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Evolution of Immunization Programme in India with recent update

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Presentation on evolution of Immunization In India, an overview

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Evolution of Immunization Programme in India with recent update

  1. 1. NATIONAL IMMUNIZATION PROGRAMME AND RECENT ADVANCES IN IT. Name of Presenter Dr. Rama Shankar PG resident Name of Moderator Dr. Nirankar Singh Professor Department of Community Medicine Muzaffarnagar Medical College 27/4/20161
  2. 2. Outline of the Presentation• Introduction • Timeline of vaccination efforts in India ( Ancient time-till 1977) • National Immunization Programme in India ( 1978 onwards) • Micro planning • Cold Chain • Immunization coverage • AEFI • Online Support • Recent advances • Summary • References 2
  3. 3. Introduction • Vaccination is a proven and the most effective child survival interventions. • There are at least 27 causative agents against which vaccines are available & more agents are targeted for development of vaccine. • The first vaccine ( small pox) was discovered in 1798 and the success can be seen in the form of eradication of smallpox disease from the planet. • Immunization avert 2 to 3 million deaths every year but still 18.7 million infants worldwide are missing out of basic vaccines • Every year in India, 5 lakh children die due to VPD. 89 lakh children remain at risk because they are either not immunised or partial immunised. • Full Immunization is critical if we need to reduce the mortality.
  4. 4. Brief History of Immunization in India • Ancient times till first documented smallpox vaccination in India in 1802 • Vaccination in India (1802-1899) • Vaccination in India (1900-1947) • Vaccination in India (1947-1977) 4
  5. 5. 18 Ancient time: Smallpox known to people - 3000 BC: Smallpox is believed to have originated from India or Egypt. - 300BC: Description of smallpox in Sanskrit literature 1000 AD: Inoculation documented from China and India also 910 AD: Smallpox differentiated from Measles by Abu Bakr • 1545: Smallpox outbreak reported from Goa, India • 1600: Documented evidences of practice of inoculation ( variolation) from India. • 1767: Dr. Holwell described practice of inoculation in India to college of physicians in London - 1774:Benjamin Jesty did experiment on his wife and two children by injecting cow-pox matter. - 1796: Edward Jenner conducted the famous observation on milk maids. - 1798: Jenner's observations were published and smallpox vaccine was discovered 1802: First smallpox vaccination done in India. 5
  6. 6. 18 1804: The practice of inoculation was banned in some provinces of India - 1820s: Vaccination continued to increase in India specially Bombay and Bengal presidency. - 1830s-1850s: Some initial research on smallpox vaccination conducted in India. - 1850s: Initial resistance to smallpox vaccination due to multiple reasons 1810: Gennaro Galbiati , an Italian physician used cows for vaccine production • 1870:Animal vaccine production in USA. First vaccine farm in Lakeview, New Jersey USA. • 1879: First Laboratory vaccine produced by Louis Pasteur for Chicken Cholera. • 1890: First animal vaccine depot was set up in Shillong. • 1892: Compulsory Vaccination Act passed by GOI. • 1893: Cholera vaccine trial conducted in Agra, India. • 1896: Epidemic act was passed in the wake of plague epidemic in India 1898: Initial Stringent regulations for vaccine production released 1899: Plague Laboratory was set up in Bombay ( later renamed as Haffkine Institute in 1925). 1897: First plague vaccine was developed by Dr.Haffkine in Laboratory, in Bombay 6
  7. 7. 18 1902: A few deaths were reported after plague vaccination in Punjab Province of India, major set-back to plague vaccination and at the reputation of Haffkine ( years later, death were found due to programmatic error). 1909: Lucien Camus develop first air dried smallpox vaccine in Paris 1958: WHA passed a resolution to eradicate smallpox. • 1910-1930: A number of vaccine institutes set up in different provinces of the country. • 1948: BCG Laboratory in Guindy, Madras set up. BCG vaccination started at pilot level. • 1951: BCG mass campaign were started in India. 1974: WHO announces EPI 1975: Last case of smallpox was reported 1962: National Smallpox Eradication Programme launched. National Tuberculosis control Programme started with BCG vaccine being offered to the people. 1904-1908:Typhoid vaccine trial was done on British Army officials posted to India ( and Egypt also) 1977: Last case of smallpox was reported from the world 1977: India declared smallpox free. 7
  8. 8. 18• 1978: EPI Launched In India. • 1980: World Declared smallpox free. It becomes the first disease to be eradicated from the planet. • 1988: WHA passes a resolution to eradicate polio by the year 2000. • 1989: First comprehensive review of UIP in India conducted. • 1990: UIP universalised to cover the entire country. • 1991: Cold chain maintenance was taken over by the state governments. • 2000: Border District Cluster Strategy for Immunization strengthening in border districts implemented. Immunization strengthening Project (ISP) implemented. • 1992: UIP became part of CSSM in the country. Another international review of UIP in India conducted. • 1995: India conducted first NID for polio eradication. • 1997: UIP became part of RCH. NPSP launched • 1985: UIP launched in 31 districts of India with a plan for expansion to the entire country. • 1986: Immunization became one of the five National Technology Missions in India. • 2001: NTAGI in India formed. • 2004: International review of UIP conducted. • 2003/2004: First Maternal and Neonatal tetanus elimination (MNTE) validation done. • 2005: UIP became part of NRHM. First MYP for UIP in India (2005-2010) released. AEFI surveillance and response operational guidelines released. • 2005/06: The glass syringes in UIP was replaced by the policy of the use of AD syringe only. • 2006: Country conducted first immunization weeks for improving coverage with UIP antigens in poor performing districts. 8
  9. 9. 18 2007/08: National, State and Districts level AEFI committee constituted. State and districts level training in AEFI conducted 2009: Guidelines for the involvement of private practitioner in UIP released. National Vaccine Wastage Survey conducted. 2011: Last wild polio virus case reported from India. National Vaccine Policy of India released. Open Vial Policy was implemented for select vaccines in UIP. 2010: Indian became the last country of the world to introduce measles second dose in the national immunization programme; 21 states provided MCV 2 in RI and rest of the states started conducting measles catch up campaigns. 2008: Immunization Handbook for Medical Officer released and training started. National cold chain assessment conducted 2012: Draft comprehensive MYP for UIP (2012-2017) ready. Declared as Year of Intensification of Routine Immunization in India. WHO removed India from endemic countries. 2014: WHO declared SEAR polio free on 27th March 2014. Mission Indradhanush launched on 25th December 2014. • 2015/16: 1st Phase of Mission Indradhanush ( 4 rounds ). First in April, 2nd in May, 3rd in June and 4th in July 2015 starting 7th of each month. • 2nd Phase of Mission Indradhanush ( 4 rounds). First in October, 2nd in November, 3rd in December and 4th in Jan 2016 starting 7th of each month. tOPV-bOPV switch on 25th April 2016. 9
  10. 10. 10 National Immunization Schedule Pregnant Women TT-1 Early in Pregnancy TT-2 4 weeks after TT-1 TT Bosster If received 2 dose of TT in pregnancy within the last 3 years Children Age Earlier Immunization Schedule Immunization schedule (post pentavalent/IPV/Rota/bOPV Introduction At Birth BCG, OPV (0 dose), Hep B ( Birth dose) BCG, bOPV (0 dose), Hep B ( Birth dose) 6 weeks OPV-1, DPT-1, Hep B-1 bOPV-1, Pentavalent-1 ( Rota) 10 weeks OPV-2, DPT-2, Hep B-2 bOPV-2, Pentavalent-2 ( Rota) 14 weeks OPV-3, DPT-3, Hep B-3 bOPV-3, Pentavalent-3 ( IPV, Rota) 9 months MCV-1 JE-1 ( Where Applicable) MCV-1 JE-1 ( Where Applicable) 16-24 months DPT- booster first dose, MCV-2, OPV booster dose, JE-2 ( where applicable) DPT- booster first dose, MCV-2, bOPV booster dose, JE-2 ( where applicable) 5-6 years DPT-booster second dose DPT-booster second dose 10 years TT first booster dose TT first booster dose 16 years TT second booster dose TT second booster dose
  11. 11. Vaccine Dose Diluent Route Site TT 0.5 ml No IM Upper Arm BCG 0.1 ml (0.05 ml) Sodium Chloride ID Left upper arm Hepatitis B 0.5 ml No IM Antero-lateral part of mid thigh (left) OPV 2 drops No Oral Rota 5 drops NO Oral IPV 0.5 ml No IM Antero-lateral part of mid thigh Right Pentavalent 0.5 ml No IM Antero-lateral part of mid thigh ( Left) Measles 0.5 ml Distil Water SC Right upper arm JE 0.5 ml Phosphate Buffer SC Left upper arm DPT 0.5 ml No IM Antero-lateral part of mid thigh ( Left) 11
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  13. 13. Presentation and Dosage form - IPV is a liquid vaccine - No reconstitution is required - In UIP it will be available in 5 or 10 dose vial - VVM present on vial - IPV is freeze sensitive vaccine - Shake test not applicable Vaccine Cost IPV is an expensive vaccine Each dose is (Approx)Rs 120-150 Each 5 dose vial is Rs 600 Each 10 dose vial is Rs 1200 13
  14. 14. 14
  15. 15. RI Microplanning: A Snapshot 15 Calculation of monthly working stock requirement for each antigen in doses as under; BCG= YIT X1 dose X2.0 ( wastage )/12 DPT= YIT X2 dose X1.11 ( wastage )/12 OPV= YIT X 5 dose X 1.11 ( wastage )/12 IPV=YIT X1 dose X 1.11 ( wastage )/12 MCV=YIT X2 dose X 1.33 ( wastage )/12 TT= YT(PW) X3.5 dose X 1.11 ( wastage )/12 Hep B=YIT X1 dose X 1.11 ( wastage )/12 LPV= YIT X3 dose X 1.11 ( wastage )/12 JE= YIT X2 dose X 1.33 ( wastage )/12 RVV=YIT X 3 dose X 1.33 ( wastage )/12 For Syringes 0.1 ml syringes: YIT, X 1 X 1.11/12 0.5 ml syringes: YIT X ( 1 {Hep B}+ 2 {DPT}+3 {LPV}+1 {IPV}+2 {MCV}+2 {JE}+3.5 {TT}) X 1.1/12 5 ml Syringe: Annual Requirement (BCG+MCV+JE) Wastage rate: (Dose Issued- Dose administered ) X100/Dose Issued WMF=100/100-WR e.g BCG, DI=10 and DA is 5 then WR=(10-5)X100/10=50% WMF=100/100-50=2 * Yearly infant target
  16. 16. Immunization supply levels in India MOHFW Immunization Division Manufacturer GMSD (4) ( Primary Vaccine Store) State vaccine store (53) District Vaccine Store (666) PHC/UHC Last cold chain point AVDS Session site outreach Block Vaccine Store (CHC/PHC) Regional Vaccine store (110) 25,555 16
  17. 17. - BCG ( After reconstitution) - OPV, Rotavirus vaccine - IPV - Measles ( Before and after reconstitution) - JE ( Before and after reconstitution) - DPT - BCG (( After reconstitution) - TT/Pentavalent , Hep B Least Sensitive Most Sensitive Heat Sensitivity - Hep B - Pentavalent - IPV - DPT - TT Freeze Sensitivity 17
  18. 18. Cold Chain Equipment Storage Transportation Electrical Solar Non-Electrical WIC WIF ILR DF DR Solar refrigerator Battery Solar Refrigerator Direct Drive Cold Box/Vaccine Carrier Refrigerated Vaccine van Insulated Vaccine van Cold box Vaccine carrier 18
  19. 19. Deep Freezer Make Model Net storage No. of icepacks storage capacity Size Haier HBD-286 200 350 Large Haier HBD-116 80 140 Small Vestfrost MF-314 264 380 Large Vestfrost MF-114 72 130 Small ILR Vestfrost MK-304 108 NA Large Vestfrost MF-114 45 Small Haier HBD-200 100 Large Haier HBD-70 50 Small In right quantity In right quality In right time In right temperature In right place To right beneficiary 19
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  21. 21. 21 • All waste generated before vaccination should go in Black Bag. • All waste generated after vaccination should go in Red Bag • All broken vials/diluents should go in Hub Cutter
  22. 22. 36 62 54 52 4242 72 63 55 5144 78 78 55 59 0 20 40 60 80 100 FullImmunization BCG(%) 3doseofOPV(%) 3doseofDPT(%) 1doseofMCV(%) NFHS 1 NFHS 2 NFHS 3 22
  23. 23. 54 73 68 66 5046 75 57 58 5654 87 66 64 70 0 22.5 45 67.5 90 112.5 FullImmunization BCG(%) 3doseofOPV(%) 2doseofDPT(%) 1doseofMCV(%) DLHS 1 DLHS 2 DLHS 3 23
  24. 24. 61 87 83 78 70 83 78 72 74 0 22.5 45 67.5 90 112.5 FullImmunization BCG(%) OPV1 OPV2 OPV3 DPT1 DPT2 DPT3 MCV1 CES 2009 24
  25. 25. 62 92 73 80 79 66 0 25 50 75 100 FI BCG (%) 3d OPV 3 d DPT MCV 1 3 d Hep B BIHAR
  26. 26. 0 22.5 45 67.5 90 DPT Polio Measles Hep-B Peumococcal Rotavirus 86 86 85 82 31 19 vaccine Global Immunization coverage 2014 26
  27. 27. Importance of Immunization monitoring chart 27
  28. 28. AEFI Currently used: An adverse event following immunization is a medical incident that take place after an immunization, causes concern, and is believed to be caused by the Immunization. Revised Definition: An AEFI is any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine. The adverse event may be any unfavourable or unintended sign, abnormal laboratory finding, symptom or disease. 28
  29. 29. Cause specific definition of AEFI 1 Vaccine product- related reaction An AEFI that is caused or precipitated by a vaccine due to one or more of the inherent properties of the vaccine product Example Extensive limb swelling following DTP vaccination. 2 Vaccine quality defect- related reaction An AEFI that is caused or precipitated by a vaccine that is due to one or more quality defects of the vaccine products including its administration device as provided by the manufacturer Example Failure by the manufacturer to completely inactivate a lot of IPV leads to cases of Paralytic polio. 3 Immunization error- related reaction An AEFI that is caused by inappropriate vaccine handling prescribing or administration. Example Transmission of infection by contaminated multi dose vial. 4 Immunization anxiety- related reaction An AEFI arising from anxiety about the immunisation. Example Vasovagal syncope in an adolescent following vaccination 5 Coincidental event An AEFI that is caused by something other than the vaccine product, Immunization error or immunization anxiety. Example A fever after vaccination and malarial parasite isolated from blood. 29
  30. 30. Causality Assessment Final assessment -district reports to state Preliminary investigation -district reports to state District decision on investigation and inform state Medical officer visit and reports to districts Case Notification 24 hrs 48 hrs Day 10 Day 100 Day 130 Day 0 24 hrs 48 hrs Day 10 Day 70 Day 100 Day 0 DIR including state causality assessment PIR FIR Only serious AEFI cases Existing guidelines Severe and serious AEFI cases. Revised Guidelines state causality assessment report Final case investigation form (CIF) Preliminary case investigation form (PCIF) Case reporting form (CRF) 30
  31. 31. Mother and Child Tracking System Steps to generate the month wise services given to beneficiaries
  32. 32. Step 1: Go to mcts site nrhm-mcts.nic.in Select the Mother Child Tracking System (Reports)
  33. 33. Step 2: On this page click the Login
  34. 34. Step 3: Select the State and enter the block user id and password and press Login
  35. 35. Step 4: From this window click on Scheduled Report
  36. 36. Step 5: Under the schedule report select the Report Type T. Facility wise work plan and services given
  37. 37. Step 6: Select the year, Month, Health Facility Type, Health Facility Name, Type of report and Services Given and Click on Submit
  38. 38. Step 7: In a new window HSC wise report get generated There might be need to allow the Pop-up blocker Similarly services given for children >1 years can be generated
  39. 39. Main highlights of first phase of MI. 9.4 lakhs sessions organised in 4 rounds. 2 crores vaccines given to pregnant and children More than 20 lakhs PW were vaccinated with TT. 75.5 lakh children vaccinated and 20 lakh children were fully Immunised. 57 lakhs Zinc tablet and 16 lakhs ORS given to children during MI. Mission Indradhanush The ultimate goal of MI is to ensure FULL IMMUNIZATION with all available vaccines for children up to 2 years and PW. 39
  40. 40. 24-30 April 2016 India joined Cambodia, Madagascar, and Mauritania in eliminating Maternal and neonatal tetanus Today one in every 5 children worldwide are still missing routine Immunization for preventable disease. 40
  41. 41. GVAP 41
  42. 42. Summary Immunization is a proven tool for controlling and eliminating life-threatening infectious diseases and is estimated to avert 2 and 3 million deaths each year. 18.7 million infants worldwide are still missing out on basic vaccine. Global vaccination coverage is generally holding steady. GOI is toiling hard in pushing full Immunization from 65% to 90% through Mission Indradhanush, strengthening ongoing Routine Immunization. tOPV -bOPV switch is a milestone achieved in the course of polio eradication!!!! 42
  43. 43. References 1.Review Article Indian J Med Res 139, April 2014, pp 491-511, A brief history of vaccines & vaccination in India Chandrakant Lahariya Formerly Department of Community Medicine, G.R. Medical College, Gwalior, India 2.http://www.who.int/immunization/en/ 3.http://www.who.int/immunization/global_vaccine_action_plan/en/ 4.Handbook for vaccine and cold chain Handlers 2nd edition India 2016, Immunization division/Ministry of Health and Family Welfare GOI. 5.www.shsbihar.org, Routine Immunization micro planning system version 3, {courtesy WHO, NPSP Khagaria Division} 6. Park's Textbook of PSM 23rd Edition/Epidemiology/National Health Programme 7. rchiips.org/nfhs,1,2,3,4 8.http://www.nhp.gov.in/1mission-indradhanush_pg43
  44. 44. Thank You!!!! 44 http://www2a.cdc.gov/nip/kidstuff/newsched uler_le/ ??????????

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