IMMUNIZATION

 

                           

OVERVIEW:-

Immunization is the most effective way of protecting the human body from infectious diseases. Immunization programmes are an integral and important part of the health activities of every country in the world. Immunization is one of the most well – known and effective methods of preventing childhood diseases. With the implementation of Universal Immunization Programme, significant achievements have been made in preventing controlling the vaccine preventable diseases. Immunization has to be sustained as a high priority to further reduce the incidence of all VPDs, control measles, eliminate tetanus and eradicate poliomyelitis.

OBJECTIVES:-

v Full immunization (I,e received one dose of BCG, three doses of DPT, four doses of Hepatitis-B and OPV each and one dose of measles before one year of age) gives a child for a healthy life.

v Immunization is one of the safest and most cost effective health instrument available in the world today.

v Preventing diseases before it occurs saves, money energy and live.

v Immunization is a key strategy to child survival.

v By protecting infants from VPDs, immunization significantly lowers morbidity and mortality rates in children.

v Immunization is an indicator of a strong primary health care system.

Common vaccines used in prevention of vaccine preventable diseases:-

The following are the common vaccines which are used to prevent vaccine preventable diseases.

 BCG VACCINE:-

Tuberculosis which is caused by a bacteria (mycobacterium tubercle) affects the lungs, intestine, bones and joints.

Indication:- to prevent tuberculosis.

Contraindication:- BCG should not given to patients suffering from generalized eczema, infective dermatosis, with a history of deficient immunity6, patients under immunosuppressive treatment .

Adverse reaction:-prolonged severe ulceration at the site of vaccination, suppurative lymphadenitis, osteomyelitis, disseminated BCG infection and death.

POLIO:-

Poliomyelitis is an acute viral infection caused by RNA virus. It is primarily an infection of human alimentary tract but the virus may infect the central nervous system resulting in varying degree of paralysis and possible death.

Indication:-both inactivated polio vaccine (IPV) and oral polio vaccine (OPV) is essential to give all infants before 6 months of age to protect against polio.

Contraindication:- live vaccines are not usually given to immunocompromised individuals. Patients suffering from leukemia and malignancy and those receiving corticosteroids may not be given OPV. IPV is an alternative choice for immunization of children with HIV infection.

Adverse reaction :- OPV is remarkably free from complication. No serious adverse reaction to IPV vaccines currently in use have been reported except minor local erythema, induration and tenderness.

DPT (Diphtheria, pertussis and tetanus) vaccine:-

Diphtheria which is caused by corynebacteriumdiptheriae is an infectious disease that commonly infects the tonsil and pharynx forming a membrane that can lead to obstructed breathing and death. pertussis  is an acute infectious diseases, usually of young children, caused by B>pertussis. It is spared mainly by droplet infection and direct contact. Tetanus is caused by bacteria (clostridium tetani). People of all age can infected with it.

Indication:- a combination of DPT vaccine is indicated to immunize infants against three diseases, viz; diphtheria, pertussis and tetanus.

Contraindication:- DPT should not be repeated if a severe reaction occurred after a previous dose. such reaction include collapse or shock-like state, temperature above 40 degree C, convulsion, other neurological symptoms and anaphylactic reaction.

Adverse reaction:- local reaction at the site of injection, mild fever and irritability. The rare reactions are seizure, hypotonic hypo- responsive episodes, anaphylactic reaction and very rarely encephalopathy.

HEPATITIS-B

Hepatitis is a highly infectious viral diseases and is the leading cause of jaundice, fulminant liver disease cirrhosis and liver cancer.

Indications – Is indicated for active immunisation against Hepatitis B infection Contraindications – Should not be administered to subjects with known hypersensitivity to any component of the vaccine, or who had hypersensitivity for previous Hepatitis B vaccination.

Adverse reactions – Mild soreness, erythema, induration, fatigue, fever, malaise, influenza like symptoms.

ROTAVIRUS

Rotavirus are the leading cause of severe diarrhea among infants and young children.

Indications – For active immunization of infants from age of 6weeks for prevention of gastro-enteritis due to rotavirus infection.

Contraindications – Should not be administered to subjects with hypersensitivity to any components. Subjects with uncorrected congenital malformation of the GIT – Intussusception.

Adverse reactions – Diarhoea, vomiting, loss of appetite, fever, flatulence, abdominal pain.

Haemophilus Type b Conjugate vaccine

Haemophilusinfluenzae type b (Hib) is a bacteria responsible for severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than 5 years.

Indications – For active immunization against Haemophilus Influenza Type b infection for all children from the age of 6weeks to 5years.

Contraindications – Should not be administered to subjects with known hypersensitivity to any component of the vaccine.

Adverse reactions–

Local – Injection site soreness, mild redness and swelling.

Systemic –fever, loss of appetite, vomiting, diarrhoea and unusual crying.

HUMAN PAPILLOMAVIRUS VACCINE:-

Human papillomavirus (HPV) causes cervical cancer which is the second most common cancer in women worldwide.

Indications –

• In females from 10-45years for prevention of cervical cancer by protecting against incident and persistent infections.
• Cytological abnormalities including atypical squamous cells of undetermined significance & CIN.
• CIN1 & pre-cancerous lesions(CIN2 & CIN 3) caused by HPV type 16 &18.

Contraindications – Subjects with known hypersensitivity to any component of the vaccine.

Adverse reactions –

• Local : injection site reactions including pain,redness,swelling,fatigue.
• Systemic : fever, myalgia, nausea, vomiting, diarrhoea and abdominal pain.

Hepatitis A

Hepatitis A (formerly known as "infectious" hepatitis or epidemic jaundice) is an acute infectious disease caused by hepatitis A virus (HAV).

Therapeutic indications –

• Is indicated for active immunization against infections cause by hepatitis A virus.
• Recommended in subjects who are at increased risk.
• In areas of intermediate to high prevalence of hepatitis A.

Pregnancy and lactation – Should be used only when clearly needed.

Contra-indications – Should not be administered to subjects with known hypersensitivity to any component of the vaccine

Adverse reactions –

• Local – Injection site soreness, mild redness and swelling.
• Systemic –headache, malaise, vomiting, fever, nausea and loss of appetite. Rarely allergic reactions including convulsions and anaphylactoid reactions reported.

MMR(LIVE)

The MMR vaccine is an immunization shot against measles, mumps, rubella (also called German measles).

Indications – Is indicated for active immunization in children 12months to 12 years age against measles, mumps and rubella infections simultaneously.

• Even in adults who missed the dosage in childhood.

Contraindications – Pregnancy, Leukemia,othermalignancy,Severe febrile illness,History of febrile convulsions, Patients on immunosuppresants.History of known hypersensitivity to egg protein.Anaphylactic reactions to Neomycin.

Adverse reactions –

• Mild, fever, slight enlargement of cervical and occipital lymph nodes.
• Rarely parotid and other salivary gland enlargement is reported.

Varicella Vaccine, Live

Chickenpox or varicella is an acute, highly infectious disease caused by varicella-zoster (V -Z) virus.

Indications –

• Is indicated for active immunization against varicella of healthy subjects and susceptible healthy close contacts from age 12months onwards.
• Susceptible healthy close contacts i.e., parents and siblings of high risk patients, medical, paramedical personnel.

Contraindications –

• Should be postponed in patients with acute severe febrile illness.
• In subjects with primary or acquired immunodeficiency status
• Known systemic hypersensitivity to neomycin.
• During pregnancy. Pregnancy should be avoided 3months after vaccination.

Adverse reactions – Swelling at the injection site, fever reported very commonly.

Typhoid

Typhoid fever is the result of systemic infection mainly by S. typhi found only in man.

Indications – Is indicated for active immunization against typhoid fever for both adults and children 2years of age & older.

Contraindications - Should not be administered to subjects with known hypersensitivity to any component of the vaccine, or who had hypersensitivity for previous vaccination. Typhoid vaccine to be given to pregnant and nursing mothers only if clearly indicated.

Adverse reactions –

• Local : Erythema, induration and tenderness.
• Systemic : malaise, headache, vomiting, myalgia.
• Rarely allergic type reactions.

Meningococcal

Meningococcal meningitis or cerebro spinal fever is an acute communicable disease caused by N. meningitidis.

Indications - Menactra is indicated for active immunization to prevent invasive meningococcal disease caused by N meningitidisserogroups A, C, Y and W-135. Menactra is approved for use in individuals 9 months to 55 years of age.

Contraindications -  Severe allergic reaction (eg, anaphylaxis) after a previous dose of a meningococcal capsular polysaccharide-, diphtheria toxoid- containing vaccine, or to any component of Menactra vaccine.

Adverse reactions - Common (≥10%) solicited adverse events were injection site tenderness, erythema, and swelling; irritability, abnormal crying, drowsiness, appetite loss, vomiting, fever, headache, fatigue, malaise, and arthralgia.

Pneumococcal

Pneumonia caused by Streptococcus pneumoniae is a major cause of illness and death in children.

Indications – Is indicated for vaccination against pneumococcal disease caused by those pneumococcal types included in the vaccine in infants from 2months to 5 years of age.

Contraindications – Hypersensitivity to any component of the vaccine including Diphtheria toxoid.

Adverse reactions –

• Local reaction at injection site including soreness, erythema, warmth, swelling and induration.
• Systemic like Fever ≤102°F, malaise, headache.

Rabies Vaccine

Rabies also known as hydrophobia is an acute, highly fatal viral disease of central nervous system caused by Lyssavirus type-1.

Indications – Active immunization against Rabies.

• No contraindications.

Adverse reactions –

• Local – fever, headache, myalgia, lymph node swelling.
• Rare circulatory reactions, sweating, chills, allergic reactions.

H1N1

Influenza A (H1N1) virus is a subtype of influenza A virus and was the most common cause of human influenza (flu) in 2009.

Indications – Is indicated for active immunization against influenza disease caused by pandemic (H1N1) 2009 virus in the age group of 18 years and above.

Contraindications – Anyone with known hypersensitivity to egg proteins, or any component of the vaccine or who had life threatening reactions to previous vaccination

Adverse reactions –

• Local :Pain, mass, inflammation, ecchymoses,edema, allergic reaction,haemorrhage,pruritus.
• Systemic :Headache, fatigue, malaise, cough, wheezing, chest tightness, difficulty breathing.

Influenza Virus Vaccine

Influenza viruses cause the flu and are divided into three types, designated A, B, and C. Influenza types A and B are responsible for epidemics .

Indications - Is indicated for active immunization for the prevention of disease caused by influenza virus subtypes A and type B contained in the vaccine. FLUARIX is approved for use in persons 3 years of age and older.

Contraindications -

• Known severe allergic reactions to egg proteins (a vaccine component) or a life-threatening reaction to previous influenza vaccination

Adverse reactions –

The most common (≥10%) local and general adverse events were pain, redness and swelling at the injection site, muscle aches, fatigue, and headache. irritability, loss of appetite, and drowsiness.

Japanese Encephalitis

Japanese encephalitis (JE) is a mosquito-borne encephalitis caused by a group B arbovirus (Flavivirus) and transmitted by culicine mosquitoes.

Indications – IXIARO is a vaccine indicated for the prevention of disease caused by Japanese encephalitis virus (JEV) in persons.

Contraindications – Severe allergic reaction (e.g.,anaphylaxis) after a previous dose.

Adverse reactions -

• Systemic -The most common (≥ 10%) were headache and myalgia.
• The most common (≥ 10%) injection-site reactions were pain and tenderness

Yellow fever

Yellow fever is an acute viral illness caused by a mosquito-borne flavivirus.

Indications - YF-VAX vaccine is recommended for active immunization of persons 9 months of age and older in the following categories:

• Persons Living in or Traveling to Endemic Areas
• International Travel
• Laboratory Personnel.

Contraindications – YF-VAX vaccine is contraindicated in anyone with a history of acute hypersensitivity reaction to any components (including gelatin)

• History of acute hypersensitivity to eggs or egg products.
• Acute or Febrile Disease
• Infants below 9 months, lactation.
• Immunosuppressed Patients.
• In pregnancy only if clearly indicated.

Adverse reactions –

• Local reactions including edema, hypersensitivity, pain or mass at the injection site have also been reported
• Immediate hypersensitivity reactions, characterized by rash, urticaria, and/or asthma, are uncommon and occur principally among persons with histories of egg allergy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Recommendation for IAP Immunization - updated 2014 Schedule

 

AGE	VACCINE	DOSE	ROUTE
Birth dose	BCG,  OPV-0, Hep-B-0	0.5 ml 2 drops 0.5 ml	Intra dermal Oral Intra muscular
6 weeks	Penta (DPT+Hep-B+Hib) – 1 IPV-1 PCV-1	0.5 ml 2 drops 0.5 ml	Intra muscular Oral Intra muscular
10 weeks	Penta- 2 IPV-2 PCV-2 Rota-1	0.5 ml 2 drops 0.5 ml 1 ml	Intra muscular Oral Intra muscular Oral
14 weeks	Penta – 3 IPV – 3 PCV – 3 Rota-2	0.5 ml 2 0.5 ml 1 ml	Intra musclular   Intra muscular Oral
6 month	OPV-1	2 drops	Oral
9 month	OPV-2 MMR -1	2 drops 0.5 ml	Oral subcutaneous
9-12 month	Conjugated Typhoid Vaccine	0.5 ml	Intra muscular
12 month	HepA-1	0.5 ml	Intra muscular
15 month	MMR-2 Varicella-1 PCV(b)	0.5 ml 0.5 ml 0.5 ml	Subcutaneous Subcutaneous Intra muscular
16-18 month	DPT(b) IPV(b) Hib(b)	0.5ml   0.5 ml	Intra muscular   Intra muscular
18 month to 2 year	HepA-2 Thyphoid (b)	0.5 ml 0.5 ml	Intra muscular Intra muscular
4 to 6 year	DPT(b) OPV- 3 Varicella-2 Typhoid(b)	0.5 ml 2 drops 0.5 ml 0.5 ml	Intra muscular Oral Subcutaneous Intra muscular
10 to 12 year	DT HPV series begins (3 doses)	0.5 ml 0.5 ml	Intra muscular Intra muscular