Spotters in "National Immunization Schedule (NIS) " for CFM & MPH students

For Infants & Children:

1. Vaccine: BCG


Important points:

  • Type: Live bacterial, lyophilized
  • Strain: Bovine strain Danish-1331
  • When to give: At birth or as soon as possible after birth.
  • Maximum age: Till one year of age.
  • Dose: 0.05 ml until one month, 0.1 ml beyond the age of one month.
  • Diluent: Yes, Sodium chloride (Manufacturer-supplied).
  • Route: Intra- dermal (ID).
  • Site: Upper Arm - LEFT.
  • Booster dose: Not required.
  • Contraindications: Symptomatic HIV infection, Pregnancy, Radiation therapy (i.e. total-body radiation).
  • Possible minor adverse reaction: Local reaction (pain, swelling, redness).
  • Expected Frequency: Common.
  • Rare vaccine reactions: Suppurative lymphadenitis (2-6 months), BCG osteitis (1-12 months), Disseminated BCG infection (1-12 months).
  • Storage: +2 to +8 degree C; Unused reconstituted vaccine should be discarded after 6 hours or at the end of session whichever is earlier. Protect the vaccine from direct sunlight.
  • Note: There is no need to revaccinate the child if a scar is not formed after BCG vaccination.
  • Protective value: 15 to 20 years, up to 80%.

2.  Vaccine: Hepatitis B

Important points:

  • Type: Monovalent antigen, subunit genetically engineered plasma-derived vaccine (PDV).
  • Composition: 20 mcg of 22 nm surface antigen particles (HbsAg) per ml.
  • When to give: Birth dose- At birth or as early as possible.
  • Maximum age: Within 24 hours as it helps to prevent perinatal transmission of Hepatitis B.
  • Dose: 0.5 ml
  • Diluent: No
  • Route: Intramuscular 
  • Site: Antero-lateral side of mid-thigh-LEFT
  • Contraindications: Current serious illness.
  • Possible minor adverse reaction: Local reaction (pain, swelling, redness), Fever.
  • Expected frequency: Adults up to 30%, Children up to 5%. 
  • Rare vaccine reactions: Anaphylaxis (0-1 hour).
  • Storage: +2 to +8 degree C, Never freeze.
  • Protective value: Over 95% for 5 years.


3.  Vaccine: OPV



Important points:

Type: Live Bivalent

OPV-0: 

  • When to give: As early as possible.
  • Maximum age: within the first 15 days.
  • Dose: 2 drops
  • Diluent: No
  • Route: Oral

OPV-1, 2 & 3: 

  • When to give: 6, 10 & 14 weeks.
  • Maximum age: Up to 5 years of age.
  • Dose: 2 drops
  • Diluent: No
  • Route: Oral
OPV booster:
  • When to give: 16-24 months.
  • Maximum age: Up to 5 years of age.
  • Dose: 2 drops
  • Diluent: No
  • Route: Oral

Possible minor adverse reaction: None

Rare vaccine reactions: VAPP

Storage: +2 to +8 degree C, may be frozen for a long duration.

Protective value: Lifetime


4.  Vaccine: IPV

Important points:

  • When to give: At 14 weeks.
  • Maximum age: Up to one year of age.
  • Dose: 0.5 ml
  • Diluent: No
  • Route: Intra- muscular 
  • Site: Antero-lateral side of mid-thigh-RIGHT
  • Possible minor adverse reaction: None


5.  Vaccine: Rotavirus

Important points:

  • When to give: At 6, 10 & 14 weeks.
  • Maximum age: Up to one year of age.
  • Dose: 5 drops.
  • Diluent: No
  • Route: Oral
  • Storage: +2 to +8 degree C.
  • Protective value: 80%
  • Rotavirus vaccine is being introduced in phases.

6.  Vaccine: Pentavalent

Important points:

  • It contains a combination of DPT, Hepatitis B & Hib.
  • Pentavalent vaccine is introduced in place of DPT and Hep B 1, 2 & 3 .
  • When to give: At 6, 10 & 14 weeks.
  • Maximum age: Up to one year of age.
  • Dose: 0.5 ml
  • Diluent: No
  • Route: Intra-muscular
  • Site: Antero-lateral side of mid-thigh-LEFT
  • Storage: +2 to +8 degree C.
DPT booster-1:
  • When to give: 16-24 months. 
  • Maximum age: Up to 7 years of age.
  • Dose: 0.5 ml 
  • Diluent: No
  • Route: Intra-muscular
  • Site: Antero-lateral side of mid-thigh-LEFT
DPT booster-2:
  • When to give: 5-6 years. 
  • Maximum age: Up to 7 years of age.
  • Dose: 0.5 ml 
  • Diluent: No
  • Route: Intra-muscular
  • Site: Upper arm-LEFT
TT:
  • When to give: 10 years & 16 years. 
  • Dose: 0.5 ml 
  • Diluent: No
  • Route: Intra-muscular
  • Site: Upper arm.
  • Storage: +2 to +8 degree C, never freeze.
  • Note: Td - Tetanus diphtheria to replace TT - to be added in schedule.

7.  Vaccine: Measles

Important points: 

1st dose:

  • When to give: 9-12 completed months.
  • Maximum age: Up to 5 years of age.
  • Dose: 0.5 ml
  • Diluent: Sterile water
  • Route: Subcutaneous
  • Site: Right upper arm

2nd dose:

  • When to give: 16-24 months.
  • Maximum age: Up to 5 years of age.
  • Dose: 0.5 ml
  • Diluent: Sterile water
  • Route: Subcutaneous
  • Site: Right upper arm
  • Storage: +2 to +8 degree C, may be frozen during long storage.
  • Protective value: Lifetime.

Contraindications: Pregnancy, Radiation therapy.

Possible minor adverse reaction: Local reactions (pain, swelling, redness); irritability, malaise & non-specific symptoms.

Rare vaccine reactions: Febrile seizures

Note:  MR vaccine introduced in phases replacing measles vaccine in the UIP schedule. If first dose delayed beyond 12 months ensure minimum one month gap between 2 MR doses.

8.  Vaccine: JE

Important points:

1st dose:

  • When to give: 9-12 completed months.
  • Maximum age: Up to 15 years of age.
  • Dose: 0.5 ml
  • Diluent: Phosphate buffer 
  • Route: Subcutaneous
  • Site: Left upper arm

2nd dose:

  • When to give: 16-24 months.
  • Dose: 0.5 ml
  • Diluent: Phosphate buffer 
  • Route: Subcutaneous
  • Site: Left upper arm
  • Storage: +2 to +8 degree C.
  • Protective value: About 3 years.

Possible minor adverse reaction: Local reactions, Low-grade fever, myalgia, gastrointestinal upset.

Rare vaccine reactions: Neurologic events (encephalitis, encephalopathy, peripheral neuropathy).

Note: JE vaccine has been introduced in select endemic districts. If first dose is delayed beyond 12 months ensure minimum 3 months gap between 2 JE doses.

9.  Vaccine: Vitamin A

Important points:

1st dose:

  • When to give: At 9 completed months with measles.
  • Maximum age: Up to 5 years of age.
  • Dose: 1 ml (1 lake IU)
  • Diluent: No
  • Route: Oral

2nd-9th dose:

  • When to give: At 16 months, then one dose every 6 months.
  • Maximum age: Up to 5 years of age.
  • Dose: 2 ml (2 lake IU)
  • Diluent: No 
  • Route: Oral 
  • The 2nd to 9th doses of Vitamin A can be administered to children 1-5 years old during biannual rounds, in collaboration with ICDS.


For pregnant women:

10.  Vaccine: TT

Important points:

1st dose:

  • When to give: Early in pregnancy. 
  • Dose: 0.5 ml
  • Diluent: No 
  • Route: Intra-muscular
  • Site: Upper arm

2nd dose:

  • When to give: 4 weeks after TT-1.
  • Dose: 0.5 ml
  • Diluent: No 
  • Route: Intra-muscular
  • Site: Upper arm
3rd dose:
  • When to give: If received TT doses in pregnancy within the last 3 years.
  • Dose: 0.5 ml
  • Diluent: No 
  • Route: Intra-muscular
  • Site: upper arm

Possible minor adverse reaction: Local reactions (pain, swelling, redness); malaise & non-specific symptoms.

Rare vaccine reactions: Brachial neuritis, Anaphylaxis. 

Note: Give TT-2 or Booster doses before 36 weeks of pregnancy. However, give these even if more than 36 weeks have passed. Give TT to a woman in labor, if she has not previously received TT.

References:

  1. Park, K. (2019). Park's textbook of preventive and social medicine. 25th. Jabalpur, India: M/S Banarsidas Bhanot.
  2. Kadri AM. (2019). IAPSM's Textbook of Community Medicine. 1st. New Delhi, India: Jaypee Brothers Medical Publishers (P) Ltd.
  3. https://www.indiamart.com/proddetail/bcg-vaccine-5068383112.html photo credit
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  8. https://www.indiamart.com/proddetail/hivac-b-hepatitis-b-vaccine-13778965697.html photo credit
  9. https://www.who.int/immunization_standards/vaccine_quality/vvm_use_availability_7sep10.pdf photo credit
  10. https://www.indiamart.com/proddetail/oral-polio-vaccine-15626476573.html photo credit
  11. https://polioeradication.org/polio-today/polio-prevention/the-vaccines/opv/ photo credit
  12. https://zeenews.india.com/news/health/health-news/inactivated-polio-vaccine-ipv-a-new-tool-in-the-fight-against-polio-watch-to-know-more-about-it_1880645.html photo credit
  13. http://edithzikpi.blogspot.com/2018/06/inactivated-polio-vaccine-introduced.html?m=1 photo credit
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  15. https://health.economictimes.indiatimes.com/news/pharma/sii-invents-the-first-ever-heat-stable-rotavirus-vaccine-in-the-world-rotasiil/70712802 PHOTO CREDIT
  16. https://www.cdc.gov/vaccines/vpd/rotavirus/index.html PHOTO CREDIT
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  18. https://www.congruentpharmaceutical.com/rotavac-5032209.html photo credit
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  20. https://en.vietnamplus.vn/pentavalent-vaccine-combe-five-to-be-used-nationwide/143808.vnp photo credit
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  24. https://www.who.int/immunization_standards/vaccine_quality/pq266_je_1dose_biologicale/en/ photo credit
  25. https://www.empr.com/home/news/fda-approves-accelerated-vaccination-schedule-for-ixiaro/ photo credit
  26. https://www.indiamart.com/proddetail/pharma-jenvac-7555738812.html photo credit
  27. https://www.path.org/articles/how-once-little-used-vaccine-now-protects-millions-japanese-encephalitis/ photo credit
  28. https://blogs.unicef.org/evidence-for-action/vitamin-supplements-can-save-childs-life/ photo credit
  29. https://www.jaypeedigital.com/eReader/chapter/9789351527794/ch3 photo credit
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  31. https://www.historyofvaccines.org/index.php/content/tetanus-toxoid-india photo credit


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