The

pentavalent vaccine which was introduced in Nepal from April 2009 is a combination of five vaccines in one against the diseases: diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenza type b (the bacteria that causes meningitis, pneumonia and otitis). has also led to a reduction in cases of immuno-preventive illnesses, especially meningitis caused by Haemophilus influenza type b.

It

 The

National Immunization Programme (at the time known as the Expanded Programme on Immunization - EPI) was initiated in 1979 in three districts with only two antigens (BCG and DPT) and was rapidly expanded to include all 75 districts with all six recommended antigens (BCG, DTP, OPV, and measles) by 1988. In 2003, with the support of Alliance, monovalent Hepatitis vaccine was introduced, which administered as a single tetravalent injection. the GAVI B (HepB) was later (DPT-HepB)

 In2009,vaccinationagainst

Haemophilus influen zae type b was introduced through out the nation in a phase wise manner starting in Far Western (FWDR) and Western (WDR) Development Regions.
Also in 2009, Japanese encephalitis (JE) vaccine was introduced into the routine immunizationprogramme in 16 JE endemic districts following JE mass vaccination campaigns

 Pentavalent

is a conjugate adsorbed vaccine containing five antigens Diphtheria , Pertussis , Tetanus , Hepatitis B and Hib (Haemophilus influenzae type b).
is a homogenous liquid containing purified diphtheria and tetanus toxoids, inactivated whooping cough (pertussis) organisms, highly purified, non-infectious particles of Hepatitis B surface antigen (HBsAg) and Hib component as a bacterial subunit vaccine containing highly purified, noninfectious Haemophilus Influenza type b (Hib) capsular polysaccharide chemically conjugated to a protein (Tetanus Toxoid)

It

 It

shouldnot be frozen. It should be stored in a refrigerator between 4 to 8 degree celsius. The vaccine should be used before the date of expiry indicated on vial. When issued to a subcentre,the vaccine should be used within a week. The vaccine will lose potency if kept at room temperature over a longer period of time.

Pentavalent can be used in future immunization session for up to a maximum of 4 weeks, provided that all of the following conditions are met1. The expiry date has not passed. 2. The vaccines are stored under appropriate cold chain conditions. 3. The vaccine vial septum has not been submerged in water. 4. Aseptic technique has been used to withdraw all doses 5. The vaccine vial monitor (VVM), if attached, has not reached the discard point (see figure).

The vaccine should be visually inspected for any foreign particulate matter and/or variation of physical aspect prior to administration. In event of either being observed discard the vaccine.

 Vaccine

vial monitors (VVMs) are part of the

label. The color dot which appears on the label of the vial is a VVM. This is a time temperature sensitive dot that provides an indication of the cumulative heat to which the vial has been exposed. It warns the end user when the exposure to heat is likely to have degraded the vaccine beyond an acceptable level.

 The

interpretation of the VVM is simple. Focus on the central square. Its colour will change progressively. As long as the color of this square is lighter than the colour of the ring, then the vaccine can be used. As soon as the colour of the central square is the same colour as the ring or of a darker colour than the ring, then the vial should be discarded.

 For

active immunization of infants and preschool children, it is recommended that three deep intra muscular injection of 0.5 ml be administered with an interval of four weeks between doses. (i.e.6,10,14 weeks)
of the priciple recommendation of 1984,Global Advisory Group is that for child under one year of age it should be administered in lateral aspect of thigh.

One

booster dose of Diphtheria, Tetanus, Pertussis, Hepatitis B and Haemophilus Influenza type b Conjugate Vaccine Adsorbed can be given at the age of 15-18 months.

 Fever

and mild local rxns are common. It is estimated that 2 to 6 % of vacinees develop fever of 39 degree celcius or higher. 5 to 10% experience swelling and induration or pain lasting more than 48 hrs. Most severe complications are neurological (encephalitis/encephalopathy, prolonged convulsions , infantile spasms and Reye syndrome) The type and rate of severe adverse reactions do not differ significantly from the DTP, HepB and Hib vaccine reactions described separately.

 Individuals

infected with the human immunedeficiency virus (HIV), both asymptomatic and symptomatic, should be immunized with combined vaccine according to standard schedules.

 Any

children who are seriously ill or need hospitalization. It should not be repeated if a severe rxn occur after a previous dose.(such rxns include collapse or shock like state,persistent screaming episodes,temperatur above 40 degree C, convulsions ,other neurological symptoms and anaphylactic reactions)

 Known

hypersensitivity to any component of the vaccine, or a severe reaction to the previous dose of the combination vaccine or any of its constituents is an absolute contraindication to subsequent doses of the combination vaccine or the specific vaccine knows to have provoked an adverse reaction. In this case the vaccine should not be given as a combination vaccine but DT should be given instead of DPT and Hep B and Hib vaccines given separately.

ADRENALINE INJECTION (1:1000) MUST BE IMMEDIATELY AVAILABLE SHOULD AN ACUTE ANAPHYLACTIC REACTION OCCUR DUE TO ANY COMPONENT OF THE VACCINE. For treatment of severe anaphylaxis the initial dose of adrenaline is 0.1 0.5mg (0.1 0.5 ml of 1:1000 injection) given s/c or I/m. single dose should not exceed 1mg (1 ml) For infants and children the recommended dose of adrenaline is 0.01 mg/kg (0.01ml/kg of 1:1000 injection). Single pediatric dose should not exceed 0.5 mg (0.5ml). The mainstay in the treatment of severe anaphylaxis is the prompt use of adrenaline, which can be life saving.