Immunization

Dr Basant Rai
Dept of Pediatrics
BPKIHS
24 April 2024
The global context
‘The two public health interventions
that have had the greatest impact on
the world’s health are clean water and
vaccines’ .

WHO
 Epidemiology

• 8.8 million under 5 years die yearly due to various

reason ; out of 5 death 1 die due to vaccine
preventable diseases.
• Vaccine prevents 1.8 million yearly death among
children.
• 20% mortality can be decreased for under 5 years
age if all available vaccine complete dose are given .
 Immunity Type
• Active
- Natural : 1) Clinical infection
2) Sub clinical

- Acquired : Vaccination
• Passive
- Natural : 1) Transfer of antibody through placenta
2) Transfer of antibody through mother’s milk

- Acquired : Administration of IVIG and anti sera

 Basic immunology

Immune response

Natural Acquired
(Innate) (Adaptive)
 Basic immunology

Immunity

Cell mediated immunity Antibody mediated

(Humoral immunity)
 Basic immunology
Antigen

Antigen presenting cells

T- Helper lymphocytes

Th- 1 Memory cell Th-2

Cytotoxic T cells Memory Cells B - Cells

CMI Memory Antibody

 Vaccination and Immunization
definitions…

Vaccine : a suspension of live (usually

attenuated) or inactivated microorganisms (eg
bacteria or viruses) or fractions thereof
administered to induce immunity and prevent
infectious disease or its sequels.

Vaccination (vacca=cow): physical act of

administering any vaccine or toxoid
 Vaccination and Immunization
definitions…

 Immunization : process of inducing or

providing immunity by administering an
immunobiological.

 Immunization can be active or passive.

 Active immunization
• Administration of all or part of a microorganism or a
modified product of a microorganism to evoke an
immunologic response and clinical protection that
mimics that of natural infection but usually presents
little or no risk to the recipient.
• Eg toxoid , a purified antigen or an antigen produced
by genetic engineering.
 Passive immunization
• Administration of preformed antibody to a
recipient , confers immediate protection but
for only a short period of time.
• Eg Post exposure passive immunization (IVIG)
is available for rabies, measles, hepatitis B,
varicella, tetanus.
 Principle of Immunization
• When exposed to a pathogenic organism, the
body mounts an immune response.

• When exposed to an infectious agent the second

time, the host immune response is fairly rapid
and sufficient to prevent the disease.
 Why scheduling immunization?
• Vaccination is intended to be administered to
a person capable of an appropriate
immunologic response and likely to benefit
from the protection given.

• Possible impaired immune response.

 Types of Vaccines
• Live attenuated
• Inactivated/Killed
– Whole cell
– Toxoid
– Polysaccharide antigen
– Subunit
• Adjuvants: Substances given along with antigens
in order to enhance immunogenic efficacy. Eg.
aluminium salts in DPT

• Preservatives, stabilizing agents:

- Improve shelf life of vaccine. Eg. Mgcl2 in OPV
- Erythromycin, Kanamycin in Bivalent Polio
- Gentamycin in JE
 Types of Vaccines:
Type of Antigen Examples
Live bacteria, attenuated BCG, [Link] Ty 21a
Live virus, attenuated OPV,MMR, JE ,Varicella, Rota
Killed bacteria Pertussis, TCV
Killed virus IPV, Rabies, HAV,
influenza(whole virion)
Modified bacterial Toxoid DT, TT, Td
Capsular polysaccharide [Link] (Vi) , Hib,
meningococcal, pneumococcal
Viral subunit Recombinant Hepatitis B,
influenza (split subunit)
Bacterial subunit Acellular pertussis
Principles in administration of vaccines
Combination Recommendation
≥ 2 killed antigens Give simultaneously or at any interval
(exception – cholera and yellow fever, 3-
4 wks gap)
Killed and live antigens Can be given simultaneously or at any
interval.
≥ 2 live antigens 4 weeks minimum interval if not given
together, except OPV and BCG, MMR.
IG and corresponding For MMR - 3 months interval
antigen For Hep B, tetanus, Rabies – can be given
simultaneously
 Vaccine safety
• Hand washing each time

• Use of sterile & disposable syringes/needles.

• No recapping of the needle. Immediately discard

used syringes and needle in puncture proof
container.

• Do not mix different vaccines unless specified.

• Keep resuscitation drugs & equipments ready

 Vaccine storage
• All vaccines are sensitive biological substances
and will loose their potency.

• Sensitive to- heat, cold and light.

• Follow the recommended storage temperature

• Cold chain maintenance

• Vaccine vial monitoring(VVM)

 National immunization schedule
Age Vaccines
Birth BCG
6 weeks DPT - Hep B - Hib, PCV 10, OPV,
Rota , fIPV
10 weeks DPT- Hep B – Hib , PCV 10, OPV, Rota

14 weeks DPT- Hep B – Hib , fIPV, OPV

9 months MR , PCV 10
12-23 months JE

15 months MR , TCV
Pregnant women Td 2 doses
 Vaccine Dose(s) Age of Route of
administration administration
BCG (Bacillus- Calmette 1 (0.05 ml) At birth Intradermal (I.D)
Guerin)i.e Copenhagen
strain(Danish 1331).
Pentavalent i.e DPT-Hep B- 3 (0.5 ml) 6 , 10 , 14 wks Intramuscular(I.M)
HiB (Diphtheria , pertussis,
tetanus , Hepatitis B ,
Hemophilus influenza)
OPV (Oral Polio vaccine) 3 ( 2 drops) 6, 10 , 14 wks Oral
Rota Vaccine 2 ( 1.5 ml 6 , 10 wks Oral
mini-bottle )
PCV-10 ( Pneumococcal 3 (0.5 ml ) 6 , 10 wks and 9 Intramuscular (I.M)
conjugate vaccine ) months
fIPV (fractional inactivated 2( 0.1 ml) 6, 14 wks Intradermal (I.D)
polio vaccine )
MR (measles ,Rubella) 2( 0.5 ml) 9 and 15 months Subcutaneous (S.C)
JE (Japanese encephalitis) 1 (0.5 ml ) 12 -23months Subcutaneous ( S.C)
i.e SA 14-14-2 strain
TCV (Typhoid conjugate 1 (0.5 ml) 15 months Intramuscular (I.M)
vaccine )
 Missed opportunity vaccination/Delay Schedule
Vaccine < 12 months 12 – 23months 24 -59 months

BCG 1 dose (0.05 ml) 1 dose (0.1 ml) 1 dose (0.1 ml)
Pentavalent < 7 mths 1st dose at 1st visit , 3 doses , 4 wks
2nd dose 4 wks apart, 3rd dose apart
at 9mths age ;
7-12 mths 3 doses 4 wks
apart
OPV 3 doses , 4 wks apart 3 doses, 4 wks 3 doses, 4 wks
apart apart

Rota Vaccine 2 doses , 4wks apart 2 doses , 4 wks No given

apart
PCV-10 3 doses, 4 week apart 2 doses , 8 wks 2 doses , 8 wks apart
apart
fIPV 2 doses , 8 weeks apart 2 doses , 8 wks 2 doses , 16 wks (4
apart mths)apart
MR 1 dose after 9 mths age 2 doses , 4 wks 2 doses, 4 wks
apart apart
 Adverse Reactions
• BCG vaccine : Subcutaneous abscess , regional
lymphadenopathy , osteitis, disseminated BCG
disease (immunocompromised).

• DPT vaccine: Anaphylaxis , Seizures ,Prolonged

crying , Hypotonic-hyporesponsive episode (HHE).
 Adverse reactions
• OPV : Vaccine associated paralytic poliomyelitis
(VAPP)

• MR vaccine :Toxic shock syndrome , Febrile seizure ,

Rash, Transient thrombocytopenia, encephalitis /
encephalopathy ,Joint pain ( small peripheral joints).
 Vaccines Contraindications
• History of anaphylaxis to a previous dose or
to a vaccine component.
• Live vaccines in severely
immunocompromised people.
• Children who experienced encephalopathy
within 7 days after administration of a
previous dose of DTwP , DTaP or Tdap.
• Pregnant women should not receive live-
vaccine.
Immunization in Special situations
• Preterm babies
• Children on steroid
• HIV infection
• Unknown immunization status
• Immunization for unimmunized child
• Lapsed immunization
• Children with immune deficiency/dysfunction /
immunosuppressive drugs
• Children with splenectomy
Immunization in special circumstances

I) Immunization in preterm infants

• All vaccines to be given except hepatitis B
vaccine if weight < 2 kg & if mother is
HBsAg negative.
• Vaccination postponed till baby attains
weight > 2 kg.
• To be given if mother is HBsAg positive.
 (II) Children with corticosteroids
• Killed vaccines to be given.
• Live vaccines not to be given if on steroid ~
2mg/kg/day for ≥14 days.
• To be given after one month of discontinuation
of steroid.
• Low dose steroid, topical/inhaled steroid is not
a contraindication.
 III) Vaccination in HIV/AIDS
Asymptomatic Symptomatic
Vaccines
WHO AAP WHO AAP

BCG Y N N N
DPT Y Y Y Y
OPV Y N N N
Measles Y Y Y Y
Hib Y Y Y Y
Varicella Consider Consider Consider Consider
Hepatitis Y Y Y Y
B vaccine
Y = Yes, N = No , AAP=American Academic of Pediatrics
IV) Unknown or unknown immunization status
• Recommended immunization should be
initiated without delay on a schedule
commensurate with the person’s current
age.

• No evidence suggests that administration of

vaccines to already immune recipients is
harmful.
 Immunization against which other
diseases?
• Mumps
• Cholera
• Chicken pox
• Human papilloma virus
• Hepatitis A
• Meningococcus
• Rabies
• Yellow fever
• Dengue
 Common misconception/myths

• Giving multiple vaccines at same time

causes an “overload” of the immune system.

• Relation between MMR vaccine and autism.

 Prospects for future vaccines

• Hepatitis E
• Malaria
• HIV
Thank You