VACCINATION CHART

NATIONAL IMMUNIZATION SCHEDULE FOR NEW BORN

THE INDIAN ACADEMY OF PEDIATRICS

The largest professional organisation of pediatricians in our country fully endorses and supports the national schedule. It supplements the above schedule further ,with 2 additional vaccines namely Hepatitis B vaccine to be given in three doses (at birth, one month and six months of age.). The IAP also recommends MMR (Measles,Mumps & Rubella vaccine) at about 15 to 18 months of age. It must be remembered that even though rubella may appear to be a mild illness, it has a serious potential to cause congenital defects in a baby ,whose mother is not protected against rubella and catches the infection during early pregnancy.

History of Vaccines

Even before the world of microorganisms was discovered and before diseases were associated with microorganisms, many societies had made one observation: if a person was down with a disease and survived, he was less likely to catch it again. The

Important Milestones
1796 - First vaccination. Jenner tests for smallpox resistance. 1883 - Vaccination for children against rabies 1892- Cholera vaccine 1913 - Toxoid, Antitoxin immunization against diphtheria 1921 - BCG vaccine 1923 - Diphtheria Toxoid 1923 - Pertussis vaccine 1927 - Tetanus Toxoid 1937 - Influenza vaccine 1937 - Yellow Fever vaccine 1949 - Mumps vaccine 1954 - Salk's Polio vaccine 1957 - Sabin's Oral Polio vaccine 1960 - Measles vaccine 1962 - Rubella vaccine 1968 - Type C Meningococcus vaccine 1970 - Researchers in Israel proved that injection of a peptide from a virus or disease can induce the production of antibodies that recognise the entire virus or disease 1971 - Type A Meningococcus vaccine 1980 - First commercial vaccine for Hepatitis B 1982 - First vaccine produced through genetic engineering (vaccines for diarrhoea in pigs) 1982 - First synthetic vaccine created at Institute Pasteur and at Weizmann Institute from diphtheria toxin.

Diseases that Vaccines can Prevent or Treat

Today, vaccines can prevent the following diseases:

Cholera

How Vaccines Work

First let us see what happens when we contract an infection. The obvious reactions associated with the illness are pain, fever, rashes, vomiting, etc. What is not so obvious is that the body mounts its own defence against the disease. If this is adequate, the patient recovers. If not, the patient succumbs.

What is this defence mechanism? The disease causing organisms contain proteins called "antigens" which stimulate the immune response. The resulting immune response is multi-fold and includes the synthesis of proteins called "antibodies." These proteins bind to the disease-causing organisms and lead to their eventual destruction. In addition, 'memory cells' are produced in an immune response. These are cells that remain in the blood stream, sometimes for the life span of the host, ready to mount a quick protective immune response against subsequent infections with the particular disease-causing agent, which induced their production. If such an infection were to occur, the memory cells would respond so quickly that the resulting immune response could inactivate the disease-causing agents, and the symptoms would be prevented. This response is often so rapid that infection does not develop and the person is immune to the infection.

Vaccines stimulate the production of protective antibodies and other immune mechanisms. The immunity the body acquires naturally, or by vaccines, producing antibodies, which have a specific action on the germs of a specific disease, is called Active Immunity. This depends on the humoral and cellular response of the infected person.

When antibodies produced in one body are introduced into another (by vaccination, through placenta or breast milk, or transfer of lymphocytes) to fight disease, it is called Passive Immunity. Here the infected person gets the defensive ammunition readymade. Immunity is quick but short-lived, only till the current bout of infection is present. The patient's own immune system has no memory of the infection and cannot tackle it as quickly the next time round.

Types of Vaccines
Active Immunization Live Vaccines Inactivated or Killed Vaccines Toxoids Cellular Fractions Combinations Passive Immunization Immunoglobulins Anitisera Live Vaccines

Inactivated or Killed Vaccine Certain organisms when killed by heat or chemicals and then introduced into the body induce immunity. Killed vaccines are not as effective as live vaccines. For instance the pertussis vaccine, after three doses is about 80% effective in the first three years and after 12 years not at all. Inactivated vaccines may require two or three doses. These are

Immunoglobulins Immunoglobulins are specific protein substances that are produced by certain cells in the body to help in fighting infection. They are also referred to as antibodies and are a vital part of the body's defence mechanism. Immunoglobulins are of five different types - Immunoglobulin G, A, M, D and E. These are classified based upon the speed with which they are formed in response to the infection, as well as their mechanism and site of action. The invading organisms or vaccines promote the production of immunoglobulins (antibodies) against that particular disease-causing organism which is then destroyed. The body also retains in its memory the template of the disease-causing organism so that the next time it attacks, the antibodies are quick to counter any threat to the body and the person does not develop the disease. Antisera, antitoxins Materials prepared in animals are called antisera. Since human immunoglobulin preparations are not available for all diseases, we rely on antitoxins produced from animal sources. These are used to fight tetanus, diphtheria, gas gangrene, snakebite and botulism. Antisera can produce serum sickness due to the recipient's sensitivity. So, today the preference is toward immunoglobulins. Some Processes associated with preparation of Vaccines Attenuation To "attenuate" is to weaken a live micro-organism by ageing it or altering its growth conditions. This is accomplished by serial passage, that is, passing the live micro-organism through animal tissue several times to reduce its potency. Vaccines made in this way are often the most successful vaccines, probably because they multiply in the body thereby causing a large immune response. However, these live, attenuated vaccines also carry the greatest risk because they can mutate back to the virulent form at any time. Detoxification Some vaccines are made from toxins. In these cases, the toxin is often treated with aluminium or adsorbed onto aluminium salts to decrease the toxin's harmful effects. After the treatment, the toxin is called a "toxoid". Examples of toxoids are the diphtheria and the tetanus vaccines. Vaccines made from toxoids often induce lowlevel immune responses and are therefore sometimes administered with an "adjuvant", an agent that increases the immune response. For example, the diphtheria and tetanus vaccines are often combined with the pertussis vaccine and administered together as a DPT vaccination. The pertussis acts as an adjuvant in this vaccine.

Vaccination Chart for Infants and Children

The Government of India recommends the following schedule for vaccinations: Age Birth 6 weeks BCG Oral Polio Vaccine (OPV) and Diphtheria, Pertussis and Tetanus (DPT) OPV, DPT OPV, DPT Measles OPV, DPT DT, Typhoid Tetanus, Typhoid Vaccine

10 weeks 14 weeks 9 - 12 months 15 - 18 months 4 - 5 years 10 - 16 years

The schedule recommended by the Government of India has fully incorporated the recommendations of the EPI schedule given by the World Health Organisation. The following table shows the possible adverse reactions for each vaccine: Vaccine BCG OPV DPT Measles MMR DT TT* Type Adverse Reactions

live attenuated axillary adenitis (swelling in the armpits) live attenuated none killed fever, excessive crying, encephalopathy, seizures

live attenuated fever, rash live attenuated fever, rash, arthralgia (pain in the joints) killed killed fever fever pain, erythema

Hepatitis B recombinant

Some Recent Vaccines

Infectious diseases continue to be a major health hazard in all developing countries, including India. Fortunately medical research continues to give us new tools to tackle at least some of these problems. New

Who is Susceptible? Who can get chicken pox? Both adults and children can get chicken pox. It is more common in children below ten years of age. But when adults get it the attack can be virulent. What are the complications Chicken Pox might lead to? Chicken pox could lead to bacterial infections from scratching the sores. It could also lead to two more serious conditions: encephalitis and pneumonia. About ten to twenty percent of people who have had chicken pox develop shingle later in life.

Hepatitis B About Hepatitis B This is a viral infection that can cause serious problems. It is caused by the Hepatitis B Virus (HBV). Chronic infection can cause serious liver damage, leading to fatalities. The signs and symptoms of the infection are, Jaundice (yellowing of the skin and whites of the eyes) , Tiredness , Loss of appetite Pain in the muscles, joints or stomach, Diarrhoea or vomiting The Route of Spread. It is a blood borne infection and can spread in the following ways: From an infected pregnant mother to the child in the womb , Unprotected sexual intercourse, Unsterilised needles Who is susceptible? HBV can affect all individuals. Among adults the high risk groups are: Those who are in close contact with infected persons , Health care workers, Injected drug users , Men who have sex with men , Infants born to infected mothers , Hemodialysis patients About the Vaccine: Engerix B is a recombinant vaccine that is used to combat Hepatitis B. It has no live parts. It contains a portion of the outer protein of the HBV or Hepatitis B surface antigen (HBsAg). This vaccine is administered in three doses intramuscularly. Shanvac is the other brand of Hepatitis B vaccine available in India. What are the benefits of the vaccine? Hepatitis B is a serious illness. It can lead to cirrhosis of liver or cancer of liver, even to death Therefore prevention saves a lot of trouble. Vaccinating the child makes it safe against the disease in the adult years. A pregnant woman with infection can pass on the infection to the foetus, which will affect the newborns health. As vaccination is not advised during pregnancy, it is better to take the vaccination earlier. The vaccine has been found to be safe with no serious side effects. Who is advised the vaccine? Since anybody can get Hepatitis B the vaccination is advised for all age groups. Though this vaccination has not been included in the Indian governments mandatory vaccination list, paediatrician feel that this vaccination has real benefits and advise vaccination for children under their care. People in the high risk groups are definitely advised to take these shots.

Immunization / Vaccination Schedule by delhi

Age Birth Vaccine BCG Oral Polio Vaccine - 1st dose Hepatitis B Vaccine - 1st dose 6 - 8 Weeks DPT/DTaP - 1st Dose IPV/Oral Polio Vaccine - 2nd dose Hepatitis B Vaccine - 2nd dose 10 - 16 Weeks DPT/DTaP - 2nd Dose IPV/Oral Polio Vaccine - 3rd dose 14 - 24 Weeks DPT/DTaP - 3rd Dose IPV/Oral Polio Vaccine - 4th dose Hepatitis B Vaccine - 3rd dose 9 Months Measles Vaccine

15 - 18 Months

MMR (Measles, Mumps, Rubella) DPT/DTaP - 1st booster dose IPV/Oral Polio Vaccine - 1st booster dose

2,5,8,11,14 & 17 Years 4.5 - 5 Years

Typhoid Fever Vaccine DPT/DTaP - 2nd booster dose IPV/Oral Polio Vaccine - 2nd booster dose

8 - 10 Years

MMR booster dose DT (Diphtheria - Tetanus) 3rd booster dose

15-16 Years Other Vaccines* Vaccine Haemophilus Influenzae Type B (HIB) 6 - 8 Weeks

TT (Tetanus) - 4th booster dose

1st dose

10 - 16 Weeks 14 - 24 Weeks 15 - 18 Months Hepatitis A Vaccine 13 - 24 Months 19 - 30 Months Varicella Vaccine (Chicken Pox) 15 - 16 Months Pneumococcal Conjugate Vaccine 6 - 8 Weeks

2nd dose 3rd dose Booster dose

1st dose 2nd dose

1st dose

10 - 16 Weeks 14 - 24 Weeks 15 - 18 Months Other Vaccines Human Influenzae Virus Vaccine Rabies Vaccine

2nd dose 3rd dose 4th booster dose

Please seek your doctor's advice regarding these vaccines *Haemophilus Influenzae Type B Vaccine. Hepatitis A Vaccine. Varicella and Pneumococcal vaccines are additional vaccines as recommended by the Indian Academy of Paediatrics. ABBREVIATIONS: BCG=Bacillus calmittee Guerin. DPT=Diphtheria,Pertussis & Tetanus. OPV =Oral Polio Vaccine. DT=Diph & Tetanus vaccine.

India Immunization Chart

Vaccine Age Birth 6 weeks 10 weeks 14 weeks

Primaryvaccination
BCG Oral polio DPT Hepatitis B* Measles BoosterDoses DPT + Oral polio DT Tetanus toxoid (TT) Vitamin A Pregnantwomen Tetanus toxoid (PW): 1st dose As early as possible during pregnancy (first contact) 2nd dose 1 month after 1st dose Booster If previously vaccinated, within 3 years 16 to 24 months 5 years At 10 years and again at 16 years 9, 18, 24, 30 and 36 months X X X X X X X X X X X

Thank You
Compiled and Created By

Amit Kumar Shrivastava Senior Software Engineer Center For Railway Information System(CRIS) Chankyapuri New Delhi 110021 Email [email protected]