This slide is about the " Vaccination " presented in the class of second professional (Community Medicine), BUMS, GTCH, Patna

1. Vaccination (Amale Talqeeh)
Dr Md Tanwir Alam, MD
Assistant Professor, Dept. of PCM,
Govt. Tibbi College & Hospital, Patna
Tanveernium@gmail.com

2. IgG: Major-80%(of total serum),-small molecular weight- half life-21 days
Transported across placenta
Ant viral/bacterial
IgM: 6%, indicative of recent infection, half life-7days
✓ Produced by foetus undergoing an infection
IgA: 13%, Ab activities for wide range of virus/bacteria, half life:6-8 days
✓ Provide primary defence at mucous membrane against local infection
large quantity in body secretion - milk, saliva, tears, colostrum, bronchial
secretion, nasal mucosa, prostatic fluid, vaginal secretion, mucous secretion of
small intestine.
✓ IgE: in trace (<0.0005mg/ml), Half Life-2 days
Concentrated in submucous tissues, raised on allergy & Helminthic infestation
Major Ab- responsible for immediate allergic anaphylactic reactions- mediate
allergic hypersensitivity
IgD: an antigen receptors at surface of B Cells. in trace (<0.003mg/ml), Half Life-2 days
Rewind…last class

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Rewind…last class

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Rewind…last class

5. Vaccines
“Immunobiological substance designed to
produce specific protection against a
given disease”
• Save 2-3 millions live/year
• Stimulates the production of protective Ab
and other immune mechanisms
• Prepared from:
✓ Live & modified organisms
✓ Inactivated/killed organisms
✓ Extracted cellular fractions
✓ Toxoids
✓ Combination of all these
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7. The Cold Chain
• The "cold chain" is a system of storage
and transport of vaccines at low
temperature from the manufacturer to the
actual vaccination site.
• The cold chain system is necessary
because vaccine failure may occur due to
failure to store and transport under strict
temperature controls.
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13. Vaccines vulnerable to heat
BCG (after reconstitution)
OPV
Measles DPT
BCG (before
reconstitution)
DT TT
Hep B
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14. Vaccines vulnerable to Freezing
Hep- B
DPT
DT
TT
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17. Vaccine Vial Monitor (VVM)
The square is lighter than the circle.
If the expiry date is not passed, use the
vaccine
The square is lighter than the circle.
If the expiry date is not passed, use the
vaccine
The square matches the circle.
Do not use the vaccine.
Inform your supervisor
The square is darker than the circle.
Do not use the vaccine.
Inform your supervisor 17

18. Summary of Vaccine
Vulnerabilities
Vaccine Heat Light Freezing Temperature
at PHC
OPV
(live attenuated)
Sensitive Sensitive Okay to freeze +2˚C to +8˚C
(-15˚C to -25˚C at
state, regional and
district stores)
Sensitive Sensitive +2˚C to +8˚CBCG
(live attenuated)
Measles
(live attenuated)
Sensitive Sensitive
Okay to freeze (before
reconstitution)
Okay to freeze (before
reconstitution)
+2˚C to +8˚C
(-15˚C to -25˚C at
state, regional and
district stores)
DPT
(toxoid, killed)
Relatively
heat stable
Freezes at -3˚C. Discard
if frozen.
+2˚C to +8˚C
Hep B
(recombinant)
Relatively
heat stable
+2˚C to +8˚C
TT
(toxoid)
Relatively
heat stable
Freezes at- .5˚C.
Discard if frozen.
Freezes at -3˚C.
Discard if frozen.
+2˚C to +8˚C
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19. Why have the Cold Chain?
If vaccines are exposed to excessive
They loose their potency
Heat
Freezing
Light
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20. In general
▪ All Vaccines lose potency on
exposure to heat above +80 C
▪ Some Vaccines lose potency when
exposed to freezing temperatures
▪ The damage is irreversible
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26. Cold Chain Equipment: Various
Levels –State
Refrigerator
Truck
Walk-in Freezer
Walk-in Cooler
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27. Cold Chain Equipment: District Level
Cold Box
Deep Freezer (DF) 300 ltr
Ice-Lined Refrigerator(ILR) 300 ltr
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28. Cold Chain Equipment: Unit Level
Ice-Lined Refrigerator(ILR) 140 ltr
Deep Freezer (DF) 140 ltrCold BoxVaccine Carriers
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29. Walk-in Cooler & Freezer
Walk-in Cooler
(+2o C to +8o C)
Walk-in Freezer
(-15o to -25o C)
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30. Walk-in-Freezers (WIF)
• Used for bulk storage of OPV, and also
to prepare frozen ice packs at state
stores.
• Maintain a temperature around (-) 20oC.
• Available in sizes of 16.5 Cum. and 32
Cum.
• Provided with two identical cooling units
and standby generator.
• Installed in all of the states
• Serves 4-7 districts 30

31. Walk-in-Coolers (WIC)
•
•
•
•
•
•
•
•
Used for bulk storage of vaccines at State and
Regional/Divisional Stores.
Maintain a temperature of +2oC to +8oC. Available in
sizes of 16.5 Cum. and 32 Cum.
Used for storage of large quantities of vaccines, like
DPT, DT, TT, Measles, BCG, Hepatitis B
Also provided with temperature recorder and alarm
WIC/WIF store vaccines of three months requirement
and 25% buffer stock for the districts they cater.
Cater 4-5 districts
3 deep freezers and 10 cold boxes.
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32. •
•
•
•
Vaccine delivery vans
Transportation of vaccines
from Regional centers to
districts
From districts to PHCs
Temperature maintained at
+2o to +8o C.
Refrigerated Truck
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33. Ice-Lined Refrigerator(ILR)
Size: 300 ltr / 140 ltr
Level: District (300 ltr) / PHC (140 ltr)
Temperature: +2˚C to +8˚C
Utilization: BCG, DPT, OPV, Measles, TT,
Hep-B vaccine
Holdover time: 24 hrs after 8 hrs
continuous power supply
Storage capacity:
300 ltr: 60,000 doses of mixed antigen &
20,000 doses of OPV
140 ltr : 25,000 doses of mixed antigen &
18,000 doses of OPV*
* OPV and Measles for 1 month
only. Store in DF if longer than a
month
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34. Right way of keeping vaccines in ILR
• Keep all vaccines in baskets
• Avoid placing vaccines at bottom
of ILR. (never diluents, freeze sensitive)
•
•
Leave space between the
vaccine boxes
Place a thermometer in the
center of the ILR.
Same vaccines in same area.•
• Diluent / freeze sensitive/ Closer expiry
date vaccines on top
•Heat sensitive / Further expiry date
vaccines in the bottom of basket
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35. Deep Freezer(DF)
Size: 300 ltr / 140 ltr
Level: District (300 ltr) / PHC (140 ltr)
Temperature: -15o to -25o C
Utilization:
1.Preparation of ice packs
2.Storing measles and OPV (only
district)
Holdover time: 24 hours with 8 hours
supply
Storage capacity:
300 ltr: 150, 000 to 200, 000 doses 140
ltr :Approx. 20 Ice Packs
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36. Do’s for Deep freezer and ILR
•
•
•
•
•
•
•
•
Make one person responsible for loading, unloading,
maintenance and temperature recording.
Install it in a cool and well ventilated room.
Place them at least 10-20 cm away from the wall.
Insure that it is LEVELLED.
Let the electrician fix the cable permanently inside
the socket.
Use voltage stabilizer
Tape the switches in ON position so that there s no
accidental switching off.
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37. Contd…
•
•
•
•
•
•
Check the temperature at least every morning and
evening.
Adjust the thermostat knob if the temperature is not
correct.
Note the expiry date of all vaccines.
Clean and dry the chamber before loading. Keep
the lid locked.
Place the ILR and deep freezer in the same room.
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38. Donts for deep freezer and ILR
• Do not open the lid too often..
• Do not store other drugs
• Don’t keep drinking water or food
• Don’t keep more than one month supply
• Don’t keep outdated Vac.
• Don’t fill ice packs to the top.
• Don’t keep ILR and deep freezer hugging
together.
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40. The Cold Chain Room
•
•
•
•
•
▪ ILRs and deep-freezers to be installed in a room that is
➢ Not directly exposed to sunlight or any other
source of heat.
➢ Ventilated and protected from rain or flooding.
▪ ILR and deep-freezers should be level, on wooden
blocks, at least 10 cms away from wall
▪ The plugs should be permanently fixed & labeled “DO
NOT REMOVE”
▪ Equipment should be locked and opened only if
necessary
▪ Keys to the equipment should be accessible
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41. Cold Boxes
Size: 20 ltr and 5 ltr Level: District / PHC
Temperature: +2˚C to +8˚C
Utilization: All vaccines can be stored for
transportation or in case of power failure
Holdover time: 5 days (20 ltr) and 3 days (5
ltr) if unopened
Storage capacity:
20 ltr: 52 Ice Packs & 6000 doses of mixed
antigens
5 ltr: 20 Ice Packs & 1500 doses of mixed
antigens
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42. • Cold boxes. For transportation.
• Fully frozen packs at the sides and bottom
• Vac. in polythene bags
• DPT, DT, TT & diluents not to be kept in
direct contact with frozen ice packs
• Vaccine carriers: 4 frozen packs at the
sides.
• For small quantities
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43. Vaccine Carriers
Size: 1.7 ltr
Level: PHC/ Sub Centre
Temperature: +2˚C to +8˚C
Utilization: All vaccines can be
carried in small quantity for
vaccination sessions
Holdover time: 12 hours
Storage capacity: 4 Ice Packs
&15- 20 vials of mixed antigens
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44. Ice Packs
Size: 763 X 90 X 33 mm Ice
capacity: 360 ml Weight: 80 gm
Level: District / PHC/ Sub Centre
Temperature: +2˚C to +8˚C
Utilization: line the walls of vaccine
carrier/cold box
Time to Freeze: 48 hours in DF at
- 20˚C
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45. Foam Pads
Material: Soft Foam
Thickness: 30 mm with at least 6
incisions
Utilization:
•temporary lid for unopened vaccines
inside the carrier
•surface to hold, protect and keep
cool opened vaccine vials
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46. Preparing icepacks for use:
Filling and Freezing
• Fill icepacks with water to mark
• Fit the sealing plug and screw on
the lid tightly
• Hold each ice-pack upside down
and squeeze it to make sure it
does not leak.
• Place the icepacks in the deep
freezer.
• Ice-packs need not be refilled
every time they are used. The
same water can be used
repeatedly.
• Do not use saline water for filling
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47. Preparing icepacks for use:
Conditioning
• On the session day, take
the frozen ice-packs you
•
need from the freezer
and place on a table
Allow ice-packs to sweat
at
•
room temperature
for 15
minutes
Shake the ice pack to
listen to
melted for water.
A Conditioned an ice-pack
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