9/15/2023

NATIONAL IMMUNIIZATION Objectives

PROGRAMME " Immunization
Immunízation
" Significance of
"Types ofImmunity
Dr:Sanjiv Kamble "Immunizing Agents
Schedule
A, rof Comunity Medicine, MOM Medical College Vaki
" National Immunization
MRBS MD(PSM) "Contraindications to vaccinations
" Reactions to Vaccines
9th Sept 2023

Introduction
"Immunization is the artificial mecans by which the state of immunity
is increased. This is the most important invention that conferred the
highest benefit to children in the world. It has prevented many
communicable diseases such as diphtheria and polio. It has helped
eradicate polio and small pox for the community.
Definition
4Immunization is a process of protecting an individual form a disease
through introduction of live or killed or attenuated organisms in the
individual system to create immunity."

1
 Immunity
Passive " healthcost It"
"These
Immanoglobulin
blood, antibodies. soon Passive
exogenous " Artificiallyresistance Itaeffective
" or diseases
various tois Significance
is
immunoglobulins. augmenting one
intestinal are after diseases. massrelated of
antibodies. Immunity is acquired the
animal
or means
immunity
Passive prior the morbidity 'best
secretions It
or immuni
immunity ty . gives of
Antibodies human
temporarily
produced
to by interventionsbuys'
in
protecting
expoSure and
and in
respiratory
antibody is mortality. community
are
developed the
of
a infectious
largest
group agents an to reduction
secretions infection.
suppress by health
of antiseraare
immunizationdiseasesnumber
proteins supplying
preformed and
communicable of
Itthe one
of
present disease,
is by
people of
readymade producing the
in given from most
and
the

Toxoid
Antibody
" Antitoxin Toxins
"A Antigen
"A Immunity
Act"ive
quality. A proteins
that vaccines.
toxin substance
poisonous
usually variety exposure
administration
mechani
through
smActive micAcquired
roorgani"Immuni
sms ty
nonsusceptibilitImmuni
y ty
that immunity
of to immunity
has formulation
stimulatethe
foreign is
been formed infection.
treated substances is or the
can toto
in produced the
bethe security
destroy
to responseproduced agents
Active pathogenic
active invasive
including
bacteria toxic
to antibodies.of immunological
stimulatingby
immunizing or against
its a by
toxic toxin. of passive,effect or
the
antigen
properties invading a
viruses,
toxinsand of
particular
microorganisms. usually
prior antigenic
but effects
retain are
its known to substances. disease
of
antigenic foreign defence
natural foreign
as and

9/15/2023
 National
formulzted.india
for of
Continued... the couni
Expended
Program on
Januryimmunization
WHO, immunization
schedule
National
he
The -Immuniration
problemsRmust
agaiwornlistd community.
Immunization 1978
uníform onlaunched Every
schedule. scheduke
It
six country should be
implementation Immunization
be
Schedule kil e(EPI)
r global should
effective,
diseases. i has relevant
its be
as
own
feasibleandplanned
recommended
throughout In
immunization with
India,program existing
health
tocommunity
according and
protect
EPI
countrythe by acceptable
in
was 1974,
all to
Government launched the
children
known needs
by
was the
in ofas of

recommended ""Minor
upto. contraindication
vaccination.
AtIn toInteryal
Recommendations
some
population
eligible
Influenzae
the vaccinVacci
es nmie ssivacci
oncoalneition Thesponsor
(UIP) ed The
5months
9
years oba! and EPI
states cough,between Fund access
'Bthein of Glof was byis
Continued..
of sGovt
(Hib) usedalorgani
of
age dosehepatitis o ., zatandion, launched now
Alliance UNICEF.
age, colds two developing
and increase
are adoptedNGOs, renamed
Vitamin doses highly for in In
then "B' and established declaration
1985, a, as
the global
countries, UNICEE,
vaccine worlVacci
dwidneesand IndiUniversal
to mildshould prevalent.objective Chiitld
be'A' immunization
coverage.
GAVI November
in calledis
continued oil not
is fever where WHO 1999,
given be universal Immunization of
should the new and to as
less Immunization,
as or disease reduce Universal
atroutine coverage
introduction World
six be diarrhea than
orally
given
with one like Bank.disparities
Immunization
(GAVI)
months immunization to
of
immunization. month. hepatitis as
are but The is
in is per
interval collaborative
underGAVI
not life
B Program
and saving
a H and

9/15/2023
3
 "
Contraindications
General
occurred.
arilsk Acute
and discasesSpeciis
infection,
discases,
"Airitability.
"Malaise,
"Transient rash. Local "
"Mild
Fever.
PainReactions
with size is
12 asplenia
weeks, generally Lump illness
the upto Down high risk
formation 6- or
only or groups feverwith
10papule
not include
mm to syndrome,
hyposplenism. in
a painful
small appears EPI
of in
pus. thosewhom above
scardiameter but HIV
No is on Vaccines the
is with
treatment
visible tender tothe 38°C.
by
the third chronic of
sixthtouch.week complications Postpone
is Low lung
necessary.week.
The after birth and until
The BCG
papule congenital form
At weight recovery
nodule
tvaccination,
he
increases infecious
end (LBW),
softens heart has
of
10 in It

" " "

further In weeks Vaccines
Regional
collapse injected Continued...
very
innodit vmiildVaccination
ual Mild to
doses rare after
contraindications acute Condi
or tions
subcutaneously
after Lymph
ofcases, BCG respiratorymoderanad tely
DPT DPT community
vaccination node Not
vaccination
should a for il
feverinstead
enlargement
infection, to
vaccinations children
not of protection.
low be
of is
bemore usually or taken
has
intra-dermally.
given diarrhea should
been than and
a Malnutrition,
observed
result 2-8
observed. 105suppuration and be as
immunized
of contra-indication
other
F, the
In
convulsions mínor
such vaccine grade to
illness:increase
cases being fever,
or are

9/15/2023
4
 Rotavirusvaccine Expansion Plan in India
Introduction
Stateselectionfor RVV
. Critería for
diseaseburden
/Diarrheal
AEFlpreparedness
system
immunizationcoverage and
VRoutine
preparedness
New Vaccine Introduction / State
willingness to
19, around
RVV
introduce

6.49 crore doses

of Rotavirus
. Ti March' administered to children.
vaccinehave been POSHAN
vaccine under
Expansion of Rotavirus all states in 2019-20 as per
Abhivaan' to be done in
directionsof PMO
the
Phass 2: Itroduced in 2017
Phase 3:COngoing in 2018

Pneumococcal Conjugate Vaccine (PCV) Expansion Plan, India Measles Rubella (MR)Campaign
PCV has been Measles
Introduced in Bihar, Himachal of achieving
Pradesh, Madhya Pradesh, 19 districts . WHO-SEARO goal also relterated by
2020,
Pradesh 18 districts of Rajasthan and ofHaryana
and Utar elimination by the budget
(state initlative),. Hon'ble Finance Minister in
Tll March '19, around 116.89 lakh speech of 2017.
doses of PCy vaccination campaign
have been administered to children across Measles-Rubella
above 41 crore
mentioned areas.
In 2019, it will be further expanded to
launched in Feb'17 targeting approx.
across the
cover 9 and
7 additional districts in Rajasthan and Uttar
children aged 9 months-15 years
country.
Pradesh respectively,. completed in 31
Percent birth cohort covered: " Campaign has been
states/UTs and ongoing in 1 state Ogg
Year-1 (2017): Himachal Pradesh (100%), Bihar (50%)
Uttar Pradesh (10%) (Meghalaya).
" Subsegquent to the completion of
campaign,
Yoar-2 (2018): Bihar (100%), Madhya Pradesh (100%). introduced ir Routine
Rajasthan (25%) and Uttar Pradesh (20%) MR vaccine
Immunization replacing Measles vaccine at 9 >30.50 erore children vaccinated tHt date
Year-3 (2019): Rajasthan (50%) and Uttar Pradesh 12 months and 16-24 months of age.
2017 2018 2019 Duzavonn

5
 " " "Encephalitis(JE)
Japanese "
Adult
aged vaccination
"35 Around
campaigns 268 from JE No
S.
3 2 1.
high vaccination:
JE
15-65 JE 1
to
vaccination burden 15.5 endemic <15
Timelines-MR
years in completedcrore years
endemicdistricts
districts One
were children
WestRemaining
Campaign
State/UT States
Rajasthan Bengal
of time Delhi SIkkim
campaign in age
vaccinated. blocks 230
(including (including >Jcampaign
E
immunizeddistricts
completed(Assam, vaccination
4
identified > 37 strategy
UP, during identifiedJE
inWest now is
31 the included >
districts;Bengal). in part single
8)
April'1campaign in Timeline
Proposed
April'
of18)
RI. into dose August
2019 2019July
more identified RI
identified vaccine in JE
than endemic
3.3 in targeting
crore 3 acrossdistricts.
states
beneficiaries for 21 all
Adult states. children
JE

" . Tetanus
and Td
Tetanus Advisory Increase
to in
. Tetanus immunization
TT
vaccine vaccine school IPoLI
(VACCI afitjealo
PV) IoNVIEACTIRatUSVrATED
booster
and Group and going injctios
IPY
wil &
doses Diphtheria has adult adult
replace on children
been
at Diphtheria
Immunization
10
2 replaced
in and
and doses coverage Diphtheria . .2 " Inactivated
"Vaccine
Polio
adults. states 6
16 adults. cOuntry
across
vaccine Til 14
Expanded Launched
years of (Td) doses
TT by
(NTAGI) March weeks
Td vaccine in
of or children
age. single vaccine (Td) have
in of of to
2016. has '19, fractional
age lPV on
booster led al
and been vaccine been
around 30th
to of states
dose l
wirecommended shitt child November
provide
administered
in 8.89 by
of age-group
TT (fIPV)
givenat April
given protection crore
by 2016 2015,
to of
pregnant National diphtheria
childrendoses
to
against initially
woman Technical IPVof and 6
both cases
in
9/15/2023

6
 Revised Natlonall
9/15/2023
Age
Birth
Vaccines gven lmmunlzation Schedule
BCG, OPV-0, Hepatitis BBirth dose
Rapidly changing landscape of Universal Immunization Prooramme
6Weeks OPV-1, Pentavalent-1,
fIPV-1,
OPV-2,Pentavalent-2 &Rota-2Rota-]&PCV-1
10 weeks 2014: India declared Polio free
S OPV-3, Pentavalent-3, Milestones 2015, Maternal Neonatal Tetanus Elimination
14 weeks f1PV-2,
MR-1, JE1, PCV-Booster Rota-3 PCV-2
& validation
9-12 months
16-24 months MR-2, JE2*, DPT-Bo0ster 1, OPV- 2015: Mission Indradhanush
Booster Improving Coverage 2017:Intensified Mssion Indradharush
5-6 years DPT-Booster 2 " 2018: Gram Swaraj Abhiyan (G5A)/Etended GSA
10 years Td NCCRC/NCCTC
To EVM assessment
16 years Improving Quality eVIN epansion
Pregnant Mother Td1, 2 or Td Boosters*
"Capacity building of HR
"2015. Inactivated Polio Vaccine (PV)
*in endemic districts only New vaccines "2016: Rotavirus Vaccine (RVV)
**one dose if previously vaccinated within 3 years Being introduced/scaled up "2017: Measles-Rubella (MR) Vaccine and
introduced
Pneumococcal Conjugate Vaccine (PCV)

Two milestones achieved

Mission Indradhanush (MI)
GREAT NEWS!
ONE INDIA IS DECLARED
POLIO-FREE
INDIA CELEBRATES
MATEKNAL AND MEOWATAL TETAN
Reaching
ELIMINATION &YAW3-FREE INDIA the
unreached
with all
available
vaccines
Increasing full immunization coverage to 90%
and sustain it through RI
" 554 districts covered in six phases including
On 27 March 2014, South-East On 14tk July 2016, WHO Certified Intensified MI
Asia Region of WHO, inciding India for eliminating maternal and Launched on 25th December 2014
Indla, certífied POLUO-FREE neonatal tetanus " One of the flagship schemes under Gram
Swaraj Abhiyan (GSA) &Extended GSA

7
 9/15/2023
Mission Reviewed by Impact of MI in
Indradhanush Hon'ble Prime improving
0mmuni zation
tnatargioetHonalwofevc90%eor,veranotge
Includedunder
PRAGATI
Minister of lndia
coverage Intensified Mission Indradhanush
acknowledged S\mlugprjoshvempeancte Ionf
achieved INTENSIFIED MISSION
urban areas INDRADHANUSH LAUNCHEO

To ersure ti mnjtn in

Sustainablity of
Be Wise!achievements hot Target shifted
Get your childplanned from 2020 to lor pkes of oe meon féahe

fully Immunized 2018

11 ministries supporting utWAATE
Mifors ion
achiggrldeIrsnednivraedforhaactnuisohn: plaPMn toModiCovercolls
the program

SpecificImtimume-nfízroometion
o
In o
Hon'ble Prime Minister launched Inteisified Missfon Indradhanush on 8t October 2017

MI under Gram Swaraj Abhiyan

. MI under GSA - 16,850 villages across 25 states:
(GSA)/Extended GSA (EGSA) Vaccine Logistics & Cold Chain Management
and all UTs from Apr'18 to Jun'18

" MI - EGSA covered 48,929 villages across 117 National Cold Chain Resource Centre (NCCRC), Pune and National Cold Chain &
aspirational districts. (7,408 villages in West Vaccine Management Resource Centre (NCCVMRC) -NIHEW, New Delhi established
Bengal did not participate). to provide technical training to cold chain technicians in repair & maintenance of
cold chain equipment.
During MI in GSA/EGSA :
National Cold Chain Management Information System (NCCMIS) to track cold chain
o Children vaccinated: 20.22 lakh equipment inventory, availability and functionality.

o Pregnant women vaccinated: 5.41 lakh

8
 9/15/2023

Cold Chain is a system of ftransporting and

recommended temperature from the storing
point of vaccinestoatthe refrigerators (ILRs)
Use
imanufacture point of
Ice lined litres at PHClevel(1200 vials)
Capacity: 140

Tenmperature: 42°C to
8°C
" ldeal supply of8/24 hrs)
(Effective with electricity
section
the basket
Storage: Always in and Diluents)
" Safe Hepatitis-B
PENTA, space ís
(Always T series, below basket in case
(OPVMeasles/BCG JE may be kept
not available)
ILR-basket
"Thermometer: Place in the

Adverse Event Followinglmmunization(AEFI) State and National levels

system Surveil ance AEFI CommitteesDistrict,
Although vaccines are safe, surveillance of adverse events is required to Composition
Epidemiologist/Public Health Specialist
Detect, correct and prevent immunization errors.
Authority
Prevent false blame arising from coincidental adverse events. " Representative from Drug
Pediatrician, Microbiologist, Neurologist
VMaintain confidence by addressing parent/community concerns,
Pathologist, Forensic Expert, Cold Chain
and raising awareness about vaccine risks. officer
Member Infectious Disease Surveillance
Program(DSP)
An Adverse Event Following Immunization (AEFI) is any untoward medical occurrence Representative from local bodies like
which follows immunization and which does not necessarily have a causal corporations
relationship with the usage of the vaccine.
Representatives from professional
may be any unfavorable or unintended sign, abnormal laboratory bodies like lAP, IMA
The adverse event Representatives from partners agencies
finding, symptom or disease.
Terms of reference
(national/state/district)
" Meet at least once a quarter
Strengthen and validate AEFl reporting at all
levels
Ensure implementation of uniform standards and
formats.
" Prompt &thorough investigation of serious AEFls
and periodic review of non serious AEFIs
" Timely classification of cases
Causality assessment (Brighton Classificotion)
" Support spokesperson for media interface and
management.

Member Secretary: lmmunization Programme Manager

 9/15/3

Expectations from states

MISSION
" Regular review of coverage/monitoring data from all sources including HMIS at A0HANUS
all
levels.

" Regular meetings of State Task Force & District Task Force Meetings on
Immunization with focus on inter-sectoral convergence
Be Wise!
" Capacity building and supportive supervision of healthcare staff for Get your child
" Focus on immunization in urban areas by utilization of NUHM
Microplanning. fuly immunized
structure and its
reviewthrough regular meetings of City/District Task force on Urban Immunization.
. Expedited transfer of funds from state treasury to State health societies THANK YOU