National Immunisation Programme-Introduction To Vpds, EPI :- World & India , UIP

NATIONAL IMMUNISATION PROGRAMME-Introduction to VPDs, EPI :- World & India , UIP


VACCINE PREVENTABLE DISEASES:

  • An infectious disease for which an effective preventive vaccine exists.
  • If a person dies from it, the death is considered a vaccinepreventable death
TARGETED VPDS:
  • Tuberculosis
  • Diphtheria
  • Pertussis
  • Poliomyelitis
  • Measles
  • Tetanus
  • Hepatitis B
  • Japanese Encephalitis

FULLY IMMUNIZED CHILD:

  • A child who received :
  • One dose of BCG, Three doses of DPT and OPV, One dose of measles before one year of age.

EXPANDED PROGRAMME ON IMMUNISATION (EPI):

  • EPI launched in 1974
  • Build on pox infrastructure
  • Targeted 6 diseases
Original EPI infant schedule:

Vaccines

Birth

6 weeks

10 weeks

14 weeks

9 months

BCG

BCG

OPV

OPV1

OPV2

OPV 3

DPT

DPT 1

DPT 2

DPT 3

Measles

Measles

Addition to EPI :
  • Yellow fever in 1988
    • For endemic countries only
    • Given with measles vaccine
  • Hepatitis B in 1992
    •  In high seroprevalence countries by 1995
    • In all countries by 1997
  • Haemophilus influenzae type b (Hib)
    • Based on disease burden and capacity
    • 2006 : all countries.

EPI IN INDIA:

  • The Govt of India launched it’s EPI in 1978.
  • Introduced BCG, OPV, DPT, & Typhoid-paratyphoid vaccines
  • Objectives
    •  To reducing mortality, morbidity resulting from VPDs.
    •  To achieve a self sufficiency in vaccine production.
  • Target :- at least 80% coverage in infancy.
  •  As vaccination was offered through major hospitals & largely restricted to urban areas so coverage remained low.
  • In 1983 tetanus toxoid vaccine for pregnant woman

MILESTONES IN THE IMMUNIZATION PROGRAM:

  • 1978 : EPI introduced after smallpox eradication:
    • BCG, DPT, OPV, Typhoid.
    • Limited to mainly urban areas
  • 1985 : Universal Immunization Program (UIP) introduced
    • Expanded to entire country; Measles added.
  • 1986 : National Technology Mission

Objectives:

  • Monitoring under PMO’s 20 point programme
  • Improve coverage with existing antigens
  • Develop self sustainability in vaccine production
  • 1990 : Vitamin-A supplementation.
  • 1992 : Child Survival and Safe Motherhood Program.
  • 1995:- India 1st conducted national immunisation day for polio eradication.
  • 1997:- Reproductive and Child Health Programme
    • National Polio Surveillance Project launched as WHO & GOI collaboration.
  • 2001:- National Technical Advisory Group On immunisation formed
  • 2005:- National Rural Health Mission
UNIVERSAL IMMUNIZATION PROGRAMME:

OBJECTIVES:

  • To increase immunization coverage.
  • To improve quality of service.
  •  To achieve self sufficiency in vaccine production & manufacturing of cold chain equipments.
  • To establish reliable cold chain equipment and establish a good surveillance network.
  •  To introduce a district wise system monitoring & evaluation
  • To train health personnel.
COMPONENTS:
  •  Immunization of pregnant women against tetanus
  •  Immunization of children in their first year of life against 6 VPDs.

TARGETS:

  • To achieve 100 % coverage of pregnant women with 2 doses of TT.
  • At least 85% coverage of children under one year (with 3 doses of DPT, OPV & one dose of BCG, One dose of Measles) by march 1990.
  • Target was increased to cover 100% of infants as the vaccination programme became universalised in geographical coverage
  • UIP was first started in 31 selected districts with plan of scale up to additional districts.

GOALS:

  • Goal 1:Districts will provide efficient and safe immunization services to all infants and pregnant woman
  • Goal 2: Contribute global polio eradication, measles mortality reduction and neonatal tetanus elimination
  • Goal 3: UIP will have sufficient and sustainable funding with established adequate, accountable, efficient fund flows
  • Goal 4: Sustain demand & reduce social barriers to access immunisation services
  • Goal 5: Accelerated introduction of licensed new and under utilized vaccines against diseases with significant mortality and morbidity in India
  • Goal 6: To monitor & use accurate, complete & timely data on vaccine preventable disease , AEFIs, antigen coverage & drop out rates by district

CHANNELS OF SERVICE PROVISION:

  • Immunization services are provided through the existing Health Care Delivery System. (MCH centers, PHC, CHCs, Hospitals, Dispensaries).
National Immunization Schedule:

Age

Vaccines

Birth

BCG, OPV-O, Hep B 

6 weeks

DPT -1, OPV -1, Hep B

10 weeks

DPT -2, OPV -2, Hep B

14 weeks

DPT -3, OPV-3, Hep B

9 months

Measles with vitamin A

16-24 months

DPT booster 1st , OPV – Booster

5 years

DPT Booster 2nd

10 years

TT

16 years

TT

16-24 months

Measles 2 nd dose; Japanese Encephalitis

18 , 24, 30, 36, 42, 48, 54, 60 months

Vitamin A

Vaccines added:

  • On 2nd July GOI introduced 4 new vaccines on recommendations given by NTAGI
  • ROTAVIRUS
  • INJECTABLE POLIO
  • RUBELLA
  • JAPANEASE ENCEPHALITIS
IAP Schedule:

Vaccines

Age

BCG

Birth – 2 weeks

OPV 

Birth ; 6,10,14 weeks; 16-18 months; 5 years

DPT  

6,10,14 weeks; 16-18 months; 5 years

 Hep B

Birth, 6 weeks, & 14 weeks or 6 weeks, 10 weeks & 14 weeks

Hib Conjugate 

6 weeks, 10 weeks & 14 weeks

Measles

9 months; 16-24 months

MMR

15 months

Typhoid

2 years, 5 years, 8 years & 12 years

TT

10 & 16 years

TT

Early in pregnancy & 4 weeks after TT-1

Vaccines that can be given after discussion with parents :

  • Varicella —- 15 months
  •  Hepatitis A — 18 months and 6 months later
  •  Influenza vaccine — 6 months of age
  •  Pneumoccocal conjugate vaccine — 6 weeks

 Indian academy of pediatrics (IAP) classification of malnutrition is based on weight for age.

IAP designates a weight of more than 80% of expected for age as normal.

Grades of malnutrition are ?

  • Grade I → 71-80%
  • Grade II  → 61-70%
  • Grade III → 51-61%                   
  • Grade IV →  50%
VACCINE SCHEDULE FOR UNIMMUNIZED CHILD:

Age

< 5 YEARS

> 5 YEARS

FIRST VISIT

BCG, OPV, DPT, HB

TT/TD, HB

2nd VISIT(1 month later) 

OPV, DPT, HB

TT/TD, HB

3rd VISIT  (1 month later) 

OPV, DPT, MMR, Typhoid

MMR, Typhoid

1 year later

OPV, DPT, HB

HB

Every 3 year

Typhoid Booster

Typhoid Booster

INTRODUCTION OF PENTAVALENT VACCINE (DPT + HEP-B + HIB)

  • India introduced pentavalent vaccine containing DPT, hepatitis B and Hib vaccines in two states viz.
    • Kerala and Tamil Nadu under routine immunization programme from December 2011.
  • DPT and hepatitis B vaccination requires 6 injections to deliver primary dose
  • New antigen, i.e., Hib has been added which protects against Haemophilus influenza type B (associated with pneumonia and meningitis) and the number of injections are reduced to 3.
  • The vaccine has been expanded to 6 more states, i.e.,
    • Haryana, Jammu and Kashmir. Gujarat, Karnataka, Goa and Puducherry in 2012-13.
  • Further expansion is planned to 11 states in October 2014 and rest of 15 states from April 2015.

Exam Important

  • Give BCG, OPV, DPT, measles vaccines and vitamin A is given if  3year old in unimmunized
  • 18 month old child, has received one dose of DPT and OPV at 2 months of age should be given BCG, 2nd dose of DPT and OPV
  • Grade III malnurtition according to IAP is 51-60 %
  •  In a 8 yrs old unimmunized child  Pertusis & Salk vaccine can not be given
  • In national immunization shedule of India, measles vaccine is given at 9 Months
  • In National immunization schedule TT, OPV & Measles are given.
  • In the WHO recommended EPI Cluster sampling for assessing primary immunization coverage, the age group of children to be surveyed is 12-23 months
  • In the UIP blindness can be prevented by the administration of Measles vaccines
  • Weight of child is 70% of normal according to IAP classification, categorised in Moderate
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