Immunization schedule in Pakistan in Children

1. Immunization
By
Dr. Imran Mahmood
Associate Professor
Department of Pediatrics
Fazaia Medical College, Islamabad

2. Pediatric Learning Resources
Theory Books

3. Clinical Methods’ Books

4. Definition of Immunization
 It is the process of rendering the subject immune by inoculating with a
specific antigen which induces an immune response.

5. Types of Immunity
 Active immunity:
 It is produced by administering vaccine or toxoid.
 Long lasting.
 Passive immunity:
 It is produced by administering immunoglobulins
 This produces immediate protection which only lasts for some weeks or months

6. Herd Immunity
 Herd immunity exists if the number of people in a community who have
active immunity against an infection exceeds a critical level .
 If this level is achieved then even non-vaccinated individuals are protected
from getting the disease .

7. Vaccine
 The vaccine is usually a protein similar to part of a virulent infectious
organism that can be recognized by the individual’s immune system, which
then produces antibodies or cell-mediated immunity against the antigen in
the vaccine .

8. Types of Vaccines
 Live attenuated vaccine
 A virulent organism is weakened so that it produces an antigenic response without
the serious consequences of a wild organism infection .
 Killed or inactivated vaccines
 Prepared from preformed antigen inactivated by heat, phenol , formaldehyde or
some other means.
 Conjugated Vaccines
 Conjugated with other antigens in an attempt to improve the immunological
response
 Toxoids
 These are toxins , which have been rendered non-toxic by treatment with
formaldehyde, but their antigenicity is maintained

9. Antibacterial vaccines
 Live attenuated bacteria:
 BCG, oral typhoid
 Killed bacteria:
 Pertussis , Cholera and injectable typhoid.
 Toxoids:
 Diphtheria, Tetanus.
 Polysaccharide vaccines :
 Meningococcal, Pneumococcal, H. Influenzae type b.

10. Antiviral Vaccines
 Live attenuated virus:
 Oral poliomyelitis, measles , mumps, rubella, and yellow fever.
 Completely inactivated virus:
 Influenza, injectable polio, Rabies.
 Genetically engineered vaccines:
 Hepatitis B

11. Expanded Program on Immunisation of
Pakistan- Launched in 1977

13. EPI Schedule

14. Oral Vaccines
 Oral Polio Vaccine
 Dose: 2 drops
 Rotavirus Vaccines
 Dose: 1.5 ml Prefilled syringe

15. Injectable Vaccines
 Intradermal
 BCG
 Dose: 0.05ml
 Intramuscular
 Pentavalent
 Diphtheria, Pertussis, Tetanus, Hepatitis B, H. Influenza Type b
 Pneumococcal
 Injectable Polio Vaccine Dose 0.5ml
 Subcutaneous
 Measles

16. Contraindications
 Live vaccines are contraindicated in
 Immune deficient children
 Children on steroids and chemotherapy
 Children with Organ transplant
 House hold members of above children
 Within 6 weeks of receiving immunoglobulins
 Pertussis is contraindicated in
 Epilepsy
 Encephalopathy
 All
 Anaphylactic reaction to previous vaccines.
 High grade fever above 102oF

17. Adverse Effects
 Fever
 Swelling, redness or pain at vaccination site
 Deep abscess (BCG)
 Lymphadenopathy (BCG)
 Generalized TB in immunocompromised children(BCG, rare)
 Vaccine induced Paralytic polio in immunocompromised
children(BCG1:6million)
 Inconsolable cry (pertussis)

18. Non-EPI vaccines
 Mumps
 Rubella
 Meningococcal
 Typhoid
 Cholera
 Hepatitis A
 Varicella
 Rabies

19. References
 Basis of Pediatrics by Dr. Pervez Akbar, 10th Edition.
 http://www.epi.gov.pk/immunisation-schedule/

20. Thank You

21. Questions and
Comments??