Q&A COUNT: 46*
Vaccines: (21)
National Immunization Schedule
IAP Immunization Schedule
Why Anterolateral thigh is preferred for injection in less than 2 year child?
1. Gluteus muscle not developed well in 2 years
2.When Intradermal BCG is injected, orange wheel will not appear in a child
Vaccines: (21)
National Immunization Schedule
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| The above picture is taken from Park Textbook of Social and Preventive Medicine |
IAP Immunization Schedule
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| The above picture is taken from OP Ghai Textbook of Paediatrics |
Why Anterolateral thigh is preferred for injection in less than 2 year child?
1. Gluteus muscle not developed well in 2 years
2.When Intradermal BCG is injected, orange wheel will not appear in a child
LIVE ATTENUATED VACCINES
"Thank You MICROBE" (MCR comes twice)
- T- Typhoid oral vaccine (Ty21a vaccine)
- Y- Yellow fever (17D vaccine)
- M- Measles
- M- Mumps (Strains- Jeryl Lynn, Urabe, L-Zagreb)
- I- Influenza (Trivalent vaccine)
- C- Cholera (CVD103-HgR is no longer used) &
- C- Chicken pox (Monovalent varicella or MMRV)
- R- Rubella (RA 27/3) &
- R- Rota virus (monovalent: human Rotarix & Pentavalent bovine-human reassortant: Rota Teq)
- O- Oral Sabin polio vaccine (bOPV strains 1,3)
- B- BCG (Danish 1331 strain)
- E- Epidemic typhus
Mnemonic created by Stanley CM Medonics, India
KILLED VACCINES
"RIP JET ACTion"
- R- Rabies (Cell culture vaccine, Embryonated Egg based vaccine)
- I- Influenza
- P- Polio (IPV), Plague (formalin killed vaccine) , Pertussis (Acellular)
- RIP also refers to KILLED vaccines
- J - Japanese Encephalitis (Cell culture derived SA 14-14-2 strain)
- E - Encephalitis (tick borne)
- T - Typhoid (no longer used)
- A - Hepatitis A (Formaldehyde inactivated vaccines)
- C - Cholera (Dukoral, Sanchol, mORCVAX, Euvichol)
- T - Typhus
Mnemonic created by Stanley CM Medonics, India
TOXOID/PROTEIN VACCINES
"Intra Articular DPT is Toxic"
- I - Influenza
- A - Anthrax
- D - Diphtheria
- P - Pertussis (acellular vaccine)
- T - Tetanus
- Toxic - Toxoid vaccines
Diphtheria & Tetanus are Toxoid vaccines, meanwhile others are Protein subunit vaccines
Mnemonic created by Stanley CM Medonics, India
POLYSACCHARIDE VACCINES:
(Do not elicit T cell response, ineffective before 2 years of age, serotype specific - requiring Multivalent vaccine)
(Do not elicit T cell response, ineffective before 2 years of age, serotype specific - requiring Multivalent vaccine)
"Men PIT"
- Men - Meningococcus ACWY
- P - Pneumococcus
- I - Influenza (Hib)
- T - Typhoid vaccine
Mnemonic created by Stanley CM Medonics, India
GLYCOCONJUGATE VACCINES:(Polysaccharide vaccine is conjugated with antigenic protein - to elicit T cell response)
"Men PIG"
- Men - Meningococcus ACWY
- P - Pneumococcus
- I - Influenza (Hib)
- G - Glycoconjugate vaccines
Mnemonic created by Stanley CM Medonics, India
RECOMBINANT VACCINES (low immunogenic without an adjuvant)
"Cold LiMe REcovers BP"
- C- Cholera
- Lime - Lyme disease
- M - Malaria (MOSQUIRIX)
- RE - refers to REcombinant vaccine
- B - Hepatitis B
- P - Papilloma ( HPV )
Mnemonic created by Stanley CM Medonics, India
Heat sensitive vaccines and Freeze sensitive vaccines?
How to store both in ILR?
Upper part of ILR basket - DPT, TT, HBV, IPV, pentavalent, diluents (these are freeze sensitive vaccines)
Lower part of ILR basket - OPV, Measles, BCG, JE (these are heat sensitive vaccines)
How to store both in ILR?
Upper part of ILR basket - DPT, TT, HBV, IPV, pentavalent, diluents (these are freeze sensitive vaccines)
Lower part of ILR basket - OPV, Measles, BCG, JE (these are heat sensitive vaccines)
VACCINES SENSITIVE TO FREEZING
"Indian RCH Program Provides DT vaccine
- I - Influenza, IPV
- R- Rotavirus
- C- Cholera
- H- HPV, Hib, Hepatitis B
- P- Pneumococcal
- P - Pentavalent
- D - DT
- T- Tetanus, Td
Mnemonic created by Stanley CM Medonics, India
Reconstitution of vaccines?
Some vaccines like BCG and Measles vaccine are reconstituted before use.
Reconstitution means - mixing with sterile diluent*
Diluent should be not frozen, but only cooled.
After reconstitution, vaccine must be stored in dark at 2-8°C and used within 6 hours.
Reconstitution means - mixing with sterile diluent*
Diluent should be not frozen, but only cooled.
After reconstitution, vaccine must be stored in dark at 2-8°C and used within 6 hours.
Light sensitive vaccines:
M - Measles
R - Rubella vaccines (monovalent vaccines & MR, MMR)
B - BCG
These vaccines are supplied in Dark glassed vials*
B - BCG
These vaccines are supplied in Dark glassed vials*
What is Mission INDRA-DHANUSH?
Launched by Ministry of Health and Family welfare - vaccination program to fully immunize >89 lakh children who are either unvaccinated or partially vaccinated.
Depicts 7 colours of Rainbow - symbolize vaccines against 7 preventable life threatening communicable diseases
1. Diphtheria
2. Pertussis
3. Tetanus
4. Polio
5. Tuberculosis
6. Measles
7. Hepatitis B
Depicts 7 colours of Rainbow - symbolize vaccines against 7 preventable life threatening communicable diseases
1. Diphtheria
2. Pertussis
3. Tetanus
4. Polio
5. Tuberculosis
6. Measles
7. Hepatitis B
BCG:
What to do when BCG scar is not seen in a baby?
If child is normal.. repeat BCG
If child is ill.. do Mantoux test
What to do when BCG injection causes a swelling of lymph node?
When BCG adenitis develops (mostly in axillary node), it can be normal reaction.
So wait and watch!
It can resolve spontaneously!
If there is no resolution, do Mantoux test after 6 months of age*. If it proves to be positive, give INH 10 mg/kg for 6 months
Mechanism of BCG scar
A pustule will form after injection of BCG injection around 2-3 weeks, due to cellular hypersensitivity
It will enlarge and rupture to form a healed scar around 6-8 weeks
BCG Vaccine Complications
1. Disseminated BCG infection
2. Osteomyelitis (more possible in preterm baby)
3. Keloid
4. Fever, rash, anaphylaxis (as in any vaccine)
Risk of putting BCG vaccine in a PRETERM CHILD
There will be no adequate subcutaneous tissue. So, there are chances of disseminated BCG due to invasion of periosteum
About Rota vaccine?
What is Catch up vaccination?
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| The above picture is taken from OP Ghai Textbook of Paediatrics |
From what age, iron supplements can be required?
Normally, for first 4-6 months - there is enough iron storage in newborn's body
Iron supplements can become required after 4-6 months.
What is Catch up vaccination?
Catch up vaccination denotes providing vaccines to a child who had missed the Immunization schedule and noticed late.
Schedule for Catch Up vaccination
Catch up vaccines should be given according to IAP guidelines (in India) for each vaccine on catch-up schedule
Schedule for Catch Up vaccination
Catch up vaccines should be given according to IAP guidelines (in India) for each vaccine on catch-up schedule
- BCG - upto 5 years
- HBV - Administer the 3-dose series: use 0, 1, and 6 months schedule
- OPV - upto 5 years, 3 doses each 4 weeks apart
- IPV - upto 5 years, 3 doses each 0,2,6 months
- DTP - (a) below 7 years: DTwP/DTaP at 0, 1 and 6 months; (b) at 7-10 years: Tdap at 0 month, Td at 1 and 6 months; (c) above 11 years: 1 dose of Tdap - one dose of Td every 10 years
- Rota virus vaccine - Vaccination should not be initiated after 15 weeks. The maximum age for the final dose in the series is 8 months.
- MMR - Complete schedule with >4 weeks gap between doses; can use MMR-V for >2 years child
- JE vaccine - All susceptible children up to 15 yrs should be administered during disease outbreak/ ahead of anticipated outbreak in campaigns
Topic 01: Vitamin A (16)
Sources of Vitamin A
Plants - Green leafy vegetables*, carrots, yellow fruits
Animals - Liver, meat, milk products, fish liver oil and cod liver oil, butter, egg yolk, whole milk
Others - Fortified salt, Fortified sugar
Vitamin A deficiency classification (WHO)
Sources of Vitamin A
Plants - Green leafy vegetables*, carrots, yellow fruits
Animals - Liver, meat, milk products, fish liver oil and cod liver oil, butter, egg yolk, whole milk
Others - Fortified salt, Fortified sugar
Vitamin A deficiency classification (WHO)
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| The above picture is taken from Aruchamy Textbook of Paediatrics |
What are Bitot spots?
Small triangular plaque of silver grey colour with a faomy surface, seen in lateral half of bulbar conjuctiva close to limbus.
Size 2-10 mm
Usually bilateral
Occurs in Vitamin A deficiency (stage X1B)
Size 2-10 mm
Usually bilateral
Occurs in Vitamin A deficiency (stage X1B)
Will Bitot spots disappear after treatment?
No. It persists throughout life.
Forms of Vitamin A
1. Capsule
2. Injectable oil
3. Tablet
4. Eye drops
5. Syrup
1. Capsule
2. Injectable oil
3. Tablet
4. Eye drops
5. Syrup
Indication of injectable Vitamin A oil
Given for Vitamin A deficiency when:
1. Persistent vomiting
2. Severe malabsorption
3. Clouding of cornea (emergency)
1. Persistent vomiting
2. Severe malabsorption
3. Clouding of cornea (emergency)
Treatment dosage (oral) - Vitamin A deficiency in a normal child
<6 months - 50000 IU
6-12 months (or) <8 kg --100000 IU
>1 year (or) >8 kg - 200000 IU
Doses on day 0, day 1 and day 28*
Note: For children less than 2 months, 2 lakh IU vitamin A can be given to the breastfeeding mother* (not given in any books - just know)
Treatment dosage (parenteral) - Vitamin A deficiency in a normal child (or) Dosage of Injectable vitamin A oil
Half the oral dose - for age 6-12 months
75% of oral dose - for age <6 months
Treatment dosage - Vitamin A deficiency in a HIV positive child
Same as normal children**
What is the dosage for Emergency Injection to treat clouding of cornea?
50000 to 100000 IU
Prevention dosage - For a SAM child, to prevent Vitamin A deficiency:
Dosage: 100000 IU (<1 year) or 200000 IU (>1 year)
Doses on day 0, day 1, day 14 and every once a month - till SAM recovers
Prevention dosage - For a Measles child, to prevent Vitamin A deficiency:
Dosage: 100000 IU (<1 year) or 200000 IU (>1 year)
Doses on day 0, day 1, day 14
Vitamin A prophylaxis program - current recommended Dosage in Non Endemic area?
2 doses
At 9th month - 100000 IU along with Measles vaccine
At 15-18 months (1.5 years) - 200000 IU along with DPT
Vitamin A prophylaxis program - current recommended Dosage in Endemic area for Vitamin A deficiency?
5 doses
At 9th month - 100000 IU along with Measles vaccine
At 15-18 months (1.5 years) - 200000 IU along with DPT
At 2 years- 200000 IU
At 2.5 years - 200000 IU
At 3 years - 200000 IU
Note: This program is sponsored by Ministry of health and Family welfare.
<6 months - 50000 IU
6-12 months (or) <8 kg --100000 IU
>1 year (or) >8 kg - 200000 IU
Doses on day 0, day 1 and day 28*
Note: For children less than 2 months, 2 lakh IU vitamin A can be given to the breastfeeding mother* (not given in any books - just know)
Treatment dosage (parenteral) - Vitamin A deficiency in a normal child (or) Dosage of Injectable vitamin A oil
Half the oral dose - for age 6-12 months
75% of oral dose - for age <6 months
Treatment dosage - Vitamin A deficiency in a HIV positive child
Same as normal children**
What is the dosage for Emergency Injection to treat clouding of cornea?
50000 to 100000 IU
Prevention dosage - For a SAM child, to prevent Vitamin A deficiency:
Dosage: 100000 IU (<1 year) or 200000 IU (>1 year)
Doses on day 0, day 1, day 14 and every once a month - till SAM recovers
Prevention dosage - For a Measles child, to prevent Vitamin A deficiency:
Dosage: 100000 IU (<1 year) or 200000 IU (>1 year)
Doses on day 0, day 1, day 14
Vitamin A prophylaxis program - current recommended Dosage in Non Endemic area?
2 doses
At 9th month - 100000 IU along with Measles vaccine
At 15-18 months (1.5 years) - 200000 IU along with DPT
Vitamin A prophylaxis program - current recommended Dosage in Endemic area for Vitamin A deficiency?
5 doses
At 9th month - 100000 IU along with Measles vaccine
At 15-18 months (1.5 years) - 200000 IU along with DPT
At 2 years- 200000 IU
At 2.5 years - 200000 IU
At 3 years - 200000 IU
Note: This program is sponsored by Ministry of health and Family welfare.
Vitamin A - Teratogenic dose level
>50000 IU/day of vitamin A ingestion for several months
Why Vitamin A prophylaxis is not given nowadays for child > 3 years?
Only child <3 years are at risk of vitamin A deficiency
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Topic 02: Other Micronutrients (07) (questions without answers)
Prophylactic Vitamin K dosage in normal newborn
What is Hemorrhagic disease of newborn?
>50000 IU/day of vitamin A ingestion for several months
Why Vitamin A prophylaxis is not given nowadays for child > 3 years?
Only child <3 years are at risk of vitamin A deficiency
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Topic 02: Other Micronutrients (07) (questions without answers)
Prophylactic Vitamin K dosage in normal newborn
What is Hemorrhagic disease of newborn?
Vitamin E - Dosage given for preterms
What is Vitamin F?
Vitamin D - Dosage given for newborns
Vitamin D - Dosage given for newborns
Dosage of FOLIC ACID, for 2nd conception if first child dies of neural tube defects
5 mg FA (10 times of normal dose)
During Peri conception period
Dosage of IFA tablets in Children
Dosage of IFA tablets in Children