Immunization is a cornerstone of pediatric healthcare,
playing a vital role in protecting children from potentially life-threatening
diseases. This chapter provides an in-depth overview of immunization schedules,
types of vaccines, administration techniques, management of vaccine-related
reactions, and the significance of herd immunity.
Immunization Schedule: National and WHO Guidelines
Understanding immunization schedules is critical for
ensuring timely and complete vaccination in children.
- National
Immunization Schedule (India):
- Birth:
BCG, Hepatitis B (0 dose), OPV (0 dose)
- 6
Weeks: DPT, IPV, Hib, Hepatitis B (1st dose), Rotavirus, PCV
- 10
Weeks: DPT, IPV, Hib, Hepatitis B (2nd dose), Rotavirus (2nd dose)
- 14
Weeks: DPT, IPV, Hib, Hepatitis B (3rd dose), Rotavirus (3rd dose), PCV
- 9-12
Months: Measles/MMR, Vitamin A, JE (in endemic areas)
- Booster
doses as recommended at 16-24 months, 5 years, and 10 years.
- WHO
Guidelines:
- Emphasizes
the Expanded Program on Immunization (EPI), recommending vaccines such as
BCG, DTP, Polio, and Measles in the first year of life.
- Advocates
for newer vaccines like HPV, Rotavirus, and Pneumococcal in national
schedules based on disease burden.
Types of Vaccines and Their Administration
Vaccines are classified based on their preparation and
method of action. Each type requires careful handling and administration to
ensure efficacy and safety.
- Types
of Vaccines:
- Live
Attenuated Vaccines: Contain weakened pathogens (e.g., BCG, MMR,
Rotavirus).
- Inactivated
Vaccines: Contain killed pathogens (e.g., IPV, Hepatitis A).
- Subunit,
Recombinant, or Conjugate Vaccines: Contain parts of the pathogen
(e.g., Hib, HPV, PCV).
- Toxoid
Vaccines: Use inactivated toxins produced by bacteria (e.g., Tetanus,
Diphtheria).
- mRNA
Vaccines: Introduce genetic material to produce an immune response
(e.g., COVID-19 vaccines).
- Routes
of Administration:
- Intramuscular
(IM): Common for DTP, Hepatitis B, and PCV.
- Subcutaneous
(SC): Used for MMR and Varicella.
- Oral:
Rotavirus and Oral Polio Vaccine (OPV).
- Intradermal
(ID): BCG vaccine.
- Storage
and Handling:
- Cold
chain maintenance is essential to preserve vaccine potency.
- Detailed
training for healthcare professionals on safe storage, preparation, and
disposal.
Management of Vaccine-Related Reactions
Although vaccines are generally safe, adverse reactions can
occur. Nurses play a critical role in identifying and managing these responses
effectively.
- Common
Mild Reactions:
- Pain,
redness, or swelling at the injection site.
- Fever,
irritability, or mild rash (e.g., post-MMR).
- Management:
Local cold packs, paracetamol for fever, and reassurance to parents.
- Severe
Reactions:
- Anaphylaxis:
Rare but life-threatening; symptoms include difficulty breathing, hives,
and hypotension.
- Management:
Immediate administration of epinephrine, oxygen, and monitoring in a
healthcare facility.
- Vaccine
Adverse Event Reporting: Documentation and reporting to health
authorities for monitoring vaccine safety.
Importance of Herd Immunity
Herd immunity occurs when a significant portion of the
population becomes immune to a disease, either through vaccination or previous
infections, reducing its spread.
- Significance:
- Protects
vulnerable groups, such as newborns, elderly individuals, and
immunocompromised patients who cannot receive vaccines.
- Helps
eradicate diseases; for example, smallpox was eliminated through global
immunization efforts.
- Challenges:
- Vaccine
hesitancy and misinformation can undermine herd immunity.
- Geographic
and socioeconomic disparities may leave populations unvaccinated.
- Role
of Nurses:
- Educating
parents and communities on the benefits and safety of vaccines.
- Addressing
myths and concerns about vaccines with evidence-based information.
- Advocating
for universal immunization programs to achieve optimal coverage.
International Pediatric Immunization Schedule (2024)
The International Pediatric Immunization Schedule is a
guideline provided by the World Health Organization (WHO) and adapted by
various countries according to local epidemiological needs. It aims to protect
children from vaccine-preventable diseases. Below is a comprehensive overview
of the schedule, which can vary slightly by country.
1. At Birth
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
BCG |
Tuberculosis |
Intradermal |
1 dose |
|
Hepatitis B |
Hepatitis B |
Intramuscular (IM) |
1 dose |
|
OPV (zero dose) |
Polio |
Oral |
1 dose |
2. 6 Weeks
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
DTP (Diphtheria, Tetanus, Pertussis) |
Diphtheria, Tetanus, Pertussis |
Intramuscular (IM) |
1st dose |
|
Hepatitis B |
Hepatitis B |
Intramuscular (IM) |
2nd dose |
|
Hib |
Haemophilus influenzae type b |
Intramuscular (IM) |
1st dose |
|
IPV (Inactivated Polio Vaccine) |
Polio |
Intramuscular (IM) |
1st dose |
|
PCV (Pneumococcal Conjugate Vaccine) |
Pneumonia, Meningitis |
Intramuscular (IM) |
1st dose |
|
Rotavirus |
Diarrhea caused by Rotavirus |
Oral |
1st dose |
3. 10 Weeks
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
DTP |
Diphtheria, Tetanus, Pertussis |
Intramuscular (IM) |
2nd dose |
|
Hib |
Haemophilus influenzae type b |
Intramuscular (IM) |
2nd dose |
|
IPV |
Polio |
Intramuscular (IM) |
2nd dose |
|
PCV |
Pneumonia, Meningitis |
Intramuscular (IM) |
2nd dose |
|
Rotavirus |
Diarrhea caused by Rotavirus |
Oral |
2nd dose |
4. 14 Weeks
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
DTP |
Diphtheria, Tetanus, Pertussis |
Intramuscular (IM) |
3rd dose |
|
Hib |
Haemophilus influenzae type b |
Intramuscular (IM) |
3rd dose |
|
IPV |
Polio |
Intramuscular (IM) |
3rd dose |
|
PCV |
Pneumonia, Meningitis |
Intramuscular (IM) |
3rd dose |
|
Rotavirus |
Diarrhea caused by Rotavirus |
Oral |
3rd dose (if applicable) |
5. 6 Months
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
Hepatitis B |
Hepatitis B |
Intramuscular (IM) |
3rd dose |
|
Influenza (Optional) |
Seasonal Flu |
Intramuscular (IM) |
1 dose annually |
6. 9 Months
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
Measles |
Measles |
Subcutaneous (SC) |
1st dose |
|
Yellow Fever |
Yellow Fever |
Subcutaneous (SC) |
1 dose (in endemic areas) |
|
MR (Measles-Rubella) |
Measles and Rubella |
Subcutaneous (SC) |
1st dose |
7. 12-15 Months
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
MMR (Measles, Mumps, Rubella) |
Measles, Mumps, Rubella |
Subcutaneous (SC) |
1st dose |
|
Varicella |
Chickenpox |
Subcutaneous (SC) |
1st dose |
|
PCV |
Pneumonia, Meningitis |
Intramuscular (IM) |
Booster dose |
|
Hib |
Haemophilus influenzae type b |
Intramuscular (IM) |
Booster dose |
8. 16-24 Months
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
DTP Booster |
Diphtheria, Tetanus, Pertussis |
Intramuscular (IM) |
Booster dose |
|
IPV Booster |
Polio |
Intramuscular (IM) |
Booster dose |
|
MMR (2nd dose) |
Measles, Mumps, Rubella |
Subcutaneous (SC) |
2nd dose |
9. 4-6 Years
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
DTP Booster |
Diphtheria, Tetanus, Pertussis |
Intramuscular (IM) |
Booster dose |
|
IPV Booster |
Polio |
Intramuscular (IM) |
Booster dose |
|
MMR (2nd dose) |
Measles, Mumps, Rubella |
Subcutaneous (SC) |
2nd dose |
|
Varicella (2nd dose) |
Chickenpox |
Subcutaneous (SC) |
2nd dose |
10. 9-15 Years (Adolescents)
|
Vaccine |
Disease Prevention |
Route |
Number of Doses |
|
Tdap |
Tetanus, Diphtheria, Pertussis |
Intramuscular (IM) |
1 dose |
|
HPV (Human Papillomavirus) |
Cervical Cancer |
Intramuscular (IM) |
2 doses (6 months apart) |
|
Meningococcal (optional) |
Meningitis |
Intramuscular (IM) |
1 dose |
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