Immunization (pediatrics)

Immunisation schedule and some basic facts about them

1. IMMUNIZATION POOJA SANALKUMAR

2. NATIONAL IMMUNISATION SCHEDULE FOR INFANTS

3. VACCINE WHEN TO GIVE MAX.AGE DOSE ROUTE SITE BCG At birth Till 1 yr 0.1ml (0.05 ml till 1 mth ) Intra-dermal L. Upper arm Hepatitis B At birth In 24 hrs 0.5ml I.M. Anterolateral aspect of L. Mid thigh OPV₀ At birth In 1 st 15 days 2 drops Oral OPV₁₂‏₃ At 6,10, 14w Till 5 yrs 2 drops Oral Rota virus vaccine 6, 10, 14w Till 1 yr 5 drops Oral IPV 14w Upto 1 yr 0.5ml i.m . Anterolateral aspect of R. mid thigh Pentavac ₁₂₃ 6, 10,14w Till 1 yr 0.5ml I.M. Anterolateral aspect of l. Mid thigh Measles ₁ 9-12 months Till 5 yrs 0.5ml S.C. R. Upper arm Japanese encephalitis 9-12 months Till 15 yrs 0.5ml s.c . L. Upper arm Vitamin A 9 compltd mths Till 5 yrs 1 lakh IU Oral

4. NATIONAL IMMUNISATION SCHEDULE FOR CHILDREN

5. VACCINES WHEN TO GIVE MAX. AGE DOSE ROUTE SITE DPT booster 16-24 months 7 yrs 0.5 ml I.M. Anterolateral aspect of l. Mid thigh Measles 2 nd 16-24months Till 5 yrs 0.5 ml s.c . R. Upper arm OPV booster 16-24 months Til 5 yrs 2 drops Oral Japanese encephalitis 16-24 months 0.5 ml s.c . L. Upper arm Vitamin A 2 nd -9 th dose 16 months.1 dose every 6 m Till 5 yrs 2 lakh IU Oral DPT 2 nd booster 5-6 yrs 7yrs 0.5 ml i.m . l. Upper arm TT 10 & 16 yrs 0.5ml i.m . Upper arm

6. IAP IMMUNIZATION SCHEDULE AGE VACCINES BIRTH BCG OPV0 HEP B1 6 WEEKS DTwP1 IPV1 HEP B2 HIB 1 ROTAVIRUS 1 PCV1

7. Age Vaccine 10 weeks DTwP ₂ , IPV₂ , Hib ₂ , Rotavirus₂ , PCV₂ 14 weeks DTwP ₃ , IPV₃ , Hib ₃ , Rotavirus₃, PCV₃ 6 months OPV₁ , Hep B₃ 9 months OPV₂ , MMR₁ 9-12 months Typhoid conjugate vaccine 12 months Hep-A₁ 15 months MMR₂ , Varicella 1, PCV booster 16-18 months DTwP B1/DTaP B , IPV B₁ , Hib B1

8. Age Vaccines 18 months Hep-A₂ 2 years Booster of typhoid conjugate 4-6 years DTwP B2/DTaP B₂ , OPV₃ , Varicella 2 , MMR₃ 10-12 years HPV

9. COMMONLY USED VACCINES BCG VACCINE Dose, Route Site Adverse reactions Contraindication Storage 0.1ml, intradermal Left upper arm at insertion of deltoid Local ulceration or discharging sinus, axillary lymphadenitis, disseminated infection, osteomyelitis. Cellular immunodeficiency, symptomatic HIV 2-8°C; sensitive to heat & light; discard unused vaccine after 4 hr

10. 2-3w after correct intradermal inj. of potent vaccine, paule develops at the site . Slowly increases in size (diameter=4-8mm in 5w) Subside or breaks into shallow ulcer, usually covered by crust. Healing: spontaneous, within 6-12w leaving permanent, tiny, round scar of 4-8mm. Patient becomes mantoux positive in 8w.

11. POLIOMYELITIS OPV Dose, Route Adverse reactions Contraindications Storage 2 drops; oral Vaccine derived polio virus, VAPP Inherited or acquired immunodeficiency, symptomatic HIV 2-8˚C ; sensitive to heat ; use vaccine vial monitor

12. IPV Dose, Route Adverse reactions Contraindication Storage 0.5ml; i.m . or s.c . Local pain, swelling Known allergy 2-8 ˚C sensitive to light

13. Diphtheria Toxoid, Tetanus Toxoid & Killed Whole Cell Pertussis or Acellular Pertussis Vaccine Dose , Route Site Adverse reactions Contraindication 0.5ml; i.m . Anterolateral aspect of mid thigh Local pain, swelling, fever Progressive neurological disease, anaphylaxis after previous dose , encephalopathy within 7 days of previous dose

14. Precautions Storage Previous dose associated with ( i ) fever >40.5 ˚ C within 48hr (ii) collapse within 48hr (iii) persistent inconsolable crying for more than 3hr within 48hr (iv) seizures within 72hr 2-8ºC ; sensitive to light

15. MEASLES VACCINE Dose, route Site Adverse reactions Contraindications Storage 0.5ml, sc Right upper arm or anterolateral thigh Fever, transient macular rash 5-10 days later. ( i ) immunosuppressive therapy eg:alkylating agents, high dose corticosteroids (ii) malignancy (iii) immunodeficiency eg: advanced HIV (iv) untreated TB 2-8°C;sensitive to heat and light; use within 4-6 hrs of reconstitution

16. MMR VACCINE Dose, route Site Adverse reactions Contraindications Storage 0.5ml;s.c. Right upper arm or anterolateral thigh Fever, transient rash, arthralgia, aseptic meningitis, lymphadenopathy ( i ) immunosuppressive therapy eg: alkylating agents, high dose corticosteroids (ii) malignancy (iii) severe immunodeficiency eg: advanced HIV (iv) untreated TB 2-8ºC;sensitive to heat and light; use within 4-6 hrs of reconstitutional

17. HEPATITIS B VACCINE Dose, route Site Schedule IAP 2012 0.5ML, i.m . Anterolateral thigh; avoid gluteal region At birth, 6 weeks & 6 months; may give 3-4 doses in an alternative schedule while ensuring that Doses 1& 2 are ≥4weeks apart Doses 2&3 are≥8weeks apart Final dose is at ≥6mo of age &≥16weeks beyond 1 st dose

18. Catch up Adverse reactions Contraindications storage Complete 3 doses series; 2 nd dose is given ≥4weeks & 3 rd dose ≥8weeks after previous dose Local soreness, fever, fatigue Anaphylaxis after previous dose 2-8 ˚c ;do not freeze

19. VARICELLA VACCINE Dose, route Site Schedule National program IAP 2012 Catch up 0.5ml s.c . Anterolateral thigh or upper arm Not included 2 doses at 15-18mo & 4-6yr; 2 nd dose maybe given >3mo after 1 st dose Complete 2 dose series with minimum interval of 3mo between the doses

20. Adverse reactions Contraindications Storage Fever , rash, local pain or redness Anaphylaxis after previous dose, lymphopenia, immunodeficiency ,during immunosuppressive therapy 2-8ºC; protect from light; use within 3omin of reconstitution.

21. TYPHOID VACCINE Dose, route Site Schedule National program IAP 2012 Catch up Adverse reactions Contraindications Storage 0.5ml, sc or i.m . Anterolateral thigh Not included 1 dose at 2yr ; repeat every 3yr 1 dose beyond 2yr Local pain, swelling, redness, fever Anaphylaxis after previous dose 2-8 ˚c ;do not freeze

22. HEPATITIS A VACCINE Dose, route Site Schedule National program IAP 2012 Catch up 0.5ml; i.m . Deltoid Not included 2 doses beyond 1yr of age given 6 months apart Complete 2dose series with interval of ≥6mo; if≥10 yr old, screen for HAV antibody 1 st , administer vaccine only if seronegative; use adult vaccine if≥ 13yr old.

23. Adverse reactions Contraindications Storage Local pain, nausea, anorexia, malaise Anaphylaxis after previous dose 2-8ºC;protect from light; use within 3omin of reconstitution.

24. ROTAVIRUS VACCINE Dose, route Schedule National program IAP 2012 RV1: 1ml (lyophilized) or 1.5ml(liquid) ; RV5: 2ml(liquid);oral Not included RV1: 2doses; RV5: 3 doses; at 6-14 weeks ≥ 4weeks apart; maximum age <15weeks for the 1 st dose & <8mo for the final dose; do not begin schedule at≥15weeks

25. Adverse reactions Contraindications Precaution storage Intussusception Past history of intussusception; severe immunodeficiency Postpone vaccination during ongoing diarrhoea or moderate illness 2-8 ˚c ;do not freeze; protect from light; use immediately after reconstitution or opening

26. HAEMOPHILUS INFLUENZA B VACCINE Dose, route Site Schedule National program IAP 2012 Catch up 0.5 ml; i.m . Anterolateral thigh Introduced in some states as pentavalent vaccine with DPT & hepatitis B 3 doses at ≥6 weeks given≥ 4 weeks apart; 1 booster at 15-18 mo At 6-12mo:2doses≥ 8weeks apart with 1 booster at 15- 18 mo; at 12-15mo: 1 dose and 1 booster at 15-18 mo; 15-60 mo:1 dose ; not recommended > 5yr old.

27. Adverse reactions Contraindications storage Fever, rash, local pain or redness Hypersensitivity to previous dose 2-8 ˚c

28. PNEUMOCOCCAL VACCINE Dose, route Site Schedule National program IAP 2012 Catch up 0.5ml s.c./i.m . Anterolateral thigh Not included 3 doses at ≥ 6 weeks given ≥ 4 weeks apart and 1 booster at 15-18 mo; At 7-11 mo: 2doses ≥ 4 wks apart & one booster dose at 15-18 mo; 12-23mo; 2 doses ≥ 8 wks apart; 24-59 mo; one dose; >60 mo: one dose only if in high risk category.

29. Adverse reactions Contraindications storage fever, local pain, soreness, malaise. Anaphylaxis after previous dose 2-8 ˚C; do not freeze.

30. HPV VACCINE Dose, route Site Schedule National program IAP 2012 Catch up Adverse reactions Contraindications storage 0.5ml; i.m . Upper arm (deltoid) Not included Girls 11-12 yr old HPV4: at 0, 2 & 6 mo;HPV2: 0, 1 & 6 mo Before initiation of sexual activity fever, local pain, erythema, swelling. Anaphylaxis after previous dose 2-8˚C; protect from light.

31. JAPANESE B ENCEPHALITIS VACCINE Dose, route Site Schedule National Program IAP 2012 Catch up Adverse reactions 0.5ml; s.c . Anterolateral thigh or upper arm Only in endemic areas; 1 dose at 9 mo. Only in endemic areas. 1 dose in susceptible children up to 15 yr old. Fever, malaise

32. INFLUENZA VACCINES Dose, route Site Schedule National program IAP 2012 Adverse reactions Contraindications storage 0.5ml; i.m . Anterolateral thigh or upper arm Not included Only in high risk categories; 1 st time vaccination: 2 doses ≥ 4 wks apart if 6 mo-9 yr old and 1 dose if > 9 yr; annual revaccination with 1 dose; best administered before rainy season Local pain, redness, anaphylaxis. Anaphylaxis after previous dose 2-8˚C; do not freeze.

33. MENINGOCOCCAL VACCINE Dose, route Site Schedule National program IAP 2012 Adverse reactions Contraindications Storage 0.5 ml; s.c./i.m . Anterolateral thigh or upper arm Not included Single dose in high risk categories older than 2 yrs; repeat after 3-5 yrs if required. Fever, local pain or redness Anaphylaxis after previous dose 2-8 ˚C; protect from light; use within 30 min of reconstitution

34. Cold chain System for storage and transport of vaccines at low temperature from manufacturer to the actual vaccination site. To prevent vaccine failure (sensitive to temperature). Potency of the vaccine decreases when exposed to inappropriate temperatures. Heat sensitive vaccine: OPV > Influenza > IPV, MMR > Cholera, Pentavac , Rotavirus > BCG, HPV > Hep B, Hib

35. Deep freezer: Temperature b/w -15° to -25°C. Used for storing OPV vaccine and for freezing ice packs Ice lined refrigerator: Temperature b/w +2° to +8°C. 2 parts: upper part :DPT, TT, HepB , IPV & pentavalent vaccines Lowe part: OPV, BCG, measles, JE

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