This presentation aims at helping the pediatric trainees and practitioners to brush up their knowledge in Immunization. The schedule is based on the Universal Immunisation Programme. I have tried to cover as much as possible in terms of individual vaccines and hope it is beneficial to the reader.

1. By : Dr. Sonali Paradhi Mhatre
Immunization
Pediatric
Part 4

2. Age
►
Vaccine ▼
Birth –
2 wee
ks
6 wk 10 wk 14 wk 18 wk 6 mo 9 mo 12 mo 1
5
m
o
18 mo 19-23 m
o
2-3 Yr 4-6
Yr
7-10Yr 11-12 Yr 13-18Yr
BCG BCG
Hep B Hep B1 Hep B2 Hep B3
Polio OPV 0 IPV1 IPV2 IPV3 OPV1 OPV2 IPV B1 OPV3
DTP DTP 1 DTP 2 DTP 3 DTP B1
DTP
B2
Tdap Tdap
Hib Hib 1 Hib 2 Hib 3 Hib-booster
Pneumococcal PCV 1 PCV 2 PCV 3 PCV -booster PCV
PPSV23 PPSV
Rotavirus RV 1 RV 2 RV 3
MMR MMR 1 MMR 2
MMR
3
Varicella VAR 1
VAR
2
Hep A Hep A1 & Hep A2
Typhoid Typhoid CV (TCV) Booster
Influenza Influenza (yearly)
HPV HPV
Meningococca
l
Meningococcal
Cholera Cholera 1 & 2
JE Japanese Encephalitis
Rabies Rabies (Pre-EP & PEP) Dr. Sonali Paradhi Mhatre

3. Vaccine Preventable Diseases
TB Diptheria Pertusis Tetanus Polio Measles
Mumps Rubella Rotavirus Varicella Hepatitis HIB
Cholera Typhoid
Pneumoco
ccus
Yellow
Fever
Meningoc
occus
Rabies
Japaneese
Encephalitis
HPV Influenza
Dr. Sonali Paradhi Mhatre

4. Vaccine Preventable Diseases
TB Diptheria Pertusis Tetanus Polio Measles
Mumps Rubella Rotavirus Varicella Hepatitis HIB
Cholera Typhoid
Pneumoco
ccus
Yellow
Fever
Meningoc
occus
Rabies
Japaneese
Encephalitis
HPV Influenza
Dr. Sonali Paradhi Mhatre

5. HPV Vaccines
Bivalent Quadrivalent9 valent
Dr. Sonali Paradhi Mhatre

6.  Selected types of HPV cause cervical cancer, anogenital warts, and other anogenital and head and ne
ck cancers:
 1. HPV types 16 and 18 cause about 70% of cervical cancers.
 2. HPV types 6 & 11 cause about 90% of anogenital warts.
 Three prophylactic, highly efficacious vaccines are globally available:
1. Bivalent vaccine: Non infectious protein antigens for HPV 16 and 18 with ASO4 as an adjuvant.
2. Qudarivalent vaccine: Non infectious L1 protein antigens for HPV 16, 18, 6 & 11.
3. 9valent vaccine: Non infectious protein antigens for HPV 6,11,16,18,31, 33,45,52 & 58
 Adverse effects of all these are mild to moderate pain, swelling and erythema at the site of
infection, fever.
 Stored at 2-8C but should not be frozen.
HPV vaccine
Dr. Sonali Paradhi Mhatre

7.  The vaccines are not effective against the serotype with which the infection has already occur
red before vaccination, and therefore it is best to be administered before a women becomes sexuall
y active.
 The vaccine can be simultaneously given with other vaccines and is recommended to be given toget
her with the DPT booster for the ease of administration.
 Secondary target group comprising females >15years and Males can be given the vaccine depending
on:
1. Feasibility, Affordability & Cost effectiveness.
2. Does not divert resources from vaccinating primary target population.
3. Does not divert resources from effective cervical cancer screening programmes.
 The HPV vaccines are not 100% protective against cervical cancer and are not a replacement of peri
odic screening and patients should be informed about this.
Human papilloma virus vaccine
Dr. Sonali Paradhi Mhatre

8. Time
Of
Administration
• The vaccine can be administered at the earliest age of 9 years.
• The recommended age of initiation of vaccination is 10 – 12 years.
• Catchup vaccination is permitted till the age of 45 years.
Dose
&
Schedule
•The dose is 0.5ml in deltoid.
•Current evidence supports a 2 dose schedule – at 0 & 6-15 months for age 9-14years.
•For >15years age , a 3 dose schedule 0, 1-2 & 6 months.
•Individuals known to be HIV infected or immunocompromised – 3 dose schedule at 0, 1-2, 6
months.
HPV Vaccine
Dr. Sonali Paradhi Mhatre

9. Meningococcus Vaccine
Polysaccharide bivalent or
quadrivalent vaccine
Conjugated protein
polysaccharide vaccine
Dr. Sonali Paradhi Mhatre

10.  Although purified capsular polysaccharide antigen elicits protective antibody responses conjugate
vaccines are more immunogenic and induce immunological memory.
 Both, the polysaccharide and conjugate vaccines are available against meningococci serotypes A, C,
W135 and Y but not of serogroup X.
 In terms of serious adverse events, all meningococcal vaccines are considered safe including for use
in pregnancy, although minor local reactions are common. Fever can occur.
 IAP recommends use of conjugate vaccine over polysaccharide vaccine.
 This vaccine is recommended for high risk groups in children aged >2 yrs.
 Children with planned splenectomy should receive the vaccine ideally 2 weeks prior to the procedur
e for optimal immunogenicity.
Meningococcus Vaccine
Dr. Sonali Paradhi Mhatre

11. • Polysaccharide bivalent (A&C) or quadrivalent (A,C,Y,W135) vaccines containing 50mcg of each indiv
idual serogroups are available in lyophilized forms.
• They are reconstituted with sterile water ad stored at 2-8 C.
• They can be given to children >2 yrs age and to adults.
• Short term efficacy is about 85% - 100% in children ≥2 yrs and adults.
• Protective antibody levels are achieved within 10-14 days.
• Serogroup A polysaccharide induces antibodies in children as young as 3 months of age but the
serogroup C has poor immunogenicity <2 yrs age.
• Multiple doses of A & C polysaccharides are known to cause immunogenic hyporeponsiveness.
• Single dose 0.5ml IM / SC is recommended.
Polysaccharide Meningococcus Vaccine
Dr. Sonali Paradhi Mhatre

12.  Conjugated protein polysaccharide meningococcal vaccines are available in developed countries. Recently
, Sanofi Pasteur has launched a quadrivalent meningococcal vaccine in India.
 This vaccine is approved for use in individuals 9 months through 55 years of age, but in India it is licensed
above 2 years only.
 Another conjugate vaccine is monovalent serogroup A vaccine manufactured by Serum institute of India
which is licensed but has issues with availability. Monovalent A & C are used in certain countries
depending on their local serotype.
 Conjugate vaccines have the following advantages:
1. Longer duration of protection & has lack of hyporesponsiveness
2. Quadrivalent meningococcal conjugate vaccine is preferred for anyone <55 yrs age.
3. These have been found to provide protection against nasopharyngeal carriage as well.
4. Can be given < 2 yrs age
 Disadvantage : Costly.
Conjugated Meningococcus Vaccine
Dr. Sonali Paradhi Mhatre

13. Whom to vaccinate??
•Who recommends that countries with high (>10 cases/100000
population/yr) or intermediate (2-10 cases/ 1lacpopulation/year) endemic
rates of invasive meningococcal disease and countries with frequent
epidemics introduce meningococcal vaccination through routine
immunization programmes and SIA.
•In countries with low endemicity rates of meningococcal infection
(<2cases/1lac population/year), meningococcal vaccination is
recommended for defined risk groups, such as children and adults residing
in closed communities eg. Boarding schools or military camps.
•Laboratory workers at risk for exposure to meningococci and travelers to
high endemic areas should be vaccinated.
•In addition , the vaccine should be offered to all individuals suffering from
immunodeficiency including asplenia, terminal complementary deficiencies
or HIV infections.
Meningococcal conjugate vaccine
Dr. Sonali Paradhi Mhatre

14. Dosage
&
Schedule
•Quadrivalent conjugate vaccines (A,C,W-‐135,Y-‐D and A,C,W135,Y-CRM should be
administered as a single IM dose to all > 2yrs age..
•A,C,W135,Y-D is licensed in kids <2 yrs also and can be given as a 2 dose schedule with
first dose >9 months age and 2nd at interval of 3 months.
•If the primary series is interrupted, vaccination should be resumed without repeating
the previous dose.
•Polysaccharide vaccines can be used to control outbreaks in countries where limited
economic resources or insufficient supply restrict the use of meningococcal conjugate
vaccines.
Meningococcal vaccine
Dr. Sonali Paradhi Mhatre

15.  All the current yellow fever vaccines are live attenuated viral vaccines from the 17D lineage.
 Single dose 0.5ml SC / IM.
 May be administered simultaneously with other vaccines and appears to have lifetime immunity.
 YF vaccine is contraindicated in children aged <6months. It is not recommended for those aged 6–8
months, except during epidemics.
 Contraindicated in : severe hypersensitivity to egg antigen, severe immunodeficiencies eg. Primary i
mmunodeficiency, thymus disorder, symptomatic HIV infection or CD4 T-‐cell values <200 per mm³
, malignant neoplasm treated with chemotherapy, recent haematopoietic stem cell transplantation,
immunosuppressive drugs (e.g. high dose systemic corticosteroids, alkylating drugs, antimetabolite
s, TNF-‐α inhibitors, IL-‐1 blocking agent), and current or recent radiation therapies.
Yellow fever Vaccine
Dr. Sonali Paradhi Mhatre

16. Yellow fever vaccine adverse reactions
Immediate hypersensitiv
ity or Anaphylactic
Reactions.
Yellow fever vaccine
associated neurologic
disease. (YEL - AND)
Yellow fever vaccine
associated viscerotophic
disease. (YEL - AVD)
Yellow fever Vaccine
Dr. Sonali Paradhi Mhatre

17. Whom to vaccinate??
• Populations living in areas which are subject to endemic
and epidemic YF disease.
• Travellers visiting these regions.
• For prevention of international spread by the viremic
travelers.
Yellow fever vaccine
Dr. Sonali Paradhi Mhatre