2. GENERAL OBJECTIVE
• At the end of the presentation, student
midwives should be able to have an
understanding on immunization
3. SPECIFIC OBJECTIVES
At the end of the lesson, students should be able to:
1. Define terms used in immunization.
2. Review immunology
3. Explain the EPI
4. Discuss the immunization guidelines and schedule:
• Target groups for vaccination
• Vaccination schedule
• Administration of vaccines
• Side effects
• School health and nutrition programme
4. INTRODUCTION
• At birth, infants have immunity to certain
diseases because antibodies have passed
through the placenta from the mother to
the unborn child. After birth, the
breastfed baby gets the continued benefits
of additional antibodies in breast milk.
But in both cases, the immunity is only
temporary.
5. • Immunization (vaccination) is a way of
creating immunity to certain diseases - by
using small amounts of a killed or
weakened microorganism that causes the
particular disease. Microorganisms can be
viruses, such as the measles virus, or they
can be bacteria, such as Haemophilus
Influenza
6. • Vaccines stimulate the immune system to
react as if there were a real infection - it
fends off the "infection" and remembers
the organism so that it can fight it
quickly should it enter the body later.
7. DEFINITION OF TERMS
• Immunization: the process where by people are
protected against illness caused by infection with
microbes. (science.org 12:28), 06/02/17
• Or the act of creating immunity by artificial
means.
• Immune: Protected against infectious diseases,
foreign tissue, and foreign non-toxic substances
and other antigens.
o Immunity: The resistance possessed by the body
to infectious diseases, foreign tissue, foreign non-
toxic substances and other antigens.
8. • Antigen: Any substance that, on
introduction into the body, brings about
immunity by stimulating antibody
production.
• Antibodies: Specific substances formed
in the body that counteracts the effects of
antigens or bacterial toxins.
9. • Vaccine: an antigenic substance prepared
from the causative agents of a disease or
a synthetic substitute , used to provide
immunity against one or several diseases.
• Or a suspension of killed or attenuated
organisms e.g. virus. Bacteria e.t.c
administered for prevention,
amelioration or treatment of infection
diseases (bailliers nurses dictionary)
10. • Vaccination: introduction of the vaccine
into the body to produce immunity to a
specific disease.
• Cold chain: The cold chain system is a
means for storing and transporting
vaccines in a potent state from the
manufacturer to the person being
immunized (ICN, 2005).
11. REVIEW OF IMMUNOLOGY
Has two components; these are:
1. Non-specific component or innate
immunity.
• The non-specific components act either
as barriers or as eliminators of wide range
of pathogens irrespective of antigenic
specificity.
12. 2. Specific component or adaptive
immunity or acquired immunity
• This component of the immune system
adapt itself to each new disease
encountered and is able to generate
pathogen-specific immunity
13. Natural/Innate Immunity
• This type of immunity is non-specific response
that does not require previous exposure to micro-
organisms.
• This includes intact cellular barriers (skin, and
mucous membranes), gastric acid, digestive
enzymes, complement and lysozomes.
• These act as a first line of defence against
infection in the neonate.
• Genetic factors, age, race, and hormonal levels
affect the natural immunity.
14. 2. Acquired Immunity
• These are specific responses that develop
and improve with on going exposure to a
pathogen or organism.
• It involves a change in the behaviour of
cells and in production of antibody
15. • Active Immunity: This is when the body
produces its own antibodies against a
specific antigen. This can either be
natural or artificial:
• Natural Active Immunity- this is when
the body produces antibodies after
suffering from an infectious disease.
16. • Artificial Active Immunity-this is when
the body produces antibodies after being
injected by living or dead organisms or
their products in form of toxins and
toxoids.
17. • Passive Immunity: In this immunity,
the antibodies are given to an individual.
This can either be natural or acquired:
18. • Natural Passive Immunity- this is when the
foetus obtains maternal immunoglobulin G
(IgG) via the placenta.
• This protects the infant from various infections
for a few months of life.
• The new-born also receives Immunoglobulin A
(IgA) through the breast milk that protects the
surfaces like mucous membranes.
19. • Acquired Passive Immunity- this is
when a person gets temporary immunity
after being given an injection of
antibodies of human (gamma globulin).
20.
21. TYPES OF VACCINES
Four different types of vaccines are currently
available:
• Attenuated Vaccines: these are live but
weakened viruses and bacteria used as
vaccines such as in the measles, polio, and
BCG.
• Killed (inactivated) Vaccines: these are
inactivated bacteria or viruses used as
vaccines, such as in Pertussis.
22. • Toxoid: these are vaccines, which
contain toxins produced by bacterium;
example diphtheria and tetanus are toxoid
vaccines. Toxins are rendered non-toxic
but retain its protective qualities.
• Biosynthetic vaccines (such as Hib)
contain synthetic substances.
23. N.B: Vaccines should be potent to make the child
immune.
• Vaccines lose their potency after a certain time
(expiry date).
• Heat and sunlight can damage live vaccines.
• Freezing damages the killed vaccines and
toxoids.
• Disinfectants, soap, spirit, and antiseptics kill
live vaccines
24. INTRODUCTION TO EPI
• The Expanded Program on Immunization is a
World Health Organization program with the
goal to make vaccines available to all children
throughout the world.
• The World Health Organization (WHO)
initiated the Expanded Program on
Immunization (EPI) in May 1974 with the
objective to vaccinate children throughout the
world.
25. • Ten years later, in 1984, the WHO established
a standardized vaccination schedule for the
original EPI vaccines: Bacillus Calmette-
Guérin (BCG), diphtheria-tetanus-pertussis
(DPT), oral polio, and measles.
• Increased knowledge of the immunologic
factors of disease led to new vaccines being
developed and added to the EPI’s list of
recommended vaccines:
26. • Hepatitis B (HepB), yellow fever in countries
endemic for the disease, and Haemophilus
influenza meningitis (Hib) conjugate vaccine
in countries with high burden of disease.
• In 1999, the Global Alliance for Vaccines and
Immunization (GAVI) was created with the
sole purpose of improving child health in the
poorest countries by extending the reach of the
EPI.
27. • The GAVI brought together a grand coalition,
including the UN agencies and institutions
(WHO, UNICEF, the World Bank), public
health institutes, donor and implementing
countries, the Bill and Melinda Gates
Foundation and The Rockefeller Foundation,
the vaccine industry, non-governmental
organizations (NGOs) and many more.
28. The creation of the GAVI has helped to renew
interest and maintain the importance of
immunizations in battling the world’s large
burden of infectious diseases.
The current goals of the EPI are:
• To ensure full immunization of children under
one year of age in every district
• To globally eradicate poliomyelitis
29. MAIN GOAL OF IMMUNIZATION
• The goal of Expanded Programme on
Immunization (EPI) in Zambia is to reduce
morbidity and mortality from vaccine
preventable diseases such as tuberculosis,
measles, poliomyelitis, tetanus, diphtheria,
pertussis, hepatitis B and haemophilus
Influenza type b. doing no harm in the
process.
30. • Attain and sustain coverage of 90% for
each antigen.
• Control measles through high vaccine
coverage of 95%.
31. • Children up to about 9 months of age are
targeted for routine EPI, although children
above this age that have not completed their
course may be eligible for vaccination.
• A fully protected child is one who received 1
dose of BCG,4 doses of oral polio,3 doses of
DPT+Hep B+Hib, 3 doses of PCV, 1 dose of
IPV and 1 dose of measles by the age of 24
months.
32. GENERAL PRINCIPLES
• It is safe and immunologically effective
to administer all EPI vaccines on the
same day at different sites of the body.
• Minor illnesses such as low grade fever,
mild respiratory infection, diarrhoea and
vomiting are not contra-indicated to
vaccinations.
33. • All persons with asymptomatic HIV should be
immunized with EPI vaccines. Persons with
symptomatic HIV/AIDS infection should not
receive BCG or yellow fever vaccine, but
should receive all other EPI vaccines.
• Malnutrition is an indication to immunize.
• Live vaccines should not be given to pregnant
women
34. TARGET GROUPS FOR
VACCINATION
• Children under 5 years of age
• School age children
• Pregnant women
• Women of child bearing age (15-45yrs
old)
• Special at risk groups (travellers)
35. THE TARGET DISEASES FOR
IMMUNIZATION
• The following are the target diseases for
immunization:
• Tuberculosis
• Poliomyelitis
• Tetanus
• Diphtheria
37. VACCINE AGE FOR VACINATION diseases Number of
doses
BCG At birth if no scar at
12 weeks
tuberculosis 1
OPV 0, At birth -13 days Poliomyelitis in the GIT 1
OPV 1,2,3 At 6weeks 10 and 14
OPV 4 at 9months if
OPV 0 wasn’t given at
birth
Poliomyelitis in the GIT 3
DPT, HEPB AND
HIB 1,2,3
At 6 weeks 10 and 14 Tetanus and
diphtheria, hepatitis B
and hemophils
influenza B
3
PCV 10-1,2,3 At 6 weeks 10 and 14 Meningitis, pneumonia
,bacteremia
3
Vaccination Schedule
38. VACCINE AGE DISEASE NUMBER Of
DOSES
ROTA 1,2 6 weeks 10 diarrhea 2
Measles –
rubella 1,2
9months and
18 month
booster
Measles and
rubella
2
(IPV) Ipv at 14weeks
with opv 3
Prevents polio
in the blood
1
SHEDULE
39. VACCINE DOSE SITE/ROUTE AE
BCG 0.05ML less 1yr
0.1ml more than
1year
Intra dermal in the
lower aspect of the
left arm
Pain, redness,
swelling
OPV0, 1,2,3,4 2-3 DROPS ORAL Rare close to none.
1% fever, malaise
DPT,HEB,HIPB 0.5MLS Deep IM in the left
thigh
Pain, redness,
Swelling, fever,
malaise, irritability
PCV 10 0.5mls Deep IM in the right
thigh
Pain irritability,
swelling, malaise
fever
ROTA 1.5mls oral Close to none
Measles rubbella 0.5mls Subcuteneously on
let deltoid muscle
Pain,fever,redness,
malaise
TD O.5MLS Left deltoid arm IM Numbness,pain,red
ness
ADMINISTRATION OF VACCINE.
40. Vaccine Time for administration Duration of protecton
Td 1 At first contact or as early
as possible in pregnancy
NO protection
TD2 At least 4 weeks after TD 1 3 years
TD3 At least 6 months after TD2
or during subsequent
pregnancy
5 years
TD4 At least 1 year after TD3 10 years
TD5 At least 1 year after TD 4 Up to 30 years and
throughout a woman's
reproductive age.
TATENUS DIPHTHERIA
VACCINATION
41. BCG
• BCG is a live attenuated mycobacterium,
which protects against Tuberculosis. It
was developed by Calmette and Guerin,
hence the name BCG.
• It is frozen then dried and comes as a
powder in a vial. It is reconstituted with
sterile diluent before it can be injected.
42. • Only the particular diluent that comes
with the particular brand of the vaccine
should be used.
• Storage: BCG can be safely stored and
transported between -15 to -25ºC.
• And +2 to +8 at the centre
43. • The diluents should not be frozen but
cooled immediately prior to use.
• BCG should never be exposed to
sunlight.
• Reconstituted BCG must be used
within six hours or be disposed of.
44. • Age: At birth or any time after.
• Dose: 0.05 mls for children under one
year.
• 0.1 ml for children above one year.
• Route: Intra-dermal injection in the left
fore arm.
• Number of Doses: One
45. • If there is no scar at the injection site
12 weeks after a BCG immunization,
the vaccine injection must be repeated.
• Normal Reaction: After BCG injection
there should be a flat-topped swelling
(wheel) in the skin at the injection site
looking like a mosquito bite.
46. • This usually disappears within 30- 40
minutes.
• After approximately two weeks, a red sore
develops which is about 10 mm in diameter.
The sore remains for another two weeks and
then heals.
• A small scar, about 5mm remains.
• This is a sign that the child has been
effectively immunized with BCG
47. DPT+Hep B+Hib VACCINE
• The DPT vaccine contains weakened Diphtheria
and Tetanus Toxoids and killed Pertussis
(whooping Cough) bacteria.
(i) Diphtheria Toxoid: This is the 'D' part of DPT
vaccine. Bacteria that produce toxin cause
diphtheria. The vaccine is toxiod, that is,
inactivated diphtheria toxin.
• Freezing damages it.
• It is also damaged by heat but not as quickly as
the live vaccines
48. (ii) Pertussis: This is the 'P' part of DPT
vaccine. The microorganisms that cause
pertussis are bacteria. The vaccine is
made from killed bacteria.
49. • Pertussis is damaged by heat about as
quickly as BCG. It is the most easily
damaged part of DPT.
(iii) Tetanus: This is the 'T' part of DPT
vaccine. It is also available as a separate
vaccine. Tetanus is caused by bacteria,
which produce toxins.
50. • The vaccine is called a toxiod, that is,
inactivated tetanus toxin.
• Freezing damages tetanus toxiod.
• It is also damaged by heat but more
slowly than other vaccines
51. (iv). Hepatitis B (Hep B): This is a virus
that infects the liver. Those who are
infected can become lifelong carriers of
the virus and may develop long-term
problems such as cirrhosis (liver disease)
or cancer of the liver.
52. • The hepatitis B vaccine probably creates
lifelong immunity. Infants who receive
the HBV series should be protected from
hepatitis B infection not only throughout
their childhood but also into the adult
years
53. • Eliminating the risk of HBV infections
also decreases risk for cirrhosis of the
liver, chronic liver disease, and liver
cancer. Young adults and adolescents
should also receive the vaccine if they did
not as infants.
54. (v). Haemophilus Influenza (Hib):
Haemophilus influenza type B bacteria were
the leading cause of meningitis in children
until the Hib vaccine became available.
Long-term protection from Haemophilus
influenzae type B occurs in more than 90% of
infants who receive three doses of the
vaccine.
55. • Those immunized have protection against
meningitis, pneumonia, pericarditis (an
infection of the membrane covering the
heart), and infections of the blood, bones,
and joints caused by the bacteria.
• DPT+Hep B+Hib and TD are both liquid
vaccines, which you can give by injection
56. • DPT should not be given to a child who is over
5 years old. Children older than 5 years should
be given TD instead.
• Age: Start at 6 weeks, then 10 weeks and 14
weeks.
• Dose: 0.5mls
• Route: Intra-muscular injection into the lateral
middle side of the Left thigh.
57. • Number of Doses: Three with minimum
interval between doses of 4 weeks.
• Storage: DPT+Hep B+Hib should be
stored and transported between +2 and
+8ºC.
• NEVER FREEZE DPT+Hep B+Hib
58. Side Effects:
(i) Fever: Warn the mother that many
children have fever and are irritable
after DPT+Hep B+Hib vaccine and
that it stops within a day.
• The child can be given paracetamol at
the time of vaccination to reduce the
fever.
59. (ii) Local Soreness: Reassure the mother that
some children may get a red, tender lump at
the site of the injection, tell her that it is not
serious and needs no treatment. However if
pus appears at the site of injection, she should
report to the nearest health facility.
60. (iii) Abscess: If the pain and the swelling begin
late (a week or more after the injection) it may
be due to an abscess. If the child develops an
abscess, put warm compresses on the swelling
and give antibiotics (e.g. cloxacillin
50mg/kg/day for 5 days). If the swelling does
not resolve refer for incision and drainage
61. (iv) Convulsions: This is a rare complication and
is often related to fever. This is due to pertussis
part of DPT+Hep B+ Hib.
• Note: If the child who received DPT
vaccination has convulsions or shock in the
following three days, that child should not
receive more doses of DPT+Hep B+Hib.
He/she can be given TD instead.
62. PNEUMOCOCCO CONJUGATE
VACCINE (PCV)
• PCV gives a long lasting and effective
protection to children. It protects against
severe forms of pneumococcal diseases such
as meningitis , pneumonia and bacteraemia.
• It will not protect against these conditions if
they are caused by agents other than
pneumococcal bacteria.
63. STORAGE OF THE VACCINE.
• PCV should be stored at a temperature
between +2 degrees Celsius and +8 degrees
Celsius without being frozen.
• They are freeze sensitive, if freezing is
suspected the shake test should be performed
to determine whether a vial is safe to use.
65. OPV (Oral Polio Vaccine)
• This vaccine contains a live attenuated virus. It
is damaged more easily by heat than the other
vaccines. It should be stored and transported
frozen up to health facility level.
• OPV comes either in a plastic dropper or in a
glass vial with a dropper in a separate pack. It
is important to use the right dropper with the
right vaccine in order to avoid leakage
66. • Storage: It should be kept between -15 and -
25 ºC at the district and at +2 to +8 at the
health centres
• -Vaccine Vial Monitors (VVMs) on the OPV
vials indicate if the vaccine has been damaged
by heat. If the square is lighter than the
surrounding circle the vaccine can be used.
67. • Age: Within 13 days of birth, then at
6weeks, 10 weeks and 14 weeks.
• Dose: 2-3 drops.
• Route: Oral.
68. • Number of doses: Four with minimum
interval between doses of 4 weeks.
• Contra-indication: There is none. If the child
has diarrhoea, give the vaccine, but give an
extra dose four weeks after you finish the
normal course. Do not record the dose given
during diarrhoeal episode.
• Side Effects: None.
69. MEASLES
• This is a live attenuated virus that protects against
measles.
• -It is freezing dried and has to be reconstituted
before injection.
• Only use the diluent that comes from the
vaccine manufacturer to reconstitute the
vaccine.
• Storage: At central and district stores, measles
vaccine should be kept between -15 and -25 ºC.
• -At health centre, it is stored between +2 and +8
ºC.
70. • The diluents should not be frozen, but cooled
immediately prior to use so that it does not
over heat the vaccine
• Age: 9 months & 1 year 6 months
• Dose: 0.5mls
• Route: Subcutaneous injection into the left
upper deltoid muscle (arm).
• Number of doses: two doses
71. TETANUS DIPTHERIA (TD)
• This vaccine consists of toxoids. Immunization
schedules for protection against Tetanus begin
in the newborn period.
• In addition, every woman of childbearing age
(15-49 years) should receive 5 doses of TT to
prevent neonatal tetanus. It is the same
tetanus toxoid as contained in the DPT+ Hep B
+Hib vaccine.
72. • Storage: It should be stored and transported
between +2 and +8 ºC. TD vaccine is
destroyed by freezing.
• Age: School entry, during pregnancy and 15-
45 years.
• Dose: 0.5 mls
• Route: Intra-muscular injection into the left
detoid muscles of upper arm.
• Number of doses: Five
73. • Side Effects: Mild pain, redness and swelling
are common for a couple of days at the site of
injection. Reassure the woman that this goes
away by itself and needs no treatment.
74. VITAMIN A SUPPLEMENTATION
• Vitamin A supplementation means to give Vitamin A
capsules to increase the amount of Vitamin A in the
body.
• The periodic high dose supplementation is intended
to protect against Vitamin A deficiency and its
consequences by building up reserve of the Vitamin
for periods of reduced dietary intake or increased
need.
75. Administration of Vitamin A Supplementation:
– Children 6-11 months, give once : 100,000 iu
– Children 15-59 months, give every 6 months: 200,000 iu
76. Ten critical steps to reconstitute
vaccines safely
1. Read the label on the diluent to make sure
that it is the correct diluent
2. Check the expiry date to make sure that it
has not passed.
3. Check the status of the vaccine vial monitor
(VVM) to make sure that it is not , or beyond
the discard point.
4. Cool the diluent to between +2°C and +8°C,
preferably a day prior to its use.
77. 5. Draw the entire contents of the diluent into a
new sterile reconstitution syringe and empty
the entire contents of the diluent into the
vaccine vial.
6. Discard the used reconstitution syringe and
needle into a safety box without recapping
7. Do not leave the reconstitution needle in the
vaccine vial.
8. After reconstitution, insert the vial in the foam
pad of a vaccine carrier. Never allow the vial to
become immersed in water.
78. 9. Discard all reconstituted vaccine at the end of
the session, or within six hours, whichever
comes first.
10.Use a new auto-disable (AD) syringe and needle
to withdraw each dose of the vaccine, and use
the same needle and syringe for injecting the
vaccine. After giving the injection, drop the
used syringe and needle into the safety box
without recapping.
79. Multi-dose Vial Policy
• Applies only to OPV, TD, vaccines from which one
or more doses of vaccine have been removed
during an immunization session,
• may be used in subsequent immunization
sessions for up to a maximum of four weeks,
provided that all the following conditions are
met.
1. The expiry date has not passed.
2. The vaccines are stored under appropriate cold-
chain conditions (+2°C to +8°C).
80. 3. The vaccine vial septum has not been
submerged in water.
4. Aseptic technique has been used to
withdraw all doses.
5. The VVM, if attached, has not reached the
discard point.
81. Some vaccines to which MDVP does
not apply
• Use within six hours of reconstitution or by
the end of the immunization session,
whichever comes first, and then discard.
• BCG vaccine.
• DTP-HepB+Hib vaccine.
• Yellow fever vaccine.
• Meningitis vaccine.
• Measles vaccine.
