CHAPTER–9  Communicable Diseases 373

WHO Universal Immunization Program UR

Watt
2 I
The UIP includes, in addition to those in our national immunization schedule,
the Haemophilus influenzae B vaccine to be given at 6, 10 and 14 weeks and the
yellow fever vaccine at 9 months.
Recommended schedule by Indian Academy of Pediatrics
Some vaccines which have been omitted in the National Immunization Schedule/
UIP due to financial constraints are recommended by IAP for those who can afford
it.
Table 9.3. Immunization schedule—IAP indianrendentofPediatrics
BCG Between birth and 2 weeks Zapf
OPV Birth; 6, 10 and 14 weeks, 16–18 months, 5 years I
HE
OPV 6, 10 and 14 weeks, 16–18 months, 5 years
Hepatitis B Birth; 6, 10 and 14 weeks
Haemophilus
influenzae B (Hib)
conjugate 6, 10 and 14 weeks
MMR 15 months
Typhoid 2, 5, 8 and 12 years
TT or dT[a] 10 and 16 years
TT 2 doses one month apart in pregnant woman, or a booster
dose if previously immunized
Vaccines that can be given after discussion with parents
Chickenpox After 1 year of age
Hepatitis A For high risk infants at 18 and 24 months
Pneumococcal conjugate 6 weeks
Influenza vaccine For high risk infants at 6 months of age
[a] The "adult" type diphtheria tetanus combination, which contains a lot less diphtheria
toxoid than the pediatric one, thus a small 'd'
thisis
Ithink
duetoStrom
Vaccines immunereactionof

Vaccines are antigens to induce specific active immunity against a disease.

theAdults inco
tobaby
Live attenuated vaccines
Live attenuated vaccines (LAV) are prepared by attenuation of live organisms by
heat, subculture (BCG, OPV, MMR). Live vaccines are more potent because the

EF
organisms multiply in body, express all the antigens of that particular organism

_E
and often leave a residual immunity after they have been excreted by the body (i.e.
mucosa immunity provided by oral polio vaccine).
ALLLIVEVACCINESARE CONTRAINDICATED IN IMMUNODEFICIENT
AND PREGNANCY. Also, there must remain a gap of AT LEAST 3 WEEKS
between administering a live vaccine and any other vaccine. Or they may be given
on the same day.
 374 Community Medicine There are 3 strains of polio
3times
Live vaccines are single dose (except polio, which is given thrice because
8
seroconversion occurs one strain at a time). Because live vaccines contain living
organisms, they require a stringent cold chain.
-
A
Killed vaccines 41
r
I
Killed vaccines: Organisms killed by heat/chemical methods (typhoid, pertussis,
r t
u
HAV, influenza, cholera, plague) may also induce active immunity, because they
still retain the antigens. Killed vaccines are:
• Safer than live vaccines (the organisms are already dead)
• Less potent
• Require booster doses (Fig. 9.7)

no
• Cannot be given orally (they'll be readily digested by enzymes).

:Killed vac‫ال‬
‫كوليرا‬
IPV ( Salk) ‫معروف‬
Parenteral In uenza vac
Pertussus
Plague
Typhoid+HAV

I
Figure 9.7. This 1964 poster featured what at that time, was CDC’s national symbol of
public health, the “Wellbee”, who here was reminding the public to get a booster vaccina-
tion; the image reflects the parallel development of immunology and space sciences during
the sixties [CDC Public Health Image Library].

Subunit vaccines
r
Subunit vaccines/cellular r
fractions/toxoids are particular proteins from
g
the agent which, after detoxication, may be used for immunization (HBsAg,
meningococcal cell wall antigen, Haemophilus influenzae B capsule, diphtheria
and tetanus toxoids).
n g
Adjuvants
An adjuvant is a compound that are added to potentate a vaccine (they produce
in
a local granuloma to retain the antigen and decelerate its release) i.e. aluminium
phosphate, aluminium hydroxide, water in oil.
 CHAPTER–9  Communicable Diseases 375
Freeze dried vaccines Sublimation‫تسامي‬
Freeze drying (also known as lyophilization or cryodesiccation) is a dehydration
process typically used to preserve a perishable material or make the material more
convenient for transport. Freeze-drying works by freezing the material and then
reducing the surrounding pressure and adding enough heat to allow the frozen
water in the material to sublime directly from the solid phase to the gas phase.
Freeze dried vaccines (BCG, measles, yellow fever) are powdered vaccines
prepared in such a way as to increase shelf life of vaccine. They are reconstituted
in a suitable liquid (BCG in saline, Measles in double filtered pyrogen free water.
In addition, preservatives like thiomersal are often added.

Immunoglobulins
Normal human Ig

E Ets
They are antibody rich plasma fractions obtained from a pool of at least 100 donors.
Such ‘passive immunisation’ has been devised for measles (for highly susceptible
individuals) and HAV (for travelers). Because normal human Ig contains many
other antibodies other than the one wanted, live vaccines given within 12 weeks of
normal human Ig will get inactivated by those immunoglobulins. On the contrary,
normal human Ig may be given after 2 weeks of a live vaccine.

_YIÉEy
Specifi c human Ig take
It is made from plasma of single convalescents patients, and contains antibodies
at least in five fold concentration. Such Ig’s have been devised for chickenpox,
rabies, HAV, HBV, rubella, tetanus, Rh-isoimmunization. They are more specific,
concentrated for intramuscular use and do not interfere with live vaccines.
Adverse reactions to immunoglobulins
1. Local—Pain and sterile abscess.
2. Systemic—Flushing, flank pain, rigor, dyspnea, shock, urticaria, arthralgia,
fever, diarrhea.
Antisera/ antitoxin t
É
They are crude preparations of animal serum (diphtheria, tetanus, gas gangrene,
AVS, rabies), slowly but surely being obsoleted.
ASV
d The ‘cold chain’
It is the combination of machines, personnel and procedure responsible for storing
vaccines at recommended temperature (0–8°C) from production to use. Arranging
the vaccines by heat sensitivity, we have OPV > Measles > Pertussis and mumps >
Hepatitis B > DPT > DT > BCG > DPT > TT. The T series vaccines and hepatitis
B vaccine are also ‘freeze sensitive’ and should never be exposed to subzero
temperatures.304
REGIONAL CENTERS

EE
Store > 3 months in cold rooms (< 0°C)
Transported to PHCs in cold boxes with ice packs;
cold boxes may also be used for emergency storage

01 11
19 IS
376 Community Medicine

↓
PHC
Store for < 1 month in ILR (2–8°C)
-
or for a longer duration in deep freezer (< 0°C)
↓
SUBCENTER

of
Distribute by vaccine carriers containing 4 fully frozen ice packs (2–8°C);
Unused vials are returned to PHC, marked and restored in ILR;

What to do with vials that have been opened but not used?
Global policy on this matter used to be that opened vials of all vaccines were
discarded at the end of each working day. In 1995, WHO recommended a changed
global policy on the use of opened vials of vaccine as follows.
1. Opened vials of OPV, DPT, DT, TT and hepatitis B vaccines may be used in
subsequent immunization sessions until a new shipment of vaccine arrives,
provided that each of the following 3 conditions are met
• The expiry date has not passed
• The vaccines are stored under appropriate conditions (0 to +8°C)
• Opened vials of vaccine which have been taken out of the health facility
for immunization activities (e.g. outreach, National Immunization Days) are
discarded at the end of the day.
2. Opened vials of measles, yellow fever and BCG vaccines must be discarded
within six hours.
3. An opened vial must be discarded immediately if
• sterile procedures have not been fully observed, or

I
• there is even a suspicion that the opened vial has been contaminated, or
• there is visible evidence of contamination, such as a change in appearance,
floating particles
Cold chain equipments
Walk in cold rooms. A cold room where people walk in and get the vaccine (as
simple as that, does it need any more explaining?)
Deep freezers. Deep freezers create sub zero temperatures. They are suitable
1. to store for vaccines > 3 months
2. to make ice packs which are used in vaccine carriers.
The deep freezer should be placed in a well ventilated room at least 10–20 cm
from the wall, and should not tilt on any side (should be perfectly horizontal). The
power cable should be fixed PERMANENTLY to the power line and not through a
plug (which could come open anytime). Use a voltage stabilizer so that the freezer
is not exposed to fluctuating current. The power switch should be TAPED in the
on position so that nobody can turn them off accidentally. Its temperature should
be recorded every morning and evening.The lid of the deep freezer should be
LOCKED when not in use. The device should be cleaned when ice has grown 4–6
mm thick over the inner walls (during the period of defrosting, store the vaccines
in a cold box). After defrosting, clean the freezer and make it dry before loading
vaccines again.
  Vaccines not only protect the vaccinated individuals but entire
communities as well.

DIE

They help reduce
I or somortality rates.
They help prevent infectious diseases.0
 They stop the development of antibiotic resistance by reducing the
use of antibiotics.
 They help you travel safely and comfortably.
 They provide economic benefit by saving on the costs of treating
diseases.
O
What to do when vaccination is forgotten?
Sometimes, you may forget to schedule a vaccination appointment. It is
essential to check the immunization record and schedule an appointment
with a healthcare provider as soon as possible. The healthcare provider
will help you know which vaccines the child has had and which he/she
still needs.

Children depend on their parents to be immunized.

Immunization before traveling:

When traveling to another country, everyone is at risk of contracting
diseases that can be prevented with vaccines. These could include
diseases for which vaccines are not routinely administered. Therefore,
it’s important to consult with a healthcare provider or to visit a travel
health clinic six weeks before traveling. Certain vaccines may be
recommended based on age, destination and travel plans.

Immunization of pregnant women:

Vaccines can help protect both mother and baby from preventable
diseases. The immunity gained by a mother who is vaccinated during
pregnancy is passed on to the fetus and consequently protects the infant
against certain diseases during the first months of his/her life before any
vaccines can be administered. They also helpoo protect the mother
throughout the pregnancy. All vaccines recommended to pregnant
women are also safe for breastfeeding women.
Before pregnancy, it is important for all members of the household to
receive their vaccines on time because the newborn can easily catch
infections. Infections can also be severe during the first few months of an
infant’s life, especially because some vaccines can only be administered
between 9-12 months of age (e.g. measles). Vaccines protect mother and
baby from some diseases that may cause:

Ty
  miscarriages

J
 Preterm births
 Birth defects
 Death

Vaccines necessary for pregnant women

The necessary vaccines should be taken before pregnancy as long as they
are suitable and administered at the right time after consulting with a
7
doctor, as they can help protect mother and baby. There are various
vaccines recommended during pregnancy:
F
Vaccine Before During After Notes
Pregnancy Pregnancy Pregnancy

MMR combined √ - √ Pregnancy should

E
vaccine be delayed at least
(measles, mumps, one month after
rubella) vaccination.
Ii Chickenpox √ - √ Pregnancy should
be delayed at least
attinuated 3 months after
live vaccination.

Hepatitis B √ √ √ Pregnant women

can receive this

thy vaccine when

needed.
I
Influenza √ √ √ It is a safe vaccine
B T
for pregnant
women at all
stages of
pregnancy.

DTP √ √ √ Adult vaccines

(tetanus, can be used in the

EE
diphtheria, third trimester.
whooping cough)

HPV (human
papillomavirus)
√ - √

T
Avoid during
pregnancy.

Guidelines after vaccination

Intra dermal ‫ نعطيه‬BCG‫هنا ال‬
‫لكن في مكان الدلتويد بس مش فيها‬

 Some side effects such as loss of appetite or trouble sleeping don’t

need treatment and disappear within 1 or 2 days.
 CHAPTER–9  Communicable Diseases 379
Adverse reactions to immunization
Adverse reactions to immunization can be classified as those due to the vaccine
itself (vaccine reactions), those due to program error (faulty production or
administration of vaccines), those due to anticipation and anxiety of the impending
injection (injection reactions) and incidental events.
Table 9.4. Vaccine reactions
Reaction Vaccine responsible Treatment
Acute flaccid paralysis OPV

08
Disseminated BCG infection— BCG Antitubercular drugs
Widespread infection by M.
bovis (used in BCG) within 1–12
months of vaccination, usually in
immunocompromised subjects

E
Lymphatic swelling and local ulcer BCG Firm–No treatment
within 2–6 minutes Soft–Aspiration

E
Persistent sinus after 12
weeks—INH 5 mg/ kg ×
once daily x 3 months
Incessant cry within 48–72 hours DPT Analgesic
E H TI O
Encephalopathy—Seizures, sensory DPT, measles, MMR
Feeding

and behavioral alternation within

48 hours of DPT pr 7–12 days after
measles vaccination
Seizures (24– 48 hours) DPT Diazepam, antipyretic,

Fever between 12–24 hours of

C
Measles
DPT
IV fluids
Antipyretic sponging,
vaccination Measles paracetamol
Toxic shock syndrome Measles (caused by IV fluid, cloxacillin,
contaminating Staphs) steroids, antipyretic
Sterile abscess within 72 hours T series
of vaccination HBV Drainage if needed
Typhoid
Sciatic injury (gluteal injection) Any Antimicrobial,
antipyretic, drainage of
abscess if any
Local reaction (nonfluctuant Any Paracetamol
swelling/redness)
Anaphylaxis Any Adrenaline,
cardiopulmonary
resuscitation, IV dextran,

Hypotension DPT
O
cortisol, oxygen
IV fluids, dexamethasone,
Oxygen
 ‫‪National Immunization Schedule‬‬ ‫ﺟﺪول اﻟﺘﻄﻌﻴﻤﺎت اﻟﻮﻃﻨﻲ‬

‫ﻋﻨﺪ اﻟﻮﻻدة ‪Birth‬‬ ‫ﻋﻤﺮ ﺷﻬﺮﻳﻦ ‪2 months‬‬ ‫ﻋﻤﺮ ‪ ٤‬ﺷﻬﻮر ‪4 months‬‬ ‫ﻋﻤﺮ ‪ 6‬ﺷﻬﻮر ‪6 months‬‬ ‫ﻋﻤﺮ ‪ 9‬ﺷﻬﻮر ‪9 months‬‬ ‫ﻋﻤﺮ ‪ 12‬ﺷﻬﺮ ‪12 months‬‬ ‫ﻋﻤﺮ ‪ ١٨‬ﺷﻬﺮ ‪18 months‬‬ ‫ﻋﻤﺮ ‪ 24‬ﺷﻬﺮ ‪24 months‬‬ ‫ﻋﻤﺮ ‪ 4-6‬ﺳﻨﻮات ‪4-6 years‬‬ ‫ﻋﻤﺮ ‪ 11‬ﺳﻨﺔ ‪11 years‬‬ ‫ﻋﻤﺮ ‪ ١٢‬ﺳﻨﺔ ‪12 years‬‬ ‫ﻋﻤﺮ ‪ 18‬ﺳﻨﺔ ‪18 years‬‬
‫‪ BCG‬‬ ‫‪ ‬اﻟﺴﻞ‬ ‫‪ Tdap‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬
‫‪ HepB‬‬ ‫‪   HepB‬اﻟﻜﺒﺪي ب‬ ‫‪   HepB‬اﻟﻜﺒﺪي ب‬ ‫‪ ‬اﻟﻜﺒﺪي ب‬ ‫‪ HepB‬‬ ‫‪ ‬اﻟﻜﺒﺪي ب‬
‫‪ RV‬‬ ‫‪   RV‬ﻓﻴﺮوس اﻟﺮوﺗﺎ‬ ‫‪ ‬ﻓﻴﺮوس اﻟﺮوﺗﺎ‬ ‫‪ RV‬‬ ‫‪ ‬ﻓﻴﺮوس اﻟﺮوﺗﺎ‬
‫‪ DTaP‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬ ‫‪ DTaP‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬ ‫‪ DTaP‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬ ‫‪ DTaP‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬ ‫‪ DTaP‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬
‫‪ Hib‬‬ ‫اﻟﻤﺴﺘﺪﻳﻤﺔ اﻟﻨﺰﻟﻴﺔ‬ ‫‪ Hib‬‬ ‫‪ ‬اﻟﻤﺴﺘﺪﻳﻤﺔ اﻟﻨﺰﻟﻴﺔ‬ ‫‪ Hib‬‬ ‫‪ ‬اﻟﻤﺴﺘﺪﻳﻤﺔ اﻟﻨﺰﻟﻴﺔ‬ ‫‪ Hib‬‬ ‫‪ ‬اﻟﻤﺴﺘﺪﻳﻤﺔ اﻟﻨﺰﻟﻴﺔ‬
‫‪ PCV‬‬ ‫‪   PCV‬اﻟﻌﻘﺪﻳﻪ اﻟﺮﺋﻮﻳﺔ اﻟﻤﺪﻣﺞ‬ ‫‪   PCV‬اﻟﻌﻘﺪﻳﻪ اﻟﺮﺋﻮﻳﺔ اﻟﻤﺪﻣﺞ‬ ‫‪ ‬اﻟﻌﻘﺪﻳﻪ اﻟﺮﺋﻮﻳﺔ اﻟﻤﺪﻣﺞ‬ ‫‪ PCV‬‬ ‫‪ ‬اﻟﻌﻘﺪﻳﻪ اﻟﺮﺋﻮﻳﺔ اﻟﻤﺪﻣﺞ‬
‫‪ IPV‬‬ ‫‪ ‬ﺷﻠﻞ أﻃﻔﺎل ﻣﻌﻄﻞ‬ ‫‪ IPV‬‬ ‫‪ ‬ﺷﻠﻞ أﻃﻔﺎل ﻣﻌﻄﻞ‬ ‫‪ IPV‬‬ ‫‪ ‬ﺷﻠﻞ أﻃﻔﺎل ﻣﻌﻄﻞ‬

‫‪et‬‬
‫‪ OPV‬‬ ‫‪ ‬ﺷﻠﻞ ا‪V‬ﻃﻔﺎل اﻟﻔﻤﻮي‬ ‫‪ ‬ﺷﻠﻞ ا‪V‬ﻃﻔﺎل اﻟﻔﻤﻮي ‪ OPV‬‬ ‫‪ ‬ﺷﻠﻞ ا‪V‬ﻃﻔﺎل اﻟﻔﻤﻮي ‪ OPV‬‬ ‫‪ OPV‬‬ ‫‪ ‬ﺷﻠﻞ ا‪V‬ﻃﻔﺎل اﻟﻔﻤﻮي‬
‫‪ ‬اﻟﺤﺼﺒﺔ اﻟﻤﻔﺮدة ‪ Measels‬‬

‫‪ MCV4‬‬ ‫‪ ‬اﻟﺤﻤﻲ اﻟﺸﻮﻛﻴﺔ ‪   MCV4‬اﻟﺤﻤﻲ اﻟﺸﻮﻛﻴﺔ‬ ‫‪ MCV4‬‬ ‫‪ ‬اﻟﺤﻤﻲ اﻟﺸﻮﻛﻴﺔ‬
‫اﻟﺮﺑﺎﻋﻲ اﻟﻤﺪﻣﺞ ‪The meningococcal‬‬ ‫اﻟﺮﺑﺎﻋﻲ اﻟﻤﺪﻣﺞ‬ ‫اﻟﺮﺑﺎﻋﻲ اﻟﻤﺪﻣﺞ‬
‫‪ HepA‬‬ ‫‪ HepA‬‬
‫‪conjugate vaccine or‬‬ ‫‪ ‬اﻟﻜﺒﺪي أ‬ ‫‪ ‬اﻟﻜﺒﺪي أ‬
‫‪ ‬اﻟﺠﺪﻳﺮي اﻟﻤﺎﺋﻲ ‪ Varicella‬‬ ‫‪ Varicella‬‬ ‫‪ ‬اﻟﺠﺪﻳﺮي اﻟﻤﺎﺋﻲ‬
‫‪MCV4‬‬
‫‪ ‬ﻓﻴﺮوس اﻟﻮرم اﻟﺤﻠﻴﻤﻲ*‪   HPV‬ﻓﻴﺮوس اﻟﻮرم اﻟﺤﻠﻴﻤﻲ*‪ HPV‬‬

‫‪ MMR‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﻔﻴﺮوﺳﻲ‬ ‫‪ MMR‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﻔﻴﺮوﺳﻲ‬ ‫‪ MMR‬‬ ‫‪ ‬اﻟﺜﻼﺛﻲ اﻟﻔﻴﺮوﺳﻲ‬
‫‪Influenza‬‬

‫‪ *For‬‬ ‫‪female only‬‬ ‫‪ ‬ﻟ‪a‬ﻧﺎث ﻓﻘﻂ‬

‫‪DATE‬‬

‫‪SIGNATURE‬‬

‫ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪Influenza vaccine‬‬ ‫ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪Influenza vaccine‬‬ ‫ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪Influenza vaccine‬‬ ‫ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪Influenza vaccine‬‬ ‫ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪ Influenza vaccine‬ﺗﻄﻌﻴﻢ ا‪V‬ﻧﻔﻠﻮاﻧﺰا ‪Influenza vaccine‬‬

‫‪DATE‬‬

‫‪SIGNATURE‬‬

‫‪MOHVAC_EPI Vaccines Update LandScape 3-12-2019print.indd 2-3‬‬ ‫‪12/19/19 11:09 AM‬‬

 ‫‪I‬‬ ‫اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﻴﺔ اﻟﺴﻌﻮدﻳﺔ‬
‫وزارة اﻟﺼﺤﺔ‬
‫اﻟﻤﺤﺎﻓﻈﻪ‪ /‬اﻟﻤﻨﻄﻘﻪ‪Region/City: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :‬‬
‫‪Health Directorate/ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .‬‬
‫‪Cluster :‬‬
‫اﻟﺠﻬﺔ اﻟﺼﺤﻴﺔ‪:‬‬
‫*‪vaccine‬‬
‫اﻟﺘﻄﻌﻴﻢ‬
‫‪Influenza 1‬‬
‫اﻻﻧﻔﻠﻮاﻧﺰا‬
‫‪Tdap or Td 2‬‬
‫اﻟﺜﻼﺛﻲ اﻟﺒﻜﺘﻴﺮي‬

‫‪Adults 2‬‬
‫ﻟﻠﻜﺒﺎر‬
‫‪Pregnants 3‬‬
‫ﻟﻠﺤﻮاﻣﻞ‬
‫‪National Immunization Schedule‬‬

‫‪MMR 4‬‬
‫اﻟﺜﻼﺛﻲ‬
‫اﻟﻔﻴﺮوﺳﻲ‬
‫‪Varicella 5‬‬
‫اﻟﺠﺪﻳﺮي‬
‫اﻟﻤﺎﺋﻲ‬
‫‪Herpes‬‬
‫‪Zoster 6‬‬
‫اﻟﺤ>‬
‫اﻟﻨﻄﺎﻗﻲ‬
‫‪HPV 7‬‬
‫ﻓﻴﺮوس اﻟﻮرم‬
‫اﻟﺤﻠﻴﻤﻲ‬
‫‪Pneumococcal‬‬
‫اﻟﻤﻜﻮرات اﻟﻌﻘﺪﻳﺔ اﻟﺮﺋﻮﻳﺔ‬

‫‪PPSV23 8‬‬
‫اﻟﻤﻜﻮرة‬
‫اﻟﺮﺋﻮﻳﺔ‬
‫‪PCV‬‬
‫اﻟﻌﻘﺪﻳﻪ‬
‫‪9‬‬
‫ﺟﺪول اﻟﺘﻄﻌﻴﻤﺎت اﻟﻮﻃﻨﻲ ﻟﻠﻜﺒﺎر‬

‫‪Hep B 10‬‬
‫اﻟﻜﺒﺪي ب‬
‫‪MCV4 11‬‬
‫اﻟﺤﻤﻲ‬
‫اﻟﺸﻮﻛﻴﺔ‬
‫اﻟﺮﺑﺎﻋﻲ‬
‫اﻟﻤﺪﻣﺞ‬
‫‪Other‬‬
‫‪Vaccinations‬‬
‫ﺗﻄﻌﻴﻤﺎت‬
‫اﺧﺮي‬
‫اﻟﺮﺋﻮﻳﻪ اﻟﻤﺪﻣﺞ‬
‫اﻟﻤﺘﻌﺪد‬
‫ﺷﻬﺎدة اﻟﺘﻄﻌﻴﻢ‬
‫‪Date and‬‬

‫‪Health Center/Hospital‬‬ ‫ﻣﺮﻛﺰ ﺻﺤﻲ ‪ /‬ﻣﺴﺘﺸﻔﻰ‬ ‫‪Signture‬‬

‫‪..............................................................................................................................................................................................................................................................‬‬
‫‪Date and‬‬
‫‪Signture‬‬
‫اﻻﺳﻢ‪Name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :‬‬
‫‪Date of Birth‬‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﻫـ اﻟﻤﻮاﻓﻖ‬ ‫‪/‬‬ ‫‪/‬‬ ‫ﺗﺎرﻳﺦ اﻟﻤﻴﻼد‬ ‫‪Date and‬‬
‫‪Signture‬‬
‫‪Family/Medical FIle No.‬‬ ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻄﺒﻲ‬
‫‪..............................................................................................................................................................................................................................................................‬‬ ‫‪Date and‬‬
‫‪Signture‬‬
‫‪ID‬‬ ‫رﻗﻢ اﻟﺴﺠﻞ اﻟﻤﺪﻧﻲ‪ /‬ا‪Y‬ﻗﺎﻣﺔ‬
‫‪..............................................................................................................................................................................................................................................................‬‬ ‫‪Date and‬‬
‫‪Signture‬‬
‫‪HESN Client ID‬‬ ‫رﻗﻢ ﺣﺼﻦ‬
‫‪Timing/ Indication‬‬ ‫اﻟﻮﻗﺖ‪ /‬دواﻋﻲ اﻻﺳﺘﻌﻤﺎل‬
‫‪..............................................................................................................................................................................................................................................................‬‬
‫‪1.‬‬ ‫‪1 dose annually‬‬ ‫‪ .١‬ﺟﺮﻋﺔ واﺣﺪة ﺳﻨﻮﻳ‪.c‬‬
‫‪2.‬‬ ‫‪1 dose TdaP then Td booster every 10 years.‬‬
‫‪Full Address‬‬ ‫اﻟﻌﻨﻮان ﻛﺎﻣﻼً‪:‬‬ ‫‪3.‬‬ ‫‪Pregnant women (For each pregnancy between 27 & 36 Weeks).‬‬
‫‪ .٢‬ﺟﺮﻋﺔ واﺣﺪه ﺛﻢ ﺟﺮﻋﺔ ﻣﻨﺸﻄﺔ ﻛﻞ ‪ ١٠‬ﺳﻨﻮات‪.‬‬
‫‪ .٣‬ﻟﻠﺤﻮاﻣﻞ ﺟﺮﻋﺔ ﻣﻊ ﻛﻞ ﺣﻤﻞ ﺟﺪﻳﺪ )ﻓﻲ اﻟﻔﺘﺮة ﻣﺎﺑﻴﻦ ا‪V‬ﺳﺒﻮع ‪ ٢٧‬إﻟﻰ ‪.(٣٦‬‬
‫‪4.‬‬ ‫‪For unvaccinated individuals, premarital and post natal women if no evidence of immunity or‬‬ ‫‪ .٤‬اذا ﻟﻢ ﺗﻜﻦ ﻫﻨﺎك ﻣﻨﺎﻋﺔ ﻣﺆﻛﺪة أو ﻣﺮض ﺳﺎﺑﻖ ﺟﺮﻋﺔ و اﺣﺪة أو اﺛﻨﺘﺎن ﺗﺒﻌ‪ c‬ﻟﻠﺤﺎﻟﺔ ﺗﻄﻌﻴﻢ اﻟﺴﻴﺪات‬
‫‪..............................................................................................................................................................................................................................................................‬‬ ‫‪prior disease (1 or 2 doses depend on indication).‬‬ ‫ﻗﺒﻞ اﻟﺰواج وﺑﻌﺪ اﻟﻮﻻدة‪.‬‬
‫‪5.‬‬ ‫)‪If no evidence of immunity or prior disease (2 doses 8 weeks apart‬‬ ‫‪ .٥‬إذا ﻟﻢ ﺗﻜﻦ ﻫﻨﺎك ﻣﻨﺎﻋﺔ ﻣﺆﻛﺪة أو ﻣﺮض ﺳﺎﺑﻖ ﺟﺮﻋﺘﺎن ﺑﻴﻨﻬﻤﺎ ‪ ٨‬أﺳﺎﺑﻴﻊ‪.‬‬
‫‪Tel. Home:‬‬ ‫‪.........................................................................................................................................................................................................‬‬ ‫ﻫﺎﺗﻒ اﻟﻤﻨﺰل‪:‬‬ ‫‪6.‬‬
‫‪7.‬‬
‫‪2 doses 2-6 m apart for adult age 50 years or older‬‬
‫‪3 doses (0,1-2,and 6m) from the first dose catch up immunization for female age 15-26 years‬‬
‫‪ .٦‬ﺟﺮﻋﺘﺎن ﺑﻴﻨﻬﻤﺎ ‪ ٦-٢‬أﺷﻬﺮ ﻟﻌﻤﺮ ‪ ٥٠‬ﺳﻨﺔ أو أﻛﺒﺮ‪.‬‬
‫‪ .٧‬ﺛﻼث ﺟﺮﻋﺎت ﻟﻠﻨﺴﺎء ﻋﻤﺮ ‪ ٢٦-١٥‬ﺳﻨﺔ اﻟﺠﺮﻋﺔ اﻟﺜﺎﻧﻴﺔ ﺑﻌﺪ ﺷﻬﺮﻳﻦ ﻣﻦ أول ﺟﺮﻋﺔ و اﻟﺠﺮﻋﺔ اﻟﺜﺎﻟﺜﺔ ﺑﻌﺪ ‪ ٦‬أﺷﻬﺮ ﻣﻦ اﻟﺠﺮﻋﺔ اﻻوﻟﻰ‪.‬‬

‫اﻟﻬﺎﺗﻒ اﻟﺠﻮال‪Mobile: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . :‬‬ ‫‪8.‬‬

‫‪9.‬‬
‫‪1 dose adults aged 65 years or older (1 year after PCV 13 dose) from the first dose.‬‬
‫‪1 dose adults with comrobid/immunocompromised condtions and adults aged 65 years or older.‬‬
‫‪ .٨‬ﺟﺮﻋﺔ واﺣﺪة ﻟﻠﻜﺒﺎر ﻣﻦ ﻋﻤﺮ ‪ ٦٥‬أو أﻛﺒﺮ ﺑﻌﺪ ﺟﺮﻋﺔ اﻟﺒﻜﺘﺮﻳﺎ اﻟﻌﻘﺪﻳﺔ اﻟﺮﺋﻮﻳﺔ ﺑﻌﺎم واﺣﺪ‪.‬‬
‫‪ .٩‬ﺟﺮﻋﺔ واﺣﺪة ﻟﻤﻨﻘﻮﺻﻲ اﻟﻤﻨﺎﻋﺔ أو أﺻﺤﺎب ا‪V‬ﻣﺮاض اﻟﻤﺰﻣﻨﺔ اﻟﻤﺼﺎﺣﺒﺔ و أﻳﻀﺎ ﻟﻌﻤﺮ ‪ ٦٥‬ﺳﻨﺔ أو أﻛﺒﺮ‪.‬‬
‫‪10.‬‬ ‫‪3 doses (0,1m and 6m) if no previous immunization or no evidence of immunity.‬‬ ‫‪ .١٠‬ﺛﻼث ﺟﺮﻋﺎت إذا ﻟﻢ ﻳﻜﻦ ﻫﻨﺎك ﻣﻨﺎﻋﺔ ﻣﺆﻛﺪة أو ﺗﻄﻌﻴﻢ ﺳﺎﺑﻖ اﻟﺠﺮﻋﺔ اﻟﺜﺎﻧﻴﺔ ﺑﻌﺪ ﺷﻬﺮ ﻣﻦ اﻟﺠﺮﻋﺔ ا‪V‬وﻟﻲ و اﻟﺠﺮﻋﺔ اﻟﺜﺎﻟﺜﺔ ﺑﻌﺪ ‪ ٦‬أﺷﻬﺮ‪.‬‬
‫‪11.‬‬ ‫‪1 dose depending on indication, then booster every 5 years if risk remains.‬‬ ‫‪ .١١‬ﺟﺮﻋﺔ واﺣﺪة ﺣﺴﺐ اﻟﺤﺎﻟﺔ ﺛﻢ ﺟﺮﻋﺔ ﻣﻨﺸﻄﺔ ﻛﻞ ‪ ٥‬ﺳﻨﻮات‪.‬‬

‫‪MOHVAC_EPI Vaccines Update LandScape 3-12-2019print.indd 4-5‬‬ ‫‪12/19/19 11:09 AM‬‬

376 Community Medicine

↓
PHC
Store for < 1 month in ILR (2–8°C)
or for a longer duration in deep freezer (< 0°C)
↓
SUBCENTER
Distribute by vaccine carriers containing 4 fully frozen ice packs (2–8°C);
Unused vials are returned to PHC, marked and restored in ILR;

What to do with vials that have been opened but not used?
Global policy on this matter used to be that opened vials of all vaccines were
discarded at the end of each working day. In 1995, WHO recommended a changed
global policy on the use of opened vials of vaccine as follows.
1. Opened vials of OPV, DPT, DT, TT and hepatitis B vaccines may be used in
subsequent immunization sessions until a new shipment of vaccine arrives,
provided that each of the following 3 conditions are met
• The expiry date has not passed
• The vaccines are stored under appropriate conditions (0 to +8°C)
• Opened vials of vaccine which have been taken out of the health facility
for immunization activities (e.g. outreach, National Immunization Days) are
discarded at the end of the day.
2. Opened vials of measles, yellow fever and BCG vaccines must be discarded
within six hours.
3. An opened vial must be discarded immediately if
• sterile procedures have not been fully observed, or
• there is even a suspicion that the opened vial has been contaminated, or
• there is visible evidence of contamination, such as a change in appearance,
floating particles
Cold chain equipments
Walk in cold rooms. A cold room where people walk in and get the vaccine (as
simple as that, does it need any more explaining?)
Deep freezers. Deep freezers create sub zero temperatures. They are suitable
1. to store for vaccines > 3 months

EE
2. to make ice packs which are used in vaccine carriers.
The deep freezer should be placed in a well ventilated room at least 10–20 cm
from the wall, and should not tilt on any side (should be perfectly horizontal). The
power cable should be fixed PERMANENTLY to the power line and not through a
plug (which could come open anytime). Use a voltage stabilizer so that the freezer

Y
is not exposed to fluctuating current. The power switch should be TAPED in the
on position so that nobody can turn them off accidentally. Its temperature should
be recorded every morning and evening.The lid of the deep freezer should be

Ti
LOCKED when not in use. The device should be cleaned when ice has grown 4–6
mm thick over the inner walls (during the period of defrosting, store the vaccines
in a cold box). After defrosting, clean the freezer and make it dry before loading
vaccines again.
 CHAPTER–9  Communicable Diseases 377
What not to do with a deep freezers
• Do not store food and drinks
• Do not open the lid too often
• Do not store DPT, DT, TT or BCG vaccine in a deep freezer
• Do not store diluent for vaccines in deep freezer
• Do not keep the deep freezer and ILR in contact with each other.
One person should be responsible for maintenance of the freezer.
Ice lined refrigerators. They maintain a temperature of 2–8°C; vaccines can be
stored up to a month in ILR. The same precautions as the deep freezer apply also
to the ILR. However, the T series vaccines and BCG can be kept in ILR (Fig. 9.8).

Figure 9.8. The temperature reader of an ILR

so
Cold boxes. Cold boxes, packed with ice packs, are used for regional transportation
of vaccines.
Vaccine carriers. These are packed with 4 fully frozen ice packs on the day of vac-
cination. They can maintain the vaccine for 48 hours in 2–8° if not opened (Fig. 9.9).

Figure 9.9. A vaccine carrier, with a Figure 9.10. An ice pack

É
prohibitive warning

Ice packs. They are filled with salt free water (salt reduces freezing point of water)
up to a preset mark (if we fill up to the brink, water will expand when frozen and
crack the pack) and frozen in a deep freezer (Fig. 9.10).
In all these devices, the T series vaccine and hepatitis vaccine should never be
placed in direct contact with ice.
 378 Community Medicine

Vaccine vial monitor (Fig. 9.11)

It is a heat sensitive label to monitor cumulative heat exposure. It consists of round
piece of blue material inside which lies a heat sensitive square of lighter hue. The
square changes to darker shades with
1. high temperature, short exposure or
2. lower temperature, long exposure or
3. high temperature, long exposure
The vaccine is usable only until the inner square is lighter than the outer circle.
The VVM is initiated with the OPV as it is the most heat sensitive vaccine.

3411 a USABLE UNUSABLE UNUSABLE

Figure 9.11. Vaccine vial monitor

MEDT and TT vaccine shipping indicators

This is another type of indicator, which travels with the vaccines from manufacturer
to central store and is included with each 3,000 doses of DT, DPT and TT procured
through UNICEF. This indicator has a temperature sensitive dot that irreversibly
change from silver-gray to black at temperatures above +48°C, temperatures
which may be reached if vaccines are left in the sun or in poorly ventilated places.
The shake test
Before administering a T series vaccine, it is a must to shake it and see a uniform
mixture; any granules indicate freezing at some point of time, and the vial is
discarded.
WHO recommendation on vaccine storage temperatures
To summarise, if you work, to
At the national level. Keep your vaccines for a maximum of 6 months
a • Store OPV, measles, and mumps vaccines at –15 to –25°C
D
SN
007
• Store hepatitis B, DPT, DT, TT and BCG at 0 to +8°C
• Send vaccines to regions in insulated containers at 0 to +8°

Ha At the regional level. Keep your vaccines for a maximum of 3 months

• Store OPV, measles, and mumps vaccines at –15 to –25°
• Store hepatitis B, DPT, DT, Td, TT and BCG at 0 to +8°
• Send vaccines to districts in insulated containers at 0 to +8°
At the district level. Keep your vaccines for a maximum of 1 month,
• Store OPV, measles, and mumps vaccines at –15 to –25°C, if possible
• Store hepatitis B, DPT, DT, Td, TT and BCG at 0 to +8°C
• Send vaccines to health facilities in insulated containers at 0 to +8°C
At the health facility level. Keep all your vaccines for a maximum of 1 month:
pk Store all vaccines at 0 to +8°C.