Immunization

- provision of an individual with antibodies to destroy or inactivate the disease producing agent
or neutralize its toxin

Immediate goal: prevention of the disease to occur in an individual

Ultimate goal: eradication of the disease

Terminologies:
1. Active immunization: administration of microorganisms or it modified product to evoke an
immunologic response

2. Passive immunization: administration of preformed antibodies to a recipient

eg. MMR

3. Live Attenuated Vaccine: actual infection ensues after administration with little or no adverse
host reaction
eg. BCG, OPV, MMR, Measles, Rotavirus, Varicella (Chickenpox), Influenza (intranasal)

4. Killed: not capable of replicating in the host and must contain a sufficient antigenic mass to
stimulate a desired response
eg. DTaP (Diphtheria, Tetanus, Pertussis) ,Hib (Hemophilus Influenza Serotype b), IPV
(Inactivated Polio Vaccine) Menigococcal, Pneumococcal, Rabies

Routes:
1. Per Orem
 breast feeding does not interfere with oral vaccine
 repeat the dose if vomited within in 10 minutes of vaccination
 eg. OPV, Rotavirus
2. Intramuscular (IM)
 based on volume of the vaccine and the size of the muscle
a. Anterolateral aspect of the thigh - <1 year
b. Deltoid area – older children
c. Buttocks – rarely used (ie. Rabies and Hepatitis B Vaccine lose immunogenicity 
goes to the fat)
 eg. DTP, HBV,HAV, Typhoid, Hib (IM or SC)
3. Subcutaneous (SC)
 45 degree angle into the anterolateral aspect of the thigh or upper outer triceps
 eg. MMR, Measles, Varicella
4. Intradermal
 volar aspect of the forearm
 eg. Rabies (preexposure), BCG (deltoid)
5. Intranasal
 upright position, 0.25 mL is sprayed into one nostril, the second half is administered
to the other nostril
 sneezing - MAY NOT REPEAT
 eg. Live Attenuated Influenza Vaccine
SCHEDULING

Antigen Combination Recommended Minimum Interval b/w Dosage

≥ 2 Inactivated Vaccine NONE; Can be administered simultaneously or at any interval

between dosage

Inactivated and Live Vaccine NONE; Can be administered simultaneously or at any interval
between dosage

≥ 2 Live Vaccines 28 days minimum interval if not administered at the same dame

CONTRAINDICATIONS

1. Absolute
 Severe anaphylactic or allergic reaction to previous vaccines
 Encephalopathy within 7 days of administration of Pertussis
2. Relative
 Immunosuppressive therapy
 Egg allergy
 Seizure within 3 days of last dose of Pertussis
 Shock within 48 days of last dose
 Fever >40.5 ⁰C within 48 hours of last dose
3. Not
 Mild illness with or without low grade fever
 Current antibiotic therapy
 Recent infectious disease
 Positive PPD
 Prematurity except in infants still hospitalized at 2 months
 OPV should be delayed until discharge OR if mother is HBsAg (-), HBVaccine can be
delayed until child >2000g

EXPANDED PROGRAM IMMUNIZATION (EPI)

Main Objective:
a. to reduce the morbidity and mortality rates of seven EPI diseases
 Poliomyelitis (oral)
 Diphtheria
 Tetanus
 Hepatitis
 Measles
 Pertussis
 Tuberculosis
b. to reduce the incidence of neonatal tetanus by providing pregnant women with tetanus
immunization
Vaccine Age Interval Amount Site/Route Booster
BCG (1dose) at birth If >2 months, do PPD NB: 0.05mL Intradermal @
first before giving >1mo: 0.1mL deltoid area
BCG
DPT (3 doses) 6 weeks 4 weeks 0.5 mL IM @ anterolateral 1st: 1 year after last
thigh dose
2nd: 4-6 y/o
OPV (3 doses) 6 weeks 4 weeks 0.5 mL Mouth 1st: 1 year after last
dose
2nd: 4-6 y/o
Hepatitis B (3 doses) at birth 1-2 months 0.5 mL IM @ anterolateral HepatitisB 3 doses
6-8 months thigh
Measles (1 dose) 6 months or 9 months 0.5 mL SC @ thigh 1st: 6 months after
in EPI last dose
2nd: 4-6 y/o
3rd: 11-14 y/o

Note:
Schedule for Hepatitis

0-1-6 months
0-1-2 months (booster is given after 3 rd dose)

Schedule for Measles Booster as MMR

If the 1st dose is given at 9 months (EPI)  booster can be given 12/15 months after
BCG (Bacille Calmette Guerin)

 live attenuated vaccine

 prevents extrapulmonary manifestations of TB
 given any time after birth
 DOSE: 0.05 cc for < 1 month
0.10 cc for > 1 month
if given after 2 month of age, do a PPD test first

Natural Course:
1. Wheal formation – disappearance after 30 minutes of injection
2. Induration – 2 to 3 weeks after injection
3. Pustule formation –2 to 3 weeks after induration
4. Ulceration – 2 to 3 weeks after pustule formation
5. Scar Formation – 8 to 12 weeks after injection

Adverse Reactions
1. Koch’s Phenomenon – accelerated TB reaction
2. Indolent Ulcers – ulceration of more than 3 weeks
3. Uncommonly in 1 to 2 % result in local adverse reaction
4. Subcutaneous abscess and lymphadenopathy
5. Osteomyelitis and muscle necrosis

DPT
inactivated vaccine
Age: as early as 6 weeks old and
Primary series interval: 4 weeks apart for 3 doses
Dose: 0.5 cc
Route: IM
Booster:
1st: 1 year after last dose
2nd: 4-6 y/o
DTPw – given in health centers
DTPacellular – least reactions
Adverse reactions:
 Local and febrile reactions (40.5⁰C within 24 hours)
 Bacterial/sterile abscesses at the site of injections are infrequent
 Allergic reactions
 Seizures
 Hypotonic hyporesponsive episodes (HHE) – collapse or shocklike state
 Incessant cry
POLIO Vaccine

 OPV – live attenuated vaccine

 IPV – inactivated vaccine
 Age: as early as 6 weeks
 Primary series interval: 4 weeks apart for 3 doses
 Dose: 0.5 cc / 2 drops
 Route: PO for OPV, IM for IPV
 Booster:
1st: 1 year after last dose
2nd: 4-6 y/o
 Adverse Reaction:
OPV – Vaccine Associated Paralytic Polio (VACC)
IPV – Hypersensitivity Reaction

Measles Vaccine

 live attenuated vaccine

 see table for details
 Adverse reactions:
1. Fever after 5 to 7 days
2. Local swelling or pain on site
3. Rashes

Passive
 In susceptible and immunosuppressed patients
 Immunoglobulin is given within six days after exposure
 Dose: 0.25 cc/kg IM or 100-400 mg/kg

Hepatitis B Vaccine

 inactivated vaccine
 given at birth
 see table for details

Hemophilus Influenzae (Hib) Vaccine

 inactivated vaccine
 age: 2 months
 if given to children < 6 months  3 doses at 2 months apart
to children 6-12 moths  2 doses at 2 months apart
to children > 1 year old  1 dose

 Dose: 0.5 cc
 Route: IM or SC
Varicella Vaccine

 1st dose: 12 to 15 months – 1 dose for universal immunity

 2nd dose: 4 to 6 years old
 3rd dose: 13 years old
 All individual aged 13 years and above, without previous evidence of immunity, should receive 2
doses given in at least 4 weeks apart
 Adverse reactions: fever and mild rash

Typhoid Vaccine

 given at 2 years of age

 Dose: 0.5 cc
 RouteL IM
 Revaccination after every 3 years with continued exposure to S. typhi

Pneumococcal Vaccine

 23 valent polysaccharide vaccine (PPV) is given to children > 2 years old and are given booster
every 5 years
 7 valent conjugate vaccine (PCV7) is given to children < 2 years old and lasts until 9 years of age
 If PCV7 is given after 2 years of age, the immunity it gives lasts for life
 Dose: 0.5 cc (3 doses)
 Route: IM or SC
 Adverse reactions:
1. Fever
2. Pain at the site of injection
3. Mild erythema

Meningococcal Vaccine

 Given at ≥ 2 years of age to children in high risk group

a. Frictional or anatomic splenism
b. Terminal component or properdin deficiency
 Routine immunization is not recommended

Rotavirus Vaccine

 Most common virus causing diarrhea in children

 Rotarix (Monvalent Human RV) – 2 doses
- 1st dose: administered from age of 6 weeks
- Interval: 4 weeks
- 2nd dose: given not later than 6 months (intussuception)
  Rotateq (Pentavalent Human Bovine Reassortment RV) – 3 doses
- 1st dose: 6 to 12 weeks of age
- Interval: 4 to 10 weeks
- Last Dose should not be administered later than 8 months

Influenze Vaccine

 inactivated virus
 all children after 6 months of life
 for children < 8 y/o given the vaccine for the first time  2 doses 1 month apart
 < 3 years old – 0.25 mL
 > 3 years old – 0.5 mL
 Given yearly – antigenic drift/antigenic shift

Hepatitis A Vaccine

 1st dose: 1 year old

 2nd dose: 6 to 12 months apart
 <19 y/o: 0.5 mL
 >19 y/o: 1 mL

Human Papilloma Virus Vaccine

 Cervarix (Bivalent HPV)

- Indicated for females 10-55 years
- 0-1-6 month schedule
- More strains of viruses
 Gardacil (Quadrivalent HPV)
- Indicated for females 9-26 years
- 0-2-6 month schedule
- Commons strains of virus (16/18)