PENTAVALENT VACCINE

The pentavalent vaccine is a

combination of five vaccines in one:

diphtheria, tetanus, whooping cough,

hepatitis B and Haemophilus influenza

type b

Immunisation is one of the most important preventive health actions in childrens lives, as it provides protection against the most dangerous childhood diseases.

Pentavalent vaccine in India

Govt introduced this vaccine as part of the routine

immunisation programme in Kerala on a Wednesday 14th dec 2011

Goa has been administering pentavalent vaccine from the

State budget since 2008 which was initially introduced in selected blocks but the entire State was covered in 2011.
As on November 2011, more than 28,000 doses of pentavalent

vaccine have been administered in Goa

 Pointing out that there had been reports of adverse events

following immunisation (AEFI) in three countries, Sri Lanka and Bhutan had resumed vaccination after investigation of these cases while Pakistan continued vaccination.
The reports on the deaths following pentavalent vaccine

were assessed for casualty by respective countries and WHO and concluded that there is no real evidence of a link between the use of the vaccine and deaths.

Kerala kids to get new pentavalent vaccine shots

on Dec 14, 2011 introduced the

pentavalent vaccine The government of Kerala is seriously concerned about how to bring down the infant mortality in the state from the present 12 (per 1,000 births) to six in the next five years. The infant mortality in the country currently stands at 53 per 1,000 births and in the US it stands at seven.

Pentavalent vaccine availabilty

In UIP, pentavalent vaccine comes in a liquid form in a vial

which contains 10 doses

The pentavalent is a two dose preparation The pentavalent (DTP-HepB+Hib) uses liquid DTP-HepB

as diluent

Pentavalent vaccine
Pentavalent will replace the DPT

and HepB vaccines at 6, 10 and 14 weeks of age. Standalone HepB vaccine will be used for birth dose DPT for 2 booster doses, as earlier There is no need of booster dose for Hib vaccine

When to administer
At 6, 10 and 14 weeks of age

Till what age can pentavalent vaccine be administered?

Pentavalent vaccine can be given to any child aged more

than 6 weeks and up to 1 year of age.

How to administer
The pentavalent is lyophilised (freeze-dried) Hib that uses liquid

DTP-HepB as diluent
The DTP-HepB must be drawn from the vial using a reconstitution

syringe and put in the vial containing the lyophilised Hib.

Ensure that the entire content of the DTP-HepB is drawn and put in

the Hib vial

Shake well before use- check for impurities

Discard if vaccine is frozen or VVM reaches discard point.

administration of Pentavalent (DTP-HepB-Hib) vaccine will be

carried out using AD (auto-disable) syringes

Contd..
The dose is 0.5 ml

It is injected, intramuscularly,

in the anterolateral aspect of the thigh of the infant

do not inject in the buttock,

fat reduces efficacy of the HepB vaccine

do not use the arm of the

infant, the muscle mass is too small

Storage and transportation

cold chain The pentavalent must be stored at +20 C to +80 C
These vaccine should never be frozen Do not keep vials in direct contact with ice packs, eg use

brown paper to wrap vaccine vials before placing on ice pack

Or ensure that the ice packs have water around the ice (shake to see if you can hear water sloshing around in the ice pack)

 Cold chain

Cold chain
do not store the pentavalent or other HepB vaccines in freezers If you must, readjust the thermostat so that they do not freeze

Even so, do not place these vaccine in direct contact with the

bottom or sides of the freezers (for top opening) or close to the freezer compartment (for front opening)

Phasing In of Pentavalent vaccine

It is recommended that the introduction of Hib as

pentavalent vaccine should be gradually phased in the NIS by synchronizing it with OPV/ DPT schedule at 6 wks, 10 wk & 14 wks of age.
Pentavalent vaccine schedule thus may be started with fresh

batch of vaccinees for better compliance & utilization.

Give pentavalent vaccine to only those children who are

coming for first dose of DPT (Those coming for DPT2 or 3 should receive DPT only).

BENEFITS
Benefit of HiB in Pentavalent This has reduced number of pricks from 9+1 (3 each for DPT, HepB and Hib + HepB birth dose) to 3+1.
No additional cold chain space required in fact,

reduced need, 6 doses will be replaced by 3 of pentavalent vaccine

Any side effects?

Pentavalent vaccine has not been associated with any

serious side effects. However, redness, swelling, and pain may occur at the limb site where the injection was given. These symptoms usually appear the day after the injection has been given and last from one to three days. Less commonly, children may develop fever for a short time after immunization.

PRECAUTIONS
Rise of body temperature to more than 40 degrees over less

than 48 hours after being given a previous dose of DPT or

DTaP vaccine Fainting and in state of shock, being unconscious, for less than 48 hours after being given a previous dose of DPT or DTaP vaccine

Having convulsions for less than three days after being given
a previous dose of DPT or DTaP vaccine

Crying continuously for more than three hours over a range of 48 hours after being given a previous dose of DPT or DTaP vaccine Acute or mild infection with/without high temperature.

Not given to adults. Scientific data on the use of this

vaccine during pregnancy and birth is not available

CONTRAINDICATIONS
Although serious side effects have not been reported, a child who has had a severe reaction to pentavalent vaccine earlier should not be given another dose. Severe allergy: anaphylaxis after a previous vaccine dose Severe allergy: anaphylaxis to a vaccine component, such as: Neomycin, Streptomycin, Polymyxine B

A history of an encephalopathy of unknown aetiology after a previous immunization with a vaccine containing pertussis A progressive neurological disease. A severe acute illness with temperature above 38.5 degree Celsius. DPT boosters at 16-24 months and 5-6 years will continue as before.

Not a contraindications.
Minor illnesses such as respiratory tract infection or

diarrhoea with temperature below 38.5 degree celsius

Allergy or asthma Family history of convulsions Treatment with antibiotics Infection with HIV

 Breast feeding Chronic illnesses such as those of heart, lung, kidney or liver Stable neurological conditions e.g. cerebral palsy, Down

syndrome
Prematurity or low birth weight History of jaundice at birth. Treatment with topical corticosteroids or systemic use of

corticosteroids at low dosage (<0.5 mg/kg of prednisone or equivalent) in case of skin diseases like dermatitis, eczema, or other localised skin disorders

FORMULATION AND TYPES

The pentavalent vaccine is available in various forms of

liquid and lyophilised.

However, under the UIP in India, the vaccine will be

available as a liquid formulation only

RECORDING AND REPORTING

For pentavalent vaccine, separate paper reports need

to be sent to immunization division, MoHFW. On the use of DPT vaccines After introduction of pentavalent vaccines, DPT will continue to be used for booster doses,ANMs need to be sensitized

WASTAGE REDUCTION
The priority is to reach every child and to reduce missed opportunities, but wastage can be reduced even within the framework of this policy Careful planning & ordering vaccine can reduce wastage Proper storage and proper handling will reduce waste Correct reconstitution and correct administration can minimise waste Wastage must be monitored and reported

REVIEW OF LITERATURE
Pentavalent vaccine: A major breakthrough in india's universal immunization program september 2012
Authors: Mohan Bairwa, Manju Pilania, Meena Rajput, Pardeep Khanna, Neelam Kumar, Mukesh Nagar and Sumit Chawla Abstract: Immunization is one of the most important public health interventions and a cost effective strategy to control the infectious diseases especially in children. Complete immunization coverage in India has increased from below 20% in the 1980s to nearly 61% at present, but still more than 1/3rd children remain un-immunized.

Advent of combination vaccines has facilitated incorporation of additional vaccines into immunization schedule. Pentavalent vaccine, against five killer diseases- diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenza type B (Hib), has been introduced in almost all GAVI (global alliance for vacines and immunization) eligible countries by 2011. Government of India introduced the vaccine in two States in pilot phase and has given green signal to 6 more States. The use of pentavalent vaccine automatically raises the coverage level of Hepatitis B and Hib vaccines. If the vaccines are provided individually, the coverage of Hepatitis B and Hib vaccines usually lags behind DPT coverage. This gap can be filled by using pentavalent vaccine in routine immunization programmes.

REFERENCES
Kerala kids to get new pentavalent vaccine shots

available from http://ibnlive.in.com/news december 2011 Pentavalent introduced in kerala available from http://www.thehindu.com/health/policy-and-issue Pentavalent india program Available from http://healthadvisor.co.in/pentavalentvaccine February 14, 2012 Decision about pentavalent vaccine available from http://www.thehindu.com/health/policy-andissues/article

 Pentavalent vaccine; a breakthrough in Indias UIP

available from http://www.landesbioscience.com/journals/vaccines/a rticle. Hib pentavalent available from www.epid.gov.lk/web/article