Vaccines and Vaccination

Meningococcal vaccine:
  • The vaccine for meningococcal meningitis is ineffective in children < 2 years old .
  • Vaccines are available for group A, C, Y and W-125. There is no group B vaccine available at present.
  • Meningococcal vaccines should be stored at 2-8° C.
  • Vaccine for meningococcal meningitis should be routinely given to young adolescents.
  • Bivalent meningococcal vaccine is is AC.
Rabies:
  • Recombinant glycoprotein vaccines (Subunit vaccines) for Rabies are still in experimental Stage.
  • Following rabies vaccines are commercially available : Killed sheep brain vaccine, Human diploid cell vaccine , Vero continous cell vaccine.
  • Recommended vaccines for rabies is HDCV.
  • Chick fibroblast anti-rabies vaccine has been recommended by WH.
  • Neurological complications following Rabies vaccine is common with Semple Vaccine.
  • Fixed virus is used to produe rabies vaccine.
  • In rabies, human diploid cell culture vaccine for post-exposure vaccination is given on 0, 3, 7, 14, 28 then booster dose 90 days.
  • Schedule of intradermal rabies vaccine is 8-0-4-0-1-1.
  • Number of doses of HDCV vaccine required for preexposure prophylaxis is 3.
  • Site for injection of cell culture rabies vaccine is Deltoid.
  • It an cause adverse effects in persons with allergy to egg ,
Rota virus:
  • Best vaccine for rotavirus infection is Genetic Reassortment.
  • Contraindication of rota virus vaccine is SCID , Intussusception , Severe allergic raction
Hepatitis B:
  • Risk of HIV transmission is not seen with plasma derived hepatitis B vaccine.
  • Hepatitis B vaccine should be given as per which schedule at 0,1,6 months.
  • Hepatitis B vaccine is a killed 'inactivated' vaccine
Live vaccines:
  • Live Vaccines should be avoided in the long-term follow-up of a renal transplant recipient on ciclosporin.
  • Two live vaccines can be administered simultaneously..
  • Booster doses are not required when live vaccines are administered.
  • Single dose of live vaccine gives life long immunity.Live vaccine contains both major and minor antigens.
  • Live, attenuated virus and live bacterial vaccines generally are contraindicated during pregnancy.
  • Minimum interval between 2 live vaccine immunization is 4 weeks.
Examples of Subunit vaccines are:
  • Meningococcal vaccine from cell wall polysacchlaride
  • Pneumococccal vaccine from Capsular polysaccharide
  • Hepatitis B polypeptide vaccine
  • Typhoid vaccine from Vi polysaccharide
  • H. Influenza vaccine from capsular polysaccharide.
BCG vaccine :
  • It is a live attenuated vaccine
  • It has no preservative at all .
  • WHO recommends Danish 1331 strain for vaccine production.
  • BCG vaccine is diluted with normal saline.
Polio vaccines:
  • Two types of vaccines are used throughout the world :?Inactivated (salk) polio vaccine (IPV) and Oral (sabin) polio vaccine (OPV)
  • In OPV, the vaccine potency is stabilized with molar magnesium chloride or sucrose..
  • IPV:Given in 4 doses,Being an inactivated vaccine, it can be given to immunosuppressed individuals, e.g. AIDS patients,Produces circulatory antibody,Does not require stringent refrigeration,Not effective in an epidemic,Does not provide Immunity against paralytic and wild strains ,It prevents paralysis,Easily transported,Oral polio can be given as booster.
  • Trivalent oral polio vaccine contains:
  1. Over 300,000 TCID 50 of type 1 poliovirus
  2. Over 100,000 TCID 50 of type 2 poliovirus
  3. Over 300,000 TCID 50 of type 3 poliovirus.
  • OPV bivalent vaccine contains type 1 and 3 viruses.
  • Being living viruses, the vaccine viruses, particularly type 3 do mutate in the course of their multiplication in vaccinated children, and rare cases of vaccine associated paralytic polio have occured in -Recipients of the vaccine and their contacts.
  • Maintenance of cold chain.
  • 5 doses of OPV given.
  • Killed vaccine is effective in India.
  • OPV:Stored at Sub-zero temprature,Intestinal & humoral immunity,Main problem is residual neuro-virulenceoor growth in stable cell line of monkey kidney,
  • OPV was discovered by → Albert Sabin (Sabin vaccin). IPV was discovered by → Jonas Salk (Salk vaccine).
  • As it prevents heat inactivation mgCl2 can be added to polio vaccine so that it can be stored at a higher temperature.
  • In a epidemic of poliomyelitis, the best way to stop spread is by OPV drops to all children.
  • Reverse cold chain is used for Carrying stool samples of polio patients from MC to lab .
  • The efficiency of cold chain system for oral polio vaccine as monitored by Vaccine Vial Monitor (VVM) depends on Change in Colour of Monitor.
Vaccine Vial Monitor:
  • Colour of central square Lighter than ring --Can be used
  • Colour of central square  → Same or darker than ring --Discard.
DPT vaccine:
  • Thiomersal is preservative in DPT vaccine.
  • Aluminium salt has an adjuvant effect in DPT vaccine.
  • Whole killed bacteria of Bordetella pertusis has an adjuvant effect in DPT vaccine.
  • Presence of acellular pertusis component in DPT vaccine.
  • DPT vaccine should not be given to a child suffering from convulsions.
  • DPT vaccine must be stored in cool part of a freeze (at 4-8°C) but not in freezer.
  • Exposure to direct sunlight should be avoided.
  • Open multi-dose vials which have not been fully used should be discarded at the end of session.
  • The adjuvant used is Al.
  • The peripheral workers in a primary health centre return one day late; after an immunisation session. The primary health centre is locked. The vaccine carrier still contains a few unopened vials of DPT vaccine and sufficient ice. The workers are to retain the vaccine in the ice-box.
  • Prevent development of carrier
Measles:
  • Usually there is no preservative in measles vaccine, though it may contain very small amounts of Kanamycin, neomycin or erythromycin..
  • Measles vaccine given to contact of measles case exerts protective effect within 7 days.
  • In measeles vaccine can be given within- 6 months.
  • MMR is a type of live attenuated vaccine.
  • Can cause TSS.
  • Contraindicated in neomycin allergic patients.
  • In epidemics measles vaccine is to be given within 3days of exposure.
  • Encephalopathy can occur as complication
  • At PHC level vaccine storage is by IRL.
Chicken pox vaccine:
  • It is a live vaccine.
  • OKA strain is used to produce vaccine for Chicken Pox.
  • Rubella vaccine is given in 1-14 years age .
  • Newer Influenza vaccine are Split-virus vaccine & Neuraminidase.
Cholera Vaccine:
  • It is WC-r BS.
  • Oral cholera vaccine is effective for 3 years.
Typhoid:
  • For a typhoid endemic country like India, the immunization of choice is Typhoral 21 A oral vaccine.
  • Typhoid oral vaccine is given at 1,3,5 days.
  • The Vi polysaccharide vaccine can be co-administered with other vaccines relevant for international travelers.
Yellow fever vaccine :
  • In India is produced at- Central research institute,Kasauli.
  • It is contraindicated in pregnancy.
  • SA-14-14-2 Japanese Encephalitis vaccine - is a Cell culture derived live attenuated vacine.
  • Pneumococcal vaccine is most effective when given preoperatively.
  • German measles (rubella) need not be given to boys.
  • After reconstitution, the vaccine must be stored in the dark at 2-8 degree C and used within: 6 hours.
  • Term vaccine was coined by Louis Pasteur.
Refrigerator:
  • Deep freezers are used for making ice packs and to store OPV and measles vaccines.
  • Vaccines which must be stored in cold part but never allowed to freeze are: typhoid, DPT, Tetanus toxoid, DT, BCG, and diluents.
  • Polyvalent snake vaccines contains immunoglobins against : Naja naja , Daboia rusellii , Bungarus caeruleus.
  • Bivalent HPV vaccine contains types 16,18.
  • Mumps vaacine efficacy is 95%..
Hepatitis A:
  • Both live and inactivated for Hepatitis A.
  • Recomended at age of 12 months.
  • 2 dose of killed vaccine 6 months apart.
  • 1 dose of live vaccine
  • Intramuscular is is the route of administration of avian influenza vaccine.
  • Children should receive Influenza vaccine at 2 doses at one month interval with one booster dose later.
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