PREVENTIVE IMMINUIZATION.pptx

mmunization currently prevents 3.5-5 million deaths every year from diseases like diphtheria, tetanus, pertussis, influenza and measles. Immunization is a key component of primary health care and an indisputable human right. It's also one of the best health investments money can buy.

1. DR.ANJALATCHI MUTHUKUMARAN VICE PRINCIPAL ERA COLLEGE OF NURSING EXPANDED PROGRAM FOR IMMUNIZATION

2. SESSION OUTLINE History What is immunization Why immunization How vaccine works Types of Vaccines Universal Immunization Programme National Immunization schedule Cold chain and vaccines Achievements

3. BEGINNING OF VACCINATION

4. IMMUNIZATION Immunization is a process of protecting an individual from a disease through introduction of live attenuated, killed or organisms or antibodies in the individual system. Immunization is the process of protecting an individual by active or passive method .

5. ACTIVE VS PASSIVE IMMUNIZATION Active K ille d or li ve atte nu at e d org a n i s m i n jec t e d w h ic h ca n i ndu c e imm une response Long term I mm une s y s te m p la ys ro l e E x- H e p ati t i s B v acci n e , DP T , In acti v a t e d po li o v acci n e , M ea s l e s -rub e l l a ( MM R ) c o m b i n e d v acc i ne Passive T r a n s f e r of a n ti bod ie s Short term N o ro l e of imm une s y s te m E x- A n t i T eta nu s , s e ru m , Anti Rabies imm unog l o b u l i n et c

6. Importance of IMMUNIZATION Prevention of deadly and debilitating diseases. Keeps child from suffering through a preventable illness. Less doctor visits No hospitalization

7. COMMUNICABLE DISEASES AND VACCINES AVAILABLE TB – BCG M ea s l e , M u m p s , R ub e ll a - MMR Chicken Pox - Varicella Diptheria, Tetanus, Pertussis (aka Whooping Cough) - DPT H e p a titi s ( A a nd B ) – H e p A , H e pB P o li o – O P V , I P V R o t a v i r us – R V V P n e u m o cc us – P C V H ae m oph il us i n f l u e n za e B - H i b

8. TYPES OF VACCINES Live, attenuated vaccines Inactivated vaccines Subunit vaccines Toxoids

9. LIVE VACCINES L i v e , a tt e nu a t e d v acc i n e s c on t a i n a v e r s i o n o f t h e li v i n g m i c r ob e t h a t h a s b ee n w ea k e n e d i n t h e l a b so it can’t cause disease. Because a live, attenuated vaccine is the closest t h i n g t o a n a t u r a l i n f ec ti on , t h e s e v acc i n e s a r e good “teachers” of the immune system. E x a m p l e : V acc i n e s a g a i n s t po li o ( O P V ) , measles, mumps, rubella and chickenpox

10. INACTIVATED VACCINES Scientists produce inactivated vaccines by killing the disease-causing microbe with chemicals, heat, o r r a d i a ti on . S u c h v acc i n e s a r e m o r e s t a b l e a nd safer than live vaccines. Because dead microbes can’t mutate back to their d i s ea s e - ca u s i n g s t a t e. Example: Vaccines against influenza, inactivated po l i o v acc i n e , h e p a titi s A e t c .

11. TOXOIDS For bacteria that secrete toxins, or harmful c h e m i ca l s , a t oxo i d m i gh t b e t h e a n s w e r . T h e s e v acc i n e s a r e u s e d w h e n a b ac t e r i a l t ox i n is t h e m a i n ca u s e o f ill n e ss . Scientists have found that they can inactivate toxins b y t r ea ti n g t h e m w it h f o r m a li n . S u c h “ d e t ox i f i e d ” toxins , called toxoids, are safe for use in vaccines. E x a m p l e : D i ph t h e r i a , T e t a nu s t oxo i d

12. SUBUNIT VACCINE I n s t ea d o f t h e e n ti r e m i c r ob e , s ubun i t v acc i n e s i n c l ud e on l y t h e a n ti g e n s t h a t b e s t s ti m u l a t e t h e i mm un e s y s t e m . B eca u s e s ubun i t v acc i n e s c on t a i n on l y t h e e ss e n ti a l a n ti g e n s a n d no t a l l t h e o t h e r m o l ec u l es t h a t m a k e u p t h e m i c r ob e . E x a m p l e : P l a gu e i mm un i za ti o n .

13. COMBINATIONS The aim is to – simplify administration. - reduce costs -minimise the no. of contacts with the health system. Eg. DPT, DT, MMR, DPT& Hep.B, DPT, Hep B & H i b, H e p A & B e t c .

14. EXPANDED IMMUNIZATION PROGRAMME In 1974, E xp a nd e d progr a m of I mm un iz a t i on ( E P I) org a n iz e d by WHO It w a s calle d E xp a nd e d b eca u s e : Adding more disease controlling antigens of vaccination schedules. Extending coverage to all corners of a country. O n 19 N ov em b e r 1985 , GO I r e n ame d E P I progr am , m od i fy i ng the schedule as ‘ Universal Immunization Program ’ ‘ Universal ’ immunization is, therefore, best interpreted as im p l y i ng t he i d ea l t h a t no c h il d s hou l d be d e n ie d imm un iz a t i on against tuberculosis, diphtheria, whooping cough, tetanus, polio and measles.

15. Milestone of the EPI

16. Objectives of the EPI To reduce the morbidity and mortality of the major six childhood disease. To achieve 100% coverage for eligible children by an ongoing integrated program . To deliver an integrated immunization services through health centers, as primary health care services package . To develop a surveillance system which collect adequate information on the disease preventable by immunization . To minimize the efforts and cost of treatment . To promote a new healthy generation.

17. STRATEGIES of the EPI Integrated vaccination sessions with PHC services. Appropriate measures to expand the vaccination coverage of the eligible population . Ensuring regular supply of potent vaccine . Strengthening the cold chain. Training of health personnel . Promotion of community participation. Ensuring logistic support(supplies and equipments). Undertaking operational research to find out deficiencies & difficulties in the programme and suggest methods of improvement.

18. Targets of the EPI Under – 5 years children . Women in child bearing age Schedule of immunization Types of vaccine . Dose & route of each vaccine . Precautions of vaccination

19. IF A DOSE IS MISSED…….. Give the dose at the next opportunity irrespective of the time gap Do not start the schedule all over again

20. TETANUS TOXOID I n t r a m u s c u l a r – upp e r a r m – . 5 m l P r e gn a n c y – 2 do s e s - 1 s t do s e a s ea r l y a s po ss i b l e a nd s ec ond do s e a f t e r 4 w ee ks of f i r s t do s e a nd b e f o r e 36 w ee ks of pregnancy T T boo s t e r f or bo t h boys a nd g i r l s a t 10 y ea r s a nd 16 y ea r s The booster dose should be given a year after the initial doses. I t s hou l d be s t o r e d b e t w ee n 4 a nd 10 d e g C .

21. BCG ▣ Initial dose birth or as early as possible till one year of age ▣ . 1 m l ( . 05 m l un t i l o n e m o n t h o f a g e ) ▣ Intra-dermal ▣ L e f t u pp e r a r m ▣ F r ee z e d r i e d i s m o r e s t a b l e . D i l u e n t i s N o r m a l s a l i n e .

22. HEPATITIS B Birth dose – within 24 hours of birth . 5 m l Intramuscular A n t e r o - l a t e r a l a s p ec t o f m i d - t h i g h Rest three doses at 6 weeks, 10 weeks and 14 weeks I t s h o u l d b e s t o r e d a t 2 t o 8 d eg C . 1 ml in adults, 05ml in children <10 yrs, given IM. Mostly used 0,1,6 m schedule.

23. ORAL POLIO VACCINE ▣ Z e r o d o s e – a t b i r t h ▣ 2 drops ▣ Oral ▣ First, second and third doses at 6, 10 and 14 weeks with Pentavalent-1, 2 and 3 ▣ O P V b oo s t e r w i t h D P T b oo s t e r a t 16 - 2 4 m o n t hs

24. P E N T A V A L E N T V A CC I N E S im u lta n e ous imm un i z a t i on a g ai n s t d i ph t h e r i a , P e r t u i s i s & T eta nu s , Hep B, Hib. S t or e d a t 4-8 d e gr e e C . G i v e n 0.5 m l IM a t a n te ro la t . a s p ec t of t h i gh. Primary 3 doses with a booster in 16 -24 months. DT 5-6 yrs. C / I –progr e ss i ve n e uro l og i c a l d i s ea s e s .

25. ROTAVIRAL VACCINE 3 d o s e s g i v e n i n 6 t h , 1 t h a nd 1 4 t h w e e k s . C a n b e g i v e n t i l l o n e y e a r o f a g e G 9 P hu m a n s t r a i n . D o s e - 5 d r o p s / . 5 m l o r a ll y for prevention of diarrhoea among infants due to rotavirus .

26. IPV 2 f r a c t i o n a l d o s e s g i v e n i n 6 t h a nd 14 t h w e e k s . D o s e – . 1 m l G i v e n i n t r a d e r m a ll y i n R i g h t u pp e r a r m

27. JAPANESE ENCEPHALITIS . 5 m l , 2 d o s e s 9 m o n t h s a n d 16 - 2 4 m o n t hs Subcutaneous L e f t u pp e r a r m

28. MR VACCINE Bivalent Live atteunated against measles and rubella. G i v e n . 5 m l S C a t 9 - 1 2 a n d 16 - 2 4 m o n t h s . Stored 2-8 deg C S t r a i n - M e a s l e s - E d m on s t o r n - z a g r e b , R u b e ll a - W i l s t a r R A 27 / 3 Reactions- Fever, Resp. symp.s, Lymphadenitis or parotitis

29. DPT P r i m a r y d o s e s w e r e i n p e n t a v a l e n t v a cc i n e . One booster at 16-24 m with OPV booster (antero-lateral side of mid-thigh) and se c o n d b oo st e r a t 5 - 6 ye a r s ( upp e r a r m) . 5 m l Intra-muscular

30. VITAMIN A 1 s t d o s e – 1 m l ( 1 I U ) - a l o n g -w i t h M e a s l e s f i r s t d o s e - O r a l Subsequent 8 doses (2 ml or 2 lakh IU) every six months till 5 years of age starting w i t h D P T f i r s t b oo s t e r a t 1 6 - 2 4 m o n t hs U s e o n l y p l a s t i c s p oo n p r o v i d e d w i t h V i t a m i n A s o l u t i o n

31. REFERENCE :- - Saxena R.P . Textbook of community health nursing . 2 nd edition. Lotus publication. New Delhi. 2018. page no. 508-5011 - Park,s K. text book of preventive and social medicine. 23 rd edition m/s banarasidas bhanot publishers. Prem nagar nagpur road jabalpur (India).2015 - https://apps.who.int/iris/handle/10665/61767  - UNICEF. “Expanding Immunization Coverage”

32. vaccines and Cold Chain

33. Cold WHY HAVE THE COLD CHAIN? I f v a cc i n e s a r e e xpo s e d t o e x c e ss i v e Hea t Light they may lose their potency or effectiveness .

34. HEAT DAMAGE Heat damage is cumulative effect Reconstituted vaccine is most sensitive to heat and light. Measles and BCG vaccines should not be used 4 hrs after reconstitution and JE 2 hrs after reconstitution Temperature of diluents & vaccine must be same during reconstitution

35. HEAT SENSITIVITY BCG (after reconstitution) OPV M e a s l e s ( b e f o r e a n d a f t e r r ec o n s t i t u t i o n ) DPT B C G ( b e f o r e r e c o n s t i t u t i o n ) DT TT HepB LEAST SENSITIVE MOST SENSITIVE

36. SENSITIVITY FROM FREEZING Hep B DPT DT TT LEAST SENSITIVE MOST SENSITIVE

37. COLD CHAIN System of storage & transport of vaccines at low temp. from the manufacturer to the actual vaccination site. M a n u f a c tu r e r A i r p o r t State/Region District store Health centre Outreach S u b c e n t r e

38. COLD CHAIN Walk-in-cold rooms-at regional levels. Deep freezers-for making ice packs and storage of OPV. Ice-lined refrigerators-at PHC level.

39. REMEMBER All vaccines tend to lose potency on exposure to heat above +8 C Some vaccines (Hep B,TT, DPT) lose potency when exposed to freezing temperatures Some vaccines are sensitive to light (BCG, Measles). T he d a m a g e i s i r r e v e r s i b l e P h y s i c a l a pp e a r a nc e o f t he v a cc i ne m a y r e m a i n un c h a n g e d but p o t e nc y m i g ht be l o s t .

40. Monitoring of Cold Chain The physical appearance of the vaccine may remain unchanged even after it is damaged The loss of potency due to either exposure to heat or cold is permanent and can not be regained. Heat Damage- All vaccines are damaged by temperatures more than +8°C. Checking for heat damage: The Vaccine Vial Monitor contains a heat-sensitive material, placed on a vaccine vial to register cumulative heat exposure over time.

41. Cold chain equipments

42. Walk-in-Freezers (WIF) Installed in all of the states and larger divisional head quarters. They maintain a temperature around -20°C. bulk storage of OPV, and also to prepare frozen ice packs at state stores. Available in sizes of 16.5 Cum. and 32 Cum.

43. Ice Lined Refrigerator Available in different sizes: 108 liters or 26000 to 30000 doses 45 liters or 11000 to 13000 doses 100 liters or 24000 to 28000 doses 50 liters or 12000 to 14000 doses Top opening because they can hold the cold air inside better than a refrigerator with a front opening. There is a lining of water containers (Ice packs or tubes) fitted all around the walls and held in place by frame. Keep vaccine safe with as little as 8 hours continuous electricity supply in a 24-hour period.

44. Deep Freezer Available in different sizes: 264 liters or 380 icepacks 72 liters or 130 icepacks 80 liters or 140 ice packs. C a bine t t emp e r a tu r e is mai n t ain e d bet w e e n - 15° C t o - 25°C. Used for storing of OPV (district level and above only) and also for freezing ice packs. All districts have been provided 2-5 large deep freezers Most PHCs have been provided with one small deep freezer.

45. W alk -in- Coolers Established at regional levels , which store vaccines for about 4-5 districts Maintains temperature of +2°C to +8°C . Used for storage of large quantities of vaccines, like DPT, DT, TT, Measles, BCG, Hepatitis B. WIC/WIF store vaccines of three months requirement and 25% buffer stock for the districts they cater. Available in sizes of 16.5 Cum. and 32 Cum.

46. VACCINE CARRIERS Used for carrying vaccines (16-20 vials) and diluents from PHC to the outreach session sites. With 4 conditioned icepacks maintain inside temperature of 2-8 C for 12 hours. Close the lid of the carrier tightly. Never use any day carriers with 2 i c epa cks o r t he rm o s f la sk f o r carrying vaccines.

47. Cold Box Big insulated boxes Mainly used to collect and transport large quantities of vaccines In emergency they can be used to store vaccines as well as frozen ice packs. Store vaccines for transfer up to five days, if necessary for outreach sessions or when there is power cut. Available in different sizes: 5& 8 liters for 1500 & 2400 doses 20-22 liters for 6000 -6600 doses

48. Preparation of vaccine carriers Take out the required number of ice packs from the deep freezer and wipe them dry. Keep them out side for conditioning. Place four conditioned ice packs in the carrier wait till temperature to fall to <8 ° C in the carrier Wrap vaccine vials and ampoules in thick paper before putting in polythene bag so as to prevent them from touching the ice packs.

49. Cont…. Place some packing material between `T’ series vaccine and the ice packs. Place foam pad at the top of ice packs Ensure that some ice is present in the ice packs while conducting immunization sessions. Secure the lid tightly.

50. Vaccine vial monitor

51. USABLE AND UNUSABLE STAGES OF VVM

52. ACHIEVEMENTS: The biggest achievement of the immunization program is the e r a d ica t i on of s mal l pox. O ne m ore s i gn i f ica nt mil e s t one i s t h a t Ind i a i s fr e e of P o li o m y el i t i s ca u s e d by W il d P o li o V i rus ( W PV ) . Vaccination has contributed significantly to the decline in the ca s e s a nd d eat hs due t o t he V acci ne P r e v e n ta b l e D i s ea s e s ( VPDs ).

53. SUMMARY Its is very essential for health of all individual of citizens and must to follow the instruction. Every one know knowledge of immunization share to every one to follow