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Vaccination
- 1. Vaccination (Amale Talqeeh) DrMd Tanwir Alam, MD Assistant Professor, Dept. of PCM, Govt. Tibbi College & Hospital, Patna Tanveernium@gmail.com
- 2. IgG: Major-80%(of totalserum),-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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- 5. Vaccines “Immunobiological substance designedto 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 5
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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. 7
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- 13. Vaccines vulnerable toheat BCG (after reconstitution) OPV Measles DPT BCG (before reconstitution) DT TT Hep B 13
- 14. Vaccines vulnerable toFreezing Hep- B DPT DT TT 14
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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 VaccineHeat 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 18
- 19. Why have theCold Chain? If vaccines are exposed to excessive They loose their potency Heat Freezing Light 19
- 20. In general ▪ AllVaccines lose potency on exposure to heat above +80 C ▪ Some Vaccines lose potency when exposed to freezing temperatures ▪ The damage is irreversible 20
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- 26. Cold Chain Equipment:Various Levels –State Refrigerator Truck Walk-in Freezer Walk-in Cooler 26
- 27. Cold Chain Equipment:District Level Cold Box Deep Freezer (DF) 300 ltr Ice-Lined Refrigerator(ILR) 300 ltr 27
- 28. Cold Chain Equipment:Unit Level Ice-Lined Refrigerator(ILR) 140 ltr Deep Freezer (DF) 140 ltrCold BoxVaccine Carriers 28
- 29. Walk-in Cooler &Freezer Walk-in Cooler (+2o C to +8o C) Walk-in Freezer (-15o to -25o C) 29
- 30. Walk-in-Freezers (WIF) • Usedfor 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 forbulk 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. 31
- 32. • • • • Vaccine delivery vans Transportationof vaccines from Regional centers to districts From districts to PHCs Temperature maintained at +2o to +8o C. Refrigerated Truck 32
- 33. Ice-Lined Refrigerator(ILR) Size: 300ltr / 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 33
- 34. Right way ofkeeping 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 34
- 35. Deep Freezer(DF) Size: 300ltr / 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 35
- 36. Do’s for Deepfreezer 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. 36
- 37. Contd… • • • • • • Check the temperatureat 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. 37
- 38. Donts for deepfreezer 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. 38
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- 40. The Cold ChainRoom • • • • • ▪ 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 40
- 41. Cold Boxes Size: 20ltr 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 41
- 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 42
- 43. Vaccine Carriers Size: 1.7ltr 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 43
- 44. Ice Packs Size: 763X 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 44
- 45. Foam Pads Material: SoftFoam 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 45
- 46. Preparing icepacks foruse: 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 46
- 47. Preparing icepacks foruse: 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 47
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