Bcg opv ipv vaccines and catchup vaccination (immunization)

BCG OPV and IPV

1. Bcg , opv , ipv & catch-up vaccination Praveen rk No: 75

2. Bcg vaccine

3. bcg Bacillus Calmette Guerin Live attenuated vaccine against Tuberculosis Protects against TB Meningitis, Miliary TB Common strains used- Copenhagen(Danish1331), Pasteur , Glaxo Danish 1331- Produced at Guindy , Tamil Nadu, India Available as lyophilised (freeze dried) powder Reconstituted with sterile normal saline

4. Induces Cell mediated immunity Primary infection is not prevented Protects against severe form of TB – miliary TB, TB meningitis Protective efficacy – 80% Duration of protection – 15 to 20 years Maternal antibodies do not interfere as CMI do not transfer transplacentally Administration at birth provides – early protection ensures compliance convenient to implement

5. Dose – 0.05ml (neonates) , 0.1ml (infants and children) Route of administration – intradermal (26G needle) Site – left upper arm at insertion of deltoid

6. Phenomena after vaccination

7. schedule National I mmunization P rogram At birth Catch up till 1 yr IAP 2016 At birth Catch up till 5 yr

8. Adverse reactions P ersistent ulceration at injection site Discharging sinus Ipsilateral axillary or cervical lymphadenopathy Disseminated infection Osteomyelitis Scrofuloderma ( immunodeficient persons)

9. contraindication Immunodeficiency (HIV, leukemia, lymphoma) Generalized eczema Infective dermatosis Hypogammaglobinemia

10. storage 2-8 o C S ensitive to heat and light D iscard unused vaccine after 4h

11. Oral polio vaccine

12. opv Live attenuated polioviruses (types 1, 2, 3) Developed by Sabin Each dose (2drops) contain 10 5 to 10 6 median cell culture doses of each serotypes Stabilizing agent – Magnesium chloride Multiple doses are needed to ensure take Vaccine of choice for eradication of poliovirus where wild poliovirus is still circulating Given as bivalent OPV (serotypes 1&3)

13. Included in Pulse Polio Immunization Supplementary immunization activities National Polio Surveillance Project National Immunization program

14. Development of immunity

15. Dose – 2 drops Route of administration – Oral Method of administration – Tilt the child’s back and gently squeeze the cheeks or pinch the nose to make the mouth open. Let the drops fall from the dropper onto the child’s tongue. Repeat the process if child spits out the vaccine

16. schedule National Immunization Program OPV0 at birth or within 15 days OPV1 at 6th week OPV2 at 10th week OPV3 at 14 th week OPVb at 15-18 months and 5yr

17. IAP 2016 OPV at birth, 6mo, 9mo and 5yr (In case of sequential IPV- OPV Schedule) Same as in National Program (IPV not available)

18. advantages Easy to administer Induces both humoral and intestinal immunity Antibody is quickly produced Vaccinee excretes the virus and infects others who are also immunized thereby Useful in controlling epidemics Relatively inexpensive

19. Adverse reactions Vaccine associated paralytic polio( type 3 mutation) Vaccine derived poliovirus (type 2)

20. contraindications Immunocompromised individuals (symptomatic HIV, leukemia, malignancy, those under corticosteroids) Active viral infections Breast feeding and mild diarrhoea are not contraindications

21. storage Stable at 4-8 C for 3-4 months -20 o C for a year Potency drops rapidly with temperature fluctuations Potency monitored using Vaccine Vial Monitor (VVM) Vaccine discarded if color of inner square in vvm is as dark as or darker than color of outer circle

22. Inactivated polio vaccine

23. ipv Developed by Salk Suspension of formaldehyde killed poliovirus grown in monkey kidney, human diploid or vero cell culture Induces humoral immune response and gives protection from paralysis Does not induce local immunity Vaccine potency measured by ‘D’ antigen Currently used Enhanced potency IPV ( eIPV ) contain 40D, 8D, 32D units of types 1, 2, 3 polioviruses.

24. Highly immunogenic Seroconversion – 90-95% in infants beyond 8 weeks age administered of two doses of IPV 2months apart 99% of those given 3 doses 4 weeks apart

25. Dose – 0.5ml Route of administration – intramuscular or subcutaneous

26. schedule National Immunization Program At 14 weeks IAP 2016 Sequential IPV-OPV schedule 3 doses IPV at 6, 10 and 14 weeks , or 2 doses IPV at 8 and 16 weeks (primary) and 1 dose IPV at 15-18 months (booster) Also give OPV at 6mo, 9mo, and 5yr and on NIDs and SIAs Catchup upto 5yr; 3 doses at 0, 2 and 6months

27. advantages Efficacy of IPV in preventing poliomyelitis is excellent Does not cause Vaccine associated paralytic poliomyelitis Vaccine of choice in patients with immunodeficiency Can be administered to pregnant women

28. disadvantage Immunity not rapidly achieved Injections during epidemic can precipitate paralysis Does not produce local immunity , virus can multiply in gut and can be a source of infection to others

29. Adverse reactions No serious adverse reactions Minor local erythema, induration, swelling and tenderness

30. contraindications Any known allergy

31. storage 2-8 o C Sensitive to light

32. Catch up vaccination

33. Catch up vaccination Not infrequently, children who present for immunization have missed out on previously scheduled vaccines To ensure that these ‘overdue’ children can be protected as quickly as possible, ‘catch-up’ vaccination schedules are available Every opportunity should be taken to check vaccination status and to provide missing doses. When infants and children have missed scheduled vaccine doses, a catch-up schedule should be commenced Missed immunization does not require restarting of the entire series or addition of doses to the series for any vaccine in the recommended schedule

34. Two or more inactivated vaccines can be given simultaneously or at any interval between doses without affecting the immune response An inactive vaccine can similarly be given simultaneously or at any interval with a live vaccine 2 live (intranasal/injectable) vaccines should either be given simultaneously or at least 4 weeks apart If a dose of DTP, IPV , Hib, pneumococcal conjugate, hepatitis A, hepatitis B, HPV, MMR , or varicella vaccine is missed, subsequent immunization should be given at the next visit as if the usual interval had elapsed

35. For rotavaccine same principle can be followed, though upper age limit of last dose should be maintained Minimal interval recommendation should be followed for administration of all doses .

36. Thank you