QB Ps Research Methodology

OPV (Oral) Vitamin A (Oral)
Measles (Subcutaneous)
BCG (Intradermal)
Hepatitis B (Intramuscular)
DPT (Intramuscular)
Thursday, June 20, 2019 K.C.Meghwal 3
 Attenuated: Reduced Virulence But Retaining Antigenicity For Host
 Virulent: Harmful
 Immunization: process by which an individuals immune system
become fortified against an agent
 Vaccine: a vaccine is a biological preparation that improve immunity
to a particular disease.
 DPT: Diphtheria, Pertusis, Tetanus
 OPV: Oral Polio Vaccine
 VVM: Vaccine Vial Monitor
 IPV: Inactivated Polio Vaccine
 DT: Diphtheria, Tetanus
 ILR-Ice lined refrigerator
 NIS- National immunization schedule
 Antigen: any substance which can cause production of antibody.
 Antibody: a globulin produced in the response to the antigen or
foreign bodies.
 Antiserum: a serum containing antibodies against particular
organism
 Antitoxin: an antibody against particular toxin.
 Toxoid: toxin rendered harmless but retaining antigenicity.
 Fragment: a piece broken off
 TT: Tetanus Toxoid
 BCG: Bacillus Of Calmette & Guirine
 EPI: Expanded Program On Immunization
 UIP: Universal Immunization Program.
 Booster: an auxiliary dose that increase effectiveness of a vaccine.

 Vaccination: administration of vaccine
 Hib: Haemophilus influenza type B
 Hep B: Hepatitis B
 VPD- Vaccine Preventable Disease
 CSSM- Child Survival & Safe Motherhood
 PPIP-Pulse Polio Immunization Programme
 RCH-I-Reproductive & Child Health Programme-I
 NRHM – National Rural Health Mission
 RCH-II-Reproductive & Child Health Programme-II
 ICDS-Integrated Child Development Scheme
 ADS-Auto Disable Syringe
 DIO-District Immunization Officer
 Immunization is the process by which an individuals
immune system become fortified against an agent.
 Immunization is the process by which acquired immunity
is induced.

 Over 250 years ago
 Edward Jenner (1749-1823), a British physician,
 On May 14, 1796, used material from cowpox pustules
to provide protection against smallpox.
 He called the process “vaccination,” derived from the
Latin name for cowpox, vaccinia. (latin: vacca= cow)
 Boy-James Phipps-8 yrs was vaccinated by Edward
Jenner
Vaccine Year of development
Live attenuated viral vaccine (rabies) in humans 1885
BCG 1909
Diphtheria 1921
Tetanus 1924
Pertusis 1930
Yellow fever vaccine 1932
DTP combination 1940
Inactivated polio vaccine (IPV) 1955
Live attenuated oral polio vaccine (OPV) 1963
Measles vaccine 1963
First recombinant vaccine (hepatitis B) 1966
First polysaccharide conjugate vaccine (Haemophilus 1990
infuenzae type b)
Immunizing agents
Vaccines Immunuglobulins Antisera

 Vaccination is a method of giving antigen to stimulate
the immune response through active immunization.
 A vaccine is an immuno-biological substance designed

to produce specific protection against a given disease.
 A vaccine is “antigenic” but not “pathogenic”.

 Vaccines are weakened or killed forms of disease causing
micro organisms
 When the antigen is injected into the body → this allows
the immune system to deal with and neutralize the
invader.
 Next time the same micro organism enters the body, the
body has already preformed antibodies to destroy the
invader

 An ideal vaccine is one that:-
 Promotes effective immunity.
 Controls lifelong protection.
 Safe, do not carry side effects.
 Stable
 Cheap
 Acceptable by public.

 Prevention of infectious disease spread worldwide
 A key to public health maintenance
 Protection for oneself and the surrounding in contact
 To eradicate diseases (e.g. Smallpox, Poliomyelitis)

 Maternal Antibodies against certain disease do not offer a
life long immunity to the baby
 Many fatal childhood diseases can be prevented through

vaccination (e.g. Whooping cough)
 Protection of those with weak immune system from

disease (e.g. Leukemia)
 To maintain healthy, active and productive community

members

 There are three main types of vaccines:
 Live vaccines
 Live vaccines are made from live infectious agents
without any amendment.
 The only live vaccine is “Variola” small pox vaccine,
made of live vaccinia cow-pox virus (not variola
virus) which is not pathogenic but antigenic, giving
cross immunity for variola.

 Live attenuated vaccines are derived from disease-causing
viruses or bacteria that have been weakened under laboratory
conditions. They will grow in a vaccinated individual, but because
they are weak, they will cause no disease or only a mild form.
They usually require only one dose to provide life-long immunity,
with the exception of oral polio vaccine which requires multiple
doses.
 Oral Polio Vaccine [OPV]

 Measles
 Yellow Fever

 (BCG) vaccine
 Inactivated/killed vaccines are produced by
inactivating disease causing viruses and bacteria by heat
or chemicals. They may be whole-cell (made of an entire
bacterial or viral cell) or fractional (composed of only
part of a cell). Fractional vaccines are either protein- or
polysaccharide-based.
 Whole

 Inactivated Polio Vaccine [IPV]


 Whole-cell Pertusis
 Fractional

 Subunit (e.g., Acellular Pertusis)

 Toxoid (e.g., Diphtheria and Tetanus)
Pure -Meningococcal

 Conjugate -Haemophilus influenza type b [Hib]
 Surface antigen (Recombinant) vaccines are produced by

inserting genetic material from a disease-causing organism into a
harmless cell, which replicates the proteins of the disease-causing
organism. The proteins are then purified and used as vaccine. An
example of this is:

 Oral Intra Nasal Parenteral
 OPV live attenuated ID-BCG
 Typhoid influenza SC-Measles, MMR, Chicken pox
 Vitamin A vaccine IM-DPT, DT, TT, Hep-B, Hib, IPV,

Bacterial vaccine Viral vaccine

Live Live Killed Toxoids Cellular Recombin
vaccines Attenuated Inactivated fraction ant
vaccines vaccines vaccines vaccines
•Small pox •BCG •Pertusis •Diphtheria •Meningoco •Hepatitis

variola •Oral polio •Rabies •Tetanus ccal B vaccine
vaccine •Measles •Salk polio polysacchari
de vaccine
•Mumps •Typhoid
•Pneumococ
•Rubella •Cholera cal
•Typhoid oral •Plague polysacchari
•Yellow fever •Intra- de vaccine
•Plague muscular •Hepatitis B
•Intranasal influenza polypeptide
Influenza •Japanese vaccine
encephalitis
•Typhus

 Monovalent
 Bivalent
 Trivalent- DPT, OPV
 Pentavalent-DPT-Heb-Hib

Advantages
 Single dose enough
 Produce local immunity
 Induces cell mediated immunity
 More convenient for mass immunization
Disadvantages
 Reversion to virulence
 Difficulty in storage

Advantages
 No danger of spread
 Stability and safety
Disadvantages
 Multiple injection may be required

Specific defenses
Immunity
Active immunity Passive immunity
Natural Transfer of maternal

Following clinical infection Antibodies Through placenta
Transfer of maternal
Following subclinical infection Antibodies Through milk
Acquired
Following administration of
Following vaccination Immunoglobulin or antiserum

Active immunity
Resistance developed in response to stimulus by an
antigen (infecting agent or vaccine) and is
characterized by the production of antibodies by the
host.
 Naturally acquired  Artificially acquired
 Repeated clinical &  Immunity induced
subclinical infection in
by vaccination
childhood give immunity.
 eg: Chicken pox

Passive immunity
 Immunity conferred by an antibody produced in
another host. It may be acquired naturally or artificially
(through an antibody-containing preparation
 Naturally acquired  Artificially acquired
 Transfer of maternal
 Following administration of
antibodies
Immune globulin or antiserum
 eg:
 eg: Anti tetanus serum(ATS)
 Through placenta=Ig G
TETGLOB (tetanus immunoglobin)
 Through colostrum=Ig A

Passive Immunization Highly Successful
Saves in Acute Infections
• Diphtheria Antitoxin
• Tetanus Antitoxin
• Rabies Hyper immune Globulins( HRIG )
• Varicella Zoster Hyper Immune Globulins (HZIG)

Year PROGRAMME
1978 •EPI Introduced (Extended Program on Immunization)
•BCG, OPV, DPT, Typhoid
•Limited to mainly urban areas
1985 •UIP Introduced (Universal Immunization Program)
•Expanded to entire country
•Measles added
1986 Technology mission
1990 Vitamin supplementation
1992 CSSM (child survival & safe motherhood)
1995 PPIP (pulse polio immunization program)
1997 RCH-I
2005 NRHM & RCH-II
2011 Hepatitis B added
Vaccine When to give Dose Route Site
TT-1 Early in pregnancy 0.5 ml IM Upper arm
TT-2 4 weeks after TT-1 0.5 ml IM Upper arm
TT- If received 2TT dose 0.5 ml IM Upper arm

Booster in a pregnancy
within the last 3 year

Age Vaccine Dose Quantity Route Site
At birth Hep-B Birth dose 0.5 ml IM Anterolateral aspect of
midthigh
At birth OPV ‘0’ dose 2 drops Oral Mouth
At birth BCG 0.05 ml ID Left upper arm

0.1 ml

OPV 1st dose 2 drops Oral Mouth
RVV 1st dose 5 drops Oral Mouth

6 weeks age
flPV 1st dose 0.1 ml ID Right upper arm
Pentavalent 1st dose 0.5 ml IM Anterolateral aspect

of midthigh

10 weeks OPV 2nd dose 2 drops Oral Mouth

age
RVV 2nd dose 5 drops Oral Mouth
Pentavalent 2nd dose 0.5 ml IM Anterolater

al aspect of
midthigh

14 weeks OPV 3rd dose 2 drops Oral Mouth

age
RVV 3rd dose 5 drops Oral Mouth
flPV 3rd dose 0.1 ml ID Right upper arm
Pentavalent 3rd dose 0.5 ml IM Anterolateral aspect

of midthigh

9 completed Measles 1st dose 0.5 ml SC Right upper arm

months age
Vitamin-A 1st dose 1.0 ml Oral Mouth
16-24 OPV Booster 2 drops Oral Mouth

Months age
Measles 2nd dose 0.5 ml SC Right upper arm
DPT 1st 0.5 ml IM Anterolateral aspect

booster of thigh
5 year DPT 2nd 0.5 ml IM Left upper arm
booster
10 & 16 year TT Booster 0.5 ml IM Upper arm

 Local
 Pain, swelling, redness at site of injection
 Common with inactivated vaccines
 Usually mild and self-limited
 Systemic
 Fever, malaise, headache
 Nonspecific
 May be unrelated to vaccine
 Allergic
 Due to vaccine component
 Rare

 Fever & rash may develop after measles vaccine with
in 5 to 10 days in 15 to 20% cases
 Fever may persist for 1-2 days & rashes for 1-3 days
 If contaminated vaccine /same vial used for more than
one session on the same day or next day toxic shock
syndrome may develop with in few hours of measles
vaccine
 Features of TSS
 Diarrhea, vomiting & high fever
 This may cause death within 48 hours
 Causative MO: Mycobacterium tuberculosis
 Provide Protection against- tuberculosis
 Mechanism of Protection is largely unknown but cellular
immunity has been shown
 Disease transmitter: Droplet
 Type: Live attenuated bacterial vaccine (Attenuated strains of
Bovine Tubercle Bacilli)
 Age of vaccine administration: As soon as possible after birth
 Can be given up to: one year of age.
 Route of administration: Intra dermal (ID)
 Site: left upper arm
 Doses: 0.05 ml at birth & up to 1 month
 0.1 ml from 1 month to 1 year
 Interval between each dose: - No
 Booster dose: - No
 Supply: freeze dried form (1ml) multiple dose vial
(0.05ml=20 doses/0.1ml=10 dose)
 Special considerations:
 Stored at 2 to 8 °C
 Reconstituted solution should be used with in 3 hrs
 BCG Vaccine is light sensitive so keep it away from direct light
 Vaccine must not be contaminated with antiseptic used to swab the
skin
 Diluent: Normal saline
 Syringe used: tuberculin syringe
 Adverse reactions: If administered SC instead of ID, this may cause
lymphadenitis.
 C/I: In those with compromised immune system
 Possible reaction/complications:
 Keloid scar
 Local abscess formation
 Deep ulceration
 Enlargement of axillary lymph glands
 Osteomyelitis in immunocompromised child
 Duration of protection:15-20 years
 after BCG vaccination, the skin gets raised and later a scar will form.
 However, BCG vaccination is not to be repeated even if the scar does
not form.
 BCG if missed earlier can be given till 1yr of age of the child.
 After reconstitution, BCG should be used within 4 hours.
 Causative MO: Poliovirus (Enteroviruses of
the family Picorna viridae)
 Provide Protection against: poliomyelitis
 Developed by: Albert Sabin in 1957
 Disease transmission: Droplet/faeco-oral route
 Type: Live attenuated viral vaccine of three
strains 1,2&3(Sabin)
 Route of administration: Orally
 Age of vaccine administration: 0 dose- at birth
:1st dose-at 6th weeks
: 2nd dose –at 10 weeks
: 3rd dose –at 14 weeks
 Booster dose: at 16-24 months
 Doses: 2 drops
 Interval between each dose: At least 4 weeks between each dose
 Supply: 20 dose vial with dropper.
 Special considerations: -
 Hot drinks, hot milk should withheld for ½ hour after OPV dose
 Complete primary course of OPV within 6 months
 Adverse effects: Anaphylaxis, tachycardia, pyrexia, paralytic polio
 C/I: acute infectious disease, fever, diarrhoea, dysentry, leukemias.
 Storage: OPV is the most sensitive to heat, requiring storage at –
20° C in deep freezer.
 Recently available heat stabilized vaccine can be stored at 4° C
 Potency monitoring: by VVM (Vaccine Vial Monitors)

 Mixture of three types of live attenuated poliovirus
 Mechanism of protection:
 Local Secretory IgA at GIT so preventing implantation
and multiplication of wild virus
 Humoral antibody (IgM & IgG)

 Causative MO: Poliovirus (Enteroviruses
of the family Picorna viridae)
 Provide Protection against: poliomyelitis
 Developed by: Jonas Salk in 1952
 Disease transmission: Droplet/faeco-oral
route
 Type: Inactivated (dead) polio viruses
 Route of administration: IM
 Age of vaccine administration:
 Booster dose:

 Causative MO:
 Diphtheria: Corinebacterium diphtheriae-
 Pertusis: Bordetella pertusis
 Tetanus: Clostridium tetani
 Provide protection against: Diphtheria, Pertusis, Tetanus.
 Vaccine contains: toxoids of Clostridium tetani &
Corinebacterium diphtheriae
:whole cell preparation from B. pertusis
 Disease transmission: Droplet, contaminated wound
 Type: inactivated/killed vaccine
 Age of vaccine administration: 1st dose at 6 weeks
 2nd dose at 10 weeks
 3rd dose at 14 weeks
 Booster dose:
 16-24 months
 5-6 years of age

 Dose: 0.5 ml
 Site:
 infant-vastus lateralis muscle (lateral aspect of thigh)
 In older children: upper & outer quaderent of gluteous muscle
 Can be given up to 6-7 years of age
 Interval between each dose: 1-2 months between each dose
 Special considerations: vaccine lose their potency if frozen
 Storage: store at 4-8°C
 Adverse effects: Excessive crying, encephalopathy (usually
occurring with pertussis)
 C/I: Hypersensitivity to any vaccine component

 Induce multiple antibodies to B. Pertussis antigen
 TT
 Production of neutralizing antibodies (antitoxins)
Fig: Modification of toxin to toxoid

 T series vaccines are destroyed if frozen and should be
stored and transported in temperatures between 2 and 8
degrees Celsius.
 Giving DPT in buttocks may injure the sciatic nerve and
cause paralysis.
 It should never be given there.
 it should be given in the outer mid-thigh.

 Causative MO: Paramyxovirus
 Disease transmitter: Droplet/aerosol
 Type: Chicken embryo cell culture (live attenuated viral)
 Supply: freeze dried form 2.5 ml (multiple dose vial with 5
doses)
 Age of vaccine administration: 9 or 12 months of age
 Route of administration: SC
 Site: Right upper arm
 Doses: 1
 Interval between each dose: No
 Solvent: pyrogen free double distilled water.
 Can be given up to: 5 yrs of age
 Vaccine is light sensitive so keep it away from direct light
 Following reconstitution the measles vaccine has to be used
within 4 hrs.
 Adverse effects: Idiopathic epilepsy, febrile seizures, toxic
shock syndrome, fever
 C/I: Allergy to any vaccine component.
 Induced IgG & secretory IgA in nasal secretions
 Stimulation of cell mediated immunity
 Vitamin A is not a vaccine but an
important micronutrient for:
 Maintaining normal growth
 Regulating cellular proliferation and
differentiation
 Controlling development
 Maintaining visual and reproductive
functions.
 However, it is included in the Universal
Immunization schedule.
 Supply:
 Bottles of 100 ml as a solution with oil base.
 It is also supplied with a 2 ml spoon with a marking in the
middle indicating 1 ml.
 Age of vitamin-A administration:
 1st Dose-9 months
 2nd Dose-18 months (1 ½ yrs)
 3rd Dose-24 months (2 yrs)
 4th Dose-30 months (2 ½ yrs)
 5th Dose-36 months (3 yrs)
 6th Dose-42 months (3 ½ yrs)
 8th Dose-54 moths (4 ½ yrs)

 Route of administration: Oral
 Interval between each dose: 6 months
 Doses: 9 month-1 year- 1 ml (half spoon) -1,00,000 IU
beyond 1 year -2 ml (1 spoon) -2,00,000 IU
 Total doses: a total of 9 doses till the age of 5 years.

 Vitamin A solution must be kept away from direct
sunlight.
 Vitamin A bottle, once opened, should be used within
6-8 weeks.
 Write the date of opening on the bottle.

 Causative MO: Japanese Encephalitis virus
 Disease transmitter: Culex tritaeniorhynchus
mosquito bite
 Type: live attenuated SA 14-14-2 JE vaccine.
 Supply: Multi-dose vials with 5 doses
 Diluent: 2.5 ml which contains Phosphate Buffer
solution
 Age of vaccine administration: 1-3 yrs
 Site: left upper arm
 Dose: 0.5 ml (Single dose)
 Interval between each dose: NO
 Booster dose: -NO

 The reconstituted vaccine should be used within two hours of
reconstitution, beyond which the vaccine should be discarded
 Contraindications (situations when not to give vaccine):
 High Fever
 Severe malnourishment
 Acute infectious disease
 Ear infection
 Tuberculosis
 Heart, liver and kidney problems
 Pregnancy
 Allergy
 Convulsions
 Person treated with any immunosuppressive therapy

 Causative MO: Paramyxovirus (ssRNA)
 Type: Live attenuated viral vaccine
 Age of vaccine administration: 12-18 months with measles
 Doses: 2
 Interval between each dose: at least 4 weeks
 Booster dose: - 0.5 ml
 Special considerations: Coverage of more than 80%
 Adverse effects: Parotitis, fever, rash
 C/I: Pregnancy, Low immunity (e.g. Leukemia)

 Causative MO: Clostridium tetani
 Provide Protection against- tetanus
 Mechanism of Protection:
 Disease transmitter: wound/cut
 Type: Bacterial Toxoid vaccine
 Can be given up to: after 6 weeks of age
 Route of administration: Intra muscular (IM)
 Site: Anterolateral aspect of mid thigh
 Doses: 0.5 ml

 Adverse reactions: .
 C/I:
 Possible reaction/complications:

 Causative MO: Hepatitis B virus (dsDNA)
 Disease transmitter: Blood transfusion, sexually, through the
birth canal
 Type: Subunit
 Age of vaccine administration: 0 dose at birth
 1st dose at 6 weeks
 2nd dose at 10 weeks
 3rd dose at 14 weeks
 Booster dose: after 3-5 years
 Dose: 0.5 ml up to 10 years
 1 ml above 10 years of age
 Total doses: 3
 Interval between each dose: 4 weeks

 Site: anterolateral thigh
-Vaccine lose their potency if frozen
-Premature infants’ 1st dose after 1 month of age
-Infants to infected mother receive hepatitis B
immunoglobulins with the initial dose.
 Adverse effects: anaphylaxis; Tachycardia; Numbness.
 C/I: Infants weighing less than 2 kg

 Causative MO: Haemophilus influenza type b (GN
bacteria)
 Protect against: Meningitis & Pneumonia
 Disease transmission: Droplet
 Type: Conjugated polysaccharide vaccine
 Also available in combination with DPT as DPT-Hib,
with DPT & Hepatitis B as DPT-HB-Hib-Pentavalent
vaccine
 Age of vaccine administration: 1st-6 weeks of age
2nd -10 weeks
 Booster dose-at 12-18 months
 Dose:0.5 ml
 Total doses: 3
 Interval between each dose: 4 weeks
 Special considerations: Those older than 12 months who
did not receive the vaccine should receive a single dose
 Adverse reactions: rare, but if occurring, are in the form
of redness, pain and hotness at site of injection.
 C/I: Severe allergic reaction to any component

 Provide protection against/Causative MO
 Diphtheria-corinebacterium diphtheriae (Bacteria)
 Pertusis-bordetella pertusis ((Bacteria)
 Tetanus-clostridium tetani (Bacteria)
 Hepatitis-B-hepatitis-B virus (Virus)
 Meningitis, Pneumonia & Pericarditis-Hemophilus
influenza type B (Bacteria)
 Involved in immunization schedule in Rajasthan state
from 1st November 2014

 Age of administration: 6weeks
10 weeks
14 weeks
 DPT booster at 16-24 months & 5-6 yrs will continue as
before.
 Hepatitis-B birth dose will continue as before
 Supply: 10 multiple dose vial
 Dose: 0.5 ml
 Route: IM

 Causative MO: Rhabdovirus
 Disease transmitter: Through infected animal bite
 Incubation period is long, so post exposure prophylaxis is
possible
 Type: 3 types of vaccine available
1.cell culture vaccine
 Human diploid cell (HDC) vaccines
 Purified chick embryo cell (PCEC)vaccine
2. Duck embryo vaccine (DEV)
3. Nervous tissue vaccine (NTV)
 Age of vaccine administration: Any age requiring
protection
I. Human diploid cell (HDC) vaccines & Purified chick embryo cell
(PCEC) Vaccines are effective & safe but costly
 Schedule: 0,3,7,14 &30 days total 5 doses
 Booster dose: at 90 days
 Route of administration: SC/IM
II. DEV (duck embryo vaccine) is not available in India
III. NTV (nervous tissue vaccine) is cheaper & old conventional
vaccine
 Dose:1-2 ml
 Total doses: 14 days
 Site :over abdominal wall

 Causative MO: Rotavirus
 Disease transmitter: Contaminated water
 Type: Attenuated virus
 Age of vaccine administration: Rotarix (at 6 weeks of age)
RotaTeq (at 6 weeks of age)
 Route of administration: RotaTeq (oral),
Rotarix (Oral)
 Doses: Rotarix (2)
RotaTeq (3)

 Interval between each dose: Rotarix (4 weeks), RotaTeq
(4 weeks between the 2nd and 3rd doses)
 Booster dose: -
 Special considerations: -
 Adverse effects: Intussusception
 C/I: Anaphylaxis due to vaccine component;
Intussusception (especially in patients with previous
history of Intussusception)

 Causative MO: Rubella virus (RNA Virus of toga virus family)
 Protect against: Rubella (German measles)
 : Congenital rubella syndrome
 Disease transmitter: Droplet/aerosol
 Type: Live attenuated viral vaccine
 1-2 yr in girls
 in child bearing women before 2-3 of pregnancy
 Doses: 0.5 ml
 Total doses: 1
 Interval between each dose: - No
 Special considerations: May also be given with MMR
 Adverse effects: arthritis, febrile seizures, anaphylaxis
 C/I: Allergy, thrombocytopenia, immunosuppressant
& pregnancy.
 Brand name: RA 27/3

 Health care workers: hepatitis B, influenza, MMR,
polio
 Public safety personnel (police, fire fighters) and staff
of institutions for the developmentally disabled: hepatitis
B, influenza
 Vets and animal handlers: rabies, plague and anthrax
 Sewage workers: DT, hepatitis A, polio, TAB
 Food handlers: TAB
 Military troops and camp dwellers: pneumococcal,
meningococcal, influenza, tetanus etc.

 Causative MO: A flaviviridae (ssRNA virus)
 Protect against: yellow fever
 Disease transmitter: The Yellow fever mosquito, Aedes Aegypti
 Type: live attenuated viral vaccine
 Developed by: Max Theiler in 1937
 Age of vaccine administration: 9-12 months with measles
 Doses: Single (0.5 ml)
 Interval between each dose: No
 Booster dose: - in every 10 years (in endemic area)
 Adverse effects: Fever, headache, anaphylaxis, swelling at the
injection site
 C/I: Immunosuppressed individuals

 Causative MO: Salmonella typhi
 Protect against: Typhoid
 Disease transmitter: Contaminated food items with the bacteria
 Type: 1) monovalent anti-typhoid vaccine (killed)
 2) bivalent anti-typhoid vaccine
 3) TAB Vaccine
 4) Oral typhoid vaccine (typhoral) (live attenuated
bacterial vaccine in capsule)
 Age of vaccine administration: Minimum 5 years of age
 Route of administration: Oral
 Doses: 3 or 4 (1,3 & 5 days before 1 hr of meal with cold milk
 Interval between each dose: 2 day between each dose
 Booster dose: every 3 years
 Stored at : 2-40c & not to be frozen
 Special considerations: Preschool and school children of
high risk areas of the disease
 Adverse effects: Anaphylaxis, fever, headache, nausea
 C/I: Recent illness with fever, immunosuppressed
individuals

 Causative MO: Vibrio cholera
 Disease transmitter: Contaminated drinking water
 Type: Killed/inactivated
 Route of administration: Oral, IM, ID
 Age of vaccine administration: Dukoral: 2 years at minimum
Shanchol And mORCVAX: 1 year minimum
 Doses: Dukoral: 3
Shanchol And mORCVAX: 2
 Interval between each dose: Dukoral: between 1 and 6 weeks between each other dose
Shanchol And mORCVAX: 14 days
 Booster dose: Dukoral: every 6 months
Shanchol And mORCVAX: After 2 years
 Special considerations:The vaccine (dukoral) is not licensed for children below the age
of 2 years
 Advese effects: Erythema, pain, malaise, headache
 C/I: IV infusion of the vaccine; Pregnants (category C)

 Causative MO: Neisseria meningitidis
 Disease transmitter: Saliva, close contact
 Type: -MenA conjugate
-MenC conjugate
-Quadrivalent conjugate
-MenA conjugate: 1-29 years
-MenC conjugate: 2-11 months
-Quadrivalent conjugate: at about the age of 2 years
 Doses: -MenA conjugate: 1
-MenC conjugate: 2
-Quadrivalent conjugate: 1
 Interval between each dose:
-MenC conjugate: 1st to 2nd: 8 weeks
 Booster dose: After 1 year
 Special considerations:-
 Adverse effects: Pain at the site of injection, redness
 C/I: Currently ill patient, immunocompromised
 Causative MO: Orthomyxoviridiae (RNA)
 Type: Avian (H5N1) or Swine (H1N1)- Live attenuated
 Age of vaccine administration: Minimum age is 6 months
 Doses: 1(>9 years) or 2 (<9 years)
 Interval between each dose: -
 Booster dose: Annual dose (as strains mutate)
 Special considerations: Prioritization of those at risk (children and
elderly)
 Adverse effects: Pain and redness at site of injection, narcolepsy
has been noted in some patients receiving the vaccine
 C/I: Allergy to any drug component or egg allergy.

 Causative MO: Pneumococcus pneumonia
 Type: Conjugate
 Age of vaccine administration: 1,5 months of age (minimum)
 Doses: 2 or 3
 Interval between each dose: 4 weeks between each of the 2nd and 3rd
doses (for the 3 dosed variety) and at 8th week interval for the 2 dosed
variety)
 Booster dose: For the 2 dosed type given a booster at 9-15th month later
 Special considerations: Use the same type of product vaccine when
giving the other doses
 Adverse effects: Redness, swelling, tenderness (at site of injection)
 C/I: Any kind of hypersensitivity (anaphylaxis)

 Causative MO: Influenza A (H1N1) Virus
 Protect against: swine flu
 Disease transmitter: pig to human & human to human transmission
 Type: Inactivated viral vaccine (trivalent)
 : live attenuated viral vaccine
 Route of administration:
 Inactivated viral vaccine-
 Children 4 through 9 years of age Two 0.5-mL IM injections approximately
1 month apart
 Children 10 through 17 years of age: A single 0.5-ml IM injection
 Adults 18 years of age and older: A single 0.5-mL IM injection
 live attenuated viral vaccine- by nasal spray
 Age of vaccine administration: 6 month-4 yrs

 Doses:
 Do not rub the site vigorously.
 Gentle pressure at the site for a few seconds will suffice.
 If blood oozes do not blot. Just apply gentle pressure
with cotton swab.
 No Heat, Ice or Cold Water fomentation is advocated.
 The wet cloth soaked in ordinary portable water can be
applied at the site of swelling or tenderness for about 5
– 10 minutes.
 Repeat the procedure, if necessary, 3-4 times a day.
 A correctly and completely filled mother child protection /
immunization card contains mother’s and child’s name, date
of birth, complete address and immunization status.
 The card is important for immunization for the following
reasons
 Issue a new maternal child protection/immunization card to
the pregnant woman at the time of first ANC visit
 If the immunization card is lost, issue a duplicate card and
record previous
 Do not refuse vaccination for not bringing the card
 Inform care-givers mothers about the next due date for
vaccination

 Efficient immunization service; urban and rural
 Health awareness and cooperation of the public
 Periodic mass immunization campaigns, to cover

those who missed regular immunizations
 Outreach programs in rural and nomad areas, and

home visits
 Dutta Parul, Pediatric Nursing, 2nd Edition 2009 Reprint-2012,
Jaypee Brothers New Delhi Page No. 36-46.
 Ghai O.P, Essential Pediatrics, 7th Edition2009, Reprint-2012, CBS
Publishers & Distributers Pvt Ltd New Delhi Page No. 160-180.
 Hockenberry J. Marilyn, Wilson David, Wongs Essentials Pediatric
Nursing 8th Edition 2009, Page No. 350-365.
 Immunization handbook for medical officers ( revised edition 2009)
published by department of health & family welfare, ministry of
H& FW GOI new Delhi page no. 5-27.
 Jacob alphonsa, singh sangram-pediatric nursing 4th edition 2008,
reprinted 2009, published by N.R. Brothers page no.188-196.

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OPV (Oral) Vitamin A (Oral)

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Vaccines Immunuglobulins Antisera

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 A vaccine is an immuno-biological substance designed

 A vaccine is “antigenic” but not “pathogenic”.

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 A key to public health maintenance

 Protection for oneself and the surrounding in contact

 To eradicate diseases (e.g. Smallpox, Poliomyelitis)

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 Many fatal childhood diseases can be prevented through

 Protection of those with weak immune system from

 To maintain healthy, active and productive community

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 Oral Polio Vaccine [OPV]

 Inactivated Polio Vaccine [IPV]

 Subunit (e.g., Acellular Pertusis)

 Conjugate -Haemophilus influenza type b [Hib]

 Surface antigen (Recombinant) vaccines are produced by

Thursday, June 20, 2019 K.C.Meghwal 22

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•Small pox •BCG •Pertusis •Diphtheria •Meningoco •Hepatitis

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Active immunity Passive immunity

Natural Transfer of maternal

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Thursday, June 20, 2019 K.C.Meghwal 30

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TT-1 Early in pregnancy 0.5 ml IM Upper arm

TT-2 4 weeks after TT-1 0.5 ml IM Upper arm

TT- If received 2TT dose 0.5 ml IM Upper arm

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At birth OPV ‘0’ dose 2 drops Oral Mouth

At birth BCG 0.05 ml ID Left upper arm

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OPV 1st dose 2 drops Oral Mouth

RVV 1st dose 5 drops Oral Mouth

flPV 1st dose 0.1 ml ID Right upper arm

Pentavalent 1st dose 0.5 ml IM Anterolateral aspect

Thursday, June 20, 2019 K.C.Meghwal 37

10 weeks OPV 2nd dose 2 drops Oral Mouth

RVV 2nd dose 5 drops Oral Mouth

Pentavalent 2nd dose 0.5 ml IM Anterolater

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14 weeks OPV 3rd dose 2 drops Oral Mouth

RVV 3rd dose 5 drops Oral Mouth

flPV 3rd dose 0.1 ml ID Right upper arm

Pentavalent 3rd dose 0.5 ml IM Anterolateral aspect

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9 completed Measles 1st dose 0.5 ml SC Right upper arm

16-24 OPV Booster 2 drops Oral Mouth

DPT 1st 0.5 ml IM Anterolateral aspect

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