EXPERIMENT NO.

SOCIAL PHARMACY ER20-15P

F.Y.D. PHARM

Mrs. Madhura M. Karale (M. Pharm)

BVIOP, CBD, NAVI MUMBAI
 NATIONAL IMMUNIZATION SCHEDULE FOR CHILDREN
AIM: To study and understand the immunization schedule for infants and children.
Theory:
A national immunization programme (NIP) is the organizational component of
Ministries of Health charged with preventing disease, disability, and death from
vaccine-preventable diseases in children and adults.
A NIP is a government programme that operates within the framework of overall health
policy.
Immunizations, also known as vaccinations, help to protect you from getting an
infectious disease. When you get vaccinated, you help to protect others as well,
Vaccines are very safe. It is much safer to get the vaccine than an infectious disease.
 TYPES OF VACCINES
• There are several types of vaccines, including:
• Inactivated vaccines.
• Live-attenuated vaccines.
• Messenger RNA (mRNA) vaccines.
• Subunit, recombinant, polysaccharide, and conjugate vaccines.
• Toxoid vaccines.
• Viral vector vaccines.
 Types of vaccines
• Types:
• Viral:
• Injected polio vaccine (Salk vaccine)
• Hepatitis A vaccine
• Rabies vaccine
• Most influenza vaccines
• Tick-borne encephalitis vaccine
• Some COVID-19 vaccines: BBIBP-CorV, WIBP-CorV, CoronaVac, Covaxin, QazVac, TURKOVAC, CoviVac
• Bacterial:
• Injected typhoid vaccine
• Cholera vaccine
• Plague vaccine
• Pertussis vaccine
 Inactivated vaccines
• 1. An inactivated vaccine (or killed vaccine):
• It is a vaccine consisting of virus particles, bacteria, or other pathogens that
have been grown in culture and then killed to destroy disease-producing
capacity.
• Pathogens for inactivated vaccines are grown under controlled conditions and
are killed as a means to reduce infectivity and thus prevent infection from the
vaccine.
• Inactivated vaccines were first developed in the late 1800s and early 1900s for
cholera, plague, and typhoid.
• Today, inactivated vaccines exist for many pathogens, including influenza,
polio (IPV), rabies, hepatitis A and pertussis.
Inactivated vaccines
• Because inactivated pathogens tend to produce a weaker response by
the immune system than live pathogens, immunologic adjuvants and
multiple "booster" injections may be required in some vaccines to
provide an effective immune response against the pathogen.
• Whole pathogen inactivated vaccines are produced when an entire
pathogen is 'killed' using heat, chemicals, or radiation, although only
formaldehyde and beta-Propiolactone exposure are widely used in
human vaccines.
 Live vaccines
• 2. Live vaccines:
• These vaccines use pathogens that are still alive (but are almost
always attenuated, that is, weakened).
• Attenuated vaccines are often preferable for generally healthy people
because a single dose is often safe and very effective. However, some
people cannot take attenuated vaccines because the pathogen poses
too much risk for them (for example, elderly people or people with
immunodeficiency).
 Messenger RNA (mRNA) vaccines.

• Most vaccines contain a weakened or dead bacteria or virus.

However, scientists have developed a new type of vaccine that uses a
molecule called messenger RNA (or mRNA for short) rather than part
of an actual bacteria or virus. Messenger RNA is a type of RNA that is
necessary for protein production.
• In cells, mRNA uses the information in genes to create a blueprint for
making proteins. Once cells finish making a protein, they quickly
break down the mRNA. mRNA from vaccines does not enter the
nucleus and does not alter DNA.
 Messenger RNA (mRNA) vaccines.

• mRNA vaccines work by introducing a piece of mRNA that corresponds to a viral

protein, usually a small piece of a protein found on the virus’s outer membrane.
(Individuals who get an mRNA vaccine are not exposed to the virus, nor can they
become infected by the vaccine.) Using this mRNA blueprint, cells produce the viral
protein. As part of a normal immune response, the immune system recognizes that
the protein is foreign and produces specialized proteins called antibodies.
• Antibodies help protect the body against infection by recognizing individual viruses or
other pathogens, attaching to them, and marking the pathogens for destruction. Once
produced, antibodies remain in the body, even after the body has rid itself of the
pathogen, so that the immune system can quickly respond if exposed again. If a
person is exposed to a virus after receiving mRNA vaccination for it, antibodies can
quickly recognize it, attach to it, and mark it for destruction before it can cause
serious illness.
 Messenger RNA (mRNA) vaccines.

• Like all vaccines in the United States, mRNA vaccines require

authorization or approval from the Food and Drug Administration
(FDA) before they can be used. Currently vaccines for COVID-19, the
disease caused by the SARS-CoV-2 coronavirus, are the only
authorized or approved mRNA vaccines.
• These vaccines use mRNA that directs cells to produce copies of a
protein on the outside of the coronavirus known as the “spike
protein”. Researchers are studying how mRNA might be used to
develop vaccines for additional infectious diseases.
Subunit, recombinant, polysaccharide, and conjugate vaccines.

• Subunit, recombinant, polysaccharide, and conjugate vaccines use specific pieces of the germ—like its
protein, sugar, or capsid (a casing around the germ). Because these vaccines use only specific pieces of the
germ, they give a very strong immune response that's targeted to key parts of the germ.
• Immune response
• Subunit vaccines, like inactivated whole-cell vaccines, do not contain live components of the pathogen.
They differ from inactivated whole-cell vaccines, by containing only the antigenic parts of the pathogen.
These parts are necessary to elicit a protective immune response.
• This precision comes at a cost, as antigenic properties of the various potential subunits of a pathogen must
be examined in detail to determine which particular combinations will produce an effective immune
response within the correct pathway.
• Often a response can be elicited, but there is no guarantee that immunological memory will be formed in the
correct manner.
• Safety and stability
• Like inactivated vaccines, subunit vaccines do not contain live components and are considered as very safe.
 Toxoid vaccines
• Toxoid vaccines are based on the toxin produced by certain bacteria
(e.g. tetanus or diphtheria).
• The toxin invades the bloodstream and is largely responsible for the
symptoms of the disease. The protein-based toxin is rendered
harmless (toxoid) and used as the antigen in the vaccine to elicit
immunity.
• To increase the immune response, the toxoid is adsorbed to
aluminium or calcium salts, which serve as adjuvants.
 Toxoid vaccines
• Safety and stability
• Toxoid vaccines are safe because they cannot cause the disease they
prevent and there is no possibility of reversion to virulence. The
vaccine antigens are not actively multiplying and do not spread to
unimmunized individuals. They are stable, as they are less susceptible
to changes in temperature, humidity and light.
 Viral vector vaccines
• Viral vector-based vaccines differ from most conventional vaccines in that they
don’t actually contain antigens, but rather use the body’s own cells to produce them.
• They do this by using a modified virus (the vector) to deliver genetic code for
antigen, in the case of COVID-19 spike proteins found on the surface of the virus,
into human cells.
• By infecting cells and instructing them to make large amounts of antigen, which
then trigger an immune response, the vaccine mimics what happens during natural
infection with certain pathogens - especially viruses.
• This has the advantage of triggering a strong cellular immune response by T cells as
well the production of antibodies by B cells.
• An example of a viral vector vaccine is the rVSV-ZEBOV vaccine against Ebola.
 UNIVERSAL IMMUNIZATION
PROGRAMME (UIP)
• UIP is a vaccination programme launched by the Government of India in 1985.

• It became a part of Child Survival and Safe Motherhood Programme in 1992 and is currently one
of the key areas under National Rural Health Mission since 2005.

• The programme now consists of vaccination for 12 diseases,

• Tuberculosis, diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, hepatitis B,
diarrhea,
• Japanese encephalitis, rubella, pneumonia (haemophilus influenzae type B) and Pneumococcal
diseases (pneumococcal pneumonia and meningitis).
• Hepatitis B and Pneumococcal diseases were added to the UIP in 2007 and 2017 respectively.
 THE PURPOSE OF IMMUNIZATION SCHEDULE

• Purpose immunization schedule :

• To protect infants and children by providing immunity early in life, before they
are exposed to potentially life-threatening diseases.
• The protection developed after vaccination usually lasts for many years and is
able to stop the disease in most cases.
• Even if the child does get the disease after being vaccinated, the symptoms will be
much milder than symptoms in a child who was never vaccinated.
• For some vaccines, booster doses are given to children at specified ages to further
raise the protection up to an optimum level.
THE PURPOSE OF IMMUNIZATION SCHEDULE

• Vaccines ensure the best protection to children when they are given at the right
ages, and in required number of doses.
• At certain period of life, there is a maximum incidence of a particular disease.
Therefore, to prevent harm caused by the disease, vaccines are provided at that
particular age.
• For example, the occurrence of Polio is maximum in children below 5 years of
age; hence, vaccination against polio is given in routine immunization as well as
in campaigns to children below 5 years of age.
• Similarly, number of doses required is determined by the level of protection
required to prevent serious infections.
The National Immunization Schedule
• The National Immunization Schedule clearly mentions different
vaccines, ages at which they are to be given, and doses required for
ensuring full protection from vaccine-preventable diseases.
• All vaccines available in the country are licensed by Drug Controller
General of India (DCGI).
• Therefore, are safe for use.
• However, complete immunization services are given to all the children
and pregnant women free of cost, at the government health facilities.
 Result
• Result: The national immunization schedule is studied and understood.
VIVA VOCE QUESTIONS
• Q.1. Route of administration measeles vaccines is subcutaneous.
• Q.2. Pentavalent vaccines covers which diseases?
• Answer: Diphteria, Pertussis, Tetanus, Hepatitis B, Haemophilus influenzae type b-
1, 2 & 3
• Q.3. What is UIP?
• Answer: Universal immunization programme

• Q.4. What is Pulse Polio Immunization?

• Answer: The occurrence of Polio is maximum in children below 5 years of age;
hence, vaccination against polio is given in routine immunization as well as in
campaigns to children below 5 years of age.
 Pulse Polio Immunization programme
• What is Pulse Polio Immunization?
• Answer:
• With the global initiative of eradication of polio in 1988 following World Health Assembly
resolution in 1988, Pulse Polio Immunization programme was launched in India in 1995.
• Children in the age group of 0-5 years administered polio drops during National and Sub-national
immunization rounds (in high risk areas) every year. About 172 million children are immunized
during each National Immunization Day (NID).
• The last polio case in the country was reported from Howrah district of West Bengal with date of
onset 13th January 2011. Thereafter no polio case has been reported in the country (25th May
2012).
• WHO on 24th February 2012 removed India from the list of countries with active endemic wild
polio virus transmission.
Pulse Polio Immunization programme
• Objective :

• The Pulse Polio Initiative was started with an objective of achieving

hundred per cent coverage under Oral Polio Vaccine.
• It aimed to immunize children through improved social mobilization,
plan mop-up operations in areas where poliovirus has almost
disappeared and
• maintain high level of morale among the public.
VIVA VOCE QUESTIONS
• Q.5. What are vaccines?
• Answer: A vaccine is a substance that is introduced into the body to stimulate the body’s
immune response. It is given to prevent an infectious disease from developing and the
person becoming ill.

• Vaccines are made from microbes that are dead or inactive so that they are unable to cause
disease. The antigen in the vaccine is the same as the antigen on the surface of the
disease-causing microbe. The vaccine stimulates the body to produce antibodies against
the antigen in the vaccine. The antibodies created will be the same as those produced if
the person was exposed to the pathogen. If the vaccinated person then comes into contact
with the disease-causing microbe, the immune system remembers the antibodies it made
to the vaccine and can make them faster. The person is said to be immune to the pathogen.
 MULTIPLE CHOICE QUESTIONS
• Q.1. Which of the following vaccines is/are given by the intramuscular
route?
• (a) Influenza (b) BCG (c) Cholera (d) MMR
• Answer: (d) MMR
• Q.2. When should a child receive the first dose of the Hepatitis B
vaccine?
• (a) Birth(b) 2 months(c) 4 months(d) 6 months
• Answer: (a) Birth
 MULTIPLE CHOICE QUESTIONS
• Q.3.Which of these vaccines is available for oral administration?
• (a)Measles(c) Hepatitis B(b) Rabies(d) Typhoid
• Answer: (d) Typhoid
• Q.4. Vaccines protect infection by __________.
• (a) Destroying the infective agent in environment (b) Killing the insect
vectors responsible for the spread infection(C) Increasing the
immunity of the host(d) None of the above
• Answer: (C) Increasing the immunity of the host
MULTIPLE CHOICE QUESTIONS
• Q. 5. Which of these vaccines is used to prevent tuberculosis?
• (a) BCG(c) MMR(b) HCG(d) DPT
• Answer: (a) BCG
NATIONAL IMMUNIZATION SCHEDULE FOR CHILDREN
Immunization
• Immunization is one of the most important and cost effective strategies for the prevention of
childhood sicknesses and disabilities and is thus a basic need for all children. The following
schedule has been recommended by the Ministry of Health, Govt. of India and is one of the
most widely followed by the child health care providers.
• Immunization is the process whereby a person is made immune or resistant to an infectious
disease, typically by the administration of a vaccine. Vaccines stimulate the body’s own
immune system to protect the person against subsequent infection or disease.
• Immunization is a proven tool for controlling and eliminating life-threatening infectious
diseases
• It is one of the most cost-effective health investments.
 What is immunization and how does it work ?

• Immunization is a way of protecting the human body against infectious diseases

through vaccination.

• Immunization prepares our bodies to fight against diseases in case we come into
contact with them in the future.

• Babies are born with some natural immunity which they get from their mother and
through breastfeeding. This gradually wears off as the baby's own immune system
starts to develop. Having your child immunized gives extra protection against
illnesses which can kill.
The schedule recommends that the vaccinations should start when the baby is 1½ months old. But what
should be done if the baby is brought late for vaccinations? Should vaccination still be started?

What are the side effects of vaccinations?

• For example, after the DPT injection, the infant may have pain at the site of the injection and may even
develop fever.

• After the measles injection, measles like rashes may appear. These are normal. Very rarely, children can
have allergic reactions straight after immunization.

• Also if the baby develops high fever or loses consciousness, a doctor should be consulted immediately.

• People giving immunizations are trained to deal with allergic reactions and if the child is treated quickly,
he or she will recover fully.
Are there any reasons why a child should not be immunized?

There are very few reasons why a child should not be immunized. Ordinarily common
illnesses like a cold or a diarrhea are not impediments against getting the child vaccinated.
There are certain situations though, where you must let the doctor know of the child’s
conditions. Following are some of them:

The child has a high fever

S/He has had a bad reaction to another immunization
S/He has had a severe reaction after eating eggs
S/Has had a convulsion (fits) in the past. (With the right advice, children who have had
fits in the past can be immunized)
S/He has had, or is having, treatment for cancer
S/He has any illness which affects the immune system, for example, HIV or AIDS
S/He is taking any medicine which affects the immune system, for example,
immunosuppressant (given after organ transplant or for malignant disease) or high-dose
steroids.
 National Immunization Schedule For Infants
Vaccine and Disease Prevented When to give Maximum age Dose Route Site

BCG (Bacillus Calmette Guerin) & At birth or as early as possible till 1 At birth till one year 0.1ml (0.05ml until  Intra-dermal Left Upper Arm
Childhood, Tuberculosis ( or Primary Complex) year of age 1month age)

Hepatitis B - Birth dose & At birth or as early as possible At birth within 24 hours 0.5 ml Intra-muscular Antero-lateral
Hebatitis B within 24 hours side of mid-thigh

Oral Polio Vaccine (OPV) -0 At birth or as early as possible Within the first 15 days 2 drops Oral Oral
& Poliomyelitis within first 15 days

Oral Polio Vaccine (OPV) -1,2,3, At 6 weeks, 10 weeks & 14 weeks Till 5 years of age 2 drops Oral Oral
& Poliomyelitis

Inactivated Polio Vaccine (IPV) 1 & 2 At 6 weeks & 14 weeks 1 year of age 0.1 ml Intra-dermal Right Upper arm
& Poliomyelitis

Pentavalent vaccine (Diphteria, Pertussis, At 6 weeks, 10 weeks & 14 weeks 1 year of age 0.5 ml Intra-muscular Antero-lateral
Tetanus, Hepatitis B, Haemophilus-influenzae side of mid-thigh-
type b)- 1, 2 & 3 right

Rotavirus Vaccine (RVV) 1, 2 & 3 At 6 weeks, 10 weeks & 14 weeks 1 year of age 5 drops  (lyophilized Oral Oral
& Rotavirus diarrhoea. vaccine)
Pneumococcal At 6 weeks, 14 weeks & 1 year of age 0.5 ml Intra-muscular Antero-lateral side of
Conjugate Vaccine 9 months mid-thigh
(PCV) 1, 2 & Booster

Measles-Rubella (MR) 9 completed months - to 5 years of age 0.5 ml Sub-cutaneous Right upper arm
1 12 months. Give up to
5yrs if not received at 9 -
12 months age

Vitamin A (1st dose) At 9 completed months  5 years of age 1ml (1lakh IU) Oral Oral

Japanese Encephalitis At 9 completed months  - 15 years of age 0.5 ml Subcutaneous Left upper arm Antero-
(1st Dose)*** 12 months (live vaccine) lateral side of mid
Intramuscular thigh
(killed)

Pneumococcal At 6 weeks, 14 weeks & 9 1 year of age 0.5 ml Intra-muscular Antero-lateral side of
Conjugate Vaccine months mid-thigh
(PCV) 1, 2 & Booster
Rotavirus vaccine (RVV) as part of Universal Immunization Programme
• In India, every year 37 out of every 1000 children born are unable to celebrate their 5th birthday,
and one of the major reasons for this is diarrheal deaths.
• Out of all the causes of diarrhoea, rotavirus is a leading cause of diarrhoea in children less than 5
years of age.
• It is estimated that rotavirus cause 8,72,000 hospitalizations; 32,70,000 outpatient visits and
estimated 78,000 deaths annually in India.
• The introduction of Rotavirus vaccine will enable to directly address the problem of diarrheal
deaths
 National Immunization Schedule Children and adolescents
Diphtheria Pertussis Tetanus 16- 24 months 7 years of age 0. 5 ml Intra- muscular
(DPT) booster 1

 MR 2 16-24 months 5 years of age 0.5 ml Sub-cutaneous

OPV Booster 16-24 months 5 years of age 2 drops Oral

Japanese Encephalitis 16-24 months 15 years of age 0.5 ml Sub-cutaneous

(if applicable)

Vitamin A***(2nd to 9th dose) 18 months (2nd dose). Then, one 5 years of age 2 ml (2 lakh IU) Oral
dose every 6 months upto the age
of 5 years.

Diphtheria Pertussis Tetanus 5- 6 years 7 years of age 0.5 ml Intra-muscular

Booster (DPT) booster 2

Tetanus & adult Diphtheria 10 years &16 years 16 years of age 0.5 ml Intra-muscular