immunisation dr.m.l.siddaraju. definition protection from preventable diseases,disabilities and...
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IMMUNISATIONIMMUNISATION
Dr.M.L.SiddarajuDr.M.L.Siddaraju
DEFINITIONDEFINITION
Protection from preventable Protection from preventable diseases,disabilities and deaths.diseases,disabilities and deaths.
Birth right of every childBirth right of every child Most costeffective healthcare interventionMost costeffective healthcare intervention Greek word ‘ímmune’ means ‘ to be protected Greek word ‘ímmune’ means ‘ to be protected
’.’.
Acquired immunity: protection offered by Acquired immunity: protection offered by introduction of various antigens or antibodiesintroduction of various antigens or antibodies
The process by which this is obtained is The process by which this is obtained is known as immunisationknown as immunisation
Active immunisation: Specific Active immunisation: Specific antigens antigens evoke evoke the needed immune responsethe needed immune response
Passive immunisation:Antibodies are supplied Passive immunisation:Antibodies are supplied readymade as immunoglobulins and sera.readymade as immunoglobulins and sera.
Some definitionsSome definitions
Vaccination: Process of inoculating the Vaccination: Process of inoculating the vaccine or the antigenvaccine or the antigen
Immunisation: Process of inducing immune Immunisation: Process of inducing immune response, humoral or cell mediated.response, humoral or cell mediated.
Seroconversion: Change from antibody Seroconversion: Change from antibody negative state to antibody positive state.negative state to antibody positive state.
Seroprotection: The state of protection (from Seroprotection: The state of protection (from disease) due to presence of humoral immunity disease) due to presence of humoral immunity or antibody detectable in serumor antibody detectable in serum
HistoryHistory
Jenner: Cowpox vaccine – 1796Jenner: Cowpox vaccine – 1796 Pasteur: Rabies prophylaxis – 1885Pasteur: Rabies prophylaxis – 1885 EPI: WHO 1974, India – 1978EPI: WHO 1974, India – 1978 UIP: India – 1985UIP: India – 1985 Child vaccine initiative: with support from several Child vaccine initiative: with support from several
international agencies – 1991international agencies – 1991 Global programme on vaccines: WHO – 1993Global programme on vaccines: WHO – 1993 Global alliance for vaccine and immunisation - 1999Global alliance for vaccine and immunisation - 1999
ACHIEVEMENTS ACHIEVEMENTS
Small pox eradicated in 1977Small pox eradicated in 1977
EPI coverage of > 80% by 1990EPI coverage of > 80% by 1990
Certification for polio eradication by 2005Certification for polio eradication by 2005
Over 3 million lives saved globally, annuallyOver 3 million lives saved globally, annually
Types of vaccinesTypes of vaccines
Live bacteria- BCG, Ty 21 aLive bacteria- BCG, Ty 21 a Live virus – OPV, MMRLive virus – OPV, MMR Killed bacteria – Pertussis, S.typhiKilled bacteria – Pertussis, S.typhi Killed virus – IPV, Rabies, HAVKilled virus – IPV, Rabies, HAV Toxoid – DT, TTToxoid – DT, TT Capsular polysaccharide – HiB, Pneumo, MeningoCapsular polysaccharide – HiB, Pneumo, Meningo Viral subunit - HBsAgViral subunit - HBsAg Bacterial subunit – Acellular pertussisBacterial subunit – Acellular pertussis
National Immunisation National Immunisation ScheduleSchedule
AgeAge VaccineVaccine
BirthBirth BCG, OPV – 0BCG, OPV – 0
6 wks6 wks DPT –1, OPV –1DPT –1, OPV –1
10 wks10 wks DPT – 2, OPV – 2DPT – 2, OPV – 2
14wks14wks DPT – 3. OPV – 3DPT – 3. OPV – 3
9 months9 months MeaslesMeasles
15-18 months15-18 months DPT – 4, OPV –4DPT – 4, OPV –4
5 years5 years DTDT
10 years10 years TTTT
16 years16 years TTTT
Pregnant womenPregnant women 2 TT at 4 wks interval2 TT at 4 wks interval
IAP immunisation timetableIAP immunisation timetableAgeAge VaccineVaccine
Birth – 2 wksBirth – 2 wks BCGBCG
Birth, 6, 10, 14 wks, 16-18 Birth, 6, 10, 14 wks, 16-18 mo, 5 yrsmo, 5 yrs
OPVOPV
Birth, 6, 10, 14 wks, 16-18 Birth, 6, 10, 14 wks, 16-18 mo, 5 yrsmo, 5 yrs
DPTDPT
Birth., 6, 14 wks / 6, 10, 14 Birth., 6, 14 wks / 6, 10, 14 wkswks
Hepatitis BHepatitis B
Birth, 6, 10, 14 wks, 16-18 Birth, 6, 10, 14 wks, 16-18 momo
HiB ConjugateHiB Conjugate
9 mo plus9 mo plus MeaslesMeasles
15 months15 months MMRMMR
2 years2 years TyphoidTyphoid
10., 1610., 16 TT / dTTT / dT
Pregnant womenPregnant women 2 doses of TT2 doses of TT
Additional vaccinesAdditional vaccines
Varicella – above 1 yrVaricella – above 1 yr Hepatitis A – above 2 yrHepatitis A – above 2 yr
Cold chainCold chain The system of transporting, distributing and storing vaccines from The system of transporting, distributing and storing vaccines from
the manufacturers right up to the point of use under refrigeration the manufacturers right up to the point of use under refrigeration using any convenient method is referred to as cold chainusing any convenient method is referred to as cold chain
Vital link in immunisationVital link in immunisation If not maintained, vaccine efficacy will grossly sufferIf not maintained, vaccine efficacy will grossly suffer Safe temp. zone – mandatory to maintain potencySafe temp. zone – mandatory to maintain potency Safe zone for short term storage (1-2 months)is 2-8 deg C. For long Safe zone for short term storage (1-2 months)is 2-8 deg C. For long
term storage –20 degC is used only for BCG,OPV,Measles/MMRterm storage –20 degC is used only for BCG,OPV,Measles/MMR The T series of vaccine(DPT,DT,TT),typhoid Vi,Hep B should not The T series of vaccine(DPT,DT,TT),typhoid Vi,Hep B should not
be frozen as once frozen the aluminium salts used as adjuvant will be frozen as once frozen the aluminium salts used as adjuvant will be desiccated and will act as irritantbe desiccated and will act as irritantsterile abcesssterile abcess
NAMENAME BCG-LAV.Danish bovine strainBCG-LAV.Danish bovine strain
CONTENTCONTENT BCG strain of bovine mycobacterium-BCG strain of bovine mycobacterium-3-10 million bac/dose3-10 million bac/dose
PREPARATNPREPARATN LyophilisedLyophilised
INITIATIONINITIATION At birth/first contactAt birth/first contact
SCHEDULESCHEDULE Single doseSingle dose
BOOSTERBOOSTER NilNil
DOSEDOSE 0.05 ml(newborn)0.1 ml(infants and 0.05 ml(newborn)0.1 ml(infants and childrenchildren
ADMNSTRNADMNSTRN Intra dermal left deltoidIntra dermal left deltoid
EFFICACYEFFICACY 0-80%0-80%
C/IC/I ImmunodeficiencyImmunodeficiency
S/ES/E Axillary adenitisAxillary adenitis
NAMENAME DPT-killed pertusis+toxoid DPT-killed pertusis+toxoid diph&tetanusdiph&tetanus
OPV-LAVOPV-LAV
CONTENTCONTENT Diph tox 20 Lf,Tet tox 5 Diph tox 20 Lf,Tet tox 5 Lf.Pertusis 6 IU(40,000 Lf.Pertusis 6 IU(40,000 million killed bacteria million killed bacteria +ALPO+ALPO44-3 mg-3 mg
SABIN, type 1-SABIN, type 1-101066(CCID 50),type-2-(CCID 50),type-2-101055(CCID 50),type-3- (CCID 50),type-3- 101055(CCID50(CCID50
PREPARATNPREPARATN LiquidLiquid LiquidLiquid
INITIATIONINITIATION 6 wks6 wks BirthBirth
SCHEDULESCHEDULE 3 doses 6,10,14 wks3 doses 6,10,14 wks Birth,6,10,14 wksBirth,6,10,14 wks
BOOSTERBOOSTER 15- 18 mo,5 yrs15- 18 mo,5 yrs 15- 18 mo,5 yrs15- 18 mo,5 yrs
DOSEDOSE 0.5 ml0.5 ml 2 drops2 drops
ADMNSTRNADMNSTRN I/M lat thighI/M lat thigh OralOral
EFFICACYEFFICACY P80%D80%T100%P80%D80%T100% 80-90%80-90%
C/IC/I Prog neuro dis,uncontrolled Prog neuro dis,uncontrolled cry,convulsion, severe rxn cry,convulsion, severe rxn for 1for 1stst dose dose
Immuno Immuno defeciency,HIVdefeciency,HIV
S/ES/E Fever,local indurn,painFever,local indurn,pain nonenone
NAMENAME Hepatits B(HBsAg)Hepatits B(HBsAg) Measles(LAV)Measles(LAV)
CONTENTCONTENT Plasma derived/yeast derived Plasma derived/yeast derived r-DNA/CHO cells derived r-r-DNA/CHO cells derived r-DNADNA
1000TCID50.Schwarz or 1000TCID50.Schwarz or Edmonston Zagreb strain Edmonston Zagreb strain 1000 TCID/CCID1000 TCID/CCID
PREPARATNPREPARATN LiquidLiquid LyophilisedLyophilised
INITIATIONINITIATION Birth w/ I 48 hrsBirth w/ I 48 hrs6 wks6 wks >9 mo>9 mo
SCHEDULESCHEDULE Birth,6,14 wks/0,1,6 monthsBirth,6,14 wks/0,1,6 months 1 dose at 9-12 mo.21 dose at 9-12 mo.2ndnd doseafter 3 mo if 1doseafter 3 mo if 1stst dose<9 modose<9 mo
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 10 microgram,0.5 ml(<10 10 microgram,0.5 ml(<10 yrs), 1 ml(>10 yrs)yrs), 1 ml(>10 yrs)
0.5 ml0.5 ml
ADMNSTRNADMNSTRN I/M deltoidI/M deltoid S/C deltoidS/C deltoid
EFFICACYEFFICACY 90%90% 95%95%
C/IC/I NoneNone Imm def,anaphylaxis,egg Imm def,anaphylaxis,egg protein allergyprotein allergy
S/ES/E Local pain,erythemaLocal pain,erythema Fever ,rash after a weekFever ,rash after a week
NAMENAME MMR(LAV)MMR(LAV) Mumps(LAV)Mumps(LAV)
CONTENTCONTENT Measles as Measles as above,Mumps5000 TCID of above,Mumps5000 TCID of Urabe AM-9,Rubella 1000 Urabe AM-9,Rubella 1000 TCID of Wistar RA/3MTCID of Wistar RA/3M
L-Zagreb/Jerry Lynn L-Zagreb/Jerry Lynn strain 5000TCIDstrain 5000TCID
PREPARATNPREPARATN LyophilisedLyophilised LyophilisedLyophilised
INITIATIONINITIATION 15 mo15 mo 15 mo with M&R or at 15 mo with M&R or at 11 yrs11 yrs
SCHEDULESCHEDULE Single doseSingle dose Single doseSingle dose
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 0.5ml0.5ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC deltoidSC deltoid SC deltoidSC deltoid
EFFICACYEFFICACY 95%95% 90-95%90-95%
C/IC/I As in measles+pregnancyAs in measles+pregnancy Imm defImm def
S/ES/E As in measlesAs in measles FeverFever
NAMENAME H Infl b(conjugate) H Infl b(conjugate) PRPD/PRPT/HBOCPRPD/PRPT/HBOC
TYPHOID(KILLED)TYPHOID(KILLED)
CONTENTCONTENT H.Infl capsular H.Infl capsular oligosaccharide –boligosaccharide –b
S.typhi 1000 million S.typhi 1000 million killed/mlkilled/ml
PREPARATNPREPARATN Liquid/freeze driedLiquid/freeze dried LiquidLiquid
INITIATIONINITIATION 6 wks6 wks 2 yrs2 yrs
SCHEDULESCHEDULE 6,10,14 wks/2,4,6 mo6,10,14 wks/2,4,6 mo 2 doses 4 wks apart2 doses 4 wks apart
BOOSTERBOOSTER After 1 yrAfter 1 yr Every 3 yrs Every 3 yrs
DOSEDOSE 0.5 ml.10 mcg0.5 ml.10 mcg 0.25 ml<10yrs,0.5 0.25 ml<10yrs,0.5 ml>10 yrsml>10 yrs
ADMNSTRNADMNSTRN SC/IM-deltoid/ant lat thighSC/IM-deltoid/ant lat thigh SC deltoidSC deltoid
EFFICACYEFFICACY 90-100%90-100% 57-75%57-75%
C/IC/I NoneNone NoneNone
S/ES/E Local rxn,feverLocal rxn,fever Local rxn,fever Local rxn,fever
NAMENAME TYPHOID(Vi TYPHOID(Vi polysaccharidepolysaccharide
TYPHOID oralTYPHOID oral
CONTENTCONTENT Vi capsular polysach Vi capsular polysach S.typhiS.typhi
Ty 21a strAin(10Ty 21a strAin(1099 organisms)organisms)
PREPARATNPREPARATN LiquidLiquid CapsuleCapsule
INITIATIONINITIATION >2 yrs>2 yrs >6yrs>6yrs
SCHEDULESCHEDULE Single doseSingle dose 3 doses on alternate 3 doses on alternate daysdays
BOOSTERBOOSTER Every 3 yrsEvery 3 yrs Every 3 yrsEvery 3 yrs
DOSEDOSE 25-50 mcg(0.5 ml)25-50 mcg(0.5 ml) 1 capsule1 capsule
ADMNSTRNADMNSTRN I/MI/M OralOral
EFFICACYEFFICACY 70%70% 70%70%
C/IC/I NoneNone NoneNone
S/ES/E Fever,pain,induratnFever,pain,induratn Abdominal Abdominal pain,vomiting, loose pain,vomiting, loose stoolsstools
NAMENAME Pneumococcal Pneumococcal HEP-A (inactivated HEP-A (inactivated vaccine)vaccine)
CONTENTCONTENT Capsular poly saccharideCapsular poly saccharide HM 175 of HAV HM 175 of HAV 720 ELU antigen/ml720 ELU antigen/ml
PREPARATNPREPARATN LyophilisedLyophilised LiquidLiquid
INITIATIONINITIATION >2 yrs>2 yrs >2 yrs>2 yrs
SCHEDULESCHEDULE Single doseSingle dose 2 doses 0, 6 mo2 doses 0, 6 mo
BOOSTERBOOSTER Every 3-5 yrsEvery 3-5 yrs NilNil
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC/IM over Ant. Lat SC/IM over Ant. Lat thighthigh
IM antero lat thighIM antero lat thigh
EFFICACYEFFICACY 85-90 %85-90 % 99%99%
C/IC/I First trimester pregnancyFirst trimester pregnancy NoneNone
S/ES/E nonenone Mild reactionMild reaction
NAMENAME Varicella vaccineVaricella vaccine Meningococcal A+CMeningococcal A+C
CONTENTCONTENT OKA strain of varicella OKA strain of varicella zoster10zoster1033(3 PFU)(3 PFU)
N.meningitidis N.meningitidis groupA,C 50 mcg eachgroupA,C 50 mcg each
PREPARATNPREPARATN LyophilisedLyophilised LyophilisedLyophilised
INITIATIONINITIATION >1 yr>1 yr For use only in endemic For use only in endemic areas during areas during epidemics.>2 yrsepidemics.>2 yrs
SCHEDULESCHEDULE 1-12 yrs(single dose),>13 1-12 yrs(single dose),>13 yrs 2 doses 1 mo apartyrs 2 doses 1 mo apart
Single doseSingle dose
BOOSTERBOOSTER NilNil 5 yrs5 yrs
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC deltoidSC deltoid SC/IM-deltoid/Ant lat SC/IM-deltoid/Ant lat thighthigh
EFFICACYEFFICACY 95-100%95-100% 90-100%90-100%
C/IC/I NoneNone NoneNone
S/ES/E Varicella type rash after 1 Varicella type rash after 1 wk with feverwk with fever
Local rxn, mild feverLocal rxn, mild fever
NAMENAME Japanese encephalitis(killed Japanese encephalitis(killed monovalent)monovalent)
Influenza Influenza vaccine(inactivated-split vaccine(inactivated-split virion)virion)
CONTENTCONTENT Mouse brain(Nakayama/NIH Mouse brain(Nakayama/NIH strain) or Baby hamster strain) or Baby hamster kidney(P-3) or Recombinant kidney(P-3) or Recombinant DNA vaccineDNA vaccine
1.5 mcg hemaglutinin of 1.5 mcg hemaglutinin of each of the chosen strain each of the chosen strain as suspensionas suspension
PREPARATNPREPARATN Freeze dried /liquidFreeze dried /liquid LiquidLiquid
INITIATIONINITIATION Same as meningo cocciSame as meningo cocci All agesAll ages
SCHEDULESCHEDULE 2 doses 1-2 wks interval2 doses 1-2 wks interval Single doseSingle dose
BOOSTERBOOSTER After 3-4 yrsAfter 3-4 yrs Every year with current Every year with current strainstrain
DOSEDOSE 1 ml1 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC-deltoid/ant lat thighSC-deltoid/ant lat thigh SC/IMSC/IM
EFFICACYEFFICACY 60-80%,100% after booster60-80%,100% after booster 80-90%80-90%
C/IC/I NoneNone Egg protein allergyEgg protein allergy
S/ES/E Local swelling,fever,malaiseLocal swelling,fever,malaise Local reaction,feverLocal reaction,fever
NAMENAME DPT wc+HB combinationDPT wc+HB combination DPT wc+HibDPT wc+Hib
CONTENTCONTENT D and T toxoid+PWC+ D and T toxoid+PWC+ yeast derived r-DNA yeast derived r-DNA HBsAgHBsAg
D &T toxoid D &T toxoid PWC+capsular PWC+capsular polysaccharide of Hibpolysaccharide of Hib
PREPARATNPREPARATN LiquidLiquid Lyophilised/liquidLyophilised/liquid
INITIATIONINITIATION 6 weeks6 weeks 6 wks6 wks
SCHEDULESCHEDULE 6,10,14 wks6,10,14 wks 6,10,14 wks6,10,14 wks
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN IMIM IM IM
EFFICACYEFFICACY 90-100%90-100% 90-100%90-100%
C/IC/I Same as DPTSame as DPT NoneNone
S/ES/E Fever,pain,local indurationFever,pain,local induration Mild fever,local Mild fever,local indurationinduration
NAMENAME Rabies (tissue culture)-inactivatedRabies (tissue culture)-inactivated
CONTENTCONTENT 1.1. HDCV(virus grown in Human Diploid HDCV(virus grown in Human Diploid fibroblasts)fibroblasts)
2.2. PCEC (Chick embryo cells)PCEC (Chick embryo cells)
3.3. Vero cell(vervet monkey kidney cell)Vero cell(vervet monkey kidney cell)
PREPARATNPREPARATN LyophilisedLyophilised
INITIATIONINITIATION Any age-/after dog biteAny age-/after dog bite
SCHEDULESCHEDULE Pre expo:0.7,21 days.Post Pre expo:0.7,21 days.Post expo:0,3,7,14,28.Re expo0,7(<5 yrs), full expo:0,3,7,14,28.Re expo0,7(<5 yrs), full course(>5 yrs)course(>5 yrs)
BOOSTERBOOSTER First after 1 year then every 3 yrsFirst after 1 year then every 3 yrs
DOSEDOSE 0.5 ml/1ml depending on preparatn0.5 ml/1ml depending on preparatn
ADMNSTRNADMNSTRN S/C deltoid/ ant lat thighS/C deltoid/ ant lat thigh
EFFICACYEFFICACY 90-100%90-100%
C/IC/I NoneNone
S/ES/E Local pain,rarely encephalopathyLocal pain,rarely encephalopathy
BCG VaccineBCG Vaccine Attenuated M. Bovis developed in 1921Attenuated M. Bovis developed in 1921 Protects against TB meningitis ,Miliary T BProtects against TB meningitis ,Miliary T B Maternal antibodies do not interfere as CMI not Maternal antibodies do not interfere as CMI not
transplacentally transferredtransplacentally transferred Induces long term protectionInduces long term protection Supplied freeze dried and stored frozen or Supplied freeze dried and stored frozen or
refrigeratedrefrigerated Reconstituted vaccine to be used w/I 4-6 hrsReconstituted vaccine to be used w/I 4-6 hrs Dose 0.05 ml(infants),0.1 ml(infants and children)Dose 0.05 ml(infants),0.1 ml(infants and children) Intra-dermal over left deltoidIntra-dermal over left deltoid Local lesion due to bacterial multiplication which Local lesion due to bacterial multiplication which
heals leaving a scar in 12 wks(repeat if no scar)heals leaving a scar in 12 wks(repeat if no scar) C/I- Immune deficiencyC/I- Immune deficiency Side effect-Axillary adenitisSide effect-Axillary adenitis
OPVOPV
Live attenuated polio virus types1,2&3-developed by Live attenuated polio virus types1,2&3-developed by sabin ,1961sabin ,1961
Temperature sensitive store frozen or refrigeratedTemperature sensitive store frozen or refrigerated Can be given simultaneous with any other vaccineCan be given simultaneous with any other vaccine Multiple doses necessary to ensure vaccine virus take Multiple doses necessary to ensure vaccine virus take
and response to all three types of virusesand response to all three types of viruses IAP recommends additional doses of opv as a part of IAP recommends additional doses of opv as a part of
pulse polio program every year till age of 5 yrspulse polio program every year till age of 5 yrs
Why PULSE POLIO?Why PULSE POLIO?
On national immunisation days(NIDs) pulse doses of On national immunisation days(NIDs) pulse doses of oral polio vaccine has to be administered as oral polio vaccine has to be administered as simultaneous feeding of vaccine to all susceptibles is simultaneous feeding of vaccine to all susceptibles is neede to produce immunity, by preventing wild polio neede to produce immunity, by preventing wild polio viruses from multiplying in the gutviruses from multiplying in the gut
It is mandatory to give all reccomended doses in It is mandatory to give all reccomended doses in NIDs so that no wild virus remains in circulationNIDs so that no wild virus remains in circulation
OPV is contraindicated in OPV is contraindicated in immunodeficiency,HIV,active viral infectionsimmunodeficiency,HIV,active viral infections
No side effectsNo side effects
IPVIPV
Formaldehyde killed polio virus grown in Formaldehyde killed polio virus grown in monkey kidney or human diploid cellmonkey kidney or human diploid cell
Contains 20,8,32 D antigen units against type Contains 20,8,32 D antigen units against type 1,2,3 polio viruses respectively1,2,3 polio viruses respectively
Seroconversion 90-95% after 2 doses,99% Seroconversion 90-95% after 2 doses,99% after 3 dosesafter 3 doses
Thermo stable and indicated in Thermo stable and indicated in immunocompromised and HIVimmunocompromised and HIV
DPTDPT
Diphteria toxoid(Ramon &Glenny,1923)Diphteria toxoid(Ramon &Glenny,1923) Killed Bordetella pertusis(Madsen ,1923)Killed Bordetella pertusis(Madsen ,1923) Tetanus toxoid(Ramon & Zoeller,1927)Tetanus toxoid(Ramon & Zoeller,1927) Toxoids adjuvated (Aluminium hydroxide/ Toxoids adjuvated (Aluminium hydroxide/
phosphate)phosphate) Vaccine supplied as liquid, stored refrigeratedVaccine supplied as liquid, stored refrigerated Aluminium adjuvated vaccine must not be frozenAluminium adjuvated vaccine must not be frozen 0.5 ml injected IM on anterolateral asoect of thigh.0.5 ml injected IM on anterolateral asoect of thigh.
Parents must be alerted about local reaction Parents must be alerted about local reaction and fever(PCT given)and fever(PCT given)
IAP recommends 2IAP recommends 2ndnd booster at 5 yrs booster at 5 yrs H/O convulsion not contradictionH/O convulsion not contradiction Progressive neurological disease or serious Progressive neurological disease or serious
adverse reaction to earlier dose are adverse reaction to earlier dose are contraindications for DPT(replace with DT) contraindications for DPT(replace with DT)
MeaslesMeasles Live attenuated vaccine developed by Enders-Live attenuated vaccine developed by Enders-
19601960 Vaccine further attenuated by Schwarz, Vaccine further attenuated by Schwarz,
Edmonston-ZagrebEdmonston-Zagreb Supplied freeze dried- store frozen or refrigeratedSupplied freeze dried- store frozen or refrigerated Use reconstituted vaccine in 4-6 hrs(refrigerate do Use reconstituted vaccine in 4-6 hrs(refrigerate do
not freeze)not freeze) 0.5 ml injected S/C preferably right upper arm0.5 ml injected S/C preferably right upper arm Age at which recommended 9 monthsAge at which recommended 9 months During outbreak>6 monthsDuring outbreak>6 months If given < 9 mo repeat dose after 3 moIf given < 9 mo repeat dose after 3 mo Possibility of fever for 5-10 daysPossibility of fever for 5-10 days MMR-0.5ml S/C over deltoid(15 mo)MMR-0.5ml S/C over deltoid(15 mo)
TyphoidTyphoid
WHOLE CELLWHOLE CELL: : Killed S.typhi often with S.paratyphi A(TA)Killed S.typhi often with S.paratyphi A(TA) Developed by Wright ,1896Developed by Wright ,1896 Liquid,store refrigerated,inject S/CLiquid,store refrigerated,inject S/C Primary course:2 doses 4 wks apart at 6-9 mo of age Primary course:2 doses 4 wks apart at 6-9 mo of age
or at any ageor at any age Boosters once in 3-5 yrsBoosters once in 3-5 yrs Dose :0.25-0.5 ml S/C for primary,0.1ml for boosterDose :0.25-0.5 ml S/C for primary,0.1ml for booster
Vi POLSACCHARIDEVi POLSACCHARIDE:: Developed by Robbins,1984Developed by Robbins,1984 Liquid, adjuvated,store refrigeratedLiquid, adjuvated,store refrigerated Inject IM at or after 2 yrs of age(0.5 ml)Inject IM at or after 2 yrs of age(0.5 ml) Booster after 3 yrsBooster after 3 yrs
ORALORAL:: Live attenuated S.typhi developed by Live attenuated S.typhi developed by
Germanier,1975Germanier,1975 Strain name:Ty 21aStrain name:Ty 21a Enteric coated capsules,store refrigerated, Enteric coated capsules,store refrigerated,
administer orally 3 doses on alternate daysadminister orally 3 doses on alternate days Repeat 3-5 yrs laterRepeat 3-5 yrs later Recommende age7 yrs or aboveRecommende age7 yrs or above
Hib vaccineHib vaccine
H . Influenza B-capsular polysaccharideH . Influenza B-capsular polysaccharide Liquid or freeze driedLiquid or freeze dried Age of initiation 6 wksAge of initiation 6 wks 3 doses 6,10,14 wks/2,4,6 mo3 doses 6,10,14 wks/2,4,6 mo Booster 1 yr after primary doseBooster 1 yr after primary dose Dose 0.5 ml SC/IM over deltoid or Dose 0.5 ml SC/IM over deltoid or
anterolateral aspect of thighanterolateral aspect of thigh
ADDITIONAL VACCINESADDITIONAL VACCINES
Varicella vaccineVaricella vaccine:: Developed by Takahashi in 1971,JapanDeveloped by Takahashi in 1971,Japan Live attenuated Oka strain.Live attenuated Oka strain. Vaccine available as lyophilized powderVaccine available as lyophilized powder Dissolve in 0.5 ml diluentDissolve in 0.5 ml diluent SC 0.5 mlSC 0.5 ml Single dose 1-12 yrsSingle dose 1-12 yrs >13 yrs 2 doses at 1 mo interval>13 yrs 2 doses at 1 mo interval
Hepatitis AHepatitis A
Inactivated vaccine containing H M 175 strain Inactivated vaccine containing H M 175 strain grown in MRC5 cell line.grown in MRC5 cell line.
Pediatric formulation 720 ELU IM; 2 doses 6 Pediatric formulation 720 ELU IM; 2 doses 6 mo apart between 2-18 yrsmo apart between 2-18 yrs
>19 yrs 1440 ELU 2 doses 6 months apart>19 yrs 1440 ELU 2 doses 6 months apart Efficacy 94-100%Efficacy 94-100% No boostersNo boosters
Vaccines recommended during Vaccines recommended during epidemicsepidemics
Japanese B Encephalitis vaccineJapanese B Encephalitis vaccine Meningococcal A&CMeningococcal A&C
Vaccines for high risk groupVaccines for high risk group
PNEUMOCOCCAL VACCINEPNEUMOCOCCAL VACCINE:: Polysaccharide vaccine(23 valent)Polysaccharide vaccine(23 valent) 7 Valent conjugated with CRM 197 diphtheria 7 Valent conjugated with CRM 197 diphtheria
toxintoxin 23 valent effective after 2 yrs of age23 valent effective after 2 yrs of age Single dose 0.5 ml IM with booster every 3-5 Single dose 0.5 ml IM with booster every 3-5
yrsyrs
Indications Indications
Sickle cell diseaseSickle cell disease Nephrotic syndrome in remissionNephrotic syndrome in remission Congenital or acquired asplenia/splenic dys functionCongenital or acquired asplenia/splenic dys function HIVHIV Chronic cardiac/pulmonary diseaseChronic cardiac/pulmonary disease Immunodeficient conditionsImmunodeficient conditions CSF leakCSF leak Diabetes mellitusDiabetes mellitus
Combination vaccinesCombination vaccines
DPT/HiB/HepBDPT/HiB/HepB Benefits:Benefits: 1. Reduced number of injections1. Reduced number of injections 2. Reduced pain and parental anxiety2. Reduced pain and parental anxiety 3. High compliance, low drop out rates,enhanced 3. High compliance, low drop out rates,enhanced
coveragecoverage 4. Reduced no: of visits4. Reduced no: of visits 5. Less storage space5. Less storage space 6. Less burden on cold chain6. Less burden on cold chain
Vaccination schedule for Vaccination schedule for unimmunised childunimmunised child
<5 yrs<5 yrs >5 yrs>5 yrs
First visitFirst visit BCG,OPV,DPT,BCG,OPV,DPT,HBHB
TT/Td,HBTT/Td,HB
22NDND visit(1 mo visit(1 mo later)later)
OPV,DPT,HBOPV,DPT,HB TT/Td,HBTT/Td,HB
33RDRD visit(1 mo visit(1 mo later)later)
OPV,DPT,MMOPV,DPT,MMR/Measles,TyphR/Measles,Typh
MMR,TyphMMR,Typh
1 yr later1 yr later OPV,DPT,HBOPV,DPT,HB HBHB
Every 3 yrsEvery 3 yrs Typh boosterTyph booster Typh boosterTyph booster
Newer vaccinesNewer vaccines
Live attenuated varicella(oka)strainLive attenuated varicella(oka)strain Killed hep A virus vaccineKilled hep A virus vaccine 23 valent pneumococcal vaccine23 valent pneumococcal vaccine Influenza virus vaccineInfluenza virus vaccine Combination vaccinesCombination vaccines
Vaccines available in other Vaccines available in other countries countries
Conjugated pneumococcal vaccine(7 valent)Conjugated pneumococcal vaccine(7 valent) Conjugated S.typhi Vi vaccineConjugated S.typhi Vi vaccine Rota virus vaccineRota virus vaccine Combination vaccinesCombination vaccines
ADVERSE EFFECTSADVERSE EFFECTS
ADVERSE ADVERSE EVENTEVENT
VACVACCINCIN
EE
SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
AnaphylaxisAnaphylaxis anyany W/I minutes,acute W/I minutes,acute decompensation of decompensation of circ. circ. System,hypovolemic System,hypovolemic shock,laryngeal shock,laryngeal spasm/edema.Acute spasm/edema.Acute respiratory distressrespiratory distress
Adrenaline,CPR,IV Adrenaline,CPR,IV volume expanders volume expanders or or dopamine/dobutamdopamine/dobutamine, hydrocortisoneine, hydrocortisone
Hypotensive,Hypotensive,hyporesponsihyporesponsive episodesve episodes
DPTDPT Within 12 hrs.Acute Within 12 hrs.Acute paleness.Transient paleness.Transient decreased levels/loss decreased levels/loss of consciousness.Dec of consciousness.Dec muscle tonemuscle tone
IV fluids, IV fluids, dexamethasone,oxdexamethasone,oxygenygen
ADVERSE ADVERSE EVENTEVENT
VACCINEVACCINE SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
Incessant cryIncessant cry DPTDPT Within 48-72 Within 48-72 hrs.Excessive hrs.Excessive inconsolable inconsolable cryingcrying
Sedation with Sedation with triclofos-50mg/kg/triclofos-50mg/kg/day+PCT+feeding day+PCT+feeding adviceadvice
Toxic shock Toxic shock syndromesyndrome
Measles Measles contaminaticontamination by S. on by S. AureusAureus
Within 30 min- Within 30 min- few hrs. few hrs. Mounting Mounting fever,vomiting, fever,vomiting, diarrhoea,septic diarrhoea,septic shockshock
IV fluids,anti IV fluids,anti microbials,cloxacilmicrobials,cloxacillin 50-100 lin 50-100 mg/kg/day, mg/kg/day, steroids,antipyretisteroids,antipyretics,supportive cs,supportive therapytherapy
ADVERSE ADVERSE EVENTEVENT
VACCINEVACCINE SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
lymphadenitislymphadenitis BCGBCG Within 2-6 Within 2-6 months firm-soft months firm-soft axillary axillary lmphadenitis1.5-lmphadenitis1.5-3 cm with/ 3 cm with/ without sinuswithout sinus
If firm no If firm no treatment.If treatment.If soft&fluctuant soft&fluctuant HR3.Aspiration if HR3.Aspiration if needed.Steroid if needed.Steroid if sinus presentsinus present
Bacterial Bacterial abcessabcess
Any Any vaccinevaccine
Within 72 Within 72 hrs,fluctuant or hrs,fluctuant or firm abcess with firm abcess with or without feveror without fever
Antibiotics, Anti Antibiotics, Anti pyretics,drainage pyretics,drainage if neededif needed
ADVERSE ADVERSE EVENTEVENT
VACCINEVACCINE SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
Sterile abcessSterile abcess DPT,DT,TTDPT,DT,TT,Typhoid &,Typhoid &
HEP BHEP B
By 72 By 72 hrs ,minimum hrs ,minimum inflamation, no inflamation, no feverfever
Drainage if neededDrainage if needed
Moderate to Moderate to severe local severe local reactionreaction
Any Any vaccinevaccine
Non fluctuant Non fluctuant swelling/redness swelling/redness 3-10 cm in size 3-10 cm in size at injection siteat injection site
ParacetamolParacetamol
ADVERSE ADVERSE EVENTEVENT
VACCINEVACCINE SYMPTOMSSYMPTOMS MANAGEMENTMANAGEMENT
Seizures Seizures with with fever(rare)fever(rare)
DPT, DPT, measlesmeasles
Always Always generalised generalised simple/complexsimple/complex
Anticonvulsant,antAnticonvulsant,antipyretic,IV fluids ipyretic,IV fluids (if needed)(if needed)
IAP recommendations on IAP recommendations on Immunisation,2003Immunisation,2003
The IAPCOI-Indian Academy of Pediatrics The IAPCOI-Indian Academy of Pediatrics Committee On Immunisation,has formulated Committee On Immunisation,has formulated several scientific recommendations to other several scientific recommendations to other agencies pertaining to Immunisationagencies pertaining to Immunisation
Recommendation to federation of Recommendation to federation of OBG societies of IndiaOBG societies of India
To adopt routine testing of all pregnant women To adopt routine testing of all pregnant women for HBV infection and if mother is positive for HBV infection and if mother is positive baby should be given HBIG+HB vaccine soon baby should be given HBIG+HB vaccine soon after birthafter birth
Recommendations to Ministry Recommendations to Ministry of Health, Govt of Indiaof Health, Govt of India
1.1. The academy should be represented on National Technical The academy should be represented on National Technical Advisory Group on ImmunisationAdvisory Group on Immunisation
2.2. At 5 yrs booster immunisation with DPT rather than DT.At 5 yrs booster immunisation with DPT rather than DT.3.3. Inactivated polio vaccine should be licensed and gradually Inactivated polio vaccine should be licensed and gradually
introduced in phased mannerintroduced in phased manner4.4. Hep B and MMR vaccine should be included in national Hep B and MMR vaccine should be included in national
immunisation schedule immediatelyimmunisation schedule immediately5.5. Govt. should consider inclusion of typhoid vaccine(Vi Govt. should consider inclusion of typhoid vaccine(Vi
polysaccharide/whole cell inactivated) in the national polysaccharide/whole cell inactivated) in the national immunisation scheduleimmunisation schedule
6.6. Another vaccine to be included is HibAnother vaccine to be included is Hib7.7. Ensuring adequate supply of chick embryo/ tissue culture rabies Ensuring adequate supply of chick embryo/ tissue culture rabies
vaccinevaccine
SUMMING UPSUMMING UP
NAMENAME BCG-LAV.Danish bovine strainBCG-LAV.Danish bovine strain
CONTENTCONTENT BCG strain of bovine mycobacterium-BCG strain of bovine mycobacterium-3-10 million bac/dose3-10 million bac/dose
PREPARATNPREPARATN LyophilisedLyophilised
INITIATIONINITIATION At birth/first contactAt birth/first contact
SCHEDULESCHEDULE Single doseSingle dose
BOOSTERBOOSTER NilNil
DOSEDOSE 0.05 ml(newborn)0.1 ml(infants and 0.05 ml(newborn)0.1 ml(infants and childrenchildren
ADMNSTRNADMNSTRN Intra dermal left deltoidIntra dermal left deltoid
EFFICACYEFFICACY 0-80%0-80%
C/IC/I ImmunodeficiencyImmunodeficiency
S/ES/E Axillary adenitisAxillary adenitis
NAMENAME DPT-killed pertusis+toxoid DPT-killed pertusis+toxoid diph&tetanusdiph&tetanus
OPV-LAVOPV-LAV
CONTENTCONTENT Diph tox 20 Lf,Tet tox 5 Diph tox 20 Lf,Tet tox 5 Lf.Pertusis 6 IU(40,000 Lf.Pertusis 6 IU(40,000 million killed bacteria million killed bacteria +ALPO+ALPO44-3 mg-3 mg
SABIN, type 1-SABIN, type 1-101066(CCID 50),type-2-(CCID 50),type-2-101055(CCID 50),type-3- (CCID 50),type-3- 101055(CCID50(CCID50
PREPARATNPREPARATN LiquidLiquid LiquidLiquid
INITIATIONINITIATION 6 wks6 wks BirthBirth
SCHEDULESCHEDULE 3 doses 6,10,14 wks3 doses 6,10,14 wks Birth,6,10,14 wksBirth,6,10,14 wks
BOOSTERBOOSTER 15- 18 mo,5 yrs15- 18 mo,5 yrs 15- 18 mo,5 yrs15- 18 mo,5 yrs
DOSEDOSE 0.5 ml0.5 ml 2 drops2 drops
ADMNSTRNADMNSTRN I/M lat thighI/M lat thigh OralOral
EFFICACYEFFICACY P80%D80%T100%P80%D80%T100% 80-90%80-90%
C/IC/I Prog neuro dis,uncontrolled Prog neuro dis,uncontrolled cry,convulsion, severe rxn cry,convulsion, severe rxn for 1for 1stst dose dose
Immuno Immuno defeciency,HIVdefeciency,HIV
S/ES/E Fever,local indurn,painFever,local indurn,pain nonenone
NAMENAME Hepatits B(HBsAg)Hepatits B(HBsAg) Measles(LAV)Measles(LAV)
CONTENTCONTENT Plasma derived/yeast derived Plasma derived/yeast derived r-DNA/CHO cells derived r-r-DNA/CHO cells derived r-DNADNA
1000TCID50.Schwarz or 1000TCID50.Schwarz or Edmonston Zagreb strain Edmonston Zagreb strain 1000 TCID/CCID1000 TCID/CCID
PREPARATNPREPARATN LiquidLiquid LyophilisedLyophilised
INITIATIONINITIATION Birth w/ I 48 hrsBirth w/ I 48 hrs6 wks6 wks >9 mo>9 mo
SCHEDULESCHEDULE Birth,6,14 wks/0,1,6 monthsBirth,6,14 wks/0,1,6 months 1 dose at 9-12 mo.21 dose at 9-12 mo.2ndnd doseafter 3 mo if 1doseafter 3 mo if 1stst dose<9 modose<9 mo
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 10 microgram,0.5 ml(<10 10 microgram,0.5 ml(<10 yrs), 1 ml(>10 yrs)yrs), 1 ml(>10 yrs)
0.5 ml0.5 ml
ADMNSTRNADMNSTRN I/M deltoidI/M deltoid S/C deltoidS/C deltoid
EFFICACYEFFICACY 90%90% 95%95%
C/IC/I NoneNone Imm def,anaphylaxis,egg Imm def,anaphylaxis,egg protein allergyprotein allergy
S/ES/E Local pain,erythemaLocal pain,erythema Fever ,rash after a weekFever ,rash after a week
NAMENAME MMR(LAV)MMR(LAV) Mumps(LAV)Mumps(LAV)
CONTENTCONTENT Measles as Measles as above,Mumps5000 TCID of above,Mumps5000 TCID of Urabe AM-9,Rubella 1000 Urabe AM-9,Rubella 1000 TCID of Wistar RA/3MTCID of Wistar RA/3M
L-Zagreb/Jerry Lynn L-Zagreb/Jerry Lynn strain 5000TCIDstrain 5000TCID
PREPARATNPREPARATN LyophilisedLyophilised LyophilisedLyophilised
INITIATIONINITIATION 15 mo15 mo 15 mo with M&R or at 15 mo with M&R or at 11 yrs11 yrs
SCHEDULESCHEDULE Single doseSingle dose Single doseSingle dose
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 0.5ml0.5ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC deltoidSC deltoid SC deltoidSC deltoid
EFFICACYEFFICACY 95%95% 90-95%90-95%
C/IC/I As in measles+pregnancyAs in measles+pregnancy Imm defImm def
S/ES/E As in measlesAs in measles FeverFever
NAMENAME H Infl b(conjugate) H Infl b(conjugate) PRPD/PRPT/HBOCPRPD/PRPT/HBOC
TYPHOID(KILLED)TYPHOID(KILLED)
CONTENTCONTENT H.Infl capsular H.Infl capsular oligosaccharide –boligosaccharide –b
S.typhi 1000 million S.typhi 1000 million killed/mlkilled/ml
PREPARATNPREPARATN Liquid/freeze driedLiquid/freeze dried LiquidLiquid
INITIATIONINITIATION 6 wks6 wks 2 yrs2 yrs
SCHEDULESCHEDULE 6,10,14 wks/2,4,6 mo6,10,14 wks/2,4,6 mo 2 doses 4 wks apart2 doses 4 wks apart
BOOSTERBOOSTER After 1 yrAfter 1 yr Every 3 yrs Every 3 yrs
DOSEDOSE 0.5 ml.10 mcg0.5 ml.10 mcg 0.25 ml<10yrs,0.5 0.25 ml<10yrs,0.5 ml>10 yrsml>10 yrs
ADMNSTRNADMNSTRN SC/IM-deltoid/ant lat thighSC/IM-deltoid/ant lat thigh SC deltoidSC deltoid
EFFICACYEFFICACY 90-100%90-100% 57-75%57-75%
C/IC/I NoneNone NoneNone
S/ES/E Local rxn,feverLocal rxn,fever Local rxn,fever Local rxn,fever
NAMENAME TYPHOID(Vi TYPHOID(Vi polysaccharidepolysaccharide
TYPHOID oralTYPHOID oral
CONTENTCONTENT Vi capsular polysach Vi capsular polysach S.typhiS.typhi
Ty 21a strAin(10Ty 21a strAin(1099 organisms)organisms)
PREPARATNPREPARATN LiquidLiquid CapsuleCapsule
INITIATIONINITIATION >2 yrs>2 yrs >6yrs>6yrs
SCHEDULESCHEDULE Single doseSingle dose 3 doses on alternate 3 doses on alternate daysdays
BOOSTERBOOSTER Every 3 yrsEvery 3 yrs Every 3 yrsEvery 3 yrs
DOSEDOSE 25-50 mcg(0.5 ml)25-50 mcg(0.5 ml) 1 capsule1 capsule
ADMNSTRNADMNSTRN I/MI/M OralOral
EFFICACYEFFICACY 70%70% 70%70%
C/IC/I NoneNone NoneNone
S/ES/E Fever,pain,induratnFever,pain,induratn Abdominal Abdominal pain,vomiting, loose pain,vomiting, loose stoolsstools
NAMENAME Pneumococcal Pneumococcal HEP-A (inactivated HEP-A (inactivated vaccine)vaccine)
CONTENTCONTENT Capsular poly saccharideCapsular poly saccharide HM 175 of HAV HM 175 of HAV 720 ELU antigen/ml720 ELU antigen/ml
PREPARATNPREPARATN LyophilisedLyophilised LiquidLiquid
INITIATIONINITIATION >2 yrs>2 yrs >2 yrs>2 yrs
SCHEDULESCHEDULE Single doseSingle dose 2 doses 0, 6 mo2 doses 0, 6 mo
BOOSTERBOOSTER Every 3-5 yrsEvery 3-5 yrs NilNil
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC/IM over Ant. Lat SC/IM over Ant. Lat thighthigh
IM antero lat thighIM antero lat thigh
EFFICACYEFFICACY 85-90 %85-90 % 99%99%
C/IC/I First trimester pregnancyFirst trimester pregnancy NoneNone
S/ES/E nonenone Mild reactionMild reaction
NAMENAME Varicella vaccineVaricella vaccine Meningococcal A+CMeningococcal A+C
CONTENTCONTENT OKA strain of varicella OKA strain of varicella zoster10zoster1033(3 PFU)(3 PFU)
N.meningitidis N.meningitidis groupA,C 50 mcg eachgroupA,C 50 mcg each
PREPARATNPREPARATN LyophilisedLyophilised LyophilisedLyophilised
INITIATIONINITIATION >1 yr>1 yr For use only in endemic For use only in endemic areas during areas during epidemics.>2 yrsepidemics.>2 yrs
SCHEDULESCHEDULE 1-12 yrs(single dose),>13 1-12 yrs(single dose),>13 yrs 2 doses 1 mo apartyrs 2 doses 1 mo apart
Single doseSingle dose
BOOSTERBOOSTER NilNil 5 yrs5 yrs
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC deltoidSC deltoid SC/IM-deltoid/Ant lat SC/IM-deltoid/Ant lat thighthigh
EFFICACYEFFICACY 95-100%95-100% 90-100%90-100%
C/IC/I NoneNone NoneNone
S/ES/E Varicella type rash after 1 Varicella type rash after 1 wk with feverwk with fever
Local rxn, mild feverLocal rxn, mild fever
NAMENAME Japanese encephalitis(killed Japanese encephalitis(killed monovalent)monovalent)
Influenza Influenza vaccine(inactivated-split vaccine(inactivated-split virion)virion)
CONTENTCONTENT Mouse brain(Nakayama/NIH Mouse brain(Nakayama/NIH strain) or Baby hamster strain) or Baby hamster kidney(P-3) or Recombinant kidney(P-3) or Recombinant DNA vaccineDNA vaccine
1.5 mcg hemaglutinin of 1.5 mcg hemaglutinin of each of the chosen strain each of the chosen strain as suspensionas suspension
PREPARATNPREPARATN Freeze dried /liquidFreeze dried /liquid LiquidLiquid
INITIATIONINITIATION Same as meningo cocciSame as meningo cocci All agesAll ages
SCHEDULESCHEDULE 2 doses 1-2 wks interval2 doses 1-2 wks interval Single doseSingle dose
BOOSTERBOOSTER After 3-4 yrsAfter 3-4 yrs Every year with current Every year with current strainstrain
DOSEDOSE 1 ml1 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN SC-deltoid/ant lat thighSC-deltoid/ant lat thigh SC/IMSC/IM
EFFICACYEFFICACY 60-80%,100% after booster60-80%,100% after booster 80-90%80-90%
C/IC/I NoneNone Egg protein allergyEgg protein allergy
S/ES/E Local swelling,fever,malaiseLocal swelling,fever,malaise Local reaction,feverLocal reaction,fever
NAMENAME DPT wc+HB combinationDPT wc+HB combination DPT wc+HibDPT wc+Hib
CONTENTCONTENT D and T toxoid+PWC+ D and T toxoid+PWC+ yeast derived r-DNA yeast derived r-DNA HBsAgHBsAg
D &T toxoid D &T toxoid PWC+capsular PWC+capsular polysaccharide of Hibpolysaccharide of Hib
PREPARATNPREPARATN LiquidLiquid Lyophilised/liquidLyophilised/liquid
INITIATIONINITIATION 6 weeks6 weeks 6 wks6 wks
SCHEDULESCHEDULE 6,10,14 wks6,10,14 wks 6,10,14 wks6,10,14 wks
BOOSTERBOOSTER NilNil NilNil
DOSEDOSE 0.5 ml0.5 ml 0.5 ml0.5 ml
ADMNSTRNADMNSTRN IMIM IM IM
EFFICACYEFFICACY 90-100%90-100% 90-100%90-100%
C/IC/I Same as DPTSame as DPT NoneNone
S/ES/E Fever,pain,local indurationFever,pain,local induration Mild fever,local Mild fever,local indurationinduration
NAMENAME Rabies (tissue culture)-inactivatedRabies (tissue culture)-inactivated
CONTENTCONTENT 1.1. HDCV(virus grown in Human Diploid HDCV(virus grown in Human Diploid fibroblasts)fibroblasts)
2.2. PCEC (Chick embryo cells)PCEC (Chick embryo cells)
3.3. Vero cell(vervet monkey kidney cell)Vero cell(vervet monkey kidney cell)
PREPARATNPREPARATN LyophilisedLyophilised
INITIATIONINITIATION Any age-/after dog biteAny age-/after dog bite
SCHEDULESCHEDULE Pre expo:0.7,21 days.Post Pre expo:0.7,21 days.Post expo:0,3,7,14,28.Re expo0,7(<5 yrs), full expo:0,3,7,14,28.Re expo0,7(<5 yrs), full course(>5 yrs)course(>5 yrs)
BOOSTERBOOSTER First after 1 year then every 3 yrsFirst after 1 year then every 3 yrs
DOSEDOSE 0.5 ml/1ml depending on preparatn0.5 ml/1ml depending on preparatn
ADMNSTRNADMNSTRN S/C deltoid/ ant lat thighS/C deltoid/ ant lat thigh
EFFICACYEFFICACY 90-100%90-100%
C/IC/I NoneNone
S/ES/E Local pain,rarely encephalopathyLocal pain,rarely encephalopathy