UNIVERSAL IMMUNIZATION PROGRAMME AND COLD CHAIN

Immunization, also known as vaccination, is a medical process designed to enhance an individual's immune system's ability to recognize and defend against specific pathogens, such as bacteria or viruses.
One of India’s biggest public health programs, EPI aims to prevent vaccine preventable illness by offering free immunization to all children and pregnant women in nation.
In 1978, WHO officially launched global immunization programme, known as ‘Expanded Program of Immunization’ for prevention and control of 6 diseases:
Tuberculosis
Diptheria
Pertussis
Tetanus
Poliomyelitis
measles
It was called expanded because:
Adding more disease controlling antigens to vaccination schedule.
Extending coverage to all corners of country.
Spreading services to reach less privileged sectors of society.
In 1985, GOI renamed EPI programme as ‘Universal Immunization Program’.
The aim of UPI was to achieve 100% coverage of pregnant women with 2 doses of tetanus toxoid and at least 85% coverage of infants with 3 doses of DPT, OPV and 1 dose of BCG.
Under UIP, immunization is provided free of cost against 12 vaccine preventable diseases:
BCG (Bacillus Calmette-Guerin Vaccine) : Tuberculosis
OPV (Oral Polio Vaccine): Polio
Hepatitis B vaccine: Hepatitis
Hib containing Pentavalent vaccine (DPT + Hep B + Hib): Diptheria, Tetanus, Pertussis, Influenza, Hepatitis
Rotavirus Vaccine: severe diarrhoea caused by Rotavirus
Pneumococcal Conjugate Vaccine (PCV): Pneumonia
Tetanus Diptheria Vaccine (TD): Diptheria, Tetanus
Measles, Rubella vaccine (MR): Measles, Rubella
Japanese Encephalitis vaccine (JE): Japanese Encephalitis
GOI launched Mission Indradhanush on 25th December 2014, to cover children who are unvaccinated or partially vaccinated against 7 vaccine preventable diseases: Diptheria, pertusis, tetanus, polio, tuberculosis, measles and hepatitis B.
Goal: to vaccinate all under 5 by the year 2020.
It was also identified as one of the flagship schemes under Gram Swaraj Abhiyan (16,850 villages across 541 districts) and Extended Gram Swaraj Abhiyan (48,929 villages across 117 aspirational districts).
Government of India introduced ‘Intensified Mission Indradhanush’ in selected districts and urban areas of country to achieve the target of more than 90% coverage.
While the first two phases of Mission Indradhanush resulted in 6.7% increase in full immunization coverage in a year, a recent survey carried out in 190 districts covered in Intensified Mission Indradhanush (5th phase of Mission Indradhanush) shows 18.5% points increase in full immunization coverage as compared to NFHS-4 survey carried out in 2015-16.
IMI focus on children up to 2 years of age and pregnant women who have missed out on routine immunization. However, vaccination on demand to children upto 5 years of age will be provided during IMI rounds.
The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B.

1. UNIVERSAL IMMUNIZATION PROGRAMME MS. RAJOSI KHANRA

2. INTRODUCTION Immunization, also known as vaccination, is a medical process designed to enhance an individual's immune system's ability to recognize and defend against specific pathogens, such as bacteria or viruses. One of India’s biggest public health programs, EPI aims to prevent vaccine preventable illness by offering free immunization to all children and pregnant women in nation. In 1978, WHO officially launched global immunization programme, known as ‘Expanded Program of Immunization’ for prevention and control of 6 diseases: Tuberculosis Diptheria Pertussis Tetanus Poliomyelitis measles

3. It was called expanded because: Adding more disease controlling antigens to vaccination schedule. Extending coverage to all corners of country. Spreading services to reach less privileged sectors of society. In 1985, GOI renamed EPI programme as ‘Universal Immunization Program’. The aim of UPI was to achieve 100% coverage of pregnant women with 2 doses of tetanus toxoid and at least 85% coverage of infants with 3 doses of DPT, OPV and 1 dose of BCG.

4. Under UIP, immunization is provided free of cost against 12 vaccine preventable diseases : BCG (Bacillus Calmette-Guerin Vaccine) : Tuberculosis OPV (Oral Polio Vaccine): Polio Hepatitis B vaccine: Hepatitis Hib containing Pentavalent vaccine (DPT + Hep B + Hib): Diptheria, Tetanus, Pertussis, Influenza, Hepatitis Rotavirus Vaccine: severe diarrhoea caused by Rotavirus Pneumococcal Conjugate Vaccine (PCV): Pneumonia Tetanus Diptheria Vaccine (TD): Diptheria, Tetanus Measles, Rubella vaccine (MR): Measles, Rubella Japanese Encephalitis vaccine (JE): Japanese Encephalitis

5. MISSION INDRADHANUSH GOI launched Mission Indradhanush on 25 th December 2014, to cover children who are unvaccinated or partially vaccinated against 7 vaccine preventable diseases: Diptheria, pertusis , tetanus, polio, tuberculosis, measles and hepatitis B. Goal: to vaccinate all under 5 by the year 2020. It was also identified as one of the flagship schemes under Gram Swaraj Abhiyan (16,850 villages across 541 districts) and Extended Gram Swaraj Abhiyan (48,929 villages across 117 aspirational districts).

6. Government of India introduced ‘Intensified Mission Indradhanush’ in selected districts and urban areas of country to achieve the target of more than 90% coverage. While the first two phases of Mission Indradhanush resulted in 6.7% increase in full immunization coverage in a year, a recent survey carried out in 190 districts covered in Intensified Mission Indradhanush (5th phase of Mission Indradhanush) shows 18.5% points increase in full immunization coverage as compared to NFHS-4 survey carried out in 2015-16. IMI focus on children up to 2 years of age and pregnant women who have missed out on routine immunization. However, vaccination on demand to children upto 5 years of age will be provided during IMI rounds. The diseases being targeted are diphtheria, whooping cough, tetanus, poliomyelitis, tuberculosis, measles, meningitis and Hepatitis B.

7. NEW VACCINES INACTIVATED POLIO VACCINE IPV also known as Salk Vaccine, is an injectable vaccine containing killed strains of all 3 poliovirus types and is used globally to prevent poliomyelitis. It produces antibodies against all 3 types of poliovirus, preventing virus from reaching CNS and causing paralysis. IPV is one of safest vaccines available; it has no serious systemic adverse reaction. IPV can be safely used in pregnant women and HIV/AIDS affected people. IPV is given at 6,10,14 weeks of age , followed by a booster at least 6 months later. It is stored between 2ͦͦ C-8ͦC. Introduction of IPV worldwide has dramatically reduced polio cases and remains a cornerstone of eradication efforts.

8. ROTAVIRUS VACCINE RVV has been introduced to reduce mortality and morbidity caused by Rotavirus diarrhoea in March 2016. It has been introduced in 11 states (Andhra Pradesh, Haryana, Himachal Pradesh, Jharkhand, Odisha, Assam, Tripura, Rajasthan, Tamil Nadu, Madhya Pradesh and Uttar Pradesh). The vaccine will be expanded across the country in 2019-20. Types of strains: Rota Teq , Rotarix, Rotavac and Rotasil (given in India). Vaccine is given orally 6,10,14 week orally. C. MR VACCINE MR vaccine is a combination of live attenuated measles and rubella viruses, used to protect against both diseases in children and adults at risk. The vaccine is typically supplied as a freeze-dried powder with a separate diluent. Vaccine is administered as 0.5 ml subcutaneous injection in upper arm. Dose is given followed by 2 doses in routine immunization at 9-12 months and 16-24 months.

9. PCV (Pneumococcal Conjugated Vaccine) . Age (years) Year of Birth PCV was launched in May 2017 to reduce Infant mortality and morbidity caused by pneumococcal pneumonia. It has been introduced in Bihar, Himachal Pradesh, Madhya Pradesh, 19 districts of Uttar Pradesh and 18 districts of Rajasthan. PCV is administered intramuscularly, usually in anterolateral thigh in infants. Dose is given 6,10,14 weeks with booster after 12-15 months. TD (TETANUS AND DIPTHERIA) TT vaccine has been replaced with Td vaccine in UIP. Td vaccine to be administered to adolescents at 10 and 16 years of age and to pregnant women. TD is a bivalent vaccine that provides protection against tetanus and diptheria.

10. Price in US dollars (US$) Capacity building National Cold Chain Training Centre (NCCTE), Pune National Cold Chain & Vaccine Management Resource Centre (NCCVMRC) –NIHFW, New Delhi, have been established to provide technical training to cold chain technicians in repair & maintenance of cold chain equipment. NEW INITIATIVE IN COLD CHAIN MANAGEMENT AND VACCINE LOGISTICS

11. Electronic Vaccine Intelligence Network (e-VIN) rollout The Government of India has rolled out an Electronic Vaccine Intelligence Network (e-VIN)system that digitizes the entire vaccine stock management, their logistics and temperature tracking at all levels of vaccine storage – from national to the sub-district. E-VIN system has been completed in 12 states in the first phase – Assam, Bihar, Chhattisgarh, Himachal Pradesh Gujarat, Jharkhand, Madhya Pradesh, Manipur, Nagaland, Odisha, Rajasthan, and Uttar Pradesh. Second phase is ongoing in 9 states – Andhra Pradesh, Daman & Diu, Dadra & Nagar Haveli, Goa, Karnataka, Maharashtra, Telangana, Tripura and Uttarakhand. E-VIN is to be scaled up to entire country. National Cold Chain Management Information System (NCCMIS)to track the cold chain equipment inventory, availability and functionality.

12. IMMUNIZATION AGENDA 2030 The Immunization Agenda 2030 (IA2030) is a global strategy endorsed by the World Health Assembly to guide immunization efforts from 2021 to 2030. It aims to ensure that everyone, everywhere, at every age fully benefits from vaccines to improve health and well-being. IA2030 is built on four core principles: People- centred approach Country leadership Broad partnerships Data-driven implementation

13. IMMUNIZATION AGENDA 2030 Targets and Goals for 2030: A global reduction of vaccine-preventable deaths by 50 million lives. Halving the number of zero-dose children (children who have received no vaccines). Achieving at least 90% immunization coverage with essential vaccines across all eligible populations worldwide. Contribution to Sustainable Development Goals, particularly SDG3 focused on health and well-being for all ages

14. IMMUNIZATION AGENDA 2030 IA2030 is coordinated by national governments, global agencies like WHO and UNICEF, health professionals, researchers, and civil society to ensure a comprehensive and equitable approach to immunization worldwide

15. COLD CHAIN A system of storing and transporting the vaccine, at a low temperature from the place of manufacture to the actual vaccination site is called "cold chain". EQUIPEMENT OF COLD CHAIN Vaccine carriers cold packs day-carriers Refrigerators walk in coolers

16. These are suitable for carrying small quantities of vaccine (16-20 vials) to health sub-centers, villages and small town. A square box made up of heat-resistant material and lights in weight. They can be carried easily in hand or on shoulder. Four packs of ice are kept in these, along all four sides. Vaccines can be kept up to 2-3 days. VACCINE CARRIER

17. COLD BOXES AND COLD PACK This can transport large quantities of vaccine by vehicle to outreach sites. Box size: 5-20 liters It can preserve vaccine for upto 1 week. Flat bottles of plastic which are filled with water. No salt should be added in water. These are used in a vaccine carrier after freezing with water. In large cold box 50 ice packs are needed and in small cold box 24 cold boxes are needed. Maintaining temperature: 2 ͦC- 8 ͦC up to 5 days.

18. DAY CARRIERS A day carrier in the cold chain is a small, insulated container used to transport a limited number of vaccines for short periods, typically for a single day's outreach session. It is designed to hold 6 to 8 vials and keep them at a safe temperature (2 ͦC- 8 ͦC) using 2 frozen ice packs for up to 12 hours . 

19. REFRIGERATOR Ice lined refrigerator: - Maintain 2 ͦC- 8 ͦC temperature and bottom part is coldest part. Here no ice pack is needed. During power outbreak 12-24 hours can be cold. Deep freezer - Maintain (-15 ͦC)- (-20 ͦC )

20. Which vaccines should not be placed in direct contact with a frozen ice pack? DPT TD IPV PCV HEP-B Where vaccines should be kept at immunization site? Inside hole of ice pack On the surface of ice pack Naver to be kept on ice pack BCG OPV pentavalent MR JE DPT ROTA IPV PCV HEP-B TD