Dr.
Susan Peter Lado
Family Medicine Physician
> 12 million children under 5 yr die every
year
3 million < 1 wk
2 million of these deaths could be
prevented by basic 6 vaccines
1st vaccine 200 yr ago- smallpox
Today more than 60 vaccines
Vaccination:
Administration of any
vaccine or toxoid for
prevention of disease
Immunization:
The process of inducing immunity
artificially by either vaccination
(active immunization) or
administration of antibodies (passive
immunization)
Passive immunization occurs
naturally through transplacental
transmission of antibodies- first 4-6
months of life
Vaccine: preparation of proteins,
polysaccharides, or nucleic acids of
pathogenic organisms
Toxoid: modified bacterial toxin made non-
toxic but capable of stimulating immunity
Immunoglobulin: antibody-containing
solution prepared from large pools of
human plasma
Antitoxin: antibody derived
from humans or animals after
stimulation with specific antigens
Most vaccines require a temperature of 2°C-
8°C- must not be freezed
OPV must be stored at < 0°C
Varicella virus vaccine must be stored at -
15°C or lower
Launched in 1974 by WHO
Age Vaccine
Birth BCG OPV0
6 weeks Penta 1 OPV1
10 weeks Penta 2 OPV2
14 weeks Penta 3 OPV3
9 months Measles (yellow
fever)
EPI plus: 6 vaccines+ HBV+ yellow fever v+
vit A+ iodine
Immunization is one of the most cost-
effective public health interventions
National immunization days NID.
OPV or IPV
Oral polio vaccine (Sabin)
Live-attenuated- 3 serotypes
Dose: 2 drops orally
Enhances intestinal immunity
Eradicates wild polio virus
Inactivated polio vaccine
(Salk)
Inactivated injectable vaccine
OPV IPV
Cheap Costy 5 times
Easy Painful
Gut immunity No
Mass immunization Individual
(herd immunity
Risk of paralysis: 2 in every 5 million doses
of OPV
Contraindications:
HIV infection
Immunodeficiency, tumours, drugs
Family member with immunodeficiency
Precautions: pregnancy
Live-attenuated
BCG→ bacille Calmett-Guerin
Intrademal injection at birth or any time thereafter
50-80% effective in preventing disseminated TB &
meningitis
Less effective in preventing pulm TB
Dose 0.05 ml
Contraindications: immunodeficiency
Side effects:
1. Local ulceration & lymphadenitis 0.1-1%
2. Immunodeficient individuals may develop
disseminated BCG infection
Live-attenuated
Injectable- subcutaneous
EPI→ 9 months
12-15 months in low endemic areas
6 & 9 months at high endemic areas
The least coverage of the EPI vaccines
Contraindications:
Anaphylaxis
Pregnancy
Immunodeficiency
Untreated tuberculosis
Precautions:
◦ Severe intercurrent illness
◦ Personal or family history of convulsions
May be combined with rubella & mumps in MMR
Part of triple vaccine DPT or DT or dT
Toxoid given as IM injection
Dose 0.5 ml
Given at anterior lateral thigh in infants
(gluteus intermedius)
Should be boosted every 10 years for life
The higher potency dose DT is used for
children up to 6 years of age
The less potency dose dT is used > 7 years
dT less amount of toxoid to decrease local
reaction
Side effects: local reaction
No contraindications
Neonatal tetanus
3Cs: clean hands, clean delivery surface,
clean cord cutting & care
80% of neonatal tetanus occur in only 12
countries: Ethiopia, Ghana, Nepal, Somalia
Women of child bearing age should be
immunized with at least 2 boosters
Non-immunized→ 5 doses
Two vaccines
Cellular as in DPT
Acellular as in DaPT
DaPT has ↓ side effects
Pertussis vaccine is not given after 7 years of age
because
◦ ↑ of side effects & local reaction
◦ Pertussis is mild disease in this age group
The commonest vaccine with severe side effects
Absolute contraindications:
1. Immediate anaphylactic shock
2. Encephalopathy within 7 days
Relative contraindications:
1. Convulsions within 3 days
2. Persistent, severe, inconsolable crying for ≥ 3hours
within 2 days
3. Collapse or shock within 2 days
4. Fever ≥ 40° within 2 days
DT should be given instead
Complications of the disease:
1. Chronic hepatitis
2. Cirrhosis
3. Hepatocellular carcinoma
4. Fulminant hepatic failure
100 times more infectious than HIV
Second only to tobacco as a cause of
cancer
Recommended by EPI
Has been introduced recently in S. Sudan
Recombinant DNA vaccine
Injectable IM
3 doses
Infants of mothers known to be HBsAg
positive should receive hepatitis B
immunoglobulin (HBIG) + vaccine
Live-attenuated
Single dose
Subcutaneous injection
0.5 ml
Immunity lasts for 30-35 yr probably for life.
Polysaccharide vaccine
Group A & C
Quadrivalent vaccine→ A,C,Y,W135
Group B is the most common during epidemics→
no vaccine
Not effective < 2 years of age
Indications :
1. During epidemics
2. Splenectomized patients & splenic dysfunction
eg sickle cell anaemia
Polysaccharide conjugate vaccine
Children < 18 months of age
3 doses
No contraindication
80-100% effective in protection against Hib
pneumonia & meningitis
Rubella & mumps vaccine:
◦ Live attenuated in MMR
◦ Single IM inj
◦ 12-15 months
Chickenpox vaccine: SHOW
◦ Live attenuated
◦ Single inj
◦ 1-12 years
Pneumoccocal vaccine:
◦ Polysaccharide
◦ Injectable
Respiratory syncytial virus RSV vaccine
Rota virus vaccine→ intussusception
Typhoid fever vaccine
◦ Inactivated whole cell-3 inj- one month apart
◦ Oral live-attenuated vaccine
Hepatitis A vaccine:
◦ Inactivated vaccine
◦ Oral drops
◦ 2-3 drops
Cholera vaccine:
◦ Inactivated whole cell injectable vaccine
◦ Partial protection for up to 4 months
Shigella vaccine
E coli vaccine
HIV vaccine
Malaria vaccine
Schistosomiasis vaccine
Dengue fever vaccine SHOW
Herpes simplex
Cervical cancer- human papillomavirus
