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Bacille Calmette-Guérin (BCG) Bacille Calmette-Guérin (BCG) VaccineVaccine::
Live attenuated vaccineLive attenuated vaccine
Store at 0° to 8°CStore at 0° to 8°C
Age : at birth or 6 weeksAge : at birth or 6 weeks
Route of administrationRoute of administration : :
a single intra dermal injection over the deltoid a single intra dermal injection over the deltoid muscle of the arm or left forearmmuscle of the arm or left forearm. .
At site of injection: development of erythema At site of injection: development of erythema and either a papule or ulceration, followed by and either a papule or ulceration, followed by a scar at the immunization sitea scar at the immunization site..
Bacille Calmette-Guérin (BCG) VaccineBacille Calmette-Guérin (BCG) Vaccine::
Side effectsSide effects::
LymphadenitisLymphadenitisContraindicationContraindication::
Immune deficiency diseases, including congenital Immune deficiency diseases, including congenital immunodeficiency, HIV infection and impaired immune immunodeficiency, HIV infection and impaired immune function secondary to treatment with corticosteroids, function secondary to treatment with corticosteroids, chemotherapeutic agents or radiation. chemotherapeutic agents or radiation.
ORAL POLIO VACCINE (OPV)ORAL POLIO VACCINE (OPV)
Contents:Contents: Sabin attenuated polio virus (live Sabin attenuated polio virus (live attenuated vaccine)attenuated vaccine)
Ideal age of Initiating primary vaccinationIdeal age of Initiating primary vaccination : :
66 weekweek
( ( an additional dose recommended at birth by an additional dose recommended at birth by W.H.O. OPV0W.H.O. OPV0 ) )
ORAL POLIO VACCINE (OPV)ORAL POLIO VACCINE (OPV)
Boosters:Boosters: Two, at 1.5 years and between 4-5 Two, at 1.5 years and between 4-5 yearsyears..
Dose: Dose: 2 drops2 drops . .
Route of administration:Route of administration: Oral Oral..
ORAL POLIO VACCINE (OPV)ORAL POLIO VACCINE (OPV)
Contra – Indications: Contra – Indications:
Immunocompromised host or household Immunocompromised host or household member. member.
Side effects: NoneSide effects: None . . Complications: Vaccine induced Complications: Vaccine induced
poliomyelites (one in 3 million vaccine) poliomyelites (one in 3 million vaccine) The dose of OPV given during an episode of The dose of OPV given during an episode of
diarrhea should not be counted and shoud diarrhea should not be counted and shoud be to given at the earliest opportunity be to given at the earliest opportunity
Pentavalent VaccinePentavalent VaccineContents:Contents: Each 0.5 ml contains Each 0.5 ml contains::
Diphtheria toxoid, Tetanus toxoid, pertussis, Hepatitis B, Diphtheria toxoid, Tetanus toxoid, pertussis, Hepatitis B, Haemophilus influenzae bHaemophilus influenzae b..
TheThe vaccine should not kept frozen or exposed to freezingvaccine should not kept frozen or exposed to freezing
Store at 2° to 8°CStore at 2° to 8°C
Dose: Dose: 0.5 ml0.5 ml . .
Pentavalent VaccinePentavalent Vaccine
Route of administration:Route of administration: Deep intramuscular Deep intramuscular . .
Site of administration:Site of administration: Anterolateral aspect of Anterolateral aspect of thighthigh..
Pentavalent VaccinePentavalent Vaccine
Side effects:Side effects: Fever, local pain and swelling Fever, local pain and swelling..
Instruction to the mother after vaccination: Instruction to the mother after vaccination: To give antipyretic (paracetamol) in case of To give antipyretic (paracetamol) in case of
feverfever . .
Complications: Convulsions, shock, encephalitis .
Contra- Indications: a. Progressive neurological disease.
b. Uncontrolled convulsions . c. Severe reactions to first or subsequent dose
Measles VaccinesMeasles Vaccines
Contents:Contents: live attenuated measles virus grow in chick live attenuated measles virus grow in chick embryo cellsembryo cells . .
Store at 0 to 8°CStore at 0 to 8°C
Ideal age of Primary vaccinationIdeal age of Primary vaccination::
99 monthsmonths . .
In epidemics & household contacts should be In epidemics & household contacts should be between 6-9 monthsbetween 6-9 months
Measles VaccinesMeasles Vaccines
Dose:Dose: 0.5 ml 0.5 ml . .
Route of administration:Route of administration: Subcutaneous Subcutaneous . .
Site of administration:Site of administration: Upper arm or anterolateral aspect of Upper arm or anterolateral aspect of
thighthigh..
..
MeaslesMeasles
Side effects: :Side effects: : Mild fever & rash may appear Mild fever & rash may appear after 5-7 daysafter 5-7 days . .
Contra-IndicationsContra-Indications::
Immuno compromised hostImmuno compromised host . .
Severe (anaphylactic) egg allergySevere (anaphylactic) egg allergy . .
Rotavirus VaccinesRotavirus Vaccines
Contains one strain of live attenuatedContains one strain of live attenuated
rotavirus (type G1P[8]rotavirus (type G1P[8]
Store at (2-8Store at (2-8oo C) and protect from light C) and protect from light
Rotavirus VaccineRotavirus Vaccine
Dose: 1.5 mlDose: 1.5 ml22 dosesdoses
minimum interval between doses is 4 weekminimum interval between doses is 4 week
AgeAge-:-:
beginning at 6weeks of agebeginning at 6weeks of ageEarly immunization is favoured with the first dose of rotavirus vaccine to Early immunization is favoured with the first dose of rotavirus vaccine to
be administered frombe administered from66 weeks of age, however, in order to benefit those who may come late weeks of age, however, in order to benefit those who may come late
infants can receive dosesinfants can receive doseswithout age restriction. Because of the typical age distribution of rotavirus without age restriction. Because of the typical age distribution of rotavirus
gastroenteritisgastroenteritis ( (rotavirus vaccination of children >24 months of age is not recommendedrotavirus vaccination of children >24 months of age is not recommended..
Rotavirus VaccineRotavirus VaccineContraindicationsContraindications
Severe allergic reaction to a vaccine Severe allergic reaction to a vaccine component or following a prior dose of component or following a prior dose of vaccinevaccine
Rotavirus VaccineRotavirus VaccinePrecautionsPrecautions**
Altered immunocompetenceAltered immunocompetence
History of intussusceptionHistory of intussusception
*the decision to vaccinate if a precaution is present should be made on a case-by-case risk and benefit basis
Rotavirus VaccineRotavirus VaccineAdverse ReactionsAdverse Reactions
VomitingVomiting DiarrheaDiarrhea Irritability Irritability FeverFever
Serious adverse reactionSerious adverse reaction None None
Contraindications to live attenuated vaccines:Absolute:1- History of anaphylactic reactions.
2- Subsequent doses of pertussis vaccines are absolutely
contraindicated if the child gets (within 48 hours of vaccination )
• Fever (40.5º) ,
•Collapse or shock .
•Persistent crying for 3 hours without apparent cause.
•Convulsion with or without fever within 3 hours after
vaccination.Give a single dose vaccine of diphtheria + tetanus pediatric formula ( avoid pertussis component).
Contraindications to live attenuated vaccines:Absolute:
3- HIV infection is an absolute contraindication to administration of
live attenuated vaccines ( OPV & BCG).
Temporary:
1- Severe illness that needs hospitalization.Deferred immunization till the infant recovers and could be at discharge.
2- Immunosuppression.
The strategy for the vaccine delivery:
(I) The fixed site strategy.
(II) Outreach site strategy.
(III) Mopping up Immunization.
(IV) The National Immunization Days (NIDs).
1. The fixed site strategy:
There is integration of immunization services through (MCH): Advantages:-
1-Available resources.
2- Cold Chain maintenance.
3- Save ,time, effort and money.
2.The out reach Strategy The outreach is carried for routine immunization that is compulsory
for the targets in certain areas where:
- immunization services are not accessible.
- vaccination coverage is Low.
Limitations:
(i) Expensive
(ii) Cold chain failure.
(iii) Difficulty to arrange the immunization schedule.
(3) Mopping up Immunization:
• It is house-to-house immunization with OPV in high risk districts.
• High risk districts are those:
• Where the wild polio virus is still circulating
• With low immunization coverage.
• Population, with overcrowding poor sanitary environment
and low access to health services.
(4) The National Immunization Days (NIDs):
It is periodic immunization of all the eligible targets in a defined
group over a large geographic areas within a short period of time. It
is one of the strategy for polio eradication and tetanus elimination.
The cold chain:
It is the system of storage and transportation of the
vaccine at low temperature (cold condition) from the
manufacture till it is consumed.
The cold chain:
• Polio vaccine is the most sensitive vaccine to heat.
• Live attenuated vaccines are allowed to be frozen (OPV,
Measles and BCG).
• Inactivated vaccines must not be frozen ( DPT, DT, dT , TT
and HB) .
The administrative level
Storage period
TemperatureThe vaccines
Central & regional stores
Maximumthree months
-20° to- 30°COPV, Measles,
MMR,BCG
+2° to +8°CDPT, DT, dT, TT& HB,Hib
Districts stores& local immunization
centers
Maximumone month
0°C to+8°COPV, Measles,
MMR, BCG
+2° to +8°CDPT, DT, dT, TT& HB,Hib
The administrative levels of cold chain according to the duration of the storage and the temperature required to keep
the vaccine potent
Refrigeration equipment: Refrigerator
Cold boxes
Vaccine carriers
The ice packs retained in the freezer
-To stabilize the temperature of the refrigerator at the
optimum level.
- Fully frozen ice-packs are used for lining the vaccines
carriers and the cold boxes during storing the vaccines
Cold Chain EquipmentCold Chain EquipmentCold Chain EquipmentCold Chain Equipment
The recommendedThe recommended
equipment equipment typically used for typically used for vaccine storage are vaccine storage are ::
cold rooms, cold rooms, refrigerators and refrigerators and freezers. freezers.
The recommendedThe recommended
equipment equipment typically used for typically used for vaccine storage are vaccine storage are ::
cold rooms, cold rooms, refrigerators and refrigerators and freezers. freezers.
For transporting For transporting vaccinesvaccines
equipment such equipment such asas
cold boxes, cold boxes, vaccine carriers vaccine carriers
andand
For transporting For transporting vaccinesvaccines
equipment such equipment such asas
cold boxes, cold boxes, vaccine carriers vaccine carriers
andand
Cold chain equipmentCold chain equipment “For vaccine storage” “For vaccine storage”
Cold room
refrigerators
Freezer
Cold chain equipmentCold chain equipment “for transporting vaccine” “for transporting vaccine”
Cold boxVaccine carrier
Ice bags
The refrigerator :
• Placed in the coolest place of the health centers away from sunlight
• Well ventilated and adequate air circulation around it .
• Kept locked and open only when necessary.
•Ice packs are kept in the freezer.
• Its temperature is recorded twice daily.
• Both the monitor and thermometer are placed in the refrigerator.
• The temperature chart is stuck on the door outside the refrigerator.
• The diluents should be kept on the lowest shelf.
• Drugs, drinks or food must not be stored in the refrigerator
Tools for monitoring the cold chain:
1- Cold Chain Monitor Card.
2- Freeze Watch Indicator
3- Cold Chain Refrigerator Graph
4- Vaccine Vial Monitors
5- Shake Test
Cold Chain Refrigerator Graph The vaccines are stored in refrigerators, they are monitored twice a day and readings are recorded on a chart to ensure a safe temperature is maintained
+2°C
+8°C
2-Cold Chain Monitor Card: is used to show cumulative exposure to Temp. above the safe range during storage& transportation.
3-Vaccine vial monitors:
Every vial is also shipped with a
temperature-sensitive label, that health
workers monitor during vaccination
sessions.
SAFEIf the inner square is lighter than the outer
ring and the expiration date is valid, the
vaccine is usable
SPOILEDIf the inner square
matches or is darker than the outer ring, the vaccine must be
discarded.
4-The shake test
DPT, hepatitis B and
tetanus toxoid vaccines
can all be damaged by
freezing. By shaking two
vials, side-by-side, one
that might have been
frozen and one that has
never been frozen, health
workers can determine if a
vaccine has spoiled.
What damage the Vaccines?
1. Any defect in the cold chain.
2. Out date expiry.
3. Exposure of the vaccine to unacceptable temperature
during the immunization session.
4. Exposure of the vaccine to direct sunlight (BCG)