IMMUNIZATION

IMMUNIZATION

• Immunization is a process of protecting an

individual from a disease through introduction of
live attenuated, killed or organisms 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 and
antisera
Expanded Pr ogr am
on Immunisation
 WHO launch a global immunization program,
known as Expanded Program on
Immunization (EPI) in May 1974.
 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.
 EPI was launched in India in January 1978 .

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Uni ver sal
I mmuni sat i on
Programme
 The Indian version, the Universal
Immunization Programme, was launched on
November 19, 1985.
 The National Health Policy aimed at achieving
universal immunization coverage of the
eligible population by 1990.

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 ACTIVE VS PASSIVE I M M U N I Z AT I O N

Active Passive
 Killed or live • Transfer of antibodies
attenuated organism • Short term
injected which can
induce immune • No role of immune
response system
 Long term • Ex- Anti Tetanus,
serum, Anti Rabies
 Immune system plays
immunoglobulin etc
role
 Ex-Hepatitis B vaccine,
DPT, Inactivated polio
vaccine, Measles-rubella
(MMR) combined
vaccine
 UNIVERSAL I M M U N I Z AT I O N P R O G R A M M E

• In 1974, Expanded program of Immunization (EPI)

organized by WHO
• It was called Expanded because:
• Adding more disease controlling antigens of
vaccination schedules.
• Extending coverage to all corners of a country.

• On 19 November 1985, GOI renamed EPI program,

modifying the schedule as ‘Universal Immunization
Program’

• ‘Universal’ immunization is, therefore, best interpreted as

implying the ideal that no child should be denied
immunization against tuberculosis, diphtheria, whooping
cough, tetanus, polio and measles.
 WHY IMMUNIZATION

• Prevention of deadly and debilitating

diseases.
• Keeps child from suffering through a
preventable illness.
• Less doctor visits
• No hospitalization
 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.

• Example: Vaccines against polio (OPV),

measles, mumps, rubella and
 INACTIVATED VA C C I N E S

• 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.

• Example: Vaccines against influenza,

inactivated polio vaccine, hepatitis A etc.
 TOXOIDS

• For bacteria that secrete toxins, or

harmful chemicals, a toxoid might be the
answer.

• 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.

• Example: Diphtheria, Tetanus toxoid

 SUBUNIT VA C C I N E

• 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.

• Example: Plague immunization.

 CELLULAR FRACTIONS

• Meningococcal vaccine from the polysaccharide

antigen of the cell wall.

• Pneumococcal vaccine from the polysaccharide

capsule of the organism.
 C O M B I N AT I O N S

The aim is to
– simplify administration.
- reduce costs
-minimise the no. of contacts with the health
system.

Eg. DPT, DT, MMR, DPT& Hep.B, DPT, Hep B

&
Hib, Hep A & B etc.
 MAJOR C O N S T I T U E N T S OF VA C C I N E

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) Adjuvants- Al salts frequently used.
 NATIONAL IMMUNISATION SCHEDULE
VACCINE WHEN TO GIVE
For infants
BCG At birth or as early as
possible till one year of
age
Hepatitis B At birth or as early as
possible within 24 hour
OPV 0 At birth or as early as
possible within the first
15 days
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 NATIONAL IMMUNIZATION SCHEDULE
At 6 weeks , 10 weeks & 14 week
OPV 1,2 & 3

ROTA VIRUS 1,2&3 At 6 weeks , 10 weeks & 14 week

At 6 weeks , 10 weeks & 14 week
PENTAVALENT 1,2 & 3

FRACTIONAL- IPV 1&2 At 6 weeks & 14 week

MEASLES AND RUBELLA 1 9 completed months -12 month

( given up to 5 years if not
received at 9-12 month age)

JAPENESE ENCEPHALITIS 1 9-12months

Vitamin A ( 1st dose ) At 9 month with measles

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 NATIONAL IMMUNISATION SCHEDULE
For children When to given
DPT booster 16-24 month
OPV Booster 16-24 month
Measles and Rubella 2 16-24 month
Japanese Encephalitis 2 16-24 month with DPT / OPV
Booster
Vitamin A 16 month with DPT/OPV
booster. Then one dose every 6
month up to the age of 5 year

DPT booster 5-6 years

TT 10 years & 16 years
NATIONAL IMMUNISATION SCHEDULE

FOR PREGNANT
WOMEN TT-1 Early in
TT-2 pregnancy 4
TT- Booster weeks after TT-1
If received 2 TT doses
in a pregnancy within
the last years
 IAP
Birth - 15 days
SCHEDULE BCG + OPV (zero dose) +HepB1

6 weeks - 8 weeks OPV1 +IPV1 + DPT1+ HepB2 + Hib1 +

Rotavirus1 + PCV1
10 weeks- 12 weeks OPV2 + IPV2 + DPT2+ Hib2 + Rotavirus2 +
PCV2
14 weeks - 16 weeks OPV3 + IPV3 + DPT3 + Hib3 + Rotavirus3# +
PCV3
6 months HepB3 + OPV1
9months (complete Measles+OPV2
d)
IAP
SCHEDULE

12 Hepatitis A1
months MMR1 + Varicella +
PCV booster
15 OPV4 + IPV booster1 +
months DPT*booster1 + Hib booster1
+ Hepatitis A2
18 Typhoid1 (give repeat
2
months shots every 3 years)
years
OPV5 + DPT* booster2
5 +MMR2^ + Varicella2$$
years Tdap/Td (Every 10 years
10 - 12 then
years give Td)+ HPV**
 TETANUS TO X O I D

• Intramuscular – upper arm – 0.5 ml

• Pregnancy – 2 doses - 1st 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 deg C.
 BCG
¨ W H O 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, 05ml in children <10 yrs, given IM. Mostly used 0,1,6 m
schedule.
 O R A L POLIO VA C C I N E

¨ 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 VA C C I N E

• Simultaneous immunization against diphtheria, Pertuisis &

Tetanus, Hep B, Hib.
• Stored at 4-8 degree C.
• Given 0.5 ml IM at anterolat. aspect of thigh.
• Primary 3 doses with a booster in 16 -24 months. DT 5-6 yrs.
• C/I –progressive neurological diseases.
 ROTAVIRAL VA C C I N E

• 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 diarrhoea among infants due to rotavirus.
 IPV

• 2 fractional doses given in 6th and 14th weeks.

• Dose – 0.1 ml
• Given intradermally in Right upper arm
 JAPANESE ENCEPHALITIS

• SA 14-14-2 vaccine
• 0.5 ml, 2 doses
• 9 months and16-24
months
• Subcutaneous
• Left upper arm
 MR VA C C I N E
• Bivalent Live atteunated against measles and rubella.
• Given 0.5 ml SC at 9-12 and 16-24 months.
• Stored 2-8 deg C
• Strain- Measles-Edmonstorn-zagreb, Rubella- Wilstar RA27/3
• Reactions- Fever, Resp. symp.s, Lymphadenitis or parotitis
 DPT

• Primary doses were in pentavalent vaccine.

• One booster at 16-24 m with OPV booster (antero-lateral side of mid-thigh) and
second booster at 5-6 years (upper arm)
• 0.5 ml
• Intra-muscular
 VITAMIN A

• 1st dose – 1 ml (1 IU) - along-with Measles first dose - Oral

• 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
 O P T I O N A L VACCINES

• Pneumococcal vaccine
• Typhoid vaccine
• MMR vaccine
• Hepatitis A vaccine
• Chicken pox vaccine
• Flu vaccine
• Meningococcal vaccine
 VACCINES FOR ADULTS

• Hepatitis A
• Hepatitis B
• Chicken pox vaccine
• Human Papilloma Virus
vaccine
• Flu vaccine
• Pneumococcal vaccine
• Meningococcal vaccine