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VACCINES & COLD CHAINDr. Anu Mohandas

PG ResidentDepartment of Community Medicine

University College of Medical Sciences

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Expanded Immunization Programme: 1978– Reduce morbidity and mortality among under 5

children caused by vaccine preventable diseases. 1. Diphtheria2. Pertussis3. Tetanus4. Polio5. Typhoid6. Childhood Tuberculosis

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Universal Immunization Programme1. Diphtheria2. Pertussis3. Tetanus4. Polio5. Measles6. Childhood Tuberculosis7. Hepatitis B 8. Hib disease (meningitis, pneumonia)9. Japanese Encephalitis

VACCINE PREVENTABLE DISEASES

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VACCINES UNDER UIP1. BCG (Bacillus Calmette Guerin) 2. DPT (Diphtheria, Pertussis and Tetanus Toxoid)3. OPV (Oral Polio Vaccine) 4. Measles 5. Hepatitis B 6. TT (Tetanus Toxoid) 7. JE vaccination (high disease burden districts) 8. Hib containing Pentavalent vaccine (DPT+HepB+Hib) (In

selected States)

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Vaccines stimulate the body’s immune system which produces antibodies against disease

producing organisms– LIVE ATTENUATED VACCINES– KILLED VACCINES

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LIVE ATTENUATED VACCINES

Disease-causing viruses or bacteria that have been weakened under laboratory conditions. They replicate in a vaccinated individual, but because they are weak, they cause either no

disease or only a mild form of the disease

Eg. BCG, Measles and the Oral Polio Vaccine

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INACTIVATED OR KILLED VACCINES

Produced by viruses or bacteria inactivated with heat or chemicals. They cannot grow in a

vaccinated individual and so cannot cause the disease.

Eg. Whole-cell (pertussis) Fractional protein based (DT and TT)

Recombinant (hepatitis B) vaccines

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BCGTYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Live vaccineTuberculosis

At birth (upto 1 year)1 dose (0.05ml; 0.1)

Intra- dermal Left upper arm

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Questions?

• Why give BCG vaccine only on the left upper arm?

• Why do we give 0.05ml dose of BCG to newborns (below 1 month of age)?

• Why is BCG given only up to one year of age? • If no scar appears after administering BCG,

should one re-vaccinate the child?

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OPVTYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Live vaccine; BivalentPoliomyelitis

0,6,10,14wks; 18m5 dose; 2 drops

oral

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• Till what age can a child be given OPV? • Can OPV and vitamin A be given together? • Can an infant be breastfed immediately after

OPV?

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IPV

TYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Killed vaccinePoliomyelitis

14wks1 doses; 0.5mlIntra-muscular

Anterolateral aspect of thigh

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DPTTYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Diphtheria, pertusis, tetanus6,10,14wks; 16-24m;5yrs

5 doses; 0.5mlIntra-muscular

Anterolateral aspect of thigh

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• Why should there be a minimum gap of 4 weeks between two doses of DPT?

• Why give the DPT vaccine in the antero-lateral mid thigh and not the gluteal region (buttocks)?

• What should one do if the child is found allergic to DPT or develops encephalopathy after DPT?

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HEPATITIS BTYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Hepatitis B 0,6,10,14wks

4 doses; 0.5ml Intra-muscular

Anterolateral aspect of thigh

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• Until what age can Hepatitis B vaccine be given?

• What is the purpose of giving the birth dose of Hepatitis B vaccine?

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MEASLES VACCINETYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Live vaccineMeasles

9m; 16-24m2 dose; 0.5mlSubcutaneous

Right arm

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• Why give the Measles vaccine only on the right upper arm?

• If a child has received the Measles vaccine before 9 months of age, is it necessary to repeat the vaccine later?

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TYPE OF VACCINE

DISEASES

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Killed vaccineTyphoid

2yrs1 dose; 0.5ml

IntramuscularAnterolateral aspect of thigh

TYPHOID VACCINE

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TETANUS TOXOIDTYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

ToxoidTetanus

10 yrs ;16 years pregnant woman( 2 doses;1 dose if previously vaccinated within 3 Year)

IntramuscularRight arm

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PENTAVALENT VACCINETYPE OF VACCINE

DISEASES

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Diphtheria, pertusis, tetanus, hepatitis B & Hib

6,10,14wks3 doses; 0.5mlIntra-muscular

Anterolateral aspect of thigh

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Pentavalent vaccine in how many states – 9 states – Tamil Nadu, Kerala, Haryana, J&K, Gujarat,

Karnataka, Goa, Puducherry, Delhi(2012).

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MMRTYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Live vaccineMeasles, Mumps, Rubella

16-24m 1 dose; 0.5mlSubcutaneous

Right arm

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VITAMIN A• How many prophylactic doses of vitamin A should be given and

till what age? 9 prophylactic doses 5 years of age.• What should be the minimum gap between two doses of

Vitamin A? 6 months• How should Vitamin A syrup be administered? spoon/dispenser provided with each bottle. The half mark in the spoon indicates 100,000 IU and a level full

spoon contains 200,000 IU of Vitamin A.

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JE VACCINETYPE OF VACCINE

DISEASE

SCHEDULE

DOSE

ROUTE OF ADMINISTRATION

SITE OF ADMINISTRATION

Japanese Encephalitis (Brain fever) 9-12 months;16-24 months

2 doses; 0.5mlSubcutaneous

(SA 14-14-2)

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• If a child above 2 years (24 months) of age has not received the JE vaccine through either RI or an SIA, should s/he be given the JE vaccine?

JE vaccination – 113 districts (62 new JE endemic districts have

been identified). – JE second dose has been introduced under UIP in

these endemic districts from April,13

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• If a child who has never been vaccinated is brought at 9 months of age, can all the due vaccines be given to a child on the same day?

• Which vaccines can be given to a child between 1-2 years of age, who has never been vaccinated?

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COLD CHAIN

Cold Chain is a system of storing and transporting vaccine at the recommended temperature range from the point of manufacture to point of use

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All vaccines are damaged by temperatures more than +80C The physical appearance of the vaccine may remain

unchanged even after it is damaged. The loss of potency due to either exposure to heat or cold is permanent and can not

be regained.

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The Vaccine Vial Monitor (VVM)

• Label containing a heat-sensitive material which is placed on a vaccine vial

• Register cumulative heat exposure over time.• The combined effects of time and

temperature cause the inner square of the VVM to darken gradually and irreversibly. Before opening a vial, check the status of the VVM

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• Does a VVM measure vaccine potency?No, does not directly measure vaccine potency

but it gives information about heat exposure over a period of time

VVM doesnot measure exposure to freezing that contributes to the degradation of freeze-sensitive vaccines.

• How to check for cold damage?THE SHAKE TEST

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Cold Chain Equipment

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ICE LINED REFRIGERATORS (ILRs)

• Keep vaccine safe with as little as 8 hours continuous electricity supply in a 24-hour period.

• Top-opening

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VACCINE CARRIER• 4 conditioned ice packs• maintain the inside temperature between +2 to +80C for 12

hours• Use: Carrying vaccines (16-20 vials) and diluents from

PHCs to session sites. Ensure the return of unused vaccine vials from session sites to the PHC on the same day in the cold chain through alternate vaccine delivery.

• Keep a unused vaccines that can be used in subsequent sessions. Discard vaccines that have been returned unopened more than thrice. Do not keep any used vials in the cold chain. Never�

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ICE PACKS

• Plastic containers filled with water• Frozen in the deep freezer • Help increase the holdover time• Condition Icepacks:– When icepacks are removed from a freezer, they need

to be kept at room temperature for long enough to allow the temperature of the ice at the core of the icepack to rise to 0°C.

– Beads of water cover its surface and the sound of water is heard on shaking it.

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THANK YOU