Immunization and Cold Chain


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Immunization and Cold Chain

  1. 1. WHY IMMUNIZATION ? Key strategy to child survival Protecting infants from diseases. Lowers morbidity and mortality rates inchildren. Can lead to lower birth rates. Indicator of a strong primary health caresystem.
  2. 2. IMMUNIZATION: COMMON TERMS Immunization:Process of inducing immunity by stimulatingimmune system through antigens. Immunity :Resistance of a host to a specific agent,characterized by measurable and protectivesurface or humoral antibody and by cell mediatedimmune responses.
  3. 3.  Vaccine:A preparation of a weakened or killed pathogen,such as a bacterium or virus, or of a portion of thepathogens structure that upon administrationstimulates antibody production or cellularimmunity against the pathogen but is incapable ofcausing severe infection. Vaccination:Administration of antigenic material (the vaccine)to produce immunity to a disease.
  4. 4. FULL IMMUNIZATION: Beneficiary child (12-23 months) - 3 doses of DPT and OPV each, 1 dose of BCG & measleseach. Mother - two doses or 1 booster dose of tetanustoxoid during her last pregnancy.
  5. 5. Partial Immunization: Child- missed any vaccine or one or more doses Mother- received just one dose of primary tetanustoxoid during last pregnancy.Non immunization: Child and/or mother- not received a single doseof vaccine.
  6. 6.  Ring immunization:Vaccination of people in close contact with an isolatedinfected patient. Mop-up rounds:When the final pockets of polio virus transmission havebeen identified through standard surveillance, door-to-door immunization in high-risk districts. Catch up rounds:Additional effort besides routine immunization to coverleft outs
  7. 7. HERD IMMUNITY? Resistance to spread of infectious disease in agroup because of few susceptiblemembers, making transmission unlikely. The immunologic status of apopulation, determined by the ratio ofresistant to susceptible members and theirdistribution.
  8. 8.  Works only when:Probability of an infected person encounteringevery other individual in the population(random mixing) is the same; (not likely tohappen) Does not work when:An infected person interacts only with peoplewho are susceptible (no random mixing); likelyto transmit the disease to those people
  9. 9. MILESTONES IN IMMUNIZATIONPROGRAM IN INDIA 1978: EPI 1985: UIP, Measles vaccine added 1986: Technology mission 1990: Vitamin A 1992: CSSM 1995: Polio National Immunization days 1997: RCH-I 2005: RCH-II and NRHM
  10. 10. VaccineWhen togive Dose Route SiteFor Pregnant WomenTT-1 Early inpregnancy0.5 ml Intramuscular Upper ArmTT-2 4 weeks afterTT-10.5 ml Intramuscular Upper ArmTT Booster If pregnancyoccurwithin threeyrs of last0.5 ml Intramuscular Upper Arm
  11. 11. VACCINE WHEN TOGIVEDOSE ROUTE SITEFOR INFANTSBCG At birth (forinstitutionaldeliveries) oralong with DPT- I0.1 ml (0.05mlfor infant up to 1month)ID Left UpperArmOPV-0 If delivery is ininstitution2 drops Oral OralOPV- 1,2 & 3 At 6, 10 & 14weeks2 drops Oral OralDPT- 1,2 & 3 At 6, 10 & 14weeks0.5 ml IM Antero-lateralside of mid-thighHep B 1,2 & 3 At 6, 10 & 14weeks**0.5 ml IM Antero-lateral sideof mid-thighMeasles 9-12 months 0.5 ml SC Right upperArmVitamin-A (1stDose)At 9 months withmeasles1 ml (1 lakh IU) Oral Oral
  12. 12. VACCINE WHEN TOGIVEDOSE ROUTE SITEFOR CHILDRENDPTBooster16 -24 months 0 5ml IM Outer MidthighOPVBoosterVitamin A (2ndto 9th dose)16-24 months16 months withDPT/OPV booster.Then,one dose every 6 monthsupto the age of 5years.2 drops2 ml( 2 lakhIU)OralOralOralOralDPTBooster5 years 0.5 ml IM Upper ArmTT 10 years and 16 years 0.5 mil IM Upper ArmNATIONAL IMMUNIZATION SCHEDULE
  13. 13. BARRIERS TO IMMUNIZATION Physical barriers-Waiting time-Distance-Discomfort Psychological barriers-Discourtesy- Endangered privacy
  14. 14. REASONS FOR LOW IMMUNIZATIONCOVERAGE Failure to provide immunization Dropouts Un-reached populations:-- Unawareness- socio-economic barriers- geographic access Resistant populations Missed Opportunities Improper logistics management
  15. 15. WHAT SHOULD NOT HOLD ROUTINEIMMUNIZATION Minor illnesses such as upper respiratoryinfections or diarrhea, mild fever (< 38.5 c) Allergy, asthma Prematurity, underweight newborn child Malnutrition Child being breastfed Family history of convulsions
  16. 16.  Treatment with antibiotics Dermatosis, eczema or localized skin infection Chronic diseases of the heart, lung, kidneyand liver. Stable neurological conditions, such ascerebral palsy and Downs syndrome History of jaundice after birth
  17. 17. COLD CHAINA system of transporting and storing vaccinesat recommended temperature from the point ofmanufacture to the point of use.
  18. 18. ESSENTIAL ELEMENTS:• Personnel to organize and manage vaccinedistribution• Equipment for storage and transport ofvaccines• Transport facilities• Maintenance of equipment and Monitoring Responsibility – District/ Block Managers• Cold chain equipment installation, operationand maintenance
  19. 19. Name ofequipmentPlace ofInstallationTemperature UtilizationILR MK300Regional & district HQ +2 C to +8 C BCG, DPT, DT, TT,Measles, Hep- BVaccineDeep freezer300Regional & district HQ -18 C to -20 C Preparation of ice packsand storing OPVvaccines.ILR MK140 litresPHC +2 C to +8 C BCG, DPT, DT, TT,Measles, Hep- BVaccineDeepFreezer140 litresPHC -18 C to -20 C Preparation of ice packsCOLD CHAIN EQUIPMENT
  20. 20. Name ofequipmentPlace ofInstallationTemperature UtilizationCold Box 20 litres State, Regional,district HQ & PHC+2 C to +8 C Vaccines can bestored fortransportation or incase of powerfailureCold Box 5 Litres District HQ & PHC +2 C to +8 C Vaccines can bestored fortransportation or incase of powerfailureVaccine Carrier( 1.7 litres)PHC/Sub Centre +2 C to +8 C Vaccines can bestored fortransportation or incase of powerfailure
  21. 21. MAINTENANCE OF EQUIPMENT Defrosting/Cleaning:• Periodic defrosting & cleaning Cold boxes/Vaccine Carriers:• Replace or repair locally Ice Packs:• Fill clean water• Leave 10mm room for expansion• Cap tightly• Keep pack clean & dry
  22. 22. Vaccine Exposurre toHeat/ lightExposure to Cold Temperatureat PHCHEAT AND LIGHT SENSITIVE VACCINESBCG Relatively heat stable,but sensitive to lightNot damaged by freezing +2 C to +8 COPV Sensitive to heat andlightNot damaged by freezing +2 C to +8 CMeasles Sensitive to heat andlightNot damaged by freezing +2 C to +8 CAt PHC level, all vaccines are kept in ILR in which temperature ismaintained at +2 C to + 8 CVACCINE’S SENSITIVITY
  23. 23. FREEZE SENSITIVE VACCINESDPT Relatively heatstableFreezes at -3 Cshould not befrozen+2 C to +8 CHepatitis B Relatively heatstableFreezes at -5 Cshould not befrozen+2 C to +8 CDT Relatively heatstableFreezes at -3 Cshould not befrozen+2 C to +8 CTT Relatively heatstableFreezes at -3 Cshould not befrozen+2 C to +8 C
  24. 24. AEFI - RARE, MORE SEVEREREACTIONS Seizures, Thrombocytopenia, Hypotonic-hypo responsive episodes, Persistent inconsolable screaming –in mostcases they are self-limiting and lead to no long-term problems Anaphylaxis, while potentially fatal, istreatable without any long-term effects
  25. 25. MINIMIZING AEFIS Instruction for the health workers Selection of separate site One syringe & one needle/AD syringe Ensure sterilization Reconstitute vaccines only with diluents Use Reconstituted vaccines within 4 hours Keep diluents of BCG and measles vaccine separate Do not keep needles in the rubber cap (stopper) ofvaccine vials. Do not store other drugs or substances in the ILR or deep freezer.
  26. 26. MINOR REACTIONS DUE TO VACCINES( NORMAL NO NEED TO REPORT )Mild vaccine reaction Treatment When to reportLocal reaction (pain,swelling, redness) Cold cloth at injection site.Give ParacetamolIn case of anabscessFever > 38.5 C Give extra fluidsWear cool clothingGive tepid spongingGive parecetamolWhen accompaniedby other symptomsIrritability, malaise andsystemic symptomsGive extra fluidsGive ParecetamolWhen severe orunusual
  27. 27. THANK YOU !!!LIVSON THOMASM.Sc. (N) 1st YearCMC & Hospital, Ludhiana