Universal Immunization Program is a vaccination program launched by the Government of India in 1985. It became a part of Child Survival and Safe Motherhood Program in 1992 and is currently one of the key areas under National Rural Health Mission(NRHM) since 2005. Program consists of vaccination for 12 diseases - Tuberculosis Diphtheria Pertussis  Tetanus,  Poliomyelitis,  Measles, Hepatitis B,  Diarrhea, Japanese-Encephalitis,  Rubella, Pneumonia Pneumococcal diseases

1. PRESENTED BY : N/CDT. PRIYANKA GIRI
IV YEAR BASIC B.SC NURSING
GUIDED BY : LT. COL. MEENAKSHI MANOCHA
ASSOCIATE PROFESSOR

2.  Universal Immunization Program is
a vaccination program launched by
the Government of India in 1985.
 It became a part of Child Survival and Safe
Motherhood Program in 1992 and is currently
one of the key areas under National Rural
Health Mission(NRHM) since 2005.

3. Program consists of vaccination for 12 diseases -
 Tuberculosis
 Diphtheria
 Pertussis
 Tetanus,
 Poliomyelitis,
 Measles,
 Hepatitis B,
 Diarrhea,
 Japanese-Encephalitis,
 Rubella,
 Pneumonia
 Pneumococcal diseases

5. UNDER RCH I
The most common constraints of immunization
success are
- Non uniform coverage
- Poor implementation
- Poor monitoring
- High dropouts
- Over reporting
- Poor injection safety

6. - Reorientation of staff being not carried out
- Cold chain replacement plan not made
- Vacancy of staff at field level not filled
- Poor surveillance of vaccine preventable dieses
- Poor vaccine logistics
- Poor maintenance of equipment
- Extra ordinary emphasis on polio vaccine

7.  Under RCH II
The six goals and their respective objectives
with strategies to achieve these objectives are
summaries in following slides.

8.  Districts will provide efficient and safe
immunization to all infants and pregnant women.
Objectives
 Regular quality immunization sessions are
planned and held.
 Adequate trained staff are empowered to
provide quality immunization services.

9.  An annually upgraded cold chain inventory
according to level of network, in order to
maintain a functional status of 90%.
 An efficient vaccine and injection equipment
management and logistic system to forecast and
deliver adequate supplies of vaccines in timely
manner.
 The implementation of safe injection practices
and waste disposal.

10. Strategies
 Strategies include coordination between national
and state level.
 Printing and supply of national operation
guideline.
 Strengthening of supervision.
 Prioritization of under served population within
districts.
 Strengthening & training of all categories of staff.

11.  Management of cold chain.
 Procurement installation of cold chain
equipment.
 Proper inventory management.
 Cold chain maintenance and repair.
 Timely supply of vaccine.
 Phased introduction of auto disposal syringes
and safety boxes.

12.  Contribute to global polio eradication, measles
mortality reduction and neonatal tetanus
elimination.
Objectives
 Polio eradication certification by 2007.
 Elimination of neonatal tetanus by 2009.
 Reduction measles mortality by 2/3 compared to
2000 estimates, by 2010.
 Achieve and maintain 70% coverage of two
doses of vitamin A to children < 3 years.

13. Strategies
 Strategies include routine immunization for
polio.
 Supplementary immunization campaigns.
 AFP virological surveillance.
 Strengthening service delivery.
 Increasing reporting and action on cases.
 Data analysis.
 Safe delivery practices.
 Targeting supplementary immunization activities.
 Strengthening measles vaccination and
surveillance and response to the outbreaks.

14.  The UIP will have sufficient and sustainable
funding with established adequate, accountable
and efficient fund flows.
Objectives
 Adequate and reliable financial resources and
national, state and local levels for UIP to achieve
goals and objectives.
 Political commitments for adequate annual
funding at all levels.
Strategies
 Strengthening national financial planning and
building partnerships.

15.  Sustain demand and reduce social barriers to
access immunization services.
Objectives
 Widespread support by families & communities.
 All eligible children and pregnant women are
immunized.
 High level political and administrative support for
immunization.
Strategies
 Include coverage with print, electronic media
and improve interpersonal communication.

16.  Accelerated introduction of licensed new and
under utilized vaccines against diseases with
significant mortality and morbidity in India.
Objectives
 Institutional mechanisms in place to adequately
obtained, review and utilize information for
deciding on introduction of new and under
utilized vaccines.
 Review need for MMR or MR vaccine in India’s
immunization program.

17.  Review need for introduction of Japanese
encephalitis vaccine.
 A phased introduction of Hepatitis B vaccine.
Strategies
 Strategies include improve coordination
between MoHFW, research institute, NRI and
development partners, disease burden study,
surveillance and training.

18.  To monitor and use accurate, complete and
timely data on vaccine preventable disease,
AEFIs, antigen coverage and drop out rates by
districts.
Objectives
 Institutionalize surveillance of VPD’s and early
detection of any outbreaks.

19.  Strengthened vaccine quality and injection
safety by developing monitoring system.
 An effective, efficient, complete and timely
immunization, local recording and area
monitoring system.

20. Measles is highly contagious viral disease,
occur in over crowded area and coverage of
measles vaccine is poor.
 These areas needed special vaccination drive
which was initiated by UNICEF in 1998 covering
13 cities and in 1999-2000, 50 more cities were
also covered.
 Now the main focus is on covering all
unprotected children upto 3 years.
 Age of giving MMR vaccine is 15 months.

21.  MMR can be given till 5 years of age under UIP.
 Greece and Bulgaria indicates low coverage of
vaccination in children due to change in national
immunization schedule.
 Study highlights that there is need of constant
supervision of national immunization program
and repeat dose of MMR in adolescents or
youth.

23.  In some places like Delhi the measles, mumps
and rubella (MMR) vaccine has been introduced
in the program.
 It is given at 15 month of age in a dose of 0.5ml
IM/SC.
 If measles is not received by the child till 12
months of age MMR vaccine can be given.
 MMR can be given till 5 years of age under the
program.

24.  Neonatal tetanus is a common problem in many
developing countries.
 In some instances NNT is responsible for >50%
of neonatal deaths which, themselves, may
account for >50% of all infants deaths.
 It is estimated that about 3,00,000 cases NNT
occurred worldwide each year, of which
approximately 2/3 died.

25.  In 1990 neonatal tetanus accounted for almost
80,000 deaths. India was finally declared free of
maternal and neonatal tetanus on May 15, 2015
by WHO.
 Scientifically this disease has been eliminated
by immunizing all women in reproductive age
group with tetanus toxoid.
Elimination of NNT is done by-
 Coverage of all pregnant women with two doses
of tetanus toxoid

26.  Extensive IEC efforts to promote clean
deliveries;
 Five cleans-clean hands, clean surface, clean
blade, clean stump, clean cord tie.
 Providing disposable delivery kits
 Community based surveillance of neonatal
deaths and investigation and control measures
in case of neonatal deaths.

27.  Neonatal tetanus elimination is defined as less
than 1 case of neonatal tetanus per 1000 live
births in every district.
 Recommendation after validation of NTT
elimination;
 Maintain High TT vaccination coverage to
pregnant women.
 Improve institutional delivery practices
 Strengthen surveillance of NNT.

28.  Hepatitis B is viral infection that attacks the liver
and can cause both acute and chronic liver
disease.
 The virus is transmitted through contact with
blood or other body Fluids of an infected person.
 It is a major Global health problem and the most
serious type of viral hepatitis.
 About 2 billion people worldwide have been
infected with virus and about 350 million live
with chronic infection.

30.  An estimated 6 lakh persons die each year due
to acute or chronic consequences of Hepatitis B.
 The Hepatitis virus is 50 to 100 times more
infectious than HIV.
 Hepatitis B virus is an important occupational
hazard for health workers.
 India is in an intermediate endemic state with
prevalence of 2-7 %.
 Hepatitis B is preventable with a safe and
effective vaccine. A vaccine against Hepatitis B
have been available since 1982. Hepatitis B
vaccine is 95 % effective in preventing HBV
infection and its chronic consequences.

31.  First dose of hepatitis B may be given at birth or
within 48 hours of delivery in institutional
deliveries. Otherwise three doses are given
together with OPV and DPT doses in the dose of
0.5 ml intramuscularly.

32.  Typhoid is a major public health problem in
India.
 Causes heavy morbidity and mortality.
 Typhoid vaccine has been introduced in Delhi by
the Directorate of safeguards all children below
5 years of age.
 Vaccine can be given to the children above 2
years of age till 5 years of age IM.

33.  Approximately 410000 of under 5 deaths in India
are due to pneumonia out of which an estimated
70000 are caused by Haemophilus Influenzae
Type B.
 Data from some developing countries such as
Bangladesh, Chile and Malawi suggested that it
is a cause of over 20% of life threatening
childhood pneumonia.
 Small scale studies from India have documented
case fatality rate of HIB Meningitis as 11 %, and
about 30% of survivors suffer from major
disabilities.

35.  This is why HIB vaccine introduction in National
immunization Program (NIP) of India has been
done.
 The Pentavalent vaccine combines 5 different
vaccine in one injection to protect at least five
diseases;
I. Haemophilus Influenzae Type B diseases
II. Diphtheria
III. Pertussis
IV. Tetanus
V. Hepatitis B.

36.  Children immunized with the 5-in-1 vaccine don’t
need to be vaccinated separately with the DPT
or Hepatitis B vaccine
 All children during their first year of age should
receive 3 doses of pentavalent vaccine with an
interval of at least 4 weeks between the doses.
 However children who have already started
immunization with DPT and hepatitis B have to
complete their vaccination with DPT and
hepatitis B only, they are not to be given
pentavalent vaccine.

37.  Vaccination with pentavalent must be completed
within 2 years of age if the child starts before
one year of age.
 Children under 6 weeks of age, over 5 years,
teenagers and adults should not be given
pentavalent vaccine because of the DPT
component.

38.  The "cold-chain" is a system of storage and
transport of vaccine at low temperature from the
manufacturer to the actual vaccination site.
 In other words the success of national
immunization program is highly dependant on
supply chain system for delivery of vaccines and
equipments, with a functional system that meets
6 rights of supply chain;
-The right vaccine in right quantity at the right
place at the right time in the right condition
and at the right cost.

39.  Among the vaccines, Polio is the most sensitive
to heat requiring storage at -20 degree
centigrade.
 Vaccines must be stored in the freezer
compartment are; Polio and Measles.
 Vaccine which must be stored in cold part but
never allowed to freeze are "T Series" vaccines
(DPT, Tetanus toxoid, DT) Hepatitis B, BCG and
Diluents.

40.  In general all vaccine must be stored under the
conditions recommended by the manufacturer in
the literature accompanying the vaccine,
otherwise they may become denatured and
totally ineffective.
 Vaccine must be protected from sunlight and
antiseptics.
 At the health centre, most vaccines can be
stored up to 5 weeks if the refrigerator
temperature is strictly kept between 2 to 8
centigrade.

41.  Do not keep any used vials in the cold chain.
 Return the unused vaccine vial from the session
site to the PHC on the same day in the cold
chain through alternative vaccine delivery.
 Keep the box labeled "returned unused" in the
ILR for all unused vaccines that can be used in
the subsequent session, but discard vaccines
that have been returned unopened more than 3
times.

42.  Walk in cold room (WIC): located at regional
level. Store vaccine for 3 months. Serve 4 to 5
districts.

43.  Deep freezer: supplied to all districts (large) and PHC
(small) to store vaccines.
 Temperature maintain between -15 degree centigrade to
-25 degree centigrade.
 In case of power failure these freezers can maintain the
cabinet temperature for 18 to 22 hours.

44.  Ice Lined Refrigerator (ILR) : ILR are kept at
the PHC (small) and District level (large).
 The cabinet temperature is maintained at + 2
degree centigrade to + 8 degree centigrade. At
the PHC level, ILR are used for storing all UIP
vaccine. ILR are lined with tubes or Ice packs
filled with water which freezes and keeps the
internal temperature at a safe level.
 All vaccines must be kept in the basket of the
ILR along with the diluents.

45. A Dial thermometer should be kept in the ILR
and temperature recorded twice a day. At the
time of defrosting the vaccines are shifted to the
cold boxes containing required number of frozen
ice packs.

46.  COLD BOXES: Cold boxes are supplied to all
peripheral centres.
 These are used mainly for transportation of the vaccines.

47.  Before the vaccines are place in the cold boxes,
fully frozen ice packs are placed at the bottom
and sides.
 The vaccines are first kept in cartons or
Polythene bags.
 The vials of DPT, DT, TT vaccines and diluents
should not be placed in direct contact with the
frozen ice packs.

48.  Vaccine Carrier: Vaccine Carriers are used to
carry small quantities of vaccines (16 to 20 vials)
for the out of reach session.
 4 fully frozen ice packs are used for lining the
sides, and the vials of DPT, DT, TT and diluents
should not be placed in direct contact with the
frozen ice packs.
 The carriers should be closed tightly.

49.  Day Carriers: Day Carriers are used to carry
small quantities of vaccines (6 to 8) vials to a
nearby session.
 It is only used for few hours period.

50.  Ice Packs: The ice pack contain water and no salt
should be added to it.
 The water should be filled up to the level mark on the
side.
 If there is any leakage such ice pack should be
discarded.

52. The shake test to determine whether vaccine
has been frozen
 DPT, hepatitis B and Tetanus toxoid vaccines
can be damaged by freezing. You can find out
whether this has occurred by using the shake
test.
1. Take two DPT vials, one that you think might
have been frozen and another from the same
manufacturer which you KNOW has never
been frozen.

53. 2. Shake both vials.
3. Look at the vaccine inside the two vials.
4. Let the sediment settle for 15-30 minutes.
5. Again look at the vaccine inside the two vials.
(see image)

56.  Vaccines are not stored at the sub-centre level
and must be supplied on the day of use.
 PHC must not hold more than 1 month's stock.
 Immunization must be carried out in a shade.
 The vaccines (OPV and Measles) must be kept
on an ice pack or in a cup of ice during the
vaccination session.
 No direct sunlight should fall on them.

57.  OPV sample should be sent with fully frozen ice
packs and rush to the assign laboratory for the
potency test.
 Measles vaccine should be used within 4 hours
of reconstitution. Similarly BCG should not be
used after 3 hours of reconstitution.

58.  Good disease surveillance.
 No pathogen variations.
 Potent vaccine.
 Adequate development and/or procurement of
vaccines.
 Appropriate and acceptable choice of
Technologies.
 Universal vaccination (even among childhood
vaccines).
 Adequate logistics, cost benefit analyses and
resource mobilization.

59.  Immunization sessions are not being held
regularly in the community.
 Inadequate mobility of the health worker and the
supervisory staff at district and state level.
 Problem of delivery of vaccines and drugs to
outreach session's site.
 In urban areas lack of adequate health
infrastructure.
 Lack of trained manpower for vaccination.
 Impact of rumors of vaccine adverse events or
deaths.

60.  Pulse Polio is an immunization campaign
established by the government of India to
eliminate poliomyelitis (polio) in India by
vaccinating all children under the age of five
years against the polio virus. The project fights
poliomyelitis through a large-scale pulse
vaccination program and monitoring for polio
cases.

61.  In India, vaccination against polio started in
1978 with Expanded Program on Immunization
(EPI). By 1984, it covered around 40% of
infants, giving three doses of OPV to each.
 In 1985, the UIP was launched to cover all the
districts of the country. UIP became a part of
child survival and safe motherhood program
(CSSM) in 1992 and Reproductive and Child
Health Program (RCH) in 1997. This program
led to a significant increase in coverage, up to
95%.

62.  In 1995, following the Global Polio Eradication
Initiative of the World Health Organization
(1988), India launched Pulse Polio immunization
program with Universal Immunization Program
which aimed at 100% coverage.

63.  Routine immunization : Immunize every child
age <1 year with at least 4 doses of
OPV through UIP.
 National immunization days (NIDs)/Pulse Polio
Immunization (PPI) program/Sub-National
Immunization days(SNIDs) : Conducted by
giving additional doses of OPV, 4 to 6 weeks
apart to every child age less than 5 years.
 Intensification of the pulse polio immunization
program has been done by adding additional
rounds at fixed booths followed by house to
house "search and vaccinate" component.

64.  National immunization day: In India transmission
of polio has been fluctuating so it has been
decided that there is a need to make extra
efforts to reach the unreached during pulse polio
immunization days. for that reason intensified
pulse polio immunization was proposed and just
after the national immunization day (Polio
Ravivaar ).
 Immunization team would visit house to house
with a vaccine to check whether the child has
received pulse polio vaccine and if not then child
must be given a dose of that time only.

65.  Surveillance of acute flaccid paralysis AFP: to
identify all reservoirs of wild polio virus
transmission surveillance of AFP has been
started. AFP is now defined as "any child is less
than 15 years of age who have sudden onset of
flaccid paralysis or paralytic illness in a person of
any age when polio suspected."

66.  Setting up of booths in all parts of the country.
 Initializing walk-in cold rooms, freezer rooms,
deep freezers, ice-lined refrigerators and cold
boxes for a steady supply of vaccine to booths.
 Arranging employees, volunteers, and vaccines.
 Ensuring vaccine vial monitor on each
vaccine vial.

67.  Immunizing children with OPV on national
immunization days.
 Identifying missing children from immunization
process.
 Surveillance of efficacy.
 Publicity was extensive and included replacing
the national telecoms' authority ringtone with a
vaccination day awareness message, posters,
TV and cinema spots, parades, rallies, and one-
to-one communication from volunteers.
Vaccination booths were set up, with a house-to-
house campaign for remote communities.