Annals of Community Health (ISSN 2347-5455, eISSN 2347-5714), Peer Reviewed, Indexed Journal focusing exclusively on Community Medicine and Public Health

Optional Vaccines

Introduction

Optional vaccines are those which are not included in the routine immunisation programme and given on an optional basis.

  • Classification –
    • Paediatric Vaccines –Rotavirus, DTaP, Haemophilus Type b Conjugate vaccine.
    • Adult Vaccines – Hepatitis B.
    • Both – Hepatitis A, Influenza, MMR, Meningococcal, Pneumococcal, Varicella, Typhoid, HPV, Rabies, H1N1.
    • Under special circumstances - Japanese Encephalitis, Yellow fever.

ROTAVIRUS

Introduction - Rotavirus are the leading cause of severe diarrhea among infants and young children.

Burden of disease - In India diarrhoeal disease is a major health problem among children under the age of 5 years. During 2005 about 1.07 million cases of acute diarrhoea were reported in India with 2040 deaths.

Description – Is a live attenuated vaccine.

Manufactured by – GlaxoSmithKline –Rotarix (Rs.1100)

Composition – 1dose(1ml) contains Live attenuated human rotavirus RIX4414 strain not less than 106 CCID50.

Formulation – Lyophilised vaccine to be reconstituted with liquid diluent.

Storage - Store at 2° to 8°C

Indications – For active immunisation of infants from age of 6weeks for prevention of gastro-enteritis due to rotavirus infection.

Contraindications – Should not be administered to subjects with hypersensitivity to any components. Subjects with uncorrected congenital malformation of the GIT – Intussusception.

Dosage - 1ml

Schedule – 2 doses. 1st dose from the age of 6weeks. There should be an interval of 4 weeks between the doses. Course should be completed by 24 weeks.

Method of administration – For oral use only.

Adverse reactions – Diarhoea, vomiting, loss of appetite, fever, flatulence, abdominal pain.

Efficacy – After 2doses during the first year of life are

  • 87.1% - rotavirus gastroenteritis
  • 95.8% - severe form
  • 91.8% - requiring medical attention
  • 100% - requiring hospitalisation.

Haemophilus Type b Conjugate vaccine

Introduction – Haemophilus influenzae type b (Hib) is a bacteria responsible for severe pneumonia, meningitis and other invasive diseases almost exclusively in children aged less than 5 years.

Burden of disease – In 2000, Hib was estimated to have caused two to three million cases of serious disease, notably pneumonia and meningitis, and 3,86,000 deaths in young children. Hib disease is observed in all parts of the world

Description – Is a freeze dried vaccine of purified polyribosyl-ribitol-phosphate capsular polysaccharide(PRP) of Hib, covalently bound to tetanus toxoid(carrier protein).

Composition – Each dose of 0.5ml contains:

  • Purified capsular polysaccharide 10mcg
  • Tetanus toxoid (carrier protein) 19 to 33mcg.
  • Reconstitute with diluent for Haemophilus Type b conjugate vaccine.

Manufactured by –

  • SERUM INSTITUTE OF INDIA LTD – Sii HibPro (Rs 375)
  • sanofi pasteur Pentacel(Rs.2000)
  • GlaxoSmithKline – Hiberix.

Formulations – 1 dose vial plus diluent (0.5ml).

Indications – For active immunisation against Haemophilus Influenza Type b infection for all children from the age of 6weeks to 5years.

Contraindications – Should not be administered to subjects with known hypersensitivity to any component of the vaccine.

Storage – The freeze dried vaccine stored between +2deg -+8degC. Protect from light. Not affected by freezing.

Dosage – 0.5ml

Method of administration – Reconstituted vaccine is for intramuscular injection.

Site – Anterolateral aspect of thigh in infants, or in to the deltoid muscles of older children.

Adverse reactions–

  • Local – Injection site soreness, mild redness and swelling.
  • Systemic –fever, loss of appetite, vomiting, diarrhoea and unusual crying.

DTaP-IPV/Hib

Introduction – DTaP-IPV/Hib is immunisation against Diptheria, tetanus, Pertusis, poliomyelitis and invasive disease due to Haemophilus influenzae type b.

Description – Each dose contains Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated Poliovirus and Haemophilus b Conjugate (Tetanus Toxoid Conjugate) Vaccine.

Manufactured by –

  • Sanofi Pasteur Limited – Pentacel (Rs.2000)
  • GlaxosmithKline – Infanrix -DTPa( Rs.699)

Formulations - Suspension for injection.

Indications and usage -

  • Pentacel is a vaccine indicated for active immunization against diphtheria, tetanus, acellular pertussis, poliomyelitis and invasive disease due to Haemophilus influenzae type b. Pentacel vaccine is approved for use as a four dose series in children 6 weeks through 4 years of age.

Contraindications -

  • Severe allergic reaction (eg, anaphylaxis) after a previous dose of Pentacel vaccine, any ingredient of Pentacel vaccine.
  • Encephalopathy within 7 days of a previous pertussis containing vaccine with no other identifiable cause.
  • Progressive neurologic disorder until a treatment regimen has been established and the condition has stabilized.

Storage - stored at 2° to 8°C (35° to 46°F).

Dosage – 0.5ml.

Schedule - The primary immunization consists of 3doses of 0.5ml injection administered at 6,10,14weeks. Booster dose at 18months.

Method of administration – Deep Intramuscularly.

Adverse reactions –

  • Systemic - fussiness/irritability and inconsolable crying, fever.
  • Local - Injection site reactions included tenderness.
  • Efficacy – found to be 84%.

Hepatitis B

Introduction – Hepatitis B (formerly known as "serum" hepatitis) is an acute systemic infection with major pathology in the liver, caused by hepatitis B virus (HBV).

Burden of disease – The HBV infection is a global problem. More than 2 billion people worldwide have evidence of past or current HBV infection and 350 million are chronic carriers of the virus, and causes an estimated 620,000 deaths.

Description – Is a non infectious recombinant DNA Hepatitis B vaccine. It contains purified surface antigen of the virus obtained by culturing genetically engineered Hansenula polymorphia yeast cells having the surface antigen gene of the Hepatitis B virus.

Composition –

  • Paediatric dose : Each dose of 0.5ml contains
  • 10mcg of purified Hepatitis B surface antigen
  • Adsorbed on aluminium hydroxide 0.25mg to 0.40mg

Preservative :Thiomersal

  • Produced in Hansenula polymorphia

Adult dose : Each 1ml contains 20mcg of purified Hepatitis B surface antigen

Manufactured by –

  • SERUM INSTITUTE OF INDIA LTD – GeneVac-B(Rs.70)
  • GlaxoSmithKline - Engerix-B®(Rs.323), Twinrix®
  • Pediarix® - Combination vaccine: DTaP+HepB+IPV

Formulations : Suspension for injection.

Indications – Is indicated for active immunisation against Hepatitis B infection in subjects considered at risk of exposure to HBV-positive material. In areas of intermediate or high prevalence of Hepatitis B.

Contraindications – Should not be administered to subjects with known hypersensitivity to any component of the vaccine, or who had hypersensitivity for previous Hepatitis B vaccination.

Storage – Stored between +2deg -+8degC. Protect from light. Not to be frozen.

Dosage -

  • Paediatric : 0.5ml suspension for neonates, infants, children and adolescents upto 19 years of age.
  • Adult : 1ml suspension for adults aged 20 and above.

Immunisation schedule:

  • 6,10,14weeks for infants.
  • 0,1,6 months
  • 0,1,2 months(rapid schedule)
  • Booster dose if Anti-HBs antibody titres fall below 10U/l especially for immunocompromised or those on haemodialysis.
  • Immunocompromised : 40mcg at 0,1,2 and 6 months from the date of first dose.
  • Neonates born for HBV carrier mothers : 0,1,2 month schedule should start at birth.

Method of administration – IM administration into deltoid region, in the anterolateral part of the thigh in young children.

  • May be given subcutaneously in patients with thrombocytopenia or bleeding disorders.

Adverse reactions – Mild soreness, erythema, induration, fatigue, fever, malaise, influenza like symptoms.

Human Papillomavirus Vaccine

Introduction – Human papillomavirus (HPV) causes cervical cancer which is the second most common cancer in women worldwide.

Burden of disease - More than 85 % of cervical cancer deaths are in developing countries, where it accounts for 13% of all female cancers.

Description – Is a non-infectious recombinant vaccine prepared from the highly purified virus like particles of the major capsids L1 protein of oncogenic HPV types 16 & 18.

Composition – 1dose of 0.5ml contains

  • Human papillomavirus type 16 L1 protein 20mcg
  • Human papillomavirus type 18L1 protein 20mcg
  • 3-O-desacyl-4-monophosphoryl lipid A 50mcg
  • Aluminium hydroxide, hydrated 0.5mg

Manufactured by –

  • GlaxoSmith Kline : Cervarix (Rs. 2500)
  • Merck & Co., Inc. : Gardasil

Formulations – Suspension for injection.

Indications –

  • In females from 10-45years for prevention of cervical cancer by protecting against incident and persistent infections.
  • Cytological abnormalities including atypical squamous cells of undetermined significance & CIN.
  • CIN1 & pre-cancerous lesions(CIN2 & CIN 3) caused by HPV type 16 &18.

Contraindications – Subjects with known hypersensitivity to any component of the vaccine.

Storage – Store in refrigerator (2degC-8degC). Do not freeze.

Dosage – 0.5ml

Schedule - Primary vaccination schedule : 3 doses

  • 0,1,6 months. If flexibility second dose between 1month and 2.5months after first dose.
  • Method & site of administration – Intramusular injection in the deltoid region.

Adverse reactions –

  • Local : injection site reactions including pain,redness,swelling,fatigue.
  • Systemic : fever, myalgia, nausea, vomiting, diarrhoea and abdominal pain.

Efficacy –

  • Against HPV- 16/18 : 96.4%
  • Against HPV 16/18 persistent infection : 97.9%

Hepatitis A

Introduction – Hepatitis A (formerly known as "infectious" hepatitis or epidemic jaundice) is an acute infectious disease caused by hepatitis A virus (HAV).

Burden of disease – According to WHO about 10-50 persons per 100.000 are affected anually.

Description – Is a sterile suspension containing formaldehyde inactivated Hepatitis A virus antigen(HAV)(HM 175 strain, propagated in MRC5 human diploid cells). Aluminium as adjuvant.

Manufactured by –

  • GlaxoSmithKline Biologicals:
  • Havrix TM 1440(Adult)/ 720(Junior) -Rs1360.00/Rs1099.00
  • TWINRIX® [Hepatitis A & Hepatitis B (Recombinant) Vaccine] .

Formulations – Suspension for injection.

Therapeutic indications –

  • Is indicated for active immunisation against infections cause by hepatitis A virus.
  • Recommended in subjects who are at increased risk.
  • In areas of intermediate to high prevalence of hepatitis A.

Pregnancy and lactation – Should be used only when clearly needed.

Contra-indications – Should not be administered to subjects with known hypersensitivity to any component of the vaccine

Storage – At +2degC - +8degC. Do not freeze.

Dosage and Schedule–

  • Primary vaccination:
    • Children and adolescents(1-18yrs) – single dose 0.5ml suspension.
    • Adults(>19yrs ) – Single dose 1ml suspension.
  • Booster vaccination – between 6 and 12months after the primary dose.
  • Method of administration: IM administration into deltoid region, in the anterolateral part of the thigh in young children.

Adverse reactions –

  • Local – Injection site soreness, mild redness and swelling.
  • Systemic – headache, malaise, vomiting, fever, nausea and loss of appetite. Rarely allergic reactions including convulsions and anaphylactoid reactions reported.
  • Efficacy – Studies demonstrated that 80% vaccine coverage led to termination of outbreaks within 4-8 weeks.

MMR(LIVE)

Introduction - The MMR vaccine is an immunisation shot against measles, mumps, rubella (also called German measles).

Description – Is freeze dried vaccine prepared from live attenuated strains of Edmonston-zagreb Measles virus propogated on human diploid cell culture.

  • L.Zagreb Mumps virus propogated on chick embryo fibroblast cells and
  • Wistar RA 27/3 Rubella virus propogated on human diploid cell culture.

Composition – 0.5ml contains

  • 1000CCID50 Measles virus &Rubella virus,
  • 5000CCID50 Mumps virus

Manufactured by –

  • Serum Institue of India ltd – Tresivac(Rs.1058.5)
  • Aventis Pasteur – Trimovax (Rs.720)

Formulations – Vial plus Diluent.

Indications – Is indicated for active immunisation in children 12months to 12 years age against measles, mumps and rubella infections simultaneosly.

  • Even in adults who missed the dosage in childhood.

Contraindications – Pregnancy, Leukemia,other malignancy

  • Severe febrile illness
  • History of febrile convulsions.
  • Patients on immunosuppresants.
  • History of known hypersensitivity to egg protein.
  • Anaphylactic reactions to Neomycin.

Storage – Store between +2degC-+8degC.Protect from light. For long term storage -20degC is recommended.

Dosage – 0.5ml

Schedule –

  • Infants : Measles at 9 months, MMR given between 12-15months of age. If measles is given later, 3months interval is advised.
  • Adults : 2doses with an interval of minimum 4 weeks.

Method of administration – Deep subcutaneous injection in to the upper arm.

Adverse reactions –

  • Mild, fever, slight enlargement of cervical and occipital lymph nodes.
  • Rarely parotid and other salivary gland enlargement is reported.

Varicella Vaccine, Live

Introduction – Chickenpox or varicella is an acute, highly infectious disease caused by varicella-zoster (V -Z) virus.

Burden of disease – It is worldwide in distribution and occurs in both epidemic and endemic forms.

Description – Is a lyophilised preparation of the live attenuated Oka strain of varicella-zoster virus, obtained by propogation of the virus in MRC5 human diploid cell culture.

Composition – Each dose(0.5ml) contains:

  • Live attenuated Varicella virus (OKA strain, propagated in MRC5 human diploid cells) not less than 2,000 plaque forming units.
  • Neomycin Sulphate less than 25mcg.
  • Water for injection.

Manufactured by –

  • GlaxoSmith Kline – Varil rix ( Rs.1440)
  • Merck & Co., Inc.- ProQuad (Combination vaccine: Varicella+MMR), Varivax ( Rs.1420)

Formulations - vial plus diluent .

Indications –

  • Is indicated for active immunisation against varicella of healthy subjects and susceptible healthy close contacts from age 12months onwards.
  • Susceptible healthy close contacts ie.,parents and siblings of high risk patients, medical, paramedical personnel.

Contraindications –

  • Should be postponed in patients with acute severe febrile illness.
  • In subjects with primary or acquired immunodeficiency states with total lymphocyte count less than 1,200/cumm like subjects with leukemias, lymphomas, blood dyscrasias.
  • Known systemic hypersensitivity to neomycin.
  • During pregnancy. Pregnancy should be avoided 3months after vaccination.

Interactions – subjects received immunoglobulins or blood transfusion delayed for 3months.

  • Salicylates should be avoided for 6 weeks as Reye’s syndrome has been reported.

Storage - Stored between +2deg -+8degC. Protect from light.

  • The diluent can be stored in the refrigerator or at ambient temperatures.

Dosage – 0.5ml.

Schedule -

  • From the age of 12months up to and including 12years- 1dose
  • From 13years and above – 2doses.
  • Second dose atleast 6 weeks after first dose but not less than 4weeks.

Method of administration – Is for subcutaneous use only.

Adverse reactions – Swelling at the injection site, fever reported very commonly.

Efficacy – 100% (≥30vesicles), 88% (1vesicle or papule).

Typhoid

Introduction – Typhoid fever is the result of systemic infection mainly by S. typhi found only in man.

Burden of disease – In 2004, WHO estimated the global typhoid fever disease burden at 21 million cases annually,

  • Typhoid fever is endemic in India. Reported data for the year 2005 shows same picture 6.53.580 cases and 417 deaths.

Description – Is a sterile solution for intramuscular use containing the cell surface Vi polysaccharide extracted from Salmonella typhi (Ty2) strain.

Manufactured by –

  1. Bharat Biotech –BIOVAC ( Rs. 150), TYPBAR – PFS ( Rs.290)
  2. Sanofi pasteur - TYPHIM Vi ( Rs .290)

Composition – Each 0.5ml contains

  • Purified Vi capsular polysaccharide of
  • Salmonella typhi 25mcg
  • Phenol 0.25%
  • Isotonic buffer solution

Formulation – Liquid for injection.

Indications – Is indicated for active immunisation against typhoid fever for both adults and children 2years of age & older.

Selective immunisation-

  • Traveller’s to high endemic areas
  • Household contacts of carriers
  • Healthcare professional
  • Police, armed forces.

Contraindications - Should not be administered to subjects with known hypersensitivity to any component of the vaccine, or who had hypersensitivity for previous vaccination.

  • Typhoid vaccine to be given to pregnant and nursing mothers only if clearly indicated.

Storage – Stored between +2deg -+8degC. Protect from light. Not to be frozen.

Dosage & Schedule – Single dose of 0.5ml. Booster dose with an interval of not more than 3years for subjects who remain at risk.

Method of administration – Intramuscularly .

Site - In adults deltoid region, in children deltoid or anterolateral aspect of thigh.

Adverse reactions –

  • Local : Erythema, induration and tenderness.
  • Systemic : malaise, headache, vomiting, myalgia.
  • Rarely allergic type reactions.

Meningococcal

Introduction – Meningococcal meningitis or cerebro spinal fever is an acute communicable disease caused by N. meningitidis.

Burden of disease – Meningococcal disease is endemic in India. During 2005, about 8367 cases of meningococcal meningitis were reported in India with about 485 deaths.

Description - Menactra®, Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine, that contains Neisseria meningitidis serogroup A, C, Y and W-135 capsular polysaccharide antigens individually conjugated to diphtheria toxoid protein. N meningitidis A, C, Y and W-135 strains are cultured on Mueller Hinton agar2 and grown in Watson Scherp3 media.

Manufactured by – Sanofi pasteur : Menactra (Rs.600), Menomune, Novartis : Menveo

Formulations – Menactra vaccine is a liquid solution.

Indications - Menactra is indicated for active immunization to prevent invasive meningococcal disease caused by N meningitidis serogroups A, C, Y and W-135. Menactra is approved for use in individuals 9 months to 55 years of age.

Contraindications -

Hypersensitivity - Severe allergic reaction (eg, anaphylaxis) after a previous dose of a meningococcal capsular polysaccharide-, diphtheria toxoid- containing vaccine, or to any component of Menactra vaccine.

Guillain-Barré Syndrome

Storage – Store at 2° to 8°C (35° to 46°F). DO NOT FREEZE.

Dose and schedule -

  • Menactra vaccine is administered as a 0.5 ml dose.
  • In children 9 through 23 months of age, Menactra is given as a 2-dose series three months apart.
  • Individuals 2 through 55 years of age receive a single dose.

Method of administration – Intramuscular.

Adverse reactions - Common (≥10%) solicited adverse events were injection site tenderness, erythema, and swelling; irritability, abnormal crying, drowsiness, appetite loss, vomiting, fever, headache, fatigue, malaise, and arthralgia.

Pneumococcal

Introduction – Pneumonia caused by Streptococcus pneumoniae is a major cause of illness and death in children.

Burden of disease - More than 2 million children die from pneumonia each year, accounting for almost one in 5 under-five deaths worldwide.

Description – Pneumococcal 13 valent conjugate vaccine is a sterile solution of saccharides of capsular antigens of Streptococcus pneumoniae serotypes 1,3,4,5,6A,6B,7F,9V,14,18C,19A,19F,23F individually conjugated by reductive amination to non toxic diphtheria CRM197 protein.

Manufactured by –

  • John Wyeth & Brother Ltd. – Prevenar -13( Rs. 3800.)
  • Sanofi pasteur – Pneumo 23 ( Rs.1144)

Formulations – Suspension for injection.

Indications – Is indicated for vaccination against pneumococcal disease caused by those pneumococcal types included in the vaccine in infants from 2months to 5 years of age.

Contraindications – Hypersensitivity to any component of the vaccine including Diphtheria toxoid.

Storage - Store unopened and opened vials at 2-8°C.

Dosage - 0.5 mL .

Schedule –

  • Infants – 3 doses at 2 month intervals, followed by 4th dose at 12-15months of age.
  • First dose at 2months but can be given as young as 6 weeks of age.

Previously unvaccinated children –

  • 7-11months – 3 doses
  • 12-23months – 2doses
  • >24months to 5years -1dose

Method of administration –

  • intramuscular use (preferably in the deltoid muscle or lateral mid-thigh).

Adverse reactions –

  • Local reaction at injection site including soreness, erythema, warmth, swelling and induration.
  • Systemic like Fever ≤102°F, malaise, headache.

Efficacy – against AOM episodes was 57%.

Rabies Vaccine

Introduction – Rabies also known as hydrophobia is an acute, highly fatal viral disease of central nervous system caused by Lyssavirus type-1.

Burden of disease – According to WHO APCRI National multicentric rabies Survey, there are an estimated 17.4million animal bite cases and 20,000 deaths due to human rabies anually in India corresponding to 36% of total global deaths due to human rabies.

Description – It is a purified chick embryo cell rabies vaccine.

Composition – 1ml contains

  • Inactivated rabies virus(strain flury Lep) potency ≥ 2.5IU

Manufactured by- Novartis Vaccines

Others- PDEV : Vaxirab (Rs. 348.00)

PVRV – Verorab(Rs.369), Indirab(Rs.350), Abhayrab(RS.298), XPRAB(Rs.369)

HDCV – Rabivax(RS. 450)

Formulations – One vial of powder and solvent for solution for injection.

Storage - Store at 2° to 8°C

Indications – Active immunisation against Rabies.

  • No contraindications.

Dosage – 1ml

Schedule –

  • Pre-exposure : 1ml on Day 0,7,28.
  • Post Exposure : IM - Day 0,3,7,14 and 28.
  • ID – Day 0,3,7 and 28.

Method of administration – Intramuscular, Intradermally.

Site – Deltoid, Anterolateral aspect of thigh.

Adverse reactions –

  • Local – fever, headache, myalgia, lymph node swelling.
  • Rare circulatory reactions, sweating, chills, allergic reactions.

H1N1

Introduction - Influenza A (H1N1) virus is a subtype of influenza A virus and was the most common cause of human influenza (flu) in 2009.

Description – Vaxiflu-S contains inactivated influenza virus tat has been grown in allantoic fluid of embryonated chicken eggs, purified in a Sucrose Density gradient and inactivated by beta-propiolactone.

Composition – 0.5ml contains- purified 15mcg Haemagglutinin Antigen of A/California/7/2009 H1N1 influenza NBRG-121xp virus.

  • Ovalbumin, sucrose, Thiomersal, Neomycin, Polymixin.

Manufactured by –

  • Zydus Vaxxicare- Vaxiflu-S (Rs.1500/10doses)
  • Serum institute of India Ltd - Nasovac

Formulation – Multiple dose vial of liquid vaccine

Indications – Is indicated for active immunisation against influenza disease caused by pandemic (H1N1) 2009 virus in the age group of 18 years and above.

Contraindications – Anyone with known hypersensitivity to egg proteins, or any component of the vaccine or who had life threatening reactions to previous vaccination

Pregnancy – Only when clearly indicated.

Storage - 2° to 8°C.

Dosage - 0.5ml

Schedule - Single dose.

Method of administration – Intramuscular.

Site – Deltoid muscle of the upper arm.

Adverse reactions –

  • Local : Pain, mass, inflammation, ecchymoses,edema, allergic reaction,haemorrhage,pruritus.
  • Systemic : Headache, fatigue, malaise, cough, wheezing, chest tightness, difficulty breathing.

Influenza Virus Vaccine

Introduction - Influenza viruses cause the flu and are divided into three types, designated A, B, and C. Influenza types A and B are responsible for epidemics .

Description - FLUARIX is a vaccine prepared from influenza viruses propagated in embryonated chicken eggs.

Composition - Formulated to contain 45 micrograms (mcg) hemagglutinin (HA) per 0.5-mL dose, in the recommended ratio of 15 mcg HA of each of the following 3 strains: A/California/7/2009 NYMC X-181 (H1N1), A/Victoria/210/2009 NYMC X-187 (H3N2) (an A/Perth/16/2009-like virus), and B/Brisbane/60/2008.

Manufactured by –

  • GlaxoSmithKline Biologicals – Fluarix
  • Sanofi pasteur – Vaxigrip paediatric use (RS. 505)

Formulation - Suspension for injection in 0.5-mL single-dose prefilled syringes.

Indications - Is indicated for active immunization for the prevention of disease caused by influenza virus subtypes A and type B contained in the vaccine. FLUARIX is approved for use in persons 3 years of age and older.

Contraindications -

  • Known severe allergic reactions to egg proteins (a vaccine component) or a life-threatening reaction to previous influenza vaccination

Dosage – 0.5ml.

Schedule -

  • Children: 0.5 mL dose by intramuscular injection.
  • Children 3 years to <9 years of age previously unvaccinated receive two 0.5 mL doses; each 0.5 mL dose is administered at least 4 weeks apart.
  • Children 3 years to <9 years of age previously vaccinated with 2 doses of any influenza vaccine receive only one 0.5 mL dose.
  • Children 9 years of age and older receive only one 0.5 mL dose.
  • Adults: a single 0.5-mL dose by intramuscular injection.

Storage - 2º and 8ºC (36º and 46ºF).

Adverse reactions -

The most common (≥10%) local and general adverse events were pain, redness and swelling at the injection site, muscle aches, fatigue, and headache. irritability, loss of appetite, and drowsiness.

Japanese Encephalitis

Introduction – Japanese encephalitis (JE) is a mosquito-borne encephalitis caused by a group B arbovirus (Flavivirus) and transmitted by culicine mosquitoes.

  • In India repeated outbreaks reported in Assam,AP, Bihar, Haryana, Kerala, Karnataka.Provisional figures for year 2007 are 391cases & 92 deaths

Description – Each dose of vaccine contains approximately 6mcg of purified, inactivated JEV proteins and 250 mcg of aluminum hydroxide.

  • IXIARO is a vaccine prepared by propagating JEV strain SA14-14-2 in Vero cells. Multiple viral harvests are performed, which are pooled, clarified and concentrated.

Manufactured by – Intercell Biomedical : IXIARO

Formulation - Suspension for injections.

Indications – IXIARO is a vaccine indicated for the prevention of disease caused by Japanese encephalitis virus (JEV) in persons.

Contraindications – Severe allergic reaction (e.g.,anaphylaxis) after a previous dose.

Dosage – 0.5ml

Schedule - 2 doses administered 28 days apart.

  • Immunization series should be completed at least 1 week prior to potential exposure to JEV.

Method of administration – Intramuscular use

Adverse reactions -

  • Systemic -The most common (≥ 10%) were headache and myalgia.
  • The most common (≥ 10%) injection-site reactions were pain and tenderness .

Yellow fever

Introduction – Yellow fever is an acute viral illness caused by a mosquito-borne flavivirus.

Description - Is prepared by culturing the 17D-204 strain of yellow fever virus in living avian leukosis virus-free (ALV-free) chicken embryos. The vaccine contains sorbitol and gelatin as a stabilizer, is lyophilized, and is hermetically sealed under nitrogen.

Manufactured by –

  • Sanofi Pasteur Inc - YF-VAX (Rs.2800)

Formulations – Vial plus diluent.

Indications - YF-VAX vaccine is recommended for active immunization of persons 9 months of age and older in the following categories:

  • Persons Living in or Traveling to Endemic Areas
  • International Travel
  • Laboratory Personnel.

Contraindications – YF-VAX vaccine is contraindicated in anyone with a history of acute hypersensitivity reaction to any components (including gelatin).

  • History of acute hypersensitivity to eggs or egg products.
  • Acute or Febrile Disease
  • Infants below 9 months, lactation.
  • Immunosuppressed Patients.
  • In pregnancy only if clearly indicated.

Storage - Store at 2° to 8°C (35° to 46°F). Do not freeze.

Dosage - 0.5ml

Schedule -

  • Primary Vaccination: Single dose. Immunity develops by the 10th day after primary vaccination.
  • Booster Doses: Re-immunization with 17D vaccine is recommended every 10 years for those at continuing risk of exposure and is required by International Health Regulations.

Method of administration – Subcutneous route.

Adverse reactions –

  • Local reactions including edema, hypersensitivity, pain or mass at the injection site have also been reported
  • Immediate hypersensitivity reactions, characterized by rash, urticaria, and/or asthma, are uncommon and occur principally among persons with histories of egg allergy.

Public health priorities

  • Haemophilus Type b Conjugate vaccine.
  • Rotavirus vaccine.
  • Hepatitis B.
  • Pneumococcal
  • Influenza.
  • Rabies.
  • HPV.
  • Typhoid.
  • Meningococcal meningitis.
  • Hepatitis A.
  • Chicken pox


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