Transcript Immunizing children against Japanese encephalitis in China

Instructions for users
• This slide presentation provides an overview
of immunizing with the SA 14-14-2 JE
vaccine.
• This slide set should be used together with
the manual “Immunizing Children Against
Japanese Encephalitis using SA 14-14-2
Japanese Encephalitis Vaccine: A Training
Module for Vaccinators”.
• Below some of the slides, there are notes to
explain the information in the slide.
• You should adapt the presentation for your
own use.
Immunizing Children Against
Japanese Encephalitis with
SA 14-14-2 JE Vaccine
Learning Objectives
Participants will:
• Be familiar with key facts on SA 14-14-2 JE
vaccine.
• Demonstrate correct vaccine administration
techniques.
• Describe appropriate JE vaccine storage.
• Describe safe disposal of used needles and
syringes.
• Communicate more effectively with parents of
children being vaccinated.
Facts about SA 14-14-2 JE vaccine
• SA 14-14-2 is a live, attenuated vaccine.
• Licensed in the People’s Republic of China in
1988.
• Currently about 60 million doses are used
annually in China.
• Also licensed and used in South Korea, India,
Sri Lanka, Thailand and Nepal.
• Produced in primary hamster kidney cell
cultures.
Administering Japanese
encephalitis vaccine
Who should be given
JE vaccine?
Photo credit: Lisa Lundgren
The following two slides need to be
adapted according to the strategy and
immunization schedule in your area
An example is given
For areas where JE vaccine is newly
introduced
• A one-time preventive or “catch-up”campaign will
be conducted.
• This will include children 1 to 15 years of age.
For routine immunization
Standard immunization
schedule
All children who are 9
months of age should
receive a dose of JE
vaccine.
Age
Vaccines
Given
Birth
BCG HepB1
6 Weeks
OPV1 DTP1
10 Weeks
OPV2 DTP2
HepB2
14 Weeks
OPV3 DTP3
HepB3
9 Months
Measles JE1
5 years
Measles
What if a dose is missed?
• If a child misses the
date for vaccination,
the child should make
up the dose as soon
as possible.
• There is no need to
re-start the
vaccination schedule.
Photo credit: Lisa Lundgren
The SA 14-14-2 vaccine (1)
• SA 14-14-2 is a lyophilized vaccine that
needs to be reconstituted (mixed with diluent)
before use.
• Prior to reconstitution it is a milky-white caked
powder.
• After mixing with diluent it becomes a
transparent pink liquid.
Photo credit: Chengdu Institute of Biological Products
After mixing with diluent, the vaccine is a
transparent pink liquid.
The SA 14-14-2 vaccine (2)
• Provided in single-dose or 5-dose vials.
• Comes with two separate vials
1. Lyophilized (freeze-dried) JE vaccine
2. Diluent
Photo credit: Chengdu Institute of Biological Products
The diluent and vaccine (5-dose vial)
Dosage and administration
• Dosage is 0.5 mL (all ages).
• Subcutaneous injection.
• Normally given in outer upper arm.
What are the steps to follow when
immunizing a child against JE
disease?
• Initial assessment with parents and child.
• Prepare the vaccine.
• Give the injection.
Before preparing the vaccine (1)
1. Greet the parents.
2. Evaluate the child’s immunization card and
check what vaccine(s) are needed.
3. Explain the vaccine to the parents, including
possible side effects and how to manage them.
4. Ask if the parent has any questions.
5. Check to make sure the correct vaccine is
available.
6. Discuss with parents when to return for the
next vaccination.
Before preparing the vaccine (2)
7. Prepare your supplies.
Photo credit: Lisa Lundgren
Prepare the vaccine (1)
1. Read the expiry date on the
vaccine vial.
– If the expiry date has
passed, discard the vial.
– If the label has fallen off,
discard the vial.
– If the VVM is at stage III or
IV, discard the vial and
inform your supervisor.
Photo credit: Lisa Lundgren
Prepare the vaccine (2)
2. Make sure you have the correct,
manufacturer-supplied diluent. Check the vial
is in tact and read the expiry date.
– If the correct diluent is not available, do not
reconstitute the vaccine with anything else.
– Discard the vial if
▫ the expiry date has passed.
▫ the label has fallen off.
▫ the vial is cracked.
Prepare the vaccine (3)
3. Remove the plastic flip-off cap from the diluent
vial and the vaccine vial.
4. Do not remove the rubber stopper.
Photo credit: Lisa Lundgren
Prepare the vaccine (4)
5. Reconstitute only with the manufacturersupplied diluent.
6. Using a sterile syringe with mixing needle,
draw up the diluent.
Photo credit: Lisa Lundgren
Prepare the vaccine (5)
7. Insert the needle into the lyophilized JE
vaccine vial.
Photo credit: Lisa Lundgren
Prepare the vaccine (6)
8.
Inject the diluent into the lyophilized vaccine
vial.
Photo credit: Lisa Lundgren
Prepare the vaccine (7)
9.
Discard the mixing needle and syringe.
Photo credit: Lisa Lundgren
Prepare the vaccine (8)
10. Shake the vial with the diluent and lyophilized
vaccine gently, but thoroughly.
– The vaccine should be uniformly pink
when completely mixed.
11. After reconstitution the vaccine should be
stored between 2°C and 8°C. Do not freeze
reconstituted JE vaccine.
12. Used reconstituted vaccine within x hours
(adapt slide according to country regulations
for this vaccine). Discard any vaccine
remaining after this time.
Giving the injection (1)
1. Draw up the
reconstituted vaccine,
using a new sterile
needle and syringe for
each injection.
– The needle and syringe
used for reconstitution
should not be used for
giving the injection.
Photo credit: Lisa Lundgren
Giving the injection (2)
2. Give:
– 0.5 ml of JE vaccine.
– As a subcutaneous injection.
– In the outer upper arm, avoiding the BCG
scar.
Giving the injection (3)
3. To give a subcutaneous injection:
– Position child sideways on mother’s lap.
– Ask the parent to hold the child’s legs.
– Reach fingers around child’s arm and pinch up the skin.
– Push the needle into the fatty layer between the skin and
the muscle on the child’s upper, outer arm.
– The direction of the needle
is towards the shoulder.
– Do not push the needle too
far in.
Photo credit: WHO, Immunization in Practice
Giving the injection (4)
4. Dispose of the needle and syringe immediately
in the safety box.
– Needles should not be recapped due to the
danger of needle-stick injury.
Photo credit: Lisa Lundgren
Giving the injection (5)
5. Record the date of vaccination on the child’s
vaccination card.
6. Remind parents about when to bring the child
back for the next vaccination.
What are the possible side effects of
JE vaccine? (1)
• Some children may experience mild symptoms
such as tenderness or swelling at the injection
site, rash, mild fever, nausea, or dizziness.
—
These side effects are not serious and will not last
more than a few days.
• Neither acute encephalitis nor hypersensitivity
reactions have been associated with the SA 1414-2 vaccine.
What are the possible side effects of
JE vaccine? (2)
• JE vaccine does not cause JE disease.
• If a child becomes unusually or severely ill in the
days following the immunization, the parents
should bring the child to a hospital or clinic as soon
as possible.
What are the contra-indications to
SA 14-14-2 JE vaccine?
• A very severe adverse reaction (anaphylaxis) to a prior
dose of SA 14-14-2 JE vaccine.
• Known allergy to any vaccine component (gelatin,
gentamicin, kanamycin).
• Immunosuppression (due to disease or medication) or
having the signs and symptoms of AIDS.
• Pregnancy
Note: if a child has a fever higher than 38.5°C, vaccination should be
postponed. An appointment should be made for vaccination as
soon as possible after the fever settles.
How do you store JE vaccine?
• Powdered, lyophilized JE vaccine should be
stored below 8°C, protected from light.
• After reconstitution, the vaccine should be
stored between 2°C and 8°C.
• Do not freeze reconstituted JE vaccine.
• The vaccine should be discarded after x
hours* or at the end of the immunization
session, whichever comes first.
*Insert regulations for this vaccine for your country
How can you safely dispose of
used syringes and needles? (1)
1. Keep a safety box within reach whenever
you give injections.
Photo credit: Lisa Lundgren
How can you safely dispose of
used syringes and needles? (2)
2. Immediately after giving an injection, place the
used needle and syringe in the safety box.
Photo credit: Lisa Lundgren
How can you safely dispose of
used syringes and needles?
3. If no official safety box is available, use a hard
plastic container for disposing of used syringes
and needles.
– Clearly mark the container “SHARPS” so others
will know to dispose of it properly.
4. When the box is ¾ full, seal the box and burn it
in an incinerator.
– If there is no incinerator, burn the safety box in a
metal drum or shallow pit.
5. After burning, bury all remaining ashes and
debris (including burned needles and melted
plastic).
Monitoring use of JE vaccine
• Record JE vaccine doses given on the child’s
immunization card and clinic record.
• Record doses of JE vaccine used on the routine
reporting form.
• Think about ways to reduce wastage.
How can you help ensure that parents
bring their children for all needed
immunizations? (1)
• Be friendly and courteous in all interactions with
parents.
• Listen respectfully to parents’ questions and
concerns.
• Answer questions and explain things simply and
clearly.
—
Be patient with people who cannot read or who have
not attended school.
How can you help ensure that parents
bring their children for all needed
immunizations? (2)
• Speak the local language and use words the
parents can understand.
• Find out when it is convenient for parents to
bring their children for immunization and offer
immunizations at those times.
• Maintain a regular immunization schedule so
that parents know when to come.
—
Clearly post the schedule where parents will see it.
How can you help ensure that parents
bring their children for all needed
immunizations? (3)
• Explain to parents when and why the child
should return for future vaccinations.
—
Remind them to bring the child’s vaccination card.
—
Assure them that the child should be vaccinated
even if he or she has a slight fever or cold.
• Ensure a smooth patient flow so that children
are seen in the order they arrive, and without
unnecessary delay.
• Allow only one family at a time in the
immunization area.
How can you help ensure that parents
bring their children for all needed
immunizations? (4)
• Help parents understand possible common side
effects and how they can treat the symptoms.
• Explain what to do in case of uncommon allergic
reactions.
• Before the parent leaves the clinic, be sure he or
she knows when the child’s next vaccine is due.
• Guide the parents and child to the exit after
giving the immunization and thank them for
coming.
How can you help ensure that parents
bring their children for all needed
immunizations? (5)
Photo credit: Lisa Lundgren
• Ask community
leaders, school
teachers and
community
organizations to
help educate
parents about full
immunization and
motivate or assist
them to bring their
children on time.
Photo credit: Lisa Lundgren
Acknowledgements
Please include the following acknowledgement
if you use this slide set:
This slide set was adapted from a slide set
prepared by Lisa Lundgren, Northrop Grumman
Contractor with the U.S. Centers for Disease
Control and Prevention, and PATH’s Japanese
Encephalitis Project.
For information: www.JEproject.org