IMMUNIZATION

DEFINITION

🠶 The Greek word ‘immune’ means ‘to be

protected’
🠶 In medical terms immunisation is the
administration of all or part of a pathogen or
preformed antibodies to elicit an immunological
response that protects from disease
 SOME
CONCEPTS...
Acquired immunity: protection offered by
introduction of various antigens or antibodies
The process by which this is obtained is
known as immunisation
Active immunisation: Specific antigens
evoke the needed immune response
Passive immunisation:Antibodies are
supplied readymade as immunoglobulins and
sera.
 Vaccination: Process of inoculating the vaccine or the
antigen
Immunisation: Process of inducing immune
response, humoral or cell mediated.
. Seroconversion: Change from antibody
negative
state to antibody positive state.
Seroprotection: The state of protection (from
disease) due to presence of humoral immunity or
antibody detectable in serum
HERD
IMMUNITY
🠶 It refers to the proportion of immune individuals in a
population
🠶 If a large proportion of individuals are protected from
simultaneous vaccination at the same time the transmission chain
of the infectious agent can be broke thus decreasing the risk of
disease in unimmunised individuals
🠶 Eg. OPV,measles
 GENERAL
ASPECTS:
🠶
week).
Vaccination at birth-within 24 to 72 hrs (maximum <1

🠶 Multiple vaccinations together- within 24 hrs.

🠶 Recommended age- Completed age. If not administered then at

subsequent visit.

🠶 Combination vaccines preferred over separate.

🠶 If 2 or more live vaccines are not given on same day then atleast after
28days(4 weeks). Oral vaccines exempted.

🠶 Any interval between live and inactivated vaccines.

🠶 Minimum interval between 2 doses of same-4 weeks.(exc

Rabies).
🠶 If administered upto 4 days before minimum interval- Valid,
>5 days - Invalid.

🠶 Any number of antigens can be given on same day.

🠶 No mixing of multiple vaccines in same syringe.

🠶 Should be observed for 15-20 mins for allergic reactions.

🠶 2 vaccines can be given in same limb, and site-Anterolateral

aspect of thigh with space of min 1 inch.

🠶 Previous dose if less than standard or by non standard route

should not be counted.
 VACCINE
TYPES
🠶 Live bacteria- BCG, Ty 21 a
🠶 Live virus – OPV, MMR
🠶 Killed bacteria – Pertussis, S.typhi[whole cell killed]
🠶 Killed virus – IPV, Rabies, HAV
🠶 Toxoid – DT, TT
🠶 Capsular polysaccharide – HiB, Pneumo, Meningo,Vi
🠶 Viral subunit - HBsAg
🠶 Bacterial subunit – Acellular pertussis
 TYPES OF ADVERSE
EVENTS
Serious AEFI :
🠶 Results in death, hospitalization or significant disability
🠶 Occurs in clusters
🠶 Causes parental or community concern
🠶 Results in congenital anomaly or birth defect

Severe AEFI :
🠶 Minor AEFIs with increased intensity or severity eg: high grade
fever, swelling extending beyond nearest joint.

Minor AEFI :
🠶 Local reactions (pain,swelling,redness) or systemic reactions
(fever,irritability,malaise)
ADVERSE
EFFECTS
Adverse effects contd.
Adverse Effects contd.
 IAP IMMUNISATION LE
SCHEDU
AGE VACCINES
Birth BCG, OPV 0, Hep B 1
6 weeks DTwP 1, IPV 1, Hep B 2, HiB,
1, PCV 1
10 weeks DTwP 2, IPV 2, Hib 2, Rota 2,
2.
14 weeks DTwP 3, IPV 3 Hib 3, Rota 3,
3.
6 months OPV 1, Hep B 3.
9 months OPV 2, MMR 1
9-12 months Typhoid conjugate vaccine.
12 months Hep A 1
15 months MMR 2, Varicella 1, PCV booster
AGE VACCINES

16 – 18 months DTwP B1/DTaP B1, IPV B1, Hib B1.

18 months Hep A 2

2 years Typhoid conjugate booster.

4 to 6 years DTwP B2, OPV 3, Varicella 2,

MMR 3

10 to 12 years Tdap/Td, HPV

BC
G
🠶 Content: 0.1-0.4 million
units/dose.
🠶 Diluent: Normal Saline.
🠶 Dose: 0.1 ml/ 0.05
ml(<4 weeks)
🠶 Route: Intra dermal.
🠶 Site: Left Shoulder.
🠶 Side effect- local
ulceration,osteomyelitis,dissemin
ated BCG infecton
BCG scar formation:

🠶 Erythema
🠶 Pustule
🠶 Nodule
🠶 Ulcer
🠶 Crust
🠶 Scar
OP
V
🠶 Strain: Sabin.
🠶 Type: Live attenuated.
🠶 Bivalent.
🠶 Stabiliser: Magnesium
chloride.
🠶 Dose: 2 drops.
🠶 Route: Oral.
🠶 Immune Response.
🠶 VAPP
🠶 VDPV-cVDPV, iVDPV,
aVDPV.
IP
V
🠶 Salk strain.
🠶 Intramuscular or
subcutaneous[0.
5 ml]
🠶 No VAPP/VDPV.
🠶 No Herd
immunity.
HEPATITIS 🠶 Dose: 0.5 ml(>18 yrs-1ml)

B 🠶 Route: Intramuscular.
🠶 Site: Ant-lat thigh.
🠶 Adjuvant: Aluminium
hydroxide.
🠶 Preservative:
Thiomersal.
🠶 Schedules:
• 0, 6 & 14 wks
• 6wks, 10 wks, 14
wks.
• Birth, 6 wks, 6 m.
• Birth, 6wk, 10wks, 14
wks.
🠶 HBIG for HBsAg
positive
DPT
VACCINES:
🠶 DTwP:
• Diphtheria toxoid-20-30 Lf
• Tetanus Toxoid – 5-25 Lf
• Killed whole cell Pertussis(LPS)
• Dose:0.5 ml
• Route: IM
• A/E: local, HHE, Seizures,
Encephalopathy.
🠶 DTaP: Acellular
pertussis,
reduced side effects.
PENTAVALENT
VACCINE:
🠶 DPT+Hep-B+Hib.
🠶 H. Influenza B:
• Conjugated with a protein
carrier.
• Dose: 0.5 ml
• Route: IM.
PNEUMOCOCCAL CONJUGATE
VACCINE(PCV 13)
🠶 Dose: 0.5 ml.
🠶 Route: IM
🠶 Adjuvant: Aluminium
salts.
🠶 Dosage interval: At
6,10,14 weeks and a
booster at 15 months
ROTAVIRU
S
🠶 Live Oral vaccine.
🠶 Monovalent(RV1),
Pentavalent(RV5) available
ones.
🠶 Dose: 1ml.
🠶 Adverse
effects:intussusception
🠶 Contraindications: severe
combined
immnodeficiency,past h/o
intussusception
MMR
VACCINE 🠶 MEASLES:
• Strain: Edmonston
Zagreb.
• Dose: 0.5 ml
• Route: S/c in right arm.
• Diluent: Distilled water.
• A/E: TSS.
• Vitamin A.
🠶 RUBELLA:
• Strain: RA 27/3.
• C/I: PREGNANCY..
🠶 MUMPS:
• Strain: Jeryll Lynn.
• A/E: febrile seizures, Aseptic Meningitis.

🠶 Not with BCG.

🠶 2 doses are required for adequate seroconversion.
🠶 To be used within 4-6 hrs of reconstitution.
VARICELLA

🠶 Strain: Oka.
🠶 Type: Live
attenuated.
🠶 Dose:0.5ml
🠶 Route: Subcutaneous.
🠶 A/E: Breakthrough
varicella.
🠶 C/I: Pregnancy,
Hypersensitivity.
HEPATITIS
A
🠶 Inactivated:
• Strain:HM175/GBM strain.
• Adjuvant: Aluminium
hydroxide.
• Dose: 0.5 ml, IM.
• Age: >12
months. 2 doses.
🠶 Live attenuated:
• H2 strain.
• 0.5 ml,
Subcutaneous.
🠶 Spl conditions:
 CATCH UP
🠶 VACCINATION
BCG - upto 5 years

🠶 OPV - upto 5 years

🠶 IPV - upto 5 years

🠶 Hepatitis B - 3 doses at 0, 1 and 6 months, gap between 1st 2 doses

>/= 4 weeks and dose 2 and 3 is >/= 8 weeks

🠶 DTwP/ DTaP -
<7 years – DTwP or DTaP at 0,1 and 6 months
7-10 years – Tdap at 0 month, Td at 1 and 6 months
>11 years – 1 dose of Tdap, one dose of Td every 10 years
 Catch up Vaccination contd.
🠶 Hib – upto 5 years
6-12 months – 2 primary doses 4 weeks apart and 1 booster
12-15 months – 1 primary dose and 1 booster
>15 months – single dose

🠶 PCV 13 –
6-12 months – 2 doses 4 weeks apart and 1 booster
12-23 months – 2 doses 8 weeks apart
>/=24 months – single dose

🠶 PCV 10 –
6-12 months – 2 doses 4 weeks apart and 1 booster
12months – 5 years – two doses 8 weeks apart
Catch up Vaccination contd.

🠶 Rotavirus – maximum dose for 1st dose is 14 weeks and final

dose is 8 months

🠶 MMR – 2 dose for all school aged children and adolescents

with minimum interval of 4 weeks

🠶 Varicella – 2 doses with >/= 3 months between doses

(>/=1month if >12 years)

🠶 Hepatitis A – 2 doses 6 months apart

🠶 Typhoid – till 18 years

🠶 HPV – for all females aged 13 to 45 years if not previously

vaccinated