2. IMMUNIZATION
•Immunization is defined as the procedure by which
the body is prepared to fight against a specific
disease.
•Immunization is of two types:
1. Passive immunization
2. Active immunization.
3. „ 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.
4. ACTIVE IMMUNIZATION
Active 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
Naturally
Artificially
5. Active Natural Immunization
Naturally 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 Immunization
It is achieved by the administration of vaccines or toxoids.
6. Herd Immunity
•It 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.
7.
8. Vaccine
8
Vaccine 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.
9. Types of vaccine
A. 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.
10. C.Sub-unit vaccines
•Subunit vaccines include only the antigens that best
stimulate the immune system.
•In some cases, epitopes are used—the 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.
10
11. D. Combination
If more than one kind of immunizing 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
• Example of mixed vaccines are DPT,DT,DP,MMR,etc.
• POLYVALENT: It is prepared from 2 or more strain of the same species
11
14. Why Immunization ?
Key strategy to child survival
Protecting infants from diseases.
Lowers morbidity and mortality rates in children.
Indicator of a strong primary health care system.
15. What Is EPI?
• Expanded program on Immunization (EPI) is a world health organization
program, with the goal to make vaccines available to all children throughout the
world.
16. SCOPE OF EPI
Experience with smallpox eradication program showed the world that
immunization was the most powerful and cost-effective weapon against
vaccine preventable diseases.
In 1974, the WHO launched its “ Expanded program of immunization” (EPI)
against six most common preventable diseases (diphtheria, pertussis,
tetanus, polio, tuberculosis, measles and recently added
pneumococcal vaccine).
17. “Expanded” Means?
Expanding the number of diseases to be covered
Expanding the number of children and target population to be
covered
Expanding coverage to all corners of the country and spreading
services to reach the less privileged sectors of the society.
18. Component Of EPI:
Routine Immunization:
Children 0-23 months – immunization with 8 EPI antigens
Pregnant ladies by TT.
Supplemental Immunization Activities:
Routine immunization does not ensure 100% coverage of the mobile population i.e. nomads, NAs, hard to reach areas /
missed areas. So SIAs are scheduled to ensure coverage of this population / areas.
NIDs / SNIDs: children < 5 years receive polio drops (3-days campaign)
Disease Surveillance:
To detect every case of target diseases, the suspected cases of seven VPDs are reported by health facilities to the
district health authorities for immediate launching of the control measures.
Mopping up:
Special campaigns 5-8 km around the infected locality to localize the disease and stop its transmission.
19. The objectives of EPI:
1. To achieve 100% coverage with all EPI vaccines.
30. Somalia EPI
• EPI Vaccines
• All vaccines used in Somalia by EPI program are safe, procured
through UNICEF from manufactures pre-qualified and accredited by
WHO.
• The national EPI Programme provides the following vaccines:
• BCG: It contains live attenuated Mycobacterium bovis (M. bovis), and comes
in powder form. It must be reconstituted with a diluent before use. It is
essential that only the diluent supplied with the vaccine be used. BCG vaccine
should be kept at 2°C–8°C after reconstitution. Any remaining reconstituted
vaccine must be discarded after six hours or at the end of the immunization
session, whichever comes first.
31. Somalia EPI
• Oral Polio Vaccine (OPV): It is prepared from attenuated live polio virus, and is
presented as a liquid vaccine that is provided in glass vials with droppers in a
separate plastic bag. In consultation with global partners, the country will make an
informed decision on the introduction of IPV and phasing-out of OPV.
• Pentavalent DTP-HepB+Hib vaccine: It contains diphtheria toxoid, tetanus toxoid,
pertussis, Hepatitis B and Haemophilus type b vaccine; and is provided as liquid form
in vials of ten doses.
• Measles vaccine is provided as a powder, with a diluent in a separate vial. Before it
can be used, it must be reconstituted. It is essential that only the diluent supplied
with the vaccine be used. After reconstitution measles vaccine should be kept at
2°C–8°C. Any remaining reconstituted vaccine must be discarded after six hours or at
the end of the immunization session, whichever comes first.
• Tetanus Toxoid (TT) is provided as a liquid in vials and also in prefilled auto-disable
injection devices.
33. Immunization schedule
• According to the recommended schedule all children will receive one
dose of BCG vaccine, 3 doses of DTP-HepB+Hib, 4 doses of OPV, and
one dose of measles vaccine before their first birthday/First year.
• Table 1: Routine immunization schedule for infants, 0 -11 months
Age Vaccines
Birth (up to 1 week) BCG OPV0
6 weeks DTP-HepB+Hib1 OPV1
10 weeks DTP-HepB+Hib2 OPV2
14 weeks DTP-HepB+Hib3 OPV3
9 months MCV1
18 months MCV2
34. Immunization schedule for pregnant women and
WBCA (15- 45 years)
Dose Time for administration Duration of protection
TT 1 at first contact OR as early as possible during pregnancy None
TT 2 at least 4 weeks after TT1 1-3 years
TT 3 at least 6 months after TT2 5 years
TT 4 at least 1 year after TT3 10 years
TT 5 at least 1 year after TT4 For all child bearing
years
35. Summary of routes of administration and
injection sites
Vaccine Route of administration Injection site
BCG Intradermal Upper Left Arm
DTP-HepB+Hib Intramuscular Outer mid-thigh (Right)
OPV Oral Mouth
Measles Subcutaneous Upper Right arm
Tetanus toxoid Intramuscular Outer, upper arm (Left)
36.
37.
38. 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.
Manufacturer
Distributor
Vaccine
Depots
Provider
office
Client
39. Why is the cold chain important ?
1. Vaccines are:
Biological products
lose potency with time
Process irreversible and accelerated if
proper storage conditions are not
adhered to.
2. Assurance in potent product
and vaccine programmes
Professional responsibility
Confident the vaccines you give
will be effective
Public Health responsibility
Public confidence in immunisation
programmes
3. Ensuring maximum benefit
from immunisations
Responsibility not to waste scarce NHS
resources
Reduce wastage from errors
4.Compliance with
SPC/Manufacturer
Any vaccine that has not been stored at
a temperature of 2-8ºC as per its
licensing conditions is no longer a
licensed product
40. Cold chain storage equipment
Walk in cold
rooms
Deep freezers Ice lined
refrigerators
41. A. Walk in cold rooms(WIC)
At regional level
Storage up to 3 months
Serve 4-5 districts
42. B. Deep freezers
At district & PHC levels
Temp :- -15oc to -25oc
At PHC, used only for the preparation of
ice packs
In case of power failure these freezers
can maintain the cabinet temp. for 18-22
hours
20-25 icepack can be prepared by a 140L
in deep freezers with continuous electric
supply of 8 hours.
43. C. Ice Lined Refrigerators(ILR)
Both at district and PHC levels
Temp :- +2oc to +8oc
ILR’s are top opening, can hold
cold air inside better than front
opening refrigerators
It can keep vaccine safe with 8
hours of continuous electric
supply in a 24 hours period.
44. • Arrangement of vaccine order top to bottom:
Hepatitis B
DPT & TT
BCG
Measles
OPV
• Discard any frozen hep.b, DPT, & TT.
• Keep spaces between boxes
• Measles & OPV can be kept over 2 rows of empty ice-packs on the
floor of the ILR.
45. Vaccine Stability
• Sensitivity to
HEAT
OPV
Measles
BCG
MMR
Hepatitis B
DT
• Sensitivity to
COLD
HepB and
combination
Influenza
*BCG
(*Freeze dried)
MOST SENSITIVE
Temperature must be
recorded twice in a day
with dial thermometer
LEAST SENSITIVE
46. Light Sensitive
Sensitive to strong light, sunlight, ultraviolet,
fluorescents (neon)
OPV
Measles
MMR
Varicella
Meningococcal C Conjugate
Most DTaP containing vaccines
Vaccines should always
be stored in their
original packaging until
point of use to protect
them from light
47. 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)
X 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.uk
DO’sDON’T’s
49. 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
50. 3.Day carriers
Used to carry very small quantities of
vaccines(6 to 8 vials)
For a near by session
2 icepacks are used
For only 2 hours period
51. ICE PACKS
•It contains water & no salt should be added to it.
•The water should be filled up to the level marked on
the side.
•If there is leakage such icepack should be discarded.
52. 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
53. Stage 1
• Inner square
lighter than
outer circle
Stage 2
• Inner square still
lighter than
outer circle
Stage 3
• Color of inner
square matches
the outer circle
Stage 4
• Color of inner
square darker
than outer circle
Combined effects of time and temperature
cause the inner square to darken gradually and
irreversibly
VVM does not directly measure the vaccine
potency but gives info about the main factor that
affects potency
