Current programme & national immunization programme is arranged with cold chain.

1. IMMUNIZATION
&
COLD CHAIN
GAJJAR PRASHANT
ROLL NO.-36

2. IMMUNIZATION
Immunization is defined as the procedure by which
the body is prepared to fight against a specific
disease.
Immunization is of two types:
1. Passive immunization
2. Active immunization.

3. „ PASSIVE IMMUNIZATION
Passive immunization or immunity is produced without
challenging the immune system of the body.
done by administration of serum or gamma globulins from
a person who is already immunized (affected by the
disease) to a non-immune person.
Passive immunization is acquired either naturally or
artificially.

4. It is developed by injecting previously prepared
antibodies using serum from humans or animals.
This type of immunity is useful for providing
immediate protection against acute infections like
tetanus, measles, etc.

5. ACTIVE IMMUNIZATION
Active immunization or immunity is acquired by
activating immune system of the body.
Body develops resistance against disease by
producing antibodies following the exposure to
antigens.
 Active immunity is acquire
Naturally
Artificially

6. Active Natural Immunization
Naturally acquired active immunity involves activation of immune
system in the body to produce antibodies against microorganism.
 It is achieved in both clinical and subclinical infections
Active Artificial Immunization
It is achieved by the administration of vaccines
or toxoids.

7. Herd Immunity
It is a type of immunity that occurs when the vaccination
of a portion of population provides protection to
unprotected individual.
The higher the number of immune individuals, the lower
the like hood that a susceptible people will come in contact
with an infectious agent.
Resistance to spread of infectious disease in a group
because of few susceptible members, making transmission
unlikely.

9. Vaccine
9
Vaccine is a substance that is introduced into the
body to prevent the disease produced by certain
pathogens.
It consists of dead pathogens or live but attenuated
(artificially weakened) organisms.
The vaccine induces immunity against the pathogen,
either by production of antibodies or by activation of T
lymphocytes.

10. Types of vaccine
A. Live-attenuated (weakened)
vaccines:
contain modified strains of a pathogen (bacteria or viruses)
that have been weakened but are able to multiply within the
body and remain antigenic enough to induce a strong
immune response.
B.Killed-inactivated vaccines:
To produce this type of vaccines, bacteria or viruses are
killed or inactivated by a chemical treatment or heat. 10

11. C.Sub-unit vaccines
Subunit vaccines include only the antigens that best
stimulate the immune system.
In some cases, epitopes are used—the very specific parts of
the antigen that antibodies or T cells recognize and bind
to.
Subunit vaccines contain only the essential antigens and
not all the other molecules that make up the microbe, the
chances of adverse reactions to the vaccine are lower.
11

12. Types of subunit vaccines;-
1.toxoids
2.protein vaccine
3.recombinant protein vaccine
4.polysaccharide based vaccine
5.conjugated vaccine

13. D. Combination
If more than one kind of immunising agent is included in
the vaccine it is called a mixed or combined vaccine.
The advantage of combined vaccine is as below:
1.simplify administration
2.reduce cost
3.improving timeline of vaccination
4.reducing the storage
13

14. •Example of mixed vaccines are DPT,DT,DP,MMR,etc.
•POLYVALENT: It is prepared from 2 or more strain of the
same species

15. vaccine Example
Live, attenuated
Measles, mumps, rubella (MMR combined
vaccine)
Varicella (chickenpox)
Influenza (nasal spray)
Rotavirus
Inactivated/Killed
Polio (IPV)
Hepatitis A 15

16. Combined DPT,TT
Subunit/conjugate
Hepatitis B
Influenza (injection)
Homophiles influenza type b (Hib)
Pertussis, Diphtheria, tetanus

17. Why Immunization ?
Key strategy to child survival
Protecting infants from diseases.
Lowers morbidity and mortality rates in children.
Indicator of a strong primary health care system.
17

18. History of
Immunization
18

19. Edward Jenner Vaccinating
19

20. Beginning of Vaccination.
Vaccination (Latin ;
Vacca- Cow )
 Edward Jenner used
the term Vaccination
 Cow pox virus
provided immunity in
prevention of Small
pox 20

21. 14 May 1796 - Jenner inoculated James Phipps, an 8 yr old
boy.
Boy recovered after a brief illness
Jenner inoculated pus taken from a small pox patient.
Boy showed no reaction.
Jenner recommended vaccination for prevention of
smallpox
Small pox eradicated in 1977.
WHO certified India to be free of smallpox in march 1977.21

22. SMALL POX
22

23. 1978: Expanded Program of Immunization (EPI)
introduced after smallpox eradication: BCG, DPT,
OPV, Typhoid.
Limited to mainly urban areas
23

24. 1985 : Universal Immunization Program (UIP)
introduced; Expanded to entire country; Measles
added.
1990 : Vitamin-A supplementation.
1992: Child Survival and Safe Motherhood Program.
1995: Polio National Immunization Days.
1997: Reproductive and Child Health Program (RCH
I).
2005 : RCH-II and the National Rural Health Mission

25. EPI
Adding more disease controlling antigens to vaccination
schedules.
Extending coverage to all corners of a country.
Spreading services to reach the less privileged sectors of
the society

26. EPI is developed to protect all
children of the world against 6
vaccine preventable diseases
Diphtheria
Tetanus
Polio
Tuberculosis
Measles
Pertussis (whooping cough)

27. 1985 – UNICEF re named it as “UNIVERSAL
IMMUNIZATION PROGRAMME”.
There is no difference between both the programme.

28. Universal immunization programme
&
National immunization programme

29. EPI IN INDIA 1978
The Govt. of India launched it’s EPI in 1978.
The objective was to reducing mortality, morbidity
resulting from VPDs.
To achieve a self sufficiency in vaccine production.

30. COMPONENTS OF UIP
1. Immunization of pregnant women against tetanus.
2.Immunization of children in their first year of life
against 6 VPDs.
3. The aim was to achieve 100 % coverage of pregnant
women with 2 doses of TT & at least 85% coverage
of children under one year (with 3 doses of DPT,
OPV & one dose of BCG, One dose of MMR) by 1990

31. TWO COMPONENTS OF UIP

32. OBJECTIVES
To increase immunization coverage.
To improve quality of service.
To achieve self sufficiency in vaccine production
To train health personnel
To supply cold chain equipment and establish a
good surveillance network.
To ensure district wise monitoring

33. Accelerate control of vaccine-
preventable diseases
Strengthen routine
immunization to meet
vaccination coverage targets
Introduce new and improved
vaccines
Spur research and
development for the next
generation of vaccines and
technologies
Objectives of
WHO in
immunization

34. “NO CHILD
SHOULD BE
DENIED OF
IMMUNIZATION.”

35. STATUS OF VPD -INDIA
Disease 1987 2011 %
declin
e
POLIMYELI
TIS
28,257 1 100
DIPTHERI
A
12,952 4,233 62.3
PERTUSIS 163,786 3,909 76.13
MEASLES 247,519 33,634 86.41

36. NATIONAL IMMUNIZAION
SCHEDULE
VACCIN
E
When to give Does Route Site
TT-1 Early in pregnancy 0.5ml Intra-
muscula
r
Upper
arm
TT-2 4 weeks after TT-1 0.5ml Intra-
muscula
r
Upper
arm
TT-
booster
If received 2 TT
doses in a pregnancy
within the last 3
0.5ml Intra-
muscula
r
Upper
arm

37. FOR INFANT
VACCINE When to give Doe
s
Route Site
BCG At birth or early as
possible till 1 year of age
0.1 ml Intra-
dermal
Left upper
arm
Hepatitis B At birth or early as
possible within 24 hour
0.5ml IM Antero-lateral
side of mid
thigh
OPV-0 At birth or early as
possible within the 1st 15
days
2 drops Oral Oral
OPV-1,2&3 At 6,10,&14 weeks 2 drops Oral Oral
DPT-1,2&3 At 6,10,&14 weeks 0.5ml IM Antero-lateral
side of mid
thigh
Hepatitis B
1,2&3
At 6,10,&14 weeks 0.5ml IM Antero-lateral
side of mid
thigh
Measles 9 completed months-12 0.5ml Sub- Right upper

38.  For children
DPT booster 16-24 months 0.5ml IM Antero-lateral
side of mid
thigh
OPV booster 16-24 months 2
drops
ORAL ORAL
Measles 16-24 months 0.5ml Sub-
cutaneous
Right upper
arm
JE 16-24 months with
DPT/OPV booster
0.5 ml Sub-
cutaneous
Left upper arm
Vitamin A 16 months with DPT/OPV
booster. Than 1 does every 6
months up to age of 5 years
2ml(2
lakh
IU)
Oral Oral
DPT BOOSTER 5-6 years 0.5ml IM Upper arm
TT 10 year &16 year 0.5ml IM Upper arm

39. Vaccines under UIP
Under UIP, following vaccines are provided:
1. BCG (Bacillus Calmette Guerin)
2. DPT (Diphtheria, Pertussis and Tetanus Toxoid)
3. OPV (Oral Polio Vaccine)
4. Measles

40. 5. Hepatitis B
6. TT (Tetanus Toxoid)
7. JE vaccination (in selected high disease burden
districts)
8. Hib containing Pentavalent vaccine
(DPT+HepB+Hib) (In selected States)

41. Diseases covered under
UIP
1. Diphtheria
2. Pertussis.
3. Tetanus
4. Polio
5. Tuberculosis

42. 6. Measles
7. Hepatitis B
8. Japanese Encephalitis ( commonly known as brain
fever)
9. Meningitis and Pneumonia caused by Haemophilus
Influenzae type b

43. Barriers to Immunization
Physical barriers
-Waiting time
-Distance
-Discomfort
Psychological barriers
-Discourtesy
- Endangered privacy

44. Reasons for Low Immunization
Coverage
 Failure to provide immunization
 Un-reached populations:-
- Unawareness
- socio-economic barriers
- geographic access
 Resistant populations
 Missed Opportunities
 Improper logistics management

45. What Should not Hold Routine
Immunization
 Minor illnesses such as upper respiratory infections
or diarrhea, mild fever (< 38.5°c)
Allergy, asthma
Prematurity, underweight newborn child
 Family history of convulsions

46. Treatment with antibiotics
 Dermatosis, eczema or localized skin infection
 Chronic diseases of the heart, lung, kidney and liver.
 Stable neurological conditions, such as cerebral palsy and
Down's syndrome
 History of jaundice after birth

48. COLDCHAIN

49. Cold Chain
The ‘cold chain’ is the system of
transporting and storing vaccines at
recommended temperature from the
point of manufacture to the point of
use.
Manufacturer
Distributor
Vaccine
Depots
Provider
office
Client

50. Why is the cold chain important ?
1. Vaccines are:
 Biological products
 lose potency with time
 Process irreversible and accelerated if
proper storage conditions are not
adhered to.
2. Assurance in potent product
and vaccine programmes
 Professional responsibility
 Confident the vaccines you give
will be effective
 Public Health responsibility
 Public confidence in immunisation
programmes
3. Ensuring maximum benefit
from immunisations
Responsibility not to waste scarce NHS
resources
Reduce wastage from errors
4.Compliance with
SPC/Manufacturer
Any vaccine that has not been stored at
a temperature of 2-8ºC as per its
licensing conditions is no longer a
licensed product

51. Cold chain storage equipment
Walk in cold
rooms
Deep freezers Ice lined
refrigerators

52. A. Walk in cold rooms(WIC)
At regional level
Storage up to 3 months
Serve 4-5 districts

53. B. Deep freezers
 At district & PHC levels
 Temp :- -15oc to -25oc
 At PHC, used only for the preparation of
ice packs
 In case of power failure these freezers
can maintain the cabinet temp. for 18-22
hours
 20-25 icepack can be prepared by a 140L
in deep freezers with continuous electric
supply of 8 hours.

54. C. Ice Lined Refrigerators(ILR)
 Both at district and PHC levels
 Temp :- +2oc to +8oc
 ILR’s are top opening, can hold
cold air inside better than
front opening refrigerators
 It can keep vaccine safe with 8
hours of continuous electric
supply in a 24 hours period.

55. Arrangement of vaccine order top to bottom:
Hepatitis B
DPT & TT
BCG
Measles
OPV
Discard any frozen hep.b, DPT, & TT.
Keep spaces between boxes
Measles & OPV can be kept over 2 rows of empty ice-packs on the
floor of the ILR.

56. Vaccine Stability
 Sensitivity to
HEAT
OPV
Measles
BCG
MMR
Hepatitis B
DT
 Sensitivity to COLD
HepB and
combination
Influenza
*BCG
(*Freeze dried)
MOST SENSITIVE
Temperature must be
recorded twice in a day
with dial thermometer
LEAST SENSITIVE

57. Light Sensitive
Sensitive to strong light, sunlight, ultraviolet,
fluorescents (neon)
OPV
Measles
MMR
Varicella
Meningococcal C Conjugate
Most DTaP containing vaccines
Vaccines should
always be stored in
their original
packaging until point
of use to protect them
from light

58. Vaccine Storage
 Use a dedicated vaccine
fridge
 Safeguard electricity supply
 No more than 50% full
 Place vaccines in clearly
labelled plastic mesh
baskets
 Group vaccines by type
(Paediatric, Adult,
Adolescent)
 Defrost/calibrate fridge
regularly
X No food or medical
specimens
X Do not place fridge in
direct sunlight or near heat
source
X Do not store vaccines for
more than 1 month at PHC.
X Do not store vaccines in
fridge doors or in solid
plastic trays/containers
within the fridge
X Keep vaccines away from
fridge walls and cold air
vents
Picture taken from www.medisave.co.uk
DO’sDON’T’s

59. Transporting Equipment
Cold
boxes
Vaccine
carriers
Day
carriers

60. Used for transport of vaccines
Fully frozen ice packs placed at the
bottom and sides
DPT, TT, DT should not be kept in
direct contact
1.Cold boxes
Used to carry small quantity of
vaccines(16 to 20 vials)
For out of reach sessions
4 icepacks are used
2.Vaccine
carriers

61. 3.Day carriers
Used to carry very small quantities of
vaccines(6 to 8 vials)
For a near by session
2 icepacks are used
For only 2 hours period

62. ICE PACKS
It contains water & no salt shold be added to it.
The water should be filled upto the level marked on
the side.
If there is leakage such icepack should be discarded.

63. Vaccine Vial Monitor(VVM)
VVM is a label containing heat sensitive
material that is placed on a vaccine vial
to register heat exposure over time
Vaccine vial
monitor

64. Stage 1
• Inner square
lighter than
outer circle
Stage 2
• Inner square
still lighter than
outer circle
Stage 3
• Color of inner
square matches
the outer circle
Stage 4
• Color of inner
square darker
than outer circle
Combined effects of time and temperature
cause the inner square to darken gradually and
irreversibly
VVM does not directly measure the vaccine
potency but gives info about the main factor that
affects potency

67. Mission Indradhanush

68. Mission Indradhanush was launched by
Ministry of Health and Family Welfare
(MOHFW) Government of India on 25th
December, 2014. The objective of this mission is
to ensure that all children under the age of two
years as well as pregnant women are fully
immunized with seven vaccine preventable
diseases.

69. The Mission Indradhanush, depicting seven colours of the
rainbow, targets to immunize all children against seven
vaccine preventable diseases.

71. Science Hopes a Vaccine for
every Disease

72. Vaccination created HOPE
in Humanity