Universal immunization programme

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Prepared by:-
Krenil Parmar
Akshika Patel
Amisha Patel
Guided by:- Dr.Sapna Desai Pioneer Pharmacy Degree College

 Introduction
 History
 Aims
 Objectives
 Immunization schedules
1. National Immunization
Schedule
2. WHO EPI Schedule
 New Vaccines
 Implementation of Routine
Immunization
 Components
1. Strategy and policy
2. Cold Chain System,
Vaccines and logistics
3. Injection Safety and
Waste disposal
4. AEFI Surveillance System
in India
5. Strategic communication
6. Immunization Things
7. Monitoring and
Evaluation
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Pioneer Pharmacy Degree College

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 Universal Immunization Programme (UIP) is one of the largest
public health programmes targeting close of 2.67 crore newborns
and 2.9 crore pregnant women annually.
 It is one of the most cost-effective public health interventions and
largely responsible for reduction of vaccine preventable under-5
mortality rate.
 Under UIP, immunization is providing free of cost against 12 vaccine
preventable diseases:
 Nationally against 9 diseases - Diphtheria, Pertussis, Tetanus,
Polio, Measles, Rubella, severe form of Childhood Tuberculosis,
Hepatitis B and Meningitis & Pneumonia caused by Hemophilus
Influenza type B

 Sub-nationally against 3 diseases - Rotavirus diarrhoea,
Pneumococcal Pneumonia and Japanese Encephalitis; of which
Rotavirus vaccine and Pneumococcal Conjugate vaccine are in
process of expansion while JE vaccine is provided only in endemic
districts.
 A child is said to be fully immunized if child receives all due vaccine
as per national immunization schedule within 1st year age of child.
 The two major milestones of UIP have been the elimination of polio
in 2014 and maternal and neonatal tetanus elimination in 2015.
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 Under Global Smallpox Eradication Programme, it was
experienced that immunization is the most powerful and cost
effective weapon for the prevention and control and even
eradication of a disease.
 May 1974, WHO officially launched a global immunization
programme, known as Expanded Programme of Immunization for
the prevention and control of six major, killer disease of children,
namely tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis,
and measles, all over the world by the year 2000. EPI was launched
in India in January 1978.
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 It was called Expanded because:
-Number of disease covered are more.
-Services are extended to all corners of the world, irrespective of
cast, creed, community and ability to pay for it.
-The child is immunized much before it is born.
 Beneficiaries were all expectant mothers and children up to 16
years of age.
 Immunization was recommended from 3rd month of infancy and for
pregnant mothers, 3 doses of TT, respectively during 16-24 weeks,
24-32 weeks and during 36 weeks.
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 Government of India launched same program with same schedule
on 1st January 1978 with the same objectives of reducing child
morbidity and mortality rates and to achieve self sufficiency in the
production of vaccines.
 WHO launched a social target of achieving Health for all by 2000
AD.
 In 1983, the schedule was revised and recommended only 2 doses
of TT during pregnancy, respectively during 16-24 weeks and 24-
36 weeks and commencing routine immunization as early as 6
weeks during infancy and services were concentrated to under 5.
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 The Programme is now called Universal Child Immunization, 1990-
that’s the name given to a declaration sponsored by UNICEF as
part of the ‘United Nations’ 40th anniversary in October 1985. It is
aimed at adding impetus to the global programme of EPI.
 The Indian version, the ‘Universal Immunization Programme’, was
launched on November 19, 1985 and was dedicated to the memory
of Smt. Indira Gandhi. The National Health Policy was aimed at
achieving universal immunization coverage of the eligible
population by 1990.
 Impetus was added to the existing program by shifting from under 5
to under 1 year of age and the quality of services was also
improved.
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 It was recommended to give 1st dose of TT to the pregnant mother
in the first contact and 2nd dose after 1 month and BCG and OPV to
the new born as early as at birth.
 During 1992, immunization program become a component of Child
Survival and Safe Motherhood (CSSM) program. It was
recommended to cover 100% among infant also.
 In 1995, Pulse Polio Immunization Programme was launched as a
strategy to eradicate poliomyelitis.
 In 1997, immunization activities have been important component of
National Reproductive and Child Health Programme.
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 In 2005, immunization schedule was revised incorporating Hepatitis
vaccine, 2 doses of JE vaccine in selected endemic district, 1st
during 9-12 months and 2nd during 16-24 months and 2 doses of
Measles vaccine, 1st dose during 9-12 months and 2nd dose during
16-24 months, under National Rural Health Mission (NRHM).
 In 2012, GOI declared 2012 as the “Year of Intensification of
Routine Immunization”.
 In 2013, GOI along with other S-E Asia regions, declared
commitment towards measles elimination and congenital Rubella
syndrome control by 2020.
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 In 2014, India was certified as “Polio free country”.
 To strengthen routine immunization, Government of India has
planned the State Programme Implementation Plan (PIP) part C.
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 100% coverage of expectant mothers with 2 doses of Tetanus
toxoid(TT).
 At least 85% coverage of infants with 3 doses DPT and OPV 1
dose each of BCG and Measles vaccine before child’s 1st birthday.
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 Rapidly increase immunization coverage.
 Improve the quality of services.
 Establish a reliable cold chain system to the health facility level.
 Introduce a district-wise system for monitoring of performance.
 Achieve self-sufficiency in vaccine production.
 Elimination of neonatal tetanus.
 Eradication of paralytic poliomyelitis.
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 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
5. Hepatitis B
6. TT (Tetanus Toxoid)
7. JE vaccination (Japanese Encephalitis) - (in selected high
disease burden district)
8. Hib containing Pentavalent vaccine
(DPT+Hep B+Hib) - (in selected states)
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1. National Immunization Schedule
 The Indian Academy of Paediatrics(IAP) recommends inclusion of
more vaccines in the immunization schedule.
 These vaccines are not included in the UIP because of financial
constraints.
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 The immunization schedule approved by the IAP is:
BCG - Birth - 2 weeks
OPV - Birth; 6 weeks, 10 weeks and 14 weeks;
16-18 months, 5 years
DPT - 6 weeks, 10 weeks and 14 weeks;
16-18 months, 5 years
Hepatitis B - Birth, 6 weeks and 14 weeks or
6 weeks, 10 weeks and 14 weeks
Hib Conjugate - 6 weeks,10 weeks and 14 weeks
Measles - 9 months, 16-24 months
MMR - 15 months
Typhoid - 2 years, 5 years, 8 years, 12 years
TT/Td - 10 years, 16 years
TT - 2 doses one month apart for pregnant women,
or booster dose if previously immunized. 16

 Vaccines that can be given after discussion with parents:
Varicella - 15 months (or after 1 year)
Hepatitis A - High-risk selected infants,
18 months, and 6 months later
Pneumococcal - 6 weeks
conjugate vaccine
Influenza vaccine - 6 months of age to high risk selected
infants anually
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contd…
Vaccine When to
give
Max.
Age
Dose Diluent Route Site
For Pregnant Women
TT- 1 Early in
pregnancy
0.5 ml NO Intra-
muscular
Upper
arm
TT- 2 4 weeks after
TT-1
0.5 ml NO Intra-
muscular
Upper
arm
TT-
Booster
If received
TT dose in
pregnancy
within the
last 3 years
0.5 ml NO Intra-
muscular
Upper
arm
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Vaccine When
to give
Max. Age Dose Diluent Route Site
For Infants
BCG At birth Till 1 year
of age
0.1 ml (0.05
ml until 1
month of age)
Sodium
chloride
Intra-
dermal
Left upper
arm
Hepatitis
B
At birth Within 24
hrs
0.5 ml NO Intra-
muscular
Antero-
lateral
side of
mid thigh
OPV-0 At birth Within the
first 15
days
2 drops NO Oral
OPV- 1,2
& 3
At 6,10
and 14
wks
Till 5 years
of age
2 drops NO Oral
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Rota Virus
vaccine
At 6,10 and
14 wks
Till 1 year
of age
5 drops NO Oral
IPV At 14 wks Up to 1
year of
age
0.5 ml NO Intra-
muscular
Antero-
lateral side
of mid thigh
Pentavalent
1,2 & 3
At 6,10 and
14 wks
Till 1 year
of age
0.5 ml NO Intra-
muscular
Antero-
lateral side
of mid thigh
Measles 1st
dose
9-12
completed
months
Till 5
years of
age
0.5 ml Sterile
water
Sub-
cutaneous
Right upper
arm
JE 1st dose 9-12
completed
months
Till 15
years of
age
0.5 ml Phosphate
buffer
Sub-
cutaneous
Left upper
arm
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Contd…

Vitamin A
(1st dose)
At 9
completed
months with
measles
Till 5 years
of age
1 ml (1
lakh IU)
NO Oral
For Children
DPT
Booster-1
16-24
months
7 years 0.5 ml NO Intra-
muscular
Antero-
lateral side
of mid
thigh
Measles
2nd dose
16-24
months
Till 5 years
of age
0.5 ml Sterile
water
Sub-
cutaneous
Right
upper arm
OPV
Booster
16-24
months
Till 5 years
of age
2 drops NO Oral
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Contd…

JE 2nd
dose
16-24
months
0.5 ml Phosphat
e buffer
Sub-
cutaneou
s
Left
upper
arm
Vitamin
A (2nd to
9th dose )
16 month
then 1
dose
every 6
months
Till 5
years of
age
2 ml (2
lakh IU)
NO Oral
DPT
Booster
2nd dose
5-6 years 7 years 0.5 ml NO Intra-
muscular
Upper
arm
TT 10 years
and 16
years
0.5 ml NO Intra-
muscular
Upper
arm
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Contd…

2. WHO EPI Schedule
 The purpose is to assist health planners to develop an appropriate
country specific immunization schedule based on local conditions.
 The health care workers should refer to their national immunization
schedules.
 The WHO EPI Global Advisory Committee has strongly
recommended BCG and Polio vaccine to be given at birth or at first
contact, in countries where Tuberculosis and Polio have not be
controlled.
 In all countries routine immunization with DPT and oral Polio
vaccine can be safely and effectively initiated at 6 weeks of age.
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 New vaccines can be safely being added for the vaccination
schedule e.g., Hepatitis B, Rubella and Japanese
Encephalitis(JE) vaccines are now included in several country’s
programmes.
 The immunization schedule may be altered to suit the local needs
of individuals and groups.
 Interruption of the schedule with a delay between doses does not
interfere with the final immunity achieved.
 There is no basis for the mistaken belief that if a second (or third)
dose in an immunization is delayed, the immunization schedule
must be started all over again.
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 The WHO Scientific Advisory Group of Experts to EPI has indicated
the need to expand immunization activities beyond infancy, either
as part of routine immunization services or as part of disease
elimination or eradication measure.
 The vaccines of interest are MR and MMR as part of Measles
outbreak prevention or elimination campaign, Td as booster dose
for neonatal Tetanus elimination, Hepatitis B, Influenza, Varicella
and HPV vaccines etc.
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 In April 2016, India introduced the use of Fractional dose IPV
(FIPV) into the routine immunization programme in 8 states
(Odisha, Andhra Pradesh, Telangana, Karnataka, Tamil Nadu,
Pondicherry and Maharashtra).
 Since March 2017 has been scaled up nationwide in all 36 states. 2
fractional doses of IPV 0.1 ml, are being given intradermally at 6
and 14 weeks.
 On 5th Feb 2017, The Ministry of Health and Family Welfare
launched Measles Rubella (MR) vaccination campaign in the
country, following immunization, replacing the currently given 2
doses of measles vaccine, at 9-12 months and 16-24 months of age
in 5 states (karnataka, Tamil Nadu, Pondicherry, Goa and
Lakshadweep)
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 In March 2016, the Rotavirus vaccine was first introduced in 4
states (Haryana, Himachal Pradesh, Andhra Pradesh and Odisha).
On 18 Feb 2017, Union Minister for Health and Family Welfare
announced the expansion of the Rotavirus vaccine under its UIP in
five additional states of Assam, Tripura, Madhya Pradesh,
Rajasthan and Tamil Nadu.
 On 13 May 2017, Union Minister for Health and Family Welfare,
announced the introduction of pneumococcal conjugate
vaccine(PCV) in the UIP. Currently, the vaccine is being rolled out
to approximately 21 lakh children in Himachal Pradesh and parts of
Bihar and Uttar Pradesh in the first phase. This will be followed by
eventually be expanded to the country in a phased manner.
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 RI targets vaccinate 26 million new born each year with all primary
doses and ~100 million children of 1-5 year age with booster doses
of UIP vaccines. In addition, 30 million pregnant mothers are
targeted for TT vaccination each year.
 To vaccinate this cohort of 156 million beneficiaries, ~9 million
immunization sessions are conducted, majority of these are at
village level.
 As per Coverage Evaluation Survey (2009), 89.8% of vaccination in
India is provided through Public sector [(53%) from outreach
session held at Anganwadi centre (25.6%), sub centre (18.9%) etc.]
while private sector contributed to only 8.7%.
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 ASHA and AWW support ANM by mobilizing eligible children to
session site thus try to ensure that no child is missed. ASHA is also
provided an incentive of Rs.150/- per session for this activity.
 To ensure potent and safe vaccines are delivered to children, a
network of ~27,000 cold chain points have been created across the
country where vaccines are stored at recommended temperatures.
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1. Strategy and Policy:
 Directed towards achieving an acceptable, affordable and
sustainable standard of health through an appropriate health
system.
 Provision of universal immunization of children against vaccine
preventable disease is one of the major goals under this policy.
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 Country developed a comprehensive Multi Year Strategic Plan for
Immunization in 2005 with an addendum in 2010 to achieve these
targets of improving access and utilization of immunization in the
country.
 Ministry of Health and Family Welfare also revised the National
Vaccine Policy in 2011.
 Goal - develop a long term plan to strengthen the UIP.
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2. Cold Chain System,Vaccines and Logistics:
 Cold Chain is a system of storing and transporting vaccine at the
recommended temperature range from the point of manufacture to
point of use.
 The vaccines are supplied by manufactures directly to 4
Government Medical Store Depots (at Karnal, Mumbai,Chennai and
Kolkata) and state and regional vaccine stores.
 Transportation of vaccines from states/regional stores to divisions
and districts is done in cold boxes using insulated vaccine vans.
32

 Vaccine carriers with ice packs are used to transport vaccines from
PHCs to the outreach sessions in the village.
 At the PHCs and CHCs, cold chain handlers, who are health
personnel (pharmacists, male and female multi-purpose health
workers, etc) have been tasked with proper storage and handling of
vaccines and daily upkeep of Ice Lined Refrigerators (ILRs) and
Deep Freezers (DFs) including temperature charting.
 The performance and efficiency of the cold chain system at different
levels is monitored continuously, through supervisory visits, review
meetings.
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3. Injection safety and Waste Disposal:
 To ensure safe injection practices, Government of India endeavors
to ensure continuous supply of injection safety equipments (AD
syringes, reconstitution syringes, hub cutters and waste disposal
bags).
 Disposal of immunization waste is strictly as per Central Pollution
control Board (CPCB) guidelines for biomedical waste disposal.
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4. AEFI Surveillance System in India:
 The WHO defines AEFI as “A medical incident that takes place after
an immunization, causes concern, and believed to be caused by
immunization”.
 AEFI surveillance in country monitors immunization safety, detects
and responds to adverse events following immunization; corrects
unsafe immunization practices, reduces the negative impact of the
event on health and contributes to the quality of immunization
activities.
35

5. Strategic Communication:
 Strategic Communication refers to policy-making and guidance for
consistent information activity through coherent messaging.
 The issue of media advocacy, proactive planning and effective
media response is emerging as one of the key elements of strategic
communication support to achieving full Routine Immunization
coverage in the country.
36

6.ImmunizationTrainings:
 The Immunization Programme runs due to the coordinated efforts of
different cadres of health staff working in the States at different
levels(States, districts, PHCs and CHCs).
 In the year of intensification of routine immunization (2012-2013),
the government of India has supported the training of approximately
12,50,000 frontline workers (ANMs, LHVs, anganwadi workers and
ASHAs) in 9 high priority States-UP, MP, Rajasthan, Bihar,
Chhattisgarh, Jharkhand, Haryana, Gujarat and West Bengal.
 The objective is to motive and strengthen the capacity of frontline
workers to reduce dropouts and left outs and improve the quality of
services. The process followed is a cascade model.
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7.Monitoring and evaluation
 UIP performs monitoring and evaluation at three levels.
1. There is a regular reporting system from the health sub-centre to
PHC, districts, state and national level.
2. To evaluate immunization coverage, country conducts population
based surveys. These include National Family Health
Surveys(NFHS), District Level Health Surveys(DLHS), Annual Health
Survey(AHS) and UNICEF coverage evaluation survey(CES).
3. In between periodic surveys and administrative reporting, country also
plans targeted studies and surveys to evaluate the performance of
various components under UIP.
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 Park’s Textbook of Preventive and Social Medicine;Bhanot;23rd
edition,page no.122-123.
 Patnaik L. Universal Immunization Programme;slideshare;2018.
 Dixit S. Universal Immunization Programme;slideshare;2017
 Universal Immunization Programme,Government of India,Ministry of
Health and Family Welfare;2017.
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Universal immunization programme

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