1978 Expanded Programme of immunization (EPI). Limited reach - mostly urban1985 Universal Immunization Programme (UIP). For reduction of mortality and morbidity due to 6 VPD’s. Indigenous vaccine production capacity enhanced Cold chain established Phased implementation - all districts covered by 89-90 Monitoring and evaluation system implemented
Implementation of National ImmunizationProgramme District is treated as administrative unit – 593 Primary Health Centers are the last vaccine storage points - 23,109 Services are provided through 142,655 sub centers to the population residing in about 638,588 villages Target for immunization is to cover infant population of over 25 million and around 27 million pregnant women
Immunization services are being providedthrough the existing health care delivery system.There is no separate staff required for theprogramme.Pulse Polio Immunization Programme waslaunched in the country in the year 1995. Underthis, under 5’s are given additional oral poliodrops in December and January every year onfixed days.As a result, there has been a significant declinein the incidence of poliomyelitis.
Primary Vaccination Ring Those outside rings are not vaccinated.Secondary Vaccination Ring
Immuno-biological substances designed toproduce specific protection against a givendisease.*Nowadays vaccines are of sub-unit and recombinant types.Administration: SUBCUTANEOUS & INTR AMUSCULAR
Live Vaccines—BCG, MMR*Not for immunologically challenged.Inactivated(Killed)—iPV, Hepatitis BToxoids—Diphtheria, Tetanus
Immunoglobulins are for passive immunization!5 Major classes include- IgG, IgM, IgA, IgD, IgE.TYPES:Normal Human ImmunoglobulinSpecific Human Immunoglobulin*These are used to replace antibodies inimmunodeficient patients.Administration:INTRAMUSCULAR & INTRAVENOUS
LIVE KILLED TOXOIDS VACCINE VACCINEBCG, POLIO, MMR PERTUSSIS, TYPHOID, CHOLERA DIPHTHERIA, TETANUSVaccines have lost their It stimulates active Exotoxins produced bycapactiy to produce full- immunity. Usually safe but organisms are detoxicatedblown disease, retain less efficacious than live and used in preparation ofimmunogenicity. vaccines. Also requires vaccines. frequent booster doses. Antibodies produced*NOT to be administered neutralise the toxic moietyto persons with immune *NOT to be given when there produced during infection,deficiency diseases, may be or was severe local or rather than act upon thesuppressed immunity. general reaction to a previous organisms. dose.*NOT to be administered HIGHLY EFFICACIOUS.to pregnant women unlessrisk of infection exceedsrisk of harm to fetus withlive vaccine.
Materials prepared in animals. Antitoxinsprepared from non-human source sinclude: Tetanus, Diphtheria, Botulism, Gas gangrene, Snake Bite.
COLD CHAIN?A system of storage and transport of vaccines at lowtemperature from the manufacturer to the actualvaccination site.
Walk in Cold Rooms[WIC]Deep Freezers & ILRsSmall deep freezers and ILRCold boxesVaccine carriersDay CarriersIce packs
For Infants Vaccine & Dose Route At Birth BCG 0.1ml + OPV 2drops( 0 dose) Intradermal 6 weeks BCG 0.1ml [if not at birth] Intradermal DPT-1 0.5ml + OPV-1 2drops I/M + Oral 10 weeks DPT-2 + OPV-2 I/M + Oral 14 weeks DPT-3 + OPV-3 I/M + Oral 9-12 months Measles 0.5ml + Vit. A 2ml Deep S/C + Oral At 18 months DPT + OPV[Boosters-1] I/M + Oral At 24, 30, 36 months Vitamin A 2ml Oral At 5-6 years DT[Booster-2] I/M At 10 and 16 years Tetanus Toxoid I/M For Pregnant Women Vaccine & Dose Route Early in Pregnancy TT-1 or Booster I/M One month after TT-1 TT-2 I/MINTERVAL BETWEEN TWO DOSES SHOULD NOT BE LESS THAN ONE MONTH!
VACCINE PREVENTABLE DISEASE SURVILLANCE Incidence of Neonatal Tetanus Incidence of MeaslesSource CBHI In 2004 1087 NNT cases and 51546 Measles reported
VACCINE PREVENTABLE DISEASE SURVILLANCE Incidence of Diphtheria Incidence of Whooping coughSource CBHI In 2004 8465 Diphtheria cases and 32786 Pertussis reported
Full Immunization Coverage by States (in %)Coverage evaluation 100shows a varied 90 1998-99coverage among the 80 1999-00States. While the 2000-01 70Southern States 2001-02 60have been 50consistentlyachieving high 40coverage levels, the 30situation in Northern 20States is a matter of 10concern. 0 GU TN WB HR UA J khand RJ All India DL PB MP HP J&K MH Bihar UP AP Source: Unicef CES
ConcernsLarge birth cohort - 25 million births every yearDeclining coverage in some major states • An average of 14.4 % children receiving BCG do not receive measles vaccinePoor immunization data quality • Discrepancies between reported and surveyed dataVaried program management and supervision at all levelsUnsafe injection practices and waste disposal: Significant percentage of injections used in the immunization sector are unsafe Low priority on medical waste disposal
The virus is also present in body fluids andexcretions such as saliva, breast milk, semen,vaginal secretions, urine, bile and feces.Semen and Saliva are known culprits fortransmission.
Hepatitis Human ImmunoglobulinVaccineTarget Population Dose StatusPercutaneous or mucosal 0.05-0.07 ml/kg body wt Recommended For Preventionexposure Repeat after a monthNewborns of mothers 0.05 ml/kg body wt Recommended For Preventionwith HBsAg At birth, 3 & 6 monthsSexual contacts of acute 0.05 ml/kg body wt Optional for Preventionhepatitis B patients Repeat after a month Immunization against Hepatitis has become an interesting addition to the UIP in India.
i. Test for Sensitivity Reactionii. Adrenaline (1:1000 solution) to be kept ready.iii.Properly sterilize equipment and apparatus.iv. Measles and BCG vaccines to be reconstituted only with diluents supplied by manufacturer.v. Reconstituted Vaccines must NEVER be retained for subsequent use.vi. Don’t store anything else in the refrigerator other than vaccines.