REPORT ON

IMMUNIZATION
CLINIC

SUBMITTED BY, SUBMITTED TO,

MOBISHA. K MRS VILASINI. C

1ST YEAR MSc NURSING ASSO.PROFESSOR

GOVT. COLLEGE OF NURSING GOVT. COLLEGE OF NURSING
KOZHIKODE KOZHIKODE
INTRODUCTION

Immunization is the process whereby, the person is made immune or resistant to an infectious
disease, typically by the administration of vaccine. Vaccine stimulates the body’s own immune system
to protect the person against subsequent infection or disease.

PRIMARY HEALTH CENTRE

Primary Health Centre (PHCs), sometimes referred to as public health centres, are state-
owned rural health care facilities in India. They are essentially single-physician clinics usually
with facilities for minor surgeries, too. They are part of the government-funded public health
system in India and are the most basic units of this system. Presently there are 28,863 PHCs
in India.

FOCUSES OF PHC

Apart from the regular medical treatments, PHCs in India have some special focuses.

• Immunization programs: Immunization for new-borns under the national immunization

program is dispensed through the PHCs.
• Anti-epidemic programs: The PHCs act as the primary epidemic diagnostic and control
centres for the rural India. Whenever a local epidemic breaks out, the system's doctors
are trained for diagnosis. They identify suspected cases and refer for further treatment.
• Birth control programs: Services under the national birth control programs are
dispensed through the PHCs. Sterilization surgeries such
as vasectomy and tubectomy are done here. These services, too, are fully subsidised.
• Pregnancy and related care: A major focus of the PHC system is medical care
for pregnancy and child birth in rural India. This is because people from rural India resist
approaching doctors for pregnancy care which increases neonatal death. Hence,
pregnancy care is a major focus area for the PHCs.
• Emergencies: All the PHCs store drugs for medical emergencies which could be
expected in rural areas. For example antivenoms for snake bites, rabies vaccinations,

UNIVERSAL IMMUNIZATION PROGRAMME

o Immunization Programme is one of the key interventions for protection of children from
life threatening conditions, which are preventable. It is one of the largest immunization
programmes in the world and a major public health intervention in the country.
o Immunization Programme in India was introduced in 1978 as Expanded Programme
of Immunization (EPI)
o The programme gained momentum in 1985 and was expanded as Universal
Immunization Programme (UIP) to be implemented in phased manner to cover all
districts in the country by 1989-90.
o UIP become a part of Child Survival and Safe Motherhood Programme in 1992 Since,
1997, immunization activities have been an important component of National
Reproductive and Child Health Programme and is currently one of the key areas under
National Rural Health Mission (NRHM) since 2005
 o Under the Universal Immunization Programme, Government of India is providing
vaccination to prevent seven vaccine preventable diseases i.e.Diphtheria, Pertussis,
Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B,
Haemophilus influenza type b (Hib) and Diarrhoea

Immunization
Vaccination (Latin; Vacca- Cow) Edward Jenner used the term Vaccination

Immunization, or immunisation, is the process by which an individual's immune

system becomes fortified against an agent
1974: Expanded program of Immunization (EPI) organized by WHO

1985, The Universal Immunization Program (UIP) was introduced to improve coverage of
immunization

VACCINATION: administration or inoculation of vaccine

VACCINE FAILURE: if disease occurs despite immunization

The Vaccination Schedule under the UIP

National Immunization Schedule

Vaccine When to give Dose Route Site

For Infants

0.1ml (0.05ml
At birth or as early as possible
BCG until 1 month of Intra -dermal Left Upper Arm
till one year of age
age)

At birth or as early as possible Anterolateral side of

Hepatitis B Birth dose 0.5 ml Intramuscular
within 24 hours mid-thigh-LEFT

At birth or as early as possible

OPV Birth dose 2 drops Oral -
within the first 15 days

At 6 weeks, 10 weeks & 14

OPV 1,2 & 3 2 drops Oral -
weeks

IPV (inactivated Polio Anterolateral side of

14 weeks 0.5 ml Intramuscular
Vaccine) mid-thigh-RIGHT

At 6 weeks, 10 weeks & 14 Anterolateral side of

Pentavalent 1,2 & 3 0.5 ml Intramuscular
weeks mid-thigh-LEFT
 At 6 weeks, 10 weeks & 14
Rota Virus Vaccine 5 drops Oral -
weeks

9 completed months-12
months. (give up to 5 years if
Measles 1st Dose 0.5 ml Subcutaneous Right Upper Arm
not received at 9-12 months
age)

1 ml (1 lakh
Vitamin A, 1st Dose At 9 months with measles Oral -
IU)

For children

Anterolateral side of
DPT 1st booster 16-24 months 0.5 ml Intramuscular
mid-thigh-LEFT

OPV Booster 16-24 months 2 drops Oral

Measles 2nd dose 16-24 Months 0.5 ml Subcutaneous Right Upper Arm

16 months with DPT/OPV

Vitamin A (2nd to 2 ml (2 lakh
booster, then, one dose every 6 Oral -
9th dose) IU)
month up to the age of 5 years)

DPT 2nd Booster 5-6 years 0.5 ml. Intramuscular Left Upper Arm

TT 10 years & 16 years 0.5 ml Intramuscular Upper Arm

The immunization programme is large scale public health programm. It is often a programme
with extensive reach. Immunization activities are usually planned to reach every community.

OBJECTIVES OF IMMUNIZATION CLINIC AND PROGRAMME

• Ongoing assessment of immunization coverage

• Comprehensive health protection
• Strengthening the immunization system
• Ensuring the appropriate vaccine in appropriate time and prevention if caution disease
• Immunization clinic should be economically possible and socially acceptable
• Elimination of diseases
IMMUNIZING AGENTS

VACCINES

IMMUNOGLOBULINS

ANTISERA OR ANTITOXINS
Types of Vaccines

 Live vaccines

 Killed vaccines

 Toxoids

 Subunit vaccines

Live Vaccines

Contains attenuated form of wild virus or bacteria. Must replicate to provide immunity

 Produce local immunity.

 More convenient for mass immunization

 Single dose is sufficient usually

 Unstable & severe reactions are possible

 May get interfered by circulating antibodies eg maternal antibodies Eg: Bacterial-BCG, Oral typhoid
Viral-OPV, MMR, Varicella

Killed Vaccines

 Organisms are killed or inactivated by heat or chemicals but remain antigenic

.  Vaccines are stable

 Immunity induced is not permanent

 Multiple doses are required

Eg: Bacterial-DTPw, whole cell killed typhoid

Viral- IPV, Rabies, Hep A vaccine

Toxoids

 Toxoids are modified toxins.

 Primary immunization is in the form of multiple divided doses in order to decrease the adverse
effects.

 Booster doses are required to sustain the protection.

 Eg: TT, diphtheria

Subunit Vaccines

 Contains bacterial capsular polysaccharide

 Eg: Hib, meningococcal, pneumococcal, S.typhi(Vi)

 Or contains viral surface antigens Eg: Hep B

 Produce only IgM antibodies.

Combined Vaccines

More than one kind of immunizing agent is included.

Aim:

 To simplify administration

 Reduce costs

 Minimize the number of contacts of the patient with health system Eg: DTP, MMR, DT, DP

Route of Immunization

 Intradermal – BCG

 Subcutaneous - Measles, MMR, Meningococcal, Varicella  Intramuscular -DTP, Hep A, HepB, Hib

SITE OF ADMINISTRATION

 Deltoid- BCG

 Triceps (Posterior skin fold)-Measles, MMR, Meningococcal, Varicella  Vastus lateralis

(Anterolateral aspect of thigh in infants) –

Principles of Immunization

 A minimum interval of 4wks is essential between administration of 2 live vaccines.

 2 or more killed antigens can be administered simultaneously or at any interval

 If any relapse in administration occurs, the missed can be given to resume the course

 If immunization status of child is unknown, he may be given age appropriate vaccines

 Do not mix vaccines in the same syringe

Contraindications

 Congenital immunodeficiency, therapy with high dose steroids, illness with immunosuppression,
severe allergic reaction to vaccines

 The following are not contraindications:

Minor illness like URT infections & diarrhoea, mild fever, prematurity, allergy to penicillin, h/o
allergies, malnutrition, recent exposure to infections, current antibiotic therapy
National Immunization Schedule

Cold Chain

It is the system of transporting, storing & distributing vaccines in a potent state at the recommended
temperature from point of manufacture to point of use.

Consist of

 Walk in rooms

 Deep freezers
 Ice lined refrigerators

 Cold boxes

 Ice packs

Commonly Used Vaccines

BCG (Bacillus Calmette Guerin) Vaccine

 Live attenuated

 Common strains

- Copenhagen (Danish 1331), Pasteur, Glaxo

 Administered 0.1 ml i.d. on left shoulder at insertion of deltoid.

 Protection against military TB & tubercular meningitis

 Complications- ulceration, lymphadenitis

 CI – cellular immunodeficiency, symptomatic HIV

 Storage- 2-8 deg C, discard unused vaccine after 4

OPV

 Live attenuated polio virus types1,2 & 3-developed by sabin ,1961

 Dose – 2 drops orally

 Virus reach the intestine; infect the mucosal cells to elicit immune response

 Adverse reactions- Vaccine derived poliovirus; Vaccine associated paralytic poliomyelitis

 CI- inherited or acquired immunodeficiency; symptomatic HIV

 IAP recommends additional doses of OPV as a part of pulse polio program every year till age of 5
yrs

IPV

 Formaldehyde killed polio virus grown in monkey kidney or human diploid cell

 Contains 20,8,32 D antigen units against type 1,2,3 polio viruses respectively

 Dose- 0.5ml intramuscular or subcutaneous  Administer 3 doses at 6, 10, & 14wks according to
IAP

DTP

 Diphtheria toxoid, Tetanus toxoid & killed whole cell pertussis/ acellular pertussis vaccine

 0.5 ml injected IM on anterolateral aspect of mid-thigh.

 Progressive neurological disease or serious adverse reaction to earlier dose, encephalopathy within
7 days of previous dose are contraindications for DPT (replace with DT)
Measles

 Live attenuated vaccine

 Strain – Edmonston Zagreb

 0.5 ml injected S/C preferably right upper arm

 Given at 9 months

 CI- malignancy, immune deficiency, therapy with alkylating agent/corticosteroid, untreated TB

MMR

 Combination of Measles, Mumps, Rubella vaccines

 Mumps- Jeryl Lynn strain Rubella- RA 27/3 strain

 Dose is 0.5 ml s/c preferably right upper arm

 Adverse reactions- fever, transient rash, arthralgia, aseptic meningitis, lymphadenopathy

 CI- malignancy, immunodeficiency, untreated tuberculosis

Varicella Vaccine

 Live attenuated Oka strain.

 Dose 0.5ml s/c

 Two doses given at 15-18m; second dose given >3m after the first dose

Typhoid

WHOLE CELL:

 Killed S.typhi often with S.paratyphi A(TA)

 Primary course:2 doses 4 wks apart at 6-9 mo of age or at any age

 Boosters once in 3-5 yrs

 Dose :0.25-0.5 ml S/C for primary,0.1ml for booster Vi POLSACCHARIDE:

 Developed by Robbins,1984

 Inject IM at or after 2 yrs of age (0.5 ml)

 Booster after 3 yrs

Hepatitis A

 0.5ml im deltoid

 2 doses beyond 1yr of age, given 6m apart

 Aluminium hydroxide – adjuvant

  Indication- children with c/c liver ds seronegative for HA virus, children attending creches & day
care facilities, travellers to endemic areas  Effective if administered to unimmunised household
contacts of pts symptomatic with HAV within 10 days

Hepatitis B vaccine

 Recombinant DNA vaccine

 0.5ml IM in 1yr

 3 doses at 0, 1, 6 months

 HBIG gives passive immunity- dose 0.5ml in newborns & 0.6ml/kg for all other ages. It should be
given within 48 hrs of exposure

Hib vaccine

 H . Influenza B-capsular polysaccharide

 3 doses 6,10,14 wks

 Booster 1 yr after primary dose

 Dose 0.5 ml SC/IM over deltoid or anterolateral aspect of thigh

Pneumococcal vaccine

High risk groups- childern< 2yrs , cogenital immunodeficiency, HIV, asplenia, hyposplenia, nephrotic
syndrome  0.5ml IM 3 doses 6, 10, 14 wks with a booster at 15-18m

Rotavirus Vaccine

 Two live oral vaccines availiable – Rotarix & RotaTeq

 Rotarix – monovalent (RV1) live attenuated vaccine human rotavirus G1P(8) strain given orally 1ml
in a 2 dose schedule

 RotaTeq – pentavalent (RV5) vaccine strains reassorted between the bovine & human WC3
rotaviruses given orally 2 ml in 3 dose schedule 2, 4 & 6 mo

 Adverse reaction -intussusception

HPV vaccine

 0.5ml IM at deltoid

 Recommended age for initiation of vaccine is 10-12yr  HPV4- at 0, 2 & 6m  HPV2- at 0, 1 & 6m
Vaccines Recommended During Epidemics  Japanese B Encephalitis vaccine  0.5ml s/c  Site-
anterolateral thigh/ upper arm 

CONCLUSION

Immunization is one of the most important and cost-effective strategies for the prevention of
childhood sicknesses and disabilities and is thus a basic need for all children.