Updated national immunisation schedule ppt

National immunisation schedule updates

1. VACCINE UPDATES

2. Vaccination is giving vaccines. Immunization is getting protection against a disease through vaccination. TOXOID Certain organisms produce exotoxins E.g.. Tetanus bacilli Toxins produced by these organisms are detoxicated and used in the preparation of vaccines.

3. Conjugate vaccines Conjugation is the process of making non antigenic small molecules immunogenic by covalently linking them to protein antigens E.g.., Typhoid vaccine Pneumococcal vaccine Conjugate vaccines are highly immunogenic because they activate both B lymphocytes and T lymphocytes . polysaccharide vaccine contains the material prepared from the organisms, It activates only B lymphocytes .It is less immunogenic.

4. Immunoglobulin It is a sterile antibody containing solution derived through cold ethanol fractionation of large pools of human plasma from adults. Antibody concentration reflect the infectious disease exposure and immunization experience of plasma donors. Most of the antibody is IgG.

5. Immunoglobulin Routes of administration: Intramuscular Intravenous Subcutaneous Specific immunoglobulin preparations are derived from donors with high titers of antibodies to specific agents e.g …, Hepatitis B immunoglobulin Tetanus immunoglobulin Rabies immunoglobulin Varicella-zoster immunoglobulin

6. Monoclonal antibodies Antibody preparations produced against a single antigen Palivizumab is a monoclonal antibody that is used to prevent severe disease due to respiratory syncytial virus.

7. Hyperimmune animal antisera (anti toxins) These are derived from horses Examples : Diphtheria antitoxin Botulinum antitoxin These can cause allergies So test dose should be given before administration.

8. Immune response to vaccines Serum antibodies may be detected as soon as 7-10 days after injection of antigen. Early antibodies are of IgM type, IgG antibodies peak approximately one month after vaccination.

9. Assessment of immune response By measuring serum antibodies Loss of detectable antibody over time does not necessarily mean susceptibility to disease. Most vaccines induce immunologic memory leading to booster response on exposure to the micro organism with resultant protection from disease.

10. Precautions Two vaccines cannot be mixed in same syringe When multiple vaccines are given ,they should be administered in different limbs. If this is not possible at least one inch (2.54cm) gap should be maintained. Two live vaccines should be given on same day (or) a minimum of four weeks gap should be maintained.

11. Precautions When a multidose vial is opened and a few doses are used ,it can be stored for one month in refrigerator. Spirit can be used for cleaning the vaccination site. Antiseptic is not used. After vaccination child should be observed for at least 15 minutes for reactions.

12. skipping of doses There is no need to restart the schedule.

13. Clotting disorders Fine needle (23 gauze or smaller ) is used. Firm pressure is applied to the site without rubbing for at least 2 minutes.

14. vaccine prefilling Prefilling vaccines into syringes before starting the vaccine session is not recommended Due to administration and dosing errors.

15. Vaccines in children using steroids Inactivated vaccines and toxoids can be administered . Live vaccines should not be given if daily steroids are used for more than 2 weeks. No contraindications in : Alternate day steroid treatment Inhalation steroid treatment Topical steroid treatment Live vaccines can be given one month after stopping the steroids .

16. Cleaning the vaccination site Swabbing with 60 to 70 percent alcohol for 30 seconds is recommended. Area is allowed to dry for 30 seconds. Aspiration before vaccination is not needed.

17. BCG Normal saline is the diluent. Reconstituted vaccine is used within 3 hours. Distilled water causes local irritation. Satisfactory injection should produce a wheal of 5 mm in diameter. Child becomes Mantoux positive after 8 weeks. If vaccine is injected subcutaneously, abscess is more likely to develop.

18. BCG If there is local abscess formation ,we can wait until it ruptures and heals. There is no need to use ATT. Absence of scar does not indicate failure of vaccine. For late comers ,vaccine can be given up to 1 year of age. No other vaccine should be given for at least 6 months into the arm which received BCG vaccine.

19. Hepatitis B DOSE : 10 micrograms(0.5 ml) up to 10 years, 20 micrograms(1ml) after 10 years. In thrombocytopenia or bleeding disorders it can be given subcutaneously. No booster is needed even if protective antibody goes below 10 mIU . Interruption of the vaccination schedule does not require restarting of the vaccine.

20. Hepatitis B It is not given when birth weight is less than 2 kg. By one month ,all premature infants respond well irrespective of birth weight or gestational age. For late comers, it can be given at any age .

21. Oral polio Squeeze the cheeks or pinch the nose to make the mouth open. If vomits within 30 minutes ,we have to give the dose again. In diarrhoea, dose is given but it is not counted. Breastfeeding does not decrease the effectiveness of OPV. Hot water, hot milk or hot fluids should be withheld for 30 minutes.

22. Pentavalent vaccine Serious side effects (rare) Convulsions Anaphylaxis Encephalopathy Sterile injection abscess How to reduce reactions By giving deep intramuscular

23. Rota virus vaccine Live vaccine Upper limit for completion of schedule Monovalent vaccine: 24 weeks Pentavalent vaccine: 32 weeks

24. MR vaccine Used within four hours of reconstitution. In epidemics, vaccine can be given after 6 months. While reconstituting the vaccine, only gentle rolling between palms is recommended. Staphylococcal toxic shock syndrome occurred due to bacterial contamination of the reconstituted vaccine vial. Some children develop mild measles like illness 7-10 days after vaccination.

25. Meningococcal vaccine Subcutaneous vaccine After 2 years - polysaccharide vaccine After 11 years -conjugate vaccine Indications: During epidemics Before splenectomy Travellers

26. Rabies Pre exposure prophylaxis: Veterinarians Animal handlers Lab workers handling rabies vaccine Dose : 1 ml 0, 7, 28 days(3 doses) If child already received post exposure prophylaxis previously Only two doses are required (0 and 3 RD day)

27. Rabies Touching , licking on intact skin does not need vaccination. Monkey bites - vaccination is needed. Rat bites - vaccination is not needed.

28. Tetanus toxoid If child completed primary vaccination and received booster in the last 5 years , no TT is required after injuries.

29. HPV VACCINE Male children also require HPV vaccine

30. Late comers Age less than 5 years First visit : pentavalent, OPV, IPV , PCV Second visit : pentavalent, OPV (one month later) Third visit : pentavalent, OPV, IPV, MR , JE (one month later) One year later : OPV , DPT, MR , JE ,PCV

31. After 5 years First visit : Hepatitis B , dT , PCV Second visit : Hepatitis B , dT Third visit : MR , JE One year later: Hepatitis B, MR , JE , PCV

32. Vaccines in pregnancy Vaccines contraindicated in pregnancy are : BCG MMR Varicella Breast feeding is not a contraindication for any vaccine.

33. Bone marrow (or) solid organ transplant Vaccination should be preferably completed before transplant. If needed vaccination can be given after 6-12 months after transplant. After transplantation, killed vaccines are recommended.

34. Storage Freezer : OPV vials Top shelf :BCG MR MMR JE Middle shelf: Pentavalent IPV DPT TT PCV Optional vaccines Lower shelf : Diluents

35. Dengue vaccine Dengue vaccine called dengvaxia is available at present in three countries Brazil Mexico Phillipines Dengue vaccine may become available in india by 2026

36. Malaria vaccine At present malaria vaccine is administered to children in African countries as a pilot project by WHO.

37. Hepatitis E vaccine Hepatitis E vaccine in the name of hecolin is currently available in china and Pakistan .

38. Recent changes in NIS Pneumococcal vaccine is given at 6 weeks , 14 weeks and 9 months of age fiPV is given at 6 weeks, 14 weeks and 9 months of age .

39. THANK YOU