National Immunization Schedule

This video briefly describes the Vaccines provided under the National Immunisation Schedule.

1. Vaccine Dr. M anisha

2. Vaccine A vaccine is a biological preparation that improves immunity to a particular disease . A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins . LIVE ATTENUATED KILLED TOXOID 2

3. Latest changes in 5 yr New vaccine- IPV Rota PCV Open vial policy implemented Change in vaccination schedule of Measles and JE to 2 dose schedule Strengthening of AEFI system 3

4. Latest changes in 5 yr 4

5. Latest changes in 5 yr 5

6. Latest changes in 5 yr 6

7. Latest changes in 5 yr First vaccine to be introduced in India was BCG in 1962 as part of National Tuberculosis programme . 2012- 13 declared by Government of India as Year of intensification of routine immunization 7 Increased funding for supportive supervision and mobilizing of benefeciaries Regular programm review, special Immunization weeks Introduction of web based mother and child tracking system (MCTS) for preventing left out and dropouts

8. Immunization Milestones in India 8

9. 9 Immunization Milestones in India Immunization Programme in India was introduced in 1978 as Expanded Programme of Immunization (EPI) The programme gained momentum in 1985 and was expanded as Universal Immunization Programme (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90. UIP become a part of Child Survival and Safe Motherhood Programme in 1992 Since, 1997, immunization activities have been an important component of National Reproductive and Child Health Programme and is currently one of the key areas under National Rural Health Mission (NRHM) since 2005

10. Immunization in India Under the Universal Immunization Programme , Government of India is providing vaccination to prevent seven vaccine preventable diseases i.e. Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B, Hiaemophilus influenza type b ( Hib ) and Diarrhea 10

11. 11 1990 – Vitamin A supplementation 1997- VVM in Vaccines in UIP 2002 Hep B introduced 2005- NRHM, Autodisable syringes introduced 2010- Measles 2 ND DOSE Started

12. 12 2013- 2 nd dose of JE 2011- Hep B and Hib started under PENTA OPEN VIAL POLICY 2014-India and South east asia region POLIO FREE 2015- Introduction of IPV

13. 13 2016 ROTA virus in phased manner, tOPV – bOPV SWITCH Switch to fractional IPV 2017 MR VACCINE introduced PCV phased manner Use of adrenaline IM by ANM

14. Glass syringe used before 2005 14

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16. Important notes Successful elimination of polio on 27 th march 2014 IPV introduced on 30 November 2016 Globally snchronised switch from tOPV to bOPV in April 2016 Rota virus approved by GOI- Haryana, Andhra Pradesh, HP, Orrissa Rubella approved for introduction as MR vaccine thus replacing vaccine first dose at 9 m and 2 nd at 16-24 m PCV – To address the burden of pneumoccocal disease such as bacterial pneumonia, meningitis and sepsis in children 16

17. National Immunization Schedule 17

18. Infants 18 At birth BCG HEP- B Zero dose OPV- zero dose

19. Infants 19 AT 6, 10 , 14 WEEKS PENTA 1,2,3 OPV 1,2,3 IPV- 1,2

20. Infants 20 9 MONTHS MEASLES Vitamin A supplementation JE -1

21. Children 21 16-24 MONTHS DPT BOOSTER OPV booster JE -2

22. Children 22 16 -72 months Vitamin A supplementation

23. Pregnant mothers 23 Tetanus toxoid ( booster- if pregnancy after 3 yrs )

24. BCG 24 TIME: At birth or as early as possible MaXimum : One year Dose: 0.05 ml till one month 0.01 ml after 1m to 1 yr Route: Intradermal Site : Left Upper Arm Diluent: Sodium chloride

25. Hep B ZERO DOSE Time: At birth or within 24 hours Dose: 0.05 ml Route: I/M Site : ALT ( Antero lateral thigh) 25

26. OPV- ZERO DOSE Time: At birth Maximum : 15 days Dose: 2 DROPS Route: ORAL 26

27. Pentavalent 1,2,3 Diptheria + Pertusis + Tetanus+ Hep B+ Hib Time : 6,10,14 weeks Maximum : ONE YEAR OF AGE Dose: 0.5ML Route: I/M Site : ALT LEFT 27

28. DPT - BOOSTER Time: 16 -24 MONTHS maximum: 7 yrs of age Dose : 0.5ML Route: I/M Site : ALT 28

29. MEASLES Time: 9 M Maximum : 5 yrs Dose: 0.5 ML Route: S/C Site : RUA ( RIGHT UPPER ARM) 29 MR Vaccine introduced in phases replacing Measles If first dose delayed beyond 12 months, ensure minimum 1 months gap between 2 MR doses

30. TT Time: 10 YRS AND 16 YRS maximum : 16 yrs Dose: 0.5 ML Route: I/M Site : UPPER ARM 30

31. J.E. 1 AND 2 Time: 9M-12 M , 16-24 M Maximum : 15 YRS OF AGE Dose : 0.5 ML Route : S/C Site : LEFT UPPER ARM Diluent: Phosphate buffer 31 If first dose delayed beyond 12 months, ensure minimum 3 months gap between 2 JE doses Uttar Pradesh Assam West Bengal Karnataka

32. IPV Fractional IPV Time : 6 & 14 weeks Maximum : ONE YR OF AGE Dose : 0.1 ml Route : I/D Site : RUA 32

33. PCV Time: 6,10,14 WEEKS AND BOOSTER 9 completed months Maximum : one yr of age Dose: 0.5 ml Route: I/M Site : ALT RIGHT 33

34. ROTA Time: 6.10,14 WEEKS Maximum : ONE YEAR OF AGE Dose: 5 DROPS Route: ORAL 34

35. TT IN PREG Time: As early as possible maximum : 16 yrs Dose: 0.5 ML, 2 doses (one booster dose if last pregnancy less than 3 years) Route: I/M Site : UPPER ARM 35 Give before 36 weeks If not previously immunised , can give in labour also

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37. Full Immunization 37 Full – BEFORE AGE ONE 3 DOSES OF OPV, 3 doses of ROTA* 3 dose of PENTA 2doses of IPV, 3dose of PCV* MR- 1 st dose JE 1 ST DOSE*

38. Complete immunization 38 AFTER 2 YEARS OF AGE MR – 2 ND Dose DPT Booster Polio Booster JE 2 nd dose *

39. Miscellaneous 39

40. The switch 40 Rationale for switching from trivalent OPV to bivalent OPV Currently, the risks associated with the type 2 component of tOPV outweigh the benefits Since 1999, type 2 wild poliovirus has not been detected The type 2 component of tOPV : – Causes more than 90% of vaccine-derived polio viruses (VDPVs) – Causes approx. 40% of vaccine-associated paralytic polio (VAPP) cases – Interferes with the immune response to poliovirus types 1 and 3 in tOPV

41. IPV IPV introduction will help to: – Reduce risks associated with the withdrawal of OPV type 2 – Facilitate interruption of transmission with the use of monovalent OPV type 2 in the case of outbreaks – Hasten eradication by boosting immunity to poliovirus types 1 and 3 41

42. FRACTIONAL IPV As an alternative to the intramuscular injection of a full dose of IPV, countries may consider using fractional doses (1/5 of the full IPV dose) via the intradermal route . In the context of an IPV shortage, countries should consider instituting a 2-dose fractional dose schedule, where feasible, which could ensure that all eligible infants receive IPV, is dose-sparing and results in better immunogenicity than a single full dose of IPV. 42

43. FRACTIONAL IPV A fractional dose is one-fifth (1/5, 0.1 ml) of a full dose of IPV, injected via the intradermal (ID) route fIPV is safe, effective and immunogenic fIPV can be given alone, or at the same time as any other vaccine In children also receiving oral polio vaccine (OPV), two doses of fIPV given at 6 and 14 weeks will help to “boost ” their mucosal immunity against polioviruses fIPV can be used in all types of polio immunization activities: in routine immunization, in supplementary immunization activities (SIAs), and in outbreak response 43

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45. MR vaccine India, along with ten other WHO South East Asia Region member countries, have resolved to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020 . In this direction, Ministry of Health & Family Welfare has initiated measles-rubella (MR) vaccination campaign in the age group of 9 months to less than 15 years in a phased manner across the nation. The campaign aims to cover approximately 41 crore children 45 .

46. VVM 46

47. OPEN VIAL POLICY To make sure that vaccines remain effective with as little wastage as possible, a policy of managing opened vials is needed. Opened vials can be used to withdraw a number of doses if they are stored correctly. Multi -dose vials of OPV, DTP, TT, DT, hepatitis B, and liquid formulations of Hib vaccines from which one or more doses of vaccine have been removed during an immunization session may be used in subsequent immunization sessions for up to a maximum of 4 weeks3 47

48. Open vial policy provided that all of the following conditions are met: The expiry date has not passed ; The vaccines are stored under appropriate cold chain conditions; The vaccine vial septum has not been submerged in water Aseptic technique has been used to withdraw all doses; The vaccine vial monitor (VVM), if attached, has not reached the discard point. 48

49. Open vial policy Open vials of Measles and BCG must be discarded after the end of each immunization session not be kept for more than 6 hours . The freeze-dried formulation contains no preservative, and after being reconstituted with a diluent, must be discarded at the end of the session or within 6 hours, whichever comes first (the same as for BCG, measles, and yellow fever). All opened vials must be discarded immediately if the asceptic procedures have not been followed or there is any suspicion that the vial is contaminated 49

50. Q & A 50

51. Q&A If a child comes between the ages of 2 to 5 year without having received any vaccine, what vaccines should be given ? If t he child comes between 2 to 5 years without any vaccination , two doses of DT can be given with OPV with a minimum gap of 4 weeks (or one month) . A single dose of measles vaccine also needs to be given with first dose of DT. 51

52. Q &A Why should there be a minimum gap of 4 weeks between two doses of DPT? This is because decreasing the interval between two doses may interfere with the antibody response and protection. 52

53. Q&A Why give the DPT vaccine in the antero -lateral mid thigh and not the gluteal region (buttocks)? DPT is given in the antero -lateral mid-thigh and not the gluteal region to prevent damage to the sciatic nerve. Moreover, the vaccine deposited in the fat of gluteal region does not invoke the appropriate immune response 53

54. Q&A According to the National Immunization Schedule, Hepatitis B vaccine should be given with the first, second and third doses of DPT till one year of age. Why give the birth dose of Hepatitis B vaccine only within 24 hours of birth? The birth dose of Hepatitis B vaccine (within the first 24 hours ) is effective in preventing peri -natal transmission of Hepatitis B. 54

55. Q&A What should one do if the child is found allergic to DPT or develops encephalopathy after DPT ? A child who is allergic to DPT or develops encephalopathy after DPT should be given the DT vaccine instead of DPT for the remaining doses, as it is usually the P (whole cell Pertussis) component of the vaccine which causes the allergy/encephalopathy. 55

56. Q&A What vaccines should one give to a child who is brought after 6 years of age for the first time? Give the child only 2 doses of TT one month apart. Why is it not advisable to clean the injection site with a spirit swab before vaccination? This is because some of the live components of the vaccine are killed if they come in contact with spirit .   56

57. Q&A If a child who has never been vaccinated is brought at 9 months of age, can all the due vaccines be given to a child on the same day? Yes, all the due vaccines can be given during the same session but at different injection sites using separate AD syringes . It is safe and effective to give BCG, DPT , Hepatitis B, OPV and Measles vaccines and Vitamin A at the same time to a 9 months old child who has never been vaccinated . 57

58. Q&A If the mother/caregiver permits administration of ONE vaccine months of age, which vaccine should be given? At 9 months of age, the priority is to give measles vaccine with OPV and Vitamin- A 58

59. Let’s summarize 59

60. Summary 60