immunisation dr.m.l.siddaraju. definition protection from preventable diseases,disabilities and...

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


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



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


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


ADMNSTRNADMNSTRN SC deltoidSC deltoid SC/IM-deltoid/Ant lat SC/IM-deltoid/Ant lat thighthigh



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



ADMNSTRNADMNSTRN IMIM IM IM


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)


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


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


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



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



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



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


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


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


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


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


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


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



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



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


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


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


ADMNSTRNADMNSTRN SC deltoidSC deltoid SC/IM-deltoid/Ant lat SC/IM-deltoid/Ant lat thighthigh



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



ADMNSTRNADMNSTRN IMIM IM IM


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)


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


C/IC/I NoneNone

S/ES/E Local pain,rarely encephalopathyLocal pain,rarely encephalopathy

immunisation dr.m.l.siddaraju. definition protection from preventable diseases,disabilities and...

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