VACCINE: 1

SCHEDULE,
CONTRAINDICATIONS
AND
ADVERSE EFFECTS

PRESENTER: Surjan Kumar Singh

MODERATOR: Dr. Khem Raj Sharma
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OBJECTIVES:
• To know the vaccination schedule in Nepal
• To learn the adverse effects of different vaccines
• To know Contraindications of different vaccines
NATIONAL IMMUNIZATION PROGRAM 3
S.N Vaccine Age of administration Dose Route of administration Protect against

1. BCG (Bacillus Calmette Guerin) At birth 1(0.05ml) Intradermal(Right upper arm) Tuberculosis

Pentavalent Vaccine (Diphtheria, Pertussis, Diphtheria, pertussis,Tetanus,

Intramuscular(Left outer mid-
2. Tetanus,  Hepatitis B and Hemophilus influenza 6, 10 and 14 weeks 3(0.5ml) Hepatitis B and Haemophilus
thigh)
B) Influenza B

3. OPV ( Oral Polio Vaccine) 6, 10 and 14 weeks 3 (2 drops) Oral Polio

.
Pneumococcal diseases
Intramuscular(Right outer mid-
4. PCV (Pneumococcal Conjugate Vaccine) 6, 10 weeks and 9 months 3(0.5ml) (Meninges, ear and chest
thigh)
infections)

5. Rotavirus vaccine 6, 10 weeks 2 Oral Rota virus diarrhea

5. fIPV (Fractional Injectable polio vaccine) 6, 14 weeks 2(0.5ml) Intradermal(Left upper arm) Polio

6. MR (Measles – Rubella) 9 and 15 months 2(0.5ml) Subcutaneous(Left upper arm) Measles and Rubella

Subcutaneous(Right outer upper-

7. JE (Japanese Encephalitis) 12 months 1(0.5ml) Japanese Encephalitis
thigh)

Td (Tetanus diphtheria) for expecting mothers – 2 doses, 1 months apart 4

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ADVERSE EVENTS FOLLOWING IMMUNIZATION
(AEFI)
• An AEFI is any untoward medical occurrence which follows
immunization and which does not necessarily have a casual
relationship with the usage of vaccine.

• The adverse event may be any unfavourable/unintended sign, lab

findings, symptoms or disease.
 Council for International Organizations of Medical Sciences
8
(CIOMS) and WHO revised cause-specific categorization of AEFIs
in 2012

• Vaccine product-related reaction

Precipitated by a vaccine due to one or more of the inherent properties of the
vaccine product.
• Vaccine quality defect-related reaction
Precipitated by a vaccine that is due to one or more quality defects of the
vaccine product, including its administration device as provided by the manufacturer.
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• Immunization error-related reaction

Precipitated by inappropriate vaccine handling, prescribing or administration.
• Immunization anxiety-related reaction
Arising from anxiety about the immunization.
• Coincidental event
Caused by something other than the vaccine product, immunization error or
immunization anxiety.

VACCINE REACTIONS:
COMMON, MINOR VACCINE
REACTION
• Local reactions – pain, swelling,
redness in injection site.
• Systemic reactions- fever, irritability,
malaise, loss of appetite , rashes,
diarrhea, headache, muscle pain
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RARE, SERIOUS VACCINE
REACTION
• Anaphylaxis, seizures,
encephalopathies, persistent
inconsolable cry, thrombocytopenia.
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INVESTIGATING AEFI:
 STEPS:- 12

A. Confirm Information In Report

• Obtain patient medical history
• Identify any other cause that should be investigated

B. Investigate and collect data about

Patient: Immunization history, previous medical history including prior history of
similar reaction and other allergies and similar history in family members
Event: Relevant lab findings about the AEFI, diagnosis, treatment and outcome
Suspected Vaccine: Shipping condition, Storage condition, State of vaccine vial
monitor(VVM)
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Other People: If received same vaccine and developed illness

C. Asses the service:

• Vaccine storage, diluent storage, distribution, reconstitution
• Syringe sterilization
• Refrigerator
• Immunization procedure
• Observing the service in action:
A)Refrigerator- What else is stored which could be confused with?
B) Immunization procedures- Reconstitution, drawing up, injection technique
C)Do any open vial look contaminated?
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D. Formulate a working hypothesis:
• On the likely cause of the event

E. Test working hypothesis:

• Does case distribution match working hypothesis?

F. Conclude investigation:
• Reach a conclusion
• Complete AEFI investigation form
• Take corrective action and recommend further action
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SOME COMMON VACCINES:
• ADVERSE REACTIONS
• CONTRAINDICATIONS
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BCG:
Adverse Effects
• Local ulceration, discharging sinus, lymphadenitis
• Disseminated infections, osteomyelitis

Contraindications & precautions

• Cellular immunodeficiency
• Symptomatic HIV infant
 DPT: 17

Adverse effects:
• redness, swelling, pain, fever
• Anaphylaxis, convulsion, persistent inconsolable cry, encephalopathy

Contraindications:
• Progressive neurological disease
• Severe life threatening reaction to previous dose.
• Encephalopathy in 7 days of receiving vaccine.
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Hepatitis B:
Adverse effects
• injection site tenderness, soreness ,redness,
• fever, fatigue

CONTRAINDICATIONS
• Anaphylaxis to previous dose
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Haemophillus influenza B:
Adverse reactions
• Fever, rash, local pain or redness

Contraindications
• Hypersensitivity to previous dose
 ORAL POLIO VACCINE: 20

Adverse reactions:

• Vaccine associated paralytic poliomyelitis

Contraindication
• Inherited or acquired immunodeficiency
• Symptomatic HIV
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IPV:
Adverse effect
• Pain ,swelling and redness at local site
• Mild fever

CONTRAINDICATIONS
• Known allergy
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PCV:
Adverse Effect
• Local reactions (redness, pain and swelling), fever.

Contraindications
• Known hypersensitivity to a prior dose.
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Rotavirus Vaccine:

Adverse effects
• Intussusception(rare)

Contraindications
• Past history of intussusception
• Severe immunodeficiency
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Measles and Rubella Vaccine:

Adverse effect
• Mild fever with rashes
• Arthralgia, aseptic meningitis, lymphadenopathy

Contraindications
• If anaphylaxis on 1st dose
• Child with symptoms of HIV
• Immunosupressive therapy
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Japanese encephalitis:

Adverse effects
• Fever, malaise
• Local tenderness or redness

Contraindications
• Anaphylaxis after previous dose
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REFERENCE
• O. P. Ghai Textbook of pediatrics

• PARK’S textbook of preventive and social medicine

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THANKYOU