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Ranjith.R.ThampiIIIrd MBBS
DIPHTHERIA, WHOOPING COUGH, TETANUS, POLIO, TB, MEASLES.
1978 Expanded Programme of immunization (EPI).Limited reach - mostly urban
1985 Universal Immunization Programme (UIP). For reduction of mortality and morbidity due to 6
VPD’s.Indigenous vaccine production capacity enhanced
Cold chain establishedPhased implementation - all districts covered by 89-
90Monitoring and evaluation system implemented
Implementation of National Immunization Implementation of National Immunization ProgrammeProgramme
District is treated as administrative unit – 593Primary Health Centers are the last vaccine storage points - 23,109Services are provided through 142,655 sub centers to the population residing in about 638,588 villagesTarget for immunization is to cover infant population of over 25 million and around 27 million pregnant women
Immunization services are being provided through the existing health care delivery system. There is no separate staff required for the programme.
Pulse Polio Immunization Programme was launched in the country in the year 1995. Under this, under 5’s are given additional oral polio drops in December and January every year on fixed days.As a result, there has been a significant decline in the incidence of poliomyelitis.
Those outside rings are not vaccinated.
Primary Vaccination Ring
Secondary Vaccination Ring
Immuno-biological substances designed to produce specific protection against a given disease.
*Nowadays vaccines are of sub-unit and recombinant types.Administration: SUBCUTANEOUS & INTRAMUSCULAR
Live Vaccines—BCG, MMR*Not for immunologically challenged.
Inactivated(Killed)—iPV, Hepatitis B
Toxoids—Diphtheria, Tetanus
Immunoglobulins are for passive immunization!5 Major classes include- IgG, IgM, IgA, IgD, IgE.
TYPES:Normal Human ImmunoglobulinSpecific Human Immunoglobulin*These are used to replace antibodies in immunodeficient patients.Administration: INTRAMUSCULAR & INTRAVENOUS
LIVE VACCINE KILLED VACCINE TOXOIDSBCG, POLIO, MMR PERTUSSIS, TYPHOID, CHOLERA DIPHTHERIA, TETANUS
Vaccines have lost their capactiy to produce full-blown disease, retain immunogenicity.
*NOT to be administered to persons with immune deficiency diseases, suppressed immunity.
*NOT to be administered to pregnant women unless risk of infection exceeds risk of harm to fetus with live vaccine.
It stimulates active immunity. Usually safe but less efficacious than live vaccines. Also requires frequent booster doses.
*NOT to be given when there may be or was severe local or general reaction to a previous dose.
Exotoxins produced by organisms are detoxicated and used in preparation of vaccines. Antibodies produced neutralise the toxic moiety produced during infection, rather than act upon the organisms.
HIGHLY EFFICACIOUS.
Materials prepared in animals. Antitoxins prepared from non-human source s include: Tetanus, Diphtheria, Botulism, Gas gangrene, Snake Bite.
COLD CHAIN?A system of storage and transport of vaccines at low temperature from the manufacturer to the actual vaccination site.
Walk in Cold Rooms[WIC]Deep Freezers & ILRsSmall deep freezers and ILRCold boxesVaccine carriersDay CarriersIce packs
For Infants Vaccine & Dose Route
At Birth6 weeks
10 weeks14 weeks
9-12 months
BCG 0.1ml + OPV 2drops( 0 dose)BCG 0.1ml [if not at birth]
DPT-1 0.5ml + OPV-1 2dropsDPT-2 + OPV-2DPT-3 + OPV-3
Measles 0.5ml + Vit. A 2ml
IntradermalIntradermalI/M + OralI/M + OralI/M + Oral
Deep S/C + Oral
At 18 monthsAt 24, 30, 36 months
DPT + OPV[Boosters-1]Vitamin A 2ml
I/M + OralOral
At 5-6 years DT[Booster-2] I/M
At 10 and 16 years Tetanus Toxoid I/M
For Pregnant Women Vaccine & Dose Route
Early in Pregnancy TT-1 or Booster I/M
One month after TT-1 TT-2 I/M
INTERVAL BETWEEN TWO DOSES SHOULD NOT BE LESS THAN ONE MONTH!
BCG upper, small pox lower.
Progress so far ….Progress so far ….
0
2000
4000
6000
8000
10000
12000
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Incidence of Neonatal Tetanus
VACCINE PREVENTABLE DISEASE SURVILLANCE
Source CBHI
0
50000
100000
150000
200000
250000
19
75
19
76
19
77
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
Incidence of Measles
In 2004 1087 NNT cases and 51546 Measles reported
0
5000
10000
15000
20000
25000
30000
35000
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Incidence of Diphtheria
0
50000
100000
150000
200000
250000
300000
350000
400000
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
Incidence of Whooping coughVACCINE PREVENTABLE DISEASE SURVILLANCE
Source CBHI In 2004 8465 Diphtheria cases and 32786 Pertussis reported
0
10
20
30
40
50
60
70
80
90
100
Bih
ar RJ
UP
J kh
and
HR
UA
All Ind
ia
GU
DL
WB
AP
MP
PB
HP
J &
K
MH TN
1998-99
1999-00
2000-01
2001-02
Source: Unicef CES
Full Immunization Coverage by States (in %)
Coverage evaluation shows a varied coverage among the States. While the Southern States have been consistently achieving high coverage levels, the situation in Northern States is a matter of concern.
Immunisation, IFA, Vit.A: 2002-03 2003-04 2004-05 2005-06 2006-07
TT – Pregnant Women ( 2nd dose + Booster) 19294 19410 17844 17610 18186
IFA Tablets (Preg. Women-Prophylactic completed) 16326 14759 17741 18029 15537
DPT ( 3rd Dose ) 18199 17031 16836 16185 16352
Polio ( 3rd Dose) 18199 17031 16836 16185 16352
BCG 31025 30412 29354 36182 42101
Measles 16991 16555 16118 15934 16328
Vit-A (Total 1st dose for below and up to 1 year) 15544 13537 15320 15224 14495
Vit-A (Total 2nd to 5th dose ) 45062 30635 37399 38005 40104
DT ( 2nd dose) 19207 19147 18583 20383 17342
TT (10 Years) ( 2nd dose) 21303 20548 18283 19094 18329
TT (16 Years) ( 2nd dose) 21057 20286 18515 18981 14649
Performance under Immunization Programme
ConcernsConcernsLarge birth cohort - 25 million births every year
Declining coverage in some major states• An average of 14.4 % children receiving BCG do not receive
measles vaccine
Poor immunization data quality• Discrepancies between reported and surveyed data
Varied program management and supervision at all levels
Unsafe injection practices and waste disposal:
Significant percentage of injections used in the immunization sector are unsafe Low priority on medical waste disposal
The virus is also present in body fluids and excretions such as saliva, breast milk, semen, vaginal secretions, urine, bile and feces.Semen and Saliva are known culprits for transmission.
Target Population Dose Status
Percutaneous or mucosal exposure
0.05-0.07 ml/kg body wtRepeat after a month
Recommended For Prevention
Newborns of mothers with HBsAg
0.05 ml/kg body wtAt birth, 3 & 6 months
Recommended For Prevention
Sexual contacts of acute hepatitis B patients
0.05 ml/kg body wtRepeat after a month
Optional for Prevention
Hepatitis Human Hepatitis Human Immunoglobulin VaccineImmunoglobulin Vaccine
Immunization against Hepatitis has become an interesting addition to the UIP in India.
Ian Before Ian After
i. Test for Sensitivity Reactionii. Adrenaline (1:1000 solution) to be kept ready.iii. Properly sterilize equipment and apparatus.iv. Measles and BCG vaccines to be reconstituted
only with diluents supplied by manufacturer.v. Reconstituted Vaccines must NEVER be
retained for subsequent use.vi. Don’t store anything else in the refrigerator
other than vaccines.
Have a Great Day!