Few Notes on ZERO Dose Immunization

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ZERO Dose Immunization

All Children delivered in Govt. Institutions must receive the OPV,BCG & Hep-B vaccination without fail.

Oral Polio Vaccine

“zero dose” at birth and its importance?

·         OPV is a live vaccine, consisting of attenuated poliovirus serotypes 1, 2 and 3. It is given at birth, or soon after birth.

·         OPV given at birth (OPV 0) is known as zero-dose because it does not count towards the primary series.

·         OPV zero dose is so called because just after birth baby has maternal antibodies. But its own immune system is yet to develop properly, so doesn’t have intestinal immunity (local absence of lymphoid tissue in the intestines), as this immunity is zero. Hence the name “zero dose” for zero intestinal immunity.

·         OPV is given at birth to increase the level of poliovirus neutralising antibodies and seroconversion rates induced by subsequent doses of the polio vaccine, and to induce mucosal protection.

·         OPV strains produce a local immune response in the lining of the intestines - the primary site for poliovirus multiplication. The antibodies produced there inhibit the multiplication of subsequent infections of wild virus, thereby reducing transmission rates.

·         Dose: 2 drops of Oral Polio Vaccine immediately after birth.

BCG Vaccine (Bacillus Calmette Guerin)

Only effective Vaccine against Tuberculosis

Ø Miliary Tuberculosis : 50-80 % protection

Ø Tubercular Meningitis: 50-80 % protection

Ø Pulmonary Tuberculosis: <50%

Ø Early administration of the Vaccine provides early protection.

Ø Adverse events are less frequent during the Newborn period.

Ø Utilise the opportunity of the Infant being available in the hospital ie. (Institutional delivery)

Dose:  0 .1 ml at all ages

Site:     Left shoulder at the insertion of the deltoid.

Route:  Intradermal

Ø Vaccine is reconstituted with sterile normal saline.

Ø Vaccine potency, drops rapidly after reconstitution

Ø Unused Vaccine should be discarded after 4 hours

Ø Note the time & date of reconstitution on the vial.

Ø Vaccine should be used as early as possible after reconstitution.

Ø Spirit should not be used before and after administration of BCG

Ø Majority of the children will show a positive reaction to tuberculin test 4-12 weeks after Immunization.

Hepatitis – B Vaccination

Ø Of the 2.6 crore (26 million) Infants born every year in India, approximately 10 lakh(1 million) run the life time risk of developing chronic HBV infection.

Ø Risk for chronic infection is related to age at infection: approximately 90% of infected infants become chronically infected, compared with 2%–6% of adults. Chronic Hepatitis B can lead to serious health issues, like cirrhosis or liver cancer.

Ø The best way to prevent Hepatitis B is by getting vaccinated as early as possible ie. Soon after birth.

Ø HBsAg carriers are likely to suffer from cirrhosis and liver cancer and may die prematurely.

·        Hepatitis Vaccine: Dose-.5 ml.

·        Route of Administration: Intramuscular, Anterio lateral aspect of the Thigh.

Ø It prevents Horizontal transmission, Vertical transmission (Closed Contacts like mother to child)

Ø Protection from Chronic Hepatitis, Cirrhosis, Hepatocellular Carcinoma.

Note: Safe injection practice must be followed at all immunization sites.

Usage of AD Syringes, Hub cutters, Hypo Chloride solution, & black & red bags.

Vitamin ‘k₁ ’ Injection

Vitamin K₁ – phytonadione

·         Plays vials role in production of Vitamin K dependent coagulation factors i.e factor II, VII, IX, X protein C & Protein S.

·         Classic Vitamin K deficiency occurs in 0.25 – 1.7% of infants.

·         Late Vitamin K deficiency occurs 20 cases / 1,00,000 live births.

·         Vitamin K deficiency due to

Low transmission of Vitamin K across the placenta.

Paucity in the breast milk

Sterile intestines – paucity of the colonic bacteria

Premature lever  

·       Vitamin ‘K ’deficiency can lead to intra cerebral haemorrhages and  death.  

·         Prophylaxis against haemorrghagic deceases of the New Born is essential.

·         Administration of Vitamin K

Vitamin K₁ – phytonadione

Dose 1m.g

Route of administration sub-cutaneous 

Use 26 needle with syringe for administration

Site: Middle - Anterio lateral aspect of the thigh

Single dose should be given immediately after delivery in labour room