Dissemination of Updates EPI Policy and Field Guide

Revised expended programme on immunization for Ghana

1. Venue: Peninsula Resort & Golf Club
Date: 05 June 2024
Dissemination of Updates
<EPI Policy and Field Guide>
EPI ANNUAL (2023) & 1ST QUARTER (2024)
PERFORMANCE REVIEW, 2024

2. Outline
Background to EPI in Ghana
Importance of recent updates
Highlights of EPI updates (Policy & field guide)
Summary

3. Introduction:
History of EPI in Ghana
lWHO launched Expanded Programme on Immunization (EPI) in 1974
–(through resolution WHA 27.57)
lGhana’s EPI was officially launched in 1978 initially as pilot. Scaled up from 1985-1991
lThe Programme currently vaccinates against 14 VPDs in routine immunization (11
Vaccines)
lKey strategies:
–static, outreach, mobile, mop-up, campaigns
lDecentralized immunization services free of charge at all levels

4. Introduction:
Population profile & Administrative structures
Population profile, 2024
Total population32,984,353
Pop under 15 years13,853,428
Pop under 5 years6,596,871
Surviving Infants1,286,390
Total Livebirths1,319,374
Preg. Women1,319,374
Administrative Structures
Regions16
Districts261
Subdistrict1,421
Health facilities10,771

5. Introduction:
Mandate and Goal of EPI
lMandate:
–To contribute to poverty reduction by reducing the magnitude of vaccine preventable
diseases (VPDs) through immunization as an essential component of Primary Health
Care (PHC)
lGoal:
–To protect all, particularly children and pregnant women living in Ghana against
VPDs

6. 1.Tuberculosis
2.Poliomyelitis
3.Diphtheria
4.Pertussis (whooping cough)
5.Tetanus
6.Haemophilus influenza type B
7.Hepatitis B
8.Pneumococcal diseases
9.Rotavirus diarrhoea
10.Measles
11.Rubella
12.Yellow fever
13.Neisseria Meningitis
14.Malaria
Other VPDs depend on the disease
burden, vaccine safety, and effectiveness,
vaccine cost, and the net impact
1.BCG
2.OPV
3.MR
4.Td
5.Pentavalent
6.PCV (Pneumococcal
conj / pneumo)
7.Rotavirus
8.IPV
9.Yellow fever (YF)
10. Meningococcal Conj /
MenA
+1: RTS,S (Malaria
Vaccine)
11 Vaccines
Targeted diseases
(14 infections)
COVID-19 vaccines integration currently ongoing

7. BCG
OPV
DPT
Measles
Total: 6 + TT
1978
1992
YF
2002
2012
2013
2016
Hep.B
Hib
into PENTA
Total: 9
PCV
Rota
MSD
Total: 11
(M)R
Td
Total:
12
Men A
Total 13
IPV
2019
7
Malaria Vaccine pilot started on
1st May 2019 and endedin
December 2023: MVIP/RTS,S
2018
RTS,S
2021: Use of COVID-19 vaccines and integration currently ongoing
MSD = Measles Second Dose
Introduction:
Chronology of vaccine introductions in Ghana

8. NoRevision made Date
(mm/yyyy)Remarks
1Inclusion of Men A and IPV in schedule06/2016EPI team
2Td schedule for women with previous doses06/2016EPI team
3Disease Specific policy guidelines06/2016EPI team
4Inclusion of section on Children’s Act 06/2016EPI team
52YL Policy 06/2016EPI team
6Catch-up 06/2016EPI team
7Malaria Vaccine, HPV, Hep B birth dose and COVID-19 Vaccination2023EPI team
Introduction:
EPI policy and Field guidelines revision history

10. Introduction:
importance of recent updates
importance of recent
updates
Responding to emerging health challenges and dynamics
Improving efficiency and effectiveness of the immunization programme
Last version in use dated in 2016, there were series of updates over the years. Next
edition updated late 2023 undergoing finalization and yet to be launched this year.

11. lNew vaccine introduction
lRevised immunisation schedule
lCatch up policy
lOthers
–Vaccine types
–Fully Immunised Child (FIC; 1yr/2yrs)
–Recommended vaccinations in HIV
infected children
–Multi-dose vial policy
–Contraindications
–Etc
lData management
lEnhanced cold chain and logistics management
lAdverse Event Reporting
lCommunity Engagement Strategies
lEnhanced microplanning to reach the unreached
lImplementation Support
Key update areas
POLICY FIELD GUIDE

12. Highlights of EPI policy
(updates)
mostly in blue coloured font & bolded

13. New vaccine introduction
lNew Vaccines Introduced following (planned/introduced) last edition of 2016 Policy
include;
§Malaria Vaccine (introduced)
§COVID-19 Vaccination (introduced)
§HPV (planned)
§Hep B birth dose (planned)
§IPV 2nd dose (planned)

14. Revised immunisation schedule
lMalaria vaccine
–4th dose reduced from 24 months to 18 months
lRotavirus vaccine
–Switch from Rotarix (2 dose) to RotaVac (3 doses)
–6, 10 and 14 weeks for dose 1, 2 and 3 respectively
lIPV 2nd dose
–To be administered on the 7th months

15. 15
Vaccination and Vitamin A schedule in Ghana
AgeVaccinesDosesRoute and Site of Injection
7 months*Malaria Vaccine 2
IPV 2
0.5 ml
0.5 ml
Intra-muscular, antero-lateral aspect of left thigh
Intra-muscular, antero-lateral aspect of right
thigh
9 months
Measles-Rubella 1
Yellow Fever
*Malaria Vaccine 3
0.5ml
0.5ml
0.5 ml
Subcutaneous, left upper arm
Subcutaneous, right upper arm
Intra-muscular, antero-lateral aspect of left thigh
12 monthsVitamin A200,000 IUOral
18 months
Measles-Rubella 2
Men A
*Malaria Vaccine 4
Vitamin A
0.5ml
0.5ml
0.5 ml
200,000 IU
Subcutaneous, left upper arm
Intra-muscular, right upper arm
Intra-muscular, antero-lateral aspect of left thigh
Oral
9 yearsHPV0.5 mlIntra-muscular, right upper arm
After 18 months Vitamin A (200,000 IU) is given every 6 months till child is 5 years old
18 months – Give Long lasting Insecticide Treated Nets (LLINs) to the child
*The malaria vaccines currently being introduced on phased basis.
NB: Currently, all persons aged 15 years and above are provided with COVID-19 vaccines.
The primary dose is either 1 or 2 doses dependent on the vaccine type.
AgeVaccinesDosesRoute and Site of Injection
At birth
BCG
OPV0
Hep B Birth Dose
0.05ml
2 drops
0.5 ml
Intra-dermal, right upper arm
Oral
Intra-muscular, antero-lateral aspect of left thigh
6 weeks
DPT-HepB-Hib1
OPV 1
PCV 1
Rota 1
0.5ml
2drops
0.5 ml
5 drops
Intra-muscular, antero-lateral aspect of left thigh
Oral
Intra-muscular, antero-lateral aspect of right thigh
Oral
10 weeks
DPT-HepB-Hib2
OPV 2
PCV 2
Rota 2
0.5ml
2drops
0.5 ml
5 drops
Intra-muscular, antero-lateral aspect of left thigh
Oral
Intra-muscular, antero-lateral aspect of right thigh
Oral
14 weeks
DPT-HepB-Hib3
OPV 3
PCV 3
Rota 3
IPV 1
0.5ml
2drops
0.5 ml
5 drops
0.5 ml
Intra-muscular, antero-lateral aspect of left thigh
Oral
Intra-muscular, antero-lateral aspect of right thigh
Oral
Intra-muscular, antero-lateral aspect of right thigh
6 monthsVitamin A
*Malaria Vaccine 1
100,000 IU
0.5 ml
Oral
Intra-muscular, antero-lateral aspect of left thigh

16. Dose of Td
(according to card
or history)
When to give Expected duration o f protection
Td1
At first contact or as early as possible in
pregnancy
None
Td2 At least 4 weeks after Td1 1 - 3 years
Td3
At least 6 months after Td2 or during
subsequent pregnancy
At least 5 years
Td4
At least one year after Td3 or during
subsequent pregnancy
At least 10 years
Td5
At least one year after Td4 or during
subsequent pregnancy
For all childbearing years and
possibly longer

11 June 2024 16
Td Vaccination schedule in Ghana

17. Catch up policy
< Background >
lAll vaccines must be given at the age-appropriate period as per the national immunization
schedule
lThis ensures that persons eligible are protected as early as possible from vaccine
preventable diseases (VPDs)
lHowever, some persons eligible either do not start or may miss doses of routine vaccines
when they are age-eligible
lThis increases their risk of being infected with VPDs
lIt is therefore crucial that such persons eligible are vaccinated in order to ensure they are
protected against VPDs

18. Catch up policy
< Background >
lCatch-up vaccination is the immunization of unvaccinated persons eligible at the earliest
possible time
lIt offers unvaccinated persons eligible, their families and the communities in which they
live a second opportunity for disease prevention and control

19. lThe Catch-up Policy states that;
–Children could always start vaccination and benefit from all age-eligible vaccines as
long as they are less than five (5) years generally
–Children who started vaccination but failed to complete could always continue even up
to five (5) years
–Once a child starts, s/he must complete all vaccines and vaccine doses
–Refer to booster schedules for COVID-19 for details
lA vaccine series does not need to be restarted, regardless of the
time that has elapsed between doses
11 June 2024 19
Catch up policy

20. Catch up policy
VaccineMinimum AgeMaximum AgeComments I Interval
between doses
BCGBirth<1 yearAdministered at birth; preferably not beyond 2 weeks
Hepatitis BBirth2 weeks Only one dose
OPV0Birth<2 weeksAdministered at birth or within two weeks of delivery
OPV6 weeks<5 yearsTotal of 3 doses, 4 weeks apart
Pentavalent6 weeks<5 yearsTotal of 3 doses, 4 weeks apart
PCV6 weeks<5 yearsTotal of 3 doses, 4 weeks apart
Rota6 weeks
First dose: 30 weeks
Last dose: 34 weeks
Total of 3 doses, 4 weeks apart
*if a child starts at 30weeks, maximum
of 2 doses can be given
IPV14 weeks<5 years2 doses, first dose at 14 weeks, second
dose 7 month
Malaria Vaccine6 months <5 years
First dose: up to 1 year.
4th dose: < 5 years
Total of 4 doses at least 4 weeks apart
MR9 months<5 yearsTotal of 2 doses. If the first dose is given any time between 9 and 17 months the second dose should be
given at 18 months. If first contact Is at 18 months or beyond, the 2nd dose
should be 4 weeks apart
YF9 months<5 yearsOnly one dose
Men A18 months<5 yearsOnly one dose
HPV9 years 14 yearsOnly one dose

21. Td Vaccination
Dose of Td
(according to card
or history)
When to give Expected duration o f protection
Td1
At first contact or as early as possible in
pregnancy
None
Td2 At least 4 weeks after Td1 1 - 3 years
Td3
At least 6 months after Td2 or during
subsequent pregnancy
At least 5 years
Td4
At least one year after Td3 or during
subsequent pregnancy
At least 10 years
Td5
At least one year after Td4 or during
subsequent pregnancy
For all childbearing years and
possibly longer

22. Age at last
vaccination
Previous immunisation s
(based on written records)
Recommended immunisation
At present
contact/pregnancy
Later (at intervals of at
least one year)
Infancy 3 doses of DPT/Penta vaccine 1 dose of Td 2 doses of Td
School age
3 doses of DPT/Penta vaccine +
1 Td 1 dose of Td 1 dose of Td
Adolescent
3 doses of DPT/Penta vaccine +
1 Td + 1Td 1 dose of Td None

11 June 2024 22
Guidelines for immunisation of women who
have received previous TT/Td doses
NB: 3 doses of DPT/Penta vaccine is equivalent to Td2 (2 doses of Td)

23. HIGH Priority-Use Groups
Target Population Primary Series + 1st BoosterAdditional Booster Doses
Groups with the highest risk of death from COVID-19
Elderly aged 60 years and aboveRecommendedRecommended (from 6 to 12 months after previous dose)
Younger adults 15 to 59 years with significant underlying medical
conditions or severe obesityRecommendedRecommended(from 6 to 12 months after previous dose)
Subgroup of elderly aged 60 years and above with significant underlying
medical conditions:
Recommended Recommended (from 6 to 12 months after previous dose)
Groups with special consideration for vaccination
Adolescents, and children (0-14) years and older with moderate to
severe immunocompromising conditionsCurrently not recommended Not routinely recommended
Pregnant adults and adolescentsRecommendedRecommended once during a pregnancy (If previous dose was
more than 6 to 12 months earlier)
Frontline health workersRecommendedRecommended (from 6 to 12 months after previous dose)
MEDIUM Priority-Use Groups
TARGET POPULATION PRIMARY SERIES + 1ST BOOSTERADDITIONAL BOOSTER DOSES
Healthy younger adultsRecommendedRecommended(12monthsafterpreviousdose)
Children + adolescents (6 months to 14 years with severe obesity or
underlying medical conditions) that put them at higher risk of severe
COVID-19
Currently not recommended
Not routinely recommended
Low Priority-Use Groups
TARGET POPULATION PRIMARY SERIES + 1ST BOOSTERADDITIONAL BOOSTER DOSES
Children + adolescents 6 months to 14 years Currently not recommendedNot routinely recommended
COVID-19 Booster Vaccination Schedule
NB: Policy will be updated based on the epidemiology of the disease and guided by National Immunization
Technical Advisory Group

24. 24
Types of vaccines
Live Attenuated
(LAV)
Inactivated
(killed)
Subunit (Purified
antigen)
Toxoid
(Inactivated
Toxins)
Messenger
RNA (mRNA)
Viral Vector
•BCG
•Oral Polio
Vaccine
(OPV)
•Rotavirus
•Measles
•Rubella
•Yellow fever
•Whole Cell
Pertussis
(wP)
•Inactivated
Polio
Vaccine
(IPV)
•Haemophilus
influenza type b
•Hepatitis B (HepB)
•Pneumococcal
Conjugate Vaccine
(PCV)
•Conjugate
Meningococcal A
(MenAfricVac)
•Malaria vaccine
•HPV vaccine
•Tetanus
Toxoid (TT)
•Diphtheria
Toxoid
•Pfizer-
BioNTech
Covid-19
vaccine
•Moderna
Covid-19
vaccine
•Janssen/
Johnson &
Johnson
Covid-19
vaccine
•AstraZeneca
Covid-19
vaccine

25. lA fully immunized child (FIC) is a child who has received;
–a dose of BCG, three doses each of pentavalent, pneumococcal and oral polio vaccines (excluding
polio vaccine given at birth), three doses of rotavirus vaccine, and two doses of measles-rubella
vaccine, two doses of IPV, a dose each of yellow fever, and meningitis A vaccine, and where
applicable, four doses of malaria vaccine.
–A child can be fully immunized by his/her age if he/she has received all the age-appropriate
vaccines.
lFIC is categorized by age into: FIC by age 1, by age 2 and after age 2
11 June 2024 25
Fully Immunized Child

26. AntigensAsymptomatic HIVSymptomatic HIV
BCGDo not VaccinateDo not vaccinate
OPVVaccinateDo not vaccinate
IPVVaccinateVaccinate
PentaVaccinateVaccinate
PCVVaccinateVaccinate
RotaVaccinateDo not vaccinate
MRVaccinateDo not Vaccinate
YFVaccinateDo not vaccinate
Men AVaccinateVaccinate
TdVaccinateVaccinate
11 June 2024 26
Because of the risk of early and severe measles infection, HIV exposed/infected infants may receive a dose of standard
measles-rubella vaccine at 6 months of age and the second and third doses at 9 months and 18 months respectively.
Recommended vaccination of HIV infected children

27. lAll opened multi-dose vials of vaccines should be discarded at the end of the immunisation session, or
within six hours of opening, whichever comes first unless it meets the criteria below:
lOpened vial can be kept and used for up to 28 days after opening if it meets the following criteria;
–The vaccine is currently prequalified by WHO.
–The vaccine is approved for use for up to 28 days after opening the vial, as determined by
WHO.
–The expiry date of the vaccine has not passed.
–The vaccine vial has been, and will continue to be, stored at WHO- or manufacturer
recommended temperatures; furthermore, the vaccine vial monitor, if one is attached, is
visible on the vaccine label and is not exceeded its discard point, and the vaccine has not
been damaged by freezing.
11 June 2024 27
Multi-dose Vial Policy

28. Intervals Between Doses of the Same Vaccine
lPentavalent, OPV, measles-rubella, PCV and rotavirus vaccines require
administration of more than one dose for the development of adequate antibody
response
lA minimum interval of 4-weeks/28 days should be maintained between each dose
lIf a vaccine dose is given at less than the recommended 4-week interval, it should
not be counted as part of the primary series, and should be repeated at the
appropriate time
11 June 2024 28

29. Intervals Between Doses of the Same Vaccine, cont’d
lA longer-than-recommended interval between doses does not reduce final
antibody response; although it extends the time when the child is at risk of
contracting the diseases
lInterrupted immunisations need not be restarted, but the remaining dose or doses
should be given as if the prolonged interval had not occurred
–For all practical purposes there is no maximum interval between doses of the same vaccine.
11 June 2024 29

30. Validity of Doses
A vaccine dose is only valid if
1.the dose is administered on or after the minimum age as per schedule and
2.in accordance with recommended intervals*-minimum of 28 days-between
doses of multi-dose antigens (Pentavalent, OPV, measles-rubella, PCV and
rotavirus vaccines)
lAdministration at recommended ages and in accordance with recommended
intervals between doses of multi-dose antigens provide optimal protection and are
valid
11 June 2024 30

31. Missed opportunities
lMissed opportunity: when children do not receive an immunization when they are age
eligible for a vaccine(s) with no contraindication present
lOccur in two major settings:
ØDuring visits for immunization and other preventive services (e.g. growth monitoring,
nutrition assessments and oral rehydration training sessions, etc.)
ØDuring visits for curative services
lIn both settings, eliminating missed opportunities has the potential to raise
immunisation coverage in a population, particularly when the availability and use of
health services is high
11 June 2024 31

32. Simultaneous Administration of Vaccines
lAll vaccines on the schedule can be administered during the same session but they should
be at different sites
lDifferent vaccines should never be mixed in one syringe for injection
lLive vaccines (BCG, polio, rotavirus, yellow fever, measles) can be administered at any
time before or after each other for rapid protection (refer specific vaccine
recommendations)*
lTwo vaccines can be administered at the same time on the same limb as long as the
injections are given about 2.5 cm (1 inch) apart
lVitamin A can be administered in the same session as vaccines
11 June 2024 32

33. Contraindications to Immunization
lContraindications are mostly rare and temporary
lPermanent contraindications: Allergy to previous dose or component; severe AEFI after
previous dose (e.g. collapse or shock, anaphylaxis,, encephalitis/encephalopathy, or non-
febrile convulsions)
lTemporary contraindications: Febrile illness (postpone)
lContraindications to Live vaccines : immuno-suppressed (malignant disease, immuno-
suppressive agent or irradiation)
lVaccines contraindicated in symptomatic HIV infection: BCG, Rota, YF, MR and
OPV (live vaccines)
11 June 2024 33

34. Contraindications to Immunization, cont’d
lVaccines containing the whole cell pertussis component should not be given to
children with an evolving neurological disease:
–uncontrolled epilepsy
–progressive encephalopathy
lAllergy to Eggs: Persons with a history of generalized urticaria, difficulty in
breathing, swelling of the mouth and throat, shock following egg ingestion should
not receive vaccines prepared on hen’s egg tissues: yellow fever and influenza
vaccines
11 June 2024 34

35. Injection Safety Policy
lKey highlights
–One injection, one new auto-disable syringe
–No Recap of needles
–All used syringes must be immediately put in a safety box
–Safety boxes should not be filled beyond ¾ of its volume
–All safety boxes must be incinerated
–No harm to vaccinee, provider or community
11 June 2024 35

36. Immunisation of Health Workers and Travelers
lWHO recommends that all healthcare workers (HCWs) are fully vaccinated as per
the national immunization schedule
lEfforts shall be made to vaccinate all HCWs against hepatitis B, meningitis,
yellow fever, measles and rubella
lTravelers (children, adolescents, adults) should be advised to check that they have
been fully vaccinated
lTravelers should be vaccinated against measles, rubella, diphtheria, tetanus,
pertussis (whooping cough) poliomyelitis and yellow fever before starting their
travel. Only a single dose required for lifelong protection
11 June 2024 36

37. Storage and transportation of vaccines
lVaccine Storage: +2°C to +8°C at all levels
lOPV shall be stored at -15 to -25°C at the national level and in regions where
freezing capacity is available
lThe temperature of every vaccine storage equipment shall be monitored twice in a
day. Currently ultra cold (-80 to -60°C) facilities are available
lAll walk-in-cold-rooms (WICR) and walk-in-freezer-rooms (WIFR) shall be fitted
with continuous temperature loggers
lThere shall be a responsible officer designated to ensure cold chain maintenance at
all levels
11 June 2024 37

38. Highlights of EPI field guidelines
(updates)
mostly in blue coloured font & bolded

39. Enhanced datamanagement
1. Enhanced Data Collection Methods
•Digital Tools:
•Introduction of electronic immunization registries
•Use of tablets and mobile devices for data entry
•Benefits:
•Improved accuracy and completeness of data
•Real-time data availability
2. Data Integration and Interoperability
•Systems Integration:
•Linking immunization data with health
information systems
•Benefits:
•Comprehensive health records
•Better tracking of immunization status and
outcomes
3. Data Security and Privacy
•New Protocols:
•Enhanced data hosting and encryption
•Strict access controls
•Compliance:
•Adherence to national and international data protection standards
•Benefits:
•Ensures patient confidentiality
•Builds trust in the immunization program
4. Data Analysis and Reporting
•Advanced Analytics:
•Use of data analytics for program monitoring
•Identification of trends and coverage gaps
•Regular Reporting:
•Automated generation of reports for stakeholders
•Visualization tools for data presentation

40. lThe following tools and databases are used for routine data collection, recording, reporting and monitoring of
immunization-related activities have been updated to reflect needed updates -
–Tally sheet
–Child Health and Nutrition register (CWC register)
–COVID-19 vaccination register
–Maternal and child health cards (Vaccination card)
–COVID-19 vaccination card
–Vaccine ledger
–Temperature monitoring chart
–Monthly vaccination report
–Defaulter tracking register
–DHIMS-2 (Aggregated Data)
–E-tracker (Transactional Data)
–ODK supervision and monitoring tools
–Enhanced dashboards visualization
Data management

41. Enhanced cold chain and logistics management
1. New Standards
lTemperature Range:
–Must maintain between 2°C and 8°C
at all levels for use
–Storage ranges now accommodates
(-80 to -60°C) for some vaccines
lStorage Units:
–Specifications for approved storage
units
2. Improved Monitoring Systems
lContinuous Monitoring Devices:
–Real-time temperature tracking
–Alerts for temperature deviations
–Remote sensor monitoring
–Fridge tags usage
lBenefits:
–Ensures vaccine potency
–Reduces waste due to spoilage/VVM changes,
etc
3. Enhanced transportation & medical drone
delivery (zipline support)

42. Guidelines for arranging vaccines in fridge compartment
34
à
congeler
Accumu
lateurs
HPVHep BAstrazenecaMR
PENTATdRTS,SIPVPCV-13
OPVJ&JROTAPfizer
Men ABCGYFModerna
Water packs
for
freezing
¾ storage volume

43. Desirable temperature ranges for EPI vaccines
VaccineNational
IntermediateHealth CentreStatic Clinic/OutreachRegionDistrict6 months3 months1 month1 monthDaily Use
Pfizer COVID-19 Vaccine-80°Cto -60°C
OPV
-25°Cto-15°CRotavirus
Johnson & Johnson COVID-19 vaccine
Moderna COVID-19 vaccine
AstraZeneca COVID-19 vaccine
BCG
+2°Cto+8°C
Measles-Rubella
Yellow Fever
DPT-HepB-Hib (Penta)
Pneumococcal Conj. Vaccine (PCV)
Meningococcal A Vaccine
Malaria Vaccine
Tetanus-diphtheria (Td)
Hepatitis B
HPV
Inactivated Polio Vaccine (IPV)
Diluent StoreatRoomTemperatureCooltosametempasvaccineadaybeforeuse
Penta, PCV, Td, IPV, Malaria vaccine, Hepatis B, HPV and diluents must NEVER be frozen. Always store them in the top basket in the refrigerator

44. Freeze sensitiveLight sensitiveHeat sensitive
PentavalentBCGOral polio vaccine (OPV)
Hepatitis BMeasles-rubellaMeasles-rubella
Inactivated polio vaccine (IPV)Malaria vaccineYellow Fever
Pneumococal conj. VaccineBCG
AstraZeneca COVID-19 vaccineMeningitis A conj. vaccine
Tetanus-diphtheriaRotavirus
Malaria VaccinePfizer COVID-19 vaccine
HPV Moderna COVID-19 vaccine
Johnson & Johnson COVID-19 vaccine
Storage and transportation of vaccines
< Vaccine sensitivity >

45. National Central
Store
Regional
Store
District
StoreHealth
Facilities
Mobile
Strategy
Zipline
Routine Delivery
Zipline Support
Cold chain system in Ghana

46. Adverse Events reporting
•Streamlined Processes
•New Reporting Methods:
•Mobile app (Medsafety) for immediate reporting
•Simplified reporting forms
•DHIS 2 AEFI e-tracker
•Enhanced Follow-Up Procedures:
•Dedicated investigation team for follow-up
within 48 hours on serious cases
•Detailed investigation and response protocols
•Benefits:
•Faster identification and management of adverse
events
•Increased trust in vaccination program
Regional EPI
Coordinator
National EPI
Regional FDA
Focal Person
FDA
FDA Safety
Database
Signal
Generation
TAC
Possible
Regulatory Action
WHO Database
Collection
Collation
Analysis
Feedback
Facility AEFI Focal
Persons
Health worker/
Vaccinator
District AEFI Focal
Persons
Vaccine Recipients/Caregivers
Vaccination
campaign AEFI
reporting
Routine
vaccination AEFI
reporting
AEFIs are reported via multiple channels (MS Excel, Medsafety app, phone)

47. •New Approaches
•Door-to-Door Campaigns:
•Personalized engagement with families
•Addressing vaccine hesitancy directly
•Community Meetings:
•Regularly scheduled sessions
•Involving local leaders and healthcare
providers
Community Engagement Strategies
•Improved Communication Materials
•Brochures and Posters:
•Updated with new vaccine information
•Distributed in local languages
•SMS Alerts:
•Timely reminders for vaccination schedules
•Health tips and information
•Expected Impact:
•Increased awareness and uptake of vaccines
•Better community trust and participation
•Use of digital platforms such as facebook, X, etc

48. •Identifying Unreached Populations
•Use of geographic information systems (GIS)
to map communities (gDMP trainings)
•Surveys to identify unvaccinated individuals
•Community involvement to hard-to-reach
groups
•Customized Outreach Strategies
•Tailored Approaches for urban slums, remote
rural areas, and nomadic populations
•Flexible Schedules: Adjusting vaccination
schedules to meet the availability of target
populations e.g. Weekend, evening, &
Creche vaccinations, etc
Enhanced microplanning to reach the unreached
•Resource Allocation
•Targeted Resource Deployment:
•Allocating additional staff and mobile clinics to
underserved areas
•Ensuring adequate vaccine supplies and cold chain
equipment (CCEOP support)
•Monitoring and Evaluation
•Tracking Progress:
•Regular monitoring of coverage rates in targeted
areas
•Evaluating the effectiveness of micro-planning
initiatives
•Reporting outcomes to stakeholders

49. •Training Programs
•Scheduled Training Sessions:
•In-person workshops
•Online E-lessons and webinars
•Access to Updated Materials:
•Online portal with updated policy and
guidelines
•Training videos shared via platforms
•Downloadable guidelines and FAQs
•Expected Outcomes:
•Well-informed and skilled HCWs
•Consistent and high-quality immunization
practices
Implementation Support
•Monitoring and Evaluation
•New Indicators and Metrics:
•Vaccine wastage rates
•Timeliness of vaccine administration
•Regular Assessment Schedules:
•Biannual program reviews
•Quarterly supportive supervision
•Feedback Mechanisms:
•Anonymous/non feedback system
•Hotline for reporting challenges
•Expected Impact:
•Improved program performance
•Timely identification and resolution of issues

50. Some important concepts
lZero Dose
–Zero-dose children are those that have not
received any routine vaccine. For
operational purposes, Gavi defines zero-
dose children as those who lack the first
dose of diphtheria-tetanus-pertussis
containing vaccine (DTP1).
lUnder-immunised children
–This refers to children who after taking
the first dose of a particular vaccine
missed out or fail to continue with
subsequent doses of the vaccine.
lOthers are
–Gender Equity & Right (GER)
–Missed community
–Conflicts communities/internally displaced populations
–Populations/communities with Traditional/religious beliefs
–“Galamsey” (illegal gold mining) sites
–Migrant communities/populations
–Nomadic populations/communities
–Seasonal Cut-off/Overbank communities
–Hard-to-Reach communities/populations

51. Policies on Individual Vaccines
(updates)

52. BCG, OPV and IPV
Bacillus Calmette–
Guérin (BCG)
•Protects against severe clinical form of childhood tuberculosis
•1 dose given intra-dermally at birth or within 2 weeks of birth
•Vaccine can be given before the child attains one year
Polio Vaccine
•Prevent poliomyelitis
•Birth within 2 weeks of birth
•Birth dose shall not be given when the child is more than 2 weeks
•The primary series (6 weeks, 10 weeks and 14 weeks) shall be given per the
schedule
•Inactivated Polio Vaccine (IPV) shall be given at 14 weeks on the right thigh with
PCV: the 2 vaccines shall be administered 2.5 cm apart
•If any doses are missed, polio vaccine can be administered to children in routine
immunization before age five
11 June 2024 52

53. Pentavalent and PCV
Diphtheria-Pertussis-
Tetanus-Haemophilus
influenzae type B-
Hepatitis B
•Five-in-one vaccine (Pentavalent) protects against diphtheria, whooping cough,
tetanus, haemophilus influenza type B and hepatitis B infection
•Provided to infants as per the immunization schedule
•If any doses are missed, pentavalent vaccine can be administered to children in
routine immunization before age five
Pneumococcal Conjugate
Vaccine (PCV)
•PCV vaccine protects against invasive pneumococcal diseases (pneumonia,
bacteraemia/septicaemia)
•Provided to infants as per the schedule
•Last dose shall be given at the same site as IPV 2.5 cm apart
•If missed, can be administered to children in routine immunization before age
five
11 June 2024 53

54. Rotarix and Yellow Fever
Rotavirus (Rotavac)
•The rotavirus vaccine protects against rotavirus diarrhoea.
•Three doses of the vaccine shall be given to infants starting at 6 weeks. There
should be an interval of at least 4 weeks between doses.
•Ghana currently uses Rotavac vaccine, which should not be used in children
over 34 weeks of age.
•The first dose, therefore, shall not be administered to children who are 30
weeks of age or older to allow for the minimum interval of 4 weeks before the
second and third dose by 34 weeks.
Yellow Fever (YF)
vaccine
•The vaccine is given to protect against yellow fever
•One dose of the vaccine is administered at 9 months as per the immunization
schedule.
•If the dose is missed, yellow fever vaccine can be administered to children in
routine immunization before age five
11 June 2024 54

55. Measles-Rubella (MR) vaccine
Measles-Rubella (MR)
vaccine
•The measles rubella vaccine protects against measles, rubella and
congenital rubella syndrome
•Two doses of the vaccine shall be provided at 9 and 18 months as per
the immunization schedule
•Any child who does not receive the first dose of MR vaccine at 9
months shall be given the vaccine at first contact and the second dose
shall be provided at 18 months
•However, if the first contact is at 18 months or beyond, the first dose
shall be provided and the second dose shall be given after 4 weeks
•If any doses are missed, MR can be administered to children in routine
immunization before age five
11 June 2024 55

56. Men A
Meningococcal A
Conjugate Vaccine
(Men A)
•Meningococcal A Conjugate Vaccine (Men A) protects against Neisseria
meningitis
•One dose of the vaccine shall be administered at 18 months, the same
time as second dose measles-rubella vaccination
•If the dose is missed, Men A vaccine can be administered to children in
routine immunization before age five
11 June 2024 56

57. Tetanus-diphtheria
Tetanus-diphtheria
(Td)
•Protects against maternal and neonatal tetanus as well as diphtheria
•The vaccine shall be provided to pregnant women as per the Td
immunization schedule
•Five doses of Td shall be provided to give protection to women
throughout their child-bearing years
•Pregnant women who have received 5 doses of Td according to
schedule shall deem to have completed the series and shall not receive
additional doses
•Td can be given as a continuation vaccine for women who have
previously received TT according to same schedule
11 June 2024 57

58. Malaria Vaccine (MV)
Malaria Vaccine (MV)
•The malaria vaccine is given in four (4) doses at age 6 months, 7
months, 9 months and 18 months.
•The malaria vaccine is an additional form of protection against malaria
and is used as part of the malaria prevention package in Ghana.
•It reduces the number of times children get malaria, including severe
malaria, and it reduces child deaths.
•The Vaccine following successful pilot has been introduced into routine.
It is progressively been expanded in a phased approached to other
geographical areas
11 June 2024 58

59. COVID-19 Vaccines
COVID-19 Vaccines
•Currently, the only licensed COVID-19 vaccine in Ghana is Jansen or Johnson
and Johnson (J&J).
•Four other COVID-19 vaccines have been used in the past under Emergency
Use Authorisation.
•These are AstraZeneca COVID-19 vaccine, Pfizer BioNTech COVID-19
vaccine, Moderna COVID-19 vaccine and Sputnik V COVID-19 vaccine.
•Apart from Jansen COVID-19 vaccine which requires one primary dose, the
other vaccines require more than one primary dose and observing the
appropriate interval according to vaccine type is necessary for protection
against the disease.
11 June 2024 59

60. Human Papillomavirus (HPV) vaccines
Human
Papillomavirus (HPV)
vaccines
•TheHPV vaccineprotects against genital warts and most cases of cervical cancer.
•It protects against cancer of the vagina, vulva, penis or anus caused by HPV.
•Human papillomavirus (HPV) is a common sexually transmitted virus that causes
genital warts, cervical cancer and other cancers.
•HPV spreads easily by having vaginal, anal, or oral sex with someone who has the
virus.
•Primary prevention is by vaccination against HPV infection for girls 9 to 14 years
of age in Ghana.
•Other preventive measures include abstinence from sex, male circumcision and
keeping to one sexual partner
•Treatment: Has no cure. However, diseases caused by HPV such as cervical
cancer can be managed with combination of procedures such as surgery,
radiotherapy and chemotherapy
11 June 2024 60

61. Other key areas to know!
lThese are areas include;
–correctly interpreting VVM indicator changes
–correctly applying open vial policy
–correctly applying reduced contraindications policy
–correctly handling disposable materials
–providing vaccinations at every opportunity (super-marketing)
–correctly interpreting “shake test” etc.
–correctly interpreting the Catch-up Policy
–correctly conditioning ice packs before using them for vaccine transportation
11 June 2024 61

62. lThis comprehensive and engaging presentation effectively
communicates the updates to the EPI policy and field
guidelines, including;
–new policy changes
–field guidelines
–data management improvements
–micro-planning strategies to reach the unreached and
–implementation support, providing a thorough and informative session
for the audience.
Summary

63. THIS IS HOW WE
HAVE BEEN
DOING IT
WE are in this together
and everyone’s support is
needed in these abnormal
times
63

64. All other Partners
are acknowledged
Thank you Comments & questions

65. Comments & questions

66. Discussions !!!
Questions and answers – All