Vaccines and Vaccination

 MENINGOCOCCAL VACCINE:

• Ineffective in children < 2 years old .
• Available for group A, C, Y and W-125. 
• No group B vaccine available.
• Storage : 2-8° C.
• Routinely given to young adolescents.
• Bivalent vaccine- AC.

RABIES:

• Recombinant glycoprotein vaccines (Subunit vaccines) for Rabies are still in experimental Stage.
• Commercially available : 
  • Killed sheep brain vaccine, 
  • Human diploid cell vaccine (Recommended) 
  • Vero continous cell vaccine.
• Chick fibroblast anti-rabies vaccine  has been recommended by WHO.
• Neurological complications seen
• Fixed virus is used to produe vaccine.
• HDCV (post-exposure) given on 0, 3, 7, 14, 28 & booster dose at 90 days.
• HDCV( preexposure prophylaxis)-3 doses
• Site for injection of cell culture rabies vaccine- Deltoid.
• It an cause adverse effects in persons with allergy to egg.

ROTA VIRUS:

• Best vaccine -Genetic Reassortment.
• Contraindication –
  • SCID 
  • Intussusception 
  • Severe allergic raction

HEPATITIS B:

• Risk of HIV transmission is not seen with plasma derived hepatitis B vaccine.
• Hepatitis B vaccine should be given as per which schedule at 0,1,6 months.
• Hepatitis B vaccine is a killed ‘inactivated’ vaccine

LIVE VACCINES:

• Avoided in the long-term follow-up of a renal transplant recipient on cyclosporin.
• Two live vaccines can be administered simultaneously.
• Booster doses are not required when live vaccines are administered.
• Single dose  of live vaccine gives life long immunity.
• Live vaccine contains both major and minor antigens.
• Live, attenuated virus and live bacterial vaccines generally are contraindicated during pregnancy.
• Minimum interval between 2 live vaccine immunization is 4 weeks.

SUBUNIT VACCINES:

• Meningococcal vaccine from cell wall polysacchlaride
• Pneumococccal vaccine from Capsular polysaccharide
• Hepatitis B polypeptide vaccine
• Typhoid vaccine from Vi polysaccharide
• H. Influenza vaccine from capsular polysaccharide.

BCG :

• Live attenuated vaccine
• No preservative 
• WHO recommends Danish 1331 strain for vaccine production.
• BCG vaccine is diluted with normal saline.

POLIO VACCINES:

• Two types :
  • Inactivated (salk) polio vaccine (IPV) 
  •  Oral (sabin) polio vaccine (OPV)
• In OPV, the vaccine potency is stabilized with molar magnesium chloride or sucrose.
• IPV:
  • IPV was discovered by —> Jonas Salk (Salk vaccine).
  • Given in 4 doses
  • Being an inactivated vaccine, it can be given to immunosuppressed individuals, e.g. AIDS patients
  • Produces circulatory antibody
  • Does not require stringent refrigeration
  • Not effective in an epidemic
  • Does not provide Immunity against paralytic and wild strains 
  • It prevents paralysis
  • Easily transported
  • Oral polio can be given as booster.

TRIVALENT ORAL POLIO VACCINE:

1. Over 300,000 TCID 50 of type 1 poliovirus
2. Over 100,000 TCID 50 of type 2 poliovirus
3. Over 300,000 TCID 50 of type 3 poliovirus. 

• OPV bivalent vaccine contains type 1 and 3 viruses.
• Being living viruses, the vaccine viruses, particularly type 3 do mutate in the course of their multiplication in vaccinated children, and rare cases of vaccine associated paralytic polio have occured in -Recipients of the vaccine and their contacts.
• Maintenance of cold chain.
• 5 doses of OPV given.
• Killed vaccine is effective in India.
• OPV:Stored at Sub-zero temprature,Intestinal & humoral immunity
• Main problem is residual neuro-virulenceoor growth in stable cell line of monkey kidney,
• OPV was discovered by → Albert Sabin (Sabin vaccine). 
• As it prevents heat inactivation mgCl2 can be added to polio vaccine so that it can be stored at a higher temperature.
• In an epidemic of poliomyelitis, the best way to stop spread is by OPV drops to all children.
• Reverse cold chain is used for Carrying stool samples of polio patients from MC to lab .

Vaccine Vial Monitor:

• Colour of central square Lighter than ring → Can be used
• Colour of central square → Same or darker than ring –Discard. 

DPT vaccine:

• Thiomersal is preservative in DPT vaccine.
• Aluminium salt has an adjuvant effect in DPT vaccine.
• Whole killed bacteria of Bordetella pertusis has an adjuvant effect in DPT vaccine.
• Presence of acellular pertusis component in DPT vaccine.
• Not be given to a child suffering from convulsions.
• Stored at 4-8°C
• Exposure to direct sunlight should be avoided.
• Open multi-dose vials which have not been fully used should be discarded at the end of session.
• The adjuvant used is Al.
• The peripheral workers in a primary health centre return one day late; after an immunisation session. 
• The primary health centre is locked. 
• The vaccine carrier still contains a few unopened vials of DPT vaccine and sufficient ice. 
• The workers are to retain the vaccine in the ice-box.
• Prevent development of carrier

Measles:

• Usually there is no preservative in measles vaccine, though it may contain very small amounts of Kanamycin, neomycin or erythromycin..
• Measles vaccine given to contact of measles case exerts protective effect within 7 days.
• In measeles vaccine can be given within- 6 months.
• MMR is a type of live attenuated vaccine.
• Can cause TSS.
• Contraindicated in neomycin allergic patients.
• In epidemics measles vaccine is to be given within 3days of exposure.
• Encephalopathy can occur as complication 
• At PHC level vaccine storage is by IRL.

Chicken pox vaccine:

• It is a live vaccine.
• OKA strain is used to produce vaccine for Chicken Pox.
• Rubella vaccine is given in 1-14 years age .
• Newer Influenza vaccine are Split-virus vaccine &  Neuraminidase.

Cholera Vaccine:

• It is WC-r BS.
• Oral cholera vaccine is effective for 3 years.

Typhoid:

• For a typhoid endemic country like India, the immunization of choice is Typhoral 21 A oral vaccine.
• Typhoid oral vaccine is given  at 1,3,5 days.
• The Vi polysaccharide vaccine can be co-administered with other vaccines relevant for international travelers.

Yellow fever vaccine :

• In India is produced at- Central research institute,Kasauli.
• It is contraindicated in pregnancy.
• SA-14-14-2 Japanese encephalitis vaccine – is a Cell culture derived live attenuated vacine.
• Pneumococcal vaccine is most effective when given preoperatively.
• German measles (rubella) need not be given to boys.
• After reconstitution, the vaccine must be stored in the dark at 2-8 degree C and used within: 6 hours.
• Term vaccine was coined by Louis Pasteur.

Refrigerator:

• Deep freezers are used for making ice packs and to store OPV and measles vaccines.
• Vaccines which must be stored in cold part but never allowed to freeze are: typhoid, DPT, Tetanus toxoid, DT, BCG, and diluents.
• Polyvalent snake vaccines contains immunoglobins against : Naja naja  , Daboia rusellii , Bungarus caeruleus.
• Bivalent HPV vaccine contains types 16,18.
• Mumps vaacine efficacy is 95%.

Hepatitis A:

• Both live and inactivated for Hepatitis A.
• Recomended at age of 12 months.
• 2 dose of killed vaccine 6 months apart.
• 1 dose of live vaccine

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