SEMINAR ON

IMMUNIZATION

SUBMITTED TO: SUBMITTED BY:

MRS. BHAVANI.S, M.VIJIYALAKSHMI,

ASSO. PROFESSOR, M.SC (N) 1ST YEAR,

DEPT. OF CHN, DEPT. OF CHN,

CON-PIMS CON-PIMS

SUBMITTED ON :
 INDEX

S.NO TOPIC PAGE NO.

1 Introduction of immunity

2 Immunization, its purpose and objectives

3 Immunizing agents

4 Vaccine and its classification

5 Expanded programme of immunization and schedule

6 Cold chain

7 Vaccine administration and nurses’ responsibilities

8 Contraindication of vaccine

9 Hazards of vaccine

10 Reason for school vaccine

11 Conclusion

12 Bibliography
IMMUNITY
INTRODUCTION
Immunity is "the ability of the body to recognize, destroy and eliminate antigenic material (i.e.
bacteria, virus and foreign proteins)". Immunity is the resistance offered by the host to fight
against the harmful effects of a pathogenic microbial infection.

TYPES
IMMUNTY
1. innate
 Non-specific
 Specific
2. Acquired
 Active (Natural, Artificial)
 Passive (Natural, Artificial)
Innate Immunity
1. This is genetically passed on from one generation to the other generation.
2. It may be specific when it shows resistance to particular
3. It may be non-specific, i.e. it shows a degree of resistance to all infections, eg. plant
pathogens, rinderpest and distemper.
Acquired Immunity
1. Acquired immunity is acquired in the lifetime of an individual.
2. It differs from innate immunity in the following ways:
 It is not inherent in the body.
 It is specific for a particular type of micro-organism.

Types of Acquired Immunity

1. Active immunity: It is developed as a result of antigenic stimulus. It may be:
a. Natural active immunity
b. Artificial active immunity
2. Passive immunity: It is of two types:
a. Natural passive immunity
b. Artificial passive immunity

IMMUNIZATION
Immunization is a process of protecting a child or an individual from diseases through
introduction of live or killed or attenuated organism into the individual. It is one of the most cost-
effective health intervention. Immunization against vaccine-preventable diseases is essential to
reduce the child's mortality and morbidity It is the best and cheap method to protect masses. It
gives resistance to an infectious disease by producing or augmenting the immunity.

DEFINITION
It is defined as, "the process of inducing immunity artificially by administering antigenic agents
or preformed antibodies".
 It is one of the most cost-effective strategies to prevent serious infectious diseases.

PURPOSE OF IMMUNIZATION
 To provide protection before the child is exposed to infection or likely to be encountered
in childhood by use of patent specific antigens that are available.

 To control the infection in the community in addition to providing individual protection.

OBJECTIVES OF IMMUNIZATION
National immunization programme has been started in India since 1978. It was expanded in 1985
under universal immunization program to protect the children by 2000.Following are the two
important objectives:
1. To reduce the mortality and morbidity due to six killer disease among children.
2. To archive self sufficiency in the production of vaccines.

IMMUNIZING AGENTS Immunizing agents are the substances which produces

immunity when introduced into the body.
Classification of Immunizing Agents
They may be classified as vaccines, immunoglobulin and antisera:

1. VACCINES:
 It is the process of inoculating the antigen (vaccine)
into the body, regardless of its seroconversion, that is
change from antibody negative to antibody positive.
 It is not the same as seroprotection which is the actual state of protection from infection
as a consequence of development of antibodies from seroconversion.
 The vaccine contains one or more antigens of a pathogen (usually a virus or bacteria) plus
adjuvants(say aluminium hydroxide, lipids) which enhanceits ability to elicit a cellular,
humoral or combined immune response (immunogenicity).It is expected to elicit an
immune response not enhance immune response nota mounting to disease. The response
is largely humoralas in hemophilus influenza type b (Hib) vaccine,c ellular as in Bacillus
Calmette-Guérin (BCG) or both as in a majority of the vaccines.
Two terms, vaccine efficacy and vaccine protectiveness, need clarification.
 VACCINE EFFICACY
The term, vaccine efficacy, denotes an ability of the vaccine to protect against infection
and is epidemiologically expressed by the formula:

Rate of infection in unvaccinated population

Vaccine efficacy=
Rate of infection in the vaccinated population

VACCINE EFFECTIVENESS
The term, vaccine effectiveness, refers to an ability of the vaccine to protect the
population from infectious disease.
Three factors that influence vaccine effectiveness are:
1. Vaccine efficacy
2. Implementation of the immunization program
3. Herd immunity/effect. Passing on the benefit of protection to even the
unimmunized population is termed herd immunity or effect. Oral polio vaccine
(OPV) followed by measles vaccine are the out standing examples of this phenomenon.

CLASSIFICATION OF VACCINE
Vaccines are of three types, i.e. live vaccines, killed or inactivated vaccines and toxoids
a. Live vaccines: Live vaccines are prepared from live attenuated microorganisms. Live
vaccines are more potent than the killed vaccines.
b. Killed or inactivated vaccines: They are prepared from organisms killed by heat or
chemicals. They produce active immunity. They are usually safe.
c. Toxoids: Toxoids are prepared by detoxicating the exotoxins produced by certain
organisms,They are very effective and safe.
d. Cellular fractions: Sometimes vaccines are prepared from extracted cellular fractions,
e.g. meningococcal vaccine from the polysaccharide antigen of the cell wall.
e. Combinations: When more than one immunizing agent is included in the vaccine, it is
called a combined or mixed vaccine for example, DPT vaccine is a combined vaccine for
diphtheria, pertussis and tetanus.
2. IMMUNOGLOBULINS: The human immunoglobulin system is composed of five major
types, i.e. IgG, IgM,IgA, IgD and IgE.
There are two types of immunoglobulin pre-parations for passive immunization. They are:
a. Normal human immunoglobulin.
b. Specific (hyperimmune) human immuno-globulin. They are used in prophylaxis of
virulent bacterial infections and in replacement of antibodies in immunodeficient
patients.
3. ANTISERA: Antisera are specific immunoglobins prepared from the serum of immunized
animals, e.g. horse serum. They afford passive immunity for example, anti-diphtheria serum,
antirabies-serumand anti-gas gangrene serum. Administration of antisera may give rise to serum
sickness and anaphylactic shock because of animal protein to which the recipient may have
abnormal sensitivity.Test dose should be given to exclude sensitivity reaction.

EXPANDED PROGRAMME ON IMMUNIZATION

1. The expanded programme on Immunization in India initiated in 1978 with the objective
of protecting eligible population.
2. In May 1974, the WHO officially launched a global immunization programme, known as
Expanded Programme on Immunization (EPI) to protect all children of the world against
six vaccine-preventable diseases, namely-diphtheria, whooping cough, tetanus, polio,
tuberculosis and measles by the year 2000.
3. The programme is now called Universal Child Immunization, 1990 that is the name given
to a declaration sponsored by UNICEF as part of the united nations, 40tn anniversary in
October 1985.
4. It is aimed at adding impetus to the global of programme of EPI.
5. The Govt. of India started, the Universal Immunization Programme on November 19,
1985 and was dedicated to the memory of Smt. Indira Gandhi.
6. The National Health policy aimed at achieving universal immunization coverage of the
eligible population by 1990.
7. Accordingly, the universal immunization programme was launched with greater efforts
for universal coverage of immunization of infants and pregnant women.

National immunization schedule(NIS) for infants, children and

pregnant women
WHEN TO VACCINE DOSE ROUTE SITE
GIVE

For children

At birth BCG 0.1ml ID Left upper arm

Hep -B 0.5ml IM Antero-lateral side of

mid-thigh

OPV-0 2 drops oral oral

At 6 weeks OPV-1 2drops oral oral

Penta-1 0.5ml IM Antero-lateral side of

 mid thigh

IPV-1 0.1ml ID Right upper arm

Rota 5drops oral oral

At 10 weeks OPV-2 2drops oral oral

Penta-2 0.5ml Antero-lateral side of

mid thigh

Rota 5drops Oral oral

At 14 weeks OPV-3 2drops oral oral

Penta-3 0.5ml IM Antero-lateral side of

mid thigh

Rota 5drops oral oral

IPV-2 0.1ml ID Right upper arm

9- 12 months MR-1 0.5ml sub Right upper arm

JE-1 0.5ml sub Left upper arm

Vit-A-1 1ml ( 1 oral oral

lakh IU)

At 16- 24 DPT booster-1 0.5ml IM Antero-lateral side of

months mid thigh

MR-2 0.5ml sub Right upper arm

OPV booster 2drops oral oral

JE-2 0.5ml sub Left upper arm

At 5-6years DPT booster-2 0.5ml IM Upper arm

At 10 and 16 TT 0.5ml IM Upper arm

years

For pregnant women

Early TT-1 0.5ml IM Upper arm

pregnancy

After 4 weeks TT-2 0.5ml IM Upper arm

After 2 doses TT booster 0.5ml IM upper

of TT in
 pregnancy
within last
3years

COLD CHAIN
The cold chain is a system of storage and transport of vaccine at low temperature from the place
of manufacture to the actual vaccination site.
The main objective of old chain is to maintain the potency of the vaccine by providing adequate
cooling facilities.
Vaccines must be protected from sunlight and prevented from contact with antiseptics.

EQUIPMENT OF COLD CHAIN SYSTEM

The cold chain equipment are:
1) Refrigerators:
a) Deep freezers (300 Ltr.):

 Deep freezer is a top opening equipment.

 It is to be used for storing polio and measles vaccine and freezing of icepacks.

 A pair of deep freezer and a vest frost ILR is connected to a common voltage stabilizer. It
is supplied to all districts and the WIC locations to store vaccines.
b) Ice lined refrigerators (ILR):

 ILR are also top opening refrigerators kept at PHC and district level.

 ILRs are either liked with ice tubes(electrolux) or with ice packs (vest frost)filled with
water which freezes and acts as the ice lining.

 The temperature inside the refrigerator is maintained at +20°C to +8°C.

 All vaccines at PHC level are stored in the ILR. A dial thermometer should be kept in the
ILR and temperature records twice in a day.
c) Small deep freezers (140 Ltr.): Deep freezers are used to prepare frozen ice packs
which are used in cold boxes, and vaccine carriers for transportation of vaccines and
during the sessions.
2) Walk in cold rooms(WIC): They are located at regional level, meant to store vaccines
upto 3months and serve 4 5 districts.
3) Cold boxes:
  Cold boxes are supplied to all peripheral centres.

 Cold boxes are means to transport large quantities of vaccine by vehicle to reach sites.

 Fully frozen ice-pack are placed at the bottom and sides, before placing vaccines in the
cold boxes.

 The vaccines are first kept in cartons or polythene bags.

 The vials of DPT, DT, TIT, vaccines and diluents should not be placed in direct contact
with the frozen ice packs.

 If the cold packs start melting and the temperature gets close to +8°C immediately
replace them with fresh frozen ice packs or ice.
4) Vaccine carriers:

 Vaccine carriers are used to carry small quantities of vaccines (16-20 vials) for the out of
reach areas.

 They have thick walls and lids, that are made of special material which is insulated and
can keep the vaccines cold for about 2 days, if four fully frozen packs are used for lining
the sides and the lid is shut tightly.

 DPT, DT and TT vials should not be placed indirect contact with frozen ice packs.
5) Day carriers:

 Day carriers are used to carry small quantities of vaccines (6-8 vials) to a nearby session.

 Two fully frozen packs are to be used in thermocol boxes. It is used only for few hours.
6) Ice packs/cold packs:

 These are flat bottles of plastic, which are filled with water but no salt should be added to
it.

 The water should be filled up to the level marked on the side.

 These packs are used in the vaccine carriers after freezing their water.

 Some of these are sealed while caps of others can be opened. These are kept in deep
freezers for a minimum of6 hours to freeze the water inside them.

ADMINISTRATION OF VACCINE AND NURSES RESPOMSIBILITIES

 Follow strict aseptic technique, use single autoclave syringe and needle for each
injection.
 Follow instruction of manufacturers and the physicians regarding the dosage and mode of
transmission.
 Carry vaccines in a flask with ice cubes while transporting otherwise its potency and
effectiveness will be lost.
 Maintain a record of every vaccination that is given.
 As vaccine have specific life period and must be utilized before the expiry date.
 Nurse must be familiar with the manufactures direction for storage and reconciliation of
the vaccine.
 Subcutaneous or intracutaneous injection an cause local irritation, inflammation or
abscess formation.
 To minimize local reactions from vaccines, nurses should elected a needle of adequate
length to deposit the antigen deep on the muscle mass.
 An accurate documentation record of the child’s immunization is maintained for the
purpose of the parents to keep track.
 Information is documented on medical record and includes day, mouth and year of
administration, manufacture and lot number of vaccine, the name , address and title of the
person administrating the vaccine.
 Any adverse reactions after the administration of any vaccine are reported to the
concerned authorities of the respective governments.

THE VACCINE VIAL MONITOR

A VVM is a label containing a heat-sensitive material which is placed on a vaccine vial to
register cumulative heat exposure over time.
The combined effects of time and temperature cause the inner square of the VVM to darken
gradually and irreversibly. Before opening a vial, check the status of the VVM.

STAGE OF THE VVM

STAGE 1: the inner square is lighter than the outer circle. If the expiry date has been
passed ; USE the vaccine.
STAGE2: the inner square is still lighter than the outer circle. If the expiry date has not been
passed: DO NOT use the vaccine

Discard point:
STAGE3: the colour of the inner square matches that of the outer circle: DO NOT use the
vaccine
STAGE 4: the colour of the inner square is darken than the outer circle: DO NOT use the
vaccine.
 The VVM does not directly measure vaccine potency but it gives information about the main
factor that affects potency i.e. heat exposure over a period of time.

AUTO DISPOSALE SYRINGE

Auto-disposable syringe are specifically designed to prevent syringe reuse. The syringe is
automatically blocked, thus becoming unusable.
The auto disposable syringe are used for the administration of the appropriate vaccine and the
disposable syringe is used for reconstitution of vaccine where needed.
The AEFI(adverse event following immunization) kit contain other type of syringe like,
insulin type (with 0.01ml graduation and 6 G needle), 5ml disposable syringe with 24 and
26G needles.
Three types of syringe are supplied under the NIS for the purpose of vaccine administration:

 0.1ml AD syringe

 0.5ml AD syringe and

 5ml disposable syringe.

Vaccine are given using these syringe

 The 0.1ml AD syringe comes with the needle gauge of 26G and is used for intradermal
injection- BCG and fractional dose od IPV

 The 0.5ml AD syringe is used for the other injectable vaccines.

CONTRAINDIATION FOR IMMUNIZATION

1. Acute illness with fever
2. When child is on immunosuppressive drug or on radiation.
3. When child is suffering from lymphoma malignancy or leukemia

HAZARDS OF IMMUNIZATION
Some immunizations are given as a routine during infancy with periodic booster and some are
recommended only under certain circumstance e.g. cholera, plague.No immune response is
entirely free from the risk of adverse reactions.
 Reactions inherent to inoculations are pain, swelling, redness, tenderness, small nodule,
and abscess as the site of injection, fever, malaise, and headache.
 Reactions due to faulty technique related to faulty production of vaccine, too much
vaccine given in one dose, improper site or route, incorrect diluents, wrong amount,
 Example ; an absorbed vaccine not shaken properly before use, contaminated vaccine,
child who had reaction.
 Reaction due to hypersensitivity gives rise to occasionally anaphylactic shock and serum
sickness. There is bronchospasm, dyspnea, pallor, hypotension and collapse.
 Neurological involvement following anti-rabies vaccine, encephalopathy may be fetal. It
is foreign serum, keep adrenaline.

REASON FOR SCHOOL VACINATION

 The immunological response of infant is poor and it has never been shown that
the reduced dose of BCG given to babies affords lasting protection.
 The risk of tuberculosis infection in many developing countries is still high and
most infection occur after puberty. Vaccination at the age of 6 years may protect
children up to 20 years of age.
 Vaccination at school is feasible and due to growing school attendance, will cover
all the children in community.
CONCLUSION:
The process of increasing the resistance of a person to a particular infection br artificial means is
called immunization. Immunization procedures are designed to stimulate the normal response of
the tissues in such a way that the person will develop an artificial active immunity without the
risk or inconvenience of having the disease.
SUMMARY:
so far we have seen about immunity ,its type , immunization, classification of vaccines, cold
chain, administration of vaccine, nurses responsibilities, hazards of immunization and reason for
school immunization.
BIBLIOGRAPHY:

BOOK REFERENCE:

1) RimpleSharma,’’Essential Of Paediatric Nursing,’’2ndedition,Jaypee publication Pg

No:502-504.
2) Parul Data ‘’Pediatric Nursing’’ 2ndedition(2009),Jaypee Brothers medical
Publication Pg No:483-485.
3) Ghai, ‘’Essential Pediatrics’’7thEdition(2009),Cbs Publisher Pg No:371-374 .
NET REFERENCE:

1. https://main.mohfw.gov.in/sites/default/files/245453521061489663873.pdf
2. http://www.nrhmhp.gov.in/content/immunisation
3. https://www.who.int/health-topics/vaccines-and-immunization