Vaccines

Dr.Deepali Mohan Kadam

Associate Professor
Department of Community Medicine
Td vaccine
Tetanus and adult diphtheria (Td) vaccine is a combination of tetanus and
diphtheria with lower concentration of diphtheria antigen (d) as recommended for
older children and adults.
Rationale for using Td over TT vaccine
As per the lab supported vaccine preventable diseases surveillance data in India, majority of the
cases of Diphtheria are occurring in age group 5 years and above (77% and 69% respectively in
2017 and 2018) mostly in unvaccinated (~2/3rd). In 2016 diphtheria outbreak in Kerala, nearly
79% cases occurred in >10 years age group. Since 1999, there have been more than 80%
reduction in tetanus mortality,however diphtheria outbreaks are increasing which reflect gaps in
diphtheria protection. Diphtheria epidemics in Eastern Europe and South America revealed that
immunity to diphtheria subsides following the primary series of DTP infant immunization. After
experiencing outbreaks, these regions changed to Td vaccine for women of reproductive age,
and provided Td booster doses for older children and adolescents This strategy resulted in
marked decrease of diphtheria cases in Eastern Europe and South America. It is now well
established that immunity to diphtheria subsides following the primary series of DTP infant
immunization and that booster doses of diphtheria toxoid containing vaccines are needed for
continued protection.
Four key messages to be given to the mother
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Vaccine schedule related queries
Q. If a child is brought late for a subsequent dose, should one re-start with the first
dose of a vaccine?

No, do not restart the schedule again; pick up where the schedule was left off. For
example, If a child who has received BCG, penta 1 and OPV1 at 5 months of age
returns at 11 months of age, then vaccinate the child with penta 2, OPV2 ,
measles, Rotavirus vaccine (where applicable) and JE (where applicable).
Vaccine schedule related queries
Q. If a child who has never been vaccinated is brought in at 9 completed months
but before 12 completed months of age, then, can all the due vaccines be given to
a child on the same day?
Yes, all the due vaccines can be given during the same session but at
recommended injection sites, using separate AD syringes. It is safe and effective
to give BCG, penta, OPV, IPV, MR, RVV (where applicable), PCV (where
applicable) JE (where applicable) vaccines and Vitamin A at the same time
to a 9-month-old child who has never been vaccinated.
If more than one injection has to be given in one limb then ensure that the
distance between the two injection sites is at least 1 inch apart.
Vaccine schedule related queries
Q. If a child who has never been vaccinated is brought in at 9 completed months
but before 12 completed months of age, then, can all the due vaccines be given to
a child on the same day?
Yes, all the due vaccines can be given during the same session but at
recommended injection sites, using separate AD syringes. It is safe and effective
to give BCG, penta, OPV, IPV, MR, RVV (where applicable), PCV (where
applicable) JE (where applicable) vaccines and Vitamin A at the same time
to a 9-month-old child who has never been vaccinated.
If more than one injection has to be given in one limb then ensure that the
distance between the two injection sites is at least 1 inch apart.
Vaccine schedule related queries
Q. If a child who has never been vaccinated is brought in immediately after
completing 12 months of age, (beyond one year) what vaccines would you give?
As per the national immunization schedule this child need not be given – BCG,
Hepatitis B, Rotavirus, Penta and IPV. This child should be administered DPT 1,
OPV 1, Measles 1, JE 1(if applicable) and also Vitamin A solution. The subsequent
doses of DPT and OPV should be given at an interval of 4 weeks.
Administer Measles 2, JE 2 (If applicable), Vitamin A and a booster dose of DPT at
recommended age as per national immunization schedule.
.
Vaccine schedule related queries

Q. Which vaccines can be given to a child between 1 and 5 years of age who has never been
vaccinated?
Such a child will not receive BCG, Hepatitis B, Rotavirus, Penta and IPV. Give DPT1, OPV1,
measles 1, JE 1 (where applicable) and 2ml of Vitamin A solution. Then follow with the second
and third doses of DPT and OPV at 1-month intervals.
Give Measles 2 as per the schedule /1 month later*. Give booster dose of OPV/DPT at a
minimum of 6 months after administering OPV 3/DPT 3. Also give Vit A at 6 months interval till 5
years of age.
*Note: In an unvaccinated child more than 16 months of age remember the interval between
Measles 1 and Measles 2 is 4 weeks and for JE 1 and JE 2 (where applicable) the interval is 3
months.
Vaccine schedule related queries

Q. Which vaccines can be given to a child between 5 and 7 years of age who has

never been vaccinated?

Give of DPT 1, 2 and 3 at 1-month intervals. Give booster dose of DPT at a

minimum of 6 months after administering DPT 3 up to the age of 7 years.
Vaccine schedule related queries

Q. Why are the DPT, HepB (birth dose), IPV and pentavalent vaccines given in the
anterolateral mid-thigh and not the gluteal region (buttocks)?

This is done to prevent damage to the sciatic nerve. Moreover, vaccine deposited
in the fat of the gluteal region does not bring about the appropriate immune
response to protect the child.
Vaccine schedule related queries

Q. Why is BCG given only up to 1 year of age?

Most children acquire natural clinical/ sub-clinical tuberculosis infection by the age
of 1 year. This protects against severe forms of childhood tuberculosis, e.g. TB
meningitis and miliary disease.
Vaccine schedule related queries

Q. If no scar appears after administering BCG, should one re-vaccinate the child?

There is no need to re-vaccinate the child even if there is no scar.

Vaccine schedule related queries

Q. Why do we give 0.05 ml dose of BCG to newborns (below 1 month of age)?

This is because the skin of newborns is thin and an intradermal injection of 0.1 ml
may break the skin or penetrate into the deeper tissue and cause local abscess
and enlarged axillary lymph nodes.

Dose of 0.05 ml is sufficient to elicit adequate protection.

Vaccine schedule related queries

Q. Why do we give 0.05 ml dose of BCG to newborns (below 1 month of age)?

This is because the skin of newborns is thin and an intradermal injection of 0.1 ml
may break the skin or penetrate into the deeper tissue and cause local abscess
and enlarged axillary lymph nodes.

Dose of 0.05 ml is sufficient to elicit adequate protection.

Vaccine schedule related queries

Q. Why is the birth dose of hepatitis B vaccine given only within 24 hours of birth?

The birth dose of hepatitis B vaccine is most effective in preventing peri-natal

transmission of hepatitis B only if given within the first 24 hours.
Vaccine schedule related queries

Q. What vaccine will be given to a child who has received at least one dose of
pentavalent vaccine before his/her first birthday?

If a child has received at least one dose of pentavalent vaccine before his/her first
birthday, the child should be administered the due pentavalent doses at a
minimum interval of 4 weeks, at the earliest available opportunity.
Vaccine schedule related queries

Q. What is the maximum age limit for giving the first dose of Rotavirus vaccine?

The upper age limit for the first dose of Rotavirus vaccine is one year of age. If a
child has received only the first dose of Rotavirus vaccine by 12 months of age,
two more doses of the vaccine should be given at an interval of 4 weeks between
the two doses to complete the course.
Vaccine schedule related queries

Q. If a child has received the Measles Rubella vaccine before 9 months of age, is
it necessary to repeat the vaccine later?

Yes, the Measles Rubella vaccine needs to be administered, according to the

National Immunization Schedule, after the completion of 9 months until 12 months
of age as 1st dose and at 16-24 months as 2nd dose in RI.
Vaccine schedule related queries

Q. If a child comes after 2 years for the first dose of MR, then can he/she get the
second dose?

All efforts should be made to immunize all children at the right age i.e. first dose at
completed 9 months to 12 months and second dose at 16-24 months. However if
a child comes late (beyond 2 years),then two doses of the vaccine can be given at
one month interval until 5 years of age under UIP.
Vaccine schedule related queries

Q. What should be done if a PCV dose is delayed?

All The two primary doses and one booster dose of PCV should be given during the first year of life.

If the doses are delayed within the first year, Doses (both primary and booster) must be separated

by a minimum interval of at least 2 months, to be given at the next scheduled immunization visit.

In delayed cases beyond 1 year of age, due doses can be given to a child only if a child has received

at least one dose of PCV before his/her first birthday.

For those with at least one previous PCV dose, the series should be completed at the earliest

available opportunity.
Reference
1. Immunisation handbook for health workers. 2018