Community Medicine, Immunization

2. • Immunization is the process of rendering a person
immune
• Mass means of protecting the greatest number of people
by reducing the number of susceptible in the community
TYPE:
• Active Immunization
• Passive Immunization
• Combined Passive and Active Immunization

3. Active Immunization
• It is induction of immunity after exposure to an antigen
• There are some infectious diseases whose control is solely
based on active immunization such as polio, tetanus,
diphtheria and measles
• There are also immunization against certain diseases which
are offered to high risk groups or restricted to define
geographic areas where the disease is endemic or a public
health problem
• Every country has its own immunization schedule.

4. Properties of a well thought-out
immunization schedule
• Epidemiologically relevant
• Immunologically effective
• Operationally feasible
• Socially acceptable

5. Universal Immunization
Programme
• In May 1974, the WHO officially launched a global
immunization programme known as Expanded Programme of
Immunization(EPI) to protect all the children of the world
against 6 vaccine-preventable diseases and it was launched in
India in January 1978
• Consists of vaccine - preventable diseases such as Dipththeria,
Wooping Cough, Tetanus, Polio, Tuberculosis and measles
• This programme is now called Universal Child Immunization
and the Indian version of it was launched in November 19,
1985

6. National Immunization
Schedule • BCG
• OPV
• DPT
• TT
• Hepatitis B
• Vitamin A
• Measles
• Japanese Encephalitis
• Rotavirus
• Rubella
• Injectable polio
• Adult vaccine against Japanese Encephalitis

7. National Immunization Schedule
For Pregnant Woman:
Vaccine When to give Dose Route Site
TT - 1 Early in pregnancy 0.5ml Intra-muscular Upper arm
TT - 2 4 weeks after TT 1 0.5ml Intra-muscular Upper arm
TT - Booster If received 2 TT
doses in a pregnancy
within the last 3
years
0.5ml Intra-muscular Upper arm

8. • For Infants
Vaccine When to give Dose Route Site
BCG At birth or as early
as possible till one
year of age
0.1ml Intra – dermal Left upper arm
Hepatitis B At birth or as early
as possible within
24 hours
0.5ml Intra- muscular Antero lateral
aspect of mid thigh
OPV – 0 At birth or as early
as possible within
the first 15 days
2 drops Oral Oral
OPV-1,2 & 3 At 6,10 & 14 weeks 2 drops Oral Oral
DPT-1,2 & 3 At 6,10 & 14 weeks 0.5ml Intra-muscular Antero lateral
aspect of mid thigh
Hepatitis B
1,2 & 3
At 6,10 and 14
weeks
0.5ml Intra-muscular Antero lateral
aspect of mid thigh
Measles 9 completed
months – 12
months
0.5ml Sub-cutaneous Right upper arm
Vitamin A (1st
dose)
At 9 months with
measles
1ml(1 lakh
IU)
Oral oral

9. • For Children
Vaccine When to give Dose Route Site
DPT booster 16-24 months 0.5ml Intra-muscular
Antero-lateral aspect
of mid thigh
OPV booster 16-24 months 2 drops Oral Oral
Measles(2nd
dose)
16-24 months 0.5ml Sub-cutaneous
Right upper arm
Japanese
Encephalitis
16-24 months with
DPT/OPV booster
0.5ml Sub-cutaneous
Left upper arm
Vitamin A
(2nd dose to
9th dose)
16 months with
DPT/OPV booster.
Then, one dose every
6 moths up to the
age of 5 years
2ml(2
lakh IU)
Oral Oral
DPT Booster 5-6 years 0.5ml Intra-muscular
Upper arm
TT 10 years & 16 years 0.5ml Intra-muscular
Upper arm

10. Vaccines
BCG OPV DPT
TT Japanese
Encephalitis
Hepatitis B
Measles

11. Classification of adverse
events following Immunization
1. Vaccine reaction: Event caused or precipitated by the vaccine
when given correctly i.e caused by the inherent properties of
the vaccine
2. Programme error: Event caused by an error in the vaccine
preparation, handling or administration
3. Coincidental: Event that happens after immunization but not
caused by the vaccine – a chance association
4. Injection reaction : Event from anxiety or pain from the
injection itself rather than the vaccine
5. Unknown: Events cause cannot be determined

12. Adverse Events of Vaccines
Vaccines Adverse Events
BCG Lymphadenitis, Osteitis/osteomyelitis, Desseminated BCG
infections
OPV Acute Flaccid paralysis
DPT Hypotonic, hyporesponsive episode(HHE or shock
colapse), Persistent inconsolable screaming,
Encephalopathy, seizures
TT Brachial neuritis
Hepatitis B Anaphylaxis
Measles Encephalopathy, seizures
Japanese Encephalitis No specific severe side affects. Anaphylactoid,
Anaphylaxis, Fever, Infection site abscess, Sepsis, Severe
local reaction, Toxic shock syndrome

13. Passive Immunization
It is a short-term expedient useful only when exposure to
infection has just occurred or is imminent within the next few
days.
Preparations available:
• Normal human immunoglobulin
• Specific human immunoglobulin
• Antisera or anti-toxins

14. Combined Active and Passive
Immunization
• In some diseases passive immunization is often undertaken in
conjunction with inactivated vaccine products to provide both
immediate passive immunity and slowly developing active
immunity.
• Examples: Tetanus, Diphtheria, Rabies