Vaccine Schedule 2019

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Information about Vaccine Schedule 2019

Published on May 19, 2019

Author: kamleshlala


Latest Updates in Vaccine Schedule: DR. KAMLESH LALA M.B.B.S.; D.PED, FCGP FAMILY PHYSICIAN NARANPURA KAMLESHLALA@ HOTMAIL.COM Latest Updates in Vaccine Schedule INTRODUCTION: Immunisation is one of the most cost effective of all the health care interventions practiced worldwide. Vaccination provides the opportunity to eradicate, eliminate or significantly reduce common infectious diseases to save lives and to reduce human suffering. INTRODUCTION Vaccine Schedule: A vaccination schedule is a series of vaccinations, including the timing of all doses, which may be either recommended or compulsory depending on the country of residence, needs of the community, disease burden, feasibility of implementation, availability of vaccines and cost effectiveness. Based on above issues, every country decides its own immunisation schedule as per the local epidemiological situation and programmatic needs. Vaccine Schedule Basis of Recommendations: Guidelines for evidence-based review on vaccine-related recommendations are available from Advisory Committee on Immunization Practice (ACIP ), Strategic Group of Advisory Experts on immunization (SAGE), European Center for Disease Control (ECDC) and WHO. ACIP review the evidence for best practices and release updated guidance every 3 – 5 years. Basis of Recommendations Role of IAP: Indian Academy of Pediatrics (IAP) Advisory Committee on Vaccines & Immunization Practices (ACVIP), set up as a special subcommittee of the academy, has been entrusted with the responsibility to frame the recommendations. Role of IAP EPI: The WHO launched global immunisation program in 1974, known as Expanded Program on Immunisation (EPI) to protect all children of the world against six killer diseases. And the journey continues with newer and newer vaccines. EPI ORIGINAL EPI SCHEDULE: Age Vaccine Birth 6 weeks 10 weeks` 14 weeks 9 months BCG BCG OPV OPV 1 OPV 2 OPV 3 DPT DPT 1 DPT 2 DPT 3 Measles Measles ORIGINAL EPI SCHEDULE Immunisation in India: 1978 - The Govt of India launched its EPI to cover BCG, DTP , OPV and Typhoid. 1981 - Typhoid-paratyphoid vaccine was dropped from EPI due to higher reactogenicity and low efficacy of the vaccines 1983 - tetanus toxoid vaccine for pregnant woman added in EPI. 1985 - EPI was modified as Universal Immunisation Programme (UIP ). 1985 - First dose of measles was added . 1992 - UIP become a part of child survival and safe motherhood (CSSM). Immunisation in India Slide9: 2002 - Hepatitis B was piloted and scaled up in entire country . 2006 - Japanese encephalitis in endemic areas. 2010 -Phase wise introduction of Second dose of measles . 2011 December - Pentavalent vaccine introduced in phase wise. 2014 December - Mission Indradhanush was launched to cover children up to two years and pregnant women. Slide10: 2016 - New vaccines are added namely Rubella, IPV and Rotavirus . Also tOPV was replaced by bOPV . Adult JE vaccination was started 2017 - Pneumococcal conjugate vaccine PCV was added in UIP in certain states (HP, UP, Bihar). 2017 October - Intensified Mission Indradhanush IMI was launched with a target to achieve 90% coverage by 2018 instead of 2020 . 2017 February - Measles-Rubella MR campaign started. UIP: Thus under UIP, government is providing vaccination to prevent 11 vaccine preventable diseases (VPD) to infants. DTP HepB Pentavalent Hib Polio MR Childhood TB Rotavirus diarrhoea JE UIP Slide13: INDIVIDUAL VACCINES BCG: At birth or as early as possible preferably within 24 hours. If missed by any reason, it should be given till one year of age. BCG HEPATITIS B: Universal hepatitis B vaccination within 24 hours of birth for medically stable infants weighing more than 2 Kg. Three doses are given at 6-10-14 weeks as a pentavalent vaccine. Here 4 doses are permissible including zero dose. For catch up, at 0 – 1 – 6 months. No booster is required. HEPATITIS B HEPATITIS B: If mother is HBsAg positive, give 0.5 ml HBIG along with HepB vaccine. For orphan infant, post vaccination serologic testing is must. Single dose revaccination for infants born to HBsAg positive mothers not responding to initial vaccine series tested at 9-12 months age. HEPATITIS B bOPV (Bivalent): Zero dose within 15 days of birth Three doses at 6, 10,and 14 weeks OPV booster with DTP/ Quadrivalent at 18 months . Additional doses of OPV on all pulse polio days till 5 years of age. It will be discontinued once IPV is freely available. b OPV (Bivalent) PULSE POLIO IN 1995: On 25 Feb 2012 INDIA is removed from the list of “POLIO ENDEMIC COUNTRIES” PULSE POLIO IN 1995 Injectable Polio - IPV: Injectable Polio - IPV As a part of polio end game strategy, IPV has been introduced. If available or as a combination (Hexavalent) vaccine: three doses at 6-10-14 weeks If not possible, give at least one dose at 14 weeks along with OPV (either standalone or combination vaccine) Two fractional intradermal doses of IPV ( fIPV - 0.1 ml) at 6 and 14 weeks are either equally or more effective. Given in govt. facilities. Again if available, booster at 12-18 months. DTP (DTwP or DTaP): DTwP is superior to DTaP. 3 primary doses at 6-10-14 weeks either as DTP or pentavalent or hexavalent First booster at 16-24 months either as DTP or Quadrivalent Second booster at 4-6 years DTP (DTwP or DTaP) Tdap: Tdap Tdap: Immunity wanes more rapidly after first year with aP vaccine. So WHO advised to consider additional boosters and immunisation of mothers during pregnancy. So Tdap vaccine is for countries using DTaP Single dose to all adolescents and adults who have not received the same. Women are recommended to receive a dose of Tdap during each pregnancy between 27 to 36 weeks regardless of previous receipt of it. Tdap Hemophillus Influenza B infection Hib: Three doses at 6-10-14 weeks as a pentavalent Booster at 16-24 months as Quadrivalent Catch up schedule: For age 6 -12 months, two doses plus one booster For age 12-15 months, one dose plus one booster (can be given after 4 weeks of last dose) For age 15 months to 5 years, only one dose. No catch up above 5 years. Hemophillus Influenza B infection Hib ROTAVIRUS: ROTAVIRUS ROTAVIRUS: Remember, this is an ORAL vaccine. First dose should be started as early as 6 weeks. For Rotarix ® Two doses at 4 weeks interval: 6 and 10 weeks For other brands Three doses at 6-10-14 weeks age. For both the vaccines: First dose not later than 16 weeks. Last dose not later than 32 weeks ROTAVIRUS Trivalent Inactivated Influenza Vaccine: Trivalent Inactivated Influenza Vaccine INFLUENZA: If given for the first time, two doses are to be given at one month interval for children aged 6 months to 9 years Only half the dose is required for children from 6 months to 3 years. INFLUENZA INFLUENZA: Age Group Dose No of doses in the first year of vaccination If previously received one or more doses 6 months to 3 years 0.25 ml 2 doses at 4 weeks apart 1 3 years to 9 years 0.5 ml 2 doses at 4 weeks apart 1 9 years and older 0.5 ml 1 1 INFLUENZA INFLUENZA: It may not be practical to recommend routine influenza vaccine to everyone in India. It is recommended for high risk groups of children below five, medical practitioners, pregnant women and elderly. The dose is to be repeated every year around July-August. Adult (0.5 ml) dose cannot be halved to make a pediatric dose. INFLUENZA PNEUMOCOCCAL VACINE: PNEUMOCOCCAL VACINE PNEUMOCOCCAL CONJUGATE VACCINE PCV : Two brands are available: Synflorix ® and Prevenar ® Three doses at 6-10-14 weeks. One booster at 15 months Catch up schedule PNEUMOCOCCAL CONJUGATE VACCINE PCV Age No of doses Booster At 15 months 6-12 months 2 1 4 weeks apart 12-23 months 1 1 8 weeks apart 2-5 years 1 No Booster MMR: Total three doses are given 9-12 months (270 days completed) Monovalent measles is replaced by MMR 15-18 months 4-6 years Additional dose of MR vaccine during MR campaign for children 9 months to 15 years irrespective of previous immunisation. MMR TYPHOID CONJUGATE VACCINE: Compared to earlier ViPS and oral typhoid vaccines, TCV provides longer-lasting protection, Requires fewer doses and Is suitable for children under two years of age.  TYPHOID CONJUGATE VACCINE TCV: TCV Developed for the first time by an Indian Company. Two brands are available in India. (2013) Typbar TCV® (25mcg/dose) which is also WHO prequalified vaccine. Other one is Tyvax CV® (5mcg/dose) IAP advocates former one Typbar TCV® TCV: First dose starting at 6 months of age Natural boosting may occur in endemic areas . There is a lack of evidence concerning the need for booster vaccination. So at present no booster recommended TCV HEPATITIS A: HEPATITIS A HEPATITIS A: Only one dose of HepA live attenuated vaccine starting at age 12 months onward. No booster. ( Biovac A ®) Two doses of Hep A killed vaccine. ( Havrix ®) First dose at 12-23 months Second dose after six months Havrix ® 720 can be given till 18 years. Havrix ® 1440 for adults after 18 years. HEPATITIS A TWINRIX®: TWINRIX® Hepatitis A and B combination vaccine Available as junior and adult Used for catch up immunisation only – not for routine CHICKEN POX: First dose at 12-15 months. Second dose any time after 3 months of first dose. Catch up For children aged 7-12 years: 2 doses with a gap of 3 months For persons aged 13 years and older: 2 doses with a gap of 4 weeks. CHICKEN POX TETANUS TOXOID: For children age 2 months to 5 years DTaP or DTwP For child between 5 to 7 years of age, DT is given . Later on if patient needs tetanus prophylaxis, ACIP recommends Td or if appropriate Tdap , but not single antigen tetanus. Booster dose with Td is to be given every ten years throughout life time. Pregnancy 2 doses : 1 st as early as possible and second after 4 weeks of first dose and before 36 weeks. Booster dose: Only one dose in last trimester if previously two doses are taken. TETANUS TOXOID Slide41: RABIES Recommendations by WHO Position Paper April 2018: One dose is reduced both in PrEP and PEP by ACIP way back in 2010. (But by IAP recommended only this year). No need for RIG, if previously vaccinated either PrEP or PEP. hRIG and eRIG are equally effective. No need for skin testing before eRIG . Recommendations by WHO Position Paper April 2018 (cont): If anatomically feasible, the full dose of RIG should be thoroughly infiltrated in the area around and into the wounds along with first dose of ARV or within 7 days of the same in category III bites. The remaining dose if any not to be injected IM at a distance from wound. It can be spared for another patient after due aseptic precautions. ( cont ) Slide44: Scrupulous wound cleaning and deep irrigation with soap and water (at least for 15 minutes), application of a potent antiseptic agent, and timely administration of first anti rabies vaccine followed by complete course of rabies vaccine are key factors in increasing survival when RIG is unavailable . Wound toilet is must even if patient reports late (should be advised if wound is still not healed) RABIES: Pre Exposure Prophylaxis: Two doses on day 0 and 7. Post Exposure Prophylaxis: Four dose schedule Essen Regimen: 0 , 3, 7 and between 14-28 days. Zagreb Regimen: Two doses on day 0, and one dose on days 7 and 21. IPC Regimen: 2 site ID on days 0, 3 and 7. Re-exposure if within 3 months: No need for vaccine. Re-exposure at any time after three months: Two dose on days 0 and 3. 4 site ID on day 0 I site ID on days 0 and 3 RABIES Rabies (cont): No suturing or bandage No contraindication for use of PrEP or PEP including pregnancy, immunocomprised , person taking chloroquine or HCQS. It should never be given in gluteal region. And if it is given, then this dose should not be counted. Change in brand and the route of administration are acceptable. Rabies ( cont ) Rabies (cont): Should a vaccine dose is delayed, resume the schedule from where left. No need to restart. No need for ARV after a bite by rodent (rat), squirrel, hare and rabbit. Bat rabies is not conclusively proved in India and so exposure to bat also does not warrant PEP. Rabies ( cont ) Slide48: History of rabies vaccination in dog is not always a guarantee that the biting animal is not rabid. There are several factors for failure of vaccination to dog. So better to give PEP . PEP should be started immediately after the bite. The observation period of 10 days is valid for dogs and cats only. If biting animal is healthy throughout observation period, PEP can be converted to PrEP by skipping the fourth dose. RABIES HUMAN MONOCLONAL ANTIBODY: Introduced in 2017. RABIES HUMAN MONOCLONAL ANTIBODY Slide50: In view of the irregular availability and high cost of RIGs, human monoclonal Ab is an alternative to RIGs, in category III bites. Available in India as Rabishield®. Agent Dose in IU per Kg body weight Concentration IU Per ml hRIG 20 150 eRIG 40 200 RHMAB 3.33 40 and 100 HPV : HPV HPV: HPV Gardasil® is 9 valent while Cervarix ® is bivalent. Gardasil® is indicated for both male and female. Cervarix ® is indicated for females only. Cervarix ® is not available in USA. Vaccine Age in years Dose Interval Both 9 – 14 2 0 - 6 Gardasil® 15 - 45 3 0 – 2 - 6 Cervarix ® 15 - 25 3 0 – 1 - 6 Meningococcal Vaccine: Meningococcal Conjugate Vaccine MCV4 or MenACWY single dose for microbiologists , military recruits, students living in dormitories and travellers to endemic regions for adults less than 55 years. Revaccination recommended every 5 years Polysaccharide vaccine is for adults more than 55 years Vaccination must for travellers to Hajj Meningococcal Vaccine Slide54: Age wise schedule of vaccines BIRTH: BCG OPV Zero HepB BIRTH 6 -10 - 14 WEEKS: OPV IPV DTP As pentavalent or hexavalent HepB Hib Rotavirus PCV 10 ( Synflorix ®) or PCV 13 ( Prevenar ®) 6 -10 - 14 WEEKS 6 MONTHS: T yphoid TCV (Can be given at nine months to reduce the visit) Influenza 6 MONTHS 9 MONTHS: MMR - 1 Typhoid TCV, if not given at 6 months 9 MONTHS 12 MONTHS: Hepatitis A Depending upon brand, either single or two doses 12 MONTHS 15 MONTHS: MMR - 2 PCV Booster Chicken Pox – 1 Second dose can be given any time after 3 months 15 MONTHS 18 MONTHS: DTP Booster Hib Booster can be given as Quadravalent OPV - 5 IPV (If available in the market) 1 8 MONTHS 5 YEARS: DTP Booster – 2 OPV - 6 MMR - 3 5 YEARS 10 YEARS: Td or Tdap HPV Finish the schedule as per brand. 10 YEARS ADULT VACCINATION: Adults need vaccines based on their age, health conditions, job, lifestyle, or travel habits. Vaccines are given according to catch up schedule. Routine vaccinations are: Flu vaccine Pneumococcal Vaccine Tdap vaccine Zoster vaccine ADULT VACCINATION Slide66: Flu shot is given every year. Tdap and/or Td is given as discussed earlier Zoster vaccine advised depending on vaccine. RZV after 50 years and ZVL after 60 years. MMR, Chicken Pox, HepA , HepB , Hib , HPV. (If not given earlier during childhood) PCV13 OR Prevenar®: It is recommended for All children younger than 2 years old All adults 65 years or older People from 2 to 64 years old with certain medical conditions. PCV13 OR Prevenar ® Medical Conditions for PCV13: cerebrospinal fluid (CSF) leaks cochlear implants sickle cell disease or other hemoglobinopathies congenital or acquired asplenia ‚ congenital or acquired immunodeficiencies ‚ HIV infection ‚ chronic renal failure, ‚ nephrotic syndrome ‚ leukemia ‚ lymphoma ‚ Hodgkin disease ‚ generalized malignancy, ‚ iatrogenic immunosuppression, ‚ solid organ transplant,‚ multiple myeloma Medical Conditions for PCV13 Pneumococcal Polysaccharide Vaccine: PPSV23 OR Pneumovax ® It is recommended for All adults 65 years or older People from 2 to 64 years old with certain medical conditions. Pneumococcal Polysaccharide Vaccine Medical Conditions for PPSV23: Chronic heart or lung disease Diabetes mellitus, Alcoholism ‚ Chronic liver disease Adults who smoke cigarettes Medical Conditions for PPSV23 PNEUMOCOCCAL VACCINE ADULTS: PCV13 Prevenar ® and PPSV23 Pneumovax ® should not be administered simultaneously. Better immune response if PCV13 is administered first. PPSV23 after one year of PCV13. Booster of PPSV23 is given after 5 years, if first dose given before 65 years. If PPSV 23 is administered first PCV 13 after8 weeks in children 6-18 years. PCV 13 after one year in adults 19 years and older. PNEUMOCOCCAL VACCINE ADULTS Figure 1. Recommended immunization schedule: Figure 1. Recommended immunization schedule Slide73: References: Weekly Epidemiological Record WER 48(92): 2017; 729-748 . WER, Typhoid Vaccines, March 2018 http :// WHO position paper April 2018 IAP ACVIP recommendations December 2018. DISCLAIMER: The brand names and pictures mentioned are for information only. I do not advertise any brand. DISCLAIMER

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