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Partha’s Immunization Digest
A Parthasarathy
CHAPTER 1:
IMMUNIZATION: THE WAY FORWARD
SUMMARY
CHAPTER 2:
BASICS OF VACCINOLOGY
TERMINOLOGIES
Principles of Vaccination
Immunity
Active Immunity
Passive Immunity
Antigen
Antibody
Sources of Passive Immunity
Monoclonal Antibody
Vaccination
Classification of Vaccines
Inactivated Vaccines
Whole
Fractional
Live Attenuated Vaccines
Inactivated Vaccines
Whole-cell vaccines
Fractional vaccines
Polysaccharide Vaccines
Pure polysaccharide
Conjugate polysaccharide
Pure Polysaccharide Vaccines
Immune Response
Primary Response
Latent Period
Peak Period
Period of Decline
Secondary Response
Vaccine Characteristics
IMMUNE RESPONSE TO PROTEIN VACCINES:
Why so many vaccine doses?
IMMUNE MEMORY AND THE BOOSTER REQUIREMENTS
Why booster doses are not required for hepatitis B vaccine?
THE RESPONSE TO POLYSACCHARIDE VACCINES
IMMUNIZING ANTIGENS
1. Active immunizing antigens
2. Suspending fluid
3. Preservatives, stabilizers and antibiotics
4. Adjuvants
CHAPTER 3:
IMMUNIZATION SCHEDULES
IMMUNIZATION SCHEDULES
GENERAL RULES OF IMMUNIZATION — TEN COMMENDMENTS
Points to Note
Immunization of Adolescents (Table 3.5)
SUMMARY
CHAPTER 4:
VACCINES, IMMUNOGLOBULINS AND ANTISERA
VACCINES
IMMUNOGLOBULINS
ANTISERA
VACCINES
Vaccines Administered at Birth
1.BCG VACCINE
SUMMARY
2. Oral Polio Vaccine (Sabin)
Oral Polio Vaccine
Vaccine-associated Paralytic Polio
Polio Vaccine Adverse Reactions
Vaccine-associated Paralytic Polio (VAPP) 1980–1998 in the United States of America
Polio Eradication
SUMMARY
Seroconversion rates following administration of OPV-only, IPV-only, and IPV-OPV sequential vaccination schedules
Inactivated Polio Vaccine
The United States Scenario
Polio Vaccination in the United States Recommendations
Schedules that Include Both IPV and OPV
Polio Vaccine Contraindications and Precautions
3. HEPATITIS B VACCINE
Protection* by Age Group and Dose in the United States on universal Hep B vaccine program
Hepatitis B Vaccine Long-term Efficacy
Third Dose of Hepatitis B Vaccine
Preterm Infants
Prevention of perinatal Hepatitis B Virus Infection
Prevaccination Serologic Testing
Adults at Risk for HBV Infection
Adults at Risk for HBV Infection
Persistent Nonresponse to Hepatitis B Vaccine
Hepatitis B Vaccine Contraindications and Precautions
Hepatitis B Vaccine Adverse Reactions
SUMMARY
Hepatitis B vaccine–What dose/schedule?
Why Booster Doses are not required for Hepatitis B Vaccine?
VACCINES ADMINISTERED at 6, 10 AND 14 WEEKS
SUMMARY
DTPw / DTPa – vaccine – Current Concepts?
DTPw / DTPa/TDpa vaccines – Current Concepts?
2. Haemophilus influenzae type b vaccine
Haemophilus Influenzae Type to Risk Factors for Invasive Disease
Haemophilus influenzae type b Polysaccharide Vaccine
Polysaccharide Vaccines
Polysaccharide Conjugate Vaccines
Haemophilus influenzae type b Vaccine
Haemophilus Influenzae type b Vaccine
Haemophilus Influenzae type b Vaccine
Pentaxim Vaccine*
Haemophilus Influenzae type b Vaccine
SUMMARY
Hib vaccine – Current status / How many doses?
3.PNEUMOCOCCAL VACCINE
SUMMARY
Vaccines Recommended by IAP on the “Named Child” Basis
Pneumococcal vaccine – For whom?
Vaccines Recommended by IAP on the “Named Child” Basis
Vaccines Recommended by IAP on the “Named Child” Basis
4. INACTIVATED POLIO VACCINE (IPV) (SALK)
5. ROTAVIRUS VACCINE
SUMMARY
Vaccines Recommended by Iap on the “Named Child” Basis
Rotavirus Vaccine
VACCINES ADMINISTERED at 9 MONTHS
1. Measles Vaccine
Measles Vaccines
Measles Vaccines
SUMMARY
Measles Vaccine – Newer developments?
VACCINES ADMINISTERED at 15 MONTHS
1. Measles – Mumps – Rubella (Mmr) Vaccine
Measles (MMR) Vaccine Indications in the United States
Measles– Mumps–Rubella Vaccine
Second Dose of Measles Vaccine
MMR Vaccine Failure
MMR Vaccine Contraindications and Precautions
Measles and Mumps Vaccines and Egg Allergy
Measles Vaccine and HIV infection
Tuberculin Skin Testing (TST)* and Measles Vaccine
SUMMARY
MMR vaccine – The old and new controversies?
2. Varicella (Chickenpox) Vaccine
Varicella in the United States
Herpes Zoster
Varicella–Containing Vaccines
Varicella– Vaccine Immunogenicity and Efficacy
Varicella Breakthrough Infection
Varicella Vaccine Recommendations in Children
Varicella Vaccine Recommendations: Adolescents and Adults
Varicella Vaccine Recommendations: Health care personnel
Herpes Zoster Vaccine
Herpes Zoster Vaccine Efficacy
MMRV Vaccine
Varicella Vaccine Postexposure Prophylaxis
Varicella Immunity in the US
Zoster Vaccine Contraindications and Precautions
Zoster Vaccine Contraindications Immunosuppression
Zoster Vaccine Precautions
Varicella Vaccine Adverse Reactions
Zoster Following Vaccination
Herpes Zoster Vaccine Adverse Reactions
Varicella–Containing Vaccines Contraindications and Precautions
Varicella Vaccine Use in Immunocompromised Persons
Varicella–Containing Vaccine Storage and Handling
SUMMARY
Vaccines Recommended by Iap on the “Named Child” Basis
Varicella vaccine – Routine after counseling?
VACCINES ADMINISTERED at 18 MONTHS (BOOSTER)
VACCINES ADMINISTERED at 24 MONTHS
1. Hepatitis A Vaccine
Hepatitis A Vaccines
Hepatitis A Vaccine Immunogenicity
Hepatitis A Vaccine Efficacy in US
HAVRIX
VAQTA
SUMMARY
Hepatitis A vaccine – For whom and why?
2. TYPHOID VACCINES
2 (a). Whole Cell Typhoid Vaccine
2 (b). Polysaccharide Typhoid Vaccine
2 (C). Oral Typhoid Vaccine
SUMMARY
Typhoid vaccine – Which Vaccine and When?
VACCINES ADMINISTERED at 5 YEARS
1. Diphtheria and Tetanus Vaccine (Pediatric Formulation)
VACCINES ADMINISTERED at 10 YEARS
1. TT/Td/Tdap Booster
1 A. Tetanus Toxoid
DTPa, DT, Td and Tdap
Tetanus Toxoid
Routine DTPa Primary Vaccination Schedule
Children Who Receive DT
Routine DTPa Schedule Children Younger than 7 years of Age
Routine Td Schedule Unvaccinated Persons 7 years of Age or Older
Diphtheria and Tetanus Toxoids Contraindications and Precautions
Diphtheria and Tetanus Toxoids Adverse Reactions
SUMMARY
DT / TT / Td / Tdap vaccines – For whom and when?
DT/TT/Td/Tdap vaccines – For whom and when?
2. HPV Vaccine
Human Papillomavirus
Human Papillomavirus (HPV)
Human Papillomavirus Types and Disease Association
HPV–Associated Disease
Natural History of HPV Infection
HPV Clinical Features
HPV Epidemiology
Cervical Cancer Screening
Human Papillomavirus Vaccine
HPV Vaccine Efficacy*
Routine HPV Vaccination Recommendations
HPV Vaccination Schedule (Tetravalent)
HPV Vaccine Special Situations
HPV Vaccine Contraindications and Precautions
HPV Vaccine Adverse Reactions
Vaccination During Pregnancy Provisional Recommendation
HPV vaccine Storage and Handling
SUMMARY
Human Papilloma Virus Vaccine
3. Rubella Vaccine
SEASONAL/TRAVEL RELATED VACCINES
1. Flu Vaccines
SUMMARY
Influenza Vaccine – For Whom?
Dose of Inactivated Seasonal Flu Vaccine
2. Japanese B Encephalitis Vaccine
Japanese Encephalitis (JE)
Two Types of JE Vaccines are Available (see Chapter 8)
SUMMARY
Japanese B Encephalitis Vaccine – For whom?
Japanese Encephalitis Vaccine
3. Meningococcal Vaccine
Meningococcal Polysaccharide Vaccine (MPSV4)
Meningococcal Endemic Areas 2004
Meningococcal Conjugate Vaccine (MCV4)
Meningococcal Vaccine Recommendations
Meningococcal Vaccine Recommendations
Meningococcal Vaccines Adverse Reactions
SUMMARY
4. Cholera Vaccine
CHOLERA vaccine
1. Killed Cholera Vaccine
2. Oral Cholera Vaccine
Combination Vaccine (Chol–Ecol–O)
Meningococcal Vaccine (For details see Chapter 8)
Yellow Fever Vaccine
SUMMARY
POST–EXPOSURE PROPHYLAXIS VACCINES
Rabies Vaccine (Cell Culture)
WHO Recommendations for Management of Animal Bites
Adverse Reactions
Post–exposure Prophylaxis
Pre–exposure Prophylaxis
2. Hepatitis B Vaccine
Refer Page 35–41
COMBINATION VACCINES
1. DTPw/DTPa, DTPw/DTPa–HB, DTPw/DTPa–Hib, DTPa – IPV – Hib, DTPw – HB – Hib
Manufacturing Issues
Developmental Issue
Researcher's point of view
Pediatricians point of view
Combination vaccines Available
DTPa/IPV
DTPw/Hib, DTPa/Hib
DTPa – IPV – Hib
Hep A – Hep B
Combination Vaccines Recently Developed DTPa–Hib, DTPa Hib–eIPV
MMR – Varicella Vaccine
DTPa – Hib – IPV Hep B
New Thinking and Rethinking
SUMMARY
Combination Vaccines
‘Lyophilized/liquid’ combinations. What we need to know?
Triple “I” Strategy
Integrated Infant Immunization Strategy
GOI's Pentavalent Introduction Plan
Immunoglobulins
1. Hepatitis B Immunoglobulin
2. Tetanus Immunoglobulin (TIG)
3. Rabies Immunoglobulin
4. Gammaglobulin
5. Human Normal Immunoglobulin
6. Human Anti–D Immunoglobulin
C. Antisera
I. Anti–snake Venom
VACCINES LICENSED IN INDIA
IV.C. READY RECKONER – VACCINES
CHAPTER 5:
IMMUNIZATION IN SPECIAL CLINICAL CIRCUMSTANCES
CHAPTER 6:
ADVERSE EVENTS FOLLOWING IMMUNIZATION
VACCINE SAFETY—A UNIVERSAL CONCERN
WHO RECOMMENDATIONS TO MINIMIZE AEFI
Prevention of Acute Vaccine Reactions
CAUSES AND ERRORS LEADING TO AEFI
VACCINES AND CONTRAINDICATIONS
ANAPHYLAXIS AND DRUGS
DOSAGES OF COMMONLY USED SECONDARY DRUGS IN THE TREATMENT OF ANAPHYLAXIS
THREATS TO IMMUNIZATION—SAFETY CONCERNS
AEFI: PRACTICAL GUIDELINES
Precautions
COMMON ADVERSE EVENTS TO VACCINES
BCG Vaccine
DTPw/DTPa Vaccine
Hib Conjugate Vaccine
Hepatitis A Vaccine
Hepatitis B Vaccine
Human Papilloms Virus Vaccine
H Influenzae Vaccine/s (Live stock inactivated)
Japanese B Encephalitis Vaccine/s (Live stock inactivated)
Measles-Mumps-Rubella Vaccine
Meningococcal Vaccine
Pneumococal Vaccine (PCV,PPV)
Polio Vaccines (OPV, IPV)
Rabies Vaccine
Rabies Immunoglobulins (RIG)
Rota Virus Vaccine
Typhoid Vaccine
Varicella Zoster Vaccine
TAKE HOME MESSAGES AEFI PRACTICAL GUIDELINES
CHAPTER 7:
THE COLD CHAIN FOR VACCINES
THE COLD CHAIN
THE COLD CHAIN EQUIPMENTS
REFRIGERATORS
VACCINE VIAL MONITORS (VVM)
Storage of Vaccines in Domestic Refrigerator
RECOMMENDED STORAGE OF COMMONLY USED VACCINES*
POWER FAILURE
SUMMARY
CHAPTER 8:
DISEASE SURVEILLANCE
AFP SURVEILLANCE
INTEGRATED DISEASE SURVEILLANCE PROGRAM
REPORTING REQUIREMENT OF IDSP
Diseases under Surveillance by Health Providers
Method of Surveillance
REPORTING FORMAT FOR SENTINEL SITES
PRIVATE SECTOR COLLABORATION IN TB CONTROL PROGRAM
Quality Control
Method of Recruitment
Incentives
CHAPTER 9:
NEWER DEVELOPMENTS IN IMMUNIZATION
DEVELOPMENT OF NEW VACCINES
Current Challenges Include
Classical Strategies of Killed Vaccine Development
Newer Strategies of Killed Vaccine Development
Polysaccharide-Protein Conjugates
DEVELOPMENT OF NEW VACCINE ADJUVANTS
NEW STRAGIES FOR IMPLEMENTATION AND VACCINE DELIVERY
INTEGRATED DISEASE SURVEILLANCE
GLOBAL ALLIANCE FOR VACCINES AND IMMUNIZATION (GAVI)
NEW COMBINED SEASONAL FLU AND PH1 N1 VACCINES
CHAPTER 10:
FUTURE VACCINES
INTRODUCTION
Anthrax Vaccine
Cytomegalovirus Vaccine
Group B Streptococcal Vaccine
HIV Vaccine
Hepatitis C Vaccine
Herpes Simplex Virus
New Tuberculosis Vaccine
Malaria Vaccine
Meningococcal Vaccine
Staphylococci Vaccines
Respiratory Vaccines
Future Trends in Immunization
SUMMARY
Vaccinations for Adults You are never too old to get immunized
SELECT FUTURE VACCINES
Future predicted vaccine schedule 2025 (Plotkin)
Vaccine time line 1780-2020
Immunization Messages
ANNEXURE-I:
FREQUENTLY ASKED QUESTIONS (FAQs) ON IMMUNIZATION
IMMUNIZATION — GENERAL
BCG VACCINE
OPV (ORAL POLIO VACCINE)
HEPATITIS – B VACCINE
DTP/DT/TT VACCINES
HIB VACCINE
MEASLES, MMR VACCINES
TYPHOID VACCINE
HEPATITIS A VACCINE
VARICELLA VACCINE
PNEUMOCOCCAL VACCINE
ANNEXURE-II:
IMMUNIZATION WEBSITES
ANNEXURE-III:
IMMUNIZATION TECHNIQUES
IMMUNIZATION TECHNIQUES/FOR INTRAMUSCULAR, SUBCUTANEOUS AND INTRADERMAL INJECTIONS
Intramuscular Injection
Usual Sites
Method
Special Note
Subcutaneous Injection
Method
Special Note
Intradermal Injection
Method
Special Note
ADMINISTERING VACCINES: DOSE, ROUTE, SITE, AND NEEDLE SIZE
Technique
Needle Length
Multiple Vaccinations
Nonstandard Administration
Giving all the Doses Under 12 Months
Giving All the Doses Under 12 Months and Older
Giving All the Doses 12 Months Through 5 Years of Age in the US.
Using COMVAX™ (HepB/Hib) and ProQuad® (MMRV)
Giving All the Doses Including Influenza Vaccine (TIV) in US.
Using Pediarix™ (DTaP/HepB/IPV) and ProQuad® (MMR/Var)
Using COMVAX™ (HepB/Hib) and ProQuad® (MMR/Var) in the US.
GIVING ALL THE DOSES
11–12 years of age
The method
For infants and toddlers
For kindergarten and older children
ANNEXURE-IV:
VACCINE FORMULATIONS (BRANDS) AVAILABLE IN INDIA
COMMERCIALLY AVAILABLE VACCINES IN INDIA
INDEX
TOC
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