IMMUNIZATION---

What is Immunization?
Types of Immunization
Vaccination
Types of Vaccines
Schedules of Vaccines
Precautions and Contraindications of Vaccines
IMMUNIZATION---
IMMUNIZATION- a process of inducing immunity
artificially by either vaccination(Active) OR
administration of Antibodies(Passive)
Vaccination- administration of any vaccine or toxoid
for prevention of disease
IMMUNIZATION---
Active Immunization-stimulating the immune
system to produce antibodies and cellular
immune responses by giving antigens
Passive Immunization- providing temporary
protection by administration of exogenously
produced antibodies OR naturally from the
mother to the child
IMMUNIZATION---
.Immunizing agents;
- Vaccines
- Toxoids
- Antitoxins
- Antibodies/ Immunoglobulins
. Most immunizing agents contain;
- preservatives - stabilizers - antibiotics
- adjutants and suspending fluid
IMMUNIZATION---
The decision to use a vaccine involves assessment
of;
. Risk of the disease
. Benefit of vaccination
. Risk of vaccination
Vaccines- preparation of proteins, polysaccharides
or nucleic acids of pathogens
- induces the body to produce antibodies and
cell-mediated immunity against the specific
antigen in the vaccine
IMMUNIZATION---
Vaccines may be:
. Live-attenuated
. Inactivated or killed
. Toxoids OR
. Genetically engineered
o Live-attenuated vaccine-produces immunity by
causing a mild infection
- a virulent organism is weakened so that it
produces an antigenic response with no serious
consequences of a wild infection
IMMUNIZATION---
.Examples-1.Bacterial; BCG, Oral typhoid
2.Viral; OPV, Measles, Rubella, mumps
o Killed or Inactivated Vaccine-prepared from
virulent organisms or preformed antigen
inactivated by heat, phenol, or formaldehyde
. E.g.; 1. Bacterial-pertussis, cholera, injectable
typhoid
2. Viral- injectable polio, influenzae,rabies
IMMUNIZATION---
o Toxoids- toxins which have been rendered non-
toxic by treatment with formaldehyde but their
antigenecity is maintained
E.g; diphtheria, tetanus
o Conjoined Vaccines- polysaccharides are being
conjugated with protein b/c they have;
. Short-term antibody production
. Poor immunegenicity in infants and
. No memory for future antigens
IMMUNIZATION---
-so they are conjoined with other proteins to
improve their immunological response
.E.g; Hib, meningococcal, pneumococcal

• Schedule of vaccines
-based on; a. epidemiology of the disease
b. age-specific risk of complications by natural
disease
c. anticipated immunologic response of the host to
the antigen
IMMUNIZATION---
d. duration of immunity that can be induced
N.B. Age and timing of immunization are critical for the
success of vaccination
IMMUNIZATION---
 Immunization Schedules
 Mandatory
 No.
 Age
 Vaccination
 1
 0-4 weeks
 BCG/OPV 0 dose
 2
 6 weeks
 DPT/OPV I dose
 3
 10 weeks
 DPT/OPV II dose
 4
 14 weeks
 DPT/OPV III dose
 5
 9 months
 Measles Vaccine OPV IV dose
 6
 15-18 months
 MMR
 7
 18-24 months
 DPT/OPV I booster
 8
 5 years
 DT/OPV II booster
 9
 10 years
 Tetanus toxoid
 BCG: Bacillus Calmette Guerrin OPV: Oral Polio Vaccine
 DPT: Diphtheria, Pertussis, Tetanus MMR: Measles, Mumps, Rubella
IMMUNIZATION---
 Immunization Schedules
Mandatory
 No.
 Age
 Vaccination
 1
 0-4 weeks
 BCG/OPV 0 dose
 2
 6 weeks
 DPT/OPV I dose
 3
 10 weeks
 DPT/OPV II dose
 4
 14 weeks
 DPT/OPV III dose
 5
 9 months
 Measles Vaccine OPV IV dose
 6
 15-18 months
 MMR
 7
 18-24 months
 DPT/OPV I booster
 8
 5 years
 DT/OPV II booster
 9
 10 years
 Tetanus toxoid
 BCG: Bacillus Calmette Guerrin OPV: Oral Polio Vaccine
 DPT: Diphtheria, Pertussis, Tetanus MMR: Measles, Mumps, Rubella
 Recommended:
 No.
 Age
 Vaccination
 1
 0-1 week
 HBV I dose
 2
 6 weeks
 HBV II dose
 3
 6 months
 HBV III dose
 Optional:
 No
 Age
 Vaccination
 1
 1 2 years
 Parenteral Typhi M
 2
 6 years
 Oral Typhoid vaccine
 3
 2 2 months
 HIB I dose
 4
 4 months
 HIB II dose
 5
 6 months
 HIB III dose
 6
 18 months
 Booster
 HBV: Hepatitis B Vaccine; HIB: H. Influenza B Vaccine
  
IMMUNIZATION--
Age Vaccine Dose Route
.Birth BCG 0.05ml Id(rt.deltoid)
OPV0 2drops PO

.6wks DPT1 0.5ml IM

OPV1 2drops PO
Hib1 0.5ml IM
HBV1 0.5ml IM
 .10wksDPT2 0.5ml IM
IMMUNIZATION---
OPV2 2drops PO
HBV2 0.5ml IM
Hib2 0.5ml IM

.14wks DPT3
OPV3
HBV3
Hib3
.9months Measles 0.5ml SC
IMMUNIZATION---
.Notice- minimum interval b/n each schedule is
4weeks
- even if months have lapsed b/n doses just
complete the course
- If mother is positive for HBsAg, HBV1 should be
given at birth if possible with IG
- in a child who have not been vaccinated during
infancy and still below 5years of age,vaccinate as
. BCG once(if PPD is negative)
. DPT & OPV today, after 4ks and 6th month
IMMUNIZATION---
General Considerations
 Immediate goal of immunization is to prevent
disease in individuals
Ultimate goal is to eliminate/eradicate a
communicable disease
Prevention of crippling deformity(eg; Polio)
Maternal antibodies transferred through the
placenta protect the infant upto 3-4months AND
if vaccine is given before 1month of age,
circulating antibodies may neutalize the antigens
IMMUNIZATION---
•
No antibody interference with BCG, b/c
protection of TBC depends on cell-mediated
immunity so that BCG can be given at birth.
Antibodies against measles persist unto 9-
12months of age
Premature babies are vaccinated like other babies
b/c response to antigens is dependent on
postnatal age
Minimum interval b/n multiple doses should be
4wks
IMMUNIZATION---
If a vaccine is given before 4wks of the previous
dose, it shouldn’t be counted as part of the series
Longer than recommended intervals b/n doses
do not reduce final antibody concentration
All EPI antigens are safe & effective if
administered simultaneously(give at different
sites on the same day)
If 2 live vaccines are not given on the same day in
different sites, there will be problem of
interference so that they should be spaced at
least 4wks apart
IMMUNIZATION---
Live vaccines shouldn't be given to severely
immunocompromised children
Deep injection and massage may reduce antigenic
efficacy
Pertussis vaccine is not recommended after the age
of 6years

BCG- Bacille Calmette Guerin

.live-attenuated strain of M.bovis
. Effective in decreasing the liklihood and severity of
Tuberculosis
IMMUNIZATION---
. Ideal age of vaccination is in the 1st wk of age but can
be given at older age if PPD is negative but if PPD is
positive, no need to give BCG
.Dose/route = Id 0.05ml for neonates
0.1ml for older child
.Vaccine efficacy= 0-80% for pulmonary
75-90% for severe TBC
. Complications of BCG
- deep abscess - erythema nodosum
- lymphadenitis - disseminated TBC
Poliomyelitis Vaccine
.poliomyelitis causes paralysis
Vaccines-live-attenuated(OPV,Sabin) types I, II, III
-killed, injectable(IPV,Salk)
. Even if a child has paralysis due to polio, he/she
should be vaccinated to prevent other 2types of polio
Cont’d
Advantages of OPV over IPV
. Easy to administer
.superior antibody response
. Provides rapid immunity within 1wk
. Provides Herd Immunity
Contraindication-immunocompromisation
- immunodeficient household contact
 Prepared by inactivating the toxin by
formaldehyde
Even if there was previous disease, the child
should be vaccinated since disease doesn’t
confer immunity
Tetanus---
Neonatal tetanus is prevented
by maternal
immunization(3doses before &
2doses during pregnancy at
6wks interval, 2nd dose atleast 4-
6wks before delivery)
Efficacy= 85-95%
Diphtheria Toxoid
Prepared from toxin by formaldehyde
Almost always given with tetanus & pertussis as DPT
Efficacy= 80-90%

Pertussis Vaccine
.whole cell vaccines prevent serious illness
.do not protect completely against infection
.efficacy & antibody levels wane with time
.Efficacy= 80%
Measles Vaccine
Live-attenuated
Efficacy=85%
Contraindication
.anaphylaxis
.immunodeficiency
Hepatitis B Vaccine
Consists of purified inactive sub-unit of the virus, not
infectious
Not contraindicated in immunodeficiency
HBV is 85% effective in perinatally acqired infection and
80-95% effective in postnatally acquired infection
Routine vaccination is given to all infants, children and
adolescents
Infants of HBsAg-positive= Ig and vaccine within 12hrs of
birth at separate site,2nd dose at 1-2mo and 3rd dose at 6th
month of age
Haemopholus Influenzae-type
B
Hib- common cause of;
.meningitis .pneumonia .epiglottitis
.sepsis .arthritis
Conjugated vaccine
Safe (almost free of side effects) and effective
Can be given combined with other vaccines(DPT)
If a child presents after 1yr of age;
.age 12-15months= 1st dose(today), 2nd after 2mo and 3rd after 6mo
.15-59mo= 1st and 2nd dose only
Contraindications &
Precautions
Contraindication- don’t give the vaccine!
Precaution-vaccine may be given if the benefit
outweighs the risk to the child
General contraindication to all vaccines is
anaphylaxis to previous dose of that vaccine
General precaution – moderate or severe illness
with/without fever
BCG
Contraindication-severe immunodeficiency
Precaution-moderate or severe illness with/without fever
DPT
.Precaution-fever >40.5 within 48hrs
-collapse or shock-like effect within 48hrs
-seizure in 3days
- persistent, inconsolable cry >3hrs within 48hrs during the
previous dose
-moderate or severe illness with/without fever
.Contraindication-severe allergic reaction after a previous dose
-encephalopathy(eg, coma,prolonged seizure)
within 7days of previous DPT
Hib
.Precaution-moderate or severe illness with/without
fever
.Contraindication-severe allergic reaction during
the previous dose
-age below 6wks

HBV
.Precaution-moderate/severe illness
- infant weighing less than 2kgs
.Contraindication-severe allergic reaction