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IMMUNIZATION & COLD CHAIN GAJJAR PRASHANT ROLL NO.-36
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IMMUNIZATION & COLD CHAINGAJJAR PRASHANT ROLL NO.-36

IMMUNIZATIONImmunization is defined as the procedure by which the body is prepared to fight against a specific disease. Immunization is of two types:1. Passive immunization2. Active immunization.

PASSIVE IMMUNIZATION

Passive immunization or immunity is produced without challenging the immune system of the body. done by administration of serum or gamma globulins from a person who is already immunized (affected by the disease) to a non-immune person. Passive immunization is acquired either naturally or artificially.

It is developed by injecting previously prepared antibodies using serum from humans or animals.This type of immunity is useful for providing immediate protection against acute infections like tetanus, measles, etc.

ACTIVE IMMUNIZATIONActive immunization or immunity is acquired by activating immune system of the body.Body develops resistance against disease by producing antibodies following the exposure to antigens. Active immunity is acquire NaturallyArtificially

Active Natural ImmunizationNaturally acquired active immunity involves activation of immune system in the body to produce antibodies against microorganism. It is achieved in both clinical and subclinical infections

Active Artificial ImmunizationIt is achieved by the administration of vaccines or toxoids.

Herd ImmunityIt is a type of immunity that occurs when the vaccination of a portion of population provides protection to unprotected individual.The higher the number of immune individuals, the lower the like hood that a susceptible people will come in contact with an infectious agent.Resistance to spread of infectious disease in a group because of few susceptible members, making transmission unlikely.

Vaccine

9Vaccine is a substance that is introduced into the body to prevent the disease produced by certain pathogens.It consists of dead pathogens or live but attenuated (artificially weakened) organisms. The vaccine induces immunity against the pathogen, either by production of antibodies or by activation of T lymphocytes.

Types of vaccineA. Live-attenuated (weakened) vaccines: contain modified strains of a pathogen (bacteria or viruses) that have been weakened but are able to multiply within the body and remain antigenic enough to induce a strong immune response. B.Killed-inactivated vaccines:To produce this type of vaccines, bacteria or viruses are killed or inactivated by a chemical treatment or heat.

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C.Sub-unit vaccinesSubunit vaccines include only the antigens that best stimulate the immune system.In some cases, epitopes are usedthe very specific parts of the antigen that antibodies or T cells recognize and bind to.Subunit vaccines contain only the essential antigens and not all the other molecules that make up the microbe, the chances of adverse reactions to the vaccine are lower.

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Types of subunit vaccines;- 1.toxoids 2.protein vaccine 3.recombinant protein vaccine 4.polysaccharide based vaccine 5.conjugated vaccine

D. CombinationIf more than one kind of immunising agent is included in the vaccine it is called a mixed or combined vaccine.The advantage of combined vaccine is as below: 1.simplify administration 2.reduce cost 3.improving timeline of vaccination 4.reducing the storage

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Example of mixed vaccines are DPT,DT,DP,MMR,etc.POLYVALENT: It is prepared from 2 or more strain of the same species

vaccineExampleLive, attenuatedMeasles, mumps, rubella (MMR combined vaccine)Varicella (chickenpox)Influenza (nasal spray)RotavirusInactivated/KilledPolio (IPV)Hepatitis A

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Combined DPT,TTSubunit/conjugateHepatitis BInfluenza (injection)Homophiles influenzatype b (Hib)Pertussis, Diphtheria, tetanus

Why Immunization ?Key strategy to child survivalProtecting infants from diseases.Lowers morbidity and mortality rates in children.Indicator of a strong primary health care system.

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History of Immunization18

Edward Jenner Vaccinating

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Beginning of Vaccination.Vaccination (Latin ; Vacca- Cow ) Edward Jenner used the term Vaccination Cow pox virus provided immunity in prevention of Small pox

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14 May 1796 - Jenner inoculated James Phipps, an 8 yr old boy.Boy recovered after a brief illnessJenner inoculated pus taken from a small pox patient.Boy showed no reaction.Jenner recommended vaccination for prevention of smallpoxSmall pox eradicated in 1977.WHO certified India to be free of smallpox in march 1977.

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SMALL POX

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1978: Expanded Program of Immunization (EPI) introduced after smallpox eradication: BCG, DPT, OPV, Typhoid. Limited to mainly urban areas

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1985 : Universal Immunization Program (UIP) introduced; Expanded to entire country; Measles added.1990 : Vitamin-A supplementation.1992: Child Survival and Safe Motherhood Program. 1995: Polio National Immunization Days.1997: Reproductive and Child Health Program (RCH I).2005 : RCH-II and the National Rural Health Mission (NRHM).

EPIAdding more disease controlling antigens to vaccination schedules.

Extending coverage to all corners of a country.

Spreading services to reach the less privileged sectors of the society

EPI is developed to protect all children of the world against 6 vaccine preventable diseasesDiphtheriaTetanusPolioTuberculosisMeaslesPertussis (whooping cough)

1985 UNICEF re named it as UNIVERSAL IMMUNIZATION PROGRAMME.There is no difference between both the programme.

Universal immunization programme&National immunization programme

EPI IN INDIA 1978The Govt. of India launched its EPI in 1978.The objective was to reducing mortality, morbidity resulting from VPDs.To achieve a self sufficiency in vaccine production.

COMPONENTS OF UIP1. Immunization of pregnant women against tetanus.2.Immunization of children in their first year of life against 6 VPDs.3. The aim was to achieve 100 % coverage of pregnant women with 2 doses of TT & at least 85% coverage of children under one year (with 3 doses of DPT, OPV & one dose of BCG, One dose of MMR) by 1990

TWO COMPONENTS OF UIP

OBJECTIVESTo increase immunization coverage.To improve quality of service.To achieve self sufficiency in vaccine productionTo train health personnelTo supply cold chain equipment and establish a good surveillance network.To ensure district wise monitoring

NO CHILD SHOULD BE DENIED OF IMMUNIZATION.

STATUS OF VPD -INDIADisease19872011%declinePOLIMYELITIS28,2571100DIPTHERIA12,9524,23362.3PERTUSIS163,7863,90976.13MEASLES247,51933,63486.41

NATIONAL IMMUNIZAION SCHEDULEVACCINEWhen to giveDoesRouteSiteTT-1Early in pregnancy0.5mlIntra-muscularUpper armTT-24 weeks after TT-10.5mlIntra-muscularUpper armTT-boosterIf received 2 TT doses in a pregnancy within the last 3 years0.5mlIntra-muscularUpper arm

FOR INFANTVACCINEWhen to giveDoesRouteSiteBCGAt birth or early as possible till 1 year of age 0.1 mlIntra-dermalLeft upper armHepatitis BAt birth or early as possible within 24 hour0.5mlIMAntero-lateral side of mid thigh

OPV-0At birth or early as possible within the 1st 15 days2 dropsOralOralOPV-1,2&3At 6,10,&14 weeks2 dropsOralOralDPT-1,2&3At 6,10,&14 weeks0.5mlIMAntero-lateral side of mid thigh

Hepatitis B1,2&3At 6,10,&14 weeks0.5mlIMAntero-lateral side of mid thighMeasles 9 completed months-12 months0.5mlSub-cutaneousRight upper armVitamin A(1st does) At 9 months with measles1ml(1 lakh IU)oralOral

For childrenDPT booster16-24 months0.5mlIMAntero-lateral side of mid thigh

OPV booster16-24 months2 dropsORALORALMeasles16-24 months0.5mlSub-cutaneousRight upper arm JE16-24 months with DPT/OPV booster 0.5 mlSub-cutaneousLeft upper armVitamin A 16 months with DPT/OPV booster. Than 1 does every 6 months up to age of 5 years2ml(2 lakh IU)OralOralDPT BOOSTER5-6 years0.5mlIMUpper arm TT10 year &16 year0.5mlIMUpper arm

Vaccines under UIPUnder UIP, following vaccines are provided: BCG (Bacillus Calmette Guerin) DPT (Diphtheria, Pertussis and Tetanus Toxoid) OPV (Oral Polio Vaccine)Measles

Hepatitis BTT (Tetanus Toxoid)JE vaccination (in selected high disease burden districts)Hib containing Pentavalent vaccine (DPT+HepB+Hib) (In selected States)

Diseases covered under UIPDiphtheriaPertussis.TetanusPolioTuberculosis

MeaslesHepatitis BJapanese Encephalitis ( commonly known as brain fever)Meningitis and Pneumonia caused by Haemophilus Influenzae type b

Barriers to ImmunizationPhysical barriers -Waiting time -Distance -Discomfort

Psychological barriers -Discourtesy - Endangered privacy

Reasons for Low ImmunizationCoverageFailure to provide immunizationUn-reached populations:- - Unawareness - socio-economic barriers - geographic accessResistant populationsMissed OpportunitiesImproper logistics management

What Should not Hold RoutineImmunization Minor illnesses such as upper respiratory infections or diarrhea, mild fever (< 38.5c)Allergy, asthmaPrematurity, underweight newborn child Family history of convulsions

Treatment with antibiotics Dermatosis, eczema or localized skin infection Chronic diseases of the heart, lung, kidney and liver. Stable neurological conditions, such as cerebral palsy and Down's syndrome History of jaundice after birth

COLD CHAIN

Cold ChainThe cold chain is the system of transporting and storing vaccines at recommended temperature from the point of manufacture to the point of use.

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Why is the cold chain important ?Vaccines are:Biological productslose potency with timeProcess irreversible and accelerated if proper storage conditions are not adhered to.

2. Assurance in potent product and vaccine programmesProfessional responsibility Confident the vaccines you give will be effectivePublic Health responsibilityPublic confidence in immunisation programmes

3. Ensuring maximum benefit from immunisationsResponsibility not to waste scarce NHS resourcesReduce wastage from errors

4.Compliance with SPC/ManufacturerAny vaccine that has not been stored at a temperature of 2-8C as per its licensing conditions is no longer a licensed product

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A. Walk in cold rooms(WIC)At regional levelStorage up to 3 monthsServe 4-5 districts

B. Deep freezersAt district & PHC levelsTemp :- -15oc to -25ocAt PHC, used only for the preparation of ice packsIn case of power failure these freezers can maintain the cabinet temp. for 18-22 hours20-25 icepack can be prepared by a 140L in deep freezers with continuous electric supply of 8 hours.

C. Ice Lined Refrigerators(ILR)Both at district and PHC levelsTemp :- +2oc to +8ocILRs are top opening, can hold cold air inside better than front opening refrigeratorsIt can keep vaccine safe with 8 hours of continuous electric supply in a 24 hours period.

Arrangement of vaccine order top to bottom: Hepatitis B DPT & TT BCG Measles OPVDiscard any frozen hep.b, DPT, & TT.Keep spaces between boxesMeasles & OPV can be kept over 2 rows of empty ice-packs on the floor of the ILR.

Vaccine StabilitySensitivity to HEATOPVMeaslesBCGMMRHepatitis BDT

Sensitivity to COLDHepB and combinationInfluenza *BCG (*Freeze dried)

MOST SENSITIVE

Temperature must be recorded twice in a day with dial thermometerLEAST SENSITIVE

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Light SensitiveSensitive to strong light, sunlight, ultraviolet, fluorescents (neon)

OPVMeaslesMMRVaricella Meningococcal C ConjugateMost DTaP containing vaccines

Vaccines should always be stored in their original packaging until point of use to protect them from light

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Vaccine Storage Use a dedicated vaccine fridge

Safeguard electricity supply

No more than 50% full

Place vaccines in clearly labelled plastic mesh baskets

Group vaccines by type (Paediatric, Adult, Adolescent)

Defrost/calibrate fridge regularly

Ensure back up facilities are available in the event of fridge failingX No food or medical specimens

X Do not place fridge in direct sunlight or near heat source

X Do not store vaccines for more than 1 month at PHC.

X Do not store vaccines in fridge doors or in solid plastic trays/containers within the fridge

X Keep vaccines away from fridge walls and cold air vents

Picture taken from www.medisave.co.ukDOsDONTs

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Used for transport of vaccinesFully frozen ice packs placed at the bottom and sidesDPT, TT, DT should not be kept in direct contact1.Cold boxesUsed to carry small quantity of vaccines(16 to 20 vials)For out of reach sessions4 icepacks are used2.Vaccine carriers

3.Day carriers

Used to carry very small quantities of vaccines(6 to 8 vials)For a near by session2 icepacks are usedFor only 2 hours period

ICE PACKSIt contains water & no salt shold be added to it.The water should be filled upto the level marked on the side. If there is leakage such icepack should be discarded.

Vaccine Vial Monitor(VVM)VVM is a label containing heat sensitive material that is placed on a vaccine vial to register heat exposure over time

Vaccine vial monitor

Combined effects of time and temperature cause the inner square to darken gradually and irreversiblyVVM does not directly measure the vaccine potency but gives info about the main factor that affects potency

Mission Indradhanush

Mission Indradhanush was launched by Ministry of Health and Family Welfare (MOHFW) Government of India on 25th December, 2014. The objective of this mission is to ensure that all children under the age of two years as well as pregnant women are fully immunized with seven vaccine preventable diseases.

The Mission Indradhanush, depicting seven colours of the rainbow, targets to immunize all children against seven vaccine preventable diseases.

Science Hopes a Vaccine for every Disease

Vaccination created HOPE in Humanity

THANK YOU


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