IMMUNIZATION

BELLO C. B
 INTRODUCTION
• Immunization is one of the strategy used to reduce
mortality and morbidity caused by preventable
diseases in childhood and adults.
• They include Poliomyelitis, Tuberculosis, Measles,
Diphtheria, Tetanus, Pertusis (Whooping cough),
Yellow fever, Diarrhhea and Hepatitis B.
 DEFINITION

• Immunization is the introduction of antigens into

the body in order to produce antibodies that
strengthens the body system and prevent infection.
 TYPES OF IMMUNITY
• 1. Passive immunity: this can be divided into
• a) natural immunity- this type of immunity is acquired
by maternal transfer which is usually short lived.
• b) artificial immunity- this the inoculation of specific
antibodies, immune serum globulin containing
antibodies. e. g, Anti Tetanus Serum (ATS).
• 2. Active immunity- this occur when there is exposure
to an antigenic stimulus. The host produces its own
corresponding antibodies.
• a) natural immunity- the immunity is acquired when
an individual is infected by the disease causing agents
 TYPES OF IMMUNITY
• (clinical/subclinical infections)
• b) artificial immunity- immunity is acquired through
inoculation of infectious agents in form of vaccines,
dead, live or attenuated e.g, typhoid, BCG etc
 TYPES OF IMMUNITY
immunity

Innate Acquired

Passive Active

Artificial Natural Artificial Natural

 VACCINES
• Vaccines are specially prepared antigens which when
administered to a subject produce active immunity.
• The aim of administering vaccine is to induce
immunity in the individual long before he is exposed
to the natural infection.
• Vaccine may contain whole organisms (live or killed
or attenuated), component parts of the
microorganisms or the products of disease causing
organisms
• The active component of the vaccines must be
rendered incapable of causing disease
 TYPES OF VACCINES
• Live vaccines: this is giving safe, live but attenuated
organisms as vaccines to protect against diseases,
• The advantages are that live vaccines multiply in the
host to generate responses in the host, and a
relatively small quantity of the antigen is required
to evoke a large and sustained immune response;
examples of live vaccines are BCG, Yellow fever,
Measles.
 TYPES OF VACCINE CONTD
• Killed vaccines: Immune response to killed vaccines
is not as strong as for live vaccines, higher doses of
the vaccine are required to generate immune
response.
• Repeat doses given 4-6weeks apart are
recommended to boost primary response.
• All killed vaccines contain preservative.
• Examples are Pertusis, Cholera, Typhoid vaccines.
 TYPES OF VACCINE CONTD
• Toxoids : Toxoids are detoxified toxins,
detoxification is achieved by treating the exotoxins
with formaldehyde.
• Toxoids are weak in eliciting immunogenic
responses, they are usually combined with other
substances called adjuvant that increases their
antigenic properties.
• Examples are diphtheria & tetanus toxoids
• Like killed vaccines, toxoids need to be given in
repeated doses of not less than four weeks in-
between for lasting protection.
 TYPES OF VACCINE CONTD
• Recombinant vaccines: these vaccines are
produced by genetic engineering technology.
• Examples are Hepatitis & Human Papilloma Virus
(HPV).
• A segment of the respective gene is inserted into
the gene of yeast. The modified yeast cell then
produces pure Hepatitis B surface antigen or HPV.
 TYPES OF VACCINE CONTD
• Conjugate vaccine: the immune system of certain
young persons are immature, in order for vaccine to
be effective in preventing disease or to enhance
immunogenicity, a protein molecule is attached to the
antigen to create what is called conjugate vaccine.
• The protein part of a conjugate vaccine act as the
carrier for the antigen
• Safe with few adverse effects
• Vaccine against bacterial mennigitis. (Neisseria
Meningitidis, Streptococcus pneumoniae,
Haemophilus influenzae).
 BENEFITS OF IMMUNIZATION
• Prevention of deaths from killer disease
• Reduction of suffering/ morbidity from ailments
• Release of resources for other health and related
activities
• Ensuring healthy people, capable of contributing to
the social and economic development of the
society.
 DELIVERY OF IMMUNIZATION SERVICES

• Immunization may be carried out in a health facility

(clinic, health centre, hospital) or any other building
like classrooms or outside, in a shade.
• Organize any location to facilitate client flow &
crowd control.
• Vaccination sessions must be held on days, &
venues convenient for mothers & their children,
sessions must be regular e.g daily where there are
adequate staff. The community that is served must
be aware of days, times & venues.
DELIVERY OF IMMUNIZATION SERVICES CONTD
• A fixed or static centre is the centre where vaccines
are administered by workers of the same facility as
part of their regular activities. Here immunization is
integrated into maternal & child health.
• Outreach services. This is the process of taking this
essential service to distant communities to attend
to people who are far or for one reason or the other
cannot easily access the static centres. Public places
like town hall, schools, premises of traditional rulers
etc are commonly used. There must be pre-
immunization visits and arrangement, including
transportation of equipments/materials.
 IMMUNIZATION CAMPAIGNS
• Immunization campaigns are embraced by many
countries as a strategy for increasing their
immunization coverage.
• It provides a form of public enlightenment and
social mobilization.
• Mass campaigns are carried out either on house to
house basis or in designated centres. Campaigns
may include
• The president/Chief executive flag off
• Social mobilization of government, NGO, Private
sector as health sector cannot cope alone.
 EXTENDED PROGRAMME OF IMMUNIZATION
• The extended programme on immunization (EPI)
was established by WHO in 1974 with the aim of
reducing death and disability from 6 vaccine
preventable childhood diseases.
• The strategy was making immunization accessible to
children and women of reproductive age..
• The targeted diseases were diphtheria, measles,
pertusis, poliomyelitis, neonatal tetanus,
tuberculosis and tetanus for women of child bearing
age.
 EXTENDED PROGRAMME OF IMMUNIZATION

• Target population for EPI are all children aged 0-

24months, and women of child bearing age
• Targets and goals were set by WHO which each
country were expected to accomplish.
NATIONALNPROGRAMME OF IMMUNIZATION

• NPI
 NPI VACCINES
• BCG- This is a live attenuated vaccine for the
prevention of tuberculosis, it derives its name from
Bacille, Calmette Guerin after the two discoverers.
• BCG is from Mycobacterium bovis and the first human
vaccination was in 1921
• It is a freeze-dried preparation which must be
reconstituted with its chilled diluent before
administration.
• The reconstituted vaccine must be used within 2-3
hours since it loses its potency fast
• BCG is very sensitive to sunlight and loses its potency
after 5mins exposure.
 NPI VACCINES CONTD
• It is advised that the vials should be wrapped with
metal foil or dark paper to avoid the effect of the
sunlight. Should be stored between 0 and +8 oC
• Also, containers are usually made of dark glass for
the same reason
• BCG is given at birth intradermal
• The site is upper left arm, just below the insertion
of the deltoid muscle.
• Dose is 0.05ml for children under age of one but
0.1ml if over one year old
 NPI VACCINES CONTD
• Following BCG vaccine, a small raised lump appears at
the injection site. This usually disappears within 30
minutes.
• After approximately two weeks, a red sore develops
which is 10mm in diameter (the size of the end of an
unsharpened pencil)
• The sore remains for another two weeks and then
heals. A small scar about 5mm result from the sore. It
remains for life.
• This is a sign that the child has been effectively
immunized.
• Sometimes some lymph nodes in the armpit may
 NPI VACCINES CONTD
• It should not be given to children who have clinical
HIV/AIDS.
• Only one dose of BCG is required.
• If there is no nodule at the injection site 6 weeks
after a BCG vaccination, the injection must be
repeated
• If there is no scar 6 weeks after the second injection
(i.e. 12 weeks after the first) the child should be
referred to the doctor.
 NPI VACCINES
• POLIO VACCINE- the most widely used polio vaccine is
the oral preparation (Sabin). Has been in use since 1960.
should be stored between 0oC and +8oC
• Oral polio vaccine contains attenuated live virus
belonging to 3 serotypes, it is clear pink or orange liquid
that comes in small bottles with droppers
• Polio vaccine is more easily damaged by heat than any
of the NPI vaccines but it can withstand freezing
• Oral Polio vaccine are given in 4 doses : at birth (OPV0),
at 6weeks of age (OPV1), 10weeks of age OPV2),and
14weeks of age (OPV3). Interval between doses must be
at least 4 weeks
 NPI VACCINES CONTD

• On each occasion, 2drops of the vaccine are

carefully dropped into the baby’s mouth
• There is no contraindication to oral polio vaccine
• When given to a child with diarrhoea, the dose
should be repeated at the earliest possible
opportunity when the diarrhoea stops.
• OPV is dropped in the mouth using the dropper that
comes with the vaccine.
• OPV has no side effects.
 NPI VACCINE CONTD
• TRIPLE ANTIGEN (Diphtheria, Pertusis, Tetanus).
Diphtheria and tetanus components of the vaccine are
prepared from exotoxins, while the pertusis portion is
killed bacteria, the adjuvant is aluminium salt
• DPT is liquid but must never be allowed to get frozen,
its best range of temperature is 0oc and +8oc
• The vaccine loses its potency in 2days at room
temperature.
• A bottle of DPT that has frozen and thaw will be
detected by performing the “shake test” when not
spoilt and shaken and allowed to settle, after 30 mins,
there is no sediment.
 NPI VACCINE CONTD
• Three doses are given each of 0.5ml
• DPT is injected into the muscle in the outer part of
the thigh
• DPT should not be given to children over 5 years of
age or children who have suffered a severe reaction
to a previous dose of the vaccine. Instead, a
combination of diphtheria toxoids combined with
tetanus toxoid should be given where available.
 PENTAVALENT VACCINE
• Pentavalent is a new innovation introduced to
routine immunization schedule.
• Pentavalent vaccine is a combination of five
vaccines-in-one that prevents diphtheria, tetanus,
pertusis (whooping cough), Hepatitis B and
Haemophilus influenza type B (the bacteria that
causes Meningitis, Pneumonia and Otitis Media) all
through a single dose.
• Pentavalent vaccine is currently used in place of DPT
vaccine.
 NPI VACCINES CONTD
• DPT is administered intramuscularly into the thigh
at 6, 10 and 14weeks
• The usual dose is 0.5ml
• Reactions to DPT are rare, if any, is due to the
Pertusis component, may cause encephalopathy.
• Once a child has reacted to DPT he should not be
given a repeat dose.
 NPI VACCINES CONTD

• MEASLES VACCINE- it’s a live attenuated freeze-

dried vaccine.
• Measles vaccine is sensitive to heat, light and some
metals, chilled diluents are recommended for
reconstituition and vaccines must be stored below
8oc.
• For efficacy, the vaccine must not be exposed to
direct sunlight and are best administered using
plastic syringes to avoid reaction with metal plunger
or glass
 NPI VACCINES CONTD
• The vaccine is given by subcutaneous injection
usually in the left upper arm at the age of 9months
• A single dose of 0.5mls gives a lifelong immunity
just as natural infection.
• Children may have fever or mild rash following
measles vaccination. Mothers should be reassured
and advised to give paracetamol for the fever.
 NPI VACCINE CONTD
• TETANUS TOXOID- apart from being a component of
DPT, tetanus toxoid exist as a separate vaccine.
• Tetanus toxoid under NPI is administered to women
of reproductive age with the hope that antibodies
produced will be passed on to the baby in utero.
• The passive immunity protects the child during its
early days of life from Tetanus.
• Tetanus toxoid is given intramuscularly at the left
upper arm
• The dose is 0.5ml, 5doses (TT5) provides protection
for the rest of the woman’s life
 NPI VACCINES CONTD
• HEPATITIS B VACCINE- its one of the newer
generation vaccines.. Used to protect against
Hepatitis B virus infection . It is made from the
outer coat of Hepatitis B virus obtained from
plasma of carriers or through recombinant
technology.
• The vaccine must not be frozen and must be kept
between 2 0c and 8 0c
• HB Vaccine is administered by intramuscular route.
 COLD CHAIN SYSTEM
• This is a system of manufacturing, storage and
distribution of vaccines in a potent state (at
prescribed temperatures) from the manufacturer to
actual vaccination site.
• Vaccines are sensitive to heat & must be kept close
at all times
• The equipment and people that keep vaccines
during the journey are together called cold chain.
COLD CHAIN SYSTEM
Manufacturer
transit stores at the airport and clearance

National cold store Abuja

Zonal stores (6)

State stores (36)

LGA (774)

District and PHC

Health facilities
MAINTENANCE OF COLD CHAIN SYSTEM
• Maintenance of the cold chain require vaccines and
diluents to be collected from airport as soon as it
arrives the airport
• Transported at correct temperature and from one
store to another.
• Stored in correct temperature at national zonal,
state and LGA and health facilities
• Transport in correct temp. to health facilities and
outreaches
• Kept at right temperature during immunization.
 COLD CHAIN EQUIPMENTS
• Different levels of the health care system need
different equipments for transporting & storing
• National and zonal stores- cold rooms, freezers,
refrigerators & cold chain boxes with icepacks
• State and LGA stores-freezers, refrigerators, cold
boxes and icepacks
• Health facilities-cold boxes, vaccine carriers with ice
packs, may also have a refrigerator and freezer.
 COLD CHAIN EQUIPMENTS
• Cold boxes- an insulated container meant to keep
vaccines & diluents cold, used by health facility staff
to collect and transport vaccine supplies from LGA
stores to immunization posts.
• Cold life of a cold box is 2-8days
• The most suitable box for a particular health facility
is determined by
- The vaccine storage capacity needed
- The cold life needed, this depends on the longest
time that vaccine will be stored in the box
 COLD CHAIN EQUIPMENTS CONTD
• Vaccine carriers- like cold boxes, vaccine carriers are
insulated containers that are lined with frozen ice
packs to keep vaccines and diluents cold.
• They are smaller than cold boxes and easier to carry
if you are walking, but do not stay cold for as long,
only for 24 to 72hours
• Vaccine carriers are used to transport vaccine and
diluents to outreach sites & for temporary storage
during immunization sessions.
• They may be used to store vaccines when the
refrigerator is out of order or being defrosted.
 COLD CHAIN EQUIPMENTS CONTD
• Foam pad- a foam pad is a piece of soft foam that
fits on top of the ice packs in a vaccine carrier.
• When the carrier lid is opened, the foam pad keeps
the vaccine underneath in a cool state
• It also hold vaccine vials during immunization
sessions.
• Ice packs- ice packs are flat, square plasticc bottles
that can be filled with water and then frozen, the
required number in a cold box or vaccine carrier
varies.
 COLD CHAIN EQUIPMENTS CONTD
• Refrigerators- They are used for storing vaccines and for
freezing and storing ice packs.
• A refrigerator in a health centre should be able to hold:
-A one month supply of vaccines
-A 1 to 2week reserve stock of vaccines & diluents.
• Place frozen ice packs or bottle of salt water in the
bottom of the refrigerator to keep it cool if power fails
• Nothing in half of the total space to allow air circulate
around the vaccines & diluents to keep them cool.
• Freezers- freezers are used to keep vaccines at
temperatures below 0c & to freeze ice packs.
 COLD CHAIN MONITORING EQUIPMENTS
• The purpose of cold-chain monitoring equipment is to
keep track of the temperature to which vaccine &
diluent are exposed in refrigerators, cold boxes &
vaccine carriers during storage & transportation.
• 1. thermometers: health facility staff use thermometers
to monitor the temperature of refrigerators, cold boxes
and vaccine carriers. Readings are taken twice daily and
charted.
• 2. Vaccine Vial Monitor : a vaccine cold-chain monitor
is a card which changes color when vaccine is exposed
to temperatures that are too high. It is used to estimate
the length of time that the vaccine has been exposed to
 COLD CHAIN MONITORING EQUIPMENTS

• 3. Vaccine Vial Monitor (VVM): VVM is used to

track if individual vaccine vial has been exposed to
heat or not. The VVM is a round label that has been
treated with heat sensitive chemical & attached to
every vial by vaccine manufacturers. The label
changes when exposed to heat.
 COLD CHAIN MONITORING EQUIPMENTS
• 4. freeze watch indicators: a freeze watch indicator
consists of a small vial of red liquid attached to a white
card & covered in plastic. The vial breaks if the
temperature where the indicator is located drops
below 0oc for more than one hour
• Conduct the shake test, if positive do not use vaccine,
discard them.
• Place a freeze watch indicator in every refrigerator with
freeze sensitive vaccine.
• Use the freeze watch indicator to warn of exposure to
freezing temps. NOT to decide whether to discard
vaccine.
 COLD CHAIN MONITORING EQUIPMENTS

• 5. shake test: take a vial of vaccine of the same type

& batch number of the vaccine you want to test,
and made by the same manufacturer
• Gather the potentially frozen “Suspect” vials you
want to test
• Intentionally freeze one vial of vaccine and label it
“Frozen”
• Allow the “Frozen” vial to thaw completely
• Shake well and observe if there are sediments, this
indicates damage.
 CONTRAINDICATIONS TO IMMUNIZATION

• There are few contraindications for immunization

• All vaccines should be given on schedule, except a
child is so sick as to be hospitalized, that child
should be immunized before discharge.
• The child should be immunized before discharge
• Immunize even when a child has a low grade fever,
a mild cold, diarrhoea, or other mild illness.
CONTRAINDICATIONS TO IMMUNIZATION

• If a child has diarrhea, when you give OPV, administer

an extra dose, i.e. a 5th dose, at least 4weeks after he
or she has received the last dose in the schedule.
• Neither BCG nor Yellow fever vaccines should be given
to children who have clinical AIDS
• However, measles vaccine is not contraindicated in
children with clinical AIDS because measles can be
threatening in these children.
• Do not give more than one dose of the same vaccine
in a client in one session.
 REMEMBER
• DO NOT put vaccines on the door shelves in front
opening refrigerators, the temp is not low enough
• DO NOT keep expired vaccine in the refrigerator,
keep them aside and return to the LGA store for
proper disposal
• DO NOT keep any food, drink or drugs in a vaccine
refrigerator
• DO NOT keep Acute Flaccid Paralysis (AFP) stool
specimens in a vaccine refrigerator
• DO NOT open refrigerator frequently, frequent
opening raises temp
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