What is the importance of immunization?
Immunization is the procedure whereby an individual is made immune or impervious to an irresistible sickness, regularly by the administration of a Vaccine. Vaccine prepares the body’s own resistant system to secure the individual against subsequent infection or disease.
Advantages of immunization
Immunization is a proven method for controlling and wiping out hazardous irresistible illnesses and is evaluated to avert somewhere in the range of 2 and 3 million deaths every year. It is one of the most reasonable health investments with demonstrated procedures that make it available to even the mass of the population. It has plainly characterized target groups; it can easily be executed by outreach camps, immunization doesn’t require any significant way of life change.
How Immunization work?
All types of vaccination work similarly. At the point when somebody is infused with a vaccine, their body creates an immune response similarly it would following the introduction to a malady yet without the individual getting the infection. In the event that the individual interacts with the illness, later on, the body can make a resistant reaction sufficiently quick to forestall the individual building up the infection or building up a serious instance of the sickness.
To what extent do immunization take to work?
By and large, the ordinary safe reaction takes roughly fourteen days to work. means protection from an infection will not occur immediately after immunization. Most immunizations should be given a few times to construct long-lasting protection.
A youngster who has been given just 1 or 2 portions of the DTPa immunization is just mostly ensured against diphtheria, lockjaw and pertussis (challenging hack), may get wiped out whenever presented to these sicknesses until they have all the dosages they need. Be that as it may, a portion of the new antibodies, for example, the meningococcal ACWY immunization, give dependable protection after just one portion.
To what extent do Immunisations last?
The defensive impact of Immunizations isn’t generally deep-rooted. A few, similar to the lockjaw antibody, can last as long as 30 years, at which point a booster portion might be given. Some Immunizations, such as whooping cough vaccine, give protection for about 5 years after a full course. Flu Vaccination is required each year because of continuous changes to the kind of influenza infection in the environment.
How much percent Immunization work ?
In any event, when all the dosages of an antibody have been given, not every person is secured against the sickness. Measles, mumps, rubella, lockjaw, polio, hepatitis B and Hib antibodies secure over 95% of kids who have finished the course. One portion of meningococcal ACWY Immunization at a year secures over 90% of youngsters.
Three doses of whooping cough Vaccine protects Immunization secures about 85% of kids who have been Immunised and will decrease the seriousness of the sickness in the other 15% on the off chance that they do whooping cough. Booster dosages are required as immunity decreases over time.
What is the schedule for immunizations?
General Instructions for Immunization
- Vaccination at birth means as early as possible within 24-72 hours after birth or at least not later than 1 week after birth
- If multiple vaccinations are to be administered simultaneously, they should be given within 24 hours if simultaneous administration is not feasible due to some reasons
- The recommended age in weeks/months/years means completed weeks/months/years
- Any Vaccination dose not monitored at the suggested age should be monitored at a successive visit when advisable and comfortable
- The use of a combination vaccine generally is favored over divide into injections of its comparable portion vaccines .
- The second dose of varicella can be given after 3 months of 1 dose in place of 4-6 years as a short schedule. Combination of MMR + Varicella (MMRV) is available
- A combination of MMR Vis preferred If Varicella vaccine 2 dose is not given as a short schedule.
- When two or more live parenteral/intranasal vaccines are not monitored on the same day, they should be given at least 28 days (4 weeks) apart, this rule does not apply to live oral vaccines.
- Any interval can be kept between live and inactivated vaccines.
- If given c 4 weeks apart, the vaccine given second should be repeated.
- The minimum interval between two doses of the same inactivated vaccine is usually 4 weeks (exception rabies). However, any interval can be kept between doses of different inactivated vaccines.
- Vaccine doses administered up to 4 days before the minimum interval or age can be considered valid (exception rabies) If the vaccine is administered >5 days before the minimum period, it is considered as an invalid dose
- This is not applicable to live vaccines (Minimum 4 weeks gap is essential)
- Any number of antigens can be given on the same day
- Changing needles between drawing the vaccine into the syringe and injecting it into the child is not necessary
- Once the protective cap on a single-dose vial has been removed, the vaccine should be discarded at the end of the immunization session, because it may not be possible rubber seal has been punctured determine whether the
- Different vaccines should not be mixed in the same syringe unless specifically licensed and labeled for such use
- Patients should be observed for an allergic reaction for 15-20 minutes after receiving immunization.
- When necessary, two vaccines can be given in the same limb at a single visit with a gap of 1 inch to look for injection site reactions
- The anterolateral aspect of the thigh is the preferred site for two simultaneous M injections because of its greater muscle mass
- Do not repeat the entire schedule if recommended intervals are not maintained Give remaining doses only
- Repeat the dose if expired/non-potent vaccines are administered inadvertently
- If evidence of BCG administration, there is no need to repeat the dose even if the scar is absent.
- Please see the individual vaccine section for more information is a precaution for most vaccines, vaccination can be postponed individuals. Acute febrile illness with acute febrile illness.
Frequently Asked Questions
(a)Which vaccines can be administered during the same visit?
There are no contraindications to administering registered vaccines during the same visit. However, the vaccines should be administered using separate syringes at separate sites At least a 4-week interval is recommended if two or more parenteral or intranasally administered live vaccines are not given at the same visit Any time interval is acceptable between administering live oral vaccines and all parenteral vaccines (eg rotavirus and BCG vaccines), live and inactive vaccines, or two inactive vaccines.
(b)What are the steps to be followed if the vaccine schedule is interrupted or varied?
Repetition of prior doses is not required even if the schedule is interrupted. The vaccine schedule should be continued as if no interruption has occurred Special circumstances where the above does not apply are as follows
• The birth dose of Hep B vaccine administered to infants bom to HBsAg-positive mothers does not count as part of a catch-up
. The two-dose course of rotavirus vaccine (RV1) should be started before the age of 15 weeks (Le the latest is 14 weeks and 6 days) and completed by the age of 25 weeks (ie the latest is 24 weeks and 6 days). If an infant reaches the age of 25 weeks without receiving the second dose, the first dose already given may offer them some protection against the disease
. Children who receive MMR vaccines prior to the age of 12 months still require two MMR doses at the ages of 15 months and 4 years.
Age-dependent conjugate vaccine schedule requirements (eg children over 12 months of age do not require a full primary course of Hib or PCV vaccine but do require one or two doses in the second year of life)
• Remember that children who miss one vaccine dose may do so again, therefore, optimizing a catch-up schedule is important?
(c) How should the rest of vaccinations be scheduled if an adverse event has occurred following immunization?
Immunization after an adverse event depends on the type of adverse event and the likelihood that the vaccine caused it. Most adverse events that have occurred after vaccination are not contraindicated to receiving further immunization The only absolute contraindication to receiving a vaccine is an anaphylactic reaction to a prior dose or an ingredient in the vaccine. However, immune dysfunction can be a contraindication to receiving live vaccines Seek advice from a specialist, medical officer, Ministry of Health, if required) Vaccines that are not related to the adverse event can be administered as per the schedule.
(d)What would be the immunization schedule if an infant had a premature or difficult birth?
Premature birth and low birth weight are not contraindications to vaccination. The recommended vaccination schedule should be followed according to the appropriate age. The advice of the treating specialist should be sought if the infant is still in the hospital or has been recently discharged. Premature infants or infants with a low birth weight may immunization is important.
(e) What special vaccines are offered to newborn infants?
Infants born to HBsAg-positive mothers should receive
• 100-IU hepatitis B immunoglobulin (HBIG) neonatal at or as close as possible to birth
•A birth dose of Hep B vaccine, at or as close as possible to birth (preferably within 12 hours)
If HBIG and/or Hep B vaccine are inadvertently omitted, administer the vaccine as soon as the omission is recognized. HBIG can be administered up to 7 days post-delivery Seek advice from a specialist if there is a delay of more than 7 days These infants should then continue vaccination as per the schedule at 1 month 2 months, and 6 months of age. Serological testing is required at 9 months of age.
In infants who are at a higher risk of TB, BCG vaccination is given soon after birth
What are the vaccine requirements in immigrant children?
The prior vaccine history should be considered, and the immunization status of all immigrant children should be checked. It is recommended to administer vaccines according to the routine schedule if the prior history is unknown.
(f)Can vaccines be administered if a child is unwell on the day of immunization?
If child has a significant acute illness or temperature >38 C, immunization can be postponed until is better This is because the complications of acute illness may be misinterpreted as a complication of immunization, or an AEFI may complicate the clinical picture of the acute illness Vaccination should not be postponed due to minor illness or if a child is in the recovery phase of an illness if immunization is postponed the child can be vaccinated at a later date.
(g) What if the child has to undergo a surgery (elective surgery)?
There is no effect of anesthesia on the immune response to a vaccine There is no increased risk of AEFI with the use of anesthesia Inactive vaccines are preferably avoided for 48 hours prior to anesthesia in case post-vaccination symptoms, such as fever, interfere with the preparation for surgery Similarly, Live vaccines may induce fever 6-12 days after vaccination Surgery should not be delayed following vaccination with a live vaccine if the child has no symptoms of being unwell Vaccination can be administered after surgery once the child is well and has recovered
la child has been scheduled for splenectomy, then the child should be immunized at least 2 weeks prior to surgery. Pneumococcal, meningococcal, Hib, influenza, and varicella Vaccines are recommended for these children pre-or post splenectomy
If the surgery is an emergency, then vaccination should be scheduled after 2 weeks.
(h) What if the child has a chronic disease?
The routine immunization schedule should be followed in children with chronic diseases as they may be at risk due to severe acts of vaccine preventable disease. Immunization with live vaccines should be carefully considered in case of impaired immunity if being treated with medications that Lower immunity A pediatrician or a general physician should be consulted before immunization in such.
(i) What if the child has had seizures?
A diagnosed urological condition is not a contraindication to any vaccine on the schedule. However, an evolving neurological condition (eg uncontrolled epilepsy or a deteriorating neurological state) is considered as a contraindication 10 pertussis immunization Until the neurological condition has been diagnosed of stabilized there is a risk that changes may be attributed to the vaccine. A family history of seizures or epilepsy is not a contraindication to immunization A febrile reaction may occur after any vaccine and may result in a febrile seizure in a susceptible child Vaccine-related febrile seizures are rare, although the risk is higher following administration of certain vaccines such as influenza vaccines Most of these seizures are benign with no associated sequelae.
(j) What if the child is allergic?
If a child shows an anaphylactic reaction to a prior dose of vaccine, or to an ingredient in the vaccine, it is contraindicated to administer the vaccine The routine immunization schedule should be followed in children with asthma eczema, hay fever, and other allergies Studies have shown that immunized children have slightly lower rates of atopic diseases
(k) Can children be immunized if they are known to develop a rash with antibiotics?
Children can be immunized they are known to develop a rash with antibiotics, however, the vaccine data sheet for the list of components should be checked as some vaccines may contain traces of antibiotics The only concern is a child has had a previous anaphylactic reaction (a rash alone is not anaphylaxis to a component of Vie
(l)Can all children receive all vaccines?
Children should be vaccinated if they have had an anaphylactic reaction to any component of a vaccine Children may have an underlying condition that is a contraindication to some vaccines for example, children with illnesses or treatments that cause immunocompromisation may be unable to receive live, attenuated vaccines.
(m) What if the child’s mother or guardian is pregnant or breastfeeding?
Pregnancy or breastfeeding is not a contraindication to giving any of the scheduled vaccines to a child, including live vaccines such as the MMR vaccine in addition, consideration should be given to the risks for the mother or guardian and infant from diseases such as pertussis, which can be life threatening in infants Pregnancy is an important opportunity to ensure that the infant’s siblings have received age-appropriate immunization. Pertussis (as Tdap) and influenza vaccines are recommended for pregnant women.
(n) Are vaccines of different manufacturers interchangeable?
Vaccines of different manufacturers can be interchanged (provided the strains used are the same and the manufacturer’s literature states compatibility Change of brand may be necessary in case of non-availability of the same brand or if precious records are not clear about the brand used However, same brand should be used in a patient as far as possible.
(o)Can vaccines be administered in post-exposure conditions?
Post-exposure prophylaxis with vaccine should be administered as early as possible after exposure to certain disease conditions Individuals should be vaccinated within two weeks of last exposure to an infectious case Example Rabies, Hepatitis A, Varicella.
(p)What should be done in case of lapsed/or unknown immunization status?
If the vaccination schedule has been elapsed, there is no need to restart the vaccine series regardless of time between individual doses due to immune memory If immunization status is unknown, then the vaccination status of child is considered as unimmunized and vaccinated accordingly.
(q)What if a vaccine dose in a particular schedule gets inadvertently postponed?
Inactivated vaccines given up to 4 days before minimum interval between 2 doses may be considered valid, but if given before more than 4 days the vaccine should be repeated Minimum interval between two live vaccines must be at least 4 weeks .
Types of Vaccines
Vaccines administered to the pediatric population are broadly categorized into
1. Vaccines for routine use and
2.Vaccines to be used under special circumstances only
The special categories in which the vaccines must be administered are
• Individuals with congenital or acquired immunodeficiency (including HIV infection)
• Individuals having chronic cardiac pulmonary (including asthma if treated with prolonged high dose oral corticosteroids), hematologic renal (including nephrotic syndrome), liver diseases, and diabetes mellitus
• Individuals on long-term steroids, salicylates, immunosuppressives, or radiation therapy
• Individuals with diabetes mellitus, cerebrospinal fluid leak, cochlear implant, and malignancies
• Individuals with functional anatomic asplenia/hyposplenia
During disease outbreaks
• Laboratory personnel and healthcare workers
• Individuals having pets at home
• Individuals perceived to be at a higher threat dog menace while outdoors
of being bitten by dogs such as hostellers risk of stray dog menace
Vaccine for Routine use
|BCG Bacillius Calmette-Guerin.|
|OPV Ora Polio Vaccine|
|DTP Diphtheria Tetanus Pertussis|
|IPV Inactivated Polio Vaccine|
|Hib Haemophilus Influenza|
|PCV (Pneumococcal Conjugate Vaccine|
|MMR (measles, mumps, and rubella)|
|Tdap/Td Tetanus Diphtheria Pertussis|
|HPV Human Papillomavirus (HPV) Vaccines|
Vaccines under Special conditions
|Pneumococcal polysaccharide vaccine|