immunization-Vaccines,National immunization schedule.pptx

Most about immunization

1. By Dr.Anant Aaditya Shivam,MBBS,PG 1 st year.Dept . of Community Medicine,DMCH PREVENTIVE IMMUNIZATION, IMMUNIZATION PROGRAM

2. General Objectives Define Immunization. Significance of Immunization. Types of Immunity. Immunizing Agents. National Immunization Schedule. Contraindications to vaccinations. Reactions to EEPI Vaccines.

3. Introduction Immunization is the artificial means by which the state of immunity is increased. This is the most important invention that conferred the highest benefit to children in the world. It has prevented many communicable diseases such as diphtheria and polio. It has helped eradicate polio and small pox for the community. Recently, a highly successful introduction of immunization against Haemophilus influenzae type b ( Hib ) has achieved that reduced invasive infections such as Hib meningitis.

4. Definition “Immunization is a process of protecting an individual form a disease through introduction of live or killed or attenuated organisms in the individual system to create immunity.”

5. Significance It is one of the ‘best buys’ in community health and one of the most cost effective health interventions in reduction of communicable diseases related morbidity and mortality. It is a mass means of protecting the largest number of people from various diseases. It gives resistance to an infectious diseases by producing or augmenting the immunity. Artificially acquired immunity is developed by immunization.

6. Immunity Immunity is the security against a particular disease and nonsusceptibility to the invasive or pathogenic effects of foreign microorganisms or to the toxic effect of antigenic substances. Acquired immunity can be active or passive.

7. Active Immunity Active immunity is produced by stimulating immunological defence mechanism through administration of antigen usually prior to natural exposure to infection. Active immunizing agents are known as vaccines. Divided into Primary immune response and Secondary immune response

8. Primary Immune response(Active immunity) First exposure to Antigen. IgM antibodies are produced first(3-7 days).Presence of IgM antibody suggests recent infection because IgM antibodies disappear rapidly.Half life is around 7 days. IgG antibodies are produced subsequently and its alone presence suggest past infection.Half life is about 21 days.

9. Secondary Immune response(Active immunity) Repeated exposure to same antigen Rapid immune response and antibodies are produced in large amounts. Humoral Response: Formation of immunoglobulins by B cells. T-Cell mediated immune response is also called Cell mediated immunity.T -cells are the one which have memory function.

10. Passive Immunity Passive Immunity is produced temporarily by supplying preformed exogenous animal or human antibody to suppress the disease, given soon after or prior to exposure of an infection. It is readymade antibodies. Passive immunity agents are antisera and immunoglobulins. This type of immunity is very short lived and hence used only in emergencies and in previously unimmunized individuals.

11. Examples of Human immune globulins with Dose Hep A: 0.02-0.05ml/Kg Body weight Hep B: 0.05ml/kg Body weight Hep C: 0.05ml/kg Body weight Rubella: 20ml Varicella Zoster: 15-25 units/kg body weight Measles: 0.25ml/kg body weight Rabies: 20IU/kg body weight Tetanus: 250 units

12. Examples of Non Human immune globulins (Antisera) with dose Diptheria : 500-1000 IU as IM Tetanus: 1500 units equine ATS as IM Rabies: 40IU/kg equine ARS Botulism: 10000 units polyvalent antitoxin Gas Gangrene: 10000 IU as IM, Polyvalent antitoxin

13. Immunizing Agents The immunizing agents may be classified as vaccines immunoglobulin's and antisera .

14. Vaccines Vaccines are immuno -biological substances which produce specific protection against a given disease. It stimulates active production of antibody and other immune mechanisms. Vaccines are prepared from live attenuated organisms, or inactivated of killed organisms, extracted cellular fractions, toxoids or combination of these. More recent preparations are sub unit vaccines and recombinant vaccines.

15. Cont.. The ideal vaccines should induce permanent immunity, be free of toxic substances, have minimal side effects, not produce disease to the recipient and be easy to administer.

16. Types of Vaccines Live Attenuated Vaccines Killed Vaccines Subunit Vaccines

17. Live Attenuated Vaccines Serial Cultures are done to retain immugenicity but reduce pathogenicity. This Process is called attenuation.Organisms can multiply and thus produces an immune response much more than a killed vaccine.Can Provide community protection also.Contraindicated in immunocomprised states and pregnancy. Examples Bacterial – BCG, Typhoid (oral) Plague Viral- Oral polio, Measles, Mumps, Rubella, Yellow fever, Influenza. Rickettsial - Epi , typhus.

18. Killed or Inactivated Vaccines Organisms are killed using chemicals.Most commonly used chemical is formalin.These type of vaccines produce relatively lesser immune response since the organisms do not multiply.Not contraindicated in immunocompromised. Examples Bacterial- Pertussis, Typhoid, Cholera, Plague, , CS Meningitis. Viral- Rabies, Hepatitis ‘B’, Influenza, Salk Polio, Japanese encephalitis.

19. Subunit vaccines These are synthetically manufactured vaccines Types Toxoids Protein Vaccine Polysaccride Vaccine Glyco -conjugate vaccine Recombinant Vaccine

20. Toxoids Made from exotoxin produced by bacteria. E.g Diptheria , Teatanus

21. Protein Vaccine Prepared from protein subunit of an organism. E.g Influenza, acellular pertussis vaccine, Novavax(Covid vaccine prepared from spike protein)

22. Polysaccride vaccine Prepared from outer capsular polysaccharide of an organism. It should be serotype specific. It cannot be given to children < 2 years because significant immune response is not seen. E.g Hib, Typhoid, Pneumococcal vaccine

23. Glyco -conjugate vaccine Polysaccharide is conjugated with protein molecule. Should be serotype specific. Increased immunity induction is seen and hence can be used in children<2 years. Examples: PCV, Meningococcal(A,C,W1 35 ,Y )

24. Recombinant Vaccine Antigen is cultured on yeast/host and amplified. Examples: Meningococcal, HPV, Cholera toxin Vaccine ( Dukoral , Shankol )

25. Other Types Mixed Vaccine: Example: Pentavalent, DPT, DTaP Freeze dried Vaccine: Vaccine is in powder form. They should be reconstituted with diluents such as normal saline or distilled water or buffers.There is risk of contamination by staph aureus and hence should be used same day after reconstituition . Examples are BCG, Measles, JE. BCG and measles should be used within 4-6 hours of reconstituition . JE should be used within 2 hours of reconstituition .

26. Vaccine Constituents Adjuvant: Increase the potency of vaccine and hence called immunoboosters . Example: Aluminium hydroxide/Alum in Pentavalent,DPT and PCV. AS O1 in Malaria vaccine, AS O3 and AF O3 in influenza vaccine and AS O4 in HPV and Hep B vaccine. Exipients : These are inert substances added during manufacture. They have no immunological role. Stabilizers: Proteins that stabilize the vaccine by preventing chemical reactions and precipitation. They do not stick to vaccine vial walls.Examples are albumin, gelatin and globulin.

27. Vaccine constituents(2) Preservatives: Increase the shelf life of the vaccine. Examples are Phenoxyethanol(Most commonly used), Phenol, Thiomersal(No Longer used) Buffers: Inhibits the action of pH on vaccine. Examples are (1)Gastric buffer in cholera vaccine( Dukoral ) prevents the destruction of Subunit B toxin by gastric pH, (2) Phosphate Buffer in Japanese encephalitis vaccine. Most commonly used buffer is sodium chloride.

28. Vaccine Constituemts (3) Diluents: Used for freeze dried vaccines to convert powder formulation to liquid. Examples are Distilled water for measles, Normal saline for BCG, Emulsifiers: Stabilize the vaccine by decreasing the surface tension. Examples are Polysorbate, Tween 80. Antibiotics: Neomycin: Varicella, MMR, IPV Gentamycin: Influenza vaccine Erythromycin: Used previously in Measles/MR vaccine Streptomycin + Neomycin: IPV Note: Neomycin allergy is a contraindication for MMR and IPV vaccine.

29. Sensitivity of Vaccines BOTH HEAT AND FREEZE SENSITIVE

30. Sensitivity of Vaccines

31. Storage of Vaccine Cold chain is a mechanism to maintain the temperature of vaccines. Components of Cold chain Day carrier : Can carry 6-8 vials

32. Cold chain contd … Vaccine Carrier: Can carry 16-20 vaccine vials.Larger in size. Cold Box: Can carry 25-30 vaccine vials

33. Cold chain contd.. Ice Line Refrigerators(ILR): Deep Freezers Walk in cold room/Walk in freezers All these require electricity

34. ICE Lined refrigerator Temperature: 2 to 8 degree Celsius Heat sensitive vaccines are placed at the bottom since they are the coolest area. Freeze sensitive vaccines are placed at the top since they are warmer area.

35. Vaccine Placement in ice lined refrigerators

36. Deep freezers Vaccines are never stored in deep freezers.Used only for manufacturing or freezing the icepacks.However in certain situations like outbreak which would require polio immunization centres,OPV vaccines can be stored in a separate deep freezer at district level. Temperature in deep freezer ranges from -25 degree Celsius to -15 degree Celsius.

37. Walk in Cold room Used only for storage at district/state or zonal levels.

38. Vaccine Vial Monitor Vaccine vial monitor is a chemical indicator of heat stability of the vaccines. Chemical Indicator used: P-toluene Sulfonate(PTS) Types of VVM VVM2, VVM7, VVM14, VVM30 For example VVM14 will get spoiled after 14 days if the vaccine is stored at 37 degree Celsius.

39. Vaccine Vial Monitor Discard Point: When inner square colour Becomes same as outer circle Note: If the VVM is on the neck or cap, the vaccine cannot be reused. If the VVM is on the label, the vaccine can be reused after opening the vial

40. Shake Test

41. Cellular fractions Meningococcal and pneumococcal vaccines.

42. Combinations DPT – Diphtheria, Pertussis , Tetanus MMR- Mumps, Measles, Rubella DT- Diphtheria, Tetanus Hib - Hep.B (H. Influenzae ‘B’, Hepatitis ‘B’) Pentavalent – Diphtheria, Pertussis , Tetanus, Hepatitis B, and Haemophilus influenzae type B ( Hib )

43. National Immunization Schedule Immunization schedule should be planned according to the needs of the community. It should be relevant with existing community health problems. It must be effective, feasible and acceptable by the community. Every country has its own immunization schedule.

44. Cont.. The WHO, launched global immunization program in 1974, known as Expanded Program on Immunization (EPI) to protect all children of the world against six killer diseases. In India, EPI was launched in January 1978.

45. Cont.. The EPI is now renamed as Universal Child Immunization, as per declaration sponsored by UNICEF. In India, it is called as Universal Immunization Program (UPI) and was launched in 1985, November, for the universal coverage of immunization to the eligible population.

46. Cont.. The Global Alliance for Vaccines and Immunization (GAVI) is worldwide coalition of organization, established in 1199, to reduce disparities in life saving vaccine access and increase global immunization coverage. GAVI is collaborative mission of Govt., NGOs, UNICEF, WHO and World Bank. The GAVI and Vaccine Fund also adopted the objective of new introduction but under used vaccines in the developing countries, where the disease like hepatitis B and H Influenzae ‘B’ ( Hib ) are highly prevalent.

47. Cont.. National Immunization Schedule as recommended by Government of India for uniform implementation through out the country was formulated.

48. Recommendations Interval between two doses should not be less than one month. Minor cough, colds and mild fever or diarrhea are not a contraindication to vaccination. In some states hepatitis ‘B’ vaccine is given as routine immunization. At 9 months of age, Vitamin ‘A’ oil should be given orally with recommended dose and then to be continued at six months interval upto 5 years of age.

49. National Immunization Schedule Age Vaccine Route At Birth BCG Intradermal At Birth OPV Oral At Birth Hepatitis –B-0 Intramuscular 6- Weeks BCG if not given at birth Intradermal 6- Weeks Pentavalent Intramuscular 6- Weeks OPV - 1 Oral 6- Weeks Hepatitis –B 1 Intramuscular 2,4 and 6 months Rotavirus Oral

50. National Immunization Schedule Age Vaccine Route 10 Weeks Pentavalent-2 Intramuscular 10 Weeks OPV - 2 Oral 10 Weeks Hepatitis –B 2 Intramuscular 14 Weeks Pentavalent-3 Intramuscular 14 Weeks OPV - 3 Oral 14 Weeks Hepatitis –B 3 Intramuscular 9 Months Measles Subcutaneous

51. National Immunization Schedule Age Vaccine Route 16-24 Months DPT Intramuscular 16-24 Months OPV Oral 16-24 Months Measles Subcutaneous 5-6 Years DT IM 10-16 Years TT IM Early Pregnancy TT-1 IM After a month TT- 2 IM

52. General Contraindications of Vaccinations Prior allergic reactions to the same or related vaccine. Live vaccines, i.e. OPV, BCG and measles, are not to be administered in the following situations: in immunosuppressive therapy, immunodeficiency disorders, leukemia, lymphoma or generalized malignancy.

53. General Contraindications of Vaccinations Acute illness with fever above 38 . C. Postpone until recovery has occurred. Special risk groups in whom the risk of complications form infectious diseases is high include those with chronic lung and congenital heart diseases, Down syndrome, HIV infection, Low birth weight (LBW), and asplenia or hyposplenism .

54. Conditions Not to be taken as contra-indication to Vaccination. Mild or moderately ill children should be immunized to increase individual and community protection. Malnutrition, low grade fever, mild acute respiratory infection, or diarrhea and other minor illness are not contraindications for vaccinations.

55. Reactions to EPI Vaccines Mild Fever. Local Pain Malaise, irritability. Transient rash. A Lump or papule appears on the third week after BCG vaccination. It is generally not painful but is tender to touch. The papule increases in size upto 6-10 mm in diameter by the sixth week. The nodule softens with the formation of pus. No treatment is necessary. At the end of 10-12 weeks, only a small scar is visible.

56. Reactions to EPI Vaccines Regional Lymph node enlargement and suppuration observed 2-8 weeks after BCG vaccination is usually a result of the vaccine being injected subcutaneously instead of intra- dermally . In very rare cases, a fever of more than 105 . F, convulsions or collapse after DPT vaccination has been observed. In such cases, further doses of DPT should not be given.

57. Conclusion Immunization is the process whereby a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine.

58. Summary Summary includes introduction, definition, National immunization program, Immunization Schedule and contraindications.