib, PCV, HPV, Rotavirus
and/or any other freeze-sensitive vaccines on the
middle or lower shelves.
Store the diluents next to the freeze-dried vaccine
with which they are supplied, on the appropriate
shelf. If there is not enough space on the shelf, put
the diluents on the bottom shelf, clearly labeled so
they can be easily identified to their matching
vaccine.
 VACCINE VIAL MONITORING
A vaccine vial monitor (VVM) is a
label put on containing
thermochromic vials vaccines

which gives a visual indication of

whether the vaccine has been kept at a
temperature which preserves its
potency.
The labels were designed in response to
the problem of delivering vaccines to
where the
developing countries is difficult to
cold chain

preserve, and where formerly vaccines

were being rendered inactive and
administered ineffectively due to their
having been by exposure to
denatured

ambient temperature.
 MISSION INDRADHANUSH
Ministry of Health and Family Welfare
(MOHFW) has launched Mission Indradhanush
on 25th December 2014 with the aim of
expanding immunisation coverage to all children
across India by year 2020.
The Mission Indradhanush, depicting seven
colours of the rainbow, targets to immunise all
children against seven vaccine preventable
diseases namely Diphtheria, Pertussis, Tetanus,
Childhood Tuberculosis, Polio, Hepatitis B and
Measles.
In addition to this, vaccines for JE (Japanese
Encephalitis) and Hib (Haemophilus influenzae
type B) are also being provided in selected states.
UNIVERSAL IMMUNISATION PROGRAMME, 1985

Under the Universal Immunisation Programme, Government of India is providing

vaccination to prevent seven vaccine preventable diseases i.e. Diphtheria,
Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and
Hepatitis B, Haemophilus influenza type b (Hib) and Diarrhoea. (1985).
 12 Diseases Protected by Vaccination under UIP —
1. Diphtheria
2. Pertussis
3. Tetanus
4. Poliomyelitis
5. Tuberculosis
6. Measles
7. Rubella
8. Diarrhoea
9. Japanese Encephalitis
10. Pneumonia (Haemophilus Influenza Type B)

11. Hepatitis B in 2007

12. Pneumococcal Disease (Pneumococcal Pneumonia & Meningitis) in 2017

NATIONAL IMMUNISATION SCHEDULE , 2022

National Immunisation Schedule or NIS is recommended by the Indian

Government and is given free of cost, all over the country.
The National Technical Advisory Group of Experts on Immunisation (NITAG) is the
one that advises the government about the use of available vaccines in the NIS.
A number of factors such as delivery chain feasibility, cost involved, and availability
of vaccines are taken into consideration while preparing an immunisation schedule
for such a large country.
Keeping public health in focus, NIS includes the bare minimum vaccines which
every child in India must receive.
 INDIAN ASSOCIATION OF PAEDIATRICS IMMUNISATION
SCHEDULE, 2021

The other type of immunisation schedule available in India is IAP or the Indian
Academy of Paediatrics’ Immunisation Schedule.
The Advisory Committee of Experts on Vaccines and Immunization Practices
(ACVIP) is the highest body of IAP that is responsible for preparing and regularly
updating this schedule.
The IAP immunisation schedule has all the vaccines recommended by the NIS.
Plus, it also includes a few additional ones that are available in the country.
 Bacillus Calmette Guerin (BCG)

Bacillus Calmette Guerin (BCG)

Time - At birth or as early as possible
till one year of age
Dose - 0.1ml (0.05ml until 1 month age)
Route - Intra-dermal
Site - Left Upper Arm