This document provides an overview of vaccines and immunization. It begins with terminology and describes the types of immunity produced by vaccines. It then discusses the historical development of various vaccines including smallpox, polio, and measles vaccines. The document outlines Kenya's Expanded Program on Immunization including its objectives, components, and policies. Common vaccines used in Kenya like BCG, polio, measles, pentavalent and tetanus are described in terms of composition, dosage, administration, storage requirements, indications and contraindications. The importance of monitoring vaccine needs and evaluating immunization programs is also highlighted.
2. Course objectives
• By the end of the session the students will be
able to provide high quality ,culturally
sensitive immunization services to the
community.
3. Supporting objectives
• By the end of the session, the students should
be able to:-
• Describe common terminologies used in
vaccines and immunization services.
• Describe the types of immunity and they are
produced in the body.
• Understand the historical development of
vaccines and immunization.
4. Terminologies
• Vaccination- Deliberate introduction of live or
weakened disease causing micro-organisms,
or their strains into the body to induce
generation of immunity against specific
diseases.
• Variolation- Deliberate inoculation of a person
with small pox materials in order to prevent
the disease.
5. Terminologies
• Immunization: The process of increasing or
generation of body immunity against
particular diseases by introducing weakened
or live micro-organisms or parts of micro-
organisms into the body.
• Immunogenicity- Ability of an antigen to elicit
immune responses.
6. Terminologies
• Vaccines:- Substances that are prepared from
live or weakened micro-organisms or parts of
micro organism which are capable of eliciting
immune responses when introduced into the
body.
• Vaccine efficacy:- Ability of a vaccine to
effectively prevent occurrence of a disease.
7. Terminologies
• immunity:- Ability of the body to resist
harmful disease organisms.
• Natural history of diseases: progression of
disease in a person to the point of recovery,
disability or death.
8. Types of immunity
• There are two types of immunity:
Active immunity
Passive immunity
Herd immunity
9. Active immunity
• Natural active immunity that develops when
a person contracts a disease.
• Artificial active immunity develops through
administration disease specific antigens; e.g.
as in immunization.
10. Artificial passive immunity.
• Immunity acquired through administration of
ready made anti-bodies. E.g. anti tetanus
serum, anti-rabies etc. these anti-bodies are
usually drawn from animals.
11. Passive immunity
• Natural passive immunity ; immunity that
occurs when antibodies pass from one person
to the other; e.g. babies receiving antibodies
from their mothers in utero.
12. Herd immunity
• Immunity conferred to the community when
80% or high proportion of the population is
evenly immunized.
13. Historical development of vaccines and
immunization
• First form of vaccination was known as
variolation which was practiced in Africa,
India and China.
• Variolation was first introduced in Europe in
1721 by a lady known as Mary Wortley
Montagu.
14. Historical development CTD
• Around the same time variolation was
introduced in Boston America by Rev Cotton
Mather.
• 1796 A medical student by name Edward
Jenner carried out a successful vaccination
against small pox on an eight years old boy.
15. Historical development of vaccines and
immunization CTD.
• By 1801, the documented findings of Dr
Jenner had been translated into five major
languages in Europe. And more than 100,000
persons had been vaccinated in England.
16. Historical development CTD
• In the 20th century, Louis Pasteur discovered
the process of Attenuation.
• Around the 1950s, most countries of the
world had adopted immunization programs.
• In 1977, the world health assembly, set the
year 1990, as target for achieving UNIVERSAL
CHILD IMMUNIZATION.
17. Historical development of vacc& immu
CTD
• In 1978, EXPANDED PROGRAM ON
IMMUNIZATION was started to coordinate the
immunization programs and activities in the
world, and to address the challenges and
weaknesses identified after a review of the EPI
activities by the WHO.
18. Expanded program on immunization
acceleration
• Launched in the 1990 with objectives of:-
Providing immunization to all children and pregnant
mothers.
Helping countries to become self reliant in
immunization.
Implementing sustainable integrated immunization
services.
19. How the objectives would be
achieved
• These objectives were to be achieved through:-
integration of immunization services with other
primary health care services.
Training and deployment of more personnel to
manage EPI programs.
Increased financial support for E.P. I activities.
Appropriate monitoring and evaluation of the EPI
activities
Research to strengthen the management of E.P.I
programs.
20. Kenya expanded program on
immunization.
• Launched in 1980 in order to reduce child
morbidity and mortality rates through
immunization.
21. Objectives of KEPI
• To achieve an immunization coverage of
80% and above in all antigens.
• Ensure proper maintenance of cold chain
systems
• Train health workers to manage the
immunization activities.
• Integrate KEPI activities with MCH/FP.
• Monitor and evaluate E.P.I activities
• Use operational research for effective
management of EPI activities.
22. Components of K.E.P.I
• Integration of immunization activities.
• Training
• Social mobilization
• Surveillance
• Cold chain system
• Monitoring and evaluation
• Logistics and supplies
23. integration of immunization
• Provide immunization in the MCH/FP with the
other services to all eligible children and
pregnant mothers.
• This would improve the immunization
coverage by ensuring that all children and
pregnant were immunized
24. Training
• KEPI courses were organized in three levels:-
Mid level or senior management and supervisory
level- designed for senior managers in the national
, district and middle level colleges.
Operational level training- designed for health
workers
Cold chain training- designed for health workers
26. Surveillance
• Ensure the vaccines remain in potent state
from the manufacturer to the point of
administration.
• How?
27. Monitoring and evaluation
• To achieve efficiency in the immunization
activities by looking through the process.
• Examples of Monitoring activities include:-
• Supervisory visits, review of reports,
28. Logistics and supplies
• Ensure all essential logistics such as vaccines,
child health cards, syringes, cold chain
equipments, needles are available in the
health facilities all the time.
29. Policy of immunization
• These are the guidelines provided by the
national level on how immunization activities
should be carried out.
30. Main aspects of the policy.
• Integrate immunization services
• Use sterile equipments for immunization
activities e.g. one syringe and needle per
injection.
• Use potent vaccine kept at 0 to +8 degrees
centigrade.
• Keep vaccine on ice packs during a vaccination
session
31. Main aspect of the policy CTD
• Discard all opened and used vaccines at the
end of the day except , T.T. & polio.
• BCG and Measles should be discarded after
4hours of reconstitution.
• Hold vaccination sessions daily in fixed
facilities.
• Children at 9months requiring admission to
hospital should be vaccinated against measles
before entering the ward.
32. Common Vaccine Antigens used in
Kenya.
• Polio vaccine
• BCG
• DPT/Heb/Hib ( pentavalent)
• PCV 10
• Measles
• Tetanus
• Yellow fever.
33. Polio vaccine
• First developed in 1954 by an American
virologist called Dr Jonas Salk as an injectable
vaccine (IPV) from killed polio viruses.
• In 1957, Dr Albert Sabin of the USA,
developed the oral polio vaccine (OPV) made
from live attenuated polio virus.
34. Polio vaccine
• IPV is safe for immune deficient children
because it is made of killed viruses, but it
confers little herd as opposed to the oral polio
vaccine.
• Polio vaccine is very sensitive to heat, so it get
damaged when exposed to heat.
• It is stored at 0 to +8 degrees otherwise it
remains stable at freezing point.
35. Dosage and route of administration
• Polio vaccine is contained in a vial of 20 doses.
• It is given orally as drops ( each dose equivalent to 2
drops)
• It is administered in 4doses.
• Birth dose- within the first two weeks of life
• 1st 6th week.
• 2nd dose 10th week.
• 3rd week 14th week.
36. Advantages of polio vaccine
• Confers both humoral and intestinal immunity.
• Induces life long immunity
• Induces immediate large anti-body production
• Administration requires little skills
• Its administration is more acceptable than
injectables.
40. Types of BCG
• Four types namely:-
Pasteur BCG
Danish BCG
Japanese BCG.
Glaxo BCG
41. Storage BCG
• It is sensitive to heat sun light.
• It should therefore be stored away from the
sun light at 0 to +8 degrees centigrade.
42. Administration and route
• It comes as dried powder with separate diluet.
• It should be reconstituted before it is given
• In Kenya, it is administered as intra-dermal on
the lateral aspect of the upper one third of the
left hand.
• Dosages: 0.05ml ( under one year child)
• 0.1ml ( above one year child)
43. indications
• BCG can be given to:-
• All eligible children
• HIV asymptomatic children
44. contraindications
• Children with confirmed HIV positive status.
• Child with unexplained ,Persistent ulcers,
Regional and wide spread lymphadenitis or
Osteo-myelitis
45. Side-effects of BCG
• Local abscesses at vaccination site
• Persistent ulcer at vaccination site
• Regional and widespread lymphadenitis
• Osteo-myelitis
• Disseminated BCG infection
46. Special instruction following
administration of BCG
• If a scar does not form, repeat BCG
vaccination at 12 weeks ( 3months).
• Do not repeat BCG administration for HIV
exposed children
• Do not give BCG as intra muscular or
subcutaneous.
• Discard Reconstituted BCG after 4hours.
• Do not swab the site with antiseptic cotton
swab.
47. Management of adverse BCG side
effects
• Children that develop adverse side effects
following BCG administration should be put on
anti tuberculosis drugs.
• Mild ulcers can be managed by dry dressing.
48. Measles vaccine
• Developed in 1954 by Enders and Peebles.
• It is a frozen dry vaccine made of live
attenuated measles virus.
• It is contained in a vial of 10 doses , with a
separate diluet.
49. Measles vaccine ctd
• It is heat stable vaccine which can retain
minimum potency at 37 degrees centigrade
for one week.
• Reconstituted measles loose potency quickly .
• Should be discarded after 6hrs of
reconstitution.
50. storage of measles vaccine
• Measles vaccine is very sensitive to heat and
light.
• It should be stored in temperatures between 0
to +8 degrees.( measles can be frozen at -20
degrees.
51. Dosage and administration of measles
• Measles is given as subcutaneous on
the deltoid muscles of the right hand.
• Dosage – 0.5mls as two doses. At
9months and 18months
• It is reconstituted with a measles diluet
before administration.
• Measles should be discarded after 6
hours of reconstitution.
52. Indications of measles
• Measles vaccine is a relatively stable
vaccine that can be given to all
eligible children.
• Measles is given to confirmed HIV
exposed children at six months at
repeated at 9months.
53. Rationale for giving two doses of
measles.
• 15% of children given measles vaccine at
9months do not sero convert, hence the
second dose gives an opportunity to those
who fail to sero convert at 9months.
54. contra indications
• There is no real contra-
indications for giving
Measles vaccine.
• It is contraindicated to HIV
symptomatic children
55. Immunogenicity of measles vaccine
• Immunogenicity of measles vaccine is
influenced by the age at which it is
administered.
56. Measles sero conversion rate per age
•
Age of child Sero-conversion rate
6months 60%
9months 85%
12Months 90%
15months 95%
57. Immunogenicity Ctd
N/B
• Some Children who have been vaccinated
against measles may still get measles
because:-
85% of the children immunized against measles
will not sero convert.
58. Side effects of measles
• Mild fever likely to occur between day 7th
and day 8th after vaccination.
• Their may be mild rash.
59. Penta- valent vaccine
• Has five vaccines; DPT/HepB/HiB.
• DT is made from the toxins, while
pertussis part of the vaccine is made
from killed bacterial antigen.
• It comes in a 10 doses vial.
60. Dosage and Administration of
pentavalent
• It is given as intra muscular at the left
or right upper outer quadrant of the
either right or left thigh.
• Dosages- 0.5ml ; three doses.
• 1st dose – 6th week after birth.
• 2nd dose- 10th week.
• 3rd dose- 14th week.
63. Side effects
• Pain and inflammation at the site of the
injection.
• High fever
• Persistent crying
• Unusual high pitched cry.
• Convulsions.
• Shock
• Encephalopathy.
64. Management of the side effects
• Reassurance of the mother.
• Give pain killers
• Assessment and management of the children
for encephalitis.
65. Tetanus toxoid vaccine
• Made from modified tetanus toxins.
• Commonly used in pregnant women
and injured persons, and for women
of child bearing age (15-49years).
66. Administration of T.T
• Dose of T.T is 0.5mls given to women of child
bearing age are 5 doses as follows:-
Dose When to give Protection
TT1 1st contact with woman or 1st
ANC.
No protection
TT2 At least 4weeks after TT 1 3years
TT3 At least 6weeks after TT 2 5years
TT4 At least 1Year after TT 3 10 years
TT5 At least 1year after TT 4 Life-long
67. T.T Doses for pregnant women
Dose When to immunize Protection
TT 1 At first contact of as
early as possible
during pregnancy
Uncertain
TT 11 At least 4 weeks
after TT I
3years
Booster TT Dose every
subsequent
pregnancy
5years
68. Side effects of T.T
• pains and inflammation on the injection site
• Mild fever.
69. Pcv 10 vaccine
• It is made from inactivated bacteria.
• It is in a vial of 2 doses.
70. Dosage and administration
• Dose is 0.5ml , given as intra muscular at the
upper outer anterior lateral aspect of the right
or left thigh.
• It is administered at 6th week, 10th week and
14th week after birth.
74. Yellow Fever vaccine
• It is made from live attenuated yellow fever
virus.
• It is contained in a vial of 20 doses.
• Dosages- 0.5ml as a single dose at 9 months
of age.
• It is given as subcutaneous injection on the
deltoid muscle
76. contra-indications
• It should not be administered to children
below 6 months of age.
• Do not administer yellow fever vaccine to a
confirmed HIV positive child.
77. Side effects
• Allergic reaction ( quiet rare)
• Pain and inflammation on the injection site.
78. How to plan vaccine needs and
evaluate immunization program
• By Baltazar kea.
80. Specific objectives
• To be able to map out the catchment area.
• Determine area population and calculate
target population for immunization purposes.
• Maintain and submit accurate records of
immunizations.
81. Ordering of vaccines
• In order to plan for an effective immunization
program, there need to define the catchment
area in terms of:-
Description of the area.
Determine the population of the catchment
population.
82. Assessing the vaccine needs of the
catchment area.
• Number of children and women that are
eligible for immunization is the target
population.
• To determine the number of children born
each year in a specific area, the total
population of the area and the growth rate
should be known. This information is obtained
from the local offices of the Kenya bureau of
statistics.
83. Assessing vaccine needs; CTD
If for example, the population of area x that is
being served by Bahati health centre is
26000, and the number of children born each
year is 5% ( annual growth rate) of the total
population. The annual target population for
Bahati health center will be:-
5/100X 26000= 1300 children.
84. Assessing vaccine needs; CTD
• The annual immunization target population
for Bahati health center is 1300 children.
• Monthly target will be 1300/12= 108 children.
85. Calculating for vaccine anti-gen
required
• if Bahati health center immunizes 1300
at the end of the year, it will have
achieved 100%.
• Amount of vaccine required for bahati h/c
-
Anti-gen Doses Amount required vials
BCG 1 dose 1300 doses 65
Opv 4doses 1300x4 doses 260
Penta valent 3doses 1300x3 390
Pcv 10 3doses 1300x3 1950
Measles 1dose 1300doses 130
86. Calculating vaccine anti-gen required
CTD
• Please note:-
• Add the wastage rates and buffer stock on the
amount of antigen obtained.
• Waste rate for penta valent, pcv 10, opv, is 1/4
of the total doses.
• While waste rate for measles and BCG is 1/4
of the total doses.
• Buffer rate is calculated as ¼ of the total
vaccine antigen.
87. Supply periods
• Central cold store-6months
• Regional store- 6months
• District stores- 3months
• Health facilities- 1month
88. • Minimum stock- doses of vaccines available
before the new stock arrives.
• Maximum stock- stock of vaccines in a facility
after receiving the new supply of vaccines.
89. Getting the total amount of vaccine
for Bahati Health centre
Antigen
A
Total doses
B
Wastage
C
Buffer
D
Total amount
for ordering E
(B+C+D)
BCG 1300 1/4x 1300 1/4x1300 1950doses
OPV 5200 1/4X5200 1/4X5200 3033doses
90. Tools used for ordering vaccine
antigens.
• There are two types of tools that are used for
ordering vaccine antigens.
• Issue and receipt voucher& counter
requisition and issue voucher .
91. Issue and receipt voucher
• An example of issue and receipt voucher is the
S12.
• S12 is a tool that is used by the District
hospitals to order vaccines from the KEPI
regional store.
• S12 should signed by the DMOH or the DPHN.
92. Counter requisition and issue voucher
• An example of this tool is the s11.
• It is a tool that is used by:-
• Health centres, dispensaries, hospital
department such as the MCH/FP to order
vaccines from the KEPI district store.
• S11 is signed by officer incharge of the health
centres,dispensaries or MCH/FP department.
94. Monitoring and Evaluation
• What is to be monitored and evaluated in
immunization.
Achievements
Program efficiency
Immunization coverage
Performance
Dropout rates
95. How to monitor and evaluate an
immunization program
Through:-
routine reporting.
Survey.
Performance graph
Dropout rates
96. Missed opportunities for immunization
• It occurs when eligible children or women
come to the health facility and do not receive
any vaccine doses they require.
97. Causes missed opportunities for
immunization.
• The health facility not offering immunization.
• H/workers using inappropriate contra-
indications to immunization.
• H/workers failing to give all immunization to
the eligible children at the time of visit
98. Causes of missed opportunities for
immunization (CTD).
• Failure of health workers to screen children
and women for immunization.
• False shortages of vaccines at the health
facility.
99. How to determine missed
opportunities.
• Through :-
Review of patient records and other immunization
data.
Conducting exist interview to mothers.
Carryout missed opportunity surveys.
100. ways of reducing missed
opportunities for immunization.
• Examine health records .
• Conducting surveys.
• Screening children at the health facility.
• Avoiding false contra indications
• Review the national immunization schedule .
• Provide health cards to all vaccinated children.
101. ways of reducing missed opportunities
for immunization.
• Immunize all children who are sick for
admission or at discharge.
102. Cold chain system
• Objectives.
• By the end of this lesson, the students should be
able to:-
• Define cold chain system.
• List the cold chain equipments
• Demonstrate how to pack vaccines in a
refrigerator or freezer.
• Read and interpret and record the findings
appropriately.
103. Definition of cold chain system
• Process of keeping vaccines in potent state
from the manufacturer to the point of
administration of the vaccine.
105. Principles of cold chain system
Vaccine loose potency when they are exposed to
high temperatures, sunlight or freezing
conditions hence:-
should be stored between 0 to +8 degrees
centigrade.
Skilled personnel, reliable equipments and
rational distribution of vaccines should be ensured
for efficient cold chain system.
106. Principles of cold chain CTD
Arrange the vaccines in order of sensitivity in the
fridge.
Discard opened BCG vaccine 4hours after
reconstitution and measles 6 hours after
reconstitution.
Use silver foil papers to guard vaccines that are
sensitive to sunlight.
Do not the fridge containing vaccines un-
necessary.
Cold chain equipments be properly maintained.
107. Heat sensitive vaccine ( in order of
sensitivity)
• Polio ( most sensitive to heat)
• Measles
• BCG
• Dpt/HepB
• T.T.
• HiB
• PCV10 (least sensitive to heat)
109. Freezing sensitive vaccine
• Dpt/HiB/HepB.
• T.T.
• Note; do not freeze these vaccines!
• Freezing dissociate the antigen from the
adjuvant solvent thus damaging the
immunogenicity of the vaccine.
110. cold chain equipments
• Cold chain equipments includes:-
• Refrigerators e.g. RCW 42E G, for health
centers and dispensaries. TCW1151,Sibir 2323
and Sibir 240GE for district K.E.P.I stores. RA
1300, VR50 solar. The three major types of
gas electric refrigerators used in the country;
today are:-
• Sibir 170GE, RCW42EG and RCW50EG.
118. Cold rooms
• These are large rooms used for storage of large
quantities of vaccines. Have two cooling units;
One running
The other is standby. Cold rooms are found at the
national and regional levels while freezer rooms are
only found at the national level.
119. COLD ROOM CTD
• The rooms are connected with:-
A 24-hour temperature monitoring system with an
alarm.
A recorder, and a backup generator that will turn on
automatically when the regular power is interrupted.
124. COLD BOX CTD
• The cold life of a cold box varies depending on
the type,
• The number of openings and the ambient
temperature.
125. Vaccine carrier
• Vaccine carriers are used to transport vaccines
from district stores to service delivery points
• (outreach / mobile) and during immunization
sessions. The cold life in a vaccine carrier is
• approximately 8hours.
128. Icepacks
• Icepacks are flat rectangular plastic
containers filled with water or gel. They
are used in vaccine
• carriers, cold boxes or refrigerators to
maintain temperatures.
130. Thermometers
Different types of thermometers are used to
monitor cold chain temperature. These are:-
1. Dial thermometer
2. Alcohol thermometers.
They indicate the safe operating ranges of
temperature of between +2 and +8 degree
centigrade.
132. HOW TO RECEIVE AND INSTALL
(gas/electric refrigerator)
• Action on receipt
Check the packaging case for damage.
If there is damage, notify the supplier
before unpacking.
Unpack the refrigerator carefully.
Check the refrigerator. If it is damaged,
notify the supplier/District.
133. Look for the manufacturer’s
instruction manual. This should be
inside the packaging case or
in the refrigerator.
Read and follow the instructions given
in the manual carefully.
If the instructions are missing, use this
book instead
Check that the flue baffle is hanging
inside the flue
134. How to Install refrigerator
• Ensure the room is well ventilated.
• Place the refrigerator in the coolest part of
the building.
• The refrigerator should be kept off droughts.
• Minimum clearances to wall and roof must be
at least 30cm and 40cm respectively
• Upright refrigerators should be placed on
wooden blocks (25 to 50mm) thick to avoid
dampness.
135. How to install a refrigerator CTD
• Absorption refrigerators must be placed
perfectly level or it will not work properly.
136. How to keep vaccines cold in the
refrigerator
• Place vaccines in the correct compartment.
• Avoiding opening the refrigerator.
• Defrost excessive ice.
• Pack vaccines with enough air spaces.
• Avoid packing the vaccines in contact with the
evaporator
138. Lighting the gas refrigerator
Instructions for lighting the gas refrigerator (in
absence of the manufacturer’s instructions).
Make sure that there are no draughts from
doors or windows. These will make it difficult
to light the gas burner.
139. Lighting the gas refrigerator
Identify the control knobs and other parts for
gas operation.
Connect the gas cylinder to the refrigerator
with the gas supply pipe.
140. Check that the connections at each end
of the pipe are tight.
Open the valve on the gas cylinder and
check for leaks at all gas connections using
foam from soapy water.
141. Lighting the gas refrigerator
Check that the connections
at each end of the pipe are tight.
Open the valve on the gas cylinder and check for
leaks at all gas connections using foam from
soapy water.
142. Lighting the gas refrigerator
Turn the gas thermostat knob to medium
position or position number.
Open the gas valve by pushing the gas valve knob
on the flame failure device as far down as
possible and keep it pushed in.
143. Lighting the gas refrigerator
Push the igniter button to light the gas. Look
through the sight glass/window to see the
flame.
144. Lighting the gas refrigerator
If the gas does not light, push the igniter
button again. Repeat, if necessary until you
can see the flame.
After you see the flame, keep the flame
failure device button pushed in for at least 15
seconds, and then release it.
145. Lighting the gas refrigerator
Check that the flame stays lit. If it goes out,
repeat the lighting procedure.
• Note: When lighting for the first time, or after
replacing the gas cylinder, the flame may go out,
because of air in the gas supply tube..
146. Adjusting the temperature, ensure
a 48hr observation period
1. After checking the inside temperature,
the control knob can be turned towards a
warmer or colder position if necessary.
147. Adjusting the temperature, ensure a
48hr observation period
The control knob is usually marked “1” to “7”,
MIN”, “MED” and “MAX”.
or with an arrow indicating how to turn to
colder temperature.
No. “1” or “MIN” gives the warmest
temperatures.
No. “7” or “MAX” gives the coldest
temperature.
148.
149. How to pack vaccines in an RCW 42 EG
refrigerator.
Vaccines are placed on trays of different colors.
Purple color Pneumoccocal vaccine Top tray
Red color T.T&HepB 2nd tray
Orange color DPT&HiB 3rd tray
Yellow color BCG 4th tray
Green Measles 5th tray
Blue Opv Bottom tray
151. Records used in cold chain systems
• Cold chain recording sheet- used to record ice
packs, number of vaccine removed from the
refrigerator as well as temperatures
• Temperature recording sheet- used to record
temperature at the fridge.
152. How to fill temperature recording
sheet.
• Name and type of the refrigerator.
• Name of the district and of the health facility.
• Month and the year.
• Temperatures should be plotted twice a day (
morning and evening)
154. General rules for storing vaccines in
the refrigerator.
• Place vaccines neatly in piles with air spaces in
between.
• Do not let the vaccines touch the sides of the
refrigerator.
• Always put new stocks of vaccines on the right
hand side of each self and older stock on the
left hand side.
• Do not keep vaccines in the door shelves or
bottom shelf.
155. General rules for storing vaccines in
the refrigerator. CTD
• Always use the oldest vaccine first ( first in first
out).
• Never mix vaccines with other medicines or
foods in the refrigerator.
• Keep the doors of the refrigerator shut at all
times.
• Keep the refrigerator locked to ensure
security.
156. what to do incase of power failure
• Immediately switch to use of gas for RCW 42
EG
• Do not open the refrigerator any un-necessary
.and within the next one hour, arrange to
transfer the vaccines to a place with
electricity.
• Transfer the vaccines to a cold box lined with
frozen ice packs.
157. How to use and pack vaccines in a cold
box and vaccine carrier.
• Transport large quantities of vaccines.
• Place frozen ice packs side by side against the
inside walls.
• Place BCG& Measles directly to the ice packs.
• Put the DPT/HepB/T.T/Hib into a polythene
paper bag and put them into the carrier.
158. Monitoring of vaccine temperatures
• Temperatures of the vaccines in the
refrigerator is monitored by use of:-
• Thermometers
• 3M monitor
• Freeze watch
• Fridge tag
• Shake test
• Vaccine vial monitors
159. 3M vaccine cold chain monitor
card
• It is a made from material that is sensitive to
heat.
• It detects heat exposure accumulatively, from
10 degrees and any exposure over 34 degrees
as registered by the color changes on the card.
160. Vaccine cold chain monitor card
• The monitor card must always be stored
together with the vaccines through the cold
chain system through the chain of
distribution.
162. vaccine vial monitor
• A vaccine vial monitor (VVM) is a label with a
heat-sensitive material.
• It registers cumulative heat exposure over
time.
• The inner square is made of heat sensitive
material, and is a lighter than the outer circle
but it becomes dark with exposure to heat.
165. Reading the Stages of the VVM
The inner square is lighter than the outer
circle. If the expiry date has not been
passed : USE the vaccine
The inner square is still lighter than the
outer circle. If the expiry date has not been
passed: USE the vaccine
166. Discard Point:
The color of the inner square matches that of
the outer circle: DO NOT use the
vaccine
167. Beyond the Discard Point:
Color of the inner square is darker
than the outer circle: DO NOT use the
vaccine.
168. How to receive vaccines
• If vaccines are delivered at the health
institution as the in charge, you should:-
• Inspect the vaccines to ensure they are not
expired, not broken and stored temperatures
are between +2 to +8 degrees centigrade.
• Open the packages to check for the color of
the vaccine monitors.
169. How to receive vaccines
• Check that the types and amounts and
diluents are the same as in the s11 form.
• Unpack the vaccines and immediately put
them in the refrigerator as soon as possible.
• Receive the vaccines by recording them in the
vaccine stock ledger.
170. The Freeze watch indicator
• The freeze watch indicator tells you when the
vaccine has been exposed to freezing
temperatures.
• There two type of freeze watch indicators, one
for the DPT+Hep B and another for Tetanus
Toxoid vaccines.
171. The Freeze watch indicator
• It is a small vial containing:-
Blue alcohol (DPT+Hep B) OR
Red alcohol (Tetanus Toxoid) trapped inside a
plastic bulbous tube with a white paper
background.
173. How indicator the works
• Exposure to temperatures below 0 degrees
centigrade for more than one hour, makes the
vial bursts and releases the colored liquid,
staining the white paper background.
174. How indicator the works
• The freeze indicator is used to warn of
freezing.
• Usually packed with vaccines that are
sensitive to freezing .
At 0 degrees centigrade, it breaks and releases
a bright blue or red stain which spreads across
the white paper background.
175. How indicator the works
• After freezing for over one hour, the indicator has
burst out and has stained the background red.
• This shows that the temperature has been below
0 degrees centigrade.
176. FRIDGE–TAG
• This is a Data logger that shows:-
Daily minimum& maximum temperatures
over a period of 30 days;
And the current temperature in the fridge.
178. Shake test
• This is a test used for testing whether
vaccines TT, and DTP+Hep B are frozen or
not.
179. How to do the shake taste
Take a vial you think may be frozen (Test
sample).
Select another vial of the same type of
vaccine that you know has not been frozen
(control sample).
180. How to do the shake taste
Hold in one hand and shake vigorously for 10-
15 seconds
Allow to stand and leave both vials to rest for
15-30 minutes.
Compare both vials against the light to see
the sedimentation rate
183. Multi-Dose Vial Policy (MDVP)
An opened Multi-Dose Vial is a vial containing
several doses of vaccine from which one or
more doses have been taken.
WHO and UNICEF issued directives authorizing
the re-use, of opened multi-dose vials of some
of the liquid vaccines, under certain
conditions.
184. Multi-dose vial policy
• Liquid vaccines may be preserved and used for
subsequent immunization session up to 4
weeks if certain conditions are met:
185. Conditions for multi dose vial use
The expiry date has not passed
The vaccines are stored under
appropriate cold chain conditions at all
times.
The vaccine vial has not been submerged
in water.
186. Conditions for multi dose vial use
Sterile technique has been used to withdraw all
doses.
The VVM if attached has not reached the discard
point.
187. Preventive maintenance of cold chain
equipments
• Daily activities
Check temperature twice, in the morning and
evening including public holidays and
weekends
and chart on the temperature-monitoring
chart. Ensure the temperature is between
+2°C to +8°C.
188. Daily activities
Check that the refrigerator is operating and the
burner flame is blue for gas operated
refrigerator.
Make sure that there is enough gas in the
cylinder.
189. Daily activities
Health worker should know how long a
cylinder takes when running continuously.
Ensure that vaccines are well arranged in the
refrigerator
190. Daily activities
When necessary, clean inside and outside of the
refrigerator with a damp cloth.
Clean door gasket and powder it with perfume
free talcum.
Check the gas connections for leaks.
191. For solar refrigerators
• Gently wash the panels with plenty of water
and soft cloth (avoid use of detergents)
• Check battery acid level and top up with
distilled water when necessary.
• Check battery terminal for tightness and
corrosion. Lubricate with battery terminal jelly
or petroleum jelly.
192. Daily activities
• DO NOT keep any other item in refrigerator
apart from vaccines and diluents.
• Keep a spare gas cylinder available and always
replace the gas cylinder before it is completely
empty.
193. weekly activities
Check the ice formation on the evaporator. If
the ice is thicker than 6mm to 10mm defrost
the refrigerator.
Check that the refrigerator is level.
194. Monthly activities
• Check that the condenser and cooling unit are
clean. Remove any dirt or dust with a soft
brush or cloth.
195. Yearly activity – by the medical
engineering technician
Clean the gas burner and gas jet
Clean the flue and baffle
196. How to maintain the cold chain
equipments (summary)
REFRIGERATOR COLD BOX
Check Daily if
Exterior is clean
Temperature is within
prescribed
limits (twice daily)
Seal is tight and door shuts
After every use
Keep latches open and
free from
load and tension.
Clean with detergent and
dry
Examine inside and
outside surface
for cracks
197. How to maintain the cold chain
equipments ctd
Check Weekly if
Frost is less than 0.5 cm thick
(if more than 0.5 cm, then
defrost)
Check Monthly
If Equipment is defrosted and
cleaned (adjust thermostat if
necessary). Checking
temperatures twice a day.
Ensure the burner flame is blue.
Defrost thick ice
Check that the rubber
seal around the lid is not
broken (if so, replace
immediately)
Hinges and locks are
lubricated with machine
oil.
198. How to organize immunization
sessions
• OBJECTIVES:-
• By the end of the lesson, the students should
be able to:-
Arrange the waiting area.
Organize flow of patients/clients.
Describe the process of registration and
screening of children for immunization
List important tasks at the MCH/FP
Organize outreach/mobile health services
199. Preparation of the immunization area.
• Room should be having two doors. ( patients
entrance/exit).
• Two chairs.
• One table,
• Vaccine carrier,
• Registers, immunization tally sheets.
• enough Safety boxes.
• Syringes reconstituting BCG, measles
• Syringes for administering vaccine doses.
• Weighing scales
200. Arranging the waiting area
• MCH/FP clinic should be opened at 8.00am in
the morning.
• And the clients usually sit at the waiting bay.
201. Tasks at the waiting bay
• Health education
• Screening of children who are very sick.
• Sick children are attended first.
202. Registration room/desk
• Holding area for all patients requiring services,
under five year children, expectant mothers and
family planning women.
• May not be in the Mch/Fp area, but at medical
records office.
203. Tasks at the registration desk
• Greeting and welcoming clients warmly.
• Asking them for the child health
booklets/cards.
• Careful inspection of the cards and advice
mother accordingly.
• Filling of the cards and registers for hospital
registration numbers.
204. In the Mch/Fp area
• TASKS:-
Growth monitoring, e.g. weighing.
Nutritional assessment, (MUAC).
History taking, taking of vital signs for sick
children.
Immunization assessment status e.g. ( for
check for BCG scars). – review clients cards.
205. In the Mch/Fp area ctd
• Counseling:
• Interpretation of the weight, nutrition,
immunization uptake.
• Recording of the information on the Childs,
cards.
• Health education.
206. Antenatal mothers
• Tasks welcome the mother warmly.
• Take personal particulars.
• Weighing, taking of blood pressure and
height.
Fill laboratory investigation forms.
Refer them to the ANC for examination,
abdominal palpation, counseling, pmct.
207. Immunization room
Equipments:-
Vaccine carrier with enough vaccines.
Immunization tally sheets, registers, safety boxes,
syringes for reconstituting and for administration of
the vaccines.
Dustbins.
208. Tasks ………
• Vaccination of children and mothers.
• Recording of the vaccine doses given
• Counseling of mothers, ANC clients.
209. Things the health worker should do
during immunization
• Give children and ANC clients the right
vaccines and right doses.
• Counsel mothers on family planning,
immunization, nutrition including EBF.
• Recording vaccine doses immediately they are
administered.
• Observe strict infection prevention &
injection safety practices
210. Things the health worker should do
during immunization
• Reminding mothers of return dates for ANC
OR immunization.
• Explaining the anticipated immunization side
effects to the mothers.
• Ensuring that vaccines are potent by
maintaining their temperatures between +2 to
+8 degrees centigrade all through the session.
211. Safe Injections and Waste
Disposal
• LEARNING OBJECTIVES
To describe the importance and advantages
of safe injections and safe disposal of
immunization waste.
To list steps to achieve safe injections and
safe disposal of immunization waste policy
guidelines on injection safety.
213. A safe injection
• Does harm the recipient.
• Does not expose the user to any avoidable.
• Does not results in any dangerous waste
214. why injection safety is necessary
Because:-
Unsafe injection practices pose
serious health risks to recipients, health
workers, and the general public.
216. common health problems due to
unsafe injections
• Needle stick injuries
• blood diseases/Infections .e.g hepatitis B,
HIV/AIDS
217. Bad injection safety practices
• Re-capping of needles after use
• Bending of the needles.
• Disposing needles and other sharps in pits.
• Mixing sharps with other waste such as
papers, ETC.
• Improper handling of sharps and needles.
218. Bad injection safety practices
• Changing needle but re-using syringe
• Leaving needle on the vial for withdrawal of
additional doses.
• Touching sterile parts of syringe and needle.
• Applying pressure to bleeding injection site
with used materials or dirty fingers.
219. Bad injection safety practices
Throwing used needles and syringes in the open
heaps.
• Burying used needles and sharps
• Mixing two partial opened vaccines to
constitute a dose.
• Storing medications and vaccines in the same
fridge.
220. Bad injection safety practices
• Placing used needles on surfaces or carrying
them from point of use for disposal at a
designated area.
• Sorting out mixed health care wastes.
221. Ways of ensuring safe disposal of
immunization waste
Do not re-cap or bend the needle.
222. Good injection practices
• Put all sharps and needles into a safe box
immediately after use.
• Do not re-use syringes or needles.
• Proper hand washing
• Adhere to a septic techniques.
224. Good injection practices
• Do not leave a needle on the stopper. Do not
recap the needle.
• Place safety box within reach to facilitate
immediate disposal of syringes and needles at
point of use.
225. Good injection practices
• Do not carry used syringes and needles
around working area.
• Do not manually remove the used needle
from the syringe.
226. Good injection practices
• After injection dispose syringe into the safety
box at point of use immediately.
• Fill safety box three-quarter way full and close
it securely.
• Do not manually sort needles and syringes.
229. 2.11. Immunization Problems
• A. Drop Out
• A drop out is defined as a child or a woman w
ho failed to return for subsequent
• doses for which he or she is eligible.
• The possible causes of drop out rates are:
- unsure of dates of return
- long wait at the vaccination centre
230. ctd
- child develops side effects or was sick on the
appointed date.
A child or a woman who discontinued the im
munization program who have
restarted the immunization.
231. Ctd
- Vaccination Centers Open At Inconvenient H
ours
- Some Health Workers Do Not Explain The Ne
ed Of Completing Vaccination.
- Negative Attitude Of Some Health Workers T
owards The Program.
- Mothers Usually Busy On Other Engagement
s.
- Family Left The Place For A While.
232. B. Missed opportunities
• Current policy is that all children and mothers
at the health facility for any reason
• should be screened for immunization status a
nd vaccinated if eligible.
233. Causes of missed opportunities
Health Workers Do Not Know The Policy
Health Workers Screen But Tell Patients To Re
turn Later
Health Workers Only Vaccinate Women With
TT If They Are Pregnant
Health Workers Only Vaccinate The Index Chil
d, Miss The Siblings.
234. Ctd
Health Workers Only Open A Vial If There Are
Enough Clients Who Need It
- False Contraindications To Immunization, Exa
mple Not Giving Polio Vaccine To A Child With
Diarrhea.
- Logistical Problems, Such As Vaccine Shortag
es, Poor Clinic Organization, And Inefficient Cli
nic Scheduling
235. Ctd
The Failure To Administer Simultaneously All
Vaccines For Which A Child Was Eligible.
Accessibility; Time (Women Carry Household
Responsibilities), Distance, Cost Of Transporta
tion.
237. Importance of dropouts and
missed opportunities
• Dropouts and missed opportunities are causes
of low vaccination coverage.
238. How to reduce dropout and missed
opportunities.
Common ways of reducing dropouts and missed
opportunities for immunization includes :
Social mobilization
Dropout tracing mechanisms
239. Ctd
In service training to community health work
ers and utilization of other motivation mechan
isms.
High level advocacy.
-Get commitment by the local leaders.
240. Ctd
Monitoring and supervision the program.
Ensure financial and logistics support for the
health institutions.
Monitor coverage periodically.
Daily integrated health service for all women
and children attending the health units.
241. Tools of monitoring immunization
coverage and assessing community
demand
• There are two ways of measuring efficiency i
n immunization.
• measure immunization coverage by each vacci
ne, by comparing the number of doses given t
o the number of infants eligible to receive the
m.
242. • Measure drop-out rates, by comparing the nu
mber of infants that started receiving immuniz
ations to the number of infants who received
all needed doses of vaccines.
243. CTD
• Drop-out should be estimated for the followin
g vaccine doses:
• BCG, DTP3
• BCG, measles
• DTP1, DTP3
• DTP1, measles
• HepB3, DTP3
244. Calculating immunization coverage
• Immunization coverage (p)
• Target population T.
% immunization coverage= (p/TX100)
If p = 100 and T is 180 then
% immunization coverage= 100/180x100=56%
•
245. Dropout rates
• For DPT1 AND DPT3
• DPT 1accumulative- DPT 3 accumulative x 100
• DPT1accumulative totals
