Progress of Immunization program in India, Cold chain & its importance: for MBBS students

1. IMMUNISATION
PROGRAM IN INDIA

2. IMMUNIZATION: COMMON
TERMS
Immunity :
Resistance of a host to a specific agent, characterized
by measurable and protective surface or humoral
antibody and by cell mediated immune responses.
Immunization:
Process of inducing immunity by stimulating immune
system through antigens.

3. Vaccine:
A preparation of a weakened or killed pathogen, such
as a bacterium or virus, or of a portion of the
pathogen's structure that upon administration
stimulates antibody production or cellular immunity
against the pathogen but is incapable of causing
severe infection.
Vaccination:
Administration of antigenic material (the vaccine) to
produce immunity to a disease.

4. Ring immunization:
Vaccination of people in close contact with an
isolated infected patient.
Catch up rounds:
Additional effort besides routine immunization to
cover left outs
Mop-up rounds:
When the final pockets of polio virus transmission
have been identified through standard surveillance,
door-to-door immunization in high-risk districts.

5. HERD IMMUNITY?
Resistance to spread of infectious disease in a group
because of few susceptible members, making
transmission unlikely.
The immunologic status of a population, determined
by the ratio of resistant to susceptible members and
their distribution.

7. MILESTONES IN IMMUNIZATION
PROGRAM IN INDIA
1978: EPI
1985: UIP, Measles vaccine added
1988: AEFI Surveillance
1990: Vitamin A
1992: CSSM
1995: Polio National Immunization days
1997: RCH-I
2005: RCH-II and NRHM

8. EARLY VACCINES:
•BCG , DPT & Typhoid
•OPV Added
•1985: Measles added & Typhoid
dropped
•TT for Pregant
•2006: Hepatitis B, second dose of
measles and Japanese Encephalitis
•2011, pentavalent vaccine

9. STRATEGIES
•Reduce Morbidity & mortality of
VPDs by Immunisation
•Ingenious vaccine production
•Cold chain establishment
•Phased Implementation & full
coverage by 1990
•Monitoring & evaluation

10. NATIONAL IMMUNISATION
SCHEDULE
EXERCISE FOR STUDENTS

11. MONITORING
•AFP Surveillance
•Measles Surveillance
•AEFI Surveillance
•IDSP
•Mother & Child Tracking
System

12. COVERAGE
•RSOC by UNICEF 2012
•65% in INDIA
•6.6% no vaccination
•89% TT for Preg Women

13. COLD CHAIN

14. COLD CHAIN
• The ‘cold chain’ is the system
of transporting and storing vaccines at
recommended temperature from the
point of manufacture to the point of
use.
• The World Health Organization
(WHO) reported that in 2005,
nearly half of all vaccines were
in transit due to poor
Manufacturer
Distributor
Vaccine
Depots
Provider office
Client

15. Cold chain storage
equipment
Walk in
cold rooms
Deep
freezers
Ice lined
refrigerators

16. 1.Walk in cold rooms(WIC)
At regional level
Storage up to 3 months
At district & PHC levels
Temp :- -15oc to -25oc
At PHC, used only for the
preparation of ice packs
2.Deep
freezers

17. 3.Ice lined
refrigerators(ILR)
Both at district and PHC
levels
Temp :- +2oc to +8oc
ILR’s are top opening,
can hold cold air inside
better than front
opening refrigerators

18. VACCINE
SENSITIVITY
• Sensitivity to HEAT
BCG
Varicella
MMR
MenC
Hepatitis B
DT and/or
aP/IPV/HIB
• Sensitivity to COLD
HepB and
combination
DTand/or
aP/IPV/HIB
Influenza
MenC
*MMR
*Varicella
*BCG
(*Freeze
MOST
SENSITIVE
Temperature must be recorded twice in a day with dial
thermometer
LEAST
SENSITIVE

19. Transporting Equipment
(Periphery)
Cold boxes
Vaccine
carriers
Day carriers

20. Used for transport of vaccines
Fully frozen ice packs placed
at the bottom and sides
DPT, TT, DT should not be kept
in direct contact
1.Cold
boxes
Used to carry small
quantity of vaccines(16 to
20 vials)
For out of reach sessions
4 icepacks are used
2.Vaccine
carriers

21. 3.Day carriers
Used to carry very small quantities
of vaccines(6 to 8 vials)
For a near by session
2 icepacks are used
For only 2 hours period

22. Vaccine Vial Monitor(VVM)
VVM is a label containing heat
sensitive material that is placed on
a vaccine vial to register heat
exposure over time
Vaccine vial
monitor

24. SHAKE TEST
FOR COLD INJURY

26. CONCLUSION
• The Immunization program started in 1978 has
undergone various transition over the decades.
More & more vaccines are being added.
• But at its core it continues to have the same
objective. Protect the children against the most
prevalent and serious diseases through universal
coverage.
• A proper monitoring system is essential to realise
this objective.
• Quality of the vaccine is more important than
quantity as universal coverage without proper
immune response is a waste.