Immunization in India

Class on immunization for 3rd semester MBBS students

1. Immunization III Semester MBBS Class Dr. Vignesh L, M.D. (AIIMS, New Delhi) Senior Resident Department of PSM JIPMER, Puducherry Pic Credit: Aninda

2. Can you identify these diseases? 2

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4. Impact of vaccination in India 4

5. Competencies Describe Universal Immunization Program Explain the components of the Universal immunization Program and the Sub National Immunization Programs Vaccine description with regard to classification of vaccines, strain used, dose, route, schedule, risks, benefits and side effects, indications and contraindications Explain the epidemiology of Vaccine preventable diseases – Theory class 5

6. Competencies Define cold chain and discuss the methods of safe storage and handling of vaccines – Further classes Demonstrate willingness to participate in the National and sub national immunisation days – During Internship Discuss immunization in special situations – HIV positive children, immunodeficiency, preterm , organ transplants, those who received blood and blood products, splenectomised children, Adolescents, travellers - Peadiatrics 6

7. Outline of the class Immunity, vaccines, and basic principles Brief history of vaccination in India Universal Immunization Program Components of UIP Routine Immunization Mission Indradhanush Intensified Pulse Polio Immunization Sub National Immunization Programs Surveillance for Vaccine Preventable Diseases Question 7

8. Types of immunity 8

9. Vaccines Immunobiological substance Used for active immunization By introducing into the body, a live modified, attenuated, or killed inactivated infectious organism or its toxin or RNA or DNA or protein.. 9

10. Immunization Vs Vaccination 10

11. Brief history of vaccination in India 1978 - Expanded Programme of Imm. (BCG, DPT, OPV) 1980 - Small pox was declared eradicated 1983 - TT vaccine for pregnant women 1985 - Universal Immunization Programme – measles added 1990 - Vitamin-A supplementation 2002 - Hepatitis B introduced 2010 - Measles 2nd dose 2015 - Pentavalent & IPV Introduced 2016 - Rotavirus vaccine introduced & switch to fIPV 2017 - MR & PCV introduced 11

12. Universal Immunization Program One of the five ‘National Technology Missions’, while introduced in 1985 UIP and the Safe Motherhood program merged under the umbrella of the Child Survival and Safe Motherhood (CSSM) program in 1990s Became part of RCH I, RCH II (NRHM) Currently under RMNCH + A 12

13. Components of UIP Routine Immunization Mission Indradhanush Intensified Pulse Polio Immunization Sub National Immunization Programs Surveillance for Vaccine Preventable Diseases 13

14. Routine Immunization National Immunization Schedule Mother & Child tracking system Microplanning Cold chain management 14

15. National Immunization Schedule Vaccine Due age Max age Dose Diluent Route Site For Pregnant Women Td - 1 Early in pregnancy   0.5ml No IM Upper Arm Td - 2 4 weeks after Td-1   0.5ml IM Upper Arm Td - Booster Pregnancy within 3 years and 2 Td doses were received   0.5ml IM Upper Arm 15

16. Vaccine Due age Max age Dose Diluent Route Site For Infants BCG At birth 1 year 0.05ml until 1 month and 0.1ml beyond 1 month 0.9% NS (1ml) ID Upper Arm - Left Hepatitis B 1 day 0.5ml No IM Antero-lateral mid-thigh - Left OPV - 0 15 days 2 drops Oral Oral OPV - 1, 2 & 3 6 weeks, 10 weeks & 14 weeks 5 years 2 drops Oral Oral Pentavalent - 1,2 & 3 1 year 0.5ml IM Antero-lateral mid-thigh - Left RVV 1 year 5 drops Oral Oral 16

17. Vaccine Due age Max age Dose Diluent Route Site For Infants fractional IPV 6 & 14 weeks 1 year 0.1ml No ID Upper Arm - Right PCV 6 & 14 weeks; Booster at 9 months 1 year 0.5ml IM Antero-lateral mid-thigh - Right MR1 9 - 12 months 5 years 0.5ml Sterile water (2.5ml) SC Upper Arm - Right Vitamin A (1st dose) 9 months 5 years 1ml (1 lakh IU) No Oral Oral 17

18. Vaccine Due age Max age Dose Diluent Route Site Children and adolescents DPT Booster - 1 16 -24 months 7 years 0.5ml No IM Antero-lateral mid-thigh - Left MR2 5 years 0.5ml Sterile water (2.5ml) SC Upper Arm - Right OPV Booster 5 years 2 drops No Oral Oral Vitamin A 2 nd dose at 16 - 24 months 3 rd to 6 monthly till 5 years 5 years 2ml (2 lakh IU) No Oral Oral DPT Booster - 2 5 - 6 years 7 years 0.5ml No IM Upper Arm Td 10 & 16 years 16 years 0.5ml No IM Upper Arm 18

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20. Covered in following classes Principles of vaccine storage and use Adverse effects 20

21. Mother & Child Protection Card Entitlement Card Counselling and family empowerment tool Tracking tool for a mother and child cohort w.r.t. health, nutrition and development purposes Uses: Record important information Health educational & advise tool 21

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23. Microplanning 23

24. Cold chain management 24

25. Components of UIP Routine Immunization Mission Indradhanush Intensified Pulse Polio Immunization Sub National Immunization Programs Surveillance for Vaccine Preventable Diseases 25

26. Intensified Mission Indradhanush 3.0 To achieve full immunization for children up to two years of age and pregnant women 250 High – focus districts with low immunization coverage (2021) For those who missed their vaccine doses Districts in Puducherry U.T. - Karaikal , Mahe , Yanam Pic Credit: Aninda 26

27. Components of UIP Routine Immunization Mission Indradhanush Intensified Pulse Polio Immunization Sub National Immunization Programs Surveillance for Vaccine Preventable Diseases 27

28. Intensified Pulse Polio Immunization Pic Credit: Aninda 28

29. Components of UIP Routine Immunization Mission Indradhanush Intensified Pulse Polio Immunization Sub National Immunization Programs Surveillance for Vaccine Preventable Diseases 29

30. Sub National Immunization Programs Japanese encephalitis Given in 13 JE endemic districts in TN Tiruvallur, Tiruvannamalai, Villupuram, Cuddalore , Perambalur , Ariyalur , Thiruvarur , Thanjavur, Pudukottai , Tiruchirapalli , Madurai, Virudhunagar and Karur 30

31. Components of UIP Routine Immunization Mission Indradhanush Intensified Pulse Polio Immunization Sub National Immunization Programs Surveillance for Vaccine Preventable Diseases 31

32. Surveillance for Vaccine Preventable Diseases Vaccine preventable diseases AFP Measles & Rubella Diphtheria Pertussis Neonatal tetanus Surveillance system exists for AFP surveillance with support from WHO – National Polio Surveillance Platform Integrated Disease Surveillance Program 32

33. Acute Flaccid Paralysis Sudden onset of weakness and floppiness in any part of the body in a child < 15 year of age  33

34. Measles/Rubella case definition Any person with: Fever and maculopapular rash (non-vesicular) with cough or coryza or conjunctivitis  34

35. Diphtheria case definition Any person having illness of the upper respiratory tract with: Laryngitis or pharyngitis or tonsillitis  AND  Adherent membranes of tonsils, pharynx and/or nose 35

36. Pertussis case definition A person of any age with: Cough lasting ≥ two week, or of any duration in an infant or any person in an outbreak setting, without a more likely diagnosis  AND  At least one of the following symptoms on observation or parental report:  o Paroxysms of coughing  o Inspiratory whooping  o Post-tussive vomiting, or vomiting without other apparent cause  o Apnoea in infants (<1 year of age)  OR  Clinician suspicion of pertussis  36

37. Neonatal tetanus Any neonate who could suck and cry normally during the first two days of life and developed tetanus-like illness or death between 3 and 28 days of age OR Any neonate who died of an unknown cause during the first month of life. 37

38. Questions?? 38

39. Questions 1. List out the diseases that are preventable by the various vaccines in UIP schedule. 2. What are the different ways to elicit vaccination history of a child? 3. A 9 months old child who is unvaccinated since birth was identified during IMI session in a Village in Karaikal . Which vaccines can be given to her? 4. What diseases were eradicated globally and eliminated in India so far? 39