Why is BCG given only up to 1 year of age?
Most children acquire natural clinical/sub-clinical tuberculosis infection by the age of 1 year. This protects against severe forms of childhood tuberculosis, e.g. TB meningitis and miliary disease.
If no scar appears after administering BCG, should one re-vaccinate the child?
There is no need to re-vaccinate the child even if there is no scar.
Why do we give 0.05 ml dose of BCG to new borns (below 1 month of age)?
This is because the skin of newborns is thin and an intra-dermal injection of 0.1 ml may break the skin or penetrate into the deeper tissue and cause local abscess and enlarged axillary lymph nodes. Dose of 0.05 ml is sufficient to elicit adequate protection.
What does it contain?
T he vaccine contains 0.1–0.4 million live viable bacilli per dose. It is supplied as a lyophilized (freeze-dried) preparation in vacuum-sealed, multi-dose, amber-colored ampoules or 2 mL vials with normal saline as diluent.
What is efficacy of bcg ?
A meta-analysis of published BCG vaccination trials suggested that BCG is 50% effective in preventing pulmonary tuberculosis in adults and children. The protective effect for disseminated and meningeal tuberculosis appears to be slightly higher, with BCG preventing 50–80% of cases.
Nelson 22 edition
What is the normal reaction after bcg?
Correct intradermal administration can be verified by a wheal of 5 mm formation. BCG vaccine should be injected in a clean, healthy area of skin. The vaccine should be given preferably in the lateral aspect of the upper arm. T he injected site usually shows no visible change for several days. Subsequently, a papule develops after 2–3 weeks, which increases to a size of 4–8 mm by the end of 5–6 weeks. This papule often heals with ulceration and results in a scar after 6–12 weeks. The ulcer at vaccination site may persist for a few weeks before formation of the f inal scar. No treatment is required for this condition.
Why zero dose polio?
A dose of OPV administered at birth, or as soon as possible after birth, can significantly improve the seroconversion rates after subsequent doses and induce mucosal protection before enteric pathogens can interfere with the immune response, giving the first OPV dose at a time when the infant is still protected by maternallyderived antibodies may also prevent VAPP.
Why Coadministration of OPV and IPV or Sequential Use of IPV and OPV is advantageous?
IPV Followed by OPV Sequential administration of IPV followed by OPV reduces or prevents VAPP while maintaining the high levels of intestinal mucosal immunity conferred by OPV. Sequential schedules of IPV followed by two or more doses of OPV have been used or studied in several countries including Israel, Oman, Pakistan, UK, and USA. Such schedules reduce the number of doses of IPV and optimize both the humoral and gut immunity to reduce the VAPP among vaccines and contacts oral mucosal immunity among IPV recipients and prevent the spread of vaccine virus.
What is IPV?
IPV refers to Inactivated Polio Vaccine administered by injection. Evidence suggests that this vaccine, when used along with OPV, increases the protection to the individual as well as the community. IPV together with OPV prevents re-emergence and reinfection of wild poliovirus (WPV).
Will IPV (injection) replace OPV (drops)?
No, IPV (injection) will not replace OPV (polio drops), since IPV is recommended for administration in addition to OPV.
Is it safe to give IPV and OPV together?
Yes, it is absolutely safe to give IPV and OPV together. It is also important – and best – for a child to receive both IPV and OPV. Together, these two vaccines provide safe and strong protection against polio.
If a child only receives one of the vaccines it will not be as well protected as the child that has received both the vaccines. Primary doses of OPV (OPV1, OPV2 and OPV 3) should be completed as per schedule.
When is IPV to be administered?
IPV has to be administered as a two-dose fractional intradermal schedule at 6 & 14 weeks. How should you vaccinate if a child has not received the vaccine at 6th week? If missed, the Fractional IPV 1st dose should be given as early as possible after the 6th week. The 2nd dose must be given with 8 weeks interval.
What is bopv?
bOPV (LAV)Sabin strain
Type 1: 10 6 CC ID50
What is ipv?
IPV (inacti-vated)Salk strain
Type 1: 40 units Type 2: 8 units Type 3: 32 units
Type 3: 10 6 CC ID
10 raised to six
What does whole cell dpt vaccine?
The content of diphtheria toxoid varies from 20 Lf to 30 Lf and that of tetanus toxoid (TT) varies from 5 Lf to 25 Lf per dose. The vaccines need to be stored at 2–8°C. These vaccines should never be frozen, and if frozen accidentally, should be discarded. The dose is 0.5 mL intramuscularly and the preferred site is the anterolateral aspect of the thigh. The immunogenicity (protective titer for diphtheria >0.1 IU/mL and for tetanus >0.01 IU/mL) and effectiveness against diphtheria or tetanus of three doses of the vaccine exceeds 95%. Disease may occur in vaccinated individuals but is milder.
Which vaccine is better for primary immunization whole cell dpt or a cellular pertussis?
Whole cell dpt
What is the maximum age upto which dot can be given?
7years
What are the advantages of a cellular pertussis vaccine ?
Adverse Effects T he DTaP vaccines score over the whole-cell vaccines in terms of adverse effects. Broadly speaking the incidence of both minor and major adverse effects is reduced by two-thirds with the acellular vaccines. The incidence of adverse effects is similar with all currently licensed DTaP vaccines.
following past pertussis vaccination. Serious adverse events following previous pertussis vaccination (listed in DTwP section) though less likely as compared to DTwP may still occur with DTaP and are similarly considered as precautions while using the vaccine. After the primary series, the rate and severity of local reactions tend to increase with each successive DTaP dose.
How do you manage wound in a migrant child who is not sure about dpt vaccination ?
What is the catch up vaccination for dpt before 7yrs and after 7yrs?
Catch-up vaccination:
• Catch-up schedule: The second childhood booster is not required if the last dose has been given beyond the age of 4 years •
Catch up below 7 years: DTwP/DTaP at 0, 1, and 6 months
• Catch up above 7 years: Tdap, Td, and Td at 0, 1, and 6 months
What is tdap?
Tetanus and diphtheria contains 5 Lf of TT and only two units of diphtheria toxoid, is stored at 2–8°C and is administered intramuscularly in a dose of 0.5 mL.34 Administration of boosters more frequently than indicated leads to increased frequency and severity of local and systemic reactions as the preformed antitoxin binds with the toxoid and leads to immune complex-mediated reactions (swollen limbs and Arthus type 2 reactions).
Why Tdap in certain age/situations?
Immunity against pertussis following primary or booster wP or aP vaccination wanes over the next 4–12 years. The Academy therefore recommends offering Tdap vaccine instead of Td or TT vaccine to all children or adolescents
When should Tdap to be offered??
In those children who have received all three primary and the two booster doses of DTwP/DTaP, Tdap should be administered as a single dose at the age of 10–12 years
. • Catch-up vaccination is recommended till the age of 18 years.
• Persons aged 7 years through 10 years who are not fully immunized with the childhood DTwP/DTaP vaccine series, should receive Tdap vaccine as the first dose in the catch-up series; if additional
doses are needed, Td vaccine should be used. For these children, an adolescent Tdap vaccine is not required.
• A single dose of Tdap may also be used as replacement for Td/ TT booster in adults of any age, if they have not received Tdap in the past.
• Tetanus toxoid, and reduced quantity diphtheria and acellular pertussis can now be given regardless of time elapsed since the last vaccine containing TT or diphtheria toxoid.
• There is no data at present to support repeat doses of Tdap.
• Indian Academy of Pediatrics recommends decennial Td booster for those who have received one dose of Tdap (5 years for wound management). Only aP-containing vaccines should be used for vaccination in those aged >7 years.
Why Hib vaccine in children?
In unvaccinated populations, Hib is the dominant cause of nonepidemic bacterial meningitis during the first year of life. Even with prompt and adequate antibiotic treatment, 3–20% of patients
with Hib meningitis die. Where medical resources are limited, fatality rates for Hib meningitis may be much higher, and severe neurological sequelae are frequently observed in survivors (in up to 30–40%).
What is the “birth dose” of hepatitis B?
This refers to the dose given within 24 hours of birth. A child vaccinated with Hep B after more than 24 hours of birth is not considered to have received the birth dose.
Why is the birth dose of hepatitis B vaccine given only within 24 hours of birth?
The birth dose of hepatitis B vaccine is most effective in preventing peri-natal transmission of hepatitis B only if given within the first 24 hours.
Why is hepatitis B vaccine given only till 1 year of age in the UIP schedule?
Hepatitis B vaccine is given till 1 year of age because infections during first year of age have a 90% chance of becoming chronic as compared to 30% during 1–5 years and 6% after 5 years. Persons with chronic infection have 15–25% risk of dying prematurely due to HBV related liver cirrhosis and cancer.
What is the role of rotavirus vaccine in National schedule?
The available Rotavirus Vaccines are observed to be effective in preventing severe rotavirus diarrhea by 54-60%. The protective effect of Rotavirus vaccine lasts through 2nd year of life.
Will vaccination with Rotavirus vaccine prevent all diarrheas?
No it does not prevent all diarrheas. Diarrhea is caused by many organisms of which Rotavirus is one of the leading causes for diarrhea in children. Rotavirus vaccine is effective in preventing diarrhea due to Rotavirus only. So the child may still get diarrhea due to other germs and causes even after receiving Rotavirus vaccine.
What is the maximum age limit for giving the first dose of Rotavirus vaccine?
The upper age limit for the first dose of Rotavirus vaccine is one year of age. If a child has received only the first dose of Rotavirus vaccine by 12 months of age, two more doses of the vaccine should be given at an interval of 4 weeks between the two doses to complete the course.
Is a booster dose required for Rotavirus vaccine?
No booster dose of Rotavirus vaccine is recommended. Only three doses at 6, 10 and 14 weeks are required to complete the schedule of vaccination for a child.
Should Rotavirus vaccine be given to children who have already received first dose of OPV and Pentavalent vaccine?
No, during the initial period of Rotavirus vaccine introduction, only the infants coming for the first dose of OPV and pentavalent vaccine will be administered Rotavirus vaccine. These children will be given 2nd and 3rd doses in subsequent visits as per the schedule. Infants, who are coming for their second or third dose of OPV and pentavalent vaccine, will complete the schedule with OPV and pentavalent vaccine only. Rotavirus vaccine is not to be started with second or third dose of OPV and Pentavalent vaccine.
What should be done if a child has received one or two doses of Rotavirus vaccine in a private facility?
If the parents want to vaccinate their child from the public sector after receiving one or two doses of Rotavirus vaccine in a private facility, a new course of Rotavirus vaccine must be started with all three doses at one month intervals provided the child is less than one year old.
Measles / Rubella
What are Measles / Rubella diseases?
Measles is a highly infectious disease causing illness and death due to complications in the form of diarrhea, pneumonia or brain infection mostly among the children less than five years of age. Rubella is a mild disease but when infection occurs in early pregnancy, it has the potential to cause spontaneous abortions, fetal deaths, still births and serious congenital defects in the child causing lifelong disabilities.
What is CRS?
CRS, (Congenital Rubella syndrome) is a set of serious congenital defects a child may be born with when a pregnant women gets Rubella infection in early pregnancy , causing blindness, deafness, heart defects, mental retardation, liver disorders and other hematological disorder, incompatible with normal living.
Why is Measles-Rubella vaccine given?
This Measles –Rubella vaccine is given for preventing both measles and rubella disease in the child, as these diseases can be only prevented by vaccination. Does a child need to be vaccinated if she or he has history of any fever-rash illness including measles or rubella disease? Yes, every child must be vaccinated with two doses, as per the national immunization schedule with MR vaccine at the recommended ages, irrespective of any past fever-rash illness or measles/rubella disease.
If a child has received the Measles Rubella vaccine before 9 months of age, is it necessary to repeat the vaccine later? Yes, the Measles Rubella vaccine needs to be administered, according to the National Immunization Schedule, after the completion of 9 months until 12 months of age as 1st dose and at 16-24 months as 2nd dose in RI.
If a child comes after 2 years for the first dose, then can he/she get the second dose?
All efforts should be made to immunize all children at the right age i.e. first dose at completed 9 months to 12 months and second dose at 16-24 months. However if a child comes late (beyond 2 years),then two doses of the vaccine can be given at one month interval until 5 years of age under UIP.
If a child has received all vaccines as per the national immunization schedule, dose she or he need to be vaccinated during supplementary MR campaigns?
Yes, in addition to the recommended national immunization schedule the child (if eligible as per age group targeted) must be vaccinated with supplementary MR vaccines during campaigns. As measles and JE vaccine doses are recommended for the same age group, can they be given together? Yes, two live injectable vaccines can be administered simultaneously at different sites. Remember – if two live injectable vaccines are not given together as per schedule there must be a minimum interval of 28 days.
What does Mr vaccine contain?
The measles-rubella (MR) vaccine is prepared from the live, attenuated strains of Edmonston-Zagreb measles virus and Wistar RA 27/3 rubella virus.
It is a freeze-dried vaccine, available as single-dose and multidose vials and is to be administered subcutaneously. Each singlehuman dose when reconstituted in a volume of 0.5 mL contains not less than 1000 median cell culture infective doses (CCID50) of live measles virus particles and 1,000 CCID50 of rubella virus. • The dose is 0.5 mL subcutaneously or intramuscularly, preferably over the upper arm/anterolateral thigh.
Superintendent, ICH.