EXPANDED PROGRAMME IN IMMUNISATION.pptx

Help to teach and guide on the , immunization programme

1. EXPANDED PROGRAMME IN IMMUNISATION J. NKOLE CUST

2. Introduction The Expanded Program on Immunization is a World Health Organization program with the goal to make vaccines available to all children throughout the world. The World Health Organization (WHO) initiated the Expanded Program on Immunization (EPI) in May 1974 with the objective to vaccinate children throughout the world .

3. Introduction cont’d In 1999, the Global Alliance for Vaccines and Immunization (GAVI) was created with the sole purpose of improving child health in the poorest countries by extending the reach of the EPI.

4. The current goals of the EPI   To ensure immunization of children under one year of age in every district. T o globally eradicate poliomyelitis. To reduce maternal and neonatal tetanus to an incidence rate of less than one case per 1,000 births by 2005, to cut in half the number of measles-related deaths that occurred in 1999.

5. Introduction cont’d iv. To extend all new vaccines and preventive health interventions to children in all districts in the world.

6. REVIEW OF IMMUNOLOGY Immunology deals with the defense mechanisms including all physical, chemical and biological properties of the organism that help it to combat its susceptibility to foreign organisms, material, etc . There are two types of components that are involved in immunity. These are:

7. Non-specific component or innate immunity. Specific component or adaptive immunity The non-specific components act either as barriers or as eliminators of wide range of pathogens irrespective of antigenic specificity .

8. Other components of the immune system adapt themselves to each new disease encountered and are able to generate pathogen-specific immunity.

9. Nonspecific immunity or innate immunity is the natural resistances with which a person is born. It provides resistances through several physical, chemical and cellular approaches. Microbes first encounter the epithelial layers , physical barriers that line skin and mucous membranes.

10. Subsequent general defences include secreted chemical signals (cytokines), antimicrobial substances, fever, and phagocytic activity associated with the inflammatory responses.

11. Specific immunity or Adaptive immunity consists of two responses which are; Humoral response Cell mediated response

12. Humoral immune system The is the first way of the body’s response to antigens and it happens through substances called antibodies which circulate within the body and can act against antigens at sites very far from where they were originally produced Antibodies are produced by special cells called B-lymphocytes which are within the lymphatic tissues of the body.

13. They are complex chemical substances called immunoglobulins which match the particular antigen they were made for just a key matches one particular lock only.

14. Cell mediated immune system This is the second way of the body’s response to antigens and it happens through other special cells called T-lymphocytes and macrophages that circulate through the body and destroy micro-organisms or other cells that the micro-organisms may have invaded. The special T-cells are tuned in the same way as antibodies to a particular infecting germ.

15. The response to specific antigens by both systems is the reason why immunity developed against one disease , such as measles vaccine does not protect against other diseases such as poliomyelitis or pneumonia. Memory recall protects the body against subsequent attacks by the same antigens, whether germs or poisons.

16. If a person is exposed again to an infection he has already had or been vaccinated against , the body will quickly recall the cells and make more antibodies to neutralize the toxins or fight off the micro-organisms and prevent the establishment and spread of the infection again.

17. Adaptive immunity is often sub-divided into two major types depending on how the immunity was introduced. Naturally acquired immunity which occurs through contact with a disease causing agent, when the contact was not deliberate. Artificially acquired immunity which develops only through deliberate actions such as vaccination.

18. Types of immunization Immunization is the process by which an individual's immune system becomes fortified against an agent (known as the immunogen ) or it is the process of protecting a person from a specific disease. There are two types of immunizations which are: Passive immunization Active immunization

19. Passive immunization: This is the transfer of active humoral immunity in the form of ready-made antibodies, from one individual to another Or it is the acquisition of readily formed antibodies ( Transplacental transmission, immunoglobulin administration).

20. Active immunization: this is stimulating the immune system to produce antibodies and cellular elements against an infectious agent. This happens automatically when a person is exposed to an infection/antigen and develops his own antibodies. It is induced in the host itself by antigen and lasts much longer, sometimes lifelong.

21. Immunization guidelines and schedule Optimal response to a vaccine depends on multiple factors, including the type of vaccine , age of the recipient , and immune status of the recipient . Recommendations for the age at which vaccines are administered are influenced by age-specific risks for disease, age-specific risks for complications , age-specific responses to vaccination, and potential interference with the immune response by passively transferred maternal antibodies.

22. Vaccines are recommended for members of the youngest age group at risk for experiencing the disease for which efficacy and safety have been demonstrated.

23. Target Groups for Vaccination Children under five years School aged children Pregnant women Women of child bearing age (15 – 49yrs) Special at risk groups (e.g. Travellers)

24. IMMUNISATION SCHEDULE IN ZAMBIA

25. VACCINE DOSAGE AGE FOR VACCINATION No Doses ROUTE/ RECOMMENDED SITE INTERVAL BTN DOSES TARGET AGAINST BCG 0.05ml < 1 year 0.1ml > 1 year. At Birth Or 1 st contact Once Intradermal in the upper outer aspect of the left lower arm - Tuberculosis OPV (1,2,3) OPV OPV 4 2-3 drops At 6 weeks, 10 weeks, 14 weeks – 13 days At 9 months 4 doses Orally 4 weeks Polio DPT- HepB - Hib -1, 2, 3 0.5mls At 6 weeks, 10 weeks, 14 weeks 3 doses Intramuscular injection into the thigh 4 weeks Diptheria Pertussis Hepatitis B Tetanus

26. VACCINE DOSAGE AGE FOR VACCINATION No Doses ROUTE/ RECOMMENDED SITE INTERVAL BTN DOSES TARGET AGAINST Rotarix 1.5mls At 6 weeks 10 weeks 2 oral 4weeks diarrhoea PCV 0.5Mls At 6 weeks, 10 weeks, 14 weeks 3 Intramuscularly in the upper outer quadrant of the right thigh. 4 weeks Forms of pneumococcal diseases eg Meningitis pneumonia and bacteraemia . Measles 0.5mls 9 months 18 months 2 Subcutaneous injection into the upper left arm 9 months. Measles

27. VACCINE DOSAGE AGE FOR VACCINATION No Doses ROUTE/ RECOMMENDED SITE INTERVAL BTN DOSES TARGET AGAINST TT 0.5Mls 5 Intra muscular injection into the deltoid muscle of the upper arm Tetanus

28. Bacillus Calmette-Guerin (BCG) It is a frozen dried powder which is reconstituted with sterile diluent before it can be injected. Only the diluent that comes with the particular batch of vaccine must be used. BCG immunization at birth will reduce the sickness and death from Tuberclosis ; miliary or disseminated TB and TB meningitis among children

29. Storage of BCG Vaccine Can be safely stored and transported between +2 and +8 degrees Celsius BCG should never be exposed to sunlight BCG is more heat stable before reconstitution but less stable after reconstitution Reconstituted BCG must be discarded after six hours .

30. contraindications Persons with impaired immunity Symptomatic HIV infection Known HIV infection

31. Administering BCG Check the label that it is correct vaccine Check vaccine vial monitor Check expiry date of the vaccine and diluent Check that it is the right diluent Reconstitute the vaccine Check the volume of the diluent that you reconstitute with the vaccine

32. Draw up all the diluent into mixing syringe Empty the diluent into the vaccine ampoule Mix vaccine and diluent by withdrawing vaccine and diluent slowly into the reconstitution syringe and then injecting it back Do not shake the vaccine, as this may damage it

33. Normal reaction There should be a flat-topped swelling in the skin at the injection site looking like a mosquito bite, with small pits. This usually disappears within 30 minutes After approximately two weeks, a red sore develops which is around 10mm in diameter.

34. The sore remains for another two weeks and then heals A small scar about 5 mm across, remains This is a sign that the child has been effectively immunised with BCG

35. Vaccination for Pentavalent DPT- HepB - Hib D – Diphtheria P – Pertussis T – Tetanus HepB – Hepatitis B Hib – Haemophilus influenza type B

36. The vaccine contains weakened DPT-HepB-Hib and killed pertussis bacteria It is a liquid vaccine, which has to be injected

37. Storage of DPT- HepB - Hib vaccine It should be stored and transported between +2 to 8 Degrees celsius It freezes at temperatures below +2 Degrees Celsius and gets irreversibly damaged Use the shake test to test whether the vaccine has been frozen

38. Administration DPT- HepB - Hib Check the label that it is the correct vaccine Check the expiry date for the vaccine Check to make sure the vaccine has not been frozen Check the VVM status ( vaccine vial monitor) Shake the bottle gently. Using a 0.5ml draw 0.5ml of the vaccine Tap the syringe to remove any air in the syringe so that the dose is accurate before removing the needle

39. Side effects Fever : advise the mother that some children may have fever and are irritable after receiving the vaccine Local soreness : some children may get red, tender lump at the site of the injection that is not serious and needs no treatment

40. Oral Polio Vaccine (OPV) The vaccine contains a live, attenuated (weakened) virus It is damaged more easily by heat than the other vaccines Can be frozen without being damaged

41. Storage of Polio Vaccine At central level between -15 and -25 degrees Celsius At health centre level between +2 and +8 degrees Celsius.

42. Administration of OPV Check the label that it is the correct vaccine Check the expiry date Check the VVM to make sure the vaccine has not been exposed to too much heat. Check the number of drops needed for one dose with this vial. Let the mother hold the child firmly, sitting up so that he does not aspirate the vaccine

43. Open the child’s mouth by squeezing the mouth gently between your fingers Let the correct number of drops of vaccine fall from the dropper onto the child’s tongue Make sure that the child swallows the vaccine If he/she spits it out, give another dose NB: if the child has diarrhoea, give the vaccine anyway but give an extra dose 4 wks after you finish the normal course. Do not record the dose given during diarrhoea episode.

44. Measles Vaccination The vaccine is a live attenuated (weakened) form of the virus that causes measles It is a freeze – dried and has to be reconstituted before injection ONLY use the diluent that comes from the same vaccine manufacturer to reconstitute the vaccine. Maternal antibodies to measles last longer than other antibodies, so immunization against measles is often not effective before the nine months of age

45. In most developing countries, children are vaccinated against measles at 9 months of age, when maternally derived protection declines from maternal antibodies. However, it is recommended that all children have two opportunities for measles immunization to reduce the number of both unvaccinated children and those who are vaccinated but fail respond to the vaccine. ( failing to form antibodies).

46. The second opportunity for measles immunization plays an important role in increasing the proportion of the population with lifelong protection against measles, as boosting through natural infection gradually disappears.

47. Storage of measles vaccine At central, provincial and district stores the vaccine should be kept between -15 and -25 degrees Celsius At the health centre level between +2 and +8 degrees Celsius The diluents should not be frozen, but cooled immediately prior to use so it doesn’t neutralize the measles.

48. Administering Measles Vaccine Check the label that it is the correct vaccine Check expiry date Reconstitute the vaccine in the same way as BCG vaccine Fill the syringe Give the vaccine subcutaneously Inject into the outer part of the child’s upper left arm

49. Side effects from measles vaccination Fever and rash Tell the mother that the child may have a fever for one to three days about a week after the vaccination and that Sometimes there is a mild measles rash. Reassure the mother that it is much milder than the disease and goes away by itself

50. Rotarix vaccine Children infected with rotaviruses during the first 3 months of life are asymptomatic. Those infected for the first time after the age of 3 months are usually symptomatic. It is a live attenuated rotavirus vaccine.

51. The one in use in Zambia is a called Rotarix Dose – 1.5mls Route – orally 1 st dose is given at 6 weeks 2 nd dose is given at 10 weeks

52. PNEUMOCOCCAL CONJUGATE VACCINE . The pneumococcal vaccine protects children younger than 2 years old. It protects against severe forms of pneumococcal disease , such as meningitis , pneumonia and bacteraemia .

53. It will not protect against these conditions if they are caused by agents other than pneumococcus.

54. administration PVC for infant use are given by intramuscular injection in a dose of 0.5ml. The primary series consists of 3 doses at intervals of at least 4 weeks, starting at the age of six weeks or later, although some some countries use a schedule with two doses in infancy, and a third dose at or 12 months.

55. PVC can be co-administered with other EPI vaccines. The vaccine cannot be mixed with other vaccines in the same syringe and therefore, the injection should be given in a different injection site- right thigh . PVC has been proven safe and well tolerated even among children infected with HIV.

56. Storage of the vaccine PVC should be stored and transported between 2-8 ċ. Liquid vaccines, including the pneumococcal vaccine, must not be frozen. Liquid vaccines lose their potency and provide no protection against the disease, if frozen.

57. Cont. If there is doubt, the ‘shake test’ can be performed to check whether any of these vaccines have been frozen. If in doubt, shake the sample for 10-15 seconds and thereafter allow to rest. If there are some sediments at the bottom of the vial then the vaccine was once frozen.

58. Tetanus Toxoid vaccine Tetanus toxoid (TT) consists of a toxoid (an anti – toxin neutraliser ) It is the same tetanus toxoid as contained in the DPT- HepB - Hib vaccine The vaccine is given to women of child bearing age to prevent neonatal tetanus.

59. Storage of TT vaccine It should be stored and transported between +2 and +8. TT is destroyed by freezing The shake test will confirm if TT has been frozen or not A woman who has had five doses can be considered to have life long protection Tetanus doses received during childhood can be counted in the TT schedule

60. TT Dose Contact TT1 At first contact TT 2 At least 4 weeks after TT 1 TT 3 At least 6 months after TT2 TT 4 Atleast after 1 year after TT3 TT 5 At least 1 year after TT 4