This document provides information on routine immunization including the types of vaccines, how they work, and the diseases they protect against. It discusses vaccines for tuberculosis, polio, diphtheria, pertussis, tetanus, measles, hepatitis B, and MMR. It also covers key aspects of immunization like the cold chain, adverse events, contraindications, and surveillance. The overall message is that immunization is one of the most cost-effective health interventions and a child's right to protect them from vaccine-preventable diseases.

1. Routine Immunization

2. IMMUNISATION
•PROCESS OF ARTIFICIALLY PROVIDING IMMUNITY
•ACTIVE-VACCINES
•LIVEATTENUATED,KILLED,TOXOID,SUBUNIT,
RECOMBINANT
•PASSIVE-IMMUNOGLOBULIN
•MOST COST EFFECTIVE HEALTH CARE INTERVENTION
AND BIRTH RIGHT OF EVERY CHILD

4. TYPES OF VACCINES
TYPE OF ANTIGEN EXAMPLE
LIVE BACTERIA,ATTENUATEDBCG,TY21
LIVE VIRUS ATTENUATED OPV,MMR
KILLED BACTERIA PERTUSIS,S.TYPHII
KILLED VIRUS IPV,RABIES,HAV
TOXOID DT,TT
CAPSULAR POLYSACCHARIDE TYPHOID VI,HIB ,MENINGO
& PNEUMO
VIRAL SUBUNIT HBsAg
BACTERIA SUBUNIT ACELLULAR PERTUSIS

7. Vaccines and equity
Poorer / US community children at greater risk of
illness and death from vaccine preventable
diseases
Routine vaccination promotes equity in child
health

8. Tuberculosis
Tuberculosis (TB) is caused by the bacterium
Mycobacterium tuberculosis which usually attacks
the lungs, but can also affect other parts of the body,
including the bones, joints, and brain
TB is spread from one person to another through
the air often when a person with the disease coughs
or sneezes. TB spreads rapidly, especially in areas
where people are living in crowded conditions, have
poor access to health care, and are malnourished.

9. Tuberculosis…….
Immunization of infants with Bacille Calmette-
Guérin vaccine (BCG) can protect against TB
meningitis and other severe forms of TB in
children less than five years old. BCG vaccine is
not recommended after 24 months of age
because the protection provided is variable and
less certain.

10. BCG injections
 Protect the child against childhood tuberculosis
 In institutional deliveries, immediately after birth
 In home deliveries, at one and half month along
with the DPT injection and OPV

11. Poliomyelitis
Disease of young children -80-90% <5 yrs, majority
below 2 years
Clusters of susceptible needed to maintain
circulation
Infectivity typically one week before paralysis and 4-6
weeks thereafter (peak first 2 weeks)
Incubation period 7-21 days (range 3-35 days)
Incubation period: Time from infection to appearance of
symptoms
Risk of paralysis increased by tonsillectomy,
exercise, pregnancy, intramuscular injections

12. Clinical Features of Poliomyelitis
Acute onset, flaccid paralysis
Fever present at onset
No progression after 2-3 days
Asymmetric
Legs affected most often
Paralysis is permanent

13. How Polio Spreads?

14. How Polio Spreads?
Transmitted person-to-person, primarily faecal-to-
oral route
Faecal contamination
of food & water enter
through food pipe into
intestine
It then multiply in
thousands
Finally majority of virus
excrete through stool

15. Faeco-oral
route
1:1000
Loose
(Flaccid)
<14d
How does Polio occurs….

16. Outcome of Poliovirus Infection Silent
transmission - >99% of cases sub clinical
asymptomatic infection
clinical illness, no paralysis
paralytic poliomyelitis (~0.5%)

17. MMR
• MULTIDOSE ,LIVE ATTENUATED VIRAL
VACCINE
• 15 MONTHS TO 5 years
• DILUENT-DOUBLE DISTILLED WATER
• MEASLES-1000 TCID-50
• MUMPS-5000 TCID-50
• RUBELLA 1000 TCID50
• DOSE-0.5 ML S/C

18. HEPATITIS B
•RECOMBINANT
•DOSE-0.5 ML OR 10 MICROGRAM
•ROUTE INTRAMUSCULAR
•NOT TO BE GIVEN IN GLUTEAL REGION
•BIRTH DOSE-INSTITUTIONAL DELIVERIES
•3 DOSES WITH DPT STARTING FROM 6 WEEKS TO 14 WEEKS

19. Tetanus
Epidemiology and Prevention of Vaccine-
Preventable Diseases
National Immunization Program
Centers for Disease Control and Prevention
Revised March 2002

20. Clostridium tetani
Spore-forming bacteria
Spores found in soil, dust, animal feces; may persist
for months to years

21. Tetanus Pathogenesis
Toxin binds in central nervous system
Leads to muscle contraction and spasm

22. Tetanus Clinical Features
Incubation period 8 days (range, 3-21 days)
Generalized tetanus: descending symptoms of
trismus (lockjaw), difficulty swallowing, muscle
rigidity, spasms
Spasms continue for 3-4 weeks; complete recovery
may take months

23. Neonatal Tetanus
Generalized tetanus in newborn infant
Infant born without protective passive
immunity: Mother not immunized with Tetanus
Toxoid immunization
Almost all affected newborn die

24. Clinical Neonatal Tetanus

25. Clinical Aspects of Neonatal Tetanus
C. tetani enters through unclean umbilical
cord
Signs & Symptoms
– Trismus (risus sardonicus)
– Neck stiffness
– Body rigidity
– Opisthotonus
– Convulsions
– Respiratory muscle weakness resulting in
death

26. Neonatal Tetanus
Any newborn baby that
- sucks and cries normally during the first
2 (two) days of life;
- becomes ill between 3 and 28 days of life
with BOTH
1. Inability to suck
- and -
2. Generalized muscle rigidity (stiffness)

27. How to Prevent Neonatal Tetanus
Two complimentary strategies
1. Clean delivery - “ 5 cleans”
• Clean delivery surface
• Clean hands
• Clean Thread
• Clean and New Blade
• Clean umbilical cord and stump care
2. Immunization of mother with TT

28. Tetanus Epidemiology
Reservoir Soil and intestine of
animals and humans
Transmission Contaminated wounds
Tissue injury
Communicability Not contagious

29. Diphtheria
Epidemiology and Prevention of Vaccine-
Preventable Diseases
National Immunization Program
Centers for Disease Control and Prevention
Revised March 2002

30. Diphtheria Clinical Features
Incubation period 2-5 days (range, 1-10 days)
May involve any mucous membrane

31. Diphtheria Epidemiology
Reservoir Human carriers
Usually asymptomatic
Transmission Respiratory
Skin and fomites rarely
Communicability Up to several weeks
without antibiotics

32. Pertussis
Highly contagious respiratory infection
caused by Bordetella pertussis
Epidemiology and Prevention of Vaccine-
Preventable Diseases
National Immunization Program
Centers for Disease Control and Prevention
Revised August 2002

33. Pertussis Clinical Features
Incubation period 5-10 days (up to 21 days)
Slow onset, similar to minor upper respiratory
infection with nonspecific cough
Fever usually minimal throughout course

34. Pertussis Clinical Features
Primary stage 1-2 weeks
Paroxysmal
cough stage 1-6 weeks
Convalescence Weeks to months

35. Pertussis Epidemiology
Reservoir Human
Adolescents and adults
Transmission Respiratory droplets
Airborne rare
Communicability Maximum in catarrhal stage

36. DPT
 One dose gives very limited protection
 Two doses give 80-% short term protection
 Three doses lead to sustainable protection
 Administered by intramuscular injection

37. Measles
Highly contagious viral illness caused by measles
virus {Paramyxovirus (RNA)}

38. Measles Pathogenesis
Respiratory transmission of virus
Replication in nasopharynx and regional lymph
nodes

39. Measles Clinical Features
Incubation period 10-12 days
Fever, cough, coryza, conjunctivitis
2-4 days after prodrome, 14 days after exposure
Maculopapular rash
Begins on face and head
Persists 5-6 days
Complications:Diarrhea,Otitis media,Pneumonia,
Encephalitis, Death

40. Measles can cause long-lasting disabilities:
Children with Post-Measles Corneal Scars

42. Vitamin A Supplementation
9 to 12 months: First dose: With measles
vaccine: 1Lac IU ( 1ml= ½ spoon)
More than 12 to 59 months: Second to ninth
dose at the intervals of six months : 2 Lac IU
(2 ml= 1 spoon)

43. Why is Vitamin A supplementation important?
Vitamin A Deficiency (VAD) initially compromises the integrity
of the epithelial barriers and the immune system, this is then
followed by impairment of the visual system. Consequently, there
is increased severity of some infections and increased risk of
death, especially among children.
Vitamin A Supplementation can reduce the risk of mortality
from measles by about 50 % and overall mortality by 25-35%

44. Vitamin A Supplementation
9 to 12 months: First dose: With measles vaccine:
1Lac IU ( 1ml= ½ spoon)
More than 12 to 60 months: Second to ninth dose
at the intervals of six months : 2 Lac IU (2 ml= 1
spoon)

45. Measles Epidemiology
Reservoir Human
Transmission Respiratory
Airborne
Communicability 4 days before to 4 days after
rash onset

46. Measles Vaccine
Composition Live virus
Duration of
Immunity Lifelong
Schedule One dose

47. · Minor illnesses such as upper respiratory infections or diarrhoea, mild
fever (< 38.5°C)
· Allergy, asthma
· Prematurity, underweight newborn child
· Malnutrition
· Child being breastfed
· Family history of convulsions
· Treatment with antibiotics
· Dermatoses, 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
These are not contraindications to Routine
Immunization

48. AEFI
Vaccines are safe and effective
Life threatening adverse events are extremely rare
Mild side effects are commonly seen and can be self
limiting and easily manageable
Benefits of immunization greatly outweighs the risks of
AEFI
Majority are due to unsafe injection practices and
procedures

52. AEFI---- Rare, more severe reactions
Include :
 seizures,
thrombocytopenia,
 hypotonic-hypo responsive
episodes,
 persistent inconsolable
screaming
In most cases they are self-limiting and lead to no
long-term problems
Anaphylaxis, while potentially fatal, is treatable

53. COLD CHAIN
Cold Chain is a system of
transporting and storing vaccines at
recommended temperature from the
point of manufacture to the point of
use

54. COLD CHAIN
All Vaccines tend to lose potency on
exposure to heat above +80 C
Some Vaccines lose potency when exposed
to freezing temperatures
The damage is irreversible

57. COLD CHAIN EQUIPMENTS
WALK IN COOLERS & FREEZERS
ICE LINED REFRIGERATORS
DEEP FREEZERS
VACCINE CARRIERS
DAY CARRIERS
COLD BOXES
DOMESTIC REFRIGERATORS-IN DELHI

59. VACCINE VIAL MONITOR
3 = bad:
Don’t Utilize
4 = bad:
Don’t Utilize
The central square is equal to, or
darker than the surrounding circle
X
X
1 = good:
Utilize
2 = good:
Utilize
The central square is lighter
than the surrounding circle

60. AD SYRINGES
Impossible to reuse
Lowest risk of person to person transmission of
blood borne infections.
Fixed needle reduces dead space so less
wastages. Also eliminates chances of air bubble
entry due to loose fitting earlier.
Dose specific-ensure correct dose
Presterilized-no use of bulky equipment.

61. AD SYRINGE
Do not use if damaged/torn
Tear pack from plunger side.
Remove needle cover& discard
Take dose – do not touch needle or rubber cap
Draw dose. If bubble just shake, administer.
Push plunger completely. Do not recap.

62. AD SYRINGE
Cut the needle immediately from the hub with
the help of the hub cutter. It will go to the white
sturdy container.
NO UNTREATED BIO-MEDICAL WASTE
SHALL BE STORED BEYOND A PRRIOD OF 48
HOURS.

63. Auto-Disable Syringes
Advantages of the AD syringes:
AD syringe is designed to prevent the re-use of non-sterile
syringes.
The fixed-needle design reduces the dead space in the syringe
that wastes vaccine. And eliminates the chances of air bubble
entry into the syringe due to loose fitting of the needle
The AD syringe are made dose specific (0.5 ml & 0.1 ML) and
hence with drawing the plunger to the full length ensures correct
dose. No adjustment is required.
AD syringes are pre-sterilized therefore; eliminating the need to
carry bulky equipment such as pressure cooker / stove /kerosene
etc to session site.
AD syringes being pre sterilized will be advantageous to Health
worker as they would not spend any time on sterilization

64. WASTE GENERATION
AD SYRINGES TO BE USED WHERE SAFE
DISPOSAL POSSIBLE
WASTE CONSISTS OF:
1. PACKAGING MATERIAL
2. SYRINGES
3. NEEDLES
4. BROKEN/DISCARDED VIALS

65. What is Surveillance
WHO – “The continuous scrutiny of the factors
that determine the occurrence of disease and
other conditions of ill health. Surveillance is
essential for effective control and prevention and
includes the collection, analysis, interpretation
and distribution of relevant data for action”
“Data collection for Action"

66. Five steps in Surveillance
Collection of data
Compilation of data
Analysis and interpretation
Follow up action
Feed back

67. Prerequisites for effective Surveillance
Use of Standard Case Definitions
Ensuring Regularity of the Reports
Action on Reports
Medical Officer must be clear about:
– What information to gather
– How often to compile & analyze the data
– How often & to whom to report
– What Performa or formats to use
– What action to take