Vaccines & Cold Chain

Classification of Vaccines

Live Killed Toxoids Proteinaceous Recombinant Combination

OPV Rabies Diphtheria Pertussis Hep B MR (Measles Rubella)
BCG IPV Tetanus HPV MMR
YF Hep A Pentavalent
Varicella Polysaccharide & DPT
Rota Virus Glycoconjugate
Typhoral Meningococcal
MMR HiB
Zoster Pneumococcal

NIS(National Immunization Schedule, India 2019-20)

® At Birth : BCG, OPV0, Hep B

®6W : DPT1, OPV1, Hep B1, HiB1, Rota V1, fIPV1, PCV1
® 10 W : DPT2, OPV2, Hep B2, HiB2 , Rota V2
® 14 W : DPT3, OPV3, Hep B3, Rota V3, fIPV2, PCV2
®9m : Measles1/MR 1, Vitamin A (1 Lac IU), PCV Booster, JE 1
® Every 6 Months : Vitamin A (2 Lacs IU) till 5 years
® 16–24 Months : DPTB, OPV Booster, Measles 2/MR2 , JE 2
® 5 Years : DPTB
® 10 Years : TT
® 16 Years : TT
® Pregnancy : TT

® TT → To be replaced with dt
® Total Vit A given under NIS is 17 Lac IU.
C/I
® Pregnancy → all live vaccines are C/I as it is immuno-compromised state.
® HIV + → All live vaccines C/I (Except in adult we can give MMR, Varicella, Zoster)
® Similarly in a new born infant all live vaccines are contraindicated if the new born is HIV positive
except OPV & Measles vaccine. BCG vaccine use is controversial in HIV +ve new born. Ideally it should
not be given.
® Prematurity, <2 kg BW is a contraindication for Hepatitis B vaccine
® Epilepsy is C/I for Pertussis/DPT.
® Cerebral Palsy → None is C/I as it is a non-progressive cerebral neurological disorder.

AEFIs (Adverse Events Following Immunization)

® Ideal recommended observation for AEFI is 30 Minutes after immunization of child.
® Paralysis → OPV i.e. VAPP (Polio virus type 3) & VDPV (Community polio virus type 2)
® Hypersensitivity reaction & shock → Hep B
® TSS → Measles
® GBS → Killed Influenza/ Swine flu vaccine
® Intussusception → Rota V
® Febrile seizures → Measles
® Persistent crying & HHE (Hypotensive Hypo responsive episode) → Pertussis
® Thrombocytopenia → MMR, Hep B

Lyophilized Vaccines/ Freeze Dried Vaccines

® They are in powdered form.
® They should be used generally within 4 hours of reconstitution
® BCG → Reconstituted by normal saline
® YF → Reconstituted by cold physiological saline
® JE → Reconstituted by phosphate buffer saline (PBS)
® HiB → Reconstituted by DPT vaccine or saline
® Measles and MMR → Reconstituted by distil water/ Sterile water.
® Exceptionally YF vaccine should be used within half an hour of reconstitution & JE vaccine with in 1
hour of reconstitution. If not done there is r/o TSS due to S.Aureus

Vaccine Strains
® BCG → Danish 1331
® Measles → Edmonston Zagreb
® Mumps → Jeryll Lynn
® Rubella → RA 27/3
® YF → 17D
® Varicella → Oka
® JE → SA 14-14-2
® H1N1 → California
 ® Mosquirix → RTS,S/AS01 (World's first & only licensed malaria vaccine. It is
prepared from circumsporozoite protein of plasmodium falciparum using HBsAg)
® Dengvaxia → CYD – TDV
® HIV → mvA (Modified vaccinia ancara)
® Typhoral → Tyz21a
® Anthrax → Sterne strain

Cold Chain
® It is maintenance of temperature of vaccine from point of manufacturing to point
of administration.
® Temperature:+2° to +8°C
® Also used for making icepacks & storing OPVs for long term (>3 months) at
temperature -15° to -25° C

ILR (Ice Lined Refrigerator)

® Most important component of cold chain
® Kept at PHC
® Vaccines can be stored for upto 1 month
® Minimum electricity required per day is 8 hours
® If there is no electricity it can maintain temperature
of all vaccine for upto 5 days

Vaccine Carrier
® Used to transport from PHC to site of immunization and sub-centers
® It is non-electronic instrument with 4 ice packs inside it.
® Max 16-20 vaccine vials can be kept inside it.
® It can maintains temp for 24-48 hrs

Fully Frozen Ice Pack

→ Fill water upto horizontal mark with plain tap water
→ Smallest Component of cold chain
→ 2 vaccines are kept in two holes inside the ice pack

Dial Thermometer
® Principle: Thermocouple
® Measure ILR temperature twice a day
® Alcohol stamp thermometer is more sensitive but dial thermometer is more easy to use.

Reverse Cold Chain

® Transportation of Polio stool samples to lab at 2–8C f/b which virus isolation & culture is done.
Global Switch Program
® Switching from Trivalent OPV to Bivalent OPV worldwide.
® National Switch Day: 25th April 2016
® National Validation Day: 9th May 2016
Gradually all bOPV will be replaced by IPV
VVM
® Vaccine Vial monitor
® If temperature maintained properly inner square always
remains white, whereas outer circle is always blue
® If temperature not maintained, inner square color doesn't remain white.
® It has 4 grades; We can use grade 1 & 2 vaccines.
® When square color matches circle color or is darker,
do not use the vaccine.
® It is a marker of cold chain maintenance
Efficacy of Vaccines
® BCG → 0-80% (0% for pulmonary TB)
→ Average 50% (50% for severe forms of TB)
® Measles→ >90% with 1 dose
→ >99% with 2 doses
- NIS gives 2 doses for measles vaccine. This is called as 'AMMRS' i.e. Accelerated Measles Mortality
Reduction Strategy
® Rubella → >95%(Vaccine with highest efficacy with single dose)

First Vaccine
® Small pox vaccine (Developed by Edward Jenner)
® E. Jenner coined the term 'Vaccination’
® Louis Pasteur coined the term 'vaccine’