Download Immunization 5

ROUTINE
IMMUNIZATIONS
Dr SARIKA GUPTA (MD, PhD),Assistant Professor
INTRODUCTION
Immunity
• Ability of human body to tolerate
the presence of material
indigenous to the body and to
eliminate foreign material
• This discriminatory ability provide
protection from infectious disease
• Indicated by the presence of
antibody to the organism causing
infectious disease
INTRODUCTION
Vaccination versus Immunization
Vaccination
• Vaccination is a process of inoculating the
vaccine/ antigen into the body irrespective of
seroconversion
Immunization
• Immunization is the process of inducing
immune response in an individual either
humoral or cell mediated
Vaccines
Vaccines are whole or parts of
microorganisms administered to prevent
an infectious disease
Biology of Vaccines
Live
attenuated
vaccine:
Consist of
whole
inactivated
microorganisms
• The immune response-similar to natural
infection
• Produces immunity in most of the
recipients with 1 dose, except those
administered orally
• Active immunity may not develop
because of interference from
circulating antibody (Measles; OPV &
rotavirus-least affected)
• Could revert to its original pathogenic
form, only OPV
• LA viral vaccines: measles, mumps,
rubella, varicella, yellow fever,
rotavirus, OPV & intranasal influenza
• LA bacterial vaccines: BCG & typhoid
(oral)
Biology of Vaccines
Inactivated
vaccine:
Produced by
growing the
microorganism
in culture
media,
inactivating
with heat
and/or
chemicals
(formalin)
• Could not cause disease from infection
even in an immunodeficient person
• Least affected by circulating antibody
• Require multiple doses
• Immune response is mostly humoral, no
cellular immunity
• Antibody titre against IV diminish with
time
• Inactivated whole virus vaccines: IPV,
Hep-A & rabies
• Inactivated whole bacterial vaccines:
Pertusis
• Fractional vaccines: subunits-Hep B,
influenza, acellular pertussis, HPV; toxoidsDiptheria & tetanus
Biology of Vaccines
Polysaccharide
vaccine: A
type of
inactivated
subunit vaccine
composed of
long chain of
sugar molecules
that make up
the surface of
certain
bacteria
• The immune response to pure PS vaccine is
T-cell independent, therefore not
immunogenic in children<2 years of age;
pneumococcal, meningococcal & typhoid
polysaccharide vaccines
• Repeat dose of PS vaccine do not cause a
booster response; predominant antibody
produced in response to PS vaccine is IgM
• Conjugation of PS vaccine with a protein
molecule changes the immune response
from T-cell independent to T-cell
dependent- increased immunogenicity in
infants & booster response; Hib A,
Pneumococcal & Meningococcal conjugate
vaccine
Immunization schedule
Ideal Immunization schedule
• Epidemiologically relevant
• Immunologically competent
• Technologically feasible
• Socially acceptable
• Affordable
• Sustainable
For Government Programs it is cost first, efficacy
next, safety last
For Individual it is safety first, efficacy next,
cost last
National Immunization Schedule
Age
Vaccines
Birth
BCG, OPV, Hepatitis B
6 weeks
DTwP1, OPV1, HepB1, Hib1±BCG
10 weeks
DTwP2, OPV2, HepB2, Hib2
14 weeks
DTwP3, OPV3, HepB3, Hib3
9 months
Measles
16-24 months
DTwP B1, OPV4, MMR, JE
5-6 years
DTwP B2
10 years
TT
16 years
TT
Vitamin A
9,18,24, 30 & 36 months
IAP Immunization Time Table 2013
I: IAP recommended vaccines for routine use
Age
Vaccines
Birth
BCG, OPV0, Hep-B 1
6 weeks
DTwP 1, IPV 1, Hep-B 2, Hib 1, RV5 1, PCV 1
10 weeks
DTwP 2, IPV 2, Hib 2, RV5 2/RV1 1, PCV 2
14 weeks
DTwP 3, IPV 3, Hib 3, RV5 3/RV1 2, PCV 3
6 months
OPV 1, Hep-B 3
9 months
OPV 2, Measles
12 months
Hep-A 1; 2 dose after 6 months
15 months
MMR 1, Varicella 1, PCV B
16-18 months
DTwP B1, IPV B1, Hib B1
2 years
Typhoid; revaccination every 3 years if Vi PS vaccine
4-6 years
DPT B2, OPV 3, MMR 2, Varicella 2,
10-12 years
Tdap/Td every 10 years, HPV
IAP Immunization Time Table 2013
II: IAP recommended vaccines for HIGH-RISK children
(Vaccines under special circumstances)
1. Influenza vaccine
2. Meningococcal
vaccine
3. JE vaccine
4. Cholera vaccine
5. Rabies vaccine
6. Yellow fever
vaccine
7. PPSV 23
High-risk category of children:
Congenital/acquired immunodeficiency
Chronic cardiac, pulmonary, hematologic,
renal, liver disease & diabetes mellitus
Children on long term steroids, salicylates,
immunosuppressive or radiation therapy
Cerebrospinal fluid leak, Cochlear implant,
Malignancies
Children with functional/anatomic
asplenia/hyposplenia
During disease outbreaks
Laboratory personnel & health care workers
Travelers
Different type of adverse events
following immunization
Vaccine reaction Event caused/precipitated by the inherent
properties of the vaccine (active component,
adjuvant, preservative, stabilizer) when given
correctly
Program errors
Event caused by an error in vaccine
preparation, handling or administration
Coincidental
Event that happens after immunization but is
not caused by the vaccine
Injection
reaction
Event arising from anxiety about, or pain
from, the injection itself rather than the
vaccine
Unknown
The cause of the event cannot be determined
Common minor vaccine reactions
Vaccine Local reaction (pain,
redness, swelling)
Fever
Irritability, malaise &
non specific reactions
BCG
common
Hib
5-15%
2-10%
Adults-15%
Children-5%
1-6%
10%
5-15%
50% (rash)
<1%
<1%
Hep-B
Measles
/MMR
OPV
TT/DT/
Td
10%
10%
25%
DPwT
50%
50%
60%
Rare serious vaccine reactions
Vaccine
BCG
Hep-B
Reaction
Suppurative adenitis, BCG osteitis, Disseminated
BCGitis
Anaphylaxis
Measles/MMR Febrile seizures, thrombocytopenia, anaphylaxis
OPV
VAPP
TT
Brachial neuritis, anaphylaxis, sterile abscess
DTP
Persistent inconsolable screaming, seizures, HHE,
anaphylaxis, shock
JE
Serious allergic reactions, neurological events
YF
Allergic reactions/anaphylaxis
Injection site
Intramuscular Injections
Site
Preterms & neonates
Infants
Anterolateral thigh (junction of
middle & lower third)
Toddlers & older children
Deltoid or Anterolateral thigh
Adolescents & adults
Deltoid
Subcutaneous Injections
Site
Infants
thigh
>12 months
Outer triceps
Intradermal Injections
Site
All age
Left deltoid
Bacille Calmette-Guerin Vaccine

Supplied as a lyophilized freeze dried preparation in vacuum
sealed, multidose, dark colored ampoules with normal saline
as diluent

In this form can be stored for 12 months at 2-8oC

Light sensitive

No preservative; bacterial contamination & TSS may occur if
used 4-6 hours after reconstitution

Site: Left shoulder; intradermal route; 26 gauze needle

Dose independent of age & weight of the baby

The injection site may be cleaned by saline swab

A wheal of 5mm at injection site indicates successful i.d.
administration of the vaccine
Classical BCG reaction
2-3 weeks after BCG vaccinationdevelopment of a papule
End of 5-6 weeks-papule increases to a size
of 4-8mm; get converted to pustule within
few days. Pustule bursts open & again get
sealed off.
This process continue for multiple times; at
the end it dries up & a crust is formed.
Crust falls off & a scar is formed by 6-12
weeks
Bacille Calmette-Guerin Vaccine


BCG avoided in immunocompromised children; may
be given at birth in children born to HIV positive
mothers
BCG may be given with all vaccines on same day or at
any interval with the exception of measles & MMR
vaccines where a gap of 4 weeks between the two
vaccines is recommended
Bacille Calmette-Guerin Vaccine
Recommendations for use


At birth or at 6 weeks with other vaccines
Catch-up vaccination with BCG: till 5 years of age
Polio Vaccines
OPV


Two types of polio vaccines
IPV
With intelligent use of mOPV & bOPV, INDIA is free of
polio
OPV





Trivalent vaccine grown in monkey kidney cell culture &
stabilized with MgCl2
Light pink color-indicates right pH
Most heat sensitive vaccine, Strict cold
chain maintenance
Given orally; two drops
Contraindicated in immunodeficient children & their
household contacts
Polio Vaccines
IPV




Formaldehyde killed poliovirus, grown in monkey
kidney cell or human diploid cells
Contains 40, 8 & 32 D antigen units of types 1, 2 & 3
Vaccine storage: 2-8oC; Dose: 0.5 ml i.m.
Seroconversion rate: 90-100% after 2 doses given
after the age of 2 months & at 2 months intervals or
three doses given at 6, 10 & 14 weeks
Polio Vaccines
Recommendations for use IPV
 Adoption of all IPV schedule; cessation of OPV from
schedule owing to its safety issues (VAPP & cVDPVs)
 The phased removal of Sabin viruses has resulted in
elimination of VDPV type 2 in parallel with eradication
of last wild polioviruses by switching from tOPV to
bOPV & mOPV
 The schedule that provide IPV first followed by OPV
can prevent VAPP while maintaining the critical
benefits conferred by OPV
 The birth dose of OPV is retained in countries where
the risk of PV transmission is high
Polio Vaccines
Catch-up Schedule: IPV
 In children <5 years of age as three doses as 0, 2 & 6
months schedule; ensures long lasting protection
 In children <5 years of age, completed primary
immunization with OPV, 2 doses at 2 months interval
 Immunodeficient children & their household
contacts: IPV preferred
DTwP Vaccines
DTwP




Compose of diphtheria & tetanus toxoids & killed whole
cell pertussis bacilli adsorbed on insoluble aluminium
salts (adjuvants)
Vaccine storage: 2-8oC; Dose: 0.5 ml deep i.m.
Immunity against all three components wanes over the
next 6-12 years; therefore regular boosting needed
Most adverse reactions are due to pertussis component
DTwP Vaccines



Absolute contraindications to ANY pertussis vaccine:
History of anaphylaxis or development of
encephalopathy within 7 days folllowing DTwP
vaccination
Precaution to future dose of DTwP : persistent
inconsolable crying >3 hours, hyperpyrexia (>40.5oC),
HHE within 48 hours & seizures within 72 hours of
administration of DTwP
Relative contraindication: progressive neurological
illness
DTwP Vaccine



Catch-up vaccination below 7 years: three doses
DTwP / DTaP at 0,1 & 6 months
Catch-up vaccination above 7 years: Tdap vaccine as
the first dose followed by Td vaccine as 0,1 & 6
months schedule
Immunize the children recovering from diphtheria,
tetanus & pertussis; Natural disease does not offer
complete protection
DTaP Vaccines
DTaP




Components of pertussis bacilli in acellular vaccines
include PT with or without FHA, PRN & FIM 1,2 & 3
The DTaP vaccines score over whole cell vaccines in
term of both major & minor adverse effects
The absolute contraindications to DTaP vaccines are
same as those for whole cell vaccine
Both DTwP & DTaP must not be given in children >7
years of age
TT, DT, Td & Tdap Vaccines
Tdap



immunization of pregnant women with a single dose of
Tdap during the third trimester regardless of number
of years from priorTd or Tdap vaccination.
Tdap has to be repeated in every pregnancy
irrespective of the status of previous immunization
(with Tdap)
if an adolescent girl who had received Tdap one year
prior to becoming pregnant will have to take it since
there is rapid waning of immunity following pertussis
immunization
TT in wound management
History of TT
doses
Unknown, ≤3,
immunodeficient
Clean minor wounds All other wounds
TT/Td
YES
TIG
No
≥3 doses
No**
No
** Yes, if >10 years since last dose
***Yes, if >5 years since last dose
TT/Td TIG
YES
YES
No***
No
Measles Vaccine





Live attenuated vaccine
Strain: Edmonstan Zagreb strain
Supplied as freeze-dried in single dose or multiple
dose vials with distilled water as a diluent
Stored frozen at 2-80C
Reconstituted vaccine: light & heat sensitive;
susceptible to contamination as it has no preservative;
should be kept at 2-80C, protected from light & used
within 4-6 hours
Measles Vaccine



Dose: 0.5 ml by SC route at the age of completed 9
months
In case of outbreaks, the vaccine can be given to
infants as young as completed 6 months
In view of 15% cases of primary vaccine failure, an
additional dose of measles vaccine as MMR vaccine
at the age of 15 months is required for durable &
lifelong protection
MMR Vaccine





Supplied in lyophilized form
Stored frozen for long term storage
Reconstituted vaccine should be kept at 2-80C,
protected from light & used within 4-6 hours
Can be given with along with all others vaccine except
BCG vaccine
Two doses are recommended: one at the age of 12-15
months & second at 4-6 years of age
Hib conjugate Vaccine







Conjugated vaccine- Hib polysaccharide conjugated
with a protein carrier
Vaccine storage: 2-8oC; Dose: 0.5 ml i.m.
Vaccine schedule: three primary doses with a
booster at 18 months
Vaccination started between 6-12 months: two
primary doses & one booster at 18 months
Vaccination started between 12-15 months: one
primary dose & one booster at 18 months
Children >15 months: single dose only
Not recommended for NORMAL children >5 years of
age
Hepatitis B Vaccine
Vaccine contains surface antigen of Hep B, produced by
recombinant technology in yeast & adjuvanted with
aluminum salts & preserved with thiomersal
 Available as single & multidose vials
o
 Vaccine storage: 2-8 C; Dose: i.m 0.5 ml. for < 18 years
& 1 ml in those >18 years of age
Schedules:
 Birth, 1 & 6 months
 Birth, 6 & 14 weeks
 Birth, 6 weeks & 6 months
 No booster dose
 Catch-up vaccination: 0, 1 & 6 months

Hepatitis B Vaccine





Management of an infant born to Hep B positive
mother:
HBIg (0.5 ml) along with Hep B vaccine within 12 hours
of birth using two separate syringes & on separate sites
HBIg may be given upto 7 days of birth but the
efficacy of HBIg after 48 hours is not known
Two more doses of Hep B vaccine at 1 & 6 months of age
If HBIg not available: Hep B vaccine at 0, 1 & 2 months
with an additional dose between 9-12 months
All such infants should be tested for HBsAg & HBsAg
antibodies at the age of 9-15 months to identify
carriers or non-responders
Typhoid Vaccines
Vi-Capsular polysaccharide vaccine







The vaccine contain purified antigenic fraction of ViCapsular polysaccharide antigen of S. typhi (Virulence
factor)
Vaccine storage: 2-8oC; Dose: i.m 0.5 ml
Not immunogenic in children below 2 years of age
No immune memory; Efficacy 60%
Does not interfere with the interpretation of the widal
test
Recommended as a single dose in children >2 years of age
& revaccination every 3 years
Can be safely given in immunocompromisd children
Typhoid Vaccines
Vi-Conjugate typhoid vaccine



Conjugation of the Vi antigen with a protein carrier
induces a T-cell dependent response, make it
efficacious in <2 years of age & induces antibody
booster response
Recently a vaccine has been licensed in India where Vi
antigen is conjugated with tetanus toxoid
Evaluation: not satisfactory; not recommended for
routine use
Varicella Vaccine







Derived from the Oka strain
Dose is 0.5 ml by sc route; minimum
infectious virus content should be 1,000 PFU
Supplied in lyophilized form
Should be protected from light and needs to be used
within 30 minutes of its reconstitution
May be given with all other childhood vaccines
Recommendation: two doses of varicella vaccine given at
the age of 15 months & second dose at 4-6 years
VZIg: for individuals with significant contact with
varicella or herpes zoster who are at high risk for severe
disease
Hepatitis A Vaccines
Inactivated vaccine







Strain is HM 175/GBM grown on MRCs human diploid
cell lines
The virus is formalin inactivated & adjuvanted with
aluminum hydroxide
Vaccine storage: 2-8oC; Dose: i.m 0.5 ml
The vaccine is given in two dose schedule, 6 months
apart
Immunity is lifelong due to anamnestic response & no
boosters are recommended in immunocompetent person
Efficacy: 90-100%
A liposomal adjuvanted Hep A vaccine is now available
Hepatitis A Vaccines
Live attenuated vaccine



Strain: H2 strain of the virus attenuated after serial
passage in human diploid cell line (KMB 17 cell line)
Now licensed & available in India
Two doses of 1 ml sc in children aged 1-15 years
Rotavirus Vaccines

Two live oral vaccines: human monovalent (RV1) and
human bovine pentavalent rotavirus (RV5) live vaccines
RV1 vaccine




Strain: 89-12 grown in vero cells & contain the G1P1(8)
strain
Provided as a lyophilized powder
The vaccine should be administered after reconstitution
as 1 ml orally
Vaccine storage: 2-8oC
Rotavirus Vaccines
RV1 vaccine



Administered orally in a 2-dose schedule
First dose should start at 10 weeks of age instead of
6 weeks in order to achieve better immune response
The second dose can be administered at 14 weeks to fit
with existing national immunization schedule
RV5 vaccine


This is a human bovine reassortant vaccine
Consists of 5 reassortant between the bovine WC3
strain & human G1, G2, G3, G4 & P1A(8) rotavirus strain
grown in vero cells
Rotavirus Vaccines
RV5 vaccine



The vaccine is available as a liquid virus mixed with
buffer
Administered orally in a 3-dose schedule at 2, 4 & 6
months
Vaccine storage: 2-8oC
Rotavirus Vaccines





First dose should be given between 6 weeks & 14 weeks
6 days of age with minimum interval of 4 weeks between
the doses
Immunization should not be initiated in infants 15 weeks
or older
All the doses of either of the vaccines should be
completed within 32 weeks of age
Strict schedule need to be followed as there is a
potentially high risk of intussusception
Preterms: Vaccination can be considered for stable & at
least 6 weeks of age
Rotavirus Vaccines


Vaccination should be postponed in infants with acute
gastroenteritis
Risk vs benefits of vaccination should be considered for
infants with chronic gastrointestinal disease, gut
malformation, previous intussusception &
immunocompromised infants
Pneumococcal Vaccines

Three types of pneumococcal vaccines: PCV 13, PCV 10 &
unconjugated PPSV23
Pneumococcal conjugate vaccines

Conjugation of PPS of varying number of serotypes with
diptheria toxoid cross reactive material 197 (CRM197)
proteins, protein D of non-capsulated Hib, DT & TT
Pneumococcal Vaccines
PCV 13 vaccines



Administered by im route as a 0.5 ml dose
Available in latex free, single dose prefilled syringes
Can be given with all other childhood vaccines
Pneumococcal Vaccines
PCV 10 vaccine




PCV 10 is a preservative free vaccine & adsorbed on
aluminum phosphate
Available in single dose prefilled syringes (0.5 ml), given
by im route
Primary schedule (PCV 13 & PCV 10): three doses at 6,
10 & 14 weeks with a booster at 12-15 months of age
Catch-up vaccination: similar to Hib vaccine
PPSV23 vaccine

Recommended only for vaccination of children with
certain high-risk conditions
Human Papilloma Virus Vaccines





HPV4 (Gardasil) & HPV2 (Cervarix) are licensed &
available
Manufactured by recombinant technology that produces
non-infectious virus like particle comprising of HPV L1
protein, the major capsid protein of HPV
HPV4 has serotypes 16, 18, 6 & 11 with aluminum
adjuvant
HPV2 has serotypes 16 & 18 with ASO4 as an adjuvant
Either HPV4 (0, 2, 6 months) or HPV2 (0, 1, 6 months) is
recommended in three dose series for females
Human Papilloma Virus Vaccines







Both the vaccine provide protection against cervical
cancer & precancerous lesions
HPV4 also protects against ano-genital warts
Vaccine storage: 2-8oC
Dose is 0.5 ml by im route in deltoid
Catch-up vaccination till 45 years of age
Should be avoided in pregnancy
Contraindicated in those with history of previous
hypersensitivity to any vaccine
Influenza Vaccines

Two types of influenza vaccine
Inactivated influenza vaccine





Inactivated
influenza vaccine
Live attenuated
influenza vaccine
Produced from virus grown in embryonated hen 'eggs
Three types:
1. Whole virus-currently not used
2. Split product-detergent treated, purified virus
3. Subunit surface antigen- contain hemagglutinin &
neuraminidase
Influenza Vaccines
Inactivated influenza vaccine






Trivalent/monovalent
Trivalent vaccine contain WHO recommended two
influenza A strains (H1N1 & H3N2) & one influenza B
strains
Monovalent vaccine contain novel H1N1 2009 strain
Storage at 2-8O C
Trivalent vaccine: used in children ≥6 months
Should be avoided in patients with history of GullianBarre syndrome
Influenza Vaccines
Live attenuated influenza vaccine



Composed of the live attenuated reassortant of the
three WHO recommended strains
Administered as nasal spray
Not available in India
Cholera Vaccines






Wc-rBS vaccine composed of killed vibrio cholerae
01 recombinant to subunit of cholera toxoid
Oral vaccine
Administered as two doses one weeks apart
Protection is available after two weeks of the second
dose
Storage at 2-8O C
Used for those aged 2 years & above
Meningococcal Vaccines
Unconjugated meningococcal polysaccharide vaccine




Bivalent (A+C) or quadrivalent (A, C, Y & W-135)
Available in lyophilized form, reconstituted with sterile
water
Storage at 2-8O C
Indicated for children above the age of 2 years
Conjugated meningococcal polysaccharide vaccine


Two different types of MCVs are licensed in India
quadrivalent vaccine Menactra® & a monovalent
serogroup A vaccine from Serum Institute of India
Meningococcal Vaccines





Quadrivalent (A,C,W135,Y) MCV has diphtheria toxin as
carrier protein
A single dose of 0.5 mL im is recommended
Efficacy: 80-85%
Guillain-Barré Syndrome was noted as a possible but
unproven risk in some adolescents following
immunization
Interference with PCV13 immune responses when
MenACWY-D and PCV13 were administered
simultaneously in patients with asplenia
Meningococcal Vaccines
Quadrivalent meningococcal polysaccharide-protein vaccine

One month interval should be kept between PCV13 and
MenACWY-D, and PCV13 should be administered first
Monovalent serogroup A conjugate polysaccharide vaccine


A lyophilized vaccine of purified meningococcal A
polysaccharide covalently bound to TT acting as a
carrier protein
Administered as a single intramuscular injection of 0.5
mL to individuals 1-29 years of age
Meningococcal Vaccines
Recommendations for the use of meningococcal vaccine
 During disease outbreaks:
most of outbreaks in India are caused by Men A,
monovalent MCV should be employed in mass vaccination
 Children with terminal complement component
deficiencies
 Children with functional/ anatomic asplenia/ hyposplenia
(including sickle cell disease)
 Persons with Human Immunodeficiency Virus
Meningococcal Vaccines
Recommendations for the use of meningococcal vaccine
 Laboratory personnel and healthcare workers
 Adjunct to chemoprophylaxis
 International travelers:
 Students going for study abroad
 Hajj pilgrims
 Travelers to countries in the African meningitis belt
Japanese Encephalitis Vaccines

The vaccination against JE is not recommended for routine
use, but only for individuals living in endemic areas
Mouse brain derived inactivated vaccines




Prepared from either the Nakayama/Beizing strain of JE
virus grown in mice brain, purified, inactivated by
formalin & preserved with thiomersal
Given by sc route 0.5 ml in children 1-3 years & 1 ml in
older children
Primary immunization consists of three doses given on 0,
7 & 30 days along with boosters every 2-3 years
High cost, complicated schedule & option of better
vaccine – markedly declined use
Japanese Encephalitis Vaccines
Live Attenuated SA-14-14-2 Vaccine






Contain stable neuro-attenuated strain of JE virus
Dose is 0.5 ml by sc route for all ages
Should not be used as an outbreak response vaccine
All the children in JE endemic areas should be vaccinated
First dose of the vaccine can be administered at 9
months along with measles vaccine and second at 16 to 18
months
Also recommended for travelers to JE endemic areas
Japanese Encephalitis Vaccines
Inactivated Vero cell culture-derived SA 14-14-2 JE VaccineJEEV
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Recommendation is a primary schedule of 2 doses of
0.25mL for children aged 1-3 years and 2 doses of 0.5mL
for children >3 years, adolescents and adults
administered im on days 0 and 28 followed by a booster
Japanese Encephalitis Vaccines
Inactivated Vero cell culture-derived SA 14-14-2 JE VaccineJENVAC
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Recommendation of two doses of the vaccine (0.5 ml
each) administered im at 4 weeks interval for the
primary immunization series starting from 1 year of age
followed by a booster
Rabies Vaccines
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The nerve tissue vaccine- not used now
Current vaccines (MTCV): PCEC vaccine, HDCV,
PVCRV & PDEV
Available in lyophilized form, sterile water as diluent
Stored at 2-8O C
Should be used within 6 hours of reconstitution
Along with proper wound care & RIG, post exposure
prophylaxis is effective 100%
HRIG-20 IU/kg body weight
ERIG-40 IU/kg body weight
RIG – for category 3 wounds
Rabies Vaccines
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PEP schedule: days 0, 3, 7, 14 & 30; sixth dose on day
90 for patients with severe debility or those who are
immunosupressed
If RIG not available: two doses of the vaccine can be
given on day 0
Vaccines available in India for i.d. route administration
are PVRV & PCEV
This route should not be used for immunocompromised
patients & those on chloroquine therapy
Rabies Post Exposure Prophylaxis
Category
Description
Recommended
treatment
I
Touching of feeding of animals,
licks on intact skin
None if
information is
reliable
II
Nibbling of uncovered skin, minor
scratches or abrasions without
bleeding licks on broken skin
Vaccination
III
Single or multiple transdermal
bites or scratches, contamination
of mucous membrane with saliva
or exposure to bats
RIG+vaccination
IAP recommendations for immunization
in adolescents
Vaccines
Schedule
MMR
2 doses at 4-8 weeks interval
Hepatitis B
3 doses at 0,1 & 6 months
Hepatitis A
2 doses at 0 & 6 months
Typhoid
1 dose every 3 years
Varicella
2 doses at 4-8 weeks interval
Influenza
1 dose every year
JE vaccine
Catch-up up to 15 years
Tdap
1 dose followed by Td booster every 10
years
Vaccination of person with primary
immune deficiencies
Category
Contraindicated
Vaccines
Risk specificrecommended vaccine
B-lymphocyte
(X-linked agammagobulinemia
CVID, IgA deficiency & IgG
subclass deficiency)
OPV, LAIV, BCG,
Ty21a, YF
Pneumococcal, TIV,
measles & varicella
T-lymphocyte
(SCID, DiGeorge syndrome,
Wiskott-Aldrich syndrome,
ataxia-telangiectasia)
All live vaccines
Pneumococcal, TIV,
meningococcal, Hib
Comlement
(Early or late, components,
properdin, factor B)
None
Pneumococcal, TIV,
meningococcal
Phagocytic function
(CGD, LAD, MPO)
Live bacterial
vaccines
Pneumococcal, TIV (to
decrease secondary
bacterial infections)
Vaccination of person with secondary
immune deficiencies
Category
Contraindicated
Vaccines
Risk specific-recommended
vaccine
HIV/AIDS
OPV, BCG, LAIV,
MMR, varicella
Influenza (TIV),
pneumococcal, Hib,
meningococcal
Malignancy,
transplantation,
immunosuppressive or
radiation therapy,
Live vaccine
Influenza (TIV),
pneumococcal
Asplenia
none
pneumococcal, Hib,
meningococcal
Chronic renal disease
LAIV
Pneumococcal, Influenza
(TIV), Hep B
Cold chain
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System of transporting & storing vaccines within
recommended temperature from the place of
manufacture to the point of administration
Three main components:
Trained personnel
Transport & storage equipment
Efficient management procedures
Deep freezer (-15 to 25O C) for ice packs &
OPV stock for 3 months
ILR (+2 to +8OC) BCG,
DPT, DT, TT, measles,
Hep B stock for 3
months
Cold box (+2 to +8OC)
for transport & power
failure
Vaccine carrier (+2 to
+8OC) For 12 hours
Cold chain