It commonly institutes activities that limit risk exposure or increase the immunity of individuals at risk to prevent a disease from progressing in a susceptible individual to subclinical disease. For example, immunizations are a form of primary prevention.

1. PREVENTION OF IMMUNIZATION SCHEDULE

4. SESSION OUTLINE
• History
• What is immunization
• Why immunization
• How vaccine works
• Types of Vaccines
• Universal Immunization Programme
• National Immunization schedule
• Cold chain and vaccines
• Achievements

6. BEGINNING OF VACCINATION

8. IMMUNIZATION
•Immunization is a process of protecting an
individual from a disease through
introduction of live attenuated, killed or
organisms or antibodies in the individual
system.
•Immunization is the process of
protecting an individual by active or
passive method.

9. ACTIVE VS PASSIVE IMMUNIZATION
 Active
 Killed or live attenuated
organism injectedwhich
can induce immune
response
 Long term
 Immune system plays role
 Ex-Hepatitis B vaccine,
DPT, Inactivated polio
vaccine, Measles-rubella
(MMR) combined vaccine
Passive
• Transfer of antibodies
• Short term
• No role of immune
system
• Ex-Anti Tetanus,
serum, Anti Rabies
immunoglobulin etc

10. IMPORTANCE OF IMMUNIZATION
•Prevention of deadly and debilitating
diseases.
•Keeps child from suffering through a
preventable illness.
•Less doctor visits
•No hospitalization

13. COMMUNICABLE DISEASES A N D
VACCINES AVAILABLE
• TB – BCG
• Measle, Mumps, Rubella - MMR
• Chicken Pox - Varicella
• Diptheria, Tetanus, Pertussis (aka Whooping Cough) -
DPT
• Hepatitis (Aand B) – HepA, HepB
• Polio – OPV
, IPV
• Rotavirus – RVV
• Pneumoccus – PCV
• Haemophilus influenzae B- Hib

14. TYPES OF VACCINES
•Live, attenuated vaccines
•Inactivated vaccines
•Subunit vaccines
•Toxoids

15. LIVE VACCINES
• Live, attenuated vaccines contain a version of
the living microbe that has been weakened in
the lab so it can’t cause disease.
• Because a live, attenuated vaccine is the closest
thing to a natural infection, these vaccines are
good “teachers” of the immune system.
• Example: Vaccines against polio (OPV),
measles, mumps, rubella and chickenpox

16. INACTIVATED VACCINES
• Scientists produce inactivated vaccines by killing
the disease-causing microbe with chemicals, heat,
or radiation. Such vaccines are more stable and
safer than live vaccines.
• Because dead microbes can’t mutate back to their
disease-causing state.
• Example:Vaccines against influenza, inactivated
polio vaccine, hepatitisAetc.

17. TOXOIDS
• For bacteria that secrete toxins, or harmful
chemicals, a toxoid might be the answer.
• These vaccines are used when a bacterial toxin is
the main cause of illness.
• Scientists have found that they can inactivate
toxins by treating them with formalin. Such
“detoxified” toxins, called toxoids, are safe for use
in vaccines.
• Example: Diphtheria,Tetanus toxoid

18. SUBUNIT VACCINE
•Instead of the entire microbe, subunit
vaccines include only the antigens that
best stimulate the immune system.
•Because subunit vaccines contain only
the essential antigens and not all the
other molecules that make up the
microbe.
•Example: Plague immunization.

19. COMBINATIONS
THE AIM IS TO
– SIMPLIFY
ADMINISTRATION.
- reduce costs
-minimise the no. of contacts with the health
system.
Eg. DPT, DT, MMR, DPT& Hep.B, DPT, Hep
B &
Hib, HepA & B etc.

20. EXPANDED IMMUNIZATION PROGRAMME
• In 1974, Expanded program of Immunization (EPI) organized by
WHO
• It was called Expanded because:
• Adding more disease controlling antigens of vaccination
schedules.
• Extending coverage to all corners of a country.
• On 19 November 1985, GOI renamed EPI program, modifying the
schedule as ‘Universal Immunization Program’
• ‘Universal’ immunization is, therefore, best interpreted as
implying the ideal that no child should be denied immunization
against tuberculosis, diphtheria, whooping cough, tetanus, polio
and measles.

21. MILESTONE OF THE EPI

22. OBJECTIVES OF THE EPI
1. To reduce the morbidity and mortality of the major six
childhood disease.
2. To achieve 100% coverage for eligible children by an
ongoing integrated program .
3. To deliver an integrated immunization services through
health centers, as primary health care services package .
4. To develop a surveillance system which collect adequate
information on the disease preventable by immunization .
1. To minimize the efforts and cost of treatment .
1. To promote a new healthy generation.

23. STRATEGIES OF THE EPI
1. Integrated vaccination sessions with PHC services.
2. Appropriate measures to expand the vaccination coverage
of the eligible population .
3. Ensuring regular supply of potent vaccine .
4. Strengthening the cold chain.
5. Training of health personnel .
6. Promotion of community participation.
7. Ensuring logistic support(supplies and equipments).
8. Undertaking operational research to find out deficiencies &
difficulties in the programme and suggest methods of
improvement.

24. TARGETS OF THE EPI
1. Under – 5 years children .
2. Women in child bearing age
3. Schedule of immunization
4. Types of vaccine .
5. Dose & route of each vaccine .
6. Precautions of vaccination

26. IF A DOSE IS MISSED……..
•Give the dose at the next opportunity
irrespective of the time gap
•Do not start the schedule all over
again

27. TETANUS TOXOID
• Intramuscular– upper arm – 0.5 ml
• Pregnancy – 2 doses - 1st dose as early as possible and
second dose after 4 weeks of first dose and before 36
weeks of pregnancy
• TT booster for both boys and girls at 10 years and 16
years
• The booster dose should be given a year after the initial
doses.
• It should be stored between 4 and 10 deg C.

28. BCG
▣ Initial dose birth or as early as possible till one year of age
▣ 0.1 ml (0.05ml until one month of age)
▣ Intra-dermal
▣ Left upper arm
▣ Freeze dried is more stable. Diluent is Normal saline.

29. HEPATITIS B
• Birth dose – within 24 hours of birth
• 0.5 ml
• Intramuscular
• Antero-lateral aspect of mid-thigh
• Rest three doses at 6 weeks, 10 weeks and 14 weeks
• It should be stored at 2 to 8 deg C.
• 1 ml in adults, 05ml in children <10 yrs, given IM. Mostly
used 0,1,6 m schedule.

30. ORAL POLIO VACCINE
▣ Zero dose – at birth
▣ 2 drops
▣ Oral
▣ First, second and third doses at 6,10 and 14 weeks with Pentavalent-1,
2 and 3
▣ OPV booster with DPT booster at 16-24 months

31. PENTAVALENT VACCINE
• Simultaneous immunization against diphtheria, Pertuisis &
Tetanus, Hep B, Hib.
• Stored at 4-8 degree C.
• Given 0.5 ml IM at anterolat. aspect of thigh.
• Primary 3 doses with a booster in 16 -24 months. DT 5-6
yrs.
• C/I –progressive neurological diseases.

32. ROTAVIRAL VACCINE
• 3 doses given in 6th, 10th and 14th weeks.
• Can be given till one year of age
• G9P human strain.
• Dose - 5 drops/0.5 ml orally
• for prevention of diarrhoea among infants due to
rotavirus.

33. IPV
•2 fractional doses given in 6th and
14th weeks.
•Dose – 0.1 ml
•Given intradermally in Right upper
arm

34. JAPANESE ENCEPHALITIS
•0.5 ml, 2 doses
•9 months and16-24 months
•Subcutaneous
•Left upper arm

35. MR VACCINE
• Bivalent Live atteunated against measles and rubella.
• Given 0.5 ml SC at 9-12 and 16-24 months.
• Stored 2-8 deg C
• Strain- Measles-Edmonstorn-zagreb, Rubella- Wilstar
RA27/3
• Reactions- Fever, Resp. symp.s, Lymphadenitis or
parotitis

36. DPT
•Primary doses were in pentavalent vaccine.
•One booster at 16-24 m with OPV booster
(antero-lateral side of mid-thigh) and
second booster at 5-6 years (upper arm)
•0.5 ml
•Intra-muscular

37. VITAMIN A
• 1st dose – 1 ml (1 IU) - along-with Measles first dose - Oral
• Subsequent 8 doses (2 ml or 2 lakh IU) every six months till 5
years of age starting with DPT first booster at 16-24 months
• Use only plastic spoon provided with Vitamin A solution

38. • REFERENCE :-
-SAXENA R.P . TEXTBOOK OF COMMUNITY HEALTH NURSING . 2ND
EDITION. LOTUS PUBLICATION. NEW DELHI. 2018. PAGE NO. 508-5011
-PARK,S K. TEXT BOOK OF PREVENTIVE AND SOCIAL MEDICINE. 23 RD
EDITION M/S BANARASIDAS BHANOT PUBLISHERS. PREM NAGAR
NAGPUR ROAD JABALPUR (INDIA).2015
-HTTPS://APPS.WHO.INT/IRIS/HANDLE/10665/61767
-UNICEF. “EXPANDING IMMUNIZATION COVERAGE”

39. VACCINES AND
COLD CHAIN

40. Cold
W H Y HAVE THE C O L D CHAIN?
IFVACCINES ARE EXPOSED TO EXCESSIVE
Heat
Light
they may lose their potency or effectiveness.

41. HEAT DAMAGE
• Heat damage is cumulative effect
• Reconstituted vaccine is most sensitive to heat and
light.
• Measles and BCG vaccines should not be used 4 hrs after
reconstitution and JE 2 hrs after reconstitution
• Temperature of diluents & vaccine must be same during
reconstitution

42. HEAT SENSITIVITY
• BCG (after reconstitution)
• OPV
• Measles (before and after
reconstitution)
• DPT
• BCG (before reconstitution)
• DT
• TT
• HepB
LEAST SENSITIVE
MOST SENSITIVE

43. SENSITIVITY FROM FREEZING
• Hep B
• DPT
• DT
• TT
LEAST SENSITIVE
MOST SENSITIVE

44. COLD CHAIN
• System of storage & transport of vaccines at low temp. from
the manufacturer to the actual vaccination site.
Manufacturer
Airport
State/Region
District store
Health centre
Outreach
Subcentre

45. COLD CHAIN
• Walk-in-cold rooms-at regional levels.
• Deep freezers-for making ice packs and storage of OPV.
• Ice-lined refrigerators-at PHC level.

46. REMEMBER
• All vaccines tend to lose potency on exposure
to heat above +80 C
• Some vaccines (Hep B,TT,DPT) lose potency
when exposed to freezing temperatures
• Some vaccines are sensitive to light (BCG,
Measles).
• The damage is irreversible
• Physical appearance ofthe vaccine may
remain unchanged but potency might be
lost.

47. MONITORING OF COLD
CHAIN
The physical appearance of the vaccine may
remain unchanged even after it is damaged
The loss of potency due to either exposure to
heat or cold is permanent and can not be
regained.
Heat Damage- All vaccines are damaged
by temperatures more than +8°C.
Checking for heat damage: The Vaccine Vial
Monitor contains a heat-sensitive material,
placed on a vaccine vial to register cumulative
heat exposure over time.

48. COLD CHAIN
EQUIPMENTS

49. WALK-IN-FREEZERS
(WIF)
 Installed in all of the states and larger divisional head
quarters.
 They maintain a temperature around -20°C.
 bulk storage of OPV, and also to prepare frozen ice packs
at state stores.
Available in
sizes of 16.5 Cum. and
32 Cum.

50. ICE LINED REFRIGERATOR
Available in different sizes:
108 liters or 26000 to 30000 doses
45 liters or 11000 to 13000 doses
100 liters or 24000 to 28000 doses
50 liters or 12000 to 14000 doses
 Top opening because they can hold the cold air inside better than a
refrigerator with a front opening.
 There is a lining of water containers (Ice packs or tubes) fitted all
around the walls and held in place by frame.
 Keep vaccine safe with as little as 8 hours continuous electricity supp
in a 24-hour period.

51. DEEP
FREEZER
Available in different sizes:
264 liters or 380 icepacks
72 liters or 130 icepacks
80 liters or 140 ice packs.
 Cabinet temperature is maintained between -15°C to -
25°C.
 Used for storing of OPV (district level and above only) and
also for freezing ice packs.
 All districts have been provided 2-5 large deep freezers
 Most PHCs have been provided with one small deep freezer.

52. WALK-IN-COOLERS
 Established at regional levels, which store vaccines for about
4-5 districts
 Maintains temperature of +2°C to +8°C.
 Used for storage of large quantities of vaccines, like DPT, DT,
TT, Measles, BCG, Hepatitis B.
 WIC/WIF store vaccines of three months requirement and 25%
buffer
stock for the districts they cater.
Available in
sizes of 16.5 Cum. and
32 Cum.

53. VA C C I N E C A R R I E R S
• Used for carrying vaccines
(16-20 vials) and diluents
from PHC to the outreach
session sites.
• With 4 conditioned icepacks
maintain inside temperature of
2-80C for 12 hours.
• Close the lid of the carrier
tightly.
• Never use any day carriers
with 2 icepacks or thermos
flask for carrying vaccines.

54. COLD
BOX
 Big insulated boxes
 Mainly used to collect and transport large quantities of vaccines
 In emergency they can be used to store vaccines as well as frozen
ice packs.
 Store vaccines for transfer up to five days, if necessary for
outreach
sessions or when there is power cut.
Available in different sizes:
5& 8 liters for 1500 & 2400
doses
20-22 liters for 6000 -6600 doses

55. PREPARATION OF VACCINE
CARRIERS
Take out the required number of ice packs from the
deep freezer and wipe them dry.
Keep them out side for conditioning.
Place four conditioned ice packs in the carrier
wait till temperature to fall to <8 ° C in the carrier
Wrap vaccine vials and ampoules in thick paper
before putting in polythene bag so as to prevent
them from touching the ice packs.

56. CONT
….
Place some packing material between `T’ series
vaccine and the ice packs.
Place foam pad at the top of ice packs
Ensure that some ice is present in the ice
packs while conducting immunization
sessions.
Secure the lid tightly.

57. VACCINE VIAL
MONITOR

58. USABLE A N D UNUSABLE STAGES OF VVM

60. ACHIEVEMENTS:
• The biggest achievement of the immunization
program is the eradication of small pox.
• One more significant milestone is that
India is free of Poliomyelitis caused by
Wild Polio Virus (WPV) .
• Vaccination has contributed significantly to the
decline in the cases and deaths due to the Vaccine
Preventable Diseases (VPDs).