Pediatrics
Immunization
Pediatric immunization for MBBS: UIP schedule, MR versus MMR, herd immunity, cold chain, vaccine vial monitor and true versus false contraindications, mapped to NMC codes PE19.1 to PE19.16.
MedNext Academy | 3 min read
Immunization
Pediatric immunization for MBBS: UIP schedule, MR versus MMR, herd immunity, cold chain, vaccine vial monitor and true versus false contraindications, mapped to NMC codes PE19.1 to PE19.16.
This chapter covers the Universal Immunization Programme and National Immunization Schedule, vaccine descriptions, the cold chain and vaccine vial monitor, herd immunity, adverse events following immunisation and true versus false contraindications. It contrasts the national schedule with the IAP schedule.
High-yield: Immunization
- The Universal Immunization Programme (UIP) provides free vaccines including BCG, OPV, IPV, Pentavalent, rotavirus, PCV and measles-rubella.
- At birth the schedule gives BCG, the birth dose of OPV and hepatitis B, with Pentavalent, OPV, IPV, rotavirus and PCV given at 6, 10 and 14 weeks.
- The measles-rubella vaccine is given at 9 to 12 months and again at 16 to 24 months in the national schedule.
- India introduced IPV into the UIP in 2015, rotavirus in 2016, PCV in 2017, and replaced monovalent measles with measles-rubella in 2017.
- Herd immunity thresholds vary by pathogen, with measles requiring the highest at about 92 to 95 percent because of its very high R0.
- The National Immunization Schedule uses measles-rubella vaccine and does not include mumps, whereas the IAP recommends MMR which includes mumps.
- The IAP also recommends 2 doses of varicella vaccine, since a single dose gives only about 85 percent protection while 2 doses give over 99 percent.
- The cold chain keeps vaccines at 2 to 8 degrees Celsius, and the vaccine vial monitor detects heat but not freeze damage.
- For a vaccine vial monitor at Stage 2 the vaccine should be used immediately, whereas at Stage 3 it must be discarded.
- Programme errors such as non-sterile technique, syringe reuse or wrong diluent are the most common cause of severe adverse events following immunisation in developing countries.
- Auto-disable syringes and single-use vials in the UIP specifically prevent programme-error adverse events.
- True false contraindications where the child should still be vaccinated include mild fever, mild diarrhoea and malnutrition.
- Anaphylaxis to a previous dose of a vaccine is the most important true contraindication to giving that vaccine again.
- In India, assent is obtained from age 7 years and parental consent is required for all research participants below 18 years.
Immunization essentials
- **At birth:** BCG, OPV-0 and hepatitis B birth dose.
- **6, 10, 14 weeks:** Pentavalent, OPV, IPV, rotavirus and PCV as per schedule.
- **Measles-rubella:** First at 9 to 12 months, second at 16 to 24 months; no mumps in NIS.
- **Vaccine vial monitor:** Stage 2 use immediately; Stage 3 discard; does not detect freezing.
NMC competencies in this chapter
- **PE19.1:** Universal Immunization Programme and National Immunization Programme
- **PE19.2:** Epidemiology of vaccine-preventable diseases
- **PE19.3:** Vaccine description: classification, dose, route, schedule, indications and contraindications
- **PE19.4:** Cold chain and methods of safe storage and handling of vaccines
- **PE19.5:** Importance of herd immunity
- **PE19.6:** Adverse events following immunisation: definition and management
- **PE19.9:** Vaccine administration: routes and techniques
- **PE19.10:** National Immunization Schedule versus IAP schedule: comparison
- **PE19.12:** Vaccine vial monitor: correct use and stages
- **PE19.13:** Documenting immunisation in card or booklet
- **PE19.14:** Concept and contents of the Essential Medicine List
- **PE19.15:** True and false contraindications to immunisation
- **PE19.16:** Key ethical issues in clinical research in children
Frequently Asked Questions
What vaccines are given at birth under the UIP?
At birth the Universal Immunization Programme gives BCG, the zero dose of oral polio vaccine and the hepatitis B birth dose, followed by Pentavalent, OPV, IPV, rotavirus and PCV at 6, 10 and 14 weeks.
How does the National Immunization Schedule differ from the IAP schedule?
The National Immunization Schedule uses measles-rubella vaccine and does not include mumps, while the IAP recommends MMR which includes the mumps component and also recommends 2 doses of varicella vaccine.
What does a vaccine vial monitor tell you?
A vaccine vial monitor detects cumulative heat exposure but not freeze damage. At Stage 2 the vaccine should be used immediately, while at Stage 3 the vial must be discarded.
What are false contraindications to immunisation?
False contraindications, where the child should still be vaccinated, include mild fever, mild diarrhoea and malnutrition. The most important true contraindication is anaphylaxis to a previous dose of the same vaccine.
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