IMMUNIZATION
DEFINITION
• Immunization is a procedure where the immunizing agents are
administered artificially to produce specific protection against a given
disease.
• Immunizing agents: 1. Vaccines
2. Immunoglobulins
3. Anti-sera/anti-toxins
• They are studied under two headings:
1. Active immunity
2. Passive immunity
ACTIVE IMMUNITY:
• It is the immunity which an individual develops as a result of infection or by
specific immunization and is usually associated with the presence of antibodies
or cells having a specific action on micro-organisms concerned with a particular
infectious disease or on its toxin.
PASSIVE IMMUNITY:
• When antibodies produced in the body [human or animals] are
transferred to another to induce protection against disease, this is known
as passive immunity. In other words, the body does not produce its own
antibodies but depends upon readymade ones.
VACCINES
• Vaccine is an immuno-biological substance designed to produce specific
protection against a given disease. It stimulates the production of
protective antibodies and other immune cellular fractions.
• Vaccines may be prepared from live modified organisms inactivated or
killed organism, extracted cellular fractions, toxoids or combination of
these.
LIVE VACCINES:
• Prepared from live organism.
• They are more potent immunizing agents than killed vaccines.
• E.g. BCG, Measles, Oral Polio.
INACTIVATED [KILLED] VACCINES:
• Organisms killed by heat or chemicals
• When injected into the body stimulates active immunity.
• Killed vaccines are less effective than live vaccines, killed vaccines usually
require a primary series of 2-3 doses, of vaccine to produce an adequate
antibody response, and in most cases Booster doses are required.
• E.g. Typhoid, Cholera, Pertussis, Influenza and Rabies
National Immunization Schedule
Vaccine When to give Dose Route Site
0.05 ml -neonates
BCG At birth (till 1 year) ID Left Upper Arm
0.1 ml for infants
At birth (within 24 Anterolateral
Hepatitis B 0.5 ml IM
hours) aspect of mid-thigh
At birth (within 15
OPV-0 2 drops Oral Oral
days)
OPV At 6, 10 & 14 weeks
2 drops Oral Oral
1, 2 & 3 (till 5 years)
Vaccine When to give Dose Route Site
Pentavalent At 6, 10 & 14 weeks Anterolateral aspect of
0.5 ml IM
1, 2 & 3 (till 1 year) mid-thigh
At 6 & 14 weeks,
Anterolateral aspect of
PCV Booster at 9-12 0.5 ml IM
mid-thigh
months
Rota Virus At 6, 10 & 14 weeks
5 drops Oral Oral
vaccine (till 1 year)
At 6 & 14 weeks,
f-IPV 0.1 ml ID Right Upper Arm
Booster at 9 months
Vaccine When to give Dose Route Site
9-12 months
MR-1 0.5 ml SC Right Upper Arm
(till 5 years)
9-12 months
*JE-1 0.5 ml SC Left Upper Arm
(till 2 years)
1 ml (1 lakh
Vitamin A At 9 months with MR Oral Oral
IU)
Vaccine When to give Dose Route Site
OPV –
At 16-24 months 2 drops Oral Oral
Booster
DPT Anterolateral aspect
At 16-24 months 0.5 ml IM
Booster-1 of mid-thigh
MR-2 At 16-24 months 0.5 ml SC Right Upper Arm
*JE-2 At 16-24 months 0.5 ml SC Left Upper Arm
Vaccine When to give Dose Route Site
Starting from 16-18
Vitamin A months, one dose 2 ml
Oral Oral
(2nd to 9th dose) every 6 months (till 5 (2 lakh IU)
years)
At 5-6 years
DPT Booster-2 0.5 ml IM Upper Arm
(till 7 years)
TT/Td At 10 & 16 years 0.5 ml IM Upper Arm
For Pregnant women
Vaccine When to give Dose Route Site
Early in
TT / Td -1 0.5 ml IM Upper Arm
pregnancy
4 week after
TT / Td -2 0.5 ml IM Upper Arm
TT-1
If received 2
TT / Td- TT/Td doses in
0.5 ml IM Upper Arm
Booster the last 3
years
BCG Vaccine (Bacillus Calmette-Guerin)
• Discovered by French scientists while attenuating a virulent strain of
M. bovis in 1906.
• Type of Vaccine: Live attenuated Vaccine
• Strain : Danish 1331 strain
• Dose, Route & Schedule: 0.1 ml (0.05 ml until 1 month),
Intradermal
At birth (till 1 year)
• Site: Just above the insertion of deltoid, left arm using a tuberculin
syringe.
Normal phenomena after vaccination:
Papule – within 2-3 weeks
↓
Increases in size about 4-8mm In about 5 weeks
↓
Breaks into shallow ulcer and covered with crust.
Healing occur in 6-12weeks.
↓
Leaving permanent tiny round scar.
Typically 4-8 mm in diameter this is normal reaction
• Diluent used: Normal Saline
• Adverse Reactions: Prolonged severe ulceration at the site of vaccination,
Local abscess formation, Suppurative lymphadenitis, Osteomyelitis,
Disseminated BCG infection.
• Contraindications: Generalized eczema, infective dermatosis, symptomatic
HIV, congenital immunodeficiency, leukemia, lymphoma, generalized
malignant disease, patients under immunosuppressive treatment, pregnancy
• Duration of protection: 10 years
• Storage: 2-80 C
Oral Polio Vaccine (OPV)
• Live attenuated bivalent vaccine containing serotypes 1 & 3 .
• Strains used: Serotype 1: Mahoney strain
Serotype 3: Saukett strain
• Dose, Route & Schedule: 2 drops
Oral
At birth (within 15 days), 6, 10 & 14 weeks,
Booster at 16 - 24 months
• Complications: Vaccine-associated paralytic polio (VAPP)
• Advantages: easy administration, life-long immunity, can be used in
epidemics, induces humoral and systemic immunity.
• Storage: -25 to -15 ̊c.
• Efficacy determined using Vaccine vial monitor
Pentavalent Vaccine
• Type of Vaccine: Killed Vaccine
• Components: Diphtheria
Pertussis
Tetanus
Hepatitis B
Haemophilus influenzae Type B
• Strain used: Polysaccharide based vaccine
• Dose, Route, Site & Schedule: 0.5 ml
Intramuscular at 6, 10 & 14 weeks
Anterolateral aspect of mid-thigh
• Adverse Reactions: Pain, redness and swelling at the site of injection,
fever, vomiting, loss of appetite, abnormal crying, irritability, seizures,
severe allergic reaction.
• Storage: 2 – 80 C
Hepatitis B Vaccine
• Type of Vaccine: Recombinant / Genetically engineered
vaccine
• Strain used: Highly purified Hepatitis B surface antigen
• Vaccine Composition:
Each 0.5 ml contains - Purified HBsAg ≥ 10 µg
Aluminum hydroxide Gel 0.25 mg
Thiomersal 0.025 mg
• Dose, Route, Schedule & Site: 0.5 ml
Intramuscular
At birth (within 24 hours)
Anterolateral aspect of mid-thigh
• Dose, Route, Site & Schedule in Adults & Children:
- 0.5 ml if < 10 years, 1 ml if > 10 years
Intramuscular at upper arm , Given in 3 doses – 0, 1 & 6 months
• Adverse Reactions: Fever, Mild local reaction, severe anaphylaxis
• Storage: 2 – 80 C
Fractional Inactivated Polio Vaccine (f-IPV)
• Strains used: Mahoney, MEF-1 & Saukett (against serotypes 1, 2 & 3)
• Type of Vaccine: Killed Vaccine
• Dose, Route, Schedule & Site : 0.1 ml
Intradermal route
6 & 14 weeks
Right upper arm
Booster at 9 completed months along with MR vaccine
• Adverse Reactions: Minor local erythema, induration, tenderness.
• Advantages:
- No risk of VAPP (vaccine associated paralytic poliomyelitis)
- Can be given to persons with immunodeficiency diseases,
undergoing corticosteroid and radiation therapy, age over 50 years
and during pregnancy
Measles Vaccine
• Type of vaccine: Live attenuated vaccine – grown on chick embryo
• Strain used: Edmonston-Zagreb
• Dose, Route, Schedule & Site: 0.5 ml
Subcutaneous
9 - 12 months and 16 - 24 months
Right upper arm
• Adverse Reactions: Mild measles like reaction after 5 - 10 days
• Complication: Toxic shock syndrome
• Storage: 2-80 C
MR VACCINE
• Live Attenuated Vaccine
• Strain used: Measles: Edmonston, Rubella: RA 27/3
• Dose, Route, Site & Schedule:
0.5 ml,
Subcutaneous
9 - 12 months and 16 - 24 months
Right upper arm
• Adverse Reactions: Local reaction, fever, injection site abscess
• Complications: arthralgia, encephalopathy, febrile seizures,
thrombocytopenia.
• Diluent used: Distilled water and used within 4 hours of reconstitution
• Storage: 2 to 8 ̊c
Rota virus vaccine
• Type of vaccine: Live attenuated bovine-human rotavirus reassortant
[G1, G2, G3, G4 and G9] grown in Vero cells.
• Diluent used is a sterile solution of citrate bicarbonate buffer.
• Storage: Vaccine is stable for 24 months if stored at 2-25° C, for 1 hour if
stored at room temperature
• Dose, Route, Site & Schedule:
- 5 drops
- Oral
- At 6, 10 & 14 weeks
• Contraindications: Immunodeficiency, acute illness with fever,
known severe allergic reaction to components of vaccine.
Pneumococcal Conjugate Vaccine(PCV)
• “Pneumosil” – pneumonia vaccine by Serum Institute of India
• Type of Vaccine: Polysaccharide conjugate vaccine
• Dose, Route, Site & Schedule:
0.5 ml
Intramuscular
Anterolateral aspect of right mid-thigh
Three doses at 6 weeks,14 weeks and booster dose at 9 months
• Adverse reactions: Irritability, crying, swelling and tenderness at
injection site and fever.
• Contraindications: Severe allergic reaction to prior dose, to
vaccines containing diphtheria toxoid, such as pentavalent vaccine
DPT VACCINE
• Combined triple vaccination for Diphtheria, Pertussis and Tetanus.
• Type of Vaccine: Killed vaccine
• Strain used: Diphtheria toxoid, Tetanus toxoid, whole cell pertussis
• Vaccine Composition: Each 0.5 ml contains
- Diphtheria Toxoid ≥ 30 IU (20 Lf to 30 Lf)
- Bordetella pertussis ≥ 4 IU
- Tetanus Toxoid ≥ 60 IU (5 Lf to 25 Lf)
- Aluminum Phosphate (Adjuvant) ≤ 1.25 mg
- Thiomersal (Preservative) 0.01% w/v
• Dose, Route, Site & Schedule: 0.5 ml
Deep Intramuscular
Anterolateral aspect of mid-thigh
At 16 - 24 months and at 5 - 6 years
• Adverse Reactions: Fever, Mild local reaction
• Complications: Encephalitis / Encephalopathy, Prolonged Convulsions,
Infantile Spasms
• Storage: 2 – 80 C
Td Vaccine
• Type of Vaccine: Toxoid Vaccine
• Strain used: Tetanus & Diphtheria toxoids
• TT is replaced by Td.
• Dose, Route & Schedule for children: 0.5 ml
Intramuscular
At 10 & 16 years
• Dose, Route & Schedule for Pregnant Women:
0.5 ml
Intramuscular
Td1 - Early in pregnancy
Td2 – 4 weeks after Td1.
• If received 2 Td doses in the last 3 years, only booster dose is given.
Japanese Encephalitis Vaccine(JE)
• Three types of JE vaccines
1. Mouse brain-derived, purified and inactivated vaccine – Nakayama or
Beijing strains of JE virus
2. Cell culture derived, inactivated JE vaccine – Beijing P-3 strain
3. Cell culture derived, live attenuated vaccine – SA 14-14-2 strain –
Freeze dried vaccine, reconstituted by adding 2.5 ml of diluent
JE
• Dose, Route, Site & Schedule: 0.5 ml
Subcutaneous
At 9 - 12 months and 16 - 24 months
Left upper arm
• Target: Children in age group 1-15 years of 83 endemic districts of Uttar
Pradesh, Assam, West Bengal and Karnataka
• Storage: Below 80C
Covaxin
• Covaxin is an inactivated whole virus vaccine, containing SARS-
CoV-2 particles.
• Manufactured by Bharath Biotech.
• Covaxin contains two adjuvants -
chemicals designed to strengthen the immune responseto the
vaccine - aluminium hydroxide, and
a toll-like receptor (TLR) 7/8 agonist.
• Dosage, Route, Site and Schedule :
0.5 ml
Intramuscularly
Deltoid
2 doses that are given at least 28 days apart.
• AEFI: pain at the injection site, followed by headache, fatigue and
fever.
• Efficacy rate: 77.8% against symptomatic COVID-19 infections
according to phase 3 trial
Rabies Vaccine
• Type of Vaccine: Inactivated / Killed Whole Cell Vaccine
• Strain used: Fixed strain, grown on Purified Chicken Embryo Cell Vaccine
/ Purified Vero Cell Vaccine
• Vaccine Composition: Each vial contains
- Virus concentration: ≥ 2.5 IU
- Stabilizers: Maltose and Human Albumin
- Preservative: Thiomersal 0.015%
• Post-Exposure Prophylaxis
1. Essen Regimen: 0.5 / 1 ml, Deltoid region, intramuscular 5 doses
on Days 0, 3, 7, 14 and 28.
2. Zagreb Regimen: 0.5 / 1 ml, Deltoid region, intramuscular, 4 doses
on Days 0, 7 and 21 (2-1-1).
3. Thai Red Cross Regimen: 0.1 ml, Deltoid / Thigh , 8 intradermal doses
on Days 0, 3, 7 and 28 (2-2-2-0-2).
• Pre-Exposure Prophylaxis
1. I.M - 0.5 / 1 ml, deltoid / Thigh region, 3 doses
on day 0, 7, 21 or 28
2. I.D – 0.1 ml, deltoid / Thigh region, 3 doses
on day 0,7, 21 or 28
• Adverse Reactions: Local redness, pain, headache & fever
• Storage: 2 – 80 C
