Transcript dr. vidumini epi

Dr. Vidumini De Silva
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Describe the current schedule for the
Expanded Programme on Immunization
(EPI)
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Immunization
The process by which a person becomes protected
( immune) against a disease by administration of a live
modified agent, a suspension of killed organism or an
inactivated toxin. (1)
Vaccine
A killed or weakened infective organism used to
prevent disease
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Vaccines included in EPI
Live attenuated
BCG
TB
OPV
Polio
MMR
Measels, Mumps, Rubella
LJEV
Japanese Encephalitis
Inactivated
Pertussis
Whooping cough
Toxoids
Tetanus
Tetanus
Diphtheria
Diptheria
Subunits
HepB
Hepatitis B
Hib
Heamophillous influenza B
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At birth
BCG
ID
Deltoid of left arm
2nd , 4th and 6th
months
Pentavalent
(DPT, Hep B, Hib)
+ OPV
IM
Anterolateral
aspect of the thigh
9 months
LJEV
SC
Deltoid
1 year
MMR
SC
Deltoid
18 months
DPT, Hep B
+ OPV
IM
Deltoid
3 years
MMR
SC
Deltoid
5 years
DT + OPV
IM
Deltoid
12 years
aTd
IM
Deltoid
15-44 years
(Females)
MMR ( if not immunized with SC
Rubella containing vaccine
previously)
Deltoid
At completion of
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Tetanus Toxoid (TT)
1st pregnancy
1st dose
After 12 weeks of pregnancy
2nd dose
6-8 weeks after the 1st dose
2nd pregnancy
3rd dose
3rd pregnancy
4th dose
4th pregnancy
5th dose
1 Booster dose (TTb)
During 1st pregnancy with a written evidence of
previously being immunized with 6 doss of TT as
per National EPI schedule during childhood and a
gap of 10 years or more after the last TT containing
immunization
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Tetanus Toxoid is not indicated in
• Mothers who have received 5 doses of TT during previous
pregnancies
• Mothers who have received 6 doss of TT according to the National
EPI schedule during childhood and if the gap between last TT
containing immunization and the present pregnancy is less than 10
years
• Mothers who have received 6 doss of TT according to the National
EPI schedule during childhood and have received at least 1 booster
dose of TT during pregnancy or due to trauma within last 10 years
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Dosage of vaccines
Dose
No. of doses in 1 vial
BCG
0.05ml
10 doses
Penta
0.5 ml
1 dose
OPV
2 drops
10 doses
JE
0.5 ml
5 doses
MR
0.5 ml
10 doses
DPT
0.5 ml
10 doses
DT
0.5 ml
10 doses
TT
0.5 ml
10 doses
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 Up to 5 years of age vaccines are given at the child
Welfare Clinic
 After 5 years vaccines are given at school during School
Medical Inspection
 If DT is not given to a child at 5 years it is given to that
child at school during School Medical Inspection
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Why do we need booster doses for
some vaccines?
Live Attenuated Vaccine
Killed/ Inactivated Vaccine
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Reasons for modifying current
schedule of EPI
 MMR – In most countries immunization for mumps is
delivered through MMR. According to the WHO, by
December 2010, 2-dose MMR schedule has been
implemented in 132 countries out of 193 member states in
their national immunization schedules (2). Furthermore,
the current trend in private sector in Sri Lanka is for MMR
 JE – In most countries JE is given at 9 months
 Rubella – Is no longer given as a monovalent vaccine at 14
years but is included in MMR
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Some important points
 BCG – If the scar is not present at 6 months a 2nd dose
of BCG is given ( 2nd dose can be given from 6 months
to 5 years of age)
 If a vaccine is missed - There is no need to
recommence the schedule or give additional doses.
Missing doses should be provided as early as possible.
The next dose should be scheduled after an
appropriate minimal interval.
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In MOH office and field immunization clinics
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Q4.2
Describe the steps that are taken to
maintain the cold chain in the MOH office
and the field immunization clinics
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Cold chain is a…..
 System of – people
equipment
 To ensure that correct quantity of potent vaccine reach
the women and the children (1)
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Equipment used to maintain
the cold chain
1.
2.
3.
4.
5.
Refrigerator
Data lodger
Vaccine vial monitor
Vaccine stock management
Cold boxes and vaccine carriers
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1. Refrigerator
Deep freezer
OPV
1st shelf
BCG, MMR, JE, Typhoid
2nd shelf
Penta, DPT, DT, aTd
3rd shelf
TT
Bottom
Diluents
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 Arrange the stocks according to “ earliest expiration
date – first out” (EEFO)
 Stocks of vaccine that have been taken to clinics and
brought back unused should be stored separately from
the bulk stocks and should be taken to the very next
clinic and used before using the other stocks
 Maintain free space to allow air to circulate around.
 This refrigerator should only be used to store vaccines
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2. Data lodger
 The temperature in the fridge is recorded to a micro
chip in the data lodger
 With this data a temperature chart is maintained
 A weekly refrigerator temperature record is sent to
Regional Director of Health Services (RDHS)
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3.Vaccine vial monitor
 For OPV, Pentavalent and Hep B
 The monitor in the vial changes colour according to
room temperature
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Utilize as soon as
possible
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4. Vaccine stock management
 Vaccine movement register
 Monthly stock return of vaccine is send to RDHS and
drug stores
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5. Vaccine Carrier…
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In the vaccine carrier …
 Ice packs are placed against the sides of the box
 OPV and MR are stored in the bottom
 Other vaccines are stored on the top
 None of the vaccines are in contact with ice
 The box is kept in a cool shaded place
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At the clinic
 All unopened vials of vaccine should not be taken out
of the vaccine carrier till ready for use
 All opened vaccine vials should be placed in a cup of
ice or in a special cold pack during immunization
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Q4.3
Describe the process of monitoring the
Adverse Events of Immunization (AEFIs)
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Why should we monitor AEFI?
 To provide safe immunization.
 To avoid refusal of further immunization due to
adverse events
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Classification of AEFI
 Vaccine reaction - Event caused or precipitated by the
vaccine by its inherent properties
 Program error - event caused by an error in vaccine
preparation ,handling or administration
 Coincidental – event happen after immunization but
not cause by the vaccine
 Injection reaction - event from anxiety about or pain
from the injection itself
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After Administration of a vaccine
 Keep the mother and the child in the clinic for 20
minutes
 When administrating more than 2 vaccines keep an
interval of 15 – 20 minutes
 Educate mother about


Common reactions
 Mild fever, local swelling, redness
Serious reactions
 Febrile convulsions, skin rash
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Surveillance of AEFI
Notification for AEFI (Form : AEFI –1)
Health worker (government /private) should report AEFI
through this form
One copy is sent
to the relevant
MOH office
One copy sent to
Regional
Epidemiologist
One copy remain
in the Register
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Monthly Surveillance Report on AEFI (AEFI - 2)
One copy to RDHS/RE
One copy to Chief Epidemiologist
AEFI case investigation form (AEFI - 3)
Severe AEFI should be investigated by MOH & report
should be sent to the Epidemiologist & RDHS/RE
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Reference
1.
National Expanded Programme on Immunization Sri Lanka [Internet]
Epidemiological Unit Ministry of Health, Nutrition & Welfare; 2002 [cited 2011.09.30]
Available from http://www.epid.gov.lk/pdf/Immunization%20Handbook.pdf
2.
Introduction of Measels, Mumps, Rubella Vaccine (MMRV) into National
Immunization Programme and changes to the National Immunization Schedule,
general circular no. 02-123/2011 [Internet] Ministry of Health; 2011 [cited 2011.09.30]
Available from http://www.epid.gov.lk/pdf/Immunization/MMRV%20circuler.pdf
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