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.
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.
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.
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.
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.
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
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.
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
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
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
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
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
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
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
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
COLD CHAINA system of transporting and storing vaccinesat recommended temperature from the point ofmanufacture to the point of use.
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
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
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
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
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
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
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
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.
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 fluidsWear cool clothingGive tepid spongingGive parecetamolWhen accompaniedby other symptomsIrritability, malaise andsystemic symptomsGive extra fluidsGive ParecetamolWhen severe orunusual