Immunization

Mentor Dr Shubhanjali Gopal

IMMUNIZATION
• Immunization is a process of protecting an individual from a disease
through introduction of live attenuated, killed or antibodies in the
individual system
• Immunization is the process of protecting an individual by active or
passive method.
• The immunizing agents are
• Vaccines
• Immunoglobulins
• Antisera
IMMUNIZATION
• Prevention of deadly and debilitating diseases
• Keeps child from suffering through a preventable illness
• Less doctor visits
• No hospitalization
ACTIVE VS PASSIVE IMMUNIZATION
• ACTIVE IMMUNIZATION
• Killed or live attenuated organism injected which can induce immune
response
• Long term Immune system plays role
• ex-Hepatitis B vaccine, OPT, Inactivated polio vaccine, Measles-rubella
(MMR) combined vaccine
PASSIVE IMMUNIZATION
• Transfer of antibodies
• Short term
• No role of immune system
• Ex-Anti Tetanus, Anti Rabies immunoglobulin etc;
HOW VACCINE WORKS
• Development of active immunity, Humoral or cell mediated or both.
• Humoral immunity - by secretion of antibodies from B-cells.
• Cell mediated immunity-mediated by T-cells.
• Eg. In BCG, CMI & Delayed type of hypersensitivity
• Education of reticuloendothelial system of body and production of
memory cells or primed cells by both B & T cells.
• That is development of immunobiological memory.
TYPES OF VACCINES
• Live, attenuated vaccines
• Inactivated vaccines
• Subunit vaccines
• Toxoids
MAJOR CONSTITUENTS OF VACCINE
• 1) Active immunizing antigens live virus, killed bacteria, Toxoids
• 2) Suspending fluid Sterile water, saline or tissue culture fluid.
• 3) Preservatives, stabilizers, & antibiotics Thiomersal. Neomycin,
kanamycin.
• 4) Adjuants Al salts frequently used.
LIVE VACCINES
• Live, attenuated vaccines contain a version of the living microbe that
has been weakened in the lab so it can't cause disease
• Because a live, attenuated vaccine is the closest thing to a natural
infection,these vaccines are good "teachers " of the immune system
• ex: Vaccines against polio(OPV), measles, mumps, rubella and
chickenpox, BCG,Rotavac, Yellow Fever Vaccine.
• C/I: Pregnancy, Patients on Therapy with Immunosuppressive drugs,
• Patients who have Acquired or Inherited Immunodeficiencies.
INACTIVATED VACCINES
• Scientists produce inactivated vaccines by killing the disease-causing
microbe with chemicals, heat, or radiation.
• Such vaccines are more stable and safer than live vaccines
• Because dead microbes can't mutate back to their disease-causing
state.
• ex: Vaccines against influenza, inactivated polio vaccine, hepatitis A,
Rabies
• DPT, Pertusis. etc.
• C/I Severe Anaphylaxis to the Previous dose.
SUBUNIT VACCINE
• Instead of the entire microbe, subunit vaccines include only the
antigens that best stimulate the immune system.
• Because subunit vaccines contain only the essential antigens and not
all the other molecules that make up the microbe,
• ex: Recombinant DNA Vaccine Hep b and Acellular Pertusis Vaccines.
TOXOIOS
• For bacteria that secrete toxins, or harmful chemicals, a toxoid is
used.
• These vaccines are used when a bacterial toxin is the main cause of
illness.
• Scientists have found that they can inactivate toxins by treating them
with formalin.
• Such "detoxified" toxins, called toxoids, are safe for use in vaccines
• They Neutralise the exotoxin
• Ex: Diphtheria, Tetanus toxoid
CELLULAR FRACTIONS
• Meningococcal vaccine from the polysaccharide antigen of the cell
wall.
• Pneumococcal vaccine from the polysaccharide capsule of the
organism
• Polysaccharide Vaccines are not effective in Age Less than 2 years.
COMBINATIONS
• The aim is to
• simplify administration
• reduce costs
• minimize the no. of contacts with the health system.
• Ex: DPT, MMR, DPT, Hep B & Hib, Hep A & B etc.
IF A DOSE IS MISSED
• Give the dose at the next opportunity irrespective of the time gap
• Do not start the schedule all over again
BCG
• WHO recommended Danish 1331 strain to be used.
• Initial dose birth or as early as possible till one year of age
• 0.1 ml (0.05ml until one month of age)Intra-dermal
• Left upper arm
• Freeze dried is more stable.
• Diluent is Normal saline.
HEPATITIS B
• Birth dose - within 24 hours of birth-0.5 ml
• Intramuscular
• Antero-lateral aspect of mid-thigh
• Rest three doses at 6 weeks, 10 weeks and 14 weeks
• It should be stored at 2 to 8 deg C.
• 1 ml in adults, 0.5ml in children <10 yrs, given IM.
ORAL POLIO VACCINE
• Zero dose - at birth
• 2 drops
• Oral
• First, second and third doses at 6, 10 and 14 weeks with Pentavalent-
1, 2 and 3.
• OPV booster with DPT booster at 16-24 months
PENTAVALENT VACCINE
• Simultaneous immunization against diphtheria, Pertusis & Tetanus,
Hep b, Hib.
• Stored at 4-8 degree C
• Given 0.5 ml IM at anterolateral, aspect of thigh.
• Primary 3 doses with a booster in 16-24 months. at 5-6 yrs:
• C/I-progressive neurological diseases.
ROTAVIRAL VACCINE
• 3 doses given in 6th, 10th and 14th weeks.
• Can be given till one year of age
• G9P human strain.
• Dose - 5 drops/0.5 ml orally
• for prevention of diarrhea among infants due to rotavirus:
IPV
• 2 fractional doses given in 6th and 14th week8.
• Dose -0.1 ml
• Given intradermally in Right upper arm
JAPANESE ENCEPHALITIS
• SA 14-14-2 vaccine
• 0.5 ml, 2 doses
• 9 months and 16-24 months
• Subcutaneous
• Left upper arm
• DILUENT : Sterile water.
MR VACCINE
• Bivalent Live attenuated against measles and rubella.
• Given 0.5 ml SC at 9-12 and 16-24 months.
• Stored 2-8 degree C
• Strain-Measles-edmonstorn-zagreb, Rubella- Wilstar RA27/3
• Reactions- Fever, Resp. symptoms, Lymphadenitis or parotitis
• Diluent : Sterile Water.
DPT
• Primary doses were in pentavalent vaccine
• One booster at 16-24 m with 0PV booster (antero-lateral side of mid-
thigh) and
• second booster at 5-6 years (upper arm)
• 0.5 ml
• Intra-muscular
TETANUS TOXOID
• Intramuscular-upper arm-0.5 ml
• Pregnancy-2 doses - 1 st dose as early as possible and second dose
after 4 weeks of first dose and before 36 weeks of pregnancy
• TT booster for both boys and girls at 10 years and 16 years
• Primary course of immunization consists of 2 doses of tetanus toxoid
at intervals of 1-2 months
• The booster dose should be given a year after the initial doses.
• It should be stored between. 4 and 10 degC
VITAMIN A
• I dose-I ml (I IU) along-with Measles first dose- 0ral
• Subsequent 8 doses (2 ml or 2 lakh IU) every six months till 5 years of
age
• starting with DPT first booster at 16-24 months
• use only plastic spoon provided with Vitamin A solution
Vaccines vile monitoring
• USABLE STAGES
• Reading the Stages of the VVM:
• The inner square is lighter than the outer circle,
• If the expiry date has not been passed: USE the vaccine
• UNUSABLE STAGES
• Discard Point:
• The color of the inner square matches that of the outer circle: NOT
use the
vaccine
• If the color of the inner square is darker than theouter circle: NOT use
the vaccine
NEW INITIATIVES IN VACCINE
LOGISTICS & COLD CHAIN
MANAGEMENT
• Electronic Vaccine Intelligence Network (eVIN) rollout :
• The Government of India has rolled out an Electronic Vaccine
Intelligence Network (eVIN)system that digitizes the entire vaccine
stock management, their logistics and temperature tracking at all
levels of vaccine storage - from national to the sub-district.
• Thank you