NATIONAL IMMUNISATION PROGRAMME-Introduction to VPDs, EPI :- World & India , UIP

If a child comes with no previous immunizations, then catch-up immunizations of BCG, OPV, DPT and measles vaccines along with vitamin A must be given at the time of visit to the clinic. Advise the parents to bring the child after 4 weeks for OPV-2 and DPT-2, and after a further 4 weeks for OPV-3 and DPT-3.

Booster dose or fourth dose is given after a minimum interval of 6 months.

The fifth dose is not needed if the fourth dose was given at 4 years or older.

Ref: Ghai Essential Pediatrics, By O. P. Ghai, Piyush Gupta, V. K. Paul, 6th Edition, Page 121, 191, 200; Nelson Textbook of Pediatrics, By Kliegman, Stanton, St. Geme, Schor, Behrman, 19th Edition, Page 890.

A lapse in the immunization schedule does not require reinitiation of entire vaccine series.

Ans. is ‘b’ i.e., 51-60%

o Indian academy of pediatrics (IAP) classification of malnutrition is based on weight for age.

o IAP designates a weight of more than 80% of expected for age as normal.

o Grades of malnutrition are ‑

Grade I        –>         71-80%                         Grade III           —>       51-61%

Grade II      –>         61-70%                         Grade IV           –>           50%

Ans. is ‘a’ i.e., Pertusis; ‘b’ i.e., Salk vaccine

Ans. is ‘c’ i.e., 9 months 

• Interval between 2 doses of DPT, OPV and Hepatitis B should not be less than one month.
• Minor cough, colds and mild fever are not a contraindication to vacciation. In some states, Hepatitis B vaccine is given as routine immunization at 6th, 10th and 14th weeks.
• Vitamin A is given at 9^th,18^th, 24^th, 30^th, 36^th, 42′, 48^th, 54^th & 60^th month.
• If the child has diarrhoea, give a dose of OPV, but do not count the dose and ask the mother to return in 4 weeks for the missing dose.

Following information has been added in 22/e of Park

• New table of national immunization schedule has been added on page 115. It has schedule similar to the table mentioned above, with following additions : –

1. Hepatitis B vaccine (zero dose) is also given along with OPV (zero dose) and BCG at birth.
2. At 5-6 years, DPT booster is given instead of DT.
3. Japanese encephalitis vaccine is given at 16-24 months with DPT/OPV.
4. Now, for measles vaccination, two doses are given at 9 months and 16-24 months (Previously, only one dose vaccination used to be given at 9 months).

• Any number of vaccines (live and/or killed) can be given together
• There need not be a gap of 1 month between a live and a killed vaccine
• BCG and Measles vaccine can be given together for a case of delayed immunization
• Minor fever, diarrhea, ARI or other illness is NOT a contraindication for any of the vaccines
• Doses and schedule remain same even if baby is premature and/or underweight

Ans. is ‘ c’ i.e., Hepatitis B

o TT, OPV and measles are given in National immunization schedule.

Hepatitis B vaccine has also been included in recent time.

Ans. is ‘d’ i.e., 12-23 months 

o In the Expanded programme on Immunization (EPI) cluster technique, a simplified cluster sampling method is used.

It is based on ranodm selection of 210 children who are 12-23 months of age.

These patients are selected in 30 clusters of 7 children each to estimate immunization coverage levels.

Ans. is ‘a’ i.e., Measles 

o Amongst the respiratory tract infection, measles is related to malnutrition.

o It is related to malnutrition in both ways, i.e. –

i)           Measles tends to be more severe in the malnourished child.

ii)         In healthy child, measles precipitates malnutrition.

o That means measles predisposes malnutrition and vice versa.

o All cases of severe measles, and all cases of measles in areas with high case-fatality rates should be treated with vitamin A, as many children develop acute deficiency of vitamin A, which may lead to keratomalacia and blindness from corneal scarring.

o So, vitamin ‘A’ should be administred along with measles vaccine.

o A high dose of vitamin A is given immediately on diagnosis of measles and repeated the next day. The recommended age specific daily doses are 50,000 IU for infacts aged < 6 months, 100,000 IU for infants aged 6-11 months, and 200,000 IU for children aged 12 months. If the child has clinical signs of vitamin A deficiency (Such as Bitot’s spots) a third dose should be given 4-6 weeks later.

Ans. is `b’ i.e., Moderate

Ans.(d) Booster of Typhoid Conjugate Vaccine 

Recommended age at which the vaccines should be received and type of vaccine: