PEDIATRICS SEMINAR ON

IMMUNIZATION
 Rajat baloda -72
 Saifur Rahman – 76
 Saradsree - 81
 Shivangi Raj -89
 Shweta kesharwani-93
 Shweta Kumari - 94
 Sneha-95
 Soni - 97
 Introduction
 Immunization : Process of inducing immunity in an individual through introduction of live or
killed or attenuated organisms in them.

 Full immunization : A child who has taken all due vaccines till 1 year of age.

 Complete immunization : A child who has taken all due vaccines till 2 years of age.

 Partial immunization : A child who has missed one or more doses of vaccine.

 Non immunization : A child who has not received a single dose of vaccine.

 Herd immunity : Immunity that occurs when vaccination of a portion of population provides
protection to unprotected individuals. It provides an immunological barrier to spread of
infectious disease.

 Ring immunization : Vaccination of people in close contact with an isolated infected patient
 Immunity
 Immunity is defined as the capacity of the body to resist the pathogenic
agent. It is the ability of the body to resist the entry of different types of
foreign bodies like bacteria,virus,toxic substance,etc
 Immunity is of two types : I. Innate immunity
 II.Acquired immunity

 Innate Immunity: Non specific and non adaptive immunity. Innate immunity is
the first line of defense against infectious agents and doesn’t depend on
previous exposures.
 Acquired Immunity: It is developed by the host in its body after exposure to
suitable antigens or after transfer of antibodies or lymphocytes from an
immune donor.
Types of immunity
 Seroconversion and Seroprotection

 Assessment of immunogenicity

 Seroconversion is the change from antibody negative to antibody positive

state, due to induction of antibodies in response to infection or vaccination

 Seroprotection is the state of protection from the disease, due to presence of

detectable serum levels of antibody
What is a Vaccine ?
Any preparation of weakened or killed bacteria or viruses introduced into the
body, to prevent a disease by stimulating antibodies against it.
Some vaccine related terms
VACCINES CURRENTLY IN USE
 VACCINATION ROUTE
• Intramuscular- Anterolateral aspect of thigh, deltoid, gluteal
administration.

• Subcutaneous- Anterolateral thigh in infants, upper outer aspect

of triceps in older children.
• Intradermal- Skin overlying deltoid.
Vaccination schedule of universal
immunization program and india
academy of pediatric 2022 .
Comparison of the vaccination
scheduled in the national
immunisation program and the 2012
recommendation of the Indian
academy of pediatrics (IAP).
Bacilus Calmette Guerin (BCG) vaccine
Dose , route 0.1ml ;intradermal
Site schedule left upper arm at insertion of deltoid
National program At birth ; up to 1 yr if missed (catch up )
IAP 2012 as above ;catch up till 5 yr
Adverseve reactions Local ulceration or discharging sinus ;
axillary lymphadenitis ;disseminated
infection ,osteomyelitis or scrofuloderma
(in immunodeficiency recipient)
Contraindication Cellular immunodeficiency ;symptomatic
HIV
Storage 2-8 degree celcius ; sensitive to heat and
light;
discard unused vaccine after 4hr
 OPV ( Oral Polio Vaccine)
• OPV contains live attenuated virus (Sabin Poliovirus)
• Preparation : Virus is grownin monkey kidneys or
human diploid cell cultures
Dose : 2 drops
Route : oral
Schedule
National program - Dose at birth or less than 2 weeks (zero dose), 3 doses at 6,10 and 14
weeks ; one booster doses at 15-18
IAP : At birth
Adverse reactions : Vaccine derived poliovirus, vaccine associated paralytic poliomyelitis
Contradindications : Inherited or acquired immunodeficiency, symptomatic HIV
Storage : 2-8 degree Celsius, sensitive to heat
 Inactivated Polio Vaccine (IPV)
IPV is a suspension of formaldehyde killed (salk) poliovirus grown in monkey kidney, human diploid or vero cell
culture.
Dose : 0.5 ml, fractional-0.1 m
Route : Intramuscular, fractional- intradermal
Schedule
National Program – fractional dose at 6 and 14 weeks and 9-12 months
IAP – 3 IM doses of IPV at 6,10 and 14 weeks and booster dose
at 15-18 months and 4-6 years
Adverse reaction : Local pain , swelling
Contraindications : Known allergy
Storage : 2-8 degree Celsius, sensitive to light and heat
 Hepatitis B Vaccine
 Hepatitis B virus (HBV) vaccine contains the surface antigen HBsAg, produced by
recombinant DNA technology in yeast, adsorbed on aluminum salt as adjuvant.
 The vaccine as is available as monovalent vaccine in single dose or multidose vials, and
also in combination with hepatitis A, DTwP, and Hib(Pentavalent vaccine),and DTaP with
or without
Hib.
DOSE : 0.5 ml (10 mcg); 1 ml (20mcg) in adults, immunosuppressed chidren
ROUTE : Intramuscular
SITE : Anterolateral thigh or deltoid; avoid gluteal region
SCHEDULE :
Nationl Program- At birth, 6 weeks, 10 weeks and 14 weeks
IAP 2021- As above; ideally a gap of >=4 weeks between the first two doses; >= 8 weeks
between doses 2 and 3 and >= 16 weeks between the first and final doses, with the final
dose given at>= 6months of age
CATCH UP : Three doses at 0, 1, and 6 months ; preferred gaps as detailed above
ADVERSE REACTIONS: Local soreness, fever, fatigue
CONTRAINDICATION : Anaphylaxis after previous dose
STORAGE : 2-8 Degree Celsius; do not freeze
 Pneumococcal Conjugate Vaccine
 Helps prevent pneumococcal disease caused by Streptococcus pneumoniae
 Types : PCV13, PCV15, PCV20
DOSE : 0.5ml
ROUTE : Intramuscular
SITE : Anterolateral side of mid-thigh or deltoid
SCHEDULE :
National Program- 3 doses at 6 ,14 weeks and 9 months
IAP 2021- 3 doses at 6 weeks, 10 weeks and 14 weeks ; booster dose at 15-18
months
ADVERSE REACTIONS : Fever, local pain, soreness, malaise
CONTRAINDICATION : Severe allergic reaction to previous dose
STORAGE : 2-8°C (vaccine must not be frozen)
 Oral Rotavirus Vaccine
 Live attenuated oral freeze dried
 Rotavac, RotaTeq, Rotarix
 Citrate Biccarbonate buffer used as diluent

DOSE : 5 drops or 2.5ml

ROUTE : Orally
SCHEDULE:
National Program- 3 doses at 6 weeks, 10 weeks and 14 weeks
IAP 2021- 3 doses at 6, 10 and 14 weeks
ADVERSE REACTIONS : Fever, Diarrhea, Vomiting, Intussusception ( rare)
CONTRAINDICATION : Hypersensitivity to any component of vaccine;
history of intussusception; Severe Immunodeficiency
STORAGE : 2-8 degree Celsius, protect from heat, use witin 4 hour of reconstitution
or opening
 DPT Vaccine
 Diphtheria vaccine contains diphtheria toxin (DT) inactivated by formalin and adsorbed on
aluminum hydroxide, the adjuvant.
DOSE : 0.5 ml
ROUTE : Intramuscular
SITE : Anterolateral aspect of mid-thigh
SCHEDULE :
National program- DTwP at 6, 10 and 14 weeks (primary); booster at 15-18 months and 5
years
IAP 2021- DTwP or DTaP for primary immunization and booster in schedule as above
ADVERSE REACTIONS : Local pain ,swelling,fever, rarely inconsolable cry,
seizure,encephalopathy,
hypotonic hyporesponsive episodes.
CONTRAINDICATIONS
• Anaphylaxis after previous dose;
• Encephalopathy within 7 days of previous dose;
• Relative contraindication- progressive neurological disease (administer DT or Td instead)
STORAGE : 2-8°C; sensitive to light
 H. Influenza B Vaccine
 The chief antigen is Hib capsular polysaccharide, polyribosyl-ribitol-phosphate (PRP), which is
conjugated to tetanus toxoid (PRP-T), diphtheria toxoid (PRP-D), a mutant nontoxic diphtheria
toxin
CRM-197 (Hib-OC), or meningococcal outer membrane protein (PRP-OMP).
 Available in India as monovalent , and in combination (with DTP and hepatitis B, and/ or IPV)
vaccines
 Part of the Pentavalent vaccine in the Universal Immunization Program since 2015.
DOSE : 0.5ml
ROUTE : intramuscular
SITE : Anterolateral thigh
SCHEDULE :
National Program- Pentavalent vaccine 3 doses given at 6, 10 and 14 weeks
IAP SCHEDULE- <6 months old: 3 doses at 26 weeks given 24 weeks apart; one booster at 12-
18 months
ADVERSE REACTION: Local pain ,fever,nausea,anaphylaxis.
CONTRAINDICATION : Hypersensitivity to previous dose
STORAGE : 2-8 Degree Celsius
 Measles containing Vaccine
 Measles vaccine, derived from the Edmonston-Zagreb strain, is available as a monovalent
preparation, or in combination with rubella (MR), mumps (MMR) and varicella (MIMR-V).
 Each vaccine dose contains at least 1000 infective units of the attenuated virus.

DOSE : 0.5ml
ROUTE : subcutaneous
SITE : Right upper arm (at insertion of deltoid) or anterolateral thigh
SCHEDULE :
National program- At 9-12 and 15-24 months, as measles or measles rubella vaccine
IAP 2021- At 9-12 months, 15-18 months and 4-6 years; preferably as MMR; avoid MMR-V <2
years
ADVERSE REACTION: Local pain ,tenderness, febrile seizures, arthralgia, lymphadenopathy .
CONTRAINDICATIONS : Immunosuppression; malignancy; immunodeficiency (e.g. symptomatic
HIV); recent
infusion of immunoglobulin-containing blood product
STORAGE : 2-8°C; sensitive to heat and light; use within 4-6 hours of reconstitution
 Japanese Encephalitis
 The type of JE vaccine used in national program is cell-culture derived live-
attenuated vaccine using SA14-14-2 strain of JE virus.
 Sterile phosphate buffered saline used as diluent.
 Used only in JE endemic areas.
DOSE: 0.5ml
ROUTE: Sub-cutaneous
SITE: Left upper arm
SCHEDULE :
• National Program- 9-12 months, 16-24 months
• IAP 2021- 12-15 months, 16-24 month
ADVERSE REACTION: Fever,malaise, pain
CONTRAINDICATION : Allergic reaction to previous dose; event of severe acute
febrile illness
STORAGE : 2 -8 degree Celsius, do not freeze
 Vitamin A Oil
DOSE: 1st dose- 1ml(1 lakh IU); 2nd - 9th dose- 2ml(2 lakh IU)
ROUTE: Oral
SCHEDULE:
• Vitamin A(1st dose)- 9 completed months with MR 1
• Vitamin A(2nddose)- 16-18 months with MR 2
• Then 1 dose every 6 months upto the age of 5 years.
CONTRAINDICATION : Hypervitaminosis A; hypersensitivity to vitamin A
or any component of vitamin A containing pharmaceutical.
 MISSION INDRADHANUSH

Launched: December 2014

Objective: Fully immunize >90% of infants by 2020
Strategy: Special immunization drives; intense efforts in focus areas
Focus: 201 districts in 28 states that have the majority of partially immunized or unimmunized children
Coverage: 528 districts in 35 states and union territories
Personnel: 3As (Anganwandi workers, accredited social health activists, auxiliary nurse midwives)
Achievements: By August 2017, annual increment in immunization coverage increased Irom
1% in 2014 to 6.7% in 2015
ReplyForward
Intensified Mission Indradhanush
Launched: October 2017
Objective: Fully immunize >90% newborns by December 2018
Implementation: Week-long immunization drives from 7th of each month
Additional: (i) Need based interventions; (i) strengthen involvement of relevant non-health
departments;
(iii) enhanced accountability; (iv) vaccination orn demand to children <to 5 years
Coverage: Left out and drop out sites in selected 173 districts and urban areas in 17 cities (i) with low
routine Immunizationcoverage (urban slums; nomadic sites; areas with vaccine preventable disease
outbreaks); (ii) without ANMs; (ii) population per
subcenter higher than norm; (iv) >3 consecutive missed routine immunization sessions
 COLD CHAIN

 A system of storing and transporting the vaccine ,

at low temperature from the place of manufacture
to the actual vaccination site
is called Cold chain.
 In peripheral area where vaccines are used : +2 to +8°C
 Storage temperature of vaccines : -15 to -25°C
 Importance of Cold Chain

 Obtaining the vaccines from the manufacturers

 Storing and transporting the vaccines.
 Maintaining the supply of vaccines
 Keeping the vaccines at low temperature
 Protecting the vaccine from sunlight exposure
COLD CHAIN COMPONENTS
HEAT AND FREEZE SENSITIVITY OF
VACCINES
 Vaccine Vial Monitor (VVM)
 A Vaccine Vial Monitor(VVM) is a thermo-chromic
label placed on vaccine vials which registers the
cumulative effect of heat exposure over time.
 Moreover it also guides the health worker to first
use more exposed vials.
 OPEN VIAL POLICY

-Applicaple for vaccine: OPV,DPT, Hepatitis B ,TT, Liquid

pentavalent
-Not applicable for vaccine: Measles,BCG,JE
 What is AEFI ?

A medical event that

 Takes place after an immunization

 Causes concern

 Is believed to be caused by immunization

 Ranges from mild side effects to life – threatening, but rare, illnesses
 Types of AEFIs ?

1. Programmatic error

2. Vaccine reaction

3. coincidence

4. Injection reaction

5. Unknown
 Side effects of vaccines
Vaccines Side effects
BCG MC : Scar, fever
Supplementation lymphadenitis after one month of vaccine.

Hepatitis B Anaphylaxis
OPV Vaccine associated paralytic polio:
• Recipient: if a child had taken OPV before 4-40 days of onset of paralysis.
• Contact: In contact with a child who received vaccine within 4-75 days of having
onset of paralysis.

Pertussis Inconsolable cry ( most common side effect)

Neurological deficits
Encephalopathy
Hypotonia ( most common neurological side effect)

Tetanus toxoid Brachial neuritis even after one week- few months of vaccine.
Incidence: 5-10/ million injection.
 How to minimize AEFIs ?

 1. Use separate site for each vaccine

 2. Use one syringe and one needle for each injection.

 3. Use auto – disable syringes for all immunization injections.