Trivalent Oral Polio Vaccine (TOPV)

• Two polio vaccines are used throughout the world to combat polio.
The first was developed by Jonas Salk, first tested in 1952, and
announced to the world by Salk on April 12, 1955, it consists of an
injected dose of inactivated (dead) poliovirus.
The second was an oral vaccine developed by Albert Sabin using
attenuated poliovirus, human trials of Sabin's vaccine began in 1957
and it was licensed in 1962.
• Trivalent Oral Polio Vaccine (TOPV or Sabin) and Inactivated Polio
Vaccine (IPV or Salk) protect the child against poliomyelitis.
• Trivalent Oral Polio Vaccine is liquid vaccine that is provided in two
types of containers;
1. Small plastic dropper bottles.
2. Glass vials with dropper in a separate plastic bag.
How safe is TOPV and What Are Its Potential Side-Effect?
 TOPV causes almost no side –effects.
 Less than 1% of people who receive the vaccine develop headache,
diarrhea or muscle pain.
 There is a very small risk of vaccine-associated paralytic polio
(VAPP), with approximately two to four cases having been reported
for every one million.
What is supplementary immunization with TOPV?
A key strategy for polio eradication is supplementary immunization with
OPV. This is usually conducted in large scale campaigns (National
Immunization Days) where two doses of OPV, one month apart, are
given to all children under five years of age regardless of how many
doses they received in the past.

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Notes:
1. Keep the vaccines in a cup containing ice during the vaccination
session.
2. Throw away the vaccine that remains in the vial after every
vaccination session.
3. Vaccine is should not give in cases of other viral infection, to avoid
overlap between the viruses.
4. HIV or impaired immunity should not give OPV so can give Salk
(IPV).
5. Prevent breast feeding before and after OPV for 2 hours to avoid
vomiting and ensures absorption in the digestive system.
6. If child has diarrhea or vomiting or split out when you give OPV,
administer an extra dose – that is, a fifth dose – at least four weeks
after he has received the last dose in the schedule.

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 Administration Summary: TOPV

Type of vaccine Live oral polio vaccine (TOPV)

Number of doses Five in endemic countries (including birth dose)
Schedule At birth, 6,10,14 weeks
In Palestine; 2,4,6,18 month and 6 years
Booster 18 months and 6 years
Contraindication None
Adverse reaction Vaccine-associated paralytic polio (VAPP) very
rarely (approximately 2 to 4 cases per million
children vaccinated).
Special Children known to have rare congenital immune
precaution deficiency syndromes should receive IPV rather than
OPV.
Dosage 2 drops, some vials the dose may be 3 drops
Storage Storage between 2°– 8°C

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 Salk – Inactivated Polio Vaccine
WHO does not – as of July 2003 – recommend the adoption of IPV, either
alone or in a sequential schedule, in the developing countries for the
following reasons:
1. Unresolved issues related to immunogenicity of IPV when
administered at birth, six weeks, ten weeks and 14 weeks of age in the
EPI vaccination schedule.
2. High cost of IPV:
 The operational complexities of introducing a vaccine, which
requires syringes and needles in infants until new combination
products, are available, while OPV is given orally.
 The price of IPV is over 5 times that of OPV.
 Administering of IPV requires trained health workers.
These people should not get IPV:
 Anyone who has ever had a life-threatening allergic reaction to the
antibiotics neomycin, streptomycin or polymyxin B should not
get the polio shot.
 Anyone who has a severe allergic reaction to a polio shot should
not get another one.
These people should wait:
 Anyone who is moderately or severely ill at the time the shot is
scheduled should usually wait until they recover before getting
polio vaccine. People with minor illnesses, such as a cold, may be
vaccinated.
 Safe and can give for pregnant women.

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 Administration Summary: IPV

Type of vaccine Killed – inactivated polio vaccine (IPV)

Number of doses Two doses

Schedule In Palestine; 1,2 month
Booster None
Contraindication None
Dosage 0.5ml
Injection site Outer mid – thigh for infants, outer upper arm for
older children.
Injection type Subcutaneous (S.C.)
Storage Storage between 2°– 8°C

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 Pneumococcal Conjugate Vaccine (PCV)

What is pneumococcal conjugate vaccine?

• Pneumococcal conjugate vaccine (PCV) is a pneumococcal vaccine

used to protect infants and young children against diseases caused by
the bacterium Streptococcus pneumoniae (pneumococcus), diseases
include; pneumonia, ear infections, meningitis, and blood infections.

• Invasive pneumococcal infections can even lead to death in some

children. It is spread through person-to-person contact and is most
common during winter and early spring.

• The dose; four doses of PCV are recommended, they are given at 2, 4,
6 months, and again between 12 and 15 months.

• There are two types of pneumococcal vaccine — pneumococcal

polysaccharide vaccine (PPSV) and pneumococcal conjugate vaccine
(PCV).
• The first pneumococcal polysaccharide vaccine, containing 14
serotypes, was licensed in the United States in 1977.
In 1983, an improved pneumococcal polysaccharide vaccine was
licensed, containing purified protein from 23 types of pneumococcal
bacteria.
• The first pneumococcal conjugate vaccine (PCV7) was licensed in
early 2000. Ten years later, in 2010, a new pneumococcal conjugate
vaccine product (PCV13) was licensed and replaced PCV7 for use in
the routine vaccination of children. PCV13 offers additional protection
against the types of pneumococcal bacteria that cause the majority of
invasive pneumococcal diseases. PCV13 is recommended for use in
preventing pneumococcal diseases in infants and young children,
beginning as young as 6 weeks.

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What kind of vaccines?

• Both pneumococcal vaccines are made from inactivated (killed)

bacteria.
• The pneumococcal polysaccharide vaccine (PPSV) contains long
chains of polysaccharide (sugar) molecules that make up the surface
capsule of the bacteria. Generally speaking, a pure polysaccharide
vaccine induces only short-term immunity and doesn’t work as well in
children younger than 2 years.
• The pneumococcal conjugate vaccine (PCV) includes purified
capsular polysaccharides from the bacteria that are "conjugated"
(or joined) to a harmless variety of diphtheria toxin. The resultant
conjugate vaccine is able to produce an immune response in infants
and antibody booster response to multiple doses of vaccine.

How Safe is PCV And What Are its Potential Side – Effects?
 About half of children were drowsy after the shot, had a temporary
loss of appetite, or had redness or tenderness where the shot was
given.

 About 1 out of 3 had swelling where the shot was given.

 About 1 out of 3 had a mild fever, and about 1 in 20 had a higher

fever.
 Up to about 8 out of 10 became fussy or irritable.
 Signs of a severe allergic reaction can include; difficulty breathing,
hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or
dizziness.

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 Pneumococcal Conjugate Vaccine

Type of vaccine Polysaccharide - Conjugate

Number of doses Four – five doses.
Schedule In Palestine; three doses 2,4,12 month
Booster None
Contraindication Severe allergic reaction (e.g., anaphylaxis) after
a previous dose (of PCV, or any diphtheria toxoid-
containing vaccine) or to a component of a vaccine
(PCV or any diphtheria toxoid-containing vaccine)

Moderately or severely ill should usually wait until

they recover before getting the vaccine.
Adverse reaction Drowsy, temporary loss of appetite, or had redness
or tenderness, sometime irritable
Special precaution None
Dosage 0.5ml
Injection site Outer mid-thigh in infant / outer upper arm if older
Injection type Intramuscular
Storage Store between 2°– 8°C

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 Diphtheria and Tetanus toxoid and Acellular Pertussis
(DTaP) vaccine
What is DTaP vaccine?
• Diphtheria – Tetanus – Pertussis vaccine is made from:
- Diphtheria toxoid (prepared by formalin inactivation of diphtheria
toxin);
- Tetanus toxoid (a preparation of formalin inactivated toxin); and
- A variable number of purified acellular component antigens of
pertussis.
• It is a liquid vaccine, if a vial DTaP vaccine stands for a long time,
fine particles may separate from the liquid, they look like fine sand at
the bottom of the vial, so before giving the vaccine shake the vial to
mix the vaccine and liquid.
• DTaP vaccine should never be frozen because it damages Diptheria
Toxiod and Tetanus Toxiod, but sunlight damages pertussis.
Some children should not get DTaP vaccine or should wait
1. Children with moderately or severely ill should usually wait until they
recover before getting DTaP vaccine.
2. Any child who had a life-threatening allergic reaction after a dose of
DTaP should not get another dose.
3. Any child who suffered a brain or nervous system disease
(Convulsions) within 7 days after a dose of DTaP should not get
another dose of pertussis vaccine, but may get a vaccine without
pertussis (called DT).
In Older children and adults
• DTaP is not licensed for adolescents, adults, or children 7 years of age
and older, instead they are given a vaccine called Tdap which is
similar to DTaP, a single dose of Tdap is recommended for people 11
through 64 years of age.

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• Another vaccine, called Td, protects against tetanus and diphtheria,
but not pertussis. It is recommended every 10 years.
How safe is DTaP vaccine and what is its potential side effects?
Usually; reactions to DTP vaccine are mild and the side effects including:
 Fever; up to half of the children who receive DTP vaccine may have
a fever in the evening after receiving the injection, this fever should
disappear within a day.
 A fever that begins more than 24 hours after DTP injection is not
likely to be a reaction to the vaccine. Administrating paracetamol
or any appropriate antipyretic at time and at four and eight hours
after immunization decreases the subsequent incidence of febrile
and local reaction.
 Soreness; up to half of the children may have pain, redness or
swelling at the injection site.
 Crying; for more than three hours (mostly because of pain) can be
observed in up to1% of infant.
More serve reactions:
• Convulsions; usually related to fever (1 case in 12500 doses
administrated).
• Hypotonic – hyporesponsive episode (1 case in 1750 doses
administrated)
• Anaphylactic reaction are extremely rare.
• There is no evidence that the vaccine causes any serious neurological
disorder such as encephalopathy.

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 Administration summary: DTaP Vaccine

Type of vaccine Diphtheria, Tetanus as Toxoid, and a cellular Pertussis

as killed whole cell bacterium
Number of doses Six doses
Schedule In Palestine; 2,4,6 (PENTA),18 month
Booster 2 doses; DT at 6 years & Td at 15 years
Contraindication Anaphylactic reaction to previous dose or to any
constituent.
Adverse reaction Mild local or systemic reactions are common
Special precaution DTaP not usually given over 6 years of age
Dosage 0.5 ml
Injection site Outer mid-thigh in infant / outer upper arm if older
Injection Site Intramuscular
Storage Store between 2°– 8°C and should never frozen

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 Tetanus Toxoid (TT) vaccine
What is TT vaccine?
• Tetanus Toxoid (TT) vaccine protects against tetanus, it is provided as
a liquid in vials and also in prefilled injection devices.
• It is available in a number of different formulations:
1) TT: vaccine protects only against tetanus and neonatal tetanus.
2) DTP: vaccine protects against Diphtheria, Tetanus, and Pertussis.
3) DT: vaccine protects against Diphtheria, Tetanus; because it contains
a high level of diphtheria toxoid, it should not be given to children
older than six years old or adults.
4) Td: Tetanus- diphtheria toxoid for adult dose vaccine, is the same
vaccine as DT, but with a lower diphtheria toxoid dose. It is suitable
for children older than six years old and adults, including pregnant
women. Td has the added advantage of protecting against diphtheria
and tetanus.
• When given to women of child bearing age, vaccines that contain
tetanus toxoid (TT or Td) not only protect women against tetanus, but
also prevent neonatal tetanus in their newborn infant through
antibodies that passed from mother to her fetus.
• TT/Td given intramuscular in upper part of left arm (0.5ml).
• When vaccines containing tetanus toxoid stand for a long time, the
vaccine separates from the liquid and looks like fine sand at the
bottom of the vial. Shake the vial to mix the vaccine and liquid again
before giving the vaccine.
• TT/Td/DTP/ DTaP vaccines should never be frozen.

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Some people should not get T.T vaccine or should wait:

1. Anyone who has a severe allergy to any component of a vaccine

should not get that vaccine.
2. Anyone who has had a life-threatening allergic reaction after a dose of
DTP, DTaP, DT, or Td should not get another dose.
3. Anyone who had a coma, or long or multiple seizures within 7 days
after a dose of DTP should not get another dose.
4. Talk to your provider if the person getting either vaccine:
- has epilepsy or another nervous system problem.
- has had Guillain Barré Syndrome (GBS).
- had severe swelling or severe pain after a previous dose of DTP, DT,
Td vaccine.
5. Anyone who has a moderate or severe illness on the day the shot is
scheduled should usually wait until they recover before getting Td
vaccine.
6. A person with a mild/ illness or low fever can usually be vaccinated.
How safe are TT, Td and DT vaccines and what are their potential
side-effects?
Vaccines containing tetanus toxoid cause little serious reaction but quite
frequent mild reactions.
Mild reactions to TT, Td and DT vaccines include:
 Soreness; about 1:10 people who receive the vaccines have mild pain
 Redness; warmth and swelling at the injection site for about one to
three days after the injection. This mild reaction is likely to be more
common after later doses than earlier ones, and may affect between
50% and 85% of people who receive booster doses.
 Fever; about one in ten people may develop a mild fever after
receiving the vaccines.

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