immunisation anvarazad

8/7/2019 immunisation anvarazad

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IMMUNISATIONIMMUNISATION

ANVARAZAD.MANVARAZAD.M

T.D.MedicalT.D.Medical collegecollege

AlappuzhaAlappuzha


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DEFINITIONDEFINITION

ImmunizationImmunization is the process ofinducingimmunityis the process ofinducingimmunityartificially by either vaccinationartificially by either vaccination

( active immunization ) or administration of( active immunization ) or administration ofantibody ( passive immunization ).antibody ( passive immunization ).

ACTIVE IMMUNIZATIONACTIVE IMMUNIZATION

Stimulatesimmune system to produce antibodiesStimulatesimmune system to produce antibodiesand cellularimmune responses that protect againstand cellularimmune responses that protect againstinfectious agent.infectious agent.


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PASSIVE IMMUNIZATIONPASSIVE IMMUNIZATION

Provides temporary protection throughProvides temporary protection through

administration of exogenously produced antibodyadministration of exogenously produced antibodysuch asimmune globulin.such asimmune globulin.

Also occursnaturally throughAlso occursnaturally through transplacentaltransplacentaltransmission of antibodies to a fetus.transmission of antibodies to a fetus.


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VaccineVaccine

::A product of weakened or killedmicroorganismA product of weakened or killedmicroorganism

(bacterium or virus) given for the prevention or(bacterium or virus) given for the prevention or treatrea

tmenttment ofinfectiousdiseasesofinfectiousdiseases

Types of vaccinesTypes of vaccines

11-- Killed or inactivated vaccinesKilled or inactivated vaccines e.g. TAB vaccine fore.g. TAB vaccine for

typhoid and para-typhoid, Salk vaccine for poliomyelitistyphoid and para-typhoid, Salk vaccine for poliomyelitis

and human rabies vaccines.and human rabies vaccines. 22-- living attenuated vaccinesliving attenuated vaccines e.g. Sabin vaccine fore.g. Sabin vaccine for

poliomyelitis BCG vaccine for tuberculosis, 17poliomyelitis BCG vaccine for tuberculosis, 17--D vaccineD vaccine

for yellow fever, MMR vaccinefor yellow fever, MMR vaccine


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33-- ToxoidsToxoids:: These are vaccines prepared byThese are vaccines prepared by

detoxifying the toxins ofsome bacteria, e.g.detoxifying the toxins ofsome bacteria, e.g. toxoidtoxoidvaccines fordiphtheria and tetanusvaccines fordiphtheria and tetanus

44--VaccinesVaccines preparedprepared fromfrom bacterialbacterial oror viralviralcomponentscomponents

a)a) TheThe capsularcapsular polysaccharidepolysaccharide vaccinevaccine ofofMeningococciMeningococci,, pneumococcipneumococci,, andand HH.. influenzasinfluenzastypetype bb..

b)b) AcellularAcellular vaccinevaccine ofof BB.. pertussispertussis containingcontaining thethepurifiedpurified proteinsproteins fromfrom thethe organismorganism

c)c) PurifiedPurified surfacesurface antigensantigens ofof hepatitishepatitis BB virus,virus,

d)d) TheThe splitsplit virusvirus vaccinevaccine ofofinfluenzainfluenza virusvirus containingcontaining

haemagglutininhaemagglutinin andand neuraminidaseneuraminidase..


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55--Recombinant vaccinesRecombinant vaccines prepared by recombinantprepared by recombinant

DNA technology, e.g. hepatitis B virus vaccineDNA technology, e.g. hepatitis B virus vaccine..


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NationalNational ImmunisationImmunisation ScheduleSchedule

VaccineVaccine

BCG, OPVBCG, OPV 00

DPTDPT 1, OPV1, OPV 11


DPTDPT 3. OPV3. OPV 33

MeaslesMeasles


DTDT

TTTT

TTTT

AgeAge

BirthBirth

6 wks6 wks10 wks10 wks

14wks14wks

9months9months

1515--18 months18 months

5 years5 years

10 years10 years

16 years16 years


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Cold chainCold chain The system of transporting,distributing andstoringThe system of transporting,distributing andstoring

vaccines from the manufacturers right up to thevaccines from the manufacturers right up to the

point ofuse under refrigerationusing anypoint ofuse under refrigerationusing any

convenient methodis referred to as cold chainconvenient methodis referred to as cold chain

Vital linkinVital linkinimmunisationimmunisation

Ifnot maintained, vaccine efficacy will grosslyIfnot maintained, vaccine efficacy will grossly

suffersuffer

Safe temp. zoneSafe temp. zone mandatory to maintain potencymandatory to maintain potency

Safe zone forshort termstorage (1Safe zone forshort termstorage (1--2 months)is 22 months)is 2--88

deg C. For long termstoragedeg C. For long termstorage 2020 degCdegC isused onlyisused only

forfor BCG,OPV,MeaslesBCG,OPV,Measles/MMR/MMR


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The T series of vaccine(DPT,DT,TT),typhoidThe T series of vaccine(DPT,DT,TT),typhoid

Vi,HepVi,Hep B shouldnot be frozen as once frozen theB shouldnot be frozen as once frozen thealuminiumaluminium saltsused as adjuvant will be desiccatedsaltsused as adjuvant will be desiccated

and will act asand will act asirritantirritantsterilesterile abcessabcess


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BCG VaccineBCG Vaccine

Protects against TB meningitis,Protects against TB meningitis,MiliaryMiliary T BT B Induces long term protectionInduces long term protection

SCHEDULESCHEDULE

Single doseSingle dose

DOSEDOSE

DosDosee0.05 ml(infants),0.1 ml(infants and children)0.05 ml(infants),0.1 ml(infants and children)

ADMNSTRNADMNSTRN

IntraIntra--dermal over left deltoiddermal over left deltoid C/IC/I--

Immune deficiencyImmune deficiency

Side effectSide effect

--AxillaryAxillary adenitisadenitis


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OPVOPV

Live attenuated polio virus types1,2&3Live attenuated polio virus types1,2&3--INITIATIONINITIATION -- BirthBirth

SCHEDULESCHEDULE -- Birth,6,10,14 wksBirth,6,10,14 wks

BOOSTERBOOSTER -- 1515-- 18 mo,5 yrs18 mo,5 yrs

DOSEDOSE -- 2 drops2 drops

ADMNSTRNADMNSTRN -- OralOral

C/IC/I -- ImmunoImmuno defeciency,HIVdefeciency,HIV

S/ES/E -- nonenone

part of pulse polio program every year till age of 5 yrspart of pulse polio program every year till age of 5 yrs


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IPVIPV

Formaldehyde killed polio virusgrowninmonkeyFormaldehyde killed polio virusgrowninmonkeykidney or humandiploid cellkidney or humandiploid cell

Contains 20,8,32 D antigenunits against type 1,2,3Contains 20,8,32 D antigenunits against type 1,2,3

polio viruses respectivelypolio viruses respectively SeroconversionSeroconversion 9090--95% after 2 doses,99% after 395% after 2 doses,99% after 3

dosesdoses

Thermo stable andindicatedinThermo stable andindicatedinimmunocompromisedimmunocompromised andHIVandHIV


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DPTDPT DPTDPT--killedkilled pertusis+toxoidpertusis+toxoid diph&tetanusdiph&tetanus ToxoidsToxoids

adjuvatedadjuvated ((AluminiumAluminium hydroxide/ phosphate)hydroxide/ phosphate)

INITIATIONINITIATION -- 6 wks6 wks

SCHEDULESCHEDULE -- 3 doses 6,10,14 wks3 doses 6,10,14 wks

DOSEDOSE -- 0.5 ml0.5 ml

BOOSTERBOOSTER -- 1515-- 18 mo,5 yrs18 mo,5 yrs

ADMNSTRNADMNSTRN -- I/MI/M anterolateralanterolateral thighthighC/IC/I -- ProgProg neuroneuro dis,uncontrolleddis,uncontrolled cry,cry,

convulsion,convulsion,

S/ES/E -- Fever,localFever,local indurn,painindurn,pain


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MMRMMR

Live attenuated vaccineLive attenuated vaccine

Supplied freeze driedSupplied freeze dried-- store frozen or refrigeratedstore frozen or refrigerated

0.5 ml injected S/C preferably right upper arm0.5 ml injected S/C preferably right upper arm

Age at which recommended9monthsAge at which recommended9months

During outbreak>6 monthsDuring outbreak>6 months

Ifgiven < 9mo repeat dose after 3 moIfgiven < 9mo repeat dose after 3 mo

Possibility of fever for 5Possibility of fever for 5--10 days10 days

MMRMMR--0.5ml S/C over deltoid(15mo)0.5ml S/C over deltoid(15mo) C/IC/I -- AsinAsinmeasles+pregnancymeasles+pregnancy,, ImmImm defdef

S/ES/E -- Asinmeasles, FeverAsinmeasles, Fever


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TyphoidTyphoid

WHOLE CELLWHOLE CELL::

KilledKilled S.typhiS.typhi often withoften with S.paratyphiS.paratyphi A(TA)A(TA)

Liquid,storeLiquid,store refrigerated,injectrefrigerated,inject S/cS/c

Primary course:2 doses 4 wks apart at 6Primary course:2 doses 4 wks apart at 6--9mo of age or at9mo of age or at

any ageany age

Boosters once in 3Boosters once in 3--5 yrs5 yrs

Dose :0.25Dose :0.25--0.5 ml S/C for primary,0.1ml for booster0.5 ml S/C for primary,0.1ml for booster

C/IC/I -- NoneNone

S/ES/E -- Fever,painFever,pain,,


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ViPOLSACCHARIDEViPOLSACCHARIDE

Liquid,Liquid, adjuvated,storeadjuvated,store refrigeratedrefrigerated

Inject IM at or after 2 yrs of age(0.5 ml)Inject IM at or after 2 yrs of age(0.5 ml)

Booster after 3 yrsBooster after 3 yrs


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ORALORAL::

Live attenuatedLive attenuated S.typhiS.typhi

StrainStrainname:Tyname:Ty 21a21a

Enteric coatedEnteric coated capsules,storecapsules,store refrigerated,refrigerated,

administer orally 3 doses on alternate daysadminister orally 3 doses on alternate days

Repeat 3Repeat 3--5 yrs later5 yrs later RecommendeRecommende age7 yrs or aboveage7 yrs or above


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HibHib vaccinevaccine H . Influenza BH . Influenza B--capsular polysaccharidecapsular polysaccharide

Liquid or freeze driedLiquid or freeze dried

Age ofinitiation 6 wksAge ofinitiation 6 wks

3 doses 6,10,14 wks/2,4,6 mo3 doses 6,10,14 wks/2,4,6 mo

Booster 1 yr after primary doseBooster 1 yr after primary dose

Dose 0.5 ml SC/IM overdeltoid orDose 0.5 ml SC/IM overdeltoid or anterolateralanterolateral

aspect of thighaspect of thigh


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PneumococcalPneumococcal

Capsular polyCapsular poly saccharidesaccharide

INITIATIONINITIATION -- >2 yrs>2 yrs

SCHEDULESCHEDULE -- Single doseSingle dose

BOOSTERBOOSTER -- Every 3Every 3--5 yrs5 yrs


ADMNSTRNADMNSTRN -- SC/IM over Ant. Lat thighSC/IM over Ant. Lat thigh

C/IC/I -- First trimester pregnancyFirst trimester pregnancy

S/ES/E -- nonenone


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VaricellaVaricella vaccinevaccine

OKA strain ofOKA strain of varicellavaricella zoster10zoster1033

INITIATIONINITIATION -- >1 yr>1 yr

SCHEDULESCHEDULE -- 11--12 yrs(single dose),>13 yrs 212 yrs(single dose),>13 yrs 2

doses 1 mo apartdoses 1 mo apart BOOSTERBOOSTER -- NilNil


ADMNSTRNADMNSTRN -- SC deltoidSC deltoid C/IC/I -- NoneNone

S/ES/E -- VaricellaVaricella type rash after 1 wk withtype rash after 1 wk with

feverfever


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Hepatitis AHepatitis A

Inactivated vaccine .Inactivated vaccine . INITIATIONINITIATION -- >2 yr s>2 yrs

SCHEDULESCHEDULE -- 2 doses 0, 6 mo2 doses 0, 6 mo


No boostersNo boosters

ADMNSTRNADMNSTRN -- IMIM anteroantero lat thighlat thigh

C/IC/I -- NoneNone

S/ES/E -- Mild reactionMild reaction


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MeningococcalMeningococcal

N.meningitidisN.meningitidis groupA,CgroupA,C

INITIATIONINITIATION -- For use only in endemic areasForuse only in endemic areas

during epidemics.>2 yrsduring epidemics.>2 yrs

SCHEDULESCHEDULE -- Single doseSingle dose

BOOSTERBOOSTER -- 5 yrs5 yrs


ADMNSTRNADMNSTRN -- SC/IMSC/IM--deltoid/Ant lat thighdeltoid/Ant lat thigh

C/IC/I -- NoneNone

S/ES/E -- LocalLocal rxnrxn,mild fever,mild fever


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Vaccines for high risk groupVaccines for high risk group

PNEUMOCOCCAL VACCINEPNEUMOCOCCAL VACCINE::

Polysaccharide vaccine(23Polysaccharide vaccine(23 valentvalent))

77 ValentValent conjugated with CRM 197 diphtheriaconjugated with CRM 197 diphtheriatoxintoxin

2323 valentvalent effective after 2 yrs of ageeffective after 2 yrs of age

Single dose 0.5 ml IM with booster every 3Single dose 0.5 ml IM with booster every 3--55yrsyrs


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IndicationsIndications

Sickle cell diseaseSickle cell disease

NephroticNephrotic syndrome in remissionsyndrome in remission

Congenital or acquiredCongenital or acquired aspleniaasplenia//splenicsplenic dysdys functionfunction

HIVHIV

Chronic cardiac/pulmonary diseaseChronic cardiac/pulmonary disease

ImmunodeficientImmunodeficient conditionsconditions

CSF leakCSF leak DiabetesmellitusDiabetesmellitus


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Combination vaccinesCombination vaccines

DPT/DPT/HiBHiB//HepBHepB Benefits:Benefits:

1. Reducednumber ofinjections1. Reducednumber ofinjections

2. Reduced pain and parental anxiety2. Reduced pain and parental anxiety

3. High compliance, low drop out3. High compliance, low drop out rates,enhancedrates,enhanced coveragecoverage

4. Reducedno: of visits4. Reducedno: of visits

5. Lessstorage space5. Lessstorage space

6. Less burden on cold chain6. Less burden on cold chain


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ADVERSEEFFECTSADVERSEEFFECTS


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11--AnaphylaxisAnaphylaxis {any{anyVACCINE}VACCINE}

SYMPSYMP--W/IW/I minutes,acuteminutes,acute decompensationdecompensation of circ.of circ.

System,hypovolemicSystem,hypovolemic shock,laryngealshock,laryngealspasm/spasm/edema.Acuteedema.Acute respiratory distressrespiratory distress

MANAGEMENTMANAGEMENT--

Adrenaline,CPR,IVAdrenaline,CPR,IV volume expanders orvolume expanders ordopamine/dopamine/dobutaminedobutamine, hydrocortisone, hydrocortisone

22 DPTDPT

ADRADR-- Hypotensive,hyporesponsiveHypotensive,hyporesponsive episodesepisodesSYMPSYMP --Within 12Within 12 hrs.Acutehrs.Acute paleness.Transientpaleness.Transient

decreased levels/loss ofdecreased levels/loss of consciousness.Decconsciousness.Dec musclemuscle

tonetone


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MANAGEMENTMANAGEMENT

IV fluids, corticosteroid,IV fluids, corticosteroid, SedationSedation ,oxygen,,oxygen,feeding advicefeeding advice

Measles contamination by S.Measles contamination by S. AureusAureus

ADRADR --Toxic shocksyndromeToxic shocksyndrome

SYMPSYMP--Within 30 minWithin 30 min-- few hrs. Mountingfew hrs. Mounting

fever,vomitingfever,vomiting,,diarrhoea,septicdiarrhoea,septic shockshock


IVIV fluids,antifluids,anti microbials,cloxacillinmicrobials,cloxacillin 5050--100100

mg/kg/day,mg/kg/day,steroids,antipyretics,supportivesteroids,antipyretics,supportive therapytherapy


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BCGBCG

ADRADR--lymphadenitislymphadenitis

SYMPSYMP--Within 2Within 2--6 months firm6 months firm--softsoft axillaryaxillary

lmphadenitis1.5lmphadenitis1.5--3 cm with/ without sinus3 cm with/ without sinus MANAGEMENTMANAGEMENT

....AspirationifAspirationifneeded.Steroidneeded.Steroid ifsinus presentifsinus present


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DPT,DT,TT,TyphoidDPT,DT,TT,Typhoid &HEP A&HEP AADRADR--SterileSterile abcessabcess

SYMPSYMP--By 72 hrs,minimumBy 72 hrs,minimuminflamationinflamation,no fever,no fever


Drainage ifneededDrainage ifneeded


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measlesmeasles

ADRADR--Seizures with fever(rare)Seizures with fever(rare)

SYMPSYMP--AlwaysAlwaysgeneralisedgeneralised simple/complexsimple/complex


Anticonvulsant,antipyretic,IVAnticonvulsant,antipyretic,IV fluids(ifneeded)fluids(ifneeded)


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THANKYOUTHANKYOU

immunisation anvarazad

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