PENTAVALENT VACCINE

Type of Vaccine
Killed
Liquid form (liquid pentavalent vaccine) is available under UIP.

COMPOSITION
Each dose of 0.5 ml contains
1. Diphtheria Toxoid
2. Tetanus Toxoid
3. B. pertussis (whole cell)
4. HBsAg (rDNA)
5. Purified capsular Hib Polysaccharide (PRP)

Number of doses per vial
The liquid pentavalent vaccine (LPV) in the UIP (Universal Immunization Program, India) is available as a multi-dose vial with 10 doses per vial.

List the 5 diseases against which this vaccine protects.
Pentavalent vaccine provides protection to a child from 5 life-threatening diseases –
1. Diphtheria,
2. Pertussis,
3. Tetanus,
4. Hepatitis B and
5. Hib (Haemophilus influenzae type b)

Schedule of immunization under UIP
As per the National Immunization Schedule, three doses of pentavalent vaccine are to be administered at 6, 10 and 14 weeks of age.

Dose
0.5 ml injection using AD syringes

Route of administration
Intra muscular
Site of injection
Anterolateral aspect of mid-thigh LEFT

Reconstitution
Reconstitution is not required as the vaccine is already in liquid form

Contraindications
1. Severe allergic reactions: a child who has had a severe reaction to pentavalent vaccine earlier should not be given another dose.
2. Children with moderate or severe acute illness. However, minor illnesses such as upper respiratory infections (URI) are NOT a contraindication to vaccination.

Is a booster dose recommended under UIP?
Currently a booster dose is NOT recommended for pentavalent vaccine under UIP. This is because the Hib vaccine provides protection for at least 15 years
However the boosters for DPT are recommended at 16-24 months and 5-6 yr. of age.

Storage
Pentavalent vaccine should be stored at temperature of 2-8 degree Celsius, in the basket of Ice-Lined Refrigerator (ILR) and
It should never be frozen as pentavalent vaccine is freeze sensitive
Conditioned ice packs should be used during transportation to prevent freezing

Age group for vaccination under UIP
Hib containing pentavalent vaccine in India is recommended for infants from 6 weeks to less than 1 year of age.

What are the common side-effects of pentavalent vaccine?
• Local swelling, pain and redness
• Fever > 38⁰C
Other common systemic reactions
• Irritability
• Malaise, “off-color” and
• Loss of appetite

How can these be managed?
A feverish child can be cooled with a tepid sponge or bath, and by wearing cool clothing. Extra fluids need to be given to feverish children.
For the local reaction, a cold cloth applied to the site may ease the pain
Paracetamol, at a dose of up to 15mg/kg every 6–8 hours with a maximum of four doses in 24 hours is useful for the common minor reactions. It eases pain and reduces fever.

List the severe side effects of pentavalent vaccine which may occur rarely.
Some severe but rare adverse effects following vaccination with pentavalent vaccine are:
• Persistent (>3 hours) inconsolable screaming
• Seizures
• Hypotonic, hypo responsive episode(HHE)
• Anaphylaxis
• Encephalopathy

Protective efficacy
85% to 95% protection after completion of the schedule
The vaccination also reduces nasopharyngeal carriage of the H. influenzae, leading to substantially greater reduction in disease transmission and incidence. This indirect effect or ‘herd immunity’ has been demonstrated in post introduction studies2.

Is the vaccine eligible for ‘Open Vial Policy’ under UIP?
Yes

Why was the need felt to introduce Hib vaccine into the National immunization schedule under UIP?
The need was felt because H. influenzae infection was considered as a public health problem since it causes serious diseases that can result in death and disability.
Hib vaccine dramatically reduces the incidence of pneumonia and meningitis due to H. influenzae.
In addition, it also reduces nasopharyngeal carriage of Hib bacteria.

List some serious diseases caused by Haemophilus influenzae type b (Hib).
Serious diseases caused by Haemophilus influenzae type b are
• Pneumonia (one of the major causes of child deaths in India)
• Meningitis
• Bacteraemia
• Epiglottitis
• Septic arthritis
• Osteomyelitis

After introduction of pentavalent vaccine, will DPT and Hep B be required as per UIP?
Yes, Hep B birth dose (within 24 hours) for institutional deliveries and DPT boosters at 16–
24 months and 5–7 years will continue as before under the National program

References:
1. GOI. Immunization Handbook for Medical Officers. New Delhi: Department of Health and Family Welfare; 2016.
2. Park K. Epidemiology of communicable diseases. In: Park's Textbook of Preventive and Social Medicine, 24th ed. Jabalpur, India: M/S BanarasidasBhanot Publishers; 2009.
3. GOI 2013. Operational Guidelines. Introduction of Haemophilus influenzae b (Hib) as Pentavalent Vaccine in Universal Immunization Program of India. Ministry of Health & Family Welfare
4. GOI 2012. Pentavalent Vaccine, Guide for Health Workers. Ministry of Health & Family Welfare
5. Vaccines, Biological E Limited Website. Available at: http://www.biologicale.com/pdf/ProductList.pdf accessed on 10th October 2017

National Immunization Schedule in India; 2017: http://www.ihatepsm.com/blog/national-immunization-schedule-india-2017

Rotavirus vaccine: http://www.ihatepsm.com/blog/rotavirus-vaccine

Pentavalent vaccine: http://www.ihatepsm.com/blog/pentavalent-vaccine

BACILLE CALMETTE GUERIN (BCG) VACCINE: http://www.ihatepsm.com/blog/bacille-calmette-guerin-bcg-vaccine

IPV (INACTIVATED POLIOVIRUS VACCINE): http://www.ihatepsm.com/blog/ipv-inactivated-poliovirus-vaccine

DT & TT Vaccines: http://www.ihatepsm.com/blog/dpt-and-tt-vaccines

Oral Polio Vaccines (OPV): http://www.ihatepsm.com/blog/oral-polio-vaccines-opv

Measles Containing Vaccines (MCV): http://www.ihatepsm.com/blog/measles-containing-vaccines-mcv

HEPATITIS B VACCINE: http://www.ihatepsm.com/blog/hepatitis-b-vaccine

JAPANESE ENCEPHALITIS (JE) VACCINE: http://www.ihatepsm.com/blog/japanese-encephalitis-je-vaccine

Pneumococcal Conjugate Vaccine (PCV): http://www.ihatepsm.com/blog/pneumococcal-conjugate-vaccine-pcv

RABIES VACCINE: http://www.ihatepsm.com/blog/rabies-vaccine