VACCINES

M.B.B.S. FINAL YEAR PART 2

DEPARTMENT OF PAEDIATRICS
GMKMCH, SALEM
NATIONAL
IMMUNISATION SCHEDULE (NIS)
 Age Vaccines Dose Route

At birth Hepatitis B 0.5 ml i.m.

BCG 0.1 ml i.d
OPV 2 drops oral
6 weeks Pentavalent 1 0.5 ml i.m
OPV 1 2 drops oral
Rotavirus vaccine 1 5 drops oral
PCV 1 0.5 ml i.m.
IPV1 0.1 ml i.d.

10 weeks Pentavalent 2 0.5 ml i.m

OPV2 2 drops oral
Rotavirus vaccine 2 5 drops oral

14 weeks Pentavalent 3 0.5 ml i.m

OPV 3 2 drops oral
Rotavirus vaccine 3 5 drops oral
PCV 2 0.5 ml i.m.
IPV2 0.1 ml i.d.
9 months MR 1 0.5 ml s.c.
PCV booster 0.5 ml i.m.
JE 1 (in selected 0.5 ml s.c
districts)

18 months DPT 1 booster 0.5 ml i.m.

MR 2 0.5 ml s.c.
JE 2 0.5 ml s.c.

5 years DPT 2 booster 0.5 ml i.m.

10 years Td vaccine 1 0.5 ml i.m.

16 years Td vaccine 2 0.5 ml i.m.

BACILLUS CALMITTE GUERIN(BCG)
Live attenuated vaccine- Danish 1331 strain
Method: 0.1 ml; intra dermal (Diluent- normal saline)
Site: Left upper arm- insertion of deltoid
Age: At birth ( maximum of 1 year)
Storage: 2-8 c
Normal reaction: papule -2 to 3weeks ; papule
increases in size - 4 to 6 weeks; ulceration to scar -8 to
12 weeks
Protective efficacy- 20-80%; Highest efficacy(80%) for
meningeal , miliary tuberculosis; 50% primary
complex
Adverse effects: BCG adenitis, BCG abscess, acclerated
reaction, deep ulceration, disseminated BCG osis
(immunocompromised)
 Contains 0.1 to 0.4 million live viable bacilli per dose
Lyophilised form; multi dose amber coloured ampoules
Light sensitive
If reconstituted, it should be discarded after 4 to 6 hours
Correct intra dermal administration – produces wheal of
5 mm
BCG scar- is due to local inflammation: 10% don’t
develop scar; doesn’t mean protection has not been
achieved
 ORAL POLIO VACCINE
Live attenuated vaccine, SABIN
Storage frozen for long term & 2-8 c for 6 months
Bivalent vaccine(type 1& 3- Brunhilde & Leon )
Available with Vaccine vial monitor
Dosage: 2 drops into the mouth , at birth ,6 weeks, 10
weeks, 14 weeks, 18 months, in all pulse polio vaccine
campaign
Produces intestinal & circulating immunity; induces
herd immunity
Contraindication: severe immunodeficiency
Side effects: Vaccine associated paralytic polio,
Vaccine derived polio virus

Advantage: indirectly vaccinate the vaccine recipient

contacts by viral shedding through gut & upper
respiratory tract

OPV to be replaced gradually by IPV

 VACCINE VIAL MONITOR
Inner square is light colour
Outer circle- dark
If the inner square matches or darker than the outer
circle- discarded.
NATIONAL IMMUNISATION
DAY(NID)/PULSE POLIO IMMUNISATION
To reduce the wide spread transmission of wild polio
virus in the endemic countries
Children <5 years on a single day throughout the
country regardless of the prior vaccination status
Was given 2 times a year in the low transmission
period( December- January)
Now Given only on single day
Day 1,2- hospitals, booth based
Day-3 door to door visits( mopping up campaign)
INACTIVATED POLIO VACCINE(IPV)
Killed, SALK
Storage: 2 to 8 c
Right arm ; 0.1 ml intra dermal (fractional IPV)
6 weeks, 14 weeks
Can be combined with other vaccines
Produces circulating antibody; does not induce
intestinal mucosal immunity
Side effects: transient erythema, induration,
tenderness, No major AEFI
Made from selected wild polio virus- Mahoney or
Brunhilde (type1), MEF-1( type 2) & Saukett (type 3)

In IAP schedule: 0. 5 ml; intra muscular ; along with

pentavalent vaccine 6, 10,14 weeks; DPT at 18 months & 5
years

Multi dose vial in NIS

Can be used upto 28 days of opening

Efficacy: 70 to 100% after completion of

2 doses
 HEPATITIS B VACCINE
Recombinant( genetically engineered )inactivated
DNA vaccine
0.5 ml, intra muscular
At birth ( within 12 hours),
Combination as pentavalent vaccine at 6, 10 ,14 weeks
Storage: 2 to 8 degree c
Prevents the chronic carrier state of hepatitis B
Not to be used in neonates <1.5 kg
Side effects: erythema, induration , low grade fever
Contraindication: hypersensitivity to its components
Active substance- viral surface protein HBsAg

Protective efficacy- related to the induction of antibody to

Hepatitis B surface antigen (Anti- hBs)

Anti Hbs titre of 10 mIU/l - considered protection

Neonates born to HbsAg positive mothers irrespective of the

weight - should receive Hepatitis B immunoglobulin (0.5
ml/100 IU) and hepatitis B vaccine 0.5 ml at 2 separate sites

Preferably to be given Within 12 hours ( maximum up to 7

days)
PENTAVALENT VACCINE

Diphtheria
Pertussis (whole cell/ acellular vaccine)
Tetanus
Hemophilus B influenzae (Hib)
Hepatitis B (HepB)
0.5 ml ; deep intramuscular (antero lateral thigh),
6,10,14 weeks
Storage 2 to 8c
Pertussis toxoid potentiates the effect of diphtheria
toxoid
Adjuvant – aluminum salts

Content of diphtheria toxoid- 20 Lf to 30 Lf and tetanus

toxoid- 5 Lf t0 25 Lf

Should never be frozen

Immunogenecity( protective titre for diphtheria >0.1

IU/ml and for tetanus >0.01 Iu/ml)

Effectiveness >95% to 3 doses

Varaible efficacy of pertussis and waning immunity

 CONTRAINDICATIONS:
Progressive neurologic diseases

Encephalopathy within 7 days of previous vaccine

Severe anaphylactic reaction to the previous dose

SIDE EFFECTS:
Adverse effects due to the pertussis component

pain , induration, hyperpyrexia( >40.5c) ,seizure within 72

hours , inconsolable and persistent cry (> 3 hours), transient
hypotonic, hyporesponsive episode ( within 48 hours)
HEMOPHILUS INFLUENZAE B
VACCINE(HIB)
Conjugated vaccine
As pentavalent vaccine- routine for all children
6,10,14 weeks; 0.5 ml; intramuscular
High risk situation- before splenectomy for
thalassemia , sickle cell anemia, asplenia,
immunodeficiency disorder, leukemia& lymphoma
Effectiveness:90-100% elimination of invasive
serotypes; reduces nasopharyngeal carriage
No major adverse effects
Contraindication: hypersensitivity to its components
Hib capsular polysaccharide (polyribosyl ribitol
phosphate PRP) is conjuagetd with carrier protein

Waning immunity- booster doses is recommenede 12-

18 months

Measured by Anti-PRP titres

Storage 2-8c
 ROTA VIRUS VACCINE
Live attenuated
Human bovine with 5 strains (RV5)
5 drops ,oral
6, 10, 14 weeks
Storage: 2 to 8 c
Initiation should be done before 14 weeks and
schedule should be completed before 32 weeks
Side effects: rarely intussusception
Contraindication: previous H/O intussusception ,
severe immunodeficiency
PNEUMOCOCCAL CONJUGATE VACCINE
PCV 10 (Used in NIS), PCV13
Adsorbed, 10 valent ( sterile suspension of saccharides
of the capsular antigens of Streptococcus pneumoniae
1,5,6A,6B,7F,9V,14,19A,19F,23F) and conjugated,
6 weeks, 14 weeks, booster at 9 months
0.5 ml ; intramuscular ; antero lateral thigh
Storage: 2- 8c
Efficacy: against invasive pneumococcal disease
Side effects: pain, fever, local soreness
Contraindication: anaphylaxis to previous dose
MEASLES, RUBELLA VACCINE(MR)
Live attenuated vaccine( Edmonstrom Zagerab strain
of Measles & RA 27/3 strain of Rubella )
0.5 ml , sub cutaneous, upper arm
Diluent: Distilled water
Should be used within 4 hours of reconstitution
End of 9 months, 18 months
Storage: 2to 8c
Efficacy: definitive protective value 95 to 100%
Side effects: fever, rash, Toxic shock syndrome(TSS)
Contraindication: immunosuppressive therapy,
leukemia, immunodeficiency (primary & severe HIV)
JAPANESE ENCEPHALITIS VACCINE(JE)
Live attenuated cell culture derived SA 14-4-2

0.5 ml; two doses ; 9 months of age & 18 months

Sub cutaneous

Storage: 2to 8 c

Side effects : mild fever, no major AEFI

Contraindications : high fever, immunodeficiency ,

Killed vaccine also available

TETANUS DIPHTHERIA (TD) VACCINE
Contains Tetanus 5 Lf + reduced dose diphtheria(2 u)

As there were break through cases of diphtheria & regular

diphtheria can not be used in children >7 years- reduced dose
diphtheria used along with Tetanus

In 10, 16 years

0.5 ml; intra muscular; arm

Storage – 2-8 c

Side effects- fever, soreness of limbs , no major AEFI

OPTIONAL VACCINES
HEPATITIS A VACCINE
Killed vaccine (720 U)
0.5 ml ; intramuscular, antero lateral thigh
2 doses 6 months apart; starting at 12 months
Live vaccine- single dose also available
Efficacy: active immunisation against Hepatitis A.
Storage: 2 to 8 c
Side effects: fever, pain, malaise, anorexia
Single dose live vaccine also available
VARICELLA VACCINE
Live attenuated OKA Strain
0.5 ml ; sub cutaneous;
2 doses ; 3 months apart ; starting from 15 months
Can be given as post exposure prophylaxis within 3 days
of exposure
Efficacy: 95% protection after 2 doses
Storage: 2 to 8 c
Side effects: fever, rash
Contraindication: severe febrile illness,
immunodeficiency( severe HIV ), recent administration
of immuno globulins, known anaphylaxis
MEASLES, MUMPS, RUBELLA
VACCINE(MMR)
Live attenuated vaccine
Combination vaccine against measles, mumps and
rubella
 3 doses ; 9 months, 15 months, 4-6 years
0.5 ml; subcutaneous
Diluent- Distilled water
Should be used within 4 hours of reconstitution
Contraindication: severe immunodeficiency, those
who have received recent blood transfusion & IVIG
 TYPHOID CONJUGATE VACCINE
 Vaccine against the Vi capsular polysaccharide capsular
antigen conjugated with Tetanus toxoid

Can be used from 6 months of age

Single dose 0.5 ml ; intra muscular; antero lateral thigh

Storage: 2 to 8c

Side effects: local pain, induration

Contra indication: anaphylactic reaction to the previous dose

 INFLUENZA VACCINE
Killed inactivated quadrivalent vaccine against
influenza vaccine
0.5 ml; intramuscular, antero lateral thigh
From 6 months onwards; 1 st time-2 dosess
Then Single dose to be repeated every year
Storage : 2 to 8 c
Side effects: fever, rash, pain, rarely demyelination
Contraindication: anaphylaxis to the previous dose
MENINGOCOCCAL VACCINE
Vaccine Against meningococcal A,C, Y, W-135
conjugated with Diphtheria toxoid
0.5 ml; single dose; intra muscular
 can be given beyond 1 year of age
Storage : 2to 8 c
High risk children- for thalassemia child before
splencetomy, sickle cell anemia; immunodeficiency
Side effects: fever, pain, edema
Contraindication: anaphylactic reaction
HUMAN PAPILLOMA VIRUS
VACCINE
Recombinant vaccine against HPV 16,18 (bivalent),
HPV 6,11, 16,18 ( quadri valent)
0. 5 ml ; intra muscular; antero lateral thigh
From 9 years of age for girls
2 doses from 9 to 14 years ( 0,6 months)
3 doses from 14 years( 0, 1 /2 ,6 months)
Storage: 2 to 8 c
Efficacy: protects against cervical cancer (83%),
cervical intra epithelial neoplasia
Side effects: fever, pain, erythema
PNEUMOCOCCAL POLYSACCHARIDE
VACCINE PPV 23
Killed polyvalent vaccine
Single dose 0.5 ml; intra muscular; antero lateral thigh
Beyond 2 years
For high risk children- 2 months after PCV13;
thalassemia children before splenectomy, sickle cell
immunodeficiency, 15 days prior to cochlear implants
Active immunization against the 23 serotypes of
S. pneumoniae
Side effects: fever, rash, pain