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IMMUNISATION

IMMUNISATION. Dr.M.L.Siddaraju. DEFINITION. Protection from preventable diseases,disabilities and deaths. Birth right of every child Most costeffective healthcare intervention Greek word ‘ímmune’ means ‘ to be protected ’.

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IMMUNISATION

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  1. IMMUNISATION Dr.M.L.Siddaraju

  2. DEFINITION • Protection from preventable diseases,disabilities and deaths. • Birth right of every child • Most costeffective healthcare intervention • Greek word ‘ímmune’ means ‘ to be protected ’.

  3. Acquired immunity: protection offered by introduction of various antigens or antibodies • The process by which this is obtained is known as immunisation • Active immunisation: Specific antigens evoke the needed immune response • Passive immunisation:Antibodies are supplied readymade as immunoglobulins and sera.

  4. Some definitions • Vaccination: Process of inoculating the vaccine or the antigen • Immunisation: Process of inducing immune response, humoral or cell mediated. • Seroconversion: Change from antibody negative state to antibody positive state. • Seroprotection: The state of protection (from disease) due to presence of humoral immunity or antibody detectable in serum

  5. History • Jenner: Cowpox vaccine – 1796 • Pasteur: Rabies prophylaxis – 1885 • EPI: WHO 1974, India – 1978 • UIP: India – 1985 • Child vaccine initiative: with support from several international agencies – 1991 • Global programme on vaccines: WHO – 1993 • Global alliance for vaccine and immunisation - 1999

  6. ACHIEVEMENTS Small pox eradicated in 1977 EPI coverage of > 80% by 1990 Certification for polio eradication by 2005 Over 3 million lives saved globally, annually

  7. Types of vaccines • Live bacteria- BCG, Ty 21 a • Live virus – OPV, MMR • Killed bacteria – Pertussis, S.typhi • Killed virus – IPV, Rabies, HAV • Toxoid – DT, TT • Capsular polysaccharide – HiB, Pneumo, Meningo • Viral subunit - HBsAg • Bacterial subunit – Acellular pertussis

  8. National Immunisation Schedule

  9. IAP immunisation timetable

  10. Additional vaccines • Varicella – above 1 yr • Hepatitis A – above 2 yr

  11. Cold chain • The system of transporting, distributing and storing vaccines from the manufacturers right up to the point of use under refrigeration using any convenient method is referred to as cold chain • Vital link in immunisation • If not maintained, vaccine efficacy will grossly suffer • Safe temp. zone – mandatory to maintain potency • Safe zone for short term storage (1-2 months)is 2-8 deg C. For long term storage –20 degC is used only for BCG,OPV,Measles/MMR • The T series of vaccine(DPT,DT,TT),typhoid Vi,Hep B should not be frozen as once frozen the aluminium salts used as adjuvant will be desiccated and will act as irritantsterile abcess

  12. BCG Vaccine • Attenuated M. Bovis developed in 1921 • Protects against TB meningitis ,Miliary T B • Maternal antibodies do not interfere as CMI not transplacentally transferred • Induces long term protection • Supplied freeze dried and stored frozen or refrigerated • Reconstituted vaccine to be used w/I 4-6 hrs • Dose 0.05 ml(infants),0.1 ml(infants and children) • Intra-dermal over left deltoid • Local lesion due to bacterial multiplication which heals leaving a scar in 12 wks(repeat if no scar) • C/I- Immune deficiency • Side effect-Axillary adenitis

  13. OPV • Live attenuated polio virus types1,2&3-developed by sabin ,1961 • Temperature sensitive store frozen or refrigerated • Can be given simultaneous with any other vaccine • Multiple doses necessary to ensure vaccine virus take and response to all three types of viruses • IAP recommends additional doses of opv as a part of pulse polio program every year till age of 5 yrs

  14. Why PULSE POLIO? • On national immunisation days(NIDs) pulse doses of oral polio vaccine has to be administered as simultaneous feeding of vaccine to all susceptibles is neede to produce immunity, by preventing wild polio viruses from multiplying in the gut • It is mandatory to give all reccomended doses in NIDs so that no wild virus remains in circulation • OPV is contraindicated in immunodeficiency,HIV,active viral infections • No side effects

  15. IPV • Formaldehyde killed polio virus grown in monkey kidney or human diploid cell • Contains 20,8,32 D antigen units against type 1,2,3 polio viruses respectively • Seroconversion 90-95% after 2 doses,99% after 3 doses • Thermo stable and indicated in immunocompromised and HIV

  16. DPT • Diphteria toxoid(Ramon &Glenny,1923) • Killed Bordetella pertusis(Madsen ,1923) • Tetanus toxoid(Ramon & Zoeller,1927) • Toxoids adjuvated (Aluminium hydroxide/ phosphate) • Vaccine supplied as liquid, stored refrigerated • Aluminium adjuvated vaccine must not be frozen • 0.5 ml injected IM on anterolateral asoect of thigh.

  17. Parents must be alerted about local reaction and fever(PCT given) • IAP recommends 2nd booster at 5 yrs • H/O convulsion not contradiction • Progressive neurological disease or serious adverse reaction to earlier dose are contraindications for DPT(replace with DT)

  18. Measles • Live attenuated vaccine developed by Enders-1960 • Vaccine further attenuated by Schwarz, Edmonston-Zagreb • Supplied freeze dried- store frozen or refrigerated • Use reconstituted vaccine in 4-6 hrs(refrigerate do not freeze) • 0.5 ml injected S/C preferably right upper arm • Age at which recommended 9 months • During outbreak>6 months • If given < 9 mo repeat dose after 3 mo • Possibility of fever for 5-10 days • MMR-0.5ml S/C over deltoid(15 mo)

  19. Typhoid • WHOLE CELL: • Killed S.typhi often with S.paratyphi A(TA) • Developed by Wright ,1896 • Liquid,store refrigerated,inject S/C • Primary course:2 doses 4 wks apart at 6-9 mo of age or at any age • Boosters once in 3-5 yrs • Dose :0.25-0.5 ml S/C for primary,0.1ml for booster

  20. Vi POLSACCHARIDE: • Developed by Robbins,1984 • Liquid, adjuvated,store refrigerated • Inject IM at or after 2 yrs of age(0.5 ml) • Booster after 3 yrs

  21. ORAL: • Live attenuated S.typhi developed by Germanier,1975 • Strain name:Ty 21a • Enteric coated capsules,store refrigerated, administer orally 3 doses on alternate days • Repeat 3-5 yrs later • Recommende age7 yrs or above

  22. Hib vaccine • H . Influenza B-capsular polysaccharide • Liquid or freeze dried • Age of initiation 6 wks • 3 doses 6,10,14 wks/2,4,6 mo • Booster 1 yr after primary dose • Dose 0.5 ml SC/IM over deltoid or anterolateral aspect of thigh

  23. ADDITIONAL VACCINES • Varicella vaccine: • Developed by Takahashi in 1971,Japan • Live attenuated Oka strain. • Vaccine available as lyophilized powder • Dissolve in 0.5 ml diluent • SC 0.5 ml • Single dose 1-12 yrs • >13 yrs 2 doses at 1 mo interval

  24. Hepatitis A • Inactivated vaccine containing H M 175 strain grown in MRC5 cell line. • Pediatric formulation 720 ELU IM; 2 doses 6 mo apart between 2-18 yrs • >19 yrs 1440 ELU 2 doses 6 months apart • Efficacy 94-100% • No boosters

  25. Vaccines recommended during epidemics • Japanese B Encephalitis vaccine • Meningococcal A&C

  26. Vaccines for high risk group • PNEUMOCOCCAL VACCINE: • Polysaccharide vaccine(23 valent) • 7 Valent conjugated with CRM 197 diphtheria toxin • 23 valent effective after 2 yrs of age • Single dose 0.5 ml IM with booster every 3-5 yrs

  27. Indications • Sickle cell disease • Nephrotic syndrome in remission • Congenital or acquired asplenia/splenic dys function • HIV • Chronic cardiac/pulmonary disease • Immunodeficient conditions • CSF leak • Diabetes mellitus

  28. Combination vaccines • DPT/HiB/HepB • Benefits: • 1. Reduced number of injections • 2. Reduced pain and parental anxiety • 3. High compliance, low drop out rates,enhanced coverage • 4. Reduced no: of visits • 5. Less storage space • 6. Less burden on cold chain

  29. Vaccination schedule for unimmunised child

  30. Newer vaccines • Live attenuated varicella(oka)strain • Killed hep A virus vaccine • 23 valent pneumococcal vaccine • Influenza virus vaccine • Combination vaccines

  31. Vaccines available in other countries • Conjugated pneumococcal vaccine(7 valent) • Conjugated S.typhi Vi vaccine • Rota virus vaccine • Combination vaccines

  32. ADVERSE EFFECTS

  33. IAP recommendations on Immunisation,2003 • The IAPCOI-Indian Academy of Pediatrics Committee On Immunisation,has formulated several scientific recommendations to other agencies pertaining to Immunisation

  34. Recommendation to federation of OBG societies of India • To adopt routine testing of all pregnant women for HBV infection and if mother is positive baby should be given HBIG+HB vaccine soon after birth

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