Made by Ranjith R Thampi. Covers all the immunisations to be given under the UIP. Made for a SPM seminar. OVerloaded with details.

1. Ranjith.R.Thampi
IIIrd MBBS

5. DIPHTHERIA, WHOOPING COUGH,
TETANUS, POLIO, TB, MEASLES.

6. 1978 Expanded Programme of immunization (EPI).
Limited reach - mostly urban
1985 Universal Immunization Programme (UIP).
For reduction of mortality and morbidity due to 6
VPD’s.
Indigenous vaccine production capacity enhanced
Cold chain established
Phased implementation - all districts covered by
89-90
Monitoring and evaluation system implemented

7. Implementation of National Immunization
Programme
District is treated as administrative unit – 593
Primary Health Centers are the last vaccine
storage points - 23,109
Services are provided through 142,655 sub
centers to the population residing in about
638,588 villages
Target for immunization is to cover infant
population of over 25 million and around 27
million pregnant women

8. Immunization services are being provided
through the existing health care delivery system.
There is no separate staff required for the
programme.
Pulse Polio Immunization Programme was
launched in the country in the year 1995. Under
this, under 5’s are given additional oral polio
drops in December and January every year on
fixed days.
As a result, there has been a significant decline
in the incidence of poliomyelitis.

10. Primary Vaccination Ring Those outside rings are not
vaccinated.
Secondary Vaccination Ring

12. Immuno-biological substances designed to
produce specific protection against a given
disease.
*Nowadays vaccines are of sub-unit and recombinant types.
Administration: SUBCUTANEOUS & INTR AMUSCULAR

13. Live Vaccines—BCG, MMR
*Not for immunologically challenged.
Inactivated(Killed)—iPV, Hepatitis B
Toxoids—Diphtheria, Tetanus

14. Immunoglobulins are for passive immunization!
5 Major classes include- IgG, IgM, IgA, IgD, IgE.
TYPES:
Normal Human Immunoglobulin
Specific Human Immunoglobulin
*These are used to replace antibodies in
immunodeficient patients.
Administration:
INTRAMUSCULAR & INTRAVENOUS

15. LIVE KILLED TOXOIDS
VACCINE VACCINE
BCG, POLIO, MMR PERTUSSIS, TYPHOID, CHOLERA DIPHTHERIA, TETANUS
Vaccines have lost their It stimulates active Exotoxins produced by
capactiy to produce full- immunity. Usually safe but organisms are detoxicated
blown disease, retain less efficacious than live and used in preparation of
immunogenicity. vaccines. Also requires vaccines.
frequent booster doses. Antibodies produced
*NOT to be administered neutralise the toxic moiety
to persons with immune *NOT to be given when there produced during infection,
deficiency diseases, may be or was severe local or rather than act upon the
suppressed immunity. general reaction to a previous organisms.
dose.
*NOT to be administered HIGHLY EFFICACIOUS.
to pregnant women unless
risk of infection exceeds
risk of harm to fetus with
live vaccine.

16. Materials prepared in animals. Antitoxins
prepared from non-human source s
include:
Tetanus, Diphtheria, Botulism,
Gas gangrene, Snake Bite.

17. COLD CHAIN?
A system of storage and transport of vaccines at low
temperature from the manufacturer to the actual
vaccination site.

18. Walk in Cold Rooms[WIC]
Deep Freezers & ILRs
Small deep freezers and ILR
Cold boxes
Vaccine carriers
Day Carriers
Ice packs

19. For Infants Vaccine & Dose Route
At Birth BCG 0.1ml + OPV 2drops( 0 dose) Intradermal
6 weeks BCG 0.1ml [if not at birth] Intradermal
DPT-1 0.5ml + OPV-1 2drops I/M + Oral
10 weeks DPT-2 + OPV-2 I/M + Oral
14 weeks DPT-3 + OPV-3 I/M + Oral
9-12 months Measles 0.5ml + Vit. A 2ml Deep S/C + Oral
At 18 months DPT + OPV[Boosters-1] I/M + Oral
At 24, 30, 36 months Vitamin A 2ml Oral
At 5-6 years DT[Booster-2] I/M
At 10 and 16 years Tetanus Toxoid I/M
For Pregnant Women Vaccine & Dose Route
Early in Pregnancy TT-1 or Booster I/M
One month after TT-1 TT-2 I/M
INTERVAL BETWEEN TWO DOSES SHOULD NOT BE LESS THAN ONE MONTH!

20. BCG upper, small pox lower.

21. Progress so far ….

22. VACCINE PREVENTABLE DISEASE SURVILLANCE
Incidence of Neonatal Tetanus Incidence of Measles
Source CBHI In 2004 1087 NNT cases and 51546 Measles reported

23. VACCINE PREVENTABLE DISEASE SURVILLANCE
Incidence of Diphtheria Incidence of Whooping cough
Source CBHI In 2004 8465 Diphtheria cases and 32786 Pertussis reported

24. Full Immunization Coverage by States (in %)
Coverage evaluation 100
shows a varied 90 1998-99
coverage among the 80 1999-00
States. While the 2000-01
70
Southern States 2001-02
60
have been
50
consistently
achieving high 40
coverage levels, the 30
situation in Northern 20
States is a matter of 10
concern.
0
GU
TN
WB
HR
UA
J khand
RJ
All India
DL
PB
MP
HP
J&K
MH
Bihar
UP
AP
Source: Unicef CES

25. Performance under Immunization Programme
Immunisation, IFA, Vit.A: 2002-03 2003-04 2004-05 2005-06 2006-07
TT – Pregnant Women ( 2nd dose + Booster) 19294 19410 17844 17610 18186
IFA Tablets (Preg. Women-Prophylactic completed) 16326 14759 17741 18029 15537
DPT ( 3rd Dose ) 18199 17031 16836 16185 16352
Polio ( 3rd Dose) 18199 17031 16836 16185 16352
BCG 31025 30412 29354 36182 42101
Measles 16991 16555 16118 15934 16328
Vit-A (Total 1st dose for below and up to 1 year) 15544 13537 15320 15224 14495
Vit-A (Total 2nd to 5th dose ) 45062 30635 37399 38005 40104
DT ( 2nd dose) 19207 19147 18583 20383 17342
TT (10 Years) ( 2nd dose) 21303 20548 18283 19094 18329
TT (16 Years) ( 2nd dose) 21057 20286 18515 18981 14649

26. Concerns
Large birth cohort - 25 million births every year
Declining coverage in some major states
• An average of 14.4 % children receiving BCG do not receive
measles vaccine
Poor immunization data quality
• Discrepancies between reported and surveyed data
Varied program management and supervision at all levels
Unsafe injection practices and waste disposal:
Significant percentage of injections used in the immunization
sector are unsafe
Low priority on medical waste disposal

27. The virus is also present in body fluids and
excretions such as saliva, breast milk, semen,
vaginal secretions, urine, bile and feces.
Semen and Saliva are known culprits for
transmission.

28. Hepatitis Human Immunoglobulin
Vaccine
Target Population Dose Status
Percutaneous or mucosal 0.05-0.07 ml/kg body wt Recommended For Prevention
exposure Repeat after a month
Newborns of mothers 0.05 ml/kg body wt Recommended For Prevention
with HBsAg At birth, 3 & 6 months
Sexual contacts of acute 0.05 ml/kg body wt Optional for Prevention
hepatitis B patients Repeat after a month
Immunization against Hepatitis has become an interesting addition to the
UIP in India.

30. Ian Before Ian After

32. i. Test for Sensitivity Reaction
ii. Adrenaline (1:1000 solution) to be kept ready.
iii.Properly sterilize equipment and apparatus.
iv. Measles and BCG vaccines to be reconstituted
only with diluents supplied by manufacturer.
v. Reconstituted Vaccines must NEVER be
retained for subsequent use.
vi. Don’t store anything else in the refrigerator
other than vaccines.

33. Have a Great Day!