IMMUNISATION

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 immunisationAntibodies 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 gt 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
Age Vaccine
Birth BCG, OPV 0
6 wks DPT 1, OPV 1
10 wks DPT 2, OPV 2
14wks DPT 3. OPV 3
9 months Measles
15-18 months DPT 4, OPV 4
5 years DT
10 years TT
16 years TT
Pregnant women 2 TT at 4 wks interval
9
IAP immunisation timetable
Age Vaccine
Birth 2 wks BCG
Birth, 6, 10, 14 wks, 16-18 mo, 5 yrs OPV
Birth, 6, 10, 14 wks, 16-18 mo, 5 yrs DPT
Birth., 6, 14 wks / 6, 10, 14 wks Hepatitis B
Birth, 6, 10, 14 wks, 16-18 mo HiB Conjugate
9 mo plus Measles
15 months MMR
2 years Typhoid
10., 16 TT / dT
Pregnant women 2 doses of TT
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
NAME BCG-LAV.Danish bovine strain
CONTENT BCG strain of bovine mycobacterium-3-10 million bac/dose
PREPARATN Lyophilised
INITIATION At birth/first contact
SCHEDULE Single dose
BOOSTER Nil
DOSE 0.05 ml(newborn)0.1 ml(infants and children
ADMNSTRN Intra dermal left deltoid
EFFICACY 0-80
C/I Immunodeficiency
S/E Axillary adenitis
13
NAME DPT-killed pertusistoxoid diphtetanus OPV-LAV
CONTENT Diph tox 20 Lf,Tet tox 5 Lf.Pertusis 6 IU(40,000 million killed bacteria ALPO4-3 mg SABIN, type 1-106(CCID 50),type-2-105(CCID 50),type-3- 105(CCID50
PREPARATN Liquid Liquid
INITIATION 6 wks Birth
SCHEDULE 3 doses 6,10,14 wks Birth,6,10,14 wks
BOOSTER 15- 18 mo,5 yrs 15- 18 mo,5 yrs
DOSE 0.5 ml 2 drops
ADMNSTRN I/M lat thigh Oral
EFFICACY P80D80T100 80-90
C/I Prog neuro dis,uncontrolled cry,convulsion, severe rxn for 1st dose Immuno defeciency,HIV
S/E Fever,local indurn,pain none
14
NAME Hepatits B(HBsAg) Measles(LAV)
CONTENT Plasma derived/yeast derived r-DNA/CHO cells derived r-DNA 1000TCID50.Schwarz or Edmonston Zagreb strain 1000 TCID/CCID
PREPARATN Liquid Lyophilised
INITIATION Birth w/ I 48 hrs?6 wks gt9 mo
SCHEDULE Birth,6,14 wks/0,1,6 months 1 dose at 9-12 mo.2nd doseafter 3 mo if 1st doselt9 mo
BOOSTER Nil Nil
DOSE 10 microgram,0.5 ml(lt10 yrs), 1 ml(gt10 yrs) 0.5 ml
ADMNSTRN I/M deltoid S/C deltoid
EFFICACY 90 95
C/I None Imm def,anaphylaxis,egg protein allergy
S/E Local pain,erythema Fever ,rash after a week
15
NAME MMR(LAV) Mumps(LAV)
CONTENT Measles as above,Mumps5000 TCID of Urabe AM-9,Rubella 1000 TCID of Wistar RA/3M L-Zagreb/Jerry Lynn strain 5000TCID
PREPARATN Lyophilised Lyophilised
INITIATION 15 mo 15 mo with MR or at 11 yrs
SCHEDULE Single dose Single dose
BOOSTER Nil Nil
DOSE 0.5ml 0.5 ml
ADMNSTRN SC deltoid SC deltoid
EFFICACY 95 90-95
C/I As in measlespregnancy Imm def
S/E As in measles Fever
16
NAME H Infl b(conjugate) PRPD/PRPT/HBOC TYPHOID(KILLED)
CONTENT H.Infl capsular oligosaccharide b S.typhi 1000 million killed/ml
PREPARATN Liquid/freeze dried Liquid
INITIATION 6 wks 2 yrs
SCHEDULE 6,10,14 wks/2,4,6 mo 2 doses 4 wks apart
BOOSTER After 1 yr Every 3 yrs
DOSE 0.5 ml.10 mcg 0.25 mllt10yrs,0.5 mlgt10 yrs
ADMNSTRN SC/IM-deltoid/ant lat thigh SC deltoid
EFFICACY 90-100 57-75
C/I None None
S/E Local rxn,fever Local rxn,fever
17
NAME TYPHOID(Vi polysaccharide TYPHOID oral
CONTENT Vi capsular polysach S.typhi Ty 21a strAin(109 organisms)
PREPARATN Liquid Capsule
INITIATION gt2 yrs gt6yrs
SCHEDULE Single dose 3 doses on alternate days
BOOSTER Every 3 yrs Every 3 yrs
DOSE 25-50 mcg(0.5 ml) 1 capsule
ADMNSTRN I/M Oral
EFFICACY 70 70
C/I None None
S/E Fever,pain,induratn Abdominal pain,vomiting, loose stools
18
NAME Pneumococcal HEP-A (inactivated vaccine)
CONTENT Capsular poly saccharide HM 175 of HAV 720 ELU antigen/ml
PREPARATN Lyophilised Liquid
INITIATION gt2 yrs gt2 yrs
SCHEDULE Single dose 2 doses 0, 6 mo
BOOSTER Every 3-5 yrs Nil
DOSE 0.5 ml 0.5 ml
ADMNSTRN SC/IM over Ant. Lat thigh IM antero lat thigh
EFFICACY 85-90 99
C/I First trimester pregnancy None
S/E none Mild reaction
19
NAME Varicella vaccine Meningococcal AC
CONTENT OKA strain of varicella zoster103(3 PFU) N.meningitidis groupA,C 50 mcg each
PREPARATN Lyophilised Lyophilised
INITIATION gt1 yr For use only in endemic areas during epidemics.gt2 yrs
SCHEDULE 1-12 yrs(single dose),gt13 yrs 2 doses 1 mo apart Single dose
BOOSTER Nil 5 yrs
DOSE 0.5 ml 0.5 ml
ADMNSTRN SC deltoid SC/IM-deltoid/Ant lat thigh
EFFICACY 95-100 90-100
C/I None None
S/E Varicella type rash after 1 wk with fever Local rxn, mild fever
20
NAME Japanese encephalitis(killed monovalent) Influenza vaccine(inactivated-split virion)
CONTENT Mouse brain(Nakayama/NIH strain) or Baby hamster kidney(P-3) or Recombinant DNA vaccine 1.5 mcg hemaglutinin of each of the chosen strain as suspension
PREPARATN Freeze dried /liquid Liquid
INITIATION Same as meningo cocci All ages
SCHEDULE 2 doses 1-2 wks interval Single dose
BOOSTER After 3-4 yrs Every year with current strain
DOSE 1 ml 0.5 ml
ADMNSTRN SC-deltoid/ant lat thigh SC/IM
EFFICACY 60-80,100 after booster 80-90
C/I None Egg protein allergy
S/E Local swelling,fever,malaise Local reaction,fever
21
NAME DPT wcHB combination DPT wcHib
CONTENT D and T toxoidPWC yeast derived r-DNA HBsAg D T toxoid PWCcapsular polysaccharide of Hib
PREPARATN Liquid Lyophilised/liquid
INITIATION 6 weeks 6 wks
SCHEDULE 6,10,14 wks 6,10,14 wks
BOOSTER Nil Nil
DOSE 0.5 ml 0.5 ml
ADMNSTRN IM IM
EFFICACY 90-100 90-100
C/I Same as DPT None
S/E Fever,pain,local induration Mild fever,local induration
22
NAME Rabies (tissue culture)-inactivated
CONTENT HDCV(virus grown in Human Diploid fibroblasts) PCEC (Chick embryo cells) Vero cell(vervet monkey kidney cell)
PREPARATN Lyophilised
INITIATION Any age-/after dog bite
SCHEDULE Pre expo0.7,21 days.Post expo0,3,7,14,28.Re expo0,7(lt5 yrs), full course(gt5 yrs)
BOOSTER First after 1 year then every 3 yrs
DOSE 0.5 ml/1ml depending on preparatn
ADMNSTRN S/C deltoid/ ant lat thigh
EFFICACY 90-100
C/I None
S/E Local pain,rarely encephalopathy
23
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

24
OPV

• Live attenuated polio virus types1,23-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

25
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,act
  ive viral infections
• No side effects

26
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

27
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.

28

• 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)

29
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 outbreakgt6 months
• If given lt 9 mo repeat dose after 3 mo
• Possibility of fever for 5-10 days
• MMR-0.5ml S/C over deltoid(15 mo)

30
Typhoid

• WHOLE CELL
• Killed S.typhi often with S.paratyphi A(TA)
• Developed by Wright ,1896
• Liquid,store refrigerated,inject S/C
• Primary course2 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

31

• 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

32

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

33
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

34
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
• gt13 yrs 2 doses at 1 mo interval

35
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
• gt19 yrs 1440 ELU 2 doses 6 months apart
• Efficacy 94-100
• No boosters

36
Vaccines recommended during epidemics

• Japanese B Encephalitis vaccine
• Meningococcal AC

37
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

38
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

39
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

40
Vaccination schedule for unimmunised child
lt5 yrs gt5 yrs
First visit BCG,OPV,DPT,HB TT/Td,HB
2ND visit(1 mo later) OPV,DPT,HB TT/Td,HB
3RD visit(1 mo later) OPV,DPT,MMR/Measles,Typh MMR,Typh
1 yr later OPV,DPT,HB HB
Every 3 yrs Typh booster Typh booster
41
Newer vaccines

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

42
Vaccines available in other countries

• Conjugated pneumococcal vaccine(7 valent)
• Conjugated S.typhi Vi vaccine
• Rota virus vaccine
• Combination vaccines

43
ADVERSE EFFECTS
44
ADVERSE EVENT VACCINE SYMPTOMS MANAGEMENT
Anaphylaxis any W/I minutes,acute decompensation of circ. System,hypovolemic shock,laryngeal spasm/edema.Acute respiratory distress Adrenaline,CPR,IV volume expanders or dopamine/dobutamine, hydrocortisone
Hypotensive,hyporesponsive episodes DPT Within 12 hrs.Acute paleness.Transient decreased levels/loss of consciousness.Dec muscle tone IV fluids, dexamethasone,oxygen
45
ADVERSE EVENT VACCINE SYMPTOMS MANAGEMENT
Incessant cry DPT Within 48-72 hrs.Excessive inconsolable crying Sedation with triclofos-50mg/kg/dayPCTfeeding advice
Toxic shock syndrome Measles contamination by S. Aureus Within 30 min- few hrs. Mounting fever,vomiting, diarrhoea,septic shock IV fluids,anti microbials,cloxacillin 50-100 mg/kg/day, steroids,antipyretics,supportive therapy
46
ADVERSE EVENT VACCINE SYMPTOMS MANAGEMENT
lymphadenitis BCG Within 2-6 months firm-soft axillary lmphadenitis1.5-3 cm with/ without sinus If firm no treatment.If softfluctuant HR3.Aspiration if needed.Steroid if sinus present
Bacterial abcess Any vaccine Within 72 hrs,fluctuant or firm abcess with or without fever Antibiotics, Anti pyretics,drainage if needed
47
ADVERSE EVENT VACCINE SYMPTOMS MANAGEMENT
Sterile abcess DPT,DT,TT,Typhoid HEP B By 72 hrs ,minimum inflamation, no fever Drainage if needed
Moderate to severe local reaction Any vaccine Non fluctuant swelling/redness 3-10 cm in size at injection site Paracetamol
48
ADVERSE EVENT VACCINE SYMPTOMS MANAGEMENT
Seizures with fever(rare) DPT, measles Always generalised simple/complex Anticonvulsant,antipyretic,IV fluids (if needed)
49
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

50
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 HBIGHB vaccine soon after birth

51
Recommendations to Ministry of Health, Govt of
India

1. The academy should be represented on National
   Technical Advisory Group on Immunisation
2. At 5 yrs booster immunisation with DPT rather
   than DT.
3. Inactivated polio vaccine should be licensed and
   gradually introduced in phased manner
4. Hep B and MMR vaccine should be included in
   national immunisation schedule immediately
5. Govt. should consider inclusion of typhoid
   vaccine(Vi polysaccharide/whole cell inactivated)
   in the national immunisation schedule
6. Another vaccine to be included is Hib
7. Ensuring adequate supply of chick embryo/ tissue
   culture rabies vaccine

52
SUMMING UP
53
NAME BCG-LAV.Danish bovine strain
CONTENT BCG strain of bovine mycobacterium-3-10 million bac/dose
PREPARATN Lyophilised
INITIATION At birth/first contact
SCHEDULE Single dose
BOOSTER Nil
DOSE 0.05 ml(newborn)0.1 ml(infants and children
ADMNSTRN Intra dermal left deltoid
EFFICACY 0-80
C/I Immunodeficiency
S/E Axillary adenitis
54
NAME DPT-killed pertusistoxoid diphtetanus OPV-LAV
CONTENT Diph tox 20 Lf,Tet tox 5 Lf.Pertusis 6 IU(40,000 million killed bacteria ALPO4-3 mg SABIN, type 1-106(CCID 50),type-2-105(CCID 50),type-3- 105(CCID50
PREPARATN Liquid Liquid
INITIATION 6 wks Birth
SCHEDULE 3 doses 6,10,14 wks Birth,6,10,14 wks
BOOSTER 15- 18 mo,5 yrs 15- 18 mo,5 yrs
DOSE 0.5 ml 2 drops
ADMNSTRN I/M lat thigh Oral
EFFICACY P80D80T100 80-90
C/I Prog neuro dis,uncontrolled cry,convulsion, severe rxn for 1st dose Immuno defeciency,HIV
S/E Fever,local indurn,pain none
55
NAME Hepatits B(HBsAg) Measles(LAV)
CONTENT Plasma derived/yeast derived r-DNA/CHO cells derived r-DNA 1000TCID50.Schwarz or Edmonston Zagreb strain 1000 TCID/CCID
PREPARATN Liquid Lyophilised
INITIATION Birth w/ I 48 hrs?6 wks gt9 mo
SCHEDULE Birth,6,14 wks/0,1,6 months 1 dose at 9-12 mo.2nd doseafter 3 mo if 1st doselt9 mo
BOOSTER Nil Nil
DOSE 10 microgram,0.5 ml(lt10 yrs), 1 ml(gt10 yrs) 0.5 ml
ADMNSTRN I/M deltoid S/C deltoid
EFFICACY 90 95
C/I None Imm def,anaphylaxis,egg protein allergy
S/E Local pain,erythema Fever ,rash after a week
56
NAME MMR(LAV) Mumps(LAV)
CONTENT Measles as above,Mumps5000 TCID of Urabe AM-9,Rubella 1000 TCID of Wistar RA/3M L-Zagreb/Jerry Lynn strain 5000TCID
PREPARATN Lyophilised Lyophilised
INITIATION 15 mo 15 mo with MR or at 11 yrs
SCHEDULE Single dose Single dose
BOOSTER Nil Nil
DOSE 0.5ml 0.5 ml
ADMNSTRN SC deltoid SC deltoid
EFFICACY 95 90-95
C/I As in measlespregnancy Imm def
S/E As in measles Fever
57
NAME H Infl b(conjugate) PRPD/PRPT/HBOC TYPHOID(KILLED)
CONTENT H.Infl capsular oligosaccharide b S.typhi 1000 million killed/ml
PREPARATN Liquid/freeze dried Liquid
INITIATION 6 wks 2 yrs
SCHEDULE 6,10,14 wks/2,4,6 mo 2 doses 4 wks apart
BOOSTER After 1 yr Every 3 yrs
DOSE 0.5 ml.10 mcg 0.25 mllt10yrs,0.5 mlgt10 yrs
ADMNSTRN SC/IM-deltoid/ant lat thigh SC deltoid
EFFICACY 90-100 57-75
C/I None None
S/E Local rxn,fever Local rxn,fever
58
NAME TYPHOID(Vi polysaccharide TYPHOID oral
CONTENT Vi capsular polysach S.typhi Ty 21a strAin(109 organisms)
PREPARATN Liquid Capsule
INITIATION gt2 yrs gt6yrs
SCHEDULE Single dose 3 doses on alternate days
BOOSTER Every 3 yrs Every 3 yrs
DOSE 25-50 mcg(0.5 ml) 1 capsule
ADMNSTRN I/M Oral
EFFICACY 70 70
C/I None None
S/E Fever,pain,induratn Abdominal pain,vomiting, loose stools
59
NAME Pneumococcal HEP-A (inactivated vaccine)
CONTENT Capsular poly saccharide HM 175 of HAV 720 ELU antigen/ml
PREPARATN Lyophilised Liquid
INITIATION gt2 yrs gt2 yrs
SCHEDULE Single dose 2 doses 0, 6 mo
BOOSTER Every 3-5 yrs Nil
DOSE 0.5 ml 0.5 ml
ADMNSTRN SC/IM over Ant. Lat thigh IM antero lat thigh
EFFICACY 85-90 99
C/I First trimester pregnancy None
S/E none Mild reaction
60
NAME Varicella vaccine Meningococcal AC
CONTENT OKA strain of varicella zoster103(3 PFU) N.meningitidis groupA,C 50 mcg each
PREPARATN Lyophilised Lyophilised
INITIATION gt1 yr For use only in endemic areas during epidemics.gt2 yrs
SCHEDULE 1-12 yrs(single dose),gt13 yrs 2 doses 1 mo apart Single dose
BOOSTER Nil 5 yrs
DOSE 0.5 ml 0.5 ml
ADMNSTRN SC deltoid SC/IM-deltoid/Ant lat thigh
EFFICACY 95-100 90-100
C/I None None
S/E Varicella type rash after 1 wk with fever Local rxn, mild fever
61
NAME Japanese encephalitis(killed monovalent) Influenza vaccine(inactivated-split virion)
CONTENT Mouse brain(Nakayama/NIH strain) or Baby hamster kidney(P-3) or Recombinant DNA vaccine 1.5 mcg hemaglutinin of each of the chosen strain as suspension
PREPARATN Freeze dried /liquid Liquid
INITIATION Same as meningo cocci All ages
SCHEDULE 2 doses 1-2 wks interval Single dose
BOOSTER After 3-4 yrs Every year with current strain
DOSE 1 ml 0.5 ml
ADMNSTRN SC-deltoid/ant lat thigh SC/IM
EFFICACY 60-80,100 after booster 80-90
C/I None Egg protein allergy
S/E Local swelling,fever,malaise Local reaction,fever
62
NAME DPT wcHB combination DPT wcHib
CONTENT D and T toxoidPWC yeast derived r-DNA HBsAg D T toxoid PWCcapsular polysaccharide of Hib
PREPARATN Liquid Lyophilised/liquid
INITIATION 6 weeks 6 wks
SCHEDULE 6,10,14 wks 6,10,14 wks
BOOSTER Nil Nil
DOSE 0.5 ml 0.5 ml
ADMNSTRN IM IM
EFFICACY 90-100 90-100
C/I Same as DPT None
S/E Fever,pain,local induration Mild fever,local induration
63
NAME Rabies (tissue culture)-inactivated
CONTENT HDCV(virus grown in Human Diploid fibroblasts) PCEC (Chick embryo cells) Vero cell(vervet monkey kidney cell)
PREPARATN Lyophilised
INITIATION Any age-/after dog bite
SCHEDULE Pre expo0.7,21 days.Post expo0,3,7,14,28.Re expo0,7(lt5 yrs), full course(gt5 yrs)
BOOSTER First after 1 year then every 3 yrs
DOSE 0.5 ml/1ml depending on preparatn
ADMNSTRN S/C deltoid/ ant lat thigh
EFFICACY 90-100
C/I None
S/E Local pain,rarely encephalopathy
64
THANK YOU