IMMUNIZATION AGAINSTCHILDHOOD KILLER DISEASES Ms Jane Muhindo Dip Clin Med, Dip Palliative care, BSc. HCMTC & MA.HPM
Learning objectivesAt the end of this session, you are expected to:• Explain the type of immunity• List childhood immunizable diseases & types of Vaccines• Describe the role of UNEPI in Uganda• Understand cold chain management
Introduction to the Body’s immune system• The immune system is a system that fights attacks by foreign agents entering the body.• An antigen is any substance from outside the body that elicits an immune response e.g. viruses, bacteria, foreign proteins etc• The immune system is capable of recognizing the body’s own cells, because each cell has a specific marker (Major Histocompatibility Antigen or MHC).
Introduction to the Body’s immune system cont• Any cell not having this marker is treated as foreign and destroyed.• However sometimes the immune system breaks down and starts attacking body self cells, resulting into autoimmune diseases e.g. diabetes, degenerative arthritis etc.• Parts of the immune system are antigen specific. They recognize and mount an even stronger attack to the same antigen next time. This is underlying basis for vaccines.
Types of Immunity• Immunity can be natural or artificial; innate (in born) or acquired; active or passive.• Innate Immunity: – Is what a human being is born with and is non specific. All antigens are attacked equally. It is genetically based and can be passed on to the offspring.
Types of Immunity cont• Examples include surface barriers or mucosal immunity such as:• Skin• Saliva, tears, nasal secretions have an enzyme called lysozyme which kills bacteria.• Stomach has hydrochloric acid and protein digesting enzymes which also kill bacteria.
Types of Immunity contAdaptive Immunity: is often sub-divided into two major types depending on how the immunity was introduced.• Active natural immunity: Results from contact with an infection, develops slowly, is long term and antigen specific.• Active artificial immunity (Immunization): Develops slowly, lasts for several years and is antigen specific to the antigen for which the immunization was given.
Adaptive immunity cont• Passive natural immunity: (Transplacental or mother to child): develops immediately, is temporary and affects all antigens to which the mother has immunity.• Passive artificial (Injection of gamma globulin): Develops immediately, is temporary and affects all antigens to which the ‘donor’ has immunity.
Vaccination (Immunization)• The goal of all vaccines is to promote a primary immune reaction so that when the organism is again exposed to the antigen, a much stronger secondary immune response will be elicited.
Childhood Immunizable Diseases & Types of Vaccines• EPI (Expanded Programme for Immunization) Vaccines: The following immunizations shall be given routinely to all children in Uganda by their first birth day according to the schedule:
• DPT-Hep B +Hib is a pentavalent vaccine, effective against 5 diseases: Diphtheria, Pertussis, Tetanus, Hepatitis B, and haemophilus influenza type B.
UGANDA MINISTRY OF HEALTH/UNEPINATIONAL IMMUNIZATION SCHEDULE
UGANDA MINISTRY OF HEALTH/UNEPINATIONAL IMMUNIZATION SCHEDULE cont
• Tetanus toxoid (TT) shall be given routinely to all women of child bearing age (15-45 years) according to the vaccine schedule.
THE UGANDA NATIONAL EXPANDED PROGRAMME FOR IMMUNIZATION (UNEPI)• Roles of UNEPI:• The central UNEPI division initiates, develops and disseminate EPI policy and standards. The central division shall provide districts with updated guidelines/protocol for the EPI programme and shall monitor and ensure adequate and correct utilization of distributed guidelines at the district level.
Roles of UNEPI cont:• Central UNEPI division forecasts and procures the right and adequate EPI vaccines and supplies on an annual basis according to the national EPI policy.• Estimates for ordering vaccines and supplies shall be based on projected target populations, coverage targets, estimated vaccine wastage rates and balances in stock and should allow for the presence of a buffer stock and the start of each supply period equivalent to 25% of the expected usage.
Roles of UNEPI cont:• Supply of EPI vaccines and supplies to districts on a monthly basis according to demand and known balance in stock.• Maintenance of a central vaccine store capable of storing vaccines at the recommended temperatures: – Measles, polio and BCG shall be kept at -20oC to + 8o C. – DPT, DPT-HepB, Hib and TT shall be kept at + 2oC to + 8oC. – DPT-HepB, DPT and TT shall not be frozen. Currently UNEPI is using the lyophilized Hib vaccine which can be frozen.
Roles of UNEPI cont:• Central UNEPI division shall carry out technical support supervision, monitoring and provide feedback to each district at least once every quarter.• Monitor and follow up reports of adverse events following immunization (AEFI) within a period not exceeding 14 days following notification of such events.
Roles of UNEPI cont:• Carry out potency testing of viral vaccines for every consignment received and field potency testing at least once every 6 months for quality control purposes.• Conduct surveillance at the national, level for diseases targeted for eradication, elimination and control (polio, measles and neonatal tetanus), using integrated disease surveillance and response strategy (IDSRS).
Roles of UNEPI cont:• Conduct internal program review annually and external program reviews, needs assessment and coverage surveys at least once every 5 years.• Continuously advocate for EPI, identify barriers to utilization of services and support districts to conduct social mobilization strategies and grass root level.
MINIMUN SUPPLIES TO DISTRICTS• Vaccines (according to the national protocol)• Auto Disable (AD) syringes (0.05 ml to 0.8 ml)• Gas cylinders and gas• Cotton wool• Mixing needles and syringes (2 ml + 5 ml).• Child health and TT cards• Tally sheets• Supplies control cards• Vaccine and injection material control book.
FOLLOW UP TASKS AND ACTIONS FOR REPORTING OF ADVERSE EVENTS FOLLOWING IMMUNIZATION• Type, batch no., expiry date, manufacturer of the vaccine.• Possible attributable causes.• Ensure proper management of AEFI (Adverse Events Following Immunization).• Minimize reoccurrence.• Minimize impact of events on the programme.
Roles of the District Health AuthoritiesPlanning• District/Health Sub district shall have a documented annual and quarterly integrated health plan that includes immunization activities and which includes the following: – Forecasting, requisitioning, storage and distribution of supplies and vaccines to all immunization units.
Immunization activities cont– Collection, analysis, use and dissemination of immunization information with feedback to lower levels (sub-counties, health sub districts and health facilities).– Static and outreach immunization services to ensure regular services.– Technical support supervision.– Cold chain repair and maintenance.
Immunization activities cont– Advocacy and social mobilization through various channels.– Capacity building within the district.– Coordination of all partners and sectors within the district.– Identification of barriers to utilization of immunization and their solutions.
Roles cont• DHMT (District Health Management Team) has role of dissemination of EPI Policy and standards to the political and administrative leaders at district and lower levels.• Storage of vaccines at the district/HSD vaccine store, at between + 2oC to +8oC, at all times. However measles and oral polio vaccines may be kept at the District store at temperatures ranging from -20 oC to +8oC. NB: Do not freeze DPT-HepB and TT vaccines.• Districts/HSD reviews vaccine requirements using target population estimates, usage and stock balances.
Roles cont• Vaccine distribution to all health units carrying out immunization on a monthly basis and ensure no stock outs or excesses.• District/HSD ensures an uninterrupted supply of gas and other sources of energy to maintain EPI charges. Key tasks include:– Record and monitor use of gas– Collect empty cylinders for refilling prior to arrival of vaccine track.– Maintain inventory on working status of equipment.
Roles cont• All districts/HSDs to give feedback on immunization activities to districts and sub county political and administrative officials on the following: – Coverage rates by sub counties and HSDs. – Drop out rates by sub counties and HSDs. – Functional outreaches coverage. – Status of mobilization of outreaches, difficult to reach communities, groups against immunizations and specific rumours. – Funding for immunization.
COLD CHAIN MANAGEMENT• The cold chain is a system of maintaining vaccine potency right from manufacturers, central vaccine store, district vaccine store, HSD store, health static units up to the time the vaccine is administered to the recipients.
COLD CHAIN MANAGEMENT cont• UNEPI ensures availability of necessary cold chain equipment at all levels which meet the recommended WHO standards. The cold chain equipment are used exclusively for transportation, storage and distribution of EPI vaccines and freezing icepacks.
COLD CHAIN MANAGEMENT cont• Mechanisms for monitoring vaccine potency consist of cold chain monitors, vaccine vial monitors, alcohol thermometers or any other appliances as may be determined by the programme from time to time and in accordance with the level of service delivery.