Universal Immunization Program

Its about the immunization program and how it evolved.

1. UNIVERSAL IMMUNIZATION
PROGRAMME
Dr.SravaniAmbati

2. Evolution of the programme
1974: WHO launched
‘’Expanded programme on Immunization’’
against 6 vaccine preventable diseases.
1.Diphtheria
2.Pertussis.
3.Tetanus.
4.Polio.
5.Tuberculosis.
6.Measles.

3. Evolution of the programme
1978: Expanded Programme of immunization (EPI).
Limited reach -mostly urban
1985: Universal Immunization Programme (UIP).
1.For reduction of mortality and morbidity due to 6 VPD’s.
2.Indigenous vaccine production capacity enhanced
3.Cold chain established
4.Phased implementation -all districts covered by 1989-90.
5.Monitoring and evaluation system implemented

4. Evolution of the programme
1986: Technology Mission On Immunization
1.Monitoring under PMO’s 20 point programme
2.Coverage in infants (0 –12 months) monitored
1992: Child Survival and Safe Motherhood (CSSM)
Included both UIP and Safe motherhood program
1997: Reproductive Child Health (RCH 1)
2005: National Rural Health Mission (NRHM),
JE vaccine introduced.

5. Evolution of the programme
•2011-Pentavalentvaccineintroduced.
•2012-IndiaalongwithSEARregion,declaredcommitment
towardsmeasleseliminationandrubella/congenitalrubella
syndromeby2020.
•2014-Indiawascertifiedpoliofreecountryalongwith
SEARcountriesbyWHO

6. Evolution of the programme
2014Dec-MISSIONINDRADHANUSH
vaccinesagainst7vaccinepreventablediseases
2015–MNTElimination,IPVIntroduction.
2016–MRandRotavirusvaccineaddedtotheNational
immunizationprogramme.
2016-tOPVtobOPVswitchvaccineprogramme.

7. Key Facts on Immunization world wide
Immunization prevents illness, disability and death
from vaccine-preventable diseases including
Cervical cancer, Diphtheria,
Hepatitis B, Measles,
Mumps, Pertussis (whooping cough),
Pneumonia, Polio,
Rubella, Tetanus and,
Rotavirus Diarrhoea.

8. Key Facts on Immunization world wide cntd….
Globalvaccinationcoverageisgenerallyholdingsteady.
Uptakeofnewandunderusedvaccinesisincreasing.
Immunizationcurrentlyavertsanestimated2to3
milliondeathseveryyear.Anadditional1.5million
deathscouldbeavoided,however,ifglobalvaccination
coverageimproves.
Anestimated19.4millioninfantsworldwidearestill
missingoutonbasicvaccines.

9. Key Facts on Immunization in INDIA
•IndiahasoneofthelargestUniversalImmunization
Programs(UIP)intheworld.
•UndertheUIP,allvaccinesaregivenfreeofcosttothe
beneficiaries.
•Allbeneficiariescangetthemselvesvaccinatedatthe
nearestGovernment/Privatehealthfacilityonfixed
days.
•TheUIPcoversallsectionsofthesocietyacrossthe
countrywiththesamehighqualityvaccines.

10. UIP-OBJECTIVES
1)Toincreaseimmunizationcoverage.
2)Toimprovequalityofservice.
3)Toachieveselfsufficiencyinvaccineproduction&
manufacturingofcoldchainequipment's.
4)Toestablishreliablecoldchainequipmentandagood
surveillancenetwork.
5)Tointroduceadistrictwisesystemmonitoring&
evaluation.
6)Totrainhealthpersonnel.

11. Vaccines under UIP Under UIP, following
vaccines are provided:
1. BCG (Bacillus CalmetteGuerin)
2. DPT (Diphtheria, Pertussis and Tetanus Toxoid)
3. OPV (Oral Polio Vaccine)
4. Measles.
5. Hepatitis B.
6. TT (Tetanus Toxoid).
7. JE vaccination (in selected high disease burden districts).
8. Hib containing Pentavalent vaccine (DPT+HepB+Hib).
9. IPV.
10. Rota Virus Vaccine.

12. TETANUS TOXOID
•Intramuscular–upperarm–0.5ml.
•Pregnancy–2doses-1
st
doseasearlyaspossible
andseconddoseafter4weeksoffirstdoseand
before36weeksofpregnancy.
•Pregnancy–boosterdose(before36weeksof
pregnancy)–Ifreceived2TTdosesina
pregnancywithinlastthreeyears.

13. TETANUS TOXOID
•Give TT to woman in labour, if she has not received
TT previously.
•TT booster for both boys and girls at 10 years and
16 years.
•No TT required between two doses in case of injury.

14. BCG
•At birth or as early as possible till one year of age
•0.1 ml (0.05ml until one month of age)
•Intra-dermal
•Left upper arm

15. HEPATITIS B
•Birth dose –within 24 hours of birth
•0.5 ml
•Intramuscular
•Antero-lateral side of mid-thigh
•Rest three doses at 6 weeks, 10 weeks and 14 weeks

16. OPV
•Zero dose –within first 15 days of birth
•2 drops
•Oral
•First, second and third doses at 6, 10 and 14 weeks
with DPT-1, 2 and 3
•OPV booster with DPT booster at 16-24 months

17. IPV
•Boostimmunitytotype2-Reducestheriskof
paralyticpoliomyelitisifanyexposuretotype2
virusoccursafterOPV2withdrawal.
•Reducetransmissionofreintroducedtype2virus.
•ImproveresponsetoanyfutureuseofIPVor
mOPV2inthecaseofanoutbreak.
•Boostimmunitytotype1and3.

18. IPV
Based on risk assessment and operational feasibility.
•Single dose IPV
-Implemented in 6 states.
-In 22 states introduced –1 April 2016.
•Two fractional dose IPV in 8 states/UT at 6 and 14
weeks
(Andhra Pradesh, Karnataka, Kerala, Maharashtra,
Odisha, Puducherry, Tamil Nadu and Telangana).

20. DPT
•Threeprimarydosesat6,10and14weekswithOPV-1,2
and3
•0.5ml
•Intra-muscular
•Antero-lateralsideofmid-thigh
•Oneboosterat16-24mwithOPVbooster(antero-lateral
sideofmid-thigh)andsecondboosterat5-6years
(upperarm)

21. MEASLES
•At 9 completed months to 12 months
•Give upto5 years if not received at 9-12 months age
•Second dose at 16-24 months (select states after catch-up
campaign) –Measles Containing Vaccine
•0.5 ml
•Sub-cutaneous
•Right upper arm
•Along with Vitamin A (1
st
dose) –1ml (1 lakh IU) -oral

22. VITAMIN A
•1stdose–1ml(1IU)-along-withMeaslesfirst
dose-Oral
•Subsequent8doses(2mlor2lakhIU)everysix
monthstill5yearsofagestartingwithDPTfirst
boosterat16-24months
•UseonlyplasticspoonprovidedwithVitaminA
solution

23. JAPANESE ENCEPHALITIS
•SA14-14-2vaccineinselectendemicdistrictsafter
campaigninUP,Bihar,Assam,Haryana,AndhraPradesh,
Goa,Karnataka,Manipur,WestBengal,TamilNadu
•16-24monthswithDPTandOPVbooster
•0.5ml
•Subcutaneous
•Leftupperarm

24. MISSION INDRADHANUSH
•TheGovernmentofIndiahaslaunchedMission
Indradhanushon25December2014asaspecialdriveto
vaccinateallunvaccinatedandpartiallyvaccinated
childrenandpregnantwomenby2020underthe
UniversalImmunizationProgramme.

25. MISSION INDRADHANUSH cntd…
•SincethelaunchofUniversalImmunizationProgrammein
1985,fullimmunizationcoverageinIndiahasnot
surpassed65%despiteallefforts.
•MissionIndradhanushfocusesoninterventionstoexpand
tomorethiscoveragetomorethan90%children.

26. MISSION INDRADHANUSH cntd…
•Theprogrammeprovidesvaccinationagainstsevenlife-
threateningdiseases(diphtheria,whoopingcough,
tetanus,polio,tuberculosis,measlesandhepatitisB)in
theentirecountry.
•Inaddition,vaccinationagainstHaemophilusinfluenzae
typeB(Hib)andJapaneseEncephalitis(JE)isprovidedin
selecteddistricts/statesofthecountry.

28. MISSION INDRADHANUSH cntd…
•Itisestimatedthatannually,morethan89lakhchildreninthe
countrydonotreceiveallvaccinesthatareavailableunderthe
UIP
•Asastrategicendeavor,theMinistryofHealth&Family
Welfare(MoHFW),GoI,launchedMissionIndradhanushin
December2014toachievemorethan90%fullimmunization
coverageinthecountry.
•Thisinitiativewilleventuallycloseimmunitygapsand
strengthenimmunizationcoverage.

29. MISSION INDRADHANUSH cntd…
•UnderMissionIndradhanush,theGovernmenthas
identified201highfocusdistrictsacrossthecountry.
•Thesedistrictshavebeenidentifiedbasedona
compositeindicator,consideringfullimmunization
coverage,numberofpartiallyvaccinatedand
unvaccinatedchildrenandwhetherthedistrictisan
identifiedHighprevalenceorhighrisk(emergency
preparednessandresponseplan).

30. MISSION INDRADHANUSH cntd…
•Nearly50%ofallunvaccinatedorpartiallyvaccinated
childreninIndiaareinthese201districts.Intensified
routineimmunizationcampaignsinthesedistrictswill
helpreducemorbidityandmortalityduetovaccine
preventablediseases.
•Thiswillbedonethroughspecialcatch-upcampaignsto
rapidlyincreasefullimmunizationcoverage.

31. Switch of Polio Vaccine
•Date of Switch: April 2016.
•Primary objectives of Switch plan:
1.Successful recall of tOPV & replacement with bOPV in
April 2016.
2.Minimize tOPV wastage after Switch.
3.Ensure all children are vaccinated.
4.Validation that country is free of tOPV.

34. 2014 -15
•Introduction
of IPV
April 2016
•Replace tOPV
with bOPV
2019-2020
•Withdrawl
of wOPV

35. Monitoring and evaluation
•UniversalImmunizationProgramhasasetof
indicatorstomonitorprogressunderdifferent
componentsoftheprogramandevaluatethe
coverageofimmunizationamongstthetarget
population.
•Inthecountry,UIPperformsmonitoringand
evaluationatthreelevels.

36. Monitoring and evaluation cntd….
1.Regular reporting system.
2.Period population based surveys.
3.Targeted studies and surveys to evaluate the
performance of various components under UIP.

37. Monitoring and evaluation cntd….
1)Thereisaregularreportingsystemfromthe
healthsub-centretoPHC,district,stateandnational
level.
•Thisreportinghasbeencomputerizedinthecountry
asapartofHealthManagementInformation
System(HMIS),andthedataisavailablefrom
healthfacilitylevelandaboveeverymonth.

38. Monitoring and evaluation cntd….
•RecentlyMOHFWhasalsoimplementedMotherand
ChildTrackingSystem(MCTS)totrackevery
pregnantwoman,motherandchildupto5yearsof
agetoensuredeliveryofhealthservices.

39. Monitoring and evaluation cntd….
2)Toevaluateimmunizationcoverage,country
conductsperiodpopulationbasedsurveys.
•TheseincludeNationalFamilyHealthSurvey
(NFHS),DistrictLevelHealthSurvey(DLHS),
AnnualHealthSurvey(AHS)andUNICEFCoverage
EvaluationSurvey(CES).

40. Monitoring and evaluation cntd….
3)Inbetweenperiodicsurveysandadministrative
reporting,countryalsoplanstargetedstudiesand
surveystoevaluatetheperformanceofvarious
componentsunderUIP.
•SomeoftheexamplesareVMAT/EVSM, PIE,
MCTS,FieldAssessmentetc.

41. Monitoring and evaluation cntd….
•Areviewmechanismisestablishedatalllevelsof
theprogramimplementationinthecountry.
•Thoughtherearevariationsinthetimings,butPHCs
anddistrictsusuallyconductprogramreviewat
monthlyintervals.
•However,atthestateandnationallevel,itisless
frequent.

42. Monitoring and evaluation cntd….
•MOHFW hasrecommendedconstitutionoftask
forcesatthestateanddistrictlevelforcritical
reviewoftheprogramatmonthlyintervalinvolving
variousstakeholdersattheparticularlevel.
•Atnationallevelalso,immunizationdivisionhas
constitutedImmunizationActionGroup(IAG)to
reviewtheprogram,discussissuesandsuggest
solutions.

43. Routine Immunization

44. Scopeandeligibility:
IndiahasoneofthelargestUniversalImmunization
Programs(UIP)intheworldintermsofthequantities
ofvaccinesused,numberofbeneficiariescovered,
geographicalspreadandhumanresourcesinvolved.

45. Scope and eligibility:
•UndertheUIP,allvaccinesaregivenfreeofcosttothe
beneficiariesaspertheNationalImmunizationSchedule.
•Allbeneficiaries’namelypregnantwomenandchildrencan
get themselves vaccinated at the nearest
Government/Privatehealthfacilityoratanimmunization
post(Anganwadicentres/otheridentifiedsites)nearto
theirvillage/urbanlocalityonfixeddays.
•TheUIPcoversallsectionsofthesocietyacrossthe
countrywiththesamehighqualityvaccines.

46. Achievements:
•Thebiggestachievementoftheimmunizationprogramis
theeradicationofsmallpox.
•OnemoresignificantmilestoneisthatIndiaisfreeof
PoliomyelitiscausedbyWildPolioVirus(WPV)since2011.
•Besides,vaccinationhascontributedsignificantlytothe
declineinthecasesanddeathsduetotheVaccine
PreventableDiseases(VPDs).

47. Coverage:AspertheCoverageEvaluationSurvey(CES-
2009),61%ofchildreninthecountryareFullyImmunized
withallvaccines.

48. GLOBAL VACCINE ACTION PLAN
(2011-2020)
•TheGlobalVaccineActionPlan(GVAP)isaroadmap
topreventmillionsofdeathsthroughmoreequitable
accesstovaccines.
•Countriesareaimingtoachievevaccinationcoverage
ofatleast90%nationallyandatleast80%inevery
districtby2020.

49. GLOBAL VACCINE ACTION PLAN cntd…
•GVAPaimstostrengthenroutineimmunizationtomeet
vaccinationcoveragetargets:
1.Acceleratecontrolofvaccine-preventablediseases
withpolioeradicationasthefirstmilestone;
2.Introducenewandimprovedvaccinesandspur
researchanddevelopmentforthenextgenerationof
vaccinesandtechnologies.

50. GLOBAL VACCINE ACTION PLAN cntd…
TheGVAPrecommends3keystepsforclosingtheimmunization
gap:
1.Integratingimmunizationwithotherhealthservices,suchas
postnatalcareformothersandbabies;
2.Strengtheninghealthsystemssothatvaccinescontinueto
begivenevenintimesofcrisis;and
3.Ensuringthateveryonecanaccessvaccinesandaffordto
payforthem.

51. NFHS –4 (2015-16) Immunization coverage in A.P
S.NO CHILD IMMUNIZATION AND
VITAMIN-ASUPPLEMENTATION
URBANRURAL TOTAL
1.Childrenage12-23monthsfullyimmunized 60.4 67.2 65.3
2.Childrenage12-23monthswhohavereceivedBCG 97.7 97.1 97.3
3.Childrenage12-23monthswhohavereceived3dosesof
poliovaccine
64.9 75.2 72.3
4.Childrenage12-23monthswhohavereceived3dosesof
DPTvaccine
84.9 90.6 89.0
5.Childrenage12-23monthswhohavereceivedmeasles
vaccine
92.0 88.4 89.4
6.Childrenage12-23monthswhohavereceived3dosesof
HepatitisBvaccine
62.1 71.5 68.8
7.Childrenage9-59monthswhoreceivedavitaminAdose
inlast6months
73.5 71.6 72.1
8.Childrenage12-23monthswhoreceivedmostofthe
vaccinationsinpublichealthfacility
83.4 94.9 91.6
9.Childrenage12-23monthswhoreceivedmostofthe
vaccinationsinprivatehealthfacility
16.6 5.1 8.4

53. India: WHO and UNICEF estimates of
Immunization coverage: 2015

62. World Immunization Week:
•World Immunization Week is observed every year
during the last week of April (April 24-30).
•This year’s theme is
“Close the Immunization Gap
Immunization for all throughout life”.

70. References
1. India: WHO and UNICEF estimates of immunization coverage: 2015
revision. Available from
http://www.who.int/immunization/monitoring_surveillance/data/ind.
pdf.
2. Mission Indradhanush. Available from
http://www.missionindradhanush.in/
3. http://www.who.int/mediacentre/factsheets/fs378/en/
4. Immunization. Available from
http://www.who.int/topics/immunization/en/

71. References
5. NFHS-4 FACT SHEETS FOR KEY INDICATORS. Available from
http://rchiips.org/nfhs/factsheet_nfhs-4.shtml
6. Universal Immunization Program. Available from
http://www.nhp.gov.in/sites/default/files/pdf/immunization_uip.pdf
7. National immunization programme. Available from
http://www.nhp.gov.in/universal-immunization-programme-uip_pg
8. Replacing trivalent OPV with bivalent OPV. Available from
http://www.who.int/immunization/diseases/poliomyelitis/endgame
_objective2/oral_polio_vaccine/en/