Immunization and

under five care

By 4th year bsc nursing Supriya
Mandal
Introduction
 Types of immunity
• Active immunity : It is produced by stimulating immunological defence
mechanism through administration of antigen usually prior to natural
exposure to infection.
• eg – vaccine
• Passive immunity: it is produced temporarily by supplying performed
exogenous animal or human antibody to suppress the disease given soon
after or prior to exposure of an infection.It is Readymade antibody.
• Eg – antisera and immunoglobulins
 Immunizing agents

• Vaccines
• Immunoglobulins
• Antisera
 Vaccines
Types of vaccines ----
• Live attenuated vaccines : BCG, oral polio,measles,oral Typhoid, yellow
fever, influenza(nasal spray)
• Inactivated or killed vaccine : hepatitis B, salk polio, rabies,JE,
influenza (sc, intradermal),cholera., Typhoid , pertussis.
• Toxoid vaccine : Diphtheria, tetanus
• Cellular fraction: Meningococcal and pneumococcal vaccines
• Combination :DPT, MMR,DT, pentavalent
2. Immunoglobulins:
• Normal human Ig- hepatitis A, measles, rabies, tetanus
• Specific human Ig- Hepatitis B, Diphtheria.
3. Antisera: Diptheria, rabies, tetanus,boltulism.
 Cold chain
• Cold chain is a system of storage
and transport of vaccine at low
temperature

• 6 rights of supply chain –

Right vaccine in the right quantity at
the right place at the right time at the
right condition at the right cost.
 Temperature requirements of vaccines
Heat sensitive &freeze sensitive vaccine:
Vaccines are divided into 6 categories –
A,B,C,D,E,F
• Most heat sensitives are in gr A
• Least heat sensitives (freeze sensitive)are
in gr F
 Sensitivity to heat and light
• Heat sensitive vaccine: place at
the lower portion of ILR(OPV,
measles,BCG,JE,Rota virus)
• Freeze sensitive vaccines: placed
at the top level of
ILR(diluents,HepatitisB,
DPT,TT,TD,pentavalent )
 Sensitivity to light

• Sensitivity to light : light

sensitive vaccines available in
dark colour vials .eg- BCG,
Measles,MR
 Vaccine storage
• +2 to +8 degree is the Cold chain temperature of vaccines in India
• Most vaccines can be stored up to 5 weeks at the temperature between +2 to + 8 degree C.
• OPV
Routine storage. + 2 to + 8 deg C (in ILR)
Long-term storage -15 to -25 degree (in DF)
• Diluents
• +2 to+ 8degree C or can we keep outside cold chain( at room temperature but should be kept in ILR
or before 24 hours of reconstitution to prevent any difference in temperature between dilute and its
vaccine during reconstituion).
 Vaccine storage
• Vitamin A – stored outside cold chain and room temperature
• Reconstituted vaccine ( at +2 to+ 8 degree c )can be kept for
4 hours in BCG and measles.
 Cold chain equipments
• Storage and transport equipments are----
• Storage equipments
1. Electrical – walk in cooler,walk in refrigerator,Iceline
refrigerator, Domestic Refrigerator,Deep freezer .
2. Non electrical – Cold box, vaccine box .
• Transport equipments – Refrigerated vaccine van, Insulated
vaccine van, Cold box, vaccine carrier .
 Walk in freezer
• Temperature maintenance -15 to -25
degree C
• For preparation of frozen ice packs
and bulk storage of opv.
• WIF are usually installed at National,
state and regional vaccine stores.
 Walk in coolers (WIC)
• Maintain a temperature of + 2 degree c
to + 8 degree c.
• These are used for storage in large
quantities of all UIP vaccines like
BCG, hepatitis B,DPT,pentavalent,
IPV, measles and TD,TT.
• This WICs are installed at Government
medical store depot, state, regional
vaccine stores.
 Deep freezer
• Cabinet temperature is maintain between
- 15 degree c to – 25°c.
• Used for storing ice packs and OPV for
3 months (at district level & above only)
• The DF which is used for storing
vaccines should not be used for ice
packs.
• Unlike ILR the DF has got little or
limited holdover time.
Deep freezer
 Ice line refrigerator (ILR)
• Maintain a cabinet temperature between + 2 degree C
to + 8 degree c.
• It can keep vaccine safe with minimum 8 hours
continuous electric supply in a 24 hour period.
• Based on temperature zone inside of ILR can be
divided into two parts upper part and lower part.
• Vaccines likeOPV, BCG, measles ,JE can be kept in
lower part and DPT ,hepatitis B,IPV, pentavalent
vaccine and diluents are kept in the upper part of the
basket.
 ILR
• These vaccines should never be kept directly on the floor.
• In case basket is not available, two layer of empty ice packs can be laid
flat on the bottom of the ILR.
• Hold over time: the time taken by the equipments to raise the inside
cabinet temperature from its temperature at time of power cut to
maximum temperature limit of its recommended range.
• Twice daily check that temperature of ILR
ILR..
 Domestic refrigerator
• Maintain the cabinet temperature
between + 2 degree C to + 8 degree C.
• They can be used for storage of vaccine
at private clinics and nursing
homes ,provided continuous power
supply is ensured .
• Hold over time is limited.
 Cold boxes
• Cold boxes are supplied to all peripheral
centres.
• These are mainly used for transportation
• Before the vaccines are placed in the cold
boxes.
• Fully frozen ice packs are placed at the
bottom and sides.
• First kept in polythene bags.
Cold boxes
 Vaccine carriers
• 16 to 20 vials can be stored
• 4 fully frozen ice packs are used for lining
the sides.
• Ice packs must be conditioned before kept
in vaccine carrier.
• Used for transportation of vaccines from
ILR to vaccine session.
• Carrier should be closed tightly
Vaccine carriers
 Day carrier
• Used to carry small quantities of
vaccine(6-8) vials to a near by
session
• Two frozen ice packs are used
• It used only for few hours
 Ice packs
• Maintain temperature during transportation to vaccine
site.
• Capacity 320-340ml.
• Ice packs contain water and no salt should be added to it.
• Water should be filled up to the level marked on the side.
• If there is any leakage such icepacks should be discarded.
• Conditioning should be done before using it
• 2 holes for heat sensitives vaccines.
 Vaccine vial monitoring (VVM)
• A VVM is a chemical indicator label ( heat sensitive material)attached
to the vaccine container (vials, ampule or dropper) by the vaccine
manufacturer.
• Marker of- potency of vaccine & efficiency of cold chain maintenance
• VVM status helps the user to decide which vaccine should used first.
• Consist of outer circle and inner square (only inner square is made of heat
sensitive material so only inner square changes colour where as outer
circle always remains blue).
VVM
 VVM
• Stage 1- Inner square lighter white
than outer circle .( Use)
• Stage 2 -inner circle still lighter than
outer circle .(Use)
• Stage 3-colour of inner circle
matches the outer circle .(Don’t use)
• Stage 4- colour of inner circle is
datker than outer circle .(Don’t use)
 VVM
• 4 types of VVM------
VVM2,VVM7,VVM14,VVM30
Number here is the time in days that it takes for the inner square to reach the
colour indicating a discard point if the vial is exposed to constant
temperature of 37 degree C or above
 Shake test
• Test to identify frozen vaccines
• If you suspect that vaccine has been frozen in past then conducted a shake test
1. Take a control vial& freeze it, until it’s completely solid
2. Allow control vial to thaw completely
3. Select a sample of vaccine you suspect to be frozen in past
4. Shake both vial
5. Observe control & suspect vial side by side to compare how they sediment (5-
15min)
 Shake test
• If suspect vial sediments slower than
control vial - use it.
• if suspect vial sediments at the same rate
or faster than the control vial – don’t use.

• Mechanism – when vaccine freeze, it’s

alum content gets loose & sediments
faster than a non frozen.
 Open vial policy
• Implementation of open vial policy allows reuse of partially use multidose
vials of applicable vaccines under UIP in subsequent session up to 4
weeks.
• Open vial policy applies only for –
• DT, TD, Hepatitis B, OPV, liquid pentavalent, liquid JE,PCV, injectable
IPV
• Don’t apply to –
MR,BCG,Rota virus
 Open vial policy
Vaccine vials opened in session site can be used in more than one immunization
session upto 4 weeks provided:-
• Expiry date has not passed
• Vaccines are stored strictly under appropriate temperature range both during
transportation storage at cold point.
• Aseptic techniques has been used to with draw all doses.
• VVM vial monitor has not reached at discard point.
• Open vial should never be submerged in water.
 Open vial policy
• Ensure all open vials have recorded date and time of opening.
• At the end of session all open vials should be returned to cold chain point
• All open vials of BCG, measles should be destroyed after 48 hours or
before next immunization session.
• All vials (open or unopened) should be transport in a zipper bag in the
vaccine carrier and record in the stock register
• Well sealed conditioned icepacks should be used in vaccine carrier.
Adverse events following immunization
• An AEFI is any untoward medical occurance which follows
immunization which doesn’t necessarily have a casual
relationship with the usage of vaccine.
 AEFI. ........
• Types of vaccines reaction ----
1. Minor reaction:
• Usually occurs within a few hours of injection
• Resolve after short period of time .
• Local ( pain, swelling or redness at the site of injection)
• Systemic (fever, malaise, headache,loss of appetite)
 AEFI.......
2. Server reaction:
• Usually do not result in long term problems
• Can be disabling
• Rarely life threatening
• Include seizure and allergic reactions caused by the body’s reaction to
particular components in a vaccine.
• VAPP caused by OPV, prolonged crying for DPT, Anaphylaxis .
 National Immunization programme
• In 1974 Expanded programme on Immunization.(EPI)
• In 1985 Universal Immunization programme (UIP)
National Immunization schedule
National Immunization schedule
National Immunization schedule
National Immunization schedule
 Under five clinic
• Under five clinic ise center preventive , promotive ,curitive ,referral and
educational services are provided in a package manner to under 5 children
under one roof.
 Under five clinic
• Functions:
1. Care in illness:
• Acute illness like diarrhea
• Chronic illness
• Disorder of growth and development
• Xray and laboratory services
• Referral services
 Under five clinic.....
• Functions
2. Growth monitoring:
• The child is weighed periodically
• Measuring height,mid arm circumference
• Growth is plotted on the growth chart
 Under five clinic...
3.Preventive care:
• Immunization services
• Vitamin A supplimentation
• Antihelminthic treatment
• Regular check up
• ORS supply
 Under five clinic....
4.Family planning :

5. Health education:
 Under five clinic....

• Role of nurse:
• Arranging equipment
• Arranging entertainment facilities
• Providing immunization services
• Giving warm welcome to mother and children
• Maintaining growth chart, Immunization card, recording nutritional level, weight
of the child.
• Providing health education
Summerization
Conclusion
 10 year questions
• National immunization schedule – 2019,2015
• MMR -2020
• Cold chain -- 2013