• CONCEPT OF IMMUNITY

• DEFINE IMMUNITY

DEFINITION: - This is the ability possessed by the body (host) to resist infection of a
specific disease, foreign tissue, foreign non-toxic substances and other antigens.

DEFINITION: - is an intrinsic or acquired state of resistance to an infectious agent.

DEFINITION: - is the degree of resistance a host (body) possesses as a result of its exposure
to the antigen.

DEFINITION: - is a condition of being able to resist a particular disease especially through

preventing the development of a pathogenic micro – organism or by counteracting the effects
of its toxins or products.

DEFINITION: - is the ability of the body to resist infections.

DEFINITION: - is the resistance usually associated with the antibodies or immune cells
which have inhibitory effects on a specific infectious agent or its toxin that causes a
particular infectious disease
DEFINE INNATE AND ADAPTIVE IMMUNITY

INNATE IMMUNITY: Refers to non-specific defense mechanisms that come into play
immediately or within hours of an antigen’s appearance in the body. These mechanisms include
physical barriers such as skin, chemicals in the blood and immune cells that attack foreign cells
in the body.

ADAPTIVE IMMUNITY

Also referred as the acquired immune system, is a subsystem of the immune system that is
composed of specialized, systematic cells and processes that eliminates pathogens by preventing
their growth.

WAYS OF ACQUIRING IMMUNITY

• From mother to child through the placenta

• From mother to child through breastfeeding

• By having a clinical disease

• By having a sub – clinical infection i.e. through the administration of vaccines.

• Through the administration of toxoids e.g. tetanus toxoids (TT)

• Through the administration of serum with antibodies like anti-tetanus serum, anti – snake
venom, and anti – rabies etc.

IMMUNTY: Means a highly developed state of resistance against infectious diseases. It occurs
when there are sufficient antibodies within the body to prevent the successful invasion and
virulence of a particular micro - organism.

Immunity can be acquired in two ways i.e. naturally and or artificially and both forms may be
active or passive in nature.

NATURAL IMMUNITY

In this form or type of immunity, the body manufactures its own antibodies to fight infections.
Natural immunity is of two type i.e. natural active acquired immunity and natural passive
acquired immunity.

• NATURALLY ACTIVE ACQUIRED IMMUNITY

In this form of immunity, the body manufactures antibodies following recovery from previous
infection resulting from exposure of the body to specific infectious agent which is not sufficient
enough to cause the particular infection/disease, but, can stimulate the production of antibodies
within the body.

This form of immunity last longer and stands to provide future protection against the specific
infections.

• NATURALLY PASSIVE ACQUIRED IMMUNITY

This is the form of immunity in which for instance a child gets immunity from his mother
through transplacental transmission. The immunity does not last for a long period of time.

• ARTIFICIAL IMMUNITY

In this type of immunity, the resistance occurs as a result of response to the administration of
drugs introduced into the body to fight the infection. Artificial immunity is of two type i.e.
artificial active acquired immunity and artificial passive acquired immunity

• ARTIFICIALLY ACTIVE ACQUIRED IMMUNITY

This form of immunity develops in response to the administration of killed, attenuated vaccines,
or toxoids. It is of great importance because the body plays very important role in the production
of antibodies. It usually last long and may also last for life as in the case of active immunity
induced by measles.

• ARTIFICIALLY PASSIVE ACQUIRED IMMUNITY

In this form of immunity, the individual plays no part in the production of antibodies; only
readymade antibodies from the human or animal serums such as ATS, anti – tetanus are injected
into the body to fight against the invading micro – organism without delay. The immunity is
short lasting.

DEFINE ANTIGEN AND ANTIBODIES AND THEIR REACTIONS

ANTIGEN: This is any substance (vaccine serum) which when introduced into the body’s
system under favorable condition can stimulate the production of antibodies.
 ANTIBODIES: This is a specific form of blood protein produced in the lymphoid tissue and
able to counteract the effects of bacterial antigens or toxins.

VACCINE: - is defined as the causative agent of a disease so modified that is incapable of

producing disease while retaining its power to cause antibodies formation.

A vaccine is an all – immunizing preparation of living or dead organism or materials derived

from organism.

Drawing from the above definition, it can be inferred that vaccine is an immunizing agent
that when introduced into the body to illicit the production of antibodies or which provides
ready – made antibodies against specific infectious disease.

Types of vaccine

• Live vaccines

• Inactivated vaccines

• Toxoids

THE LIVE VACCINES: These are made from living organism and are of two;

• Organism that causes the disease and whose virulence has been made weak by
attenuation e.g. OPV.

• Organisms of species which are related to the causative agent but which are naturally
less virulent e.g. small pox vaccines.

INACTIVATED VACCINES: These are made from organisms that are killed during
manufacturing and include Pertussis and cholera vaccines.

TOXOIDS: Are vaccines produced from bacterial toxins which have been rendered harmless by
heat or formalin treatment e.g. diphtheria and tetanus vaccines.

VACCINATION: Is the process of giving vaccine or inoculating any antigenic material or

substances for the purpose of producing active artificial Immunity.

RESISTANCE OF THE NEW HOST

Immunity has been defined as the resistance of a new host to infection, whereas, resistance is
the ability of the body to withstand infection.

Resistance is the defense mechanism, which is called into interplay after invasion has occurred
and which enables the body to kill off the invader and combat its ill effects.

Resistance is the sum total barriers to the progress of invasion and the multiplication of
infectious agents or damage by their toxic products. If the body’s defense mechanism is
sufficiently great the term “IMMUNITY” is used. There is no absolute immunity against all
circumstances and degree of exposure, but the term “IMMUNITY” refers to the possession of
sufficient resistance which protects a person against the average infectious dose of infection.

TYPES OF IMMUNITY OR THE NATURE OF RESISTANCE

The nature of resistance is not clearly understood. However, resistance is a property of a body
which enables it to ward off the invasion of pathogenic organisms. To activate this, the factors of
resistance are classified as specific and non – specific immunity or mechanism.

TYPES OF IMMUNITY
• Specific immunity.

• Non specific immunity.

• SPECIFIC IMMUNITY

Specific or acquired immunity is the one that can be acquired either naturally or artificially and
both could be acquired passively or actively.

Acquired or specific immunity, Natural immunity and

artificial immunity
Passive Active Active Passive

1. From mother through 1- clinical diseases 1- vaccines 1.

serum with antibodies
Placenta, B/feeding 2- Sub-clinical infection. 2- Toxoids e.g. TT
e.g. ATS, ASV.

• NON - SPECIFIC IMMUNITY

This immunity applies to the physical resistance provided by protective covering e.g. the skin,
mucous membranes. Also certain secretions have antimicrobial action like mucus, tears and
gastric secretions. Also the action of microphages and other cells as well as some non-specific
serological factors may resist some infective agents.

FACTORS AFFECTING INDIVIDUAL’S RESISTANCE TO DISEASES/INFECTIONS

• AGE

Studies have shown that certain pediatric diseases such as measles, Pertussis and neonatal tetanus
amongst others are more common in childhood. In contrast to other diseases such as rectal
cancer, breast cancer, cervical cancer and scrotal hernia are predominant in adulthood. It is
pertinent therefore to note that any effort aimed at eradicating or controlling such diseases must
take into cognizance the age factor at which such diseases show high preponderance.

• SEX

It is worthy to mention that sex is a determinant factor in disease incidence among males and
females. Certain infections show marked difference in their sex incidence. Example, scrotal
hernia can only be suffered by males while ovarian cysts can only be suffered by their female
counterparts.

• PREGNANCY

It is a fact that immunity is lower during pregnancy and this increases the risk of microbial
infection especially in poorly nourished mothers.
During pregnancy, increase in the prevalence and intensity f falciparum malaria may lead to
abortion or still birth.

• NUTRITION
Adequate nutrition is very important to human survival. Cases of malnourished children who
have died due to attacks of preventable diseases abound. This is so because a child that is not
adequately fed with proper diet will lack resistance to infection.

Emphasis will be laid on adequate nutrition because what we eat determines to a great extent our
body resistance to infections.

• TRAUMA AND FATIQUE

Stress in form of trauma may predispose individuals to infections. One classical example is the
effect of trauma and fatigue on poliomyelitis.

• STRESS

Stressful conditions make the whole body become unable to resist infections. All forms of
stresses must be avoided in order to prevent diseases associated with them.

• DRUG ABUSE

Medical evidence shows that drug abuse is responsible for vitamin depletion in the human body
which in turn affects the body resistance to infection.

• EXISTING DISEASES

Many diseases bacterial, viral or parasitic in origin affects immunity leading from reduced
protection to other diseases. Some of this diseases are inherited while others are chronic
infections like malignant diseases, disorders of metabolic or hormone imbalance, diabetes
mellitus have increase susceptibility to infections of vagina, skin and urinary tract infections

• IMMUNIZATION SERVICES

• DEFINE IMMUNIZATION
IMMUNIZATION: Can be defined as the artificial means by which children under five years
and women of child bearing age are protected against the deadly effects of bacterial, viral
infections that are communicable and vaccine preventable (F.E. Dibia, 2002)

IMMUNIZATION: Is the administration of antigens into the body of a client to stimulate the
production of anti-bodies against a particular form of bacterial or viral infections (Wikipedia)

IMMUNIZATION: Is the process of administering antigens to induce immunity? (E. Jonathan,

2006)

IMMUNIZATION: Is the process of introducing live, attenuated, inactivated or weaken virus,

bacteria or detoxified toxins into the body, so that the body defense mechanism is enhanced and
stimulated to fight against certain specific organisms that causes infections or diseases.

IMMUNIZATION: Is the protection of a susceptible individual/host from communicable

diseases by administration of a living, modified agent, killed organisms or inactivated toxin?

IMMUNIZATION: Is the process by which artificial immunity is conferred on an individual?

IMMUNZATION: Can be defined as the artificial means by which children less than five years
and women of child bearing age (15 – 45yrs) are protected from the deadly effects of bacterial
and viral infections that are communicable and vaccine preventable.

It can also be defined as the process of introducing live, attenuated, weaken virus, bacteria or
detoxified toxins into the body, so that the body defense mechanism is enhanced to produce anti
bodies to fight against certain specific organisms that causes the diseases.

Immunization can be classified into two classes i.e. active and passive immunizations.

ACTIVE IMMUNIZATION: This type of immunization involves the introduction of

appropriate vaccines that trigger up the production by the host of specific antigens. It provides
complete or partial protection which may last for years and in some cases for life.

PASSIVE IMMUNIZATION: This type of immunization refers to the administration of

specific antibodies against a particular infective agent into the body of a susceptible host. It may
only offer temporal protection to a non – immune persons e.g. ATS

DIFFERENCE BETWEEN ACTIVE AND PASSIVE IMMUNIZATIONS

SNO VARIABLES ACTIVE IMMUNIZATION PASSIVE IMMUNIZATION
1 IMMUNIZATION AGENT Live or dead organism or Sera from immunized human
toxoids and animals
2 RAPIDITY OF 2 – 3 weeks, delay if no Immediate
PROTECTION immunity
3 DURATION Long lasting Few months
4 COMPLICATIONS Various but rarely serious Anaphylactic serum sickness
5 USES Long term prophylaxis, Short term prophylaxis
treatment only if previously treatment
immunized

IMMUNIZATION PROCEDURE

PROCEDURES INVOLVED IN TAKING HISTORY OF A NEWLY REGISTERED

CHILD

The taking of accurate immunization history on a newly registered child is an indispensable

aspect of any immunization exercise that must be centered on the following points;

• Know the name and date of birth of the child

• Know the address of the parents of the child

• Find out if the mother had sent the child for immunization before

• Know the immunization the child has had before. if none, tell the mother the
immunization you are going to give the child

• Note the history of any allergic reactions. This will help you guard against any future
occurrence.

• Note sites of immunization points (scars on the body of the child). This will also
enable you know if the child has been immunized or not, especially where the mother
is illiterate and cannot recall accurate immunization history of the child.

• Tell the mother the follow up instructions emphasizing that five (5) visits to the clinic
make for absolute protection against the childhood killer diseases as outlined below:

• 1st visit at birth, a child must receive BCG and OPV0

 • 2nd visit at six (6) weeks of age, the child must receive DPT1 and OPV1

• 3rd visit at ten (10) weeks of age, the child should receive DPT2 and OPV2

• 4th visit at fourteen (14) weeks of age, the child should receive DPT3 and
OPV3

• 5th visit at nine (9) months of age, the child should receive measles vaccine

CONTENTS OF IMMUNIZATION TRAY

The immunization tray contains the following;

• ICE PACK

The ice pack maintains the vaccines at their various recommended storage temperatures.
For BCG and OPV, they should be placed on top of the ice pack at the storage
temperature of -150 to -250c. DPT and TT should be kept at the sites of the ice pack
because of their storage temperature of +40 to -80c.

• TWO KIDNEY DISH WITH COVER

One (1) sterile kidney dish should contain various needles of 26G for BCG, 23G for DPT
and measles respectively. It should also contain 0.1ml syringe for BCG, 1ml for DPT and
2ml for measles.

The other kidney dish should be used as a waste receiver for syringes and needles.

• TWO GALLEY POTS

One (1) galley pot should contain cotton wool balls which are in sterile water for skin
cleansing. Whereas, the second galley pot should contain sterile water for syringes and
needles flushing.

• A JAR/JUG

Jar/Jug of sterile water.

• TWO DISSECTING FORCEPS

Two dissecting forceps used for picking sterile cotton swabs, needles and syringes and
also for opening vials.
 NB

Today we are using auto – disposable or disposal syringe and needles.

PROCEDURE FOR ADMINISTRATION OF VACCINES

The procedures are As follows:

• Welcome the mother of the child, offer her seat and explain the purpose and procedure.

• Take the immunization history of the child i.e. check the immunization card for name,
age, and vaccines so far given.

• Based on the history, decide on vaccine(s) to be given to the child.

• Explain to the mother the vaccines you want to give to the child and tell her the possible
site for vaccination e.g upper arm, buttocks or thigh as the case may be.

• Set the immunization tray with all the requirements.

• Pick up the vaccines you want to give the child and make sure it is the right vaccine and
has not expired.

• Clean the cap of the vial with sterile swab and discard the soiled swab into the waste
receiver.

• Using dissecting forceps assemble a syringe and needle for the particular vaccination.

• Draw the required dose, expel the air and return the vial to the site of ice Pack if DPT for
instance,

• Clean the site for injection with wet swab in water, position the child appropriately.

• Give the injection to the appropriate site, withdraw the plunger and ensure there is no
blood, and if there is blood remove and inject nearby, withdraw if no blood push gently
until when you exhausted the vaccine.

• Place a dry swab on the site and remove the needle and discard into waste receiver and
massage the site.

• Give follow – up instructions to the mother of the child, when there is any rise in body
temperature of the child, he/she should be tepid sponged and brought to the clinic. The
mother should also be taught on when to bring the child for subsequent visit.
 • Tidy up the immunization tray, table and room.

ROUTE OF ADMINSTRATION OF VACCINES

The recommended routes of administration of vaccines include the followings:

• Intramuscular route:

In intramuscular route, the needle is driven deep into the muscular region of the body, at
900 levels to the skin.

Vaccines that are administered through this route are;

• DPT (diphtheria, Pertussis, tetanus) vaccines.

• TT (Tetanus Toxoids) vaccines.

• HBV (Hepatitis B) vaccines

• Sub – cutaneous Route

In subcutaneous route, the needle is driven into the subcutaneous fatty region below the
dermis at 450 levels to the skin. Vaccines administered through this route include;

• CSM (Cerebro – spinal meningitis) vaccines

• YF (yellow fever) vaccines

• Measles Vaccines

• Cholera Vaccines

• Intra-dermal Route

In this route of administration, the needle is driven just very little below the skin surface
but within the epidermis layer as in the case of BCG (Baccilus, Calmette, Guerin)
vaccine.

• Oral Route

In this route, the vaccine is directly dropped into the child’s mouth and in drops.

2.1.1 IMPORTANCE OF IMMUNIZATION IN REDUCING CHILD MORTALITY

Immunizations against microorganism that causes diseases can prepare the body immune system
and help it to fight or prevent infection. They are important for both adults and children in that
they can protect same from many diseases out there.

Immunizations protects children from serious illness and complications of vaccine preventable
diseases which can include amputation of an arm or leg, paralysis of limbs, hearing loss,
convulsions, brain damage and death. Vaccine preventable diseases such as measles, mumps and
whooping cough are still a threat.

Immunization is important because:-

• It saves lives.

• Immunization is safe and effective.

• It protects those you love.

• It can save your money.

• It gives future generation the chance to live disease free.

• It is preventing infection.

• It is extending life expectancy.

• It is promoting economic growth.

• VACCINES PREVENTABLE DISEASES

The vaccine preventable diseases are listed below
• Tuberculosis.
• Poliomyelitis.

• Pertussis (whooping cough).

• Diphtheria.

• Tetanus.

• Streptococcus Pneumonia.

• Homophiles Influenza.

• Measles.
 • Yellow Fever.

• Hepatitis.

THE VACCINE PREVENTABLE DISEASES

TUBERCULOSIS

DEFINITION: Tuberculosis is a bacterial infection caused by bacterium mycobacterium

tuberculosis which usually attacks the lungs, but can also affect other parts of the body including
the bone, joints and brain. It is classified into two: pulmonary tuberculosis affecting the lungs
and non pulmonary tuberculosis affecting the other organs of the body i.e. the bones of the joints
and brain.

In 2001, approximately 2 million people worldwide died of tuberculosis.

HOW IS TB SPREAD

TB is spread from one person to another through the air often when a person with the disease
coughs or sneezes. TB spreads rapidly especially in areas where people are living in crowded
conditions, have poor access to health care and are malnourished. A variety of TB called bovine
tuberculosis is transmitted by consuming raw milk from infected cattle.

People of all ages can contact tuberculosis, but the risk of developing TB is highest in children
younger than 3 years old and in older people. People with TB infection who have weakened
immune systems (e.g. people with HIV/AIDS) are more likely to develop the disease.

SIGN AND SYMPTOMS

The period from infection to development of the first symptoms (i.e. incubation period) is
usually four to 12 weeks, but the infection may persist for months or even years before the
disease develop. A person with the disease can infect others for several weeks after he or she
begins treatment. The symptoms of TB include general weakness, weight loss, fever and night
sweats.

In TB of the lungs called pulmonary tuberculosis, the symptoms include persistent cough,
coughing up of blood, and chest pain. In young children, however, the only sign of pulmonary
TB may be stunted growth or failure to thrive. Other symptoms depend on the part of the body
that is affected. For example, in tuberculosis of the bones and joints there may be swelling, pain
and crippling effects on the hips, knees or spine.
COMPLICATION OF TB

TB can present in many ways and may be very difficult to diagnose. Untreated pulmonary TB
results in debility and death. This may be more rapid in persons infected with HIV/AIDS.

TREATMENT OF TUBERCULOSIS

People with TB must complete a course of therapy, which usually includes taking two or more
anti-tuberculosis drugs for at least six month. This is often called DoTs for (directly observed
treatment schedule). Unfortunately, some people fail to take the medication as prescribed or to
complete their course of therapy. Some may be given ineffective treatment. This can lead to
multi drug resistant TB which can be extremely dangerous if it spreads to other people. When
people who have developed TB fail to complete standard treatment regimens or are given the
wrong treatment regimen, they may remain infectious.

CONTROL AND PREVENTION

• Avoid overcrowding

• Infected articles should be sterilized

• Immunization of infants with Bacillus Calmette Guerin Vaccine (BCG)

POLIOMYELITIES

Poliomyelitis can be defined as an acute highly communicable viral childhood disease with a
wide range of severity from symptomless infection to paralytic signs. Polio which is a crippling
disease is caused by polio virus types 1, 2, or 3. All member states of WHO agreed in 1988 to
eradicate polio. World health organization aims to certify the world as free of the disease. Since
the global initiative to eradicate polio was launched, the number of reported cases of polio has
been reduced for an estimated 350, 000 in 1988 to 483 cases associated with wild polio virus.

HOW POLIO SPREAD

The only way to spread polio virus is through the faeco/oral route. The viruses enter the body
through the mouth when people eat food or drink water that is contaminated with faeces. The
virus then multiplies in the intestine, enters the blood stream, and may invade certain types of
nerve cells, which it can damage or destroy. Polio virus spread very easily in areas with poor
hygiene.
Nearly all children living in households where someone is infected become infected themselves.
Children are most likely to spread the virus between 10 days before and 10 days after they
experience the first sign and symptom of the disease. It is important to know that the great
majority of people who are infected do not have symptoms, but they can still spread the disease.
The incubation period is 6 to 20 days.

SIGN AND SYMPTOMS

Most children infected by polio virus never fail ill. Less than 5% of those infected may have
general flu like symptoms such as fever, loose stool, sore throat, upset stomach, headache or
stomach ache. Most children who have a polio virus infection without symptoms develop
immunity and have lifelong protection against paralytic polio.

Paralytic polio begins with mild symptoms and fever. The symptoms are followed by severe
muscles pain and paralysis, which usually develop during the first week of illness. Patients may
lose the use of one or both arms or legs. Some patients may not be able to breathe because
respiratory muscles are paralyzed. Some patients who develop paralysis from polio do recover to
some degree over time. But the degree of recovery varies greatly from person to person. A
diagnosis of polio is confirmed by laboratory testing of stool specimen.

COMPLICATION

• Death

• Paralysis

TREATMENT

While the initial symptoms-muscle pain and fever can be relieved, no treatment exists to cure
paralysis from polio. A respirator can help patients who have difficulty in breathing. Regular
physical therapy, as well as orthopedic treatment and operatives and the use of braces, can help
reduce the long term crippling effects of polio.

CONTROL AND PREVENTION

• Personal hygiene

• Provision of portable drinking water

• Proper excreta disposal system

 • Immunization with oral polio vaccine (OPV) or inactivated polio vaccine (IPV)

• Supplemental doses of oral polio vaccine to all children less than five years of age during
national immunization days (NIDs).

• Surveillance for wild polio virus through reporting and laboratory testing of all cases of
acute flaccid paralysis (AFP) among children under fifteen years of age

• Targeted mop-up campaign once wild polio virus transmission is limited to a specific
focal area

DIPHTHERIA

Diphtheria is caused by the bacterium Corynebacterium diphtheria. This germ produces a toxin
that can harm or destroy human body and organs. One type of diphtheria affects the throat and
sometimes the tonsils. Another type which is more common in the tropics causes ulcers on the
skin.

Diphtheria affects people of all ages, but most often it strikes unimmunized children. In
temperate climates, diphtheria tends to occur during the older months. In 2000, 10000 cases and
3000 deaths of diphtheria were reported worldwide.

HOW IS DIPHTHERIA SPREAD

Diphtheria is transmitted from person to person through close physical and respiratory contact. It
can cause infection of the naso-pharynx, which may lead to breathing difficulties and deaths.

SIGN AND SYMPTOMS

When diphtheria affects the throat and tonsils, the early symptoms are sore throat, loss of
appetite, and slight fever. Within two to three days a bluish-white or grey membrane forms in the
throat and on the tonsils. This membrane sticks to the palate of the throat and may bleed. If there
is bleeding, the membranes may become greyish-green or black. The patient may either recover
at this point or develop severe weakness and die within six to ten days. Patients with severe
diphtheria do not develop a high fever but may develop a swollen neck and obstructed airway.

COMPLICATION

During the early phase of the illness or even weeks later, patients may develop abnormal
heartbeats, which can results in heart failure. Some patients with diphtheria experience
inflammation of the heart muscle and valves, leading after many years to chronic heart disease
and heart failure. The most severe complication of diphtheria is respiratory obstruction followed
by death.

TREATMENT

Children who develop diphtheria should be given diphtheria antitoxin and antibiotics, such as
erythromycin or penicillin. They should be isolated to avoid exposing others to the disease.
About two days after starting antibiotic treatment patient are no longer infectious.

For confirmation of diagnosis, health workers should obtain throat cultures from suspected cases.
However, treatment should begin without waiting for cultures results.

PREVENTION

The most effective way of preventing diphtheria is to maintain high level of immunization in the
community. In most countries, diphtheria toxoids vaccine is given in combination with tetanus
toxoids and Pertussis vaccine (DPT). Most recently, some countries have been using a
combination vaccine that includes vaccine for diphtheria, tetanus, Pertussis, hepatitis B (hepB),
and sometimes Haemophilis influenza type b (Hib). Approximately every ten years, booster
doses of the adult form of the vaccine, tetanus, diphtheria toxoids vaccine, may be needed to
maintain immunity.

MEASLES

DEFINITION: measles is an acute highly communicable viral childhood disease which affects
pre-school and young school children. Measles give lifelong immunity after the attack of the
disease. In recent studies it was estimated that there were 30 million cases and 745000 measles-
related deaths. Measles kills more children than any other vaccine preventable disease. Because
the disease is so infectious, it tends to occur as epidemics, which may cause many deaths
especially among malnourished children.

HOW MEASLES SPREAD

Measles is spread through contact with nose and throat secretions of infected people and in
airborne droplets released when an infected person sneezes or coughs. A person with measles can
infect others for several days before and after he or she develops symptoms. The disease spreads
easily in areas where infants and children gather, for example in health centres and schools.

SIGN AND SYMPTOMS

The first sign of infection is high fever which begins approximately 10-12 days after exposure
and last s for several days. During this period, the patient may develop a runny nose, a cough, red
and watery eyes, and small white spots inside his or her cheeks.

After several days, a slightly raised rash develops, usually on the face and upper neck. Over a
period of about three days, the rash spreads to the body and then to the hands and feet. It last for
five or six days and then fades. The incubation period from exposure to the onset of the rash
averages 14 days, with a range of seven to 18 days.

COMPLICATION OF MEASLES

Unimmunized children under five years of age, and especially infants are at highest risk for
measles and its complications, including death. Infected infants may suffer from severe diarrhea,
possibly causing dehydration. Children may also develop inflammation of the middle ear and
severe respiratory tract infections.

Pneumonia is the most common cause of death associated with measles. This is usually because
the measles virus weakens the immune system. The pneumonia may be caused by the measles
virus itself or by secondary bacterial infection. Encephalitis, a dangerous inflammation of the
brain may also develop.

Severe measles is particularly likely in poorly nourished children, especially those who do not
receive sufficient vitamin A, who live in crowded conditions, and whose immune systems have
been weakened by HIV/AIDS or other diseases. Measles is a major cause of blindness among
children in Africa and other areas of the world with epidemic measles. Children who recover
from measles are immune for the rest of their lives.

TREATMENT OF MEASLES

General nutritional support and the treatment of dehydration with oral rehydration solution are
necessary. Antibiotics should only be prescribed for ear infections and severe respiratory tract
infections. It is important to encourage children with measles to eat and drink.

All children in developing countries diagnosed with measles should receive two doses of vitamin
A supplement given 24 hours apart. Given vitamin A can help prevent eye damage and blindness.
Vitamin A supplementation reduces the number of deaths from measles by 50%.
Age Immediately Next day Follow-up
on diagnosis
Infants less than 6 months old 50 000IU 50 000IU Third dose 2-4 weeks
Infants aged 6-11 months 100 000IU 100 000IU later if there are signs
Children aged 12 months and over 200 000IU 200 000IU of exophthalmia

PREVENTION OF MEASLES

Measles is prevented by immunization with measles vaccine. Measles is highly transmissible,

almost all non-immune children contract measles if exposed to infection. To reduce the risk of
infection in hospitals, all children between the ages of six and nine months who have not
received measles vaccine and who are admitted to a hospital should be immunized against
measles. If the children’s parents do not know whether they should receive measles vaccine, the
child should still be immunized. If a child has received measles vaccine before nine months of
age, a second dose should be administered at nine months or as soon as possible after nine
months.

GLOBAL ACCELERATED DISEASE CONTROL ISSUES

The strategies recommended for reducing measles deaths include the following:

• A dose of measles vaccine should be provided to all infants at nine months of age or
shortly thereafter through routine immunization services. This is the foundation of the
sustainable measles mortality reduction strategy.

• All children should be provided with a second opportunity for measles immunization.
This will assure measles immunity in children who failed to receive previous dose of
measles vaccine, as well as in those who were vaccinated but failed to develop such
immunity following vaccination. The second opportunity may be delivered either through
routine immunization services or through periodic mass campaigns.

• Measles surveillance should be strengthened through the integration of epidemiological

and laboratory information.

• The clinical management of measles should be improved.

PERTUSSIS

DEFINITION: Pertussis or whooping cough is a disease of the respiratory tract caused by

bacteria (Bordetella Pertussis) that live in the mouth, nose and throat. Many children who
contract Pertussis have coughing spells that last four to eight weeks. The disease is most
dangerous in infants. In recent years an estimated 39 million cases and 297 000 deaths occurred
worldwide, due to Pertussis.

HOW PERTUSIS SPREAD

Pertussis spreads very easily from child to child in droplets produced by coughing or sneezing.
Children exposed to the germs become infected. In many countries the disease occurs in regular
epidemic cycles of three to five years.

SIGN AND SYMPTOMS OF PERTUSSIS

The incubation period is five to 10 days. At first, the infected child appears to have a common
cold with runny nose, watery eyes, sneezing, fever, and mild cough. The cough gradually
worsens, and involves many bursts of rapid coughing. At the end of these bursts the child takes
in air with a high-pitched whoop. The child may turn blue because he or she does not get enough
oxygen during along burst of coughing, Vomiting and exhaustion often follow the coughing
attacks, which are particularly frequent at night.

During recovery coughing gradually becomes less intense. Children usually do not have a high
fever during any stage of the illness.

COMPLICATION OF PERTUSSIS

Complications are most likely in young infants. The most common and deadly complication is
bacterial pneumonia.

Children may also experience complication such as convulsion and seizures due to fever or
reduction in oxygen supply to the brain. This is caused either by coughing attacks or by toxins
released by the Pertussis bacteria. They may also experience loss of appetite, inflammation of the
middle ear and dehydration.

TREATMENT OF PERTUSSIS

Treatment with an antibiotic, usually erythromycin may make the illness less severe. Because the
medication kills bacteria in the nose and throat, the use of antibiotics also reduces the ability of
infected people to spread Pertussis to others. Children infected with Pertussis should get plenty
of fluids to prevent dehydration.
PREVENTION OF PERTUSSIS

Prevention involves immunization with Pertussis vaccine, which is usually given in combination
with diphtheria and tetanus vaccine (DPT). More recently, some countries have been using a
combination vaccine that includes vaccines for diphtheria, tetanus, Pertussis, hepatitis B (hepB),
and sometimes Haemophilis influenza type b (Hib).

TETANUS

Tetanus is a bacterial disease caused by the action of a potent neurotoxin produced during the
growth of the bacteria in dead tissues e.g. in dirty wounds or in the umbilicus following non
sterile delivery. Tetanus is acquired through exposure to the spores of the bacteria clostridium
tetani which are universally present in the soil.

People of all ages can get tetanus. But the disease is particularly common and serious in newborn
babies. This is called neonatal tetanus. Most infants who get the disease die. Neonatal tetanus is
particularly common in rural areas where most deliveries are at home without adequate sterile
procedures. World Health Organization estimates that neonatal tetanus killed about 200,000
babies.

HOW TETANUS SPREAD

Tetanus is not transmitted from person to person. A person usually becomes infected with tetanus
when dirt enters a wound or cut. Tetanus germs are likely to grow in deep punctured wounds
caused by dirty nails, knives, tools, wood splinters, and animal bites. Women face an additional
risk of infection if a contaminated tool is used during childbirth or during an abortion.

A newborn baby may become infected if the knife, razor or other instruments used to cut its
umbilical cord is dirty, if dirty material is used to dress the cord, or if the hands of the person
delivering the baby are not clean.

Infants and children may also contract tetanus when dirty instruments are used for circumcision,
scarification, and skin piercing, and when dirty charcoal or other unclean substances are rubbed
into a wound.

SIGN AND SYMPTOMS

The time between getting the infection and showing symptoms is usually between three and 10
days. But it may be as long as three weeks, the shorter the incubation period, the higher the risks
of death.
In children and adults muscular stiffness in the jaw (called lock Jaw) is a common first sign of
tetanus. This symptom is followed by stiffness in the neck, difficulty swallowing, and stiffness in
the stomach muscles, muscles spasms, sweating, and fever. Newborn babies with tetanus are
normal at birth, but stop sucking between three and 28 days after birth. They stop feeding and
their bodies become stiff while severe muscles contractions and spasms occur. Death follows in
most cases.

COMPLICATION OF TETANUS

Fractures of the spine or other bones may occur as a result of muscle spasms and convulsions.
Abnormal heartbeats and coma can occur, as can also develop pneumonia and other infections.
Death is particularly likely in the very young and in old people.

TREATMENT OF TETANUS

Tetanus at any age is a medical emergency best managed in a referral hospital.

PREVENTION OF TETANUS

Immunizing infants and children with DPT and adults with TT prevent tetanus. More recently,
some countries have been using a combination of vaccines that includes vaccine for diphtheria,
tetanus, Pertussis, hepatitis B (hepB), and sometimes Haemophilis influenza type b (Hib).

Neonatal tetanus can be prevented by immunizing women of childbearing age with tetanus
toxoids, either during pregnancy or outside of pregnancy. This protects the mother and enables
tetanus antibodies to be transferred to her baby.

Clean practices are especially important when a mother is delivering a child, even if she has been
immunized. People who recover from tetanus do not have natural immunity and can be infected
again and therefore need to be immunized.

GLOBAL ACCELERATED DISEASE CONTROL ISSUES

WHO, UNICEF and UNFPA agreed to set the year 2005 as the target date for worldwide
elimination of neonatal tetanus. This implies the reduction of neonatal tetanus incidence to below
one case per 1000 live birth per year in every district. This goal was reaffirmed by the United
Nation General Assembly Special Session (UNGASS) in 2002. Because tetanus survives in the
environment, eradication of the disease is not feasible and high levels of immunization have to
continue even after the goal has been achieved.
To achieve the elimination goal, countries implements series of strategies:

• Improve the percentage of pregnant women immunized with vaccines containing tetanus
toxoids.

• Administer vaccines containing tetanus toxoids to all women of child bearing age in high
risk areas. This is usually implemented through a three round campaign approach.

• Promote clean delivery and child care practices.

• Improve surveillance and reporting of neonatal tetanus cases.

HEPATITIS B

DEFINITION: Hepatitis B is a viral disease that affects the liver. Adults who get hepatitis B
usually recover. However, most infants infected at birth become chronic carriers i.e. they carry
the virus for many years and can spread the infection to others. In the year 2000, there were an
estimated 5-7 million cases of acute hepatitis B infection and more than 521, 000 deaths from
hepatitis B related disease.

HOW HEPATITIS B SPREADS

The hepatitis B virus is carried in the blood and other body fluids. It is usually spread by contact
with blood in the following ways.

• Through an unsafe injection or needle stick. Unsterilized needles or syringes can contain
hepatitis B virus from an infected person, for example from a patient or a needle user.

• Transmission of the virus by mothers to their babies during the birth process, when
contact with blood always occurs.

• Transmission between children during social contact through cuts, scrapes, bites and
scratches.

• Transmission during sexual intercourse through contact with blood or other body fluids.

SIGN AND SYMPTOMS OF HEPATITIS B

The incubation period averages six weeks but may be as long as six months.

Infection in young children usually is asymptomatic. However, a large proportion of children

may become chronic carriers compared to adults. People who do not show symptoms may feel
weak and may experience stomach upsets and other flu-like symptoms. They may also have very
dark urine or very pale stools. Jaundice is common (yellow skin or a yellow colour in the white
of the eyes). The symptoms may last several weeks or months. A laboratory blood test is required
for confirmation.

Most acute infections in adults are followed by complete recovery. However, many children
become chronic carriers. People who recover from acute hepatitis B (and who do not become
chronic carriers) are protected from becoming infected again throughout their lives.

COMPLICATION OF HEPATITIS B

A small portion of acute infections can be severe and lead to death. The most serious
complications, including chronic hepatitis, liver cirrhosis, liver failure and liver cancer occur in
people with chronic infection.

TREATMENT OF HAPATITIS

There is no treatment for the acute condition. Supportive treatment is indicated. In chronic
infection the disease can sometimes be stopped with medications.

PREVENTION OF HEPATITIS

It is recommended that all infants receive three doses of hepatitis B vaccine during the first year
of life. More recently, some countries have been using a combination vaccine that includes
vaccines for diphtheria, tetanus, pertussis, hepatitis B (hepB), and sometimes Haemophilis
influenza type b (hib). Programmatically, it is usually easiest if the three doses of hepatitis B
vaccine are given at the same time as the three doses of DPT. In countries where hepatitis B is
highly endemic, where feasible, a birth dose of hebB is included in the schedule to prevent
perinatal hepatitis B infection,.

Some countries also recommended immunizing adolescents, health workers and other risk
groups.

HAEMOPHILUS INFLUENZAE type b (Hib)

DEFINITION: Haemophilus influenza type b (Hib) is one of the six related types of bacterium.
In 2000 H. influenza type b (Hib) was estimated to have caused two to three million cases of
serious disease, notably pneumonia and meningitis and 450000 deaths in young children.

HOW HAEMOPHILUS INFLUENZAE SPREAD

The Hib bacterium is commonly present in the nose and throat. Bacteria are transmitted from
person to person in droplets through sneezing, coughing. Infected children may carry Hib
bacteria without showing any signs or symptoms of illness, but can still infect others. The risk of
disease is highest for children between six months and two years of age.

SIGN AND SYMPTOMS OF Hib

Pneumonia and meningitis are the most important diseases caused by Hib bacteria. In developing
countries, pneumonia is more common than meningitis in children with Hib disease. Hib disease
should be suspected in the case of any child with signs and symptoms of meningitis or
pneumonia.

COMPLICATION OF Hib

Children who survive Hib and meningitis may develop permanent neurological disability,
including brain damage, hearing loss and mental retardation. 15% to 30% of children who
survive Hib disease are at risk of these disabilities. 5% to 10% cases of Hib and meningitis are at
risk of dying.

TREATMENT OF Hib

Hib disease can be treated with specific antibiotics.

PREVENTION OF Hib

Several Hib conjugate vaccines are available. All are effective when given in early infancy, and
have virtually no side effects except occasional temporary redness or swelling at the injection
site. To reduce the number of injections, Hib is sometimes given in combination vaccines, DPT-
hepB+Hib.

MENINGOCOCCAL MENINGITIS

DEFINITION: meningitis is a bacterial disease caused by bacterium Neisseria meningitides

(meningococcus). It is an infection of the brain and spinal cord. The disease is divided into
several types. Types A, B, C, Y and W135 cause most cases of meningococcal meningitis. More
recently types Y and W135 are gaining importance.

The disease occurs globally, but in sub- Saharan Africa meningitis epidemics occur every two to
three years. Since the 1980s the intervals between major epidemics have become shorter and
more irregular. The disease is most common in young children, but it can also be found in
children and young adults living in crowded conditions such as institutions or barracks.

HOW MENINGITIS IS SPREAD

Transmission of bacteria is from person to person through airborne droplets from the nose and
throat of infected people.

SIGN AND SYMPTOMS OF MENINGITIS

Meningococcal meningitis is marked by the sudden onset of intense headache, fever, nausea,
vomiting, and sensitivity to light and stiff neck. Other sign include lethargy, delirium, coma and
convulsions. The appearance of a rash composed of small spots of bleeding into the skin is an
important sign. Infants may have illness without a sudden onset and stiff neck. They may only
appear to be slow or inactive, to be irritable, to vomit or to be feeding poorly.

COMPLICATION OF MENINGITIS

In children, if meningitis is not treated, mortality is 50%; with early treatment mortality is
reduced between 5% - 10%. Even with treatment early in the disease, between 5% and 10% of
children who are infected die. About 10%-15% of those surviving meningococcal meningitis will
suffer from complication including mental disorders, deafness, palsies and seizures. A less
common but more severe and often fatal form of meningococcal disease is meningococcal
septiceamia, which is characterized by rapid circulatory collapse and haemorrhagic rash.

TREATMENT OF MENINGITIS

Because meningitis disease is often fatal, each case should always be considered a medical
emergency and should be referred to a hospital. Several types of antibiotic are effective.

PREVENTION OF MENINGITIS

Vaccines are available to protect against types A, C, Y, and W135.

Epidemic control relies on good surveillance with early detection and treatment. A mass
immunization campaign that reaches at least 80% of the entire population with types A and C
vaccine can prevent an epidemic. These vaccines are not effective in young children and infants
and only provide protection for a limited time, especially in children than two years old.

YELLOW FEVER

DEFINITION: yellow fever is a viral disease caused by the yellow fever virus which is carried
by mosquitoes. It is endemic in 33 countries in Africa and 11 countries in South America.

HOW YELLOW FEVER IS SPREAD

The yellow fever virus can be transmitted by mosquitoes which feed on infected animals in
forests, then pass the infection when the same mosquitoes feed on humans travelling through the
forest. The greatest risk of an epidemic occurs when an infected humans return to urban areas
and are fed on by the domestic vector mosquito Aedus aegypti, which than transmit the virus to
other humans.

SIGN AND SYMPTOMS OF YELLOW FEVER

The illness may be so mild that it is not noticed or diagnosed. Three to six days after a person is
infected, he or she suddenly develops fever, chills, headache, backache, general muscle pain,
upset stomach and vomiting. As the disease progresses, the person becomes slow and weak.
There may be bleeding from the gums and blood in the urine. Jaundice (yellowing in the white
part of the eyes or yellowing of the skin and palms) and black vomiting may also occur.

The diagnosis of yellow fever is difficult to make because its signs and symptoms are similar to
other diseases such as hepatitis, malaria, dengue and typhoid fever. As a result, any person who
develops jaundice within two weeks of the start of a fever should be considered to be a possible
case of yellow fever. To confirm the diagnosis of yellow fever, a blood sample should be taken
and sent to a laboratory for testing.

COMPLICATION OF YELLOW FEVER

If the illness is severe, the patient may experience convulsions or a coma. The disease usually
lasts two weeks, after which the patient either recovers or dies. In areas where the disease is
endemic mortality is about 5%. However, up to half of infected people may die during epidemic.

TREATMENT OF YELLOW FEVER

There is no specific treatment for yellow fever, supportive treatment is indicated. Dehydration
and fever can be treatment with oral rehydration salts and medication. Any accompanying
bacterial infection should be treated with an antibiotic. Intensive supportive care may improve
the outcome for seriously ill patients.

PREVENTION OF YELLOW FEVER

Immunization is the single most important measure to control yellow fever. The main strategies
to control yellow are based on a combination of immunization for protection against the disease
and surveillance, and are outlined below.

Prevention

• Administering yellow fever vaccine as part of routine infant immunization.

• Preventing outbreaks in high-risk areas through mass campaign;

• Control of Aedes aeguptica in urban centres.

Both these strategies should ensure a minimum coverage of at least 80%.

Control

• Instituting a sensitive and reliable YF surveillance system including laboratory capacity

to analyze samples and confirm suspected cases;

• Emergency response to outbreaks through mass campaigns.

VITAMIN A DEFICIENCY (VAD)

DEFINITION: vitamin A is a substance that is required by the human body. Vitamin A:

• Strengthens resistance to infection;

• Increases a child’s chances of surviving an infections;

• Promotes growth; and

• Protects the transparent part of the eye called the cornea. If a person does not have
enough vitamin A in his or her body, the person may have difficulty seeing in dim light.

The body cannot make vitamin A, so all of the vitamin A we need must come from the food we
eat. Vitamin A is present in the following foods:

• Breast milk;

• Liver, cheese and other dairy products;

• Yellow and orange fruits, e.g. mangoes and papayas;

 • Yellow and orange vegetables, e.g. pumpkins and carrots;

• Dark green, leafy vegetables;

• Red palm oil.

Vitamin A can be added to foods such as sugar, vegetable oil, and wheat flour during processing.
This is called food fortification.

What is vitamin A deficiency (VAD)?

Vitamin A deficiency occurs when a person does not eat enough food containing vitamin A or
when it is used up too fast by the body. This is often happens during an illness, during pregnancy
and lactation, and when children’s growth is most rapid, i.e. from age six months to five years.

SIGN AND SYMPTOMS OF VITAMIN A DEFICIENCY

Vitamin A deficiency (VAD) reduces resistance to infections, leading to more severe and
prolonged illnesses and therefore increasing the risk of death. It can cause eye damage such as
corneal lesions, and when severe can cause blindness. Generally, the first clinical sign of vitamin
A deficiency is night blindness (impaired vision in dim light). However, because vitamin A
deficiency reduces the body’s resistance to infection, it is a threat even before any direct signs
become apparent. Vitamin A deficiency can also cause anaemia. Vitamin A deficiency has been
shown to increase a woman’s risk of dying during pregnancy and the first three months after
delivery.

Children suffering from vitamin A deficiency are more likely to get infections such as measles,
diarrhea and fevers; and their infections are more likely to be severe, sometimes resulting in
death.

WHAT IS VITAMIN A SUPPLEMENTATION

When diets do not contain food with enough vitamin A, it is possible to increase vitamin A levels
in the body by periodically taking a concentrated dose or supplement in the form of a capsule.
This is called supplementation. When given to children, vitamin A capsules are cut open and the
drops of liquid inside are squeezed into the mouth.

Vitamin supplementation can be combined with immunization services for children and women
when health officials know or suspect that vitamin A deficiency is present in an area or among a
certain population.
In addition, vitamin A supplementations are also given for treatment of measles and eye damage
(xerophthalmia).

IS THERE ANY CONTRAINDICATION TO VITAMIN A SUPPLEMENTS?

There are no contraindications to vitamin A supplements for children and post-partum women if
they are given according to the schedules. Vitamin A may be given at the sometimes as
immunization.

IS THERE ANY SIDE EFFECTS TO VITAMIN A SUPPLEMENTS?

Usually, there are no side effects. However, on rare occasions a child may experience headache,
loss of appetite or vomiting. The symptoms will pass by themselves, and no treatment is
necessary. Parents should be advised that this is normal.

Others include:
• Cholera.
• Cerebro spinal meningitis.

• Typhoid fever.

• IMMUNIZATION AND VITAMIN A SUPPLEMENTATION SCHEDULE

ACCORDING TO NATIONAL GUIDELINES

IMMUNIZATION SCHEDULE
VACCINE NO AGE TIME ROUTE OF DOSES VACCIN SIDE STORA
OF INTER ADMINSTR ATION EFFECTS TEMPE
DOS VAL ATION SITE URE
ES
BCG 1 AT - Intradermal 0.05mls Upper left Fever, pain, 0 to
BIRTH arm scar degrees
OPV 4 AT 4wks Oral 2 Drops mouth Paralysis 0 to
BIRTH, degrees
6, 10,
&14wk
s
HEPATITIS B 1 AT - Intramuscular 0.5mls Outer part Pain, +2 to
BIRTH of thigh swelling, degrees
 redness,
fever
PENTA-DPT, 3 AT 4wks Intramuscular 0.5mls Outer part Pain +2 to
HEPB, HiB BIRTH, of thigh swelling, degrees
6, 10, redness,
14wks fever
PCV 3 AT 4wks Intramuscular 0.5mls Outer part Pain +2 to
BIRTH, of thigh swelling, degrees
6, 10, redness,
14wks fever,
drowsiness
MEASLES 1 AT - Subcutaneous 0.5mls Upper Pain, 0 to
9mths outer part swelling, degrees
of left arm redness,
fever
YELLOW 1 AT - Subcutaneous 0.5mls Upper Pain, 0 to
FEVER 9mths outer part swelling, degrees
of right redness,
arm fever
VIT A 2 AT 6mths Oral 100,000iu mouth
9&15m &200,000i
th u

T.T ADMINISTRATION GUIDELINES FOR WOMEN OF CHILD BEARING AGE

AGE RECOMMENDATION PERIOD OF

PROTECTION
FIRST T.T at first contact with women of child 0 protection
CONTACT bearing or as early as possible.
SECOND T.T2 at least 4 weeks after T.T1 6 months protection
CONTACT
THIRD T.T3 at least 6 month after T.T2 5 years protection
CONTACT
FOURTH T.T4 at least 1 year after T.T3 10 years protection
CONTACT
FIFTH T.T5 at least 1 year after T.T4 For life
CONTACT
DOSE SIZE 0.5 mls
NO OF DOSES 5
INJECTION Muscles of left upper arm Never immunize in the
SITE buttocks

CONTRA-INDICATION TO IMMUNIZATION

There are few contra-indications to immunization. The health worker should immunize eligible
children and women except in the following rare situations.

• Do not give the 2nd or 3rd dose of Penta vaccine to a child who has had severe reaction to
an earlier dose. Severe reactions include convulsions or shock within 3 days after
injection.

• Do not give BCG or Yellow fever vaccine to child with clinical AIDS.

• If a parent strongly objects to vaccinating their sick child even after proper counseling do
not give it.

REMEMBER

• There is almost no contra-indication to immunization.

• The health worker can vaccinate children and women affected by

-Minor illnesses including colds, diarrhea and fever.

-Allergy, asthma.

-Malnutrition.

The health worker can vaccinate premature infants and breastfeeding children.

ADVERSE EFFECTS FOLLOWING IMMUNIZATION (AEFI)

DEF- An adverse following immunization (AEFI) is a medical incident that takes place after an
immunization is a cause of concern to the child’s care giver and is believed to be cause by
immunization (WHO Aide memorie: AEFI investigation, 2004).
CLASSIFICATION OF AEFI
CLASSIFICATION DESCRIPTION
VACCINE REACTION Event where an individual reacts to a particular vaccine. The
reaction could be due to the active component of the vaccine
itself; the preservative or the stabilizer. Most vaccine reactions
are mild, common and expected. They settle without treatment
and have no long term consequences. Serious reactions are very
rare.
PROGRAMMATIC ERROR Events caused by error in vaccine preparation, handling or
administration; they are the most frequent cause of adverse
events and can be avoided.
COINCIDENTAL Events happens after the immunization but is not caused by the
vaccine or the programme i.e. a chance association.
INJECTION REACTION Anxiety or pain from the injection itself rather than the vaccine
even after safe injection practice.
UNKNOWN/ Adverse event with unknown cause.
UNDERMINED

TYPES OF AEFI

MILD AEFI- Is defined as incident or reaction that is not serious. Most vaccine induced
reactions are mild and transient, most frequently being soreness at the injection site and mild
fever.

SERIOUS AEFI- is defined as those events that:

• Result in death

• Result in hospitalization or prolongation of existing hospitalization (e.g. seizures,

encephalopathy, and aseptic meningitis).

• Result in persistent or significant disability or incapacity (e.g. paralysis).

• It is life threatening.

AEFI PRESENTATION

Vaccine reactions may be classified into:

• Common minor reactions.

• Rare more serious reactions.

Most vaccine reactions are mild and settle on their own. The serious ones are rare and in
general do not result in long term problems.
Common minor reactions following immunization include:

• Local reactions like redness at injection site, pain and swelling.

• Fever <38 degrees centigrade.

• Irritability.

• Malaise.

• General apathy.

These symptoms results from normal body reaction to a vaccine or its components. The rare,
more serious vaccine reactions include:-

• Convulsion.

• Anaphylactic shock.

• Severe allergic reactions e.g. generalized Urticaria and angioedema.

• Encephalopathy.

CAUSES OF AEFI

Programme errors

• Overdose of vaccine given.

• Inadequate shaking of vaccine before it is given.

• Immunization injected in wrong place or plane.

• Use of reused syringes and needles.

• Used needles handled carelessly.

• Drugs accidentally substituted for vaccine.

• Vaccine or diluents contaminated due to poor technique.

• Vaccine stored incorrectly.

• Contraindications ignored.
 • Using vaccines beyond their discard points.

Programmatic errors can be avoided by observing for the following:

• Reconstituting vaccine only with the appropriate diluents from the same manufacturer.

• Apply correctly the multi-dose vial policy.

• Do not store anything else in the vaccine fridge except the vaccine.

• Inject vaccine in the proper place and plane at all times.

• Completely investigate each AEFI and take corrective measures.

Coincidental AEFIs

These are events caused by something other than programme errors and individual reactions to
vaccine. A coincidental event means that the medical incident would have occurred even if the
individual had not been immunized. Coincidental events are unrelated to immunizations or
vaccines in any way except for the time that they occur. The best evidence to support a
conclusion that a medical incident is coincidental is that the same event has been diagnosed in
people who have not been immunized.

Unknown causes of AEFI

These are the events that occur due to an unknown cause. As more research on AEFIs is
undertaken, events previously categorized as unknown will more appropriately fall into
programme related, vaccine-induced, or coincidental causes thereby reducing the number of
events categorized as unknown.

BARRIERS TO REPORTING AEFIs

Health workers may not report AEFI for one or more of these reasons:
• Not considering the event as related to immunization.
• Not knowing about the reporting system and process.
• Lethargy, procrastination, lack of interest or time, lack of appropriate reporting forms.

• Fear that the report will lead to personal consequences.

• Guilt about having caused harm and being responsible for the event.

• Hesitate about reporting an event when not confident about diagnosis.

Health worker must be encouraged to report adverse event without fear of penalty. It should be
clear to the supervisors and the health workers that the aim of reporting is to improve systems or
provide further training and not to blame individuals.

• DESCRIBE HOW TO TRACE DEFAULTERS

The reasons why mothers default immunizations appointments includes:-
• Travelling distance to the clinic which according to them is too far from their houses.

• Lack of money

• Ignorance due to improper feed backs from health workers (immunizers.)

• Family crisis leading to divorce, while the baby is still young.

• Cultural believes.

• Injection reactions at the site of immunization.

• Attitude of health workers.

• Lack of vaccine in the facility.

HOW TO TRACE DEFAULTERS

• Through home visits.
• Through facility immunization register.

• Though home based cards.

• Through the record of VVHW.

• Through phone calls.

• During campaigns (IPDs, SIDs).

SOLUTION TO FACTORS MILITATING IMMUNIZATION DEFAULT AGAINST

• Establishment o

• f more outreach posts and other health facilities.

• Establish baby tracking and default tracing exercise

• Promulgate immunization laws and regulations.

 • Health education.

• THE IMPORTANCE OF KEEPING RECORDS OF IMMUNIZATION

ACTIVITIES

• It helps to monitor progress.

• It gives information on the number of children immunized.

• It helps in the planning process.

• It helps to identify strength and weaknesses.

• For improvement in performance.

6. It is important in delivery of services.

7. It helps in tracing of defaulters

• MONITORING AND SUPERVISION OF JCHEWS DURING

IMMUNIZATION ACTIVITIES
2.7 HOW TO TEACH MOTHERS WHEN TO TAKE IMMUNIUZATION

• Explain to them about the six vaccine preventable diseases using their local names where
necessary.

• The dangers the diseases could cause to the afflicted children, i.e. sickness, disability and
death (to the children), loss of time, money, peace of mind etc. to the parents.

• Facts that the vaccine preventable diseases are preventable by immunization.

• The dangers of delay in terms of when to start immunization for the children.

• Which vaccines prevent which disease?

• Required doses and age of administration.

• The importance of regular clinic attendance.

• The types and the relative mildness of side effects as compared to an affliction by the
actual diseases.
 • The value of keeping safe the vaccination card.

10. The fact that uncompleted doses are useless in giving the desired protection.

CONSEQUENCES OF NOT TAKING IMMUNIZATION

• It may lead to permanent disability especially in case of poliomyelitis infection.
• It may also cause sickness in children.

• On the part of the parents it may lead to loss of time, money and peace of mind.

• It may lead to deafness, blindness and malnutrition in case of measles infection.

• It will make the children to be susceptible to many vaccine preventable diseases.

• It may lead to death.

Routine Immunizations Data Management Tools

• Talley sheets.

• Child immunizations register.

• Immunizations register for women.

• Facility immunization summary.

• LGA monthly, routine immunization activities report.

Routine immunization monitoring tools

• Monitoring chart for dropout rate.

• Monitoring chart for different antigens, coverage for children under 1 year.

• Monitoring chart for WCBA, T.T.

• Child health chart, immunization record.

Presentation of data

• Table.
 • Graph.

• Bars.

Calculating immunization coverage rate

Coverage = no. of children immunized x100

Target population x 1

Calculating dropout rate

Cumulative doses of Penta 1- cumulativepenta 3 x100

Cumulative doses of Penta 1

Common reasons for immunization drop out

• Migrant population.
• Inadequate/ lack of information
• Misinformation.
• Poor quality service resulting in client dissatisfaction.
• Erratic service.
• Inconvenient schedule.
• Poor documentation.
• Social, cultural and political barriers.
• Geographical distance + hard to reach areas.

Intervention if there is a relevant drop out

• Child tracking, contact tracing.

• Advocacy.

• Mobilization and sensitization.

• Monitoring and supervision.

• Monitor vaccine supply and utilization.

 • Creating more outreaches.

• Rescheduling immunization days.

• Attitudinal change of health workers.

• Start integrated services to reduce missed opportunities.

Ways to mobilize the community in order to effectively participate in the immunization

exercise

• Know the community.

• Make initial contact with the community leaders.

• Communicate intention to the leaders.

• Arrange meeting with the community leaders and community representatives.

• Develop agenda for the meeting.

• Attend the meeting.

• Explain the purpose of the meeting in an acceptable language.

• Request them to convey the message to other community members and bring feedback
during subsequent meeting.

• Encourage questions and participation from the audience.

• Decide with participants the time, date and venue for the next meeting.

• Have as many meeting as necessary until consensus is arrived at.

• CHALLENGES OF IMMUNIZATION COVERAGE

• Distance to the place

 • Refusal to vaccinate an eligible child

• Waiting time

• Lack of supplies

• Poor knowledge of parents

• Fear of side effects

• Lack of promotion at the community level etc

IMMUNIZATION CAMPAIGNS

Immunization campaign is an essential aspect of immunization programme, it refers to all the

sets of action intended to obtain successful immunization coverage.

STAGES INVOLVED IN IMMUNIZATION CAMPAIGN (ROUTINE AND

SUPLEMENTARY)

In order to make a desirable campaign and achieve the objectives intended, certain important
stages have to be adhered to. This includes;

• Planning stage

• Implementation stage

• Post implementation stage

Planning stage

Every campaign programme must be planned. No programme or project ever succeeds without
being planned. Planning is an inevitable part of immunization campaign. It involves the
following steps:

• Distribution of letters to the local government chairman, the PHC coordinators

and other key officers of the local government area level where the
implementation of the programme is to be done.

• Such letters should contain the following information:

• Objectives of the campaign e.g. immunization campaign may be centered

 on poliomyelitis eradication in Nigeria.

• The phase and round of the immunization programme, for instance, phase one (1)
round one (1) may be directed to a particular childhood diseases e.g tuberculosis

• Strategies to be used in achieving the programme such as house to house and use of
static or outreach methods.

• The date of commencement and the duration of the campaign should range from few
days to one or two weeks.

• The skills and number of participants

• Training programmes for others to be engaged

• Note the expectations and contributions of the LGAs towards the success of the
campaign

• Note the expectations and contributions of the state and federal government through
various agencies

• Provide a time table for the achievements of the said objectives understanding that
these activities are to be coordinated and supervised by the state where the skilled
manpower exist

• At the state level budgets have to be prepared to address the following needs:

• Personnel cost

• Materials needed and cost implication

• Cost of organizing advocacy meetings with the policy makers

• Cost of publicity/mobilization from the state to grassroots level

• Design key massages for dissemination (social mobilization)

Implementation stage

Having concluded the planning stages of the immunization campaign and at the same time
disseminated the information to those involved, the next stage is the implementation. The
implementation stage involves the following activities;

• Distribution of vaccines to local government areas

• Distribution of materials and cold chain equipments to the local government areas

• Posting of state supervisors to each local government area to supervise and report
back to the state ministry of health at the end of the programme

• Undertake a pre – implementation visit to the LGAs to ascertain their readiness

• Flag – off ceremony to bro organized a day before the actual take – off of the
programme usually at the LGA headquarters or any selected location within the LGA
to create avenue for mobilization

• Send out independent monitoring team to the LGA to evaluate the programme,
identify areas of weakness and make suggestion that will lead to sustained
improvement

• The monitoring teams and supervisors to pay for advocacy visits to the community
leaders and other leaders of thought in the LGA to solicit for more support

Post – implementation stage

This refers to all the activities that take place after the programme has been implemented.
Prominent among this activities are;

• Collection of data and presentation of reports to the state ministry of health

• Evaluation of report through review meeting

• Checking areas of strength and weakness

• Making comparative analysis of the past and present results to know if the objectives
has been achieved or not

• Decide measures that will circumvent the factors that posed some hindrance
• Reports of programme to be completed by the state authorities and sent to the federal
and donor agencies for assessment and future reference

• Resolve to reward all participants. The reward which takes the form of certain
allowances serves as motivation for participating in the programme.

IMMUNIZATION METHODS

These are various means by which immunization services can get to the people. The common
methods used for routine or supplementary immunization services are;

• STATIC CENTERS

These are designed centers or areas in which the normal routine immunization services
including health education and medical consultation services can be rendered by trained
health personnel.

The static centers can be categorize into four (4) namely;

• Hospital immunization center or unit

• Comprehensive Health centers

• Primary Health centers

• School demonstration clinics

• MOBILE UNITS

This refers to all hard to reach areas such as migrants, herdsmen and the fishermen
settlements. The areas are so remote that the only possible way of reaching them is by
foot, bicycles or in some cases by boats or motor – cycles.
 • NATIONAL IMMUNIZATION DAYS (NIDs), SIDs and LIDs:

This is the most efficient method of providing immunizations services to the people.
NIDs/SIDs/LIDs are immensely undertaken in which health workers and volunteers go
from house to house in the target areas to immunize children against e.g poliomyelitis and
other childhood killer diseases. NIDs/SIDs/LIDs also provides vitamin A
supplementation, which help in reducing childhood deat5hs resulting from common
infectious diseases.

• MANAGEMENT OF COLD CHAIN AND STORAGE SYSTEM

• THE COLD CHAIN SYSTEM

Cold chain is a logistic system of keeping vaccines cold at a recommended temperature that
will ensure their potency from the manufacturers end to the points at which they are
administered to the recipients.

Cold chain is an important component of every immunization programme, which implies that
careful attention has to be taken in transportation, storage and administration of vaccines to
avoid loss of vaccine potency.

COLD CHAIN EQUIPMENTS

The cold chain equipment includes:

• Refrigerator

• Freezers

• Cold box

• Vaccine carrier
 • Ice – pack

• Thermo flask

• Thermometer

Refrigerator

Refrigerator maintains a temperature range from 0 o – 8oc. It keeps certain vaccines and diluents
cold e.g Tetanus Toxoids (TT), Diphtheria Pertussis tetanus (DPT), and Hepatitis B (HBV)
vaccines.

The refrigerator should be checked twice daily to ensure that it is in good working condition.

Freezer

The freezer work at a temperature below freezing points that is temperature range between -15 o
to -25oc. Vaccines usually stored in freezer include oral polio vaccine (OPV), measles vaccine
and yellow fever (YF).

The freezer is also used in making ice – packs and should be checked twice daily to ensure that
it is in a good working condition.

Cold box

The cold box is used to store large quantities of vaccines from cold store to health centre. Cold
box keeps vaccines cold for up to one week. It should be handled with care especially when there
are vaccines inside.

Vaccine carrier

Is small equipment which is used in transporting small amount of vaccines to outreach unit. It is
portable and can easily be carried by an individual or on bicycles. It can only preserve vaccines
for a maximum of one day.

Ice – pack

Is a plastic bottle which contains solid ice that is formed in the freezer. It keeps the vaccines cold
within the period of immunization exercise in the same day.
Thermo flask

This is mobile cold chain equipment that can be used especially when the vaccination trips
involved house -to – house such as in the national immunization days (NIDs). It carries very little
amount of vaccines and can only keep vaccines cold for a maximum of six (6) hours

• HOW TO MAINTAIN COLD CHAIN AND STORAGE SYSTEM

Vaccine storage

This means all the steps taken to protect vaccines and to ensure that they are in good working
conditions as well as keeping to the appropriate temperature in their vaccine storage equipment.
The steps that must be considered are as follows:

• Store each vaccine at its storage temperature.

• Record temperature twice daily i.e. morning and evening.

• Insert cold chain monitoring chart which is designed to last for a whole year and in
which provisions have been made for every day and monthly charting.

• Insert functional thermometer which will enhance effective monitoring of

temperature. The thermometer is calibrated to read either positive when it is
refrigerated and negative when it is frozen. The thermometer must be kept whenever
vaccines are stored.

• Vaccines should not be compacted in a shelve or compartments, for instance, vaccines

that are to be kept frozen should be put in freezers, while the ones that are not to be
frozen should be put in refrigerators.

• Tetanus Toxoids (TT), DPT and Hepatitis B should be stored at a temperature of +2 0

to +40c and even up to +80c in refrigerators.

• Oral polio vaccines (OPV), measles vaccines, yellow fever vaccines (YFV) and BCG
vaccines should be stored at -15o to -250c.

• All received and stored vaccines should be recorded accordingly.

• Food items should not be stored in the same refrigerator with vaccines.
 • Vaccines should not be stored in refrigerator’s door.

Maintenance of cold chain system from port to zonal stores

• Ensure

• Vaccines are transported in cold boxes.

• Vehicle for transportation must be reliable.

• If it breaks down, keep vaccine in a refrigerator to keep the vaccine cold and maintain its
potency.

• Ensure that the officer handling the vaccines at the point in time is responsible, dedicated
and knowledgeable about the consignment.

At the zonal health office, health clinic and health centres

• Keep vaccines in the refrigerator at the store; check the refrigerator two times daily in a
week, day and once daily on the weekend.

• Defreeze once a week.

• Request only enough vaccine to do your work.

• Do not keep extra vaccines that cannot be used.

• Pack cold boxes properly and protect them from heat which vaccines are inside.

• Keep the ice box door shut except when taking the temperature.

• Do not allow anyone to use the vaccine refrigerator to store food or drinks

3.3 HOW TO ESTIMATE AND REQUEST FOR VACCINE AND OTHER COLD CHAIN
EQUIPMENTS

ESTIMATING TARGET POPULATION

The target population for routine immunization

• Infant under one year (0-11mth) = 4% of the total population.

 • Women of child bearing age (15-49yrs) =22% of the total population.

Population figures for settlements should be obtained from the projected census population from
the national population commission.

Calculating target population of the health facility catchment area

The target population of health facility is the total target population of all individual settlements
in the catchment area of the health facility. Therefore obtain the total population of each of the
settlements, calculate the required target for each settlement and add them together to get the
health facility target population.

Example: - three settlements in catchment area of a health facility.

Settlement A has total population of 12,200 people.

Settlement B has total population of 10,120 people.

Settlement C has total population of 6,530 people.

28,850
To calculate for children under one year (0 – 11 months)

Target population for settlement A = 12,200x4/100= 488.

Target population for settlement B= 10,120x4/100= 405.

Target population for settlement C = 6,530x4/100=262.

1,155
The target population for the health facility is 1,155.

To calculate for women of child bearing age (15 – 49 years)

Target population for settlement A = 12, 200 X 22/100 = 2684
Target population for settlement B = 10, 120 X 22/100 = 2226.4
Target population for settlement C = 6, 530 X 22/100 = 1436.6
The target population for the health facility is 6347

NB
These figures should be displayed by settlement in the health facility.

Calculating requirements

Target population is used in making the requirements calculations, including number of sessions
to be conducted by a facility e.g calculate for-

• Vaccines: - target population x target coverage x no. of doses x WF.

• Syringes: - total doses of injectable vaccines x 1.1 WF.

• Dilution syringes: - doses of injectable vaccines/no. of doses per vial.

• Safety boxes: - number of syringes (AD+ dilution)/100.

NB WF: wastage factor.

• TYPES AND METHODS OF STERILIZATION OF EQUIPMENTS

3.5 MAINTENANCE OF MATERIALS AND EQUIPMENTS

3.6 MEDICAL WASTE DISPOSAL IN IMMUNIZATION

ENSURING SAFETY DISPOSAL OF INJECTION EQUIPMENT

Used needles and syringes should be placed in safety boxes immediately after administration of
injectable vaccines. Close the nearly (approximately ¾) fill box securely with the latch provided
and store the box in a safe place until it can be properly disposed of. Closing the box securely
prevents infecting the health care worker, other health care workers and the community from
injury. To avoid an occupational hazard, safety boxes should not be more than ¾ full.

One box can hold 100 syringes and needles. If for any reason the safety boxes run out at post,
used injection equipment can be disposed of in a puncture resistant container with a lid, such as a
bucket.

INJECTION WASTE TREATMENT AND DISPOSAL

All filled safety boxes should preferably be disposed by high temperature incineration.
STEPS FOR BURNING IN A HIGH TEMPERATURE INCINERATOR

• Take filled safety boxes to a high temperature incinerator if one is available in the health
facility.

• The incinerator should be pre-heated to about 600 degrees.

• The safety boxes are introduced into the incinerator and burnt between 800 degrees to
1000 degrees.

• The residual ash should be disposed of in a protected ash pit.

• Where there is no incinerator, waste should be disposed by drum burning, not to be

buried and no pit burning.

• Take filled safety boxes to a high temperature incinerator if one is available in the health
facility.

• The incinerator should be pre-heated to about 600 degrees.

• The safety boxes are introduced into the incinerator and burnt between 800 degrees to
1000 degrees.

• The residual ash should be disposed of in a protected ash pit.

• Where there is no incinerator, waste should be disposed by drum burning, not to be

buried and no pit burning.

Do not dispose other types of waste in the safety boxes. Instead, other types of waste should be
disposed in a bin and burned regularly along with the safety boxes.

TRANSPORTATION AND DISPOSAL OF CONTAMINATED SHARPS

Ensure adequate transport is made available to collect the safety boxes at the end of each day,
from each fixed post. All vehicles used to transport injection waste must be disinfected after
completion of the circuit.

HANDLING BOXES

Contaminated sharps should not be transferred from container to container and must not be left
in a public area of the post or health facility. All filled safety boxes must be kept in a safe
location, preferably locked until disposal.

3.7 PROBLEMS THAT COULD BE ENCOUNTERED AT EACH NODAL POINT OF

THE CHAIN

• Vaccines are at risk due to inadequate temperature monitoring and maintenance system.

• Lack of trained officer to handle the vaccine at the nodal point.

• Lack of reliable vehicle for transportation.

• Lack of requesting only enough vaccine to do the work.

• Allowing people to use the vaccine refrigerator to store food and drinks.

• Lack of sufficient cold chain equipment’s e.g. refrigerator, deep freezers etc.

REMEMBER

• The safety boxes should be properly assembled according to instructions printed on the
boxes.

• Open safety boxes containing contaminated syringes are a source of infection and can be
dangerous.

• Designate someone to be responsible for overseeing the burning process.

• Since it is unlikely that someone will be at the site all the time, display a sign warning
people to steer clear of the burning site.