IMMUNIZATION /
VACCINATION IN SPECIAL
SITUATIONS /
COLD CHAIN
Basic definitions
• Immunization – Process of inducing immunity by vaccine or
toxoid.
• Vaccination – Act of giving vaccine to produce protection.
• Passive Immunity – Immune response after introduction of
preformed antibodies.
• Active Immunity – Immune response after a clinical or
subclinical infection or vaccination.
• Herd Immunity - Large susceptible population protected from
infection by simultaneous vaccination.
• Epidemiological shift - Significant change in the pattern of
disease in population after immunization(e.g., measles now in
Types of Vaccines
• Live attenuated –Mimic natural infection, do not cause disease.
BCG, OPV, MMR, Varicella
• Inactivated/Killed – Prepared by growing organisms in media, followed by
heat or chemical inactivation.
IPV, Rabies, Hepatitis A.
• Toxoids – Modified and purified toxins,not injurious
Diphtheria, Tetanus.
• Subunit/Recombinant –Produced using rDNA technology, includes viral or
bacterial antigen.
Principles of
• Different liveImmunization
(oral, parenteral, intranasal) vaccines may be given simultaneously, or 4
weeks apart.
• Different types of inactivated or subunit vaccines may be administered simultaneously or
at any
• interval between their doses.
• A minimum interval of 4 weeks between two doses of the same vaccine. An exception is
the rabies vaccine.
• Patients should be observed for allergic reactions for 15–20 minutes after receiving
immunization.
• Live vaccines are contraindicated in inherited or acquired immunodeficiency and during
therapy with immunosuppressive drugs.
• Vaccines should not be given earlier than indicated or with shorter interval between doses
than indicated in the routine immunization schedule.
• A delay or lapse in the administration of a dose does not require the schedule to be
repeated; the missed dose is administered and the course resumed at the point it was
National Immunization
Schedule
National Immunization
Schedule
Adverse Events Following Immunization
caused by it.
(AEFI)
Definition: Any untoward medical event after immunization, not necessarily
Categories:
1. Vaccine reaction – Event caused or precipitated by an active component
of vaccine. Ex- BCG lymphadenitis, measles rash.
2. Vaccine-potentiated –Event precipitated by vaccination but may have
occurred without vaccination. Ex- Febrile seizure.
3. Injection reaction –Event from anxiety, pain due to the injection (rather
than
the vaccine). Ex- syncope after vaccination.
4. Program error – Event due to error in vaccine preparation, handling or
administration.
5. Coincidental – Unrelated illness post-immunization.
Vaccination in special
situations
Primary or Secondary Immunodeficiency
• Conditions secondary to malignancy, HIV infection, corticosteroids and
immunosuppressive therapy.
• All inactivated, killed and subunit vaccines can be administered safely,
higher doses are required (ex: Hepatitis B)
• Live vaccines (BCG, measles, MMR, varicella) are contraindicated,
except for milder cases like IgA, Igg subclass deficiency.
• In HIV, live vaccines may be given in early stages of infection after
proper counseling. IPV is preferred over OPV.
• Live vaccines are contraindicated for 6 months after chemotherapy
Vaccination in special
situations
Other High-Risk Categories
• Splenectomy: Vaccines should be administered at least two weeks before
elective splenectomy.
• Chronic diseases:
Pneumococcal and inactivated influenza vaccines are particularly important in
cardiac or pulmonary diseases.
Hepatitis A and B vaccines in liver disease.
High dose Hepatitis B vaccine in renal disease.
• Prematurity: Preterm or low birth weight newborns of HBsAg positive
mothers
should receive the vaccine within 12 hours of birth.
Vaccination in special
situations
Miscellaneous Conditions:
• Minor illness are not a contraindication.
• Live vaccines avoided for 3 months after blood product(s)
administration.
• Pregnancy – Inactivated vaccines (TT, influenza) are safe.
• Live vaccines avoided during pregnancy.
Cold Chain
The cold chain is the system of storing and transporting
vaccines at recommended temperatures to maintain their
potency.
Components: trained staff, equipment, and monitoring.
Equipment: Walk-in freezers/coolers, ILR, vaccine carriers, ice packs,
thermometers.
• OPV, Measles, BCG – Store at −15°C to −25°C (heat sensitive, can
tolerate freezing).
• DTP, Pentavalent, Hepatitis B – Store at +2°C to +8°C (freezing
damages).
• BCG, MMR, measles and rubella vaccines lose their potency, if
exposed to bright light - packaged in dark brown glass.
• Reconstituted vaccines – Use within 4 hours.
Cold Chain
Thank
You
