IMMUNIZATION

 

IMMUNIZATION

 

Introduction:

 

          The WHO launched Global Immunization Programme in 1974 also known as expanded Programme on Immunization [ EPI ] To protect the children from six killer disease.  In india, expanded programme on immunization was launched in January 1978.  UNICEF renamed the EPI Expanded Programme on Immunization was launched Programme [ UIP ] and it was launched in India in November 1985.

 

Immunization:

Definition:

          It may be defined as process of protecting an individual form a disease throught introduction of live or killed or attenuated organisms in the individual body.

 

Vaccine:

          Vaccines or immune – biological substances in which produce specific protection against a given disease.  It stimulates active production of protective antibody and other immune mechanism.

 

1.     Live attenuated vaccines

a.     Bacterial – BCG Typhoid (Oral) Plague

b.     Viral – Oral Polio measles mumps, rubella yellow fever influenza.

 

2.     Killed or inactivated vaccines

a.     Bacterial – Pertusis typhoid plague cholera etc.

b.     Viral – Rabies hepatitis ‘B’ influenza salk polio Japanese encephalitis.

c.      Toxoids – Diptheria and tetanus

d.     Cellular Fractions – Meaningococcal and pneumococcal vaccines.

e.      Combinations – DPT (Diphtheria Pertesis Tetanus ]

                                                             i.      MMR [ Measles mumps Rubella]

                                                           ii.      DT [ Diphtheria Tetanus ]

 

BCG VACCINATION:

          BCG (Bacillus of Colmetle and gurin] vaccine is attenuated the vaccine obtained from the backline starain of tubercle bacilli it is controlliod by primary tuberculous infection it should be frexed storing at 2to 10⁰ in india it is produced by the BCG laboratory evindy, Chennai India it is available in multidose vibls.

 

Age to Vaccination:

          In India it is recommended at earliest contact offer birth Revaccination may be done at the time of school entry and primary school tea.

 

Site:

          The standard site is the middle deltid over the left upper arm.

 

Method:

          0.05 ml in neonate of BCG is injected intredemally with a special tuberculin syringe.

 

 

Reaction of following vaccination:

          A papule apperones in 2 to 3 weeks after vaccination by about the fourth week it grosin size then it either substidesor sheeds into shallow ulcer thus ulcer heals in nearly 8 to 12 weeks time.

 

Complication

Ø  Deep ulceration of the vaccine site together with superadded bacterial infection.

Ø Accurrence of axillary lymph gland enlargement (less than 1 cm in diameter) without any progression or signs of suppuration should be regarded as normal it should be left as each.

 

Pollo vaccine:-

          Oral Polio vaccine is a line feet attenuated circus contaningo all the three strains closing been and branchide) storage is best done at 2 to 10⁰c.

 

Age of Vaccinate:

          According to Indian accoaceodmy of Pediatrics (IAP) it is given by 5 primary dose in the very  first year stating with birth (zero clore) than at 6 weeks 10 week 14 weeks and 9 month.  A boaster dose is required to be given in second year and another in the fifth year A total of 7 doses are recommended.

Administration:

          OPV is available as liquid or as sweet drags.  The liquid vaccine is measured with a sterile syringe and fed the child directly into the month or with a small spoon.  This should be followed with the feeding of some water to ensure absolute ingestion of the vaccine.  Remember that breast feeding need not to be skipped before and after OpV administration.

 

How OPV acts in body

          One entry in the gut strains of OPV mattiply and produce local as well as systemic immunity.  This vaccine also leads to protection of antibodies like 1gG 1 gm and 1gA.  The 1gA is responsible for local immunity and 1gG with 1gm spread the polio virus to the CNS and protect against paralysis.

 

Contraindication

          It should be avoided in children suffering from severe diarrhea and in acute illness.

 

Complications:

          No local or general reactions

 

 

DPT Vaccination:

          It is a combined vaccine offers combined prophylaxis against diphtheria, pertusis (whooping cough) and tetanus vaccine available central research institute Kasauli and galaxo is to be preferred over the fluid or plain type the vaccine in best stored  at a temperature of 2 to 10⁰c.

 

Age of vaccination:

          First dose at the age of 6 weeks and second third at month interval lach, the boster is to be given about 12 to 18 months later it about the age of 1.5 to 2 years 1AP recommended as a second booster in the fifth year with DPT (not as in the AIP).

 

Administration:-

          A dose of 0.25 to 0.5ml of the triple vaccine is given deep intramuscularly over the lateral thigh or the deltoid.

 

Contraindication

          Progressive neclorgoic disease are the only contraindication to DPT immunization.

 

 

Complication

Ø  Fever and feberible convulsions

Ø Local Sterile injection doses

Ø After 1 to 3 hours from injection pallor slow pulse can size which recovers in an hour.

Ø Allergic skin rash

Ø Encephalitis

 

Measles vaccination:

     It is a live attenuated vaccine measles vaccines given in a dose of 0.5 to 1.0ml by intradermal intramuscular or subcutaneous route.  A single dose produces antibodies for an indefinitely prolonged period.  Boosters are not needed.

 

Age to vaccinate:

     The national recommendation for measles vaccine is at 9 to 12 months of age.

 

Contraindication:-

Ø  Infants under 6 months of age

Ø During course of immune suppressive drugs like steroids

Ø History of convulsions in the child

Ø Allergy / eczema

Ø Acute illness

Ø Leukemia

Ø Gross malnutrition

Ø Immune deficiency like hypogommaglobulinemia.

Recent gammaglobulin administration

 

Complications:

     Febrile reactions are sun for a day from fifth to twelth post vaccination in a proportion of the cases.  Even convulsion may occur.  Slight gastrointestinal upset and rhinopharygitis may be encountered. Fever may accur 4 to 10 days offer vaccination paracetamol syrup / tablet may be given.

 

Mumps vaccine:

     Mumps vaccine is a live attenuated viral vaccine and gives long immunity with protective values of 75 to 90%.  It is usually available combined with measles and rubella vaccines as MMR, a trivalent vaccine.

 

 

Age and route

     Aumps or mmR vaccine may be given after 12-15 months of age in subcutaneous route mumps vaccine is safe and effective.

 

Rubella Vaccine

     Rubella vaccine is also a live attenuated viral vaccine protects against the accurence of conginetal rubeal sundroma in of spring.

 

Age period

     The vaccine is administered to girls between one year of age and puberty the recommended minimum age is 12 to 15 months only after maternal antibodies have disappeared.

 

Dose and route

     The dose is 0.5ml by substetaneously as a single administration.

 

Adverse reactions:

     Skin rash lymphodenopaty and arthralgia with are self limiting.

 

Contraindications:

     Vaccine is contraindicated in pregnancy and immunosuppression the advantage as well as for cauenience.

 

Hepatitis ‘B’ Vaccination

     Hapatitis B vaccination is now induced in the immunization schedule in some status of India as routine vaccine hepatitis ‘B’ vaccines are available in two forms.

 

a)      Plasma derived vaccine and

b)    RDNA yeast derived vaccine

 

     Plasma derived vaccine as based on the surface antigen (HBS ag) which is harvested and purified from plasma of human carries of hepatitis ‘B’ virus the vaccine is safe effective and chapest.

 

Route and dose

     The hepatitis ‘B’ vaccine is given intramuscularly with 3 doses in general at 0.1 and 6 months or 4 doses at 0.1.2 and 12 months in highly endomice areas the dose of vaccine is 0.5ml for the child below 10 years and one ml above 10 years at the same time intraval boster doses may be administered after 3 to 5 years Hepatitis ‘B’ vaccine is given for pre exposure and post-exposure rophylaxis.

 

     High risk children for HBV infection should be immunized with hepatitis ‘B” vaccine e.g, repeated and multiple blood transmission (in care of thalasseima hemophilia).  Homodialysis sexual contact with carriers of HB and etc.

 

Typhoid Vaccine

     Children can be protected against typhoid fever by giving them two injection of typhoid vaccine should consist of 2 doses to subcutaneous injections.  Each dose of 0.5ml at 4 to 6 weeks interval.  The children between 1 and 10 years required smaller, dose with 0.25ml.  Immunity develops in 10 to 21 days after inoculation and gives protection for about 3 this vaccine should be stored at toxic temperature and should not be frozen.

 

Adverse reaction:

     Typhoid vaccine may produce local reaction like pain.  Sewelling and tenderness at injection site general symptoms like malaria, headache and fever may occur and usually subside within 36 hours it is a one optional vaccine.

 

SUMMARY

     Vaccines help protect against many diseases that to be much more common examples include tetanus, diphtheria, mumps, pertassis (whooping cough), meningitis and polio many of there infections can cause serious or life threatening illnesses and may lead to life long health problems.