Immunization

3. TERMENOLOGY
IMMUNITY: The resistance offered by host to the harmful effects
of pathogenic microbial infection is called immunity.
INNATE IMMUNITY: the basic immunity which is generally passed
on from one generation to other. So, it is present in individual by
birth.
ACQUIRED IMMUNITY: immunity acquired during life time from
exposure to the invading agent either a bacteria, virus or toxin.
ACTIVE IMMUNITY: A state where immune bodies are actively
formed against specific antigen, either naturally by exposure to any
infection or by by introducing the antigen artificially.

5. PASSIVE IMMUNITY: Temporary immunity acquired by infusion of
immunoglobulin either artificially like serum and antibodies from actively
immunized donors or naturally from mother to foetus through placenta
IMMUNIZTION: The process of inducing or providing active or passive immunity
to a person just to prime his immune system against the infectious agent.
ANTIBODY: A protein mostly found in serum formed in response to
exposure to specific antigen.
ANTIGEN: A variety of foreign substances stimulating the formation of
antibodies like bacteria, virus, toxins and foreign proteins.

6. ATTENUATE: Reducing
the virulence of any
pathogenic micro
organism by certain
measures like treating
with heat or
chemicals
TOXOIDS: A modified
bacterial toxin that
has been made non-
toxic but retaining the
ability to stimulate
the production of
antitoxin.

7. • Immunization is the process of protecting an individual from a disease through
introduction of live, killed or attenuated organisms .
• The immunization is essential to reduce child mortality, morbidity and
handicapped conditions.
• It is a healthy choice that saves lives. Immunization has saved lives of children
more than any other medical intervention in last 50 years.
• The recommended age for beginning primary immunization of infants is within 2
weeks of birth or at birth.
• Children born preterm should receive the full dose of each vaccine at
appropriate chronologic age.
• Children who began primary immunization at recommended age but fail to
receive all the doses do not need to begin the series again but instead receive
only the missed doses.
INTRODUCTION TO IMMUNIZATION

8. INTRODUCTION …… Contd:
• Immunization work by stimulating the immune system, the
natural disease-fighting system of the body.
• The healthy immune system is able to recognize invading
bacteria and viruses and produce substances (antibodies) to
destroy or disable them. Immunizations prepare the immune
system to prevent against a disease.
• To immunize against viral diseases, the virus used in the
vaccine is weakened or killed (Attenuation).
• To immunize against bacterial diseases, small portion of the
dead bacteria is used to stimulate the formation of antibodies
against the whole bacteria.
• The effectiveness of immunizations can be improved by
periodic repeat injections or "boosters."

9. DEFINITION
Immunization is the process by
which an individual's immune
system becomes fortified against
an agent (known as the
immunogen ).
“WIKIPEDIA”
(OR)
Immunization is the process of
inducing or providing active or
passive immunity to a person just
to prime his immune system
against the infectious agent.

10. BACKGROUND OF IMMUNIZATION:
• In 2012, the WHO estimated that vaccination prevents 2.5 million
deaths each year. With 100% immunization, and 100% efficacy of
the vaccines, one out of seven deaths among young children
could be prevented, mostly in developing countries, making this
an important global health issue. Four diseases were responsible
for 98% of vaccine-preventable deaths: measles, Haemophilus
influenza serotype b, pertussis, and neonatal tetanus.
• The Immunization Surveillance, Assessment and Monitoring
program of the WHO monitors and assesses the safety and
effectiveness of programs and vaccines at reducing illness and
deaths from diseases that could be prevented by vaccines.

11. • World immunization week
21st April ,2016 celebrated
over the theme set by WHO
as “close the immunization
gap”, immunization for all
through out life.
Immunization averts 2-3
million deaths annually.
However an additional 1.5
million deaths could be
avoided , if global
immunization improves.
Today, nearly 1 in 5 children
world wide are still missing
routine immunizations for
preventable diseases.

12. LIST OF VACCINE-
PREVENTABLE
DISEASES
The WHO lists 25 diseases
for which vaccines are
available

13. 1.
TUBERCULOSIS
2.
DIPHTHERIA
3
PERTUSSIS
4.
POLIOMYELITIS
5.
HEPATITIS B
6.
MEASLES
7
TETANUS
8
INFLUENZA
9
HEPATITIS E
10
HUMAN
PAPILLOMA-VIRUS
11
RUBELLA
12
MUMPS
13
VARICELLA AND
HERPES ZOSTER
(SHINGLES)
14
TICK-BORN
ENCEPHALITIS
15
ROTAVIRUS
GASTROENTERITIS
16
CHOLERA
17
ANTHRAX
18
PNEUMOCCOC
AL DISEASE
19
HAEMOPHILUS
INFLUENZAE TYPE
B
20
YELLOW FEVER
21
MENINGOCOC
CAL DISEASE
22
HEPATITIS A
23
TYPHOID
FEVER
24
RABIES
25
JAPANESE
ENCEPHALITIS

14. • NEED OF IMMUNIZATION:
• Immunizations are definitely less risky
and an easier way to become immune
to a particular disease than risking a
milder form of the disease itself.
Through the use of immunizations,
some infections and diseases have
almost completely been eradicated
throughout the United States and the
World. Polio in the U.S. is eradicated
since 1979.

15. Polio is still found
in other parts of
the world like
Pakistan &
Afghanistan so
certain people
could still be at
risk of getting it
 This includes
those
people:
I. who have never had the vaccine
II. Those who didn't receive all doses of the
vaccine
III. Those travelling to areas of the world
where polio is still prevalent.

16. IMMUNIZING
AGENTS: These
consists of
V
A
C
C
I
N
E
S
I
M
M
U
N
O
GLOBULIN
A
N
T
I
S
E
R
A

17. VACCINES:
• Active immunizing agents
are known as vaccines.
These are immuno
biological substances
which produce specific
protection against a given
disease. Vaccines
stimulate active
production of protective
antibody and other
immune mechanisms.
Vaccines are of various
types like:

18. LIVE ATTENUATED VACCINES: Prepared from live
organisms that has lost their ability to produce full
blown disease.
INACTIVATED OR KILLED VACCINES: Suspension of
inactivated or killed organisms
TOXIODS: Exotoxin produced by certain organisms like
diphtheria bacilli and tetanus bacilli are detoxicated and
used in preparation of vaccine.
CELLULAR FRACTIONS: Extracted cellular fragments e.g
meningococcal vaccine produced from polysaccharide
cell wall of antigen.
V. COMBINATION VACCINE: More than one kind of
immunizing agents are included in a vaccine e.g DPT,
MMR & DT etc.

19. TYPE OF VACCINE VACCINE AGAINST
BACTERIA
VACCINE AGAINST
VIRUS
LIVE
ATTENUATED
VACCINE
 BCG
 Cholera
 Typhoid oral
 Oral polio vaccine
 Mumps
 Measles
 Rubella
 Rotavirus.
INACTIVATED
OR
KILLED
VACCINE
 Diphtheria
 Pertusses
 Pneumococcal
 Typhoid.
 Rabies
 Polio
 H. Influenza
 Hepatitis B
 Measles.
TOXOIDS  Diphtheria
 tetanus

20. IMMUNOGLOBULIN:
Passive immunizing agents
obtained from humans.
WHO “ Gamma globulin”
synonym for “immunoglobulin”.
• Human immunoglobulin consists
of 5 major classes IgG, IgM, IgA,
IgD AND IgE.
• IgG constitutes 85% of total
serum immunoglobulin and is the
only Ig which is transported
across placenta.
• IgA constitutes approximately 15
% and in present in body
secretions like saliva, tears, milk,
colostrums, prostatic secretions
and vaginal secretions.
• The available human Ig’s are:
diphtheria, hepatitis A and B,
Measels, mumps and tetanus.
ANTISERA: passive immunizing agents obtained non human
sources like horses e.g;
Bacterial: diphtheria, tetanus, botulism
Viral: Rabies.

22. NOTE:
Interval between
two doses should
not be less than
one month.
Minor cough, colds
and mild fever or
diarrhoea are not a
contraindication to
vaccination.
In some states
hepatitis B vaccine is
given as routine
immunization.
If the child misses
the any dose ,the
whole schedule need
not to be repeated

23. NATIONAL IMMUNIZATION SCHEDULE

24. BENEFICIARIES AGE VACCINE DOSE ROUTE AMOU
NT
I
N
F
A
N
T
 At Birth
(for Institutional deliveries)
* BCG Single Intradermal 0.05ml
* OPV Zero dose Oral 2 drops
 At 6 weeks  BCG
(if not given at birth)
Single Intradermal 0.1 ml
 DPT-1
 OPV-1
 Hepatitis
1st
1st
1st
Intramuscular
Oral
Intramuscular
0.5 ml
2 drops
0.5 ml
 At 10 weeks  DPT-2
 OPV-2
 Hepatitis B-2
2nd
2nd
2nd
Intramuscular
Oral
Intramuscular
0.5 ml
2 drops
0.5 ml
 At 14 weeks  DPT-3
 OPV-3
 Hepatitis B-3
3RD
3RD
3RD
Intramuscular
Oral
Intramuscular
0.5ml
2 drops
0.5 ml
 At 9 months  Measles Single Subcutaneous 0.5 ml
C
H
I
L
D
R
E
N
 At 16-24 months  DP T Booster Intramuscular 0.5 ml
 OPV Booster Oral 2 drops
 At 5-6 Years  DT Single Intramuscular 0.5 ml Second dose
of DT should be given after 4 weeks, if not
vaccinated previously with DPT
 At 10-16 years  TT Single Intramuscular 0.5 ml second
dose of TT should be given if not vaccinated
previously
a) PREGNANT
WOMEN
 Early in pregnancy
 One month after
 TT-1
 TT-2
1ST
2ND
Intramuscular
Intramuscular
0.5 ml
0.5 ml

25. • OPTIONAL VACCINES

26. S. NO VACCINE DISEASE DOSE/ROUTE AGE
1 HIB Meningitis &
pneumonia
1.5ml /IM 6,10,14 WEEKS
12-14MONTHS---BOOSTER
2 Varicella Chicken pox 0.5ml/ SC 12-24 MONTHS 2 DOSES FOR ADULTS
2-4 WEEKS APART
3 Typhoid Typhoid 0.5ml/ SC
0.25ml /SC
>10year
For younger kids > 1year( 2 doses at 4-6
weeks interval
4 RRV-
TV(Rotavirus)
Diarrhoeal
diseases
1-1.5ml / PO 6-26weeks, 3-doses at 4weeks
internal
5 MMR Measles, Mumps
and Rubella
0.5ml /SC 16-24 Months
6 Rubella Congenital
Rubella
syndrome
0.5ml /SC Females 12-15 months and women of
child bearing age

27. PENTAVALENT VACCINE:
• Pentavalent vaccine is given to
those children who are coming
for first dose of DPT. Infants
who have already received
either the first dose or the 2nd
dose of DPT and Hep B will
complete the schedule with
DPT and Hep B only.
• Pentavalent vaccine has
been introduced in 8 states/
UTs. Tamil Nadu, Kerala,
Haryana, J and K, Gujarat,
Karnataka, Goa and
Pondicherry

29. AGE CURRENT SCHEDULED VACCINE AFTER INTRODUCTION OF
PENTAVALENT VACCINE.
At Birth BCG, OPV-O, Hep B- Birth
Dose.
BCG, OPV-0, Hep B- Birth
Dose.
6 weeks OPV-1, DPT-1, Hep B 1ST Dose. OPV-1, Pentavalent-1.
10 Weeks OPV-2, DPT-2, Hep B 2ND Dose. OPV-2, Pentavalent-2
14 Weeks OPV-3, DPT-3, Hep B 3RD Dose OPV-3, Pentavalent-3
9 Months Measles – 1st Dose Measles – 1st Dose
16-24 Months Measles – 2nd Dose
DPT- Booster, OPV Booster.
Measles – 2nd Dose
DPT- Booster, OPV Booster.
5 Years DPT Booster 2 DPT Booster 2
10 Years TT TT
16 Years TT TT

30. 1.BCG: VACCINATION:
 BCG (Bacillus of Calmette and Guerin)
is produced by “Dannish-1331” strain of
tubercle bacilli.
 It is a live attenuated bacterial vaccine
 It produces active immunization to
children to protect children against
tuberculosis
 It is heat stable and available in freeze
dried form
 It should be kept away from direct
sunlight and stored at 2o-8o C
 Normal saline is recommended as its
diluents for reconstituting the vaccine.
 Reconstituted vaccine is used upto 3
hours then the left over vaccine should be
discarded
 Vaccine is given by a special tuberculin
syringe in intradermal route

31. BCG ……Contd
Satisfactory route produces a wheel of
5mm in diameter.
After BCG vaccination, a papule appears in 2-3
weeks at the site of injection, in 4-5 weeks it
grows in size and then subsides into shallow
ulcer which can be covered or covered with
crust. The ulcer heals in 8-12 weeks leaving a
small scar.
Reconstituted vaccine is used upto 3 hours then the
left over vaccine should be discarded

32. COMPLICATIONS OF BCG:
Deep
ulceration.
Local
abscess
formation
Enlargement of
axillary lymph
node.
Osteomyelitis
or Keloid
formation.

33. CONTRAINDICATIONS of BCG
• It is contraindicated in children with
 Eczema.
 Infective dermatosis
 Hypogammaglobulinemia.
 Immunodefiency and HIV with
symptoms of AIDS.
DURATION OF PROTECTION:
15-20 years.

34. POLIO VACCINATION
• Salk polio vaccine is administered
in IM or SC route. It is expensive
and produce short lived immunity.
So, it is not recommended in
National Immunization Schedule.
• Government of India conducted
pulse polio immunization (PPI)
campaign towards the goal of
eradication of poliomyelitis by oral
administration of polio vaccine
(OPV).
• Oral polio vaccine was first
described by Sabin in 1957.
• Vaccine potency can be monitored
by Vaccine Vial Monitors (VVM)

35. OPV…… CONTD
OPV contains
live attenuated
polio virus of
three strains(
type 1,2 and
3), so
administered
as trivalent.
Recent OPV is
heat
stabilized and
is store at
4oC. for a
year and at
room
temperature
for a month.
It induces
both
humoral
and
intestinal
immunity.
It is very
safe
vaccine
without
any side
effects

36. CONTRAINDICATIONS OF OPV
Acute infectious disease
Fever
Diarrhoea, dysentery
Leukaemia,
malignancy.
Steroid therapy.

37.  DPT is a combined vaccine consists of diphtheria toxoid,
tetanus toxoid and killed B Pertussis bacilli. The potency of
Diphtheria toxoid is enhanced by Pertussis component of
DPT vaccine.
 The WHO recommends that only adjuvant DPT vaccine to
be utilized immunization programme. The plain DPT
vaccine can be used as a booster.
 Stored at 4 – 8 C and should not be frozen. It loses potency
if kept at room temperature for longer period of time.

38. DPT…..CONTD
• DPT vaccine is given
lateral aspect of thigh
(vastus lateralis
muscle) in infant s and
in older children it can
be given in gluteal
muscle.

39. COMPLICATIONS OF DPT
Mild Fever (2-6
%)
Swelling or
indurations (5-
10 %)
Pain for 48
hours.
• Severe complications of DPT ARE: Encephalitis,
Encephalopathy, prolonged convulsions, infantile spasms
and Reyes syndrome. These problems are thought to be
due to Pertussis component of DPT

40. CONTRAINDICATIONS OF DPT
Progressive neurological
problems
Severe reaction to first dose of
DPT like shock and convulsions.
cough, cold and mild fever are not
contraindicated but seriously ill hospitalized
children with these complications should not
be immunized with DPT

41. MEASLES VACCINATION:
 Measles vaccine is available
as freeze dried powder. Heat
stable measles and its diluting
fluid should be stored at 2o -
8o C to maintain their
potency.
 The freeze dried vaccine after
reconstitution with diluting
fluid must be kept on ice and
then used within one hour.
Left out vaccine should be
discarded and never used
after 4 hours of opening the
vial.

42. COMPLICATIONS OF MEASELS
Fever and rash after 5th
to 10th day of
immunization. Fever
and rash can persist for
1-3 days
Induces mild
measles illness (15-
20% cases)
• Severe
complications can
developed if
recommended
temperature is
not maintained
and necessary
precautions are
not followed like
Toxic shock
syndrome.

43. CONTRAINDICATIONS OF MEASELS
Acute illness
Convulsions and allergies
Malnutrition and
tuberculosis.
Immunodeficiency states
and malignancy
Immuno-suppressive therapy
like steroids.

44. HEPATITIS B VACCINE

45. HEPATITIS B….CONTD
Hepatitis B vaccine is available in two forms: plasma derived
vaccine (HBsAg) and yeast derived vaccine.
 Plasma derived Hep B
vaccine gives protection for
about 3-5 years
 Hep B vaccine is used in
pre- exposure or post-
exposure prophylaxis.
 Booster immunizations are
required
Stored at 2o-8o C and should not be frozen
It is recommended the dose be doubled in patients on haemolysis,
immuno-compromised individuals and those with malignancies.
• Recommended DNA (RDNA)
Yeast derived vaccine is
alternative to plasma derived
vaccine but it is costly
• RDNA gives protection for 9
years
• Booster immunization is not
recommended.

46. TYPHOID VACCINATION:
It does not give 100% protection but it reduces
incidence and severity of infection.
It can be given at any age after one year
Stored at 2o-8o C temperature and should not be
frozen
Oral typhoid vaccine (Typhoral) induces the local
gut immunity. It is recommended for children
above 6 years of age.

47. T
Y
P
E
S
Monovalent
anti-typhoid
vaccine
containing
killed
S. typhi
Bivalent
anti-typhoid
vaccine
containing
S. typhi and
S. paratyphi
TAB vaccine
containing
S. typhi and
S. paratyphi
A and S.
paratyphi B
The efficacy of all types of typhoid vaccines ranges from 50-70%
Primary immunization with anti-typhoid vaccine develops immunity
in 10-21 days after inoculation and gives protection for about 3
years. So, booster dose in every 3 years.

48. TYPHOID
….CONTD
•COMPLICATIONS:
It includes fever, local pain, malaise and
swelling
•CONTRAINDICATIONS:
 Antibiotics are contraindicated in case of oral typhoid
vaccines between 3 days before to 7 days after the vaccine
administration as their use may compromise the vaccine
“take”.
 Immunodeficiency states and immunosuppressive therapy
 Febrile illness
 Acute intestinal infections
 Anti-malarial therapy

50. COLD CHAIN:
• Cold Chain is a system of storing and transporting
vaccine at the recommended temperature range from
the point of manufacture to point of use. This cold
chain is needed because vaccines are very sensitive to
heat and may lose their potency if not stored and
transported at optimum temperature.
• Among all vaccines the oral polio vaccine is the most
sensitive vaccine requiring storage at -20oC

51. India has built a vast cold chain infrastructure to ensure that only potent
and effective vaccines reach millions of beneficiaries across the
country.
LAST COLD CHAIN POINTS I.E PHCS & CHCS
DISTRICT STORES
DIVISIONAL VACCINE STORES
STATE AND REGIONAL VACCINE STORES.
4 GOVT. MED. STORE DEPOTS (AT KARNAL, MUMBAI, CHENNAI
AND KOLKATA)
MANUFACTURERS

52. • Transportation of
vaccines from
States/Regional
stores to
divisions and
districts is done
in cold boxes
using insulated
vaccine vans.
Vaccines carriers
with icepacks are
used to transport
vaccines from
PHCs to the
outreach
sessions in the
village.

53. COLD CHAIN…..CONTD
• At regional, divisional and district levels, there are cold
chain technicians whose responsibility is to maintain and
repair cold chain equipment for maintaining the
recommended temperatures for storage of vaccines.
• At the PHCs and CHCs, cold chain handlers, who are
health personnel maintain Ice Lined Refrigerators
(ILRs) and Deep Freezers (DFs) including temperature
charting.
• Cold chain technicians have been provided with
trainings and tool kits for performing installation,
maintenance and repair activities. For maintenance of
cold chain equipment, Govt. of India provides funds to
the state under NRHM.

54. For successful cold
chain system, three
elements are
essential, i.e
 Cold chain
equipment.
 Transportation
system and
 Motivation and
training of workers
for maintenance of
cold chain link

55. A.Vaccines to be stored in freezer
( -15 TO -25 C)
 OPV
 Measles
B. Vaccines to be stored in cold
part of refrigerator and never
allowed to freeze (2-8 C)
 DPT
 DT
 BCG
 TT
 TYPHOID
 All
vaccine
diluents
C. Vaccines stored at room
temperature (25C)
 TT

57. VACCINE HEAT LIGHT FREEZING
OPV
Live attenuated
Sensitive Sensitive. OK to freeze
BCG
Live attenuated
Sensitive Sensitive OK to freeze before
reconstitution
Measles
Live attenuated
Sensitive Sensitive OK to freeze before
reconstitution
DPT
Toxoid, Killed
Relatively stables -- Freezes at -3oC
Discard if frozen
HEPATITIS B
recombinant
Relatively stables -- Freezes at -5oC
Discard if frozen
TETANUS
Toxoid
Relatively stables -- Freezes at -3oC
Discard if frozen

60. COLD CHAIN EQUIPMENTS:

61. LIST OF COLD CHAIN EQUIPMENTS
• Walk in cold rooms:
• Deep freezers:
• Ice Lined Refrigerators (ILR):
• Cold boxes:
• Vaccine carriers:
• Day carrier:
• Ice packs:

62. 1. Walk in cold rooms:
They are located at regional level and are meant to store
vaccines for up to 3 months. They are used to store vaccines
of 4-5 districts.

63. D
E
E
P
.
F
R
E
E
Z
E
R
S:

64. Two types of
ILR are
available,
one with
ice tubes
(Electrolux
) and
others with
ice packs
(vest frost)
as the ice
lining.

66. ……

69. Available at all
peripheral health
centres.Fully frozen
ice packs are placed
at bottom and walls
of it before placing
vaccines in it. The
vaccines are first
placed in polythene
bags then to be kept
in cold boxes. DPT,
DT, TT and all
diluents should not
placed in direct
contact with the
frozen ice packs.

70. It is used to
carry 16- 20
vials of
vaccines to
out-reach
sites to the
sub centres,
village,
vaccination
clinic or
camp.

71. Day carrier:
It is used for nearby areas and only for
few hours period with two fully
frozen ice packs. It is used to carry 6-
8 vials only

72. • Ice pack is
prepared in
deep freezers
and contains
water, filled
up to the level
marked on the
side. No salt is
added to it.
Leaking ice
pack should
not be used.

73. NURSES RESPONSIBILITIES FOR CHILD
IMMUNIZATION
• Nursing personal is mostly responsible for administration
of immunization
1. Motivation of general public regarding the immunization
and its benefits.
2. Estimation of beneficiaries of area and identification of
non-participants and drop- outs of immunization.
3. Assessment of problems and reasons for non acceptance of
immunization and intervening to solve problem.
4. Information, health education and communication about
immunization session, time, place and available vaccines
5. Organization of immunization clinics at different health
institutions, immunization camps and home based services.
6. Arrangement and maintenance of required amount of
vaccines and other necessary equipments for particular
immunization centre.

74. 7. Maintenance of cold chain at centre or during transportation of vaccines to
home or clinics with necessary precautions to preserve efficacy and
potency of vaccines.
8. Care of cold chain equipments and Maintenance of optimum temperature of
vaccines.
9. Administration of vaccine with basic skill of aseptic techniques and check
checking the vaccine vials or ampoules. Selection of proper site, position of
child, maintenance of six rights and steps of medication should be
followed.
10. Observation of possible reaction after vaccination and providing necessary
instructions about the care of child to parents and family after
immunization.
11. Nurses give information about the next dose of immunization as per the
schedule.
12. Maintenance of immunization card with required information and date of
next visit
13. Maintenance of clinical records, registers, stocks and vaccines used
14. Reporting about immunization coverage and problems of particular area
15. Participation in research activities and new approaches related to
immunization programme
16. Updating own knowledge and developing skill regarding advancement of
immunization practices and changing attitudes

75. CONCLUSION
• Prevention of disease is one of the most
important goals in child care. Immunization is
less risky and better way to immune the body
against some disease. It is a healthy choice that
saves lives. As we know prevention is better than
cure, so, complete immunization as per the
universal immunization schedule prevents and
protects us from various vaccine preventable
diseases. Nurses play a vital role in immunization
and in maintaining cold chain. Cold chain plays a
key role in making the immunization effective

76. THANK YOU