The document provides information about immunization and vaccination in India. It discusses key points such as: 1) India's Universal Immunization Programme aims to vaccinate over 2.7 crore newborns and 3 crore pregnant women each year. It is one of the largest immunization programs globally. 2) The programme provides various vaccines free of cost as per the national immunization schedule. These include BCG, DPT, polio, measles etc. 3) Proper maintenance of the cold chain is important to ensure vaccines are stored and transported at recommended temperatures from the point of manufacture to use.

1. C
IMMUNIZATION
DIVYESH R.
KANGAD
NURSING TUTOR
GNS - JUNAGADH

2. INTRODUCTION
Immunization is the process whereby a person is made immune or
resistant to an infectious disease, typically by the administration of a vaccine.
Vaccines stimulate the body’s own immune system to protect the person against
later infection or disease.
Immunization is a proven tool for controlling and eliminating life-
threatening infectious diseases and is estimated to prevent between 2 and 3
million deaths each year.
It is one of the most cost-effective health investments, with proven
strategies that make it accessible to even the most hard to reach and vulnerable
populations.

3. INTRODUCTION
It has clearly defined target groups; it
can be delivered effectively through
outreach activities; and vaccination does not
require any major lifestyle change. Over the
years various strategies to make vaccines
available to all beneficiaries across the
community/ area, including to the most
hard-to-reach and vulnerable populations
have saved countless lives. The benefits to
the individual include not only the
prevention of disease and disabilities but
also the opportunity for a healthier and a
more productive life.

4. Vaccination in India
• As per Coverage Evaluation Survey (2009), 91% of vaccination in India was
provided through Public sector while the private sector accounted for 9%. The
survey also identified the location of vaccination in the public sector at the
following sites:
• Fixed sites PHC/CHC/Govt Hospital – 37%
• Sub center- 19%,
• Outreach session held at Anganwadi center–26%
• Outreach session at any place in the village – 9%
• The frontline health workers i.e. ASHA’s, AWW and link workers play a critical role in
the process by mobilizing beneficiaries to the RI session sites.

5. IMMUNIZATION AND VACCINATION
DIVYESH R. KANGAD

6. Who is a beneficiary ?
• All children and pregnant
women in your area should
receive the benefits of
immunization. This include all
imgrants populations
temporarily staying in your
community area even if they
are not in your list or records.

7. Vaccine
• A vaccine is defined as a biological preparation formulated to provide acquired immunity for
a particular disease. Usually, vaccines contain a weakened or killed form of the disease-
causing agent, its surface proteins or its toxins. When this preparation is introduced into the
human body, the immune system is able to recognize the threat and destroy it. Moreover,
the body will “remember” the threat and can initiate an appropriate response if
encountered in the future.
• The process of administering the vaccine is called vaccination. It is responsible for the
eradication of many diseases – especially infectious diseases such as smallpox and
chickenpox. The term “vaccine” is derived from the Latin word “vaccinus”, from
“vacca”, which means “from cows”. Edward Jenner coined the term for the technique
where, he injected individuals with a mild form of cowpox, thereby rendering them immune
to smallpox.
• Vaccine is preparation of disease agent or its toxic products use to inoculate a person which
then stimulates specific antibody formulation against the pathogen.

8. Types of Vaccine
1. Attenuated Vaccine(live):
2. Inactivated Vaccine(killed):
3. Toxoid Vaccine:
4. Subunit Vaccine(Recombinant):
5. Conjugate Vaccine:
6. Valence Vaccine:
7. Heterotypic Vaccine:
8. mRNA Vaccine:

9. Types of Vaccine
Attenuated Vaccine(live):
• Attenuated vaccines can be made in several different ways. Some of the most
common methods involve passing the disease-causing virus through a series of
cell cultures or animal embryos (typically chick embryos). When the resulting
vaccine virus is given to a human, it will be unable to replicate enough to cause
illness, but will still provoke an immune response that can protect against future
infection.
• Contains live form of disease- causing agents (virus or bacteria), that have been
weakened under laboratory conditions. These agents replicate in the body of
vaccinated individual and cause a mild form of self-limiting disease, followed by
long lasting immunity.
• Examples: BCG, Oral polio vaccine (OPV), Measles/Measles Rubella (MR),
Rotavirus and Japanese encephalitis (JE) vaccine

10. Types of Vaccine
Inactivated Vaccine(killed): Vaccines of this type are created by inactivating a
pathogen, typically using heat or chemicals such as formaldehyde or formalin. This
destroys the pathogen’s ability to replicate, but keeps it “intact” so that the
immune system can still recognize it.
• Contain inactivated form of disease causing agent (virus or bacteria). They cannot
replicate but induce an immune response leading to protection against specific
disease. These vaccines require multiple doses to induce, and booster doses to
maintain immunity
• Examples: Pertussis, Haemophilus influenza type B (Hib) and Inactivated
Poliovirus Vaccine (IPV)

11. Types of Vaccine
Toxoid Vaccine:
• Some bacterial diseases are not directly caused by a bacterium itself,
but by a toxin produced by the bacterium. Immunizations for this type
of pathogen can be made by inactivating the toxin that causes disease
symptoms. As with organisms or viruses used in killed or inactivated
vaccines, this can be done via treatment with a chemical such as
formalin, or by using heat or other methods.
• Examples: Diphtheria and Tetanus toxoid (TT) vaccines

12. Types of Vaccine
Subunit Vaccine(Recombinant):
• Subunit vaccines use only part of a target pathogen to provoke a response from the immune
system. This may be done by isolating a specific protein from a pathogen and presenting it as
an antigen on its own.
• Contain genetically modified form of disease causing agent, which produce antigenic proteins
in vaccinated individual, thus inducing immunity
• Examples: Hepatitis B vaccine.
Conjugate Vaccine:
• Conjugate vaccines are somewhat similar to recombinant vaccines: they’re made using a
combination of two different components. Conjugate vaccines, however, are made using
pieces from the coats of bacteria. These coats are chemically linked to a carrier protein, and
the combination is used as a vaccine
DIVYESH
R.
KANGAD

13. Types of Vaccine
Valence Vaccine:
• Vaccines may be monovalent. A monovalent vaccine is designed to immunize
against a single antigen or single microorganism. A multivalent or polyvalent
vaccine is designed to immunize against two or more strains of the same
microorganism, or against two or more microorganisms.
Heterotypic Vaccine:
• Heterologous vaccines also known as “Jennerian vaccines”, are vaccines that are
pathogens of other animals that either do not cause disease or cause mild disease
in the organism being treated.
mRNA Vaccine:
• An mRNA vaccine (or RNA vaccine) is a novel type of vaccine which is composed of
the nucleic acid RNA, packaged within a vector such as lipid nanoparticles.
DIVYESH
R.
KANGAD

14. Factors affecting efficiency of vaccine
Different vaccines have different efficacies in terms of producing immunity and
duration for which the immunity will last. Efficacy depends on many factors,
including;
• The type of vaccine
• Age at which vaccine is administered
• Number of doses of the vaccine administered
• Gap between administration of two doses
• Administration of booster doses
• Correct route of administration
DIVYESH
R.
KANGAD

15. Universal Immunization Programme (UIP)
India’s Universal Immunization Programme (UIP) is one of the
largest immunization programs in the world. The UIP targets to
vaccinate nearly 2.7 crore newborns each year with all primary
doses and an additional 10 crore children of 1- 5 year age with
booster doses. In addition, nearly 3 crore pregnant mothers are
targeted for TT vaccination each year. Every year ~90 lakh
immunization sessions are conducted to vaccinate the
beneficiaries, majority of which are at village level.
Each vaccine provides immunity against a particular
disease; therefore, a number of vaccines are administered to
children and women to protect them from many vaccine-
preventable diseases.
DIVYESH
R.
KANGAD

16. Universal Immunization Programme (UIP)
• Expanded Programme on Immunization was launched in 1978. It was renamed as
Universal Immunization Programme in 1985 when its reach was expanded beyond urban
areas.
• In 1992, it became part of Child Survival and Safe Motherhood Programme and in 1997 it
was included in the ambit of National Reproductive and Child Health Programme.
• Since the launch of National Rural Health Mission in 2005, Universal Immunization
Programme has always been an integral part of it.
• As per the government data, 2.67 crores newborns and 2.9 crores pregnant women are
targetted under this programme.
• The programme is said to be largely responsible for the reduction of vaccine-preventable
under-5 mortality rate.
• The two major milestones of UIP have been the elimination of polio in 2014 and maternal
and neonatal tetanus elimination in 2015
DIVYESH
R.
KANGAD

17. Universal Immunization Programme (UIP)
The objectives of UIP are to:
• Rapidly increase immunization coverage
• Improve the quality of services
• Establish a reliable cold chain system up to the health facility level
• Introduce a district-wise system for monitoring of performance
• Achieve self-sufficiency in vaccine production
Scope :
• India has one of the largest Universal Immunization Programs (UIP) in the world in terms of the quantities of
vaccines used, number of beneficiaries covered, geographical spread and human resources involved.
• Under the UIP, all vaccines are given free of cost to the beneficiaries as per the National Immunization
Schedule.
• All beneficiaries’ namely pregnant women and children can get themselves vaccinated at the nearest
Government/Private health facility or at an immunization session site (Anganwadicentres/ other identified
sites) near to their village/urban locality on fixed days.
• The UIP covers all sections of the society across the country with the same high quality vaccines.

18. UIP
Vaccines
DIVYESH
R.
KANGAD

19. UIP
Vaccines
DIVYESH
R.
KANGAD

20. Immunization schedule
FOR PREGNANT WOMEN
Vaccine When to give Dose Route Site
TT-I Early in pregnancy 0.5 ml Intra-muscular Upper Arm
TT – II 4 weeks after TT-1* 0.5 ml Intra-muscular Upper Arm
TT -
BOOSTER
If received 2 TT doses in a
pregnancy within the last 3
yrs*
0.5 ml Intra-muscular Upper Arm

21. Immunization schedule
FOR INFANTS
Vaccine When to give Dose Route Site
BCG At birth or as early as possible
till one year of age
0.1ml (0.05ml
until 1 month)
ID Left Upper Arm
Hepatitis B -
Birth dose
At birth or as early as possible
within 24 hours
0.5 ml IM Antero-lateral side
of mid-thigh
OPV-0 At birth or as early as possible
within the first 15 days
2 drops ORAL Oral
OPV 1, 2 & 3 At 6 , 10 & 14 weeks (OPV can
be given till 5 years of age)
2 drops ORAL Oral
Pentavalent
1, 2 & 3
At 6, 10 & 14 weeks (can be
given till one year of age)
0.5 ml IM Antero-lateral side
of mid-thigh
DIVYESH
R.
KANGAD

22. Immunization schedule
FOR INFANTS
Vaccine When to give Dose Route Site
Rotavirus At 6, 10 & 14 weeks (can be given till
one year of age)
5 Drops Oral Oral
fIPV Two fractional dose at 6 and 14 weeks of
age
0.1 ml ID Right upper
arm
Measles /MR
1st Dose$
9 completed months-12 months. (can be
given till 5 years of age)
0.5 ml SC Right upper
Arm
JE - 1 9 completed months-12 months. 0.5 ml SC Left upper
Arm
Vitamin A (1st
dose)
At 9 completed months with
measlesRubella
1ml
(1 lakh IU)
Oral Oral

23. Immunization schedule
FOR CHILDREN
Vaccine When to give Dose Route Site
DPT booster-1 16-24 months 0.5 ml IM
Measles/ MR
2nd dose
16-24 months 0.1 ml ID Right upper
arm
OPV Booster 16-24 months 0.5 ml SC Right upper
Arm
JE-2 16-24 months 0.5 ml SC Left upper
Arm
Vitamin A*** (2
to 9 dose)
16-18 months. Then one dose every 6
months up to the age of 5 years.
1ml
(1 lakh IU)
Oral Oral
DPT Booster-2 5-6 years 0.5 ml IM Upper arm
TT 10 years & 16 years 0.5 ml IM Upper arm

24. Immunization schedule
Notes
*Give TT-2 or Booster doses before 36 weeks of pregnancy. However, give
these even if more than 36 weeks have passed. Give TT to a woman in labor, if
she has not previously received TT.
*** The 2nd to 9th doses of Vitamin A can be administered to children 1-5 years
old during biannual rounds, in collaboration with ICDS.

26. Sites of vaccine administration
DIVYESH
R.
KANGAD

27. Vaccines under UIP
DIVYESH
R.
KANGAD

28. Progress of Immunization Programme in India
Year Progress
1978 • Expanded programme of immunization BCG, DPT, OPV, typhoid (urban areas)
1983 • TT vaccine for pregnant women
1985 • UIP - measles added, typhoid removed, focus on children less than 1yr of age
1990 • Vitamin-A supplementation
1995 • Polio National Immunization Days
1997 • VVM introduced on vaccines in UIP
2002 • National Rural Health Mission Launched
• Auto Disable (AD) Syringes introduced into UIP
2006 • JE vaccine introduced after campaigns in endemic districts

29. Progress of Immunization Programme in India
Year Progress
2011 • Hepatitis B universalized and Haemophilus influenza types b introduced as
pentavalent , Open Vial Policy for vaccines in UIP
2014 • India and South east Asia Region certified POLIO-FREE
2015 • India validated for Maternal and Neonatal Tetanus elimination
• Pentavalent expanded to all states
• IPV introduced
2016 • Rotavirus vaccine introduced in 4 states in Phase 1
• tOPV to bOPV Switch
• Switch to fractional IPV (Phased)
• Rotavirus vaccine introduced (Phased launch)
2017 • MR vaccine introduced (Phased launch)
• PCV (Phased launch)
• Use of adrenaline single dose IM by ANM for anaphylaxis
DIVYESH
R.
KANGAD

30. The cold chain
• Cold Chain is a system of storing and
transporting vaccines at recommended
temperatures from the point of manufacture to
the point of use. The key elements of the cold
chain are:
• Personnel: to manage vaccine storage and
distribution (vaccine and cold chain handler at
each cold chain point).
• Equipment: to store and transport vaccine and
monitor temperature.
• Procedures: to ensure correct utilization of
equipment and ensure vaccines are stored and
transported safely.

31. The cold chain
DIVYESH
R.
KANGAD

32. Managing the Cold chain
As vaccine and cold chain handler at the cold chain point, you are responsible for:
• Daily maintenance and cleanliness of cold chain equipment;
• Twice daily temperature recording;
• Monthly vaccine and logistics indenting, receipt and storage;
• Timely issue of vaccine to the lower store/sessions as per micro plan;
• Timely update of stock and issue registers for vaccines and logistics;
• Breakdown reporting immediately;
• Monthly vaccine utilization including wastage reporting;
• Refer and follow eVIN guidelines (if launched in your state)
DIVYESH
R.
KANGAD

33. Preparing and conducting the immunization session
• Prepare for the session by selecting appropriate site;
• Arranging for required equipment and supplies;
• Review due list of beneficiaries and sharing with AWW and ASHA .
• Involve community influences and leaders to support you
• Assess infants for vaccination and possible contraindications before vaccinations;
• Use aseptic technique to prepare and reconstitute vaccines;
• After reconstitution, write the date and time of reconstitution on the label of vaccine vial;
• Use Auto Disable Syringe (ADS) for each injection;
• Explain to the caregiver the correct positioning to keep the child still and the caregiver and vaccinator
comfortable;
• Administer the vaccines by using correct technique

34. Preparing and conducting the immunization session
• After the session, store opened
vials based on open vial policy
guidelines;
• Ensure separate packing of
used vials with Session site
name and date;
• Pack the vaccine carrier and
return vaccines to the ILR;
• Follow immunization waste
disposal as per guidelines

35. Reconstitution of vaccine
DIVYESH
R.
KANGAD

36. Vaccine sensitivities
• Vaccines lose their potency due to exposure to heat (temperature above +8°C), cold (temperature
below + 2°C) and light.
• The loss of potency due to either exposure to heat or cold is permanent and cannot be regained.
• Reconstituted BCG, measles/MR and JE vaccines are the most heat and light sensitive. Since these live
vaccines do not contain preservatives, there is risk of contamination with staphylococcus aureus
leading to toxic shock syndrome and, therefore, they should be used within 4 hours of reconstitution.
• These light sensitive vaccines are supplied in amber-coloured vials. Implementation of Open Vial Policy
(OVP) allows reuse of partially used multi-dose vials of applicable vaccines under the UIP in subsequent
sessions (both fixed and outreach) up to 4 weeks (28 days) subject to meeting certain conditions. This
policy contributes to the reduction of vaccine wastage.
• Only those diluents that are provided with the vaccine by the manufacturer should be used. Keep
diluents in an ILR at +2°C to +8°C at least 24 hours before use to ensure that the vaccine and diluent are
at the same temperature when being reconstituted. Keep diluents with the vaccines in plastic zipper
bag inside the vaccine carrier during transportation.
DIVYESH
R.
KANGAD

37. Sensitivity of vaccines to heat, light and freezing
DIVYESH
R.
KANGAD

38. Sensitivity of vaccines to heat, light and freezing

39. Sensitivity of vaccines to heat, light and freezing
• Checking vaccines for cold damage (freezing) DPT, TT, IPV, HepB, PCV and Penta vaccines lose their
potency if frozen.
• Moreover, the risk of adverse events following immunization, such as sterile abscesses, may increase.
• Discard the vial if it is frozen or it contains floccules after shaking.
• Shake Test is not applicable for IPV
Shake test – Take two vaccine vial, ONE NORMAL(CONTROL
VIAL) AND ONE SUSPECTED(TEST VIAL).
• Freeze solid this vial at -20°C overnight in the DF, and this is the
‘CONTROL’ vial.
• Hold the Control and the Test vials together between thumb and
forefinger, and vigorously shake the vials for 10-15 seconds.
• Place both vials to rest on a flat surface, side-by-side and observe
them for 30 minutes.
• Compare for rate of sedimentation
DIVYESH
R.
KANGAD

40. Placement of vaccines at session site
DIVYESH
R.
KANGAD

41. Dos and Dont’s in cold chain and vaccine sensitivities
Dos Dont’s
• Keep all vaccines in ILR at +2°C to +8°C at PHC
• Use diluent provided by the manufacturer
with the vaccine
• Keep diluents in ILR at +2°C to +8°C at least 24
hours before use
• Use reconstituted Rotavirus vaccine, BCG,
Measles/MR and JE vaccine within 4 hours z
• Discard all damaged vials for disinfection and
disposal
• Do not keep in the cold chain: { Expired vials,
{Frozen vials or { Vials with VVM beyond the
end point
• Do not use Rotavirus vaccine or reconstituted
BCG, JE and Measles/MR vaccines after 4
hours.
• Do not dispose damaged or empty vials in the
village or surroundings of the session site.

42. Cold chain equipment
• Ice Lined Refrigerator
(ILR): maintains a cabinet
temperature between +2°C to
+8°C; is used to store UIP
vaccines at the PHC and district.
ILR with top opening lid
prevents loss of cold air during
door opening; can keep vaccines
safe with as little as 8 hours
electricity supply in a 24-hour
period.
DIVYESH
R.
KANGAD

43. Dos and Don'ts for ILR use
Dos Don'ts
• Keep all vaccines including those returned under
open vial policy, in the basket supplied along with
the ILR.
• Store diluents at +2°C to +8°C at least 24 hours
before use
• Leave space in between the vaccine boxes. z
Place a thermometer in the basket in between
the vaccines.
• Keep freeze sensitive vaccines at the top of the
basket.
• Keep heat sensitive vaccines in the bottom of the
basket.
• Arrange vaccines as per their expiry dates. (Early
expiry should be above the further expiry ones).
• Do not store any other drugs/Non-UIP vaccines
in the ILR.
• Do not open the ILR frequently
• Do not keep food or drinking water
• Do not keep vaccines, which have expired and
have crossed the discard point of VVM.
• Do not disturb the thermostat setting unless
needed.
• Do not place heavy weight on ILR.
• Do not store excess stock of vaccines i.e. more
than the maximum stock.
• Do not store any reconstituted vaccine vials.

44. Cold chain equipment
•Deep Freezer (DF):
maintains cabinet
temperature between -
15°C to -25°C. Unlike the
ILR the DF has little or
limited holdover time,
depending on the number
of frozen icepacks in it and
the frequency of opening.
At the PHC level, Deep
freezer is used only for
preparation of icepacks

45. Cold chain equipment
•Vaccine carrier: is an insulated
box used for transporting limited number of
vaccine vials and diluents from cold chain
point to outreach session sites, for storing
vials at the session site, and to return back
unused, partially used and completely used
vials back to cold chain point on the same
day. It is packed with four conditioned ice
packs and can maintain storage temperature
of +2OC to +8OC for 12 hours, if not opened
frequently. Vaccine carriers are used globally
for the purpose of transporting vaccines to
the point of use.
• Note: Droppers and Syringes should not be
kept in the vaccine carrier

46. Cold chain equipment
•COLD BOX: it is an insulated box, used for
transportation and emergency storage of vaccines and
icepacks.
• It is available in 2 sizes, large and small. It is used to: Collect
and transport large quantities of vaccines. Store vaccines for
transfer up to five days,
• if necessary for outreach sessions or when there is power
cut.
• Also use to Store vaccines in case of breakdown of ILR
as a contingency measure.
• Also used for storing frozen icepacks, e.g. during
emergency and before campaigns
DIVYESH
R.
KANGAD

47. Adverse events following immunization
Adverse event following immunization (AEFI) is defined as any untoward medical occurrence which
follows immunization and which does not necessarily have a causal relationship with the usage of the vaccine.
The adverse event may be any unfavorable or unintended sign, abnormal laboratory finding, symptom or disease.
Majority of the adverse event are coincidental i.e unrelated to vaccine or vaccination process but have
to be reported as the symptoms or signs have occurred after vaccination.
Types of AEFIs by severity and frequency
1. Common minor AEFIs: A vaccine induces immunity by causing the recipient's immune system to react to the
vaccine. Therefore, local reaction, fever and systemic symptoms can result as part of the immune response. In
addition, some of the vaccine's components (e.g. adjuvant, stabilizers or preservatives) can lead to reactions.
2. Severe AEFIs and serious AEFIs: An AEFI will be considered serious if it results in death, requires
hospitalization, results in persistent or significant disability/ incapacity or a cluster (two or more cases) of
AEFIs occur in a geographical area.
AEFIs that are not minor but do not result in death, hospitalization or disability are categorized as
severe. „Severe‟ is used to describe the intensity of a specific event (as in mild, moderate or severe). The event
itself, however, may be of relatively minor medical significance.
DIVYESH
R.
KANGAD

48. Types of AEFIs
Cause-specific type of AEFI Definition
1 Vaccine product-related reaction An AEFI that is caused or precipitated by a vaccine due to one or more of
the inherent properties of the vaccine product.
2 Vaccine quality defect-related
reaction (Both 1 & 2 were earlier
categorized
in Vaccine Reaction)
An AEFI that is caused or precipitated by a vaccine that is due to one or
more quality defects of the vaccine product, including its administration
device as provided by the manufacturer
3 Immunization error-related
reaction (formerly “programme
error”)
An AEFI that is caused by inappropriate vaccine handling,
prescribing or administration and thus by its nature is preventable
4 Immunization anxiety-related
reaction
An AEFI arising from anxiety about the immunization
6 Coincidental event An AEFI that is caused by something other than the vaccine
product, immunization error or immunization anxiety

49. Anaphylaxis
following
immunization
DIVYESH
R.
KANGAD

50. Common AEFIs and their management
Adverse event Signs and symptoms, reporting Treatment
Fever Fevers below 102ᵒF/ < 39°C (low/medium grade) may be listed
in AEFI register as minor AEFI if medical care was sought.
Symptomatic;
Paracetamol
Severe local
reaction
Redness and/or swelling around the injection site and one or
more of the following:
• Swelling beyond the nearest joint
• Pain, redness and swelling of more than 3 days duration
• Requires hospitalization.
Symptomatic
treatment with
analgesics.
Antibiotics are
inappropriate.
Injection
site abscess
Fluctuant or draining fluid-filled lesion at the site of injection.
Bacterial if evidence of infection (e.g. purulent, inflammatory
signs, fever, culture), sterile abscess if not.
Reported and investigated as serious, if hospitalized for
treatment.
Incise and drain
Anti-inflammatory
(e.g. Syp.Ibuprofen)
Antibiotics if
bacterial
DIVYESH
R.
KANGAD

51. Common AEFIs and their management
Adverse event Signs and symptoms, reporting Treatment
Seizures Occurrence of generalized convulsions that are not
accompanied by focal neurological signs or symptoms.
Febrile seizures; if temperature elevated >100.4 ᵒF/ > 38°C
(rectal), Afebrile seizures: if temperature normal.
Self-limiting.
Supportive care
Paracetamol and
cooling if febrile
Rarely anticonvulsants
Persistent
inconsolable
screaming
Inconsolable continuous crying lasting 3 hours or longer
accompanied by high pitched screaming.
Settles within a day or
Analgesics may help.
Hypotonic
Hypo responsive
Episode
(HHE) or
shock collapse
Event of sudden onset occurring within 48 (usually less
than 12) hours of vaccination and lasting from one minute
to several hours, in children younger than 10 years of age.
All of the following must be present:
• Limpness (hypotonic)
• Reduced responsiveness (hypo responsive)
• Pallor or cyanosis
Episode is transient
and self-limiting
Does not require
specific treatment
Not a
contraindication
for further doses.

52. AEFIs management
• Vaccinators and supervisors at the vaccination site will provide primary treatment of all AEFIs. If needed, cases
will be immediately referred to the nearest AEFI management center and reported to the appropriate
authority.
• All beneficiaries will be counselled about adverse events that may occur after the vaccination. These are
expected to be minor events such as local pain and swelling and mild to moderate fever, etc.
• In case of any type of discomfort or illness following vaccination, the vaccine recipient will be asked to visit the
nearest health care facility for treatment.
• At fixed session sites, an AEFI management kit or an emergency tray will be available for use.
• Outreach session sites will have an Anaphylaxis (a severe allergic reaction) kit.
• All vaccinators will be trained to suspect symptoms of anaphylaxis or severe allergic reaction, use the contents
of the anaphylaxis kit, and arrange transportation of the patient to the nearest AEFI management center for
further treatment.
• Each outreach session site will be linked to an identified AEFI management center to provide immediate
treatment for serious AEFI cases.
• Adequate transportation will be available to transfer persons with serious adverse reactions to the nearest
identified AEFI management center.
DIVYESH
R.
KANGAD

53. Thank you……………