IMMUNISATION PROGRAM IN INDIA

IMMUNIZATION: COMMON TERMSImmunity :

Resistance of a host to a specific agent, characterized by measurable and protective surface or humoral antibody and by cell mediated immune responses.

Immunization:

Process of inducing immunity by stimulating immune system through antigens.

Vaccine:

A preparation of a weakened or killed pathogen, such as a bacterium or virus, or of a portion of the pathogen's structure that upon administration stimulates antibody production or cellular immunity against the pathogen but is incapable of causing severe infection.

Vaccination:

Administration of antigenic material (the vaccine) to produce immunity to a disease.

Ring immunization:

Vaccination of people in close contact with an isolated infected patient.

Catch up rounds:

Additional effort besides routine immunization to cover left outs

Mop-up rounds:

When the final pockets of polio virus transmission have been identified through standard surveillance, door-to-door immunization in high-risk districts.

HERD IMMUNITY?Resistance to spread of infectious disease in a group

because of few susceptible members, making transmission unlikely.

The immunologic status of a population, determined by the ratio of resistant to susceptible members and their distribution.

MILESTONES IN IMMUNIZATION PROGRAM IN INDIA1978: EPI

1985: UIP, Measles vaccine added

1988: AEFI Surveillance

1990: Vitamin A

1992: CSSM

1995: Polio National Immunization days

1997: RCH-I

2005: RCH-II and NRHM

EARLY VACCINES:•BCG , DPT & Typhoid•OPV Added•1985: Measles added & Typhoid dropped•TT for Pregant•2006: Hepatitis B, second dose of measles and Japanese Encephalitis •2011, pentavalent vaccine

STRATEGIES•Reduce Morbidity & mortality of VPDs by Immunisation• Ingenious vaccine production•Cold chain establishment•Phased Implementation & full coverage by 1990•Monitoring & evaluation

NATIONAL IMMUNISATION SCHEDULE

EXERCISE FOR STUDENTS

MONITORING•AFP Surveillance•Measles Surveillance•AEFI Surveillance•IDSP•Mother & Child Tracking System

COVERAGE

•RSOC by UNICEF 2012•65% in INDIA•6.6% no vaccination•89% TT for Preg Women

COLD CHAIN

COLD CHAIN• The ‘cold chain’ is the system

of transporting and storing vaccines at recommended temperature from the point of manufacture to the point of use.

• The World Health Organization (WHO) reported that in 2005, nearly half of all vaccines were RUINED in transit due to poor cold chain services.

Manufacturer

Distributor

Vaccine Depots

Provider office

Client

Cold chain storage

equipmentWalk in cold rooms Deep freezers Ice lined

refrigerators

1.Walk in cold rooms(WIC)At regional levelStorage up to 3 months

At district & PHC levelsTemp :- -15oc to -25ocAt PHC, used only for the preparation of ice packs

2.Deep freezers

3.Ice lined refrigerators(ILR)Both at district and PHC levels

Temp :- +2oc to +8ocILR’s are top opening, can hold cold air inside better than front opening refrigerators

VACCINE SENSITIVITY

• Sensitivity to HEATBCGVaricellaMMRMenCHepatitis BDT and/or aP/IPV/HIB

• Sensitivity to COLDHepB and

combinationDTand/or

aP/IPV/HIBInfluenza

MenC*MMR

*Varicella *BCG

(*Freeze dried)

MOST SENSITIVE

Temperature must be recorded twice in a day with dial thermometer

LEAST SENSITIVE

Transporting Equipment

(Periphery)Cold boxes Vaccine

carriers Day carriers

Used for transport of

vaccines Fully frozen ice packs

placed at the bottom and sides

DPT, TT, DT should not be kept in direct contact

1.Cold boxes

Used to carry small quantity of vaccines(16 to 20 vials)

For out of reach sessions

4 icepacks are used

2.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

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

SHAKE TESTFOR COLD INJURY

CONCLUSION• The Immunization program started in 1978 has

undergone various transition over the decades. More & more vaccines are being added.• But at its core it continues to have the same objective.

Protect the children against the most prevalent and serious diseases through universal coverage.• A proper monitoring system is essential to realise this

objective.• Quality of the vaccine is more important than quantity as

universal coverage without proper immune response is a waste.• A proper meticulously maintained Cold chain is the most

feasible way of maintaining the quality of a vaccine.