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 smallpox 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
- Objectives:
- 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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