NAME OF ACTIVITY SHORT TALK

PRESENTER Dr. Pravin Kolekar

 Contents:

 Introduction of UIP

 Vaccines

 Types of Vaccines

 Individual vaccine

 References
 Introduction:
 It is one of the largest immunization programme in the world and a major public health intervention in
our country.
 India was introduced in 1978 as Expanded Programme of Immunization (EPI).
 In 1985 WHO, EPI was expanded as Universal Immunization Programme (UIP)
 UIP become a part of Child Survival and Safe Motherhood Programme in 1992
 It targets to vaccinate 2.6 crore new born and 3 crore pregnant mothers annually for vaccines under UIP.
 More than 90 lakh Immunization sessions are conducted annually with nearly 27,000 cold chain points
across the country.
 Government of India is providing vaccination to prevent 11 vaccine preventable diseases nationally, i.e.
Diphtheria, Pertussis, Tetanus, Polio, Measles, Tuberculosis and Hepatitis B and meningitis &
pneumonia ,Diarrhoea, Japanese Encephalitis in endemic districts.
 In Oct. 22, NTAGI accepted the recommendation and proposed three doses schedule for better
protection of the children.
 In 9th Nov. 2022,MoHFW initiated the approval process for the three doses of fIPV in UIP



Aim:
 To achieve 100% immunization coverage of pregnant women with 2doses TT/Booster doses.
 To achieve at least 85%coverage of infants with 3 doses each of DPT,OPV, one dose of BCG,
and one doses of measles vaccine.
Objectives:
 To reduce the mortality and morbidity resulting from vaccine preventable diseases of
childhood.
 To achieve the self sufficiency in the production of vaccines.
 Elimination of neonatal tetanus & Eradication of paralytic poliomyelitis.
Goal: To provide every child and pregnant women protection from VPDs.
Main Components:
 Immunization of pregnant women against tetanus.
 Immunization of children in the first year of life against the six EPI target diseases.
Polio: India reported its last case of polio on 13th January 2011.
 South East Asia Region (SEAR) has been certified Polio free on 27th March, 2014.
 As a part of Polio end game strategy, IPV vaccine has been introduced across all the states.
IPV:
 India was introduced IPV from 30 nov.2015, prior to the tOPV to bOPV switch in April 2016.
 Currently, given as fractional dose 0.1ml ID. At 6th & 14th wks. of age.
 However this schedule with fIPV- showen to have lower immunogenicity compared with two dose
schedule-79%.
 Even full doses at 6 and 14 weeks , it only reaches up to 89%.But with delayed first dose and longer
the interval between two doses (14 weeks and 9-months schedule), whether full or fractional, it
reaches nearly 100%.
 An alternative –to retain the two dose fIPV schedule at 6 and 14 weeks and 3 rd dose at 9 months
along with MCV1 Contact.
Hepatitis B: Hepatitis B vaccine was piloted in 2002-03 and then scaled up in entire country in 2010
& to protect children from liver diseases such as Jaundice and Cancer.
Now it is provided as part of pentavalent vaccine.
Pentavalent vaccine:
Pentavalent vaccine contains five antigens.
The vaccine has replaced DPT and Hep B vaccine in the immunization schedule.
Birth dose of Hep-B and two booster doses of DPT (at 16-24 month and 5 years of age) will continue
to be given.
India introduced Pentavalent vaccine initially in two states viz. Kerala and Tamil Nadu in December
2011.
At present, pentavalent vaccine has been expanded to all 36 States/UTs.
Rotavirus Vaccine:
The vaccine was launched on 26th March 2016
Rotavirus vaccine is given under UIP as a 3 dose vaccine along with PENTA.
Japanese encephalitis:

 Japanese Encephalitis (JE) is an acute viral illness with high (CFR) and long term complications.

 JE vaccination program started in 2006 in JE endemic areas with strategy to cover all children of
1-15 years of age in mass vaccination drive and integration into RI.

 Out of total 215 identified JE endemic districts, campaign activity has been completed in 206
districts(two doses, first at 9-12 months and second at 16-24 months).

 Adult JE vaccination in the age group of 15-65 years in 21 high burden districts in Assam ,UP,
WB.
Inactivated Polio Vaccine (IPV)

 There are three types of Polio viruses namely Type-1, 2 and 3 for which the vaccine was provided
under Universal Immunization Programme as trivalent Polio vaccine.

 Since last case of wild Polio virus Type-2 was reported in 1999, therefore, Global Polio
Eradication Initiative (GPEI) has recommended switch from trivalent OPV to bivalent OPV
(containing only Type-1 & 3).

 The tOPV to bOPV switch happened in India on 25thApril, 2016 As part of Global Polio end-game
strategy, to mitigate the risk associated with tOPV to bOPV switch, MoHFW has introduced
Inactivated Polio Vaccine (IPV) in UIP in November, 2015, which was expanded across the country
by June, 2016.

 Currently, two dose fractional schedule is being followed in the country with vaccination at 6
weeks and 14 weeks of age Till August 2021, around 19.83 crore doses of IPV have been
administered to children across the country.
Rubella vaccine to be initiated as MR Campaign targeting children aged 9 months to
15 years of age has been launched on 5th February 2017 in five states/UTs (Karnataka,
Tamil Nadu, Goa, Lakshadweep & Puducherry.

 All the states will be covered in a phased manner over a period of 3 years.

 Measles Vaccine 2nd opportunity –to accelerate the reduction of measles related
morbidity & mortality.

 The NTAG on immunization introduced 2nd dose of MR vaccine to children between

9 months and 10 years of age.

 The Rubella vaccine will be introduced as MR vaccine as two doses in the place of
measles containing vaccine 1st & 2nd dose at 9-12 months and 16-24 months as part
of Routine Immunization.
Pneumococcal Conjugate Vaccine (PCV):

To protect the children from Pneumonia caused by Pneumococcal bacteria.

PCV will be introduced in the state of Himachal Pradesh & parts of Uttar Pradesh & Bihar in 2017.
Two primary doses given at 6 & 14 weeks of age followed by a booster dose at 9 months of age.
Tetanus & adult Diphtheria (Td) vaccine:

 Increase in immunization coverage in children led to shift in age-group

of diphtheria cases to school going children and adults.

 Tetanus and adult Diphtheria (Td) vaccine was recommended by the

National Technical Advisory Group on Immunization (NTAGI) in 2016.

 The Td vaccine has replaced 2 doses of TT or single booster dose of

TT given to pregnant woman and booster doses at 10 and 16 years of

age.
Mission Indra Dhanush:
 Launched on 25th December-2014(MOHFW), to full immunized 90% of children of India and sustain
the same by year 2020.
 It is being provided against eight vaccine preventable diseases nationally, i.e. Diphtheria, Pertussis,
Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B and meningitis &
pneumonia caused by Hemophilus influenza type B; and against Rotavirus Diarrhea and Japanese
Encephalitis in selected states and districts respectively. During each phase of Mission Indra Dhanush,
four intensified drives of 7 days each were held every month to cover left-out and missed-out children
in the high focus districts.
 During the three phases of Mission Indra Dhanush, 497 districts across 35 states/UTs were covered.
 During these phases, more than 2.1 crore children were reached of which 55 lakh children were fully
immunized.
 In addition, 55.9 lakh pregnant women were also vaccinated with Tetanus toxoid.
 The platform of Mission Indra Dhanush was also utilized for distributing 52.2 lakh ORS packets and
183.1 lakh Zinc tablets to children.
 4th phase of Mission Indra Dhanush commenced on 7th February’ 2017 in 8 North eastern states and
Vaccines:-The antigenic substances which when administered in an individual, stimulate the
production of specific antibodies and protect an individual against that particular disease.

1) Live/attenuated vaccine:

In the preparation organisms are living but attenuated-to retain antigenicity & to loose
pathogenicity. Organisms are living, they multiply in the body after administration antigenic
stimulus more what that production antibodies-quick ,more, safe, effective immunity, lasts
longer.

Given single dose, except OPV, , safe, effective ,more potent with long standing immunity.

Required single dose as compared to killed vaccines.

Ex: BCG, OPV, MR MMRV, oral typhoid vaccine, influenza live vaccine, hepatitis A vaccine,
yellow fever vaccine.
2) Killed vaccines:

The organisms are inactivated or killed by heat and chemicals as Phenol, BPL.Usually

given in multiple doses, in the primary course,fellowd by booster doses subsequently.

 Immunity shorter than live vaccines,& reactions are frequent.

 It is less safe/effective/potent, with short-lasting immunity requiring multiple doses.

 Ex: Salk polio vaccine, cholera vaccine, plague vaccine,antirabies vaccine, JE vaccine,

KFD vaccine, yellow fever/hepatitis A vaccine.

3) Toxoids: The toxoids of organisms are modified so as to maintain the only antigenicity &
not pathogenicity used as vaccines.
 Require multiple doses in the primary course followed by booster doses.
 They safe &effective .
EX: DT, TT.
4) Cellular vaccines-Prepared from the extract of the bacterial cell wall or capsule.it is
safe, effective & require booster doses.
 EX: Pneumococcal vaccine, parental typhoid vaccine.
5) Sub-unit vaccine-Prepared from a component of the virus. EX: Influenza vaccine
6) Recombinant vaccines-Genetically engineered prepared recombinant DNA
vaccine(subunit of the virus is inserted into the genome of another a virulent virus &
vaccine is prepared.
EX: Hepatitis B Vaccine
7) Combined vaccines(Mixed):- The preparation contain more than one antigen.
Ex: Easyfive (pentavalent),DPT.
8) Tissue culture vaccine:

 These vaccine prepared by seeding the viruses into the special cells, as chick embryo cells,
Vero cells of kidney monkeys, human embryonic fibroblasts,

 Is highly safe/effective/antigenic/stable/potent/protective/purified.

 They are costly,& given multiple doses, least reactogenic.

 Ex: PCEV, PVRV, HDCV are used against rabies.

9) Immunoglobulins:-Readymade antibodies preparations, obtained from the human beings.&

produce antibodies,used for passive immunization, i.e. those who at risk, young close contacts,
not immunized before.

 Two types of Immunoglobulins:-

1) Human normal immunoglobulins

2) Human Specific immunoglobulins

2) Human normal immunoglobulins

 Prepared from pooled plasma at least 1000 plasma donors(multiple).

 It is general antibody preparation & consist of IgG.

 It produce instanstaneous & temporary immunity.

 Ex- Against measles, given to susceptible to young close contacts, Against viral
hepatitis A .

 Is is given to those who are traveling to endemic areas.

 Should not be given simultaneously with live vaccine, due to IgG will interference with
the development of immunity. If given first, live vaccine not given for 12 wks. and if
live vaccines given first, this not be given for 2 wks.
2) Human specific immunoglobulins:

 These prepared from the plasma of those persons, who have been recently immunized
or recovered from the disease, this contain specific antibodies.

 These are highly safe/effective & costly.

 Passive immunity lasts longer than that of human Ig.

 Not only, it is used for passive immunization(PEP).

 It is part of treatment to neutralize the circulating toxins in the patient as in rabies

and tetanus.

 Ex: 1) HRIG 2) HTIG 3)HBIG 4)VZIG

 These can be used simultaneously along with active immunization.

10) Antisera:

These are specific Ig prepared from the plasma of immunized animals as horses.

 They are cheap and less effective.

 Immunity lasts for about 2-3wks only. Reactions are frequent due to animals
protein.so test dose is a must required.

 EX: 1) Antitetanic serum,

2) Antidiphtheritic serum

3) Equine rabies immunoglobulin

4) Anti snake Venom

5) Anti gangrene serum.

BCG: Type-live attenuated, freeze dried vaccine.
 Constitution: lypholised strain of mycobacterium bovis
‘1331’Danish strain & Normal saline as diluent.
 Schedule-At birth-0.05ml & at 6 wks-0.1ml.
 Route-ID at deltoid region (left side arm).
 Storage Temp.-2-8 degree celcius.
 After effect-Papule formed-2-3 wks.
(4-8mm size),
ulcer-6-12wks.
 Contraindication-CMI deficiency.
 Efficacy-0-80%.
 Complications:
a) local-Ulcer, abscess, tuberculides, keloid, lymph node enlarge,
osteomyelitis.
b) General-Pyrexia, generalised TB, erythema nodosum.
OPV:(Sabin)-Type-Live attenuated,
 Constitution-Type-I-3 lakh TCID 50,Type-II-1 lakh TCID 50, Type-III-3.3 lakh TCID 50. ( Zero
dose-at institutional deliveries).
 Schdule-6,10, 14thwks. Dose- 2drops/dose, Route-oral.
 Temp.storage-2-8 degree celcius.
 MAC-It multilplies in instestine and
produces local antibodies (IgA), quickly, & control epidemics.
 Contraindications-Persistent Vomiting, fever
& diarrhoea, leukaemia, steroids, ARI, Malignancy.
 Adv.-prouduce humoral as well as intestinal immunity.
 Disadv.-Unstable at high temp.
cold chain well is maintained.
Adverse effects-Paralytic polio.
Efficacy: 1st –three dose-80%, four dosses-90%, 5-doses-95%,
 fIPV(Sabin):
 Type-Liquid-killed vaccine(killed by formalin).
 Type-I-20 D antigens units,Type-II-2 D, Type-III-4 D.
 Current Schdule-2 doses at 6 and 14th weeks of age.
Dose-0.1ml,Route-ID using BCG syringe.
 Storage-4-8 degree celcius Temp. .
 Advantages:-long shelf life-more stable, prevent paralysis,
can be given to immune person, deficient person,
person taking steroids, radiotherapy, safe for pregnancy.
 Disadvantages:-Costly, more doses are required,
no intestinal immunity, no useful during epidemic,
does not prevents entry of wild virus.
Efficacy-50%
Hepatitis –B Vaccine: Type-formalin inactivated sub-unit vaccine(Thiomersal-preservative).
 Constitution: Each 0.5ml dose contains 10mcg(0.5ml) of purified Hepatitis-B Surface antigen(ped.),Adult-
20mcg(1ml). Composition-20mg of protein & 0.5mg ALPO4-Adsorbed.
 Schedule-Two doses at one month interval
3rd dose after 6 month and
booster dose after every 5 years.
 Dose-0.5ml in children and 1ml in adults
Site –Deltoid region, Route-IM.
 Storage temp-2-8degree celcius.
 Adverse reaction-Mild soreness, erythema (MC)
induration, mild fever, fatigue, athralgia, myalgia, headache,
Nausea, skin rash.
 Contraindications-Severe febrile reactions,
Hypersensitivity.
 Efficacy-95%.
Rotavirus vaccine:
live attenuated monovalent human rotavirus vaccine(Rotarix)& pentavalent bovine-human
reassortment vaccine(RoaTecq), both are safe and effective.
Reconstitution-with a liquid diluent
before administration.
 Dose-1ml(live attenuated rotavirus-RIX14 strain)
 Route-oral-5drops/dose.
 Schedule-6th,10th ,14th wks.of age(Rotarix)
6th and 14th wks of age (RotaTecq)
Temp.storage-2-8 degree celcius.
Contraindications:-HS to previous dose & cong.malformation,
administration postponed under circumstances nausea,
vomiting and acute febrile disease.
Efficacy-55% Provide 75-85% protection against rotavirus diarrhea and 90-100% protection against
rotavirus disease. Rotatecq-Limitations: Each dose costs Rs.1000/-in India. Provide protection only
against rotavirus diarrhea.
DPT Vaccine:
 Type-mixed vaccine/liquid/killed bacterial vaccine/trivalent vaccine.
 Each dose contains-DT-30 loaffler units,
TT-10 loaffler units,Pertusis-32000million(3-IU),
Thiomersal=0.01% ,ALPO4=3mg(adsorbed).
 Schdule-3 doses at 4-6wks.interval from age 6wks of age.
 Dose-0.5ml, Route-IM, Site-Anterolateral aspects of mid thigh(lt.)
 Storage- 4-8 degree celcius Temp.
 Minor effects-Pain, redness, swelling, mild fever/vomiting,
Erythema, induration, nodule at the site of injection.
 Rare coplications- Encephalitis, Rey’s syndrome(pertussis),
Suddan infant death syndrome(rare).
 Contrindications- Acue febrile illness, Convusions/anaphylactic reaction to previous dose.
 Efficacy-90-95%.
 Precautions-Cold chain maintained, vial shaken before to use,
 if turbidity seen then not used, date of expired should check, frozen vial should not be used.
Pentavalent Vaccine:
 Constitution-DT-15lf/ml, TT-6.5lf/ml,Pertusis-30 OU/ml, HBaAg-20ug/ml,Hib-20ug/ml,Nacl-9mg/ml,Al3+-
0.6mg/ml.
 Type-Mixed/combined Vaccine
 Dose-0.5ml, Route-IM
 Site-Anterolateral aspects of midthigh left.
 Schdule-6,10 and 14th weeks of age.
 Storage -2-8 degree celcius Temp.
 Adverse effects-Pain & fever, anaphylactic shock,
 Contraindications- Aute febrile illness, HS to previous dose
convulsions, CNS disease.
 D.T.-Type-Toxoid, Diphtheria toxoid -25Lf,
 Schedule-Above 5 years-2 doses at one month interval.
 It is safe than DPT as pertussis component omitted.
 T.T-Constitution-Tetanus toxoid -5Lf.
Adsorbed on ALPO4,Thiomersal as preservative-o.o1%.
 After 10 years of age, if not vaccinated.
if already vaccinated,1 dose as booster is required.
 During pregnancy—2 doses of TT given.
 if interval between 2 pregnancy more than3 years,
then received 1 booter dose of TT.
Now currently used instead of TT as Td
Measles Rubella Vaccine(MR):
 Type-live attenuated, freeze dried vaccine.
 Constitution: Measles virus-1000 TCID 50,
Edmonston-Zagreb strain propagated on
human diploid cell & Wiatar RA27/3 strain-Rubella
 Schedule-one dose at 9-12 months of age
and 2nd at 16-24th months of age.
 Dose-0.5ml,Route-SC,
Storage-2-8 degree celcius Temp.
 Efficacy-95%.
 Adverse effects-Measles like rash(1-2%), skin reaction, anaphylaxis & TSS .
 Contraindications-Fever, Acute infectious disease, renal disease, heart disease, within 6 months
blood transfusion, severe hematopoietic disease, radiation,
glucocorticoid therapy, pregnancy, reduced immunity, immunodeficiency.
 Complications-Subacute sclerosing panencephalitis.
 JE Vaccine:
 Type –Inactivated mouse brain derived vaccine.
 Strain-Nakayama strain, lyophilized/liquid.
 Dose-0.5ml in children.
 Route-SC
 Site-Upper arm.
 Storage temp.-2-8 degree celcius.
 Schdule-9-12 months and
-16-24 months of age along with MR vaccine.
 Adverse effects local reactions,
serious allergic reactions, hypotention.
Efficacy-80%
 Vitamin A Syrup

 Contains fat soluble vitamin as retinol derivative

 Dose-1ml/2ml, Route-oral, NO- side effects.

 Schedule-Below 6 months-50000IU.At 9 months-1IU &

then every 6 months- 2IU up-to 5 years (total 9 doses)

 Should be administered using 2 ml spoon/dispencer.

 Must be kept away from direct sunlight.

 Stored in cold dark room temperature and is stable min. for 1 year.

 Bottle once opened must be utilized within 6-8 weeks.

References:

 Park’s Textbook of Preventive And Social medicine 26thedition2021.

 AH Suryakantha. Community Medicine with Recent Advances 5th edition2020;P246.

 Surendra shastri et al. Practical book of Preventive And Social Medicine 6 th edition

2019;P162-166.

 J Kishore. Competency based Practical And Viva; Community Medicine 5th

edition2021;P145-154.
 THANK YOU

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