VACCINES ARE FOR ALL AGES

“VACCINES ARE THE TUGBOATS OF PREVENTIVE HEALTH”

-William Foege

DR OM PRAKASH
CHIEF CONSULTANT
RGHCC, DARBHANGA
• The Nobel Prize in Physiology or Medicine for the year Katalin Karikó Drew Weissman
2023 was awarded jointly to Katalin Karikó and Drew
Weissman for their discoveries concerning nucleoside
base modifications that enabled the development of
effective mRNA vaccines against COVID-19 1,2,3.
• Their groundbreaking findings have fundamentally
changed our understanding of how mRNA interacts
with our immune system, and have contributed to the
unprecedented rate of vaccine development during
one of the greatest threats to human health in modern
times. 1
• [Link], 2. [Link], 3.
[Link], 4. [Link]
•COVID-19 vaccination has
been a powerful tool in the
fight against the pandemic.
Vaccines in history that have contributed to
safe human lives
[Link] vaccine: the first successful vaccine, developed in 1796 by
Edward Jenner. the only disease ever to be eradicated worldwide 1.
[Link] vaccine: The polio vaccine became available in 1955 and has been
instrumental in reducing the number of cases worldwide 1.
[Link] vaccine: It was first introduced in 1971 and has been instrumental in
reducing the number of cases of these diseases worldwide 1.
[Link] vaccine: The influenza vaccine protects against seasonal flu and
is recommended for individuals aged six months and above. It is updated
every year to protect against new strains of the virus 2.
[Link] vaccine: first introduced in 1924 and has been instrumental in
reducing the number of cases worldwide 2.

1. [Link] 2. [Link] 3. [Link] 4. [Link]

Milestone in way of
reduced mortality
[Link] water supply and
Improved sanitation: instrumental in
reducing the incidence of water-
borne diseases such as cholera and
typhoid fever 1.
[Link]: The discovery of
antibiotics has revolutionized modern
medicine and has been instrumental
in treating bacterial infections 1.
[Link] maternal and child
health: Improved maternal and child
health practices have been
instrumental in reducing maternal
and child mortality rates worldwide 2.

1. who.int2. [Link].int3. who.int4.

[Link].com5. [Link]
 Vaccines given in National Immunization Schedule
Age
Bacillus Calmette Guerin (BCG), Oral Polio Vaccine (OPV)-0 dose, Hepatitis B
Birth
birth dose
OPV-1, Pentavalent-1, Rotavirus Vaccine (RVV)-1, Fractional dose of
6 Weeks Inactivated Polio Vaccine (fIPV)-1, Pneumococcal Conjugate Vaccine (PCV) -
1*
10 weeks OPV-2, Pentavalent-2, RVV-2
14 weeks OPV-3, Pentavalent-3, fIPV-2, RVV-3, PCV-2*
9-12 months Measles & Rubella (MR)-1, JE-1** , PCV-Booster*
MR-2, JE-2**, Diphtheria, Pertussis & Tetanus (DPT)-Booster-1, OPV –
16-24 months
Booster
5-6 years DPT-Booster-2
10 years Tetanus & adult Diphtheria (Td)
16 years Td
Pregnant Mother Td-1, Td-2 or Td-Booster***
•*PCV in selected states/districts: Bihar, Himachal Pradesh, Madhya Pradesh, Uttar Pradesh (selected districts) and
Rajasthan; in Haryana as state initiative
•** JE in endemic districts only
•*** One dose if previously vaccinated within 3 years
 Indian Academy of Pediatrics (IAP) immunization schedule

Age Vaccines •OPV should be given to all

children till 5 years of age during
Birth BCG, hepatitis B, OPV0 every pulse polio immunization
6 weeks DTwP/DTaP + Hib + Hepatitis B + IPV-1, Rotavirus-1*, PCV-1 day.
•JE vaccine (12 and 13 months),
10 weeks DTwP/DTaP + Hib + Hepatitis B + IPV-2, Rotavirus-2*, PCV-2 cholera (12 and 13 months) and
meningococcal (9 and 12
14 weeks DTwP/DTaP + Hib + Hepatitis B + IPV-3, Rotavirus-3*, PCV-3 months) are advised in high-risk
6 months Typhoid conjugate vaccine (TCV), Influenza-1 situations.
•For meningococcal, menectra
7 months Influenza-2 (9–24 months = 2 doses; >2
years = 1 dose and menveo (>2
9 months MMR-1 years = 1 dose) are options.
12 months Hepatitis-A 1** •Third dose “Rotavirus” vaccine
not necessary for RV-1.
15 months MMR-2, Varicella-1 •Hepatitis A, live vaccine only
one dose, while killed vaccine
16–18 months DTwP/DTaP + Hib + IPV-4, PCV-4 Varicella-2, Hepatitis-A 2** two doses.
2 years Influenza* •For annual influenza best time
in India is April (premonsoon);
3 years Influenza* but can be given any time of
year with most recent available
4 years Influenza* influenza vaccine.
5 years MMR 3, DTwP/DTaP + IPV5 •HPV only for females; for 9–14
years only two doses, if started
10 years Tdap/ Td*, HPV-1** >15 years need three doses.
•Td to be repeated every ten
10½ years HPV-2** yearly after that.

1. [Link] 2. [Link] 3. [Link] 4. [Link]

VACCINES
• Vaccination is the act of
introducing a vaccine into the
body to stimulate the
immune system to induce
protection against infection
or disease.
• Immunisation is a process by
which a person becomes
protected against a disease,
generally through
vaccination.
 B cells and T cells

Humoral immune response: B cells, type 2 helper T cells, antibodies, mast cells,
and Cytotoxic T cells

Adaptive Cell-mediated immune response: Type 1 helper T cells and cytoxic T-cells
immune
system
Cytotoxic T cells kill pathogens through release of perforin, granzymes, and
proteases, which cause the target cell to undergo apoptosis.

Antibodies bind to pathogens to opsonize them, neutralize pathogen toxins, and

activate the complement complex system.

IgE also alerts circulating mast cells and eosinophils of known antigens, which
causes a rapid inflammatory response.
[Link]
/20%3A_Immune_System/20.3%3A_Adaptive_Immunity/20.3B%3A_Types_of_Adaptive_Immunity
 The antigen is presented to All antibodies bind to
present antigens to immature helper T cells and pathogens to opsonize them,
immature B-cells cytotoxic T cells through binding which makes it easier for
the MHC II (helper T) or MHC I phagocytic cells to bind to
The APC travels to a part of (cytotoxic T) to T-cell receptors. and destroy the pathogen.
the body that contains
immature T and B cells, such
as a lymph node. Major neutralize the
histocompatibility toxins produced by
complex
certain pathogens
The antigen is processed by
the APC and bound to MHC
class II receptors and MHC
class I receptors on membrane provide complement pathway
of the APC. activation, in which circulating
proteins are combined in a
complex cascade that forms a
membrane attack complex on a
The antigen for the pathogen is These T lymphocytes mature and proliferate.
pathogen cell membrane, which
taken up by an antigen- Helper T cells activate B cells, which proliferate
and produce antibodies specific to the antigen, lyses the cell.
presenting cell (APC), such as a while cytotoxic T cells destroy pathogens that
dendritic cell or macrophage, bear the antigen that was presented to them by Memory B and T cells are
through phagocytosis. the APCs.
formed after the infection ends.
Mast cells and eosinophils are considered part of the humoral immune
system because they can be sensitized towards certain antigens through
circulating immunoglobin E (IgE), a specific type of antibody produced by B
cells.

IgE binds to the mast cells and eosinophils when an antigen is detected, using
a type of Fc receptor on the mast cell or eosinophil that has a high-binding
affinity with IgE.

This binding will cause degranulation and release of inflammatory mediators

that start an immune response against the antigen.
Memory B cells

• This process is the reason

why memory B cells can
cause hypersensitivity
(allergy) formation, as
circulating IgE from those
memory cells will activate
a rapid inflammatory and
immune response.
 [Link]

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• [Link]
products/adult-immunization/adult-immunization-videos
 DT wP/DT aP at 0, 1 and
The IAP also 6 months for children
recommends the
following catch-up
under 7 years
immunizations:

Tdap, Td, and Td at 0, 1

and 6 months for
children over 7 years
 The IAP Hepatitis B (HepB)
recommends the
following vaccines HPV
for adolescents:
Measles, mumps, rubella (MMR)

Meningococcal disease (MenACWY)

 Influenza vaccine: This vaccine is recommended
annually to protect against seasonal flu.

IAP Pneumococcal vaccine: This vaccine is recommended

recommendation to protect against pneumococcal disease, which can
for elderly cause pneumonia, meningitis, and blood infections.
individuals 1:
Tetanus-diphtheria-pertussis (Tdap) vaccine: This
vaccine is recommended to protect against tetanus,
diphtheria, and pertussis (whooping cough).

Herpes zoster vaccine: This vaccine is recommended

to protect against shingles, a painful skin rash caused
by the varicella-zoster virus.
 • COVID-19 vaccine
• Flu vaccine (influenza)
The CDC • Pneumococcal vaccine
recommends that
• Shingles vaccine (zoster)
adults ages 65 and
• Tdap (tetanus, diphtheria, and whooping
older should be up cough) or Td (tetanus and diphtheria)
to date on the • For adults between 18 and 64 years who have
following vaccines: completed their primary vaccination
schedule, a booster dose of Td vaccine is
indicated once every 10 years.
 Malaria vaccine

• The World Health Organization (WHO) has recently

approved the second vaccine for malaria, which is named
R21/Matrix-M and is developed jointly by the Oxford
University and the Serum Institute of India (SII) 1 2.
• The SII, the world's largest vaccine-maker by doses, is set
to manufacture 100 million doses of the vaccine as a
licence-manufacturer 1

1. [Link] 2. [Link]
Malaria vaccine
• The vaccine, which is meant for children under the age of five years,
has three primary doses and a booster shot after a year.
• Since this vaccine is specific to Plasmodium falciparum, it cannot be
used to prevent infections caused by other malaria parasites like
plasmodium vivax, which is known to persist in the liver and trigger
repeated infections.
• Vivax is fairly widespread in India and there is no vaccine yet to tackle
it.
Dengue vaccine
At present, there are three vaccine
candidates that are being tested in
humans in India.
Panacea Biotec Vaccine:

• Based on weakened versions of the four

dengue serotypes by the National
Institute of Allergy and Infectious
Diseases in the United States.
• The company has already completed a
phase I/II study in 100 healthy adults
between 18 and 60 years of age. It
showed no severe adverse events, and
over 75% developed antibodies against all
four dengue serotypes.
• A larger phase III trial is expected by
December this year, enrolling 10,335
healthy adults across 20 sites in India1.

• 1. [Link]
Serum Institute of India Vaccine:

Phase I trial with 60

Utilizes the same
healthy adults (aged 18 to
weakened virus from the
45) demonstrated safety
United States.
and tolerability1.

1. [Link]
Indigenous
Vaccines:
• The Indian Council of Medical Research (ICMR) is conducting
phase-3 trials for a vaccine jointly developed by Serum
Institute and Panacea Biotec2.
• Records indicate that two more probable dengue vaccines
are also in development by Panacea Biotec Limited and
Sanofi India Private Limited3

• 1. [Link]
• 2. [Link]
• 3. [Link]
• 4. [Link]
• 5. [Link]
 • One of the main challenges of
developing a dengue vaccine is
antibody-dependent enhancement
Dengue (ADE) — a person with low levels of
vaccine antibodies against one serotype of
dengue, may end up getting a more
severe infection with another serotype
of dengue.
TRANSPORTATION, STORAGE, UTILISATION
• HEAT/ FREEZING SENSTIVITY
• LIGHT SENSITIVITY
• PRESERVATIVES
• ADJUVANTS
• COLD CHAIN
• ROUTINE IMMUNISATION
• PULSE IMMUNISATION
• MOP UP IMMUNISATION
• CATCH UP IMMUNISATION
• POST EXPOSURE IMMUNISATION
• TRAVELLAR’S IMMUNISATION
• IMMUNISATION IN SPCIAL CIRCUMSTANCES
Adverse events following immunisation(AEFI)
• Serious AEFI: If 1. results in death, hospitalisation or persistent or
significant disability / incapacity . 2. Occurs in clusters. 3. causes
parental/ community concerned or 4. result in congenital anomaly/
birth defect 5. where the vaccine quality is suspicious ‘
• Severe AEFI are minor AEFI with increased intensity or severity.
• Minor AEFI usually occur within a few hours of injection. Resolves
after short period of time, and posed little danger.