Universal Programme Immunization as per World Health Organisation in India with Cold Chain and Vaccine Storage in Overall Health Management for Children under 5 years of age

1. RN Ankita Ashok Kadam
(Registered Nurse)
Basic B.Sc. Nursing, Post Graduation Diploma in
Hospital Administration

2. Introduction
Immunity
Immunity is the security against a particular disease & no susceptibility to the
invasive or pathogenic effects of foreign micro-organisms or to the toxic effect of antigenic
substances.

3. Immunization
Immunization is aprocess of protecting an individual from a disease
through introduction of live, or killed or attenuated organisms in the
individual system.
Immunization againstvaccine-preventable diseases is essentialto
reduce the childmortality, morbidity & handicapped conditions.
It is mass means of protecting the largest number of people from
various diseases as it gives resistance to aninfectious disease by producing or
augmenting the immunity.
Artificiallyacquired immunity is developed by the immunization

4. Immunizing agents
These agents are mainly classified as
1. Vaccines
2. Immunoglobulin
3. Antisera

5. Vaccines
It is an immune biological substance, designed to produce specific protection
against a given disease. It stimulates the production of protective antibodies & other immune
mechanisms.
• Live Vaccines :These types of vaccines are preparedfrom live organisms. These organisms
lost their capacity to produce a full blown disease butretain their immunogenicity.
• Inactivated or Killed Vaccines : Organisms killed by heat or chemical when infected into
the body stimulate immunity. Theyare usually safe but areless effective than live
vaccines.
• Toxoids :Certain organisms produce exotoxins. Thetoxins produced by these organisms
aredetoxified & used in the preparation of vaccines.
• Cellular Fractions :In certain instance vaccines are prepared from extracted cellular
fractions.
• Combination Vaccines: If morethan one immunizing agent is included in a single dose
vaccine they arecalled as combination vaccines. The aim of combination vaccine is to
simplify administration, reducecost and minimize the number of contact of patients with
health system.

6. Types of Vaccines Examples
Live attenuated Mumps
Yellow fever
Rubella
Oral Polio, Oral Typhoid
Measles
Endemic Typhus
BCG (TB vaccine)
Inactivated/Killed Typhoid
Cholera
Pertussis
CS meningitis
Rabies
Salk (Polio Vaccine)
Hepatitis A & B
Japanese Encephalitis
Toxoids Diphtheria
Tetanus
Cellular Fractions Meningococcal
Pneumococcal
Combination DPT (Diphtheria, Pertussis, Tetanus)
MMR (Measles, Mumps, Rubella)
Pentavalent (Diphtheria, Pertussis, Tetanus, Hep. B, HiB)

7. Immunoglobulin
The Humanimmunoglobulinsystem composed of fivemajor
immunoglobulin (IgG, IgM, IgA, IgD and IgE).
Two types of immunoglobulinpreparations are available for
passive immunization. Theseare Normal Human
Immunoglobulin& Specific (hyper immune)Human
Immunoglobulin.
They are used in Prophylaxis of viral and bacterial infections& in
replacement of antibodiesinimmunodeficientpatients.

8. Antisera
The term ‘Antisera’ is applied to the materials prepared in
animalsor non-human immunoglobulin.
Originallypassive immunitywas achieved by the administrationof
antisera or antitoxinsprepared from nonhuman resources like
horses .
HumanIg preparations exist only for a small numberof diseases.
Administration of antisera may have adverse effectslike serum
sickness & anaphylacticshock due to abnormal sensitivity of the
recipient.

9. Immunoglobulin Examples
Human
Immunoglobulin
Hepatitis A & B
Rabies
Tetanus
Diphtheria
Measles
Mumps
Varicella
Non- human Diphtheria
Tetanus
Gas Gangrene
Botulism

10. The World Health Organisation (WHO)
launched Global Immunization Programme in
1974 known as Expanded Programme on
Immunization (EPI).
The EPI is now renamed as Universal Child
Immunization, as per declaration sponsored by
UNICEF.

11. National Immunization Programme in
India
•In India, the EPI was launched in January1978 with the objective of
increasing immunization coveragein children below2 years of age, with 3
doses of DPT & 1 dose of BCG vaccine& in Pregnant women with 2 doses of
TT.
•Oral Polio Vaccine was addedto the programme in 1979.
•In 1985, the objectives of National Immunization Programmewererevised &
it was renamed as Universalimmunization Programme (UIP)for attaining
universal immunization coverageof infants & pregnant women.
•Measles Vaccine was added to the programme in 1985.
•The Programmecoveredwhole of India by 1990.
• UIP becamea part of Child Survival & Safe Motherhood
Programme(CSSM) in 1992 &Reproductive & Child Health
Programme(RCH) in 1997.

12. Vaccine Due Age Max. age Dose Route Site
BCG** At Birth Till 1yr of age (0.05 ml until 1
month)
0.1ml beyond 1
month
Intra
Dermal
Upper Arm Left
Hepatitis ‘B’** At Birth Within 24 hours 0.5 ml Intra
muscular
Anterolateral side of
mid-thigh (Left)
Oral Polio 0** At Birth Within the first
15 days
2 Drops Oral Oral
Oral Polio 1,2 & 3 6wk 10wk
14wk
Till 5yrs of age 2 Drops Oral Oral
Pentavalent 1,2 & 3 6wk 10wk
14wk
1yr of age 0.5 ml Intra
muscular
Anterolateral side of
mid-thigh (Left)
Rotavirus
1,2 & 3
6wk 10wk
14wk
1yr of age 2.5ml
(5 drops)
Oral Oral
National immunization Schedule

13. Pneumococcal Conjugate
vaccine
6wk
14wk
1yr of age 0.5ml Intra
muscular
Anterolateral side of
mid-thigh (Right)
Inactivated Polio vaccine 6wk
14wk
Till 1yr of age 0.1ml Inter dermal Upper Arm
(Right)
Measles 1 9-12 month 5yrs of age 0.5ml Sub-
cutaneous
Upper Arm
(Right)
Vitamin A
(1st dose)
9 month 5yrs of age 1ml (1 lakh IU) Oral Oral
Japanese Encephalitis 9-12 month Till 5yr of age 0.5ml Sub-
cutaneous
Upper Arm
(Left)
MMR 15-16 month 5yrs of age 0.5ml Sub-
cutaneous
Upper Arm
(Right)
DPT Booster I 16-24 month 7yrs of age 0.5 ml Intra
muscular
Anterolateral side of
mid-thigh (Left)
OPV Booster I 16-24 month 5yrs of age 0.5 ml Intra
muscular
Anterolateral side of
mid-thigh (Left)
Vitamin A
(2nd – 9th dose)
16mn. (Then
once every
6mn.)
5yrs of age 2ml (2 lakh IU) Oral Oral
DPT Booster II 5-6yrs 7yrs of age 0.5 ml Intra
muscular
Upper Arm
TT 10 & 16yrs 16yrs of age 0.5 ml Intra
muscular
Upper Arm

14. TT – 1 Early in
pregnancy
As early as
possible
0.5ml Intra
muscular
Upper Arm
TT – 2* 4wks after TT
1
0.5ml Intra
muscular
Upper Arm
TT Booster If Received
2TT in a
pregnancy
within last 3
years
0.5ml Intra
muscular
Upper Arm
ForPregnant Women

15. * Give TT-2 orbooster doses before 36 weeks of pregnancy. However, give these
even if more than 36 weeks have passed. Give TT to a women in Labour, if shehas
not previously receivedTT.
** AtBirth in all institutional deliveries.
Note :
• Interval between 2doses should not beless than 1 month.
• Minor cough, cold & mild fever or diarrhea arenot a contraindication to
vaccination.
• In some states Hepatitis B Vaccineis given as routine immunization.
• Interruption of the schedule with a delay between doses not interfere with the
final immunity achieved. If the child missed a dose, the whole schedule need not
to berepeatedagain.

16. Type of Reaction Explanation
Vaccine reaction Event caused or precipitated by the vaccine when given
correctly, caused by inherent properties of vaccine.
Program error Event caused by an error in the vaccine preparation,
handling or administration.
Coincidental Events that happens after immunization but not caused
by the vaccine- a chance of association.
Injection Reaction Events from anxiety about or pain from the injection itself
rather than the vaccine.
Unknown Events cause cannot be determined.
Adverse reactions following immunization

17. Vaccine Contraindications
All An anaphylactic reaction following previous dose of
vaccine is a true contraindication to further
immunization with the antigen concerned.
Live vaccines
(MMR, BCG, Yellow
fever)
Pregnancy, total body reaction.
Yellow Fever Egg allergy, immunodeficiency.
BCG Symptomatic HIV infection.
Influenza, Yellow
fever
History of anaphylaxis reaction following egg allergy.
Pertussis Anaphylactic reaction to previous dose.
Contraindications to Vaccination

18. Vaccine Possible Minor Reactions
BCG Local reaction(pain, redness& swelling)
Cholera Oral presentation-none.
DTP Local reaction(pain, redness& swelling), fever.
Hepatitis A Local reaction(pain, redness& swelling
Hepatitis B Local reaction(pain, redness& swelling), fever.
Hib Local reaction(pain, redness& swelling), fever.
Japanese
Encephalitis
Local reactions, low grade fever, myalgia, GI upset.
Measles/MMR Local reaction(pain, redness& swelling), irritability,
malaise & nonspecific symptoms, fever.
Common Minor Vaccine Reactions

19. Pneumococcal Local reaction(pain, redness& swelling)
OPV None
IPV None
Rabies Local or general reaction
Meningococcal
disease
Mild local reaction
TT Local reaction(pain, redness& swelling), malaise,
nonspecific symptoms
Tick borne
Encephalitis
Local reaction(pain, redness& swelling)
Yellow fever Headache, influenza like symptoms, Local reaction(pain,
redness& swelling)

20. Vaccine Reaction
BCG Suppurative Lymphadenities, BCG osteitis, disseminated
BCG infection
Hib None
Hepatitis B Anaphylaxis
Measles/MMR Febrile seizure, thrombocytopenia, severe allergic reaction,
encephalopathy
OPV Vaccine associated Poliomyelitis
TT Brachial Neuritis, Anaphylaxis
DT Brachial Neuritis, Anaphylaxis
Pertussis/DPT Inconsolable screaming, seizure, Hypotonic or Hypo
responsive episode, anaphylaxis, encephalopathy
Rare Vaccine Reactions

21. Vaccine storage

22. Do’s Don’ts
 Keep theequipment in coolroomawayfrom
directsunlight& aleast10cmawayfromwall.
 Keep theequipment throughVoltage stabilizer.
 Keep vaccinesneatlywithspacebetween stacks
forcirculationofair.
 Keep theequipment locked& penit when
necessary.
 Defrostperiodically.
 Supervisethe temperaturerecord.
 If vaccines arein cartonmakeholes onside of
the cartonforcoldair circulations.
 Donotkeep anyotherthings otherthan
vaccinein theseboxes.
 Donotstoreanyotherdrug.
 Donotkeep drinkingwaterorfoodin them.
 Donotkeep morethan1 monthrequirements
in PHC.
 Donotkeep expireddatevaccines.

24. Cold chain
Cold chain is a system of storage & transport of vaccines at low temperature from
the manufacturer to the actual vaccination site. The cold chain system is necessary because
vaccine failure may occurdueto failure of storage & transport understrict temperature
controls.
• Vaccinestored in the freezercompartment are Polio & Measles.
• Vaccinewhich must be stored in the cold compartment & neverallowed to freezeare
BCG, DPT, DT, TT, Typhoid & diluents.
• Vaccines mustbe protected from sunlight & prevented from contact with antiseptics.
• At health centres most of the vaccine(exceptpolio) can be stored upto 5 weeks, if
refrigerators temperature is strictly keepbetween 4°C & 8°C
• Storage of Opened Vial:
With preservatives: Upto 3 hours.
Without preservatives: Upto 1 hour.

25. The Cold Chain Equipments
1. Walk in Cold Rooms
2. Deep Freezer
3. SmallDeep Freezer
4. ColdBoxes
5. Vaccine Carrier
6. Day Carrier
7. Ice packs

26. Walk in Cold Rooms: It is located at regional levels & are meant to store
vaccine supplies for upto 3 months. They are used to store vaccne supply
of 4-5 districts.
DeepFreezers(300 litres) & IceLined Refrigerators (300/240 litres):
Deep freezers & ILR are supplied at all districts & walk inCold rooms to
store vaccines. Deep freezers are used for making Ice packs & for storing
OPV & measles vaccine.
Cold Boxes : Cold Boxes are supplied to peripheral vaccinationcentres
& are of different sizes. The vaccines are first wrapped in Polythene bags
& then kept inside cold boxes.

27. Vaccine Carriers :They are usedtocarry smallquantityofvaccines
(16-20vials) for outreachsessions. Itis asquareboxmadeup of
insulatedmaterial.Four fullyfrozen icepacks areused tolinethesides.
The vaccine carrier should beclosedtightly&hasworkingcapacityof
48 hours.
Day Carrier:These are square boxes containing2ice packs,oneat
bottom& oneontop.Usetocarry forsmallquantity(6-8vials) witha
12 hours workingcapacity.
Ice packs: The icepacks containswater &no saltisaddedtoit.Water
is filleduptothemarkedlevel&itis allowedtofreeze

28. Vaccine Vial Monitor
VVM
It is the label containing a heat sensitive material to checkthe status of vaccinedurability.