The document provides information on India's National Immunization Programme and recent advances in information technology used to support immunization efforts. It discusses the timeline of vaccination efforts in India from ancient times to the present day. Key aspects of the current National Immunization Programme are outlined, including microplanning, the cold chain system, immunization coverage, monitoring of adverse events following immunization, and online support systems. Recent initiatives to strengthen immunization and advances in technologies are also summarized.

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. 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. 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. 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. 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. 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. 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. 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. 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
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. 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

12. 12

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

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. 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. - 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. 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. 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

20. 20

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. 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. 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. 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. 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. 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. Importance of Immunization
monitoring chart
27

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. 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. 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. Mother and Child Tracking
System
Steps to generate the month
wise services given to
beneficiaries

32. Step 1: Go to mcts site
nrhm-mcts.nic.in
Select the Mother Child Tracking System (Reports)

33. Step 2: On this page click the Login

34. Step 3: Select the State and enter the block user id and
password and press Login

35. Step 4: From this window click on Scheduled Report

36. Step 5: Under the schedule report select the Report Type
T. Facility wise work plan and services given

37. Step 6: Select the year, Month, Health Facility Type, Health
Facility Name, Type of report and Services Given and Click on
Submit

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. 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. 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. GVAP
41

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. 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. Thank You!!!!
44
http://www2a.cdc.gov/nip/kidstuff/newsched
uler_le/
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