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!