IMMUNIZTIONS

BY F.E. NYIRENDA

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Immunization

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 BROAD OBJECTIVE
• To equip a learner with knowledge
on common immunizations available
in Malawi and process of maintaining
vaccine potency

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 SPECIFIC OBJECTIVES
By the end of the presentation, a learner
should be able to:
• Describe the brief background of
Immunization
• Define immunization
• List EPI conditions/ diseases in Malawi
• State vaccines available and their schedule

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 OBJECTIVES CT....
• Mention immunization and Vitamin A
supplementation schedule
• Define cold chain
• Explain factors which can affect
potency of vaccines
• Outline safe injection practices

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 History of immunization
• During the pre-vaccine era, diphtheria was
one of the most feared childhood diseases,
claiming more than 10,000 lives a year in the
United States in the 1920s.
• In the 1940s and 1950s, polio paralyzed and
even killed thousands of children across the
global.
• Today, morbidity and mortality in children is
minimised through vaccinations
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 How did this idea come about?
• In the United Kingdom, Edward Jenner noticed
that some dairy maids seemed protected from
smallpox if they had already been infected by
the much less dangerous virus that caused
cowpox.
• In 1796, Jenner conducted an experiment,
scratching the arm of an 8-year-old boy
named James Phipps using material from a
cowpox sore in one of these dairy maids
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 Cont....
• Then he repeated the same experiment, but
this time added a small amount of smallpox
into the same child.
• He hoped that the procedure would immunize
the child against the deadly smallpox
infection. In fact, it did. Jenner’s experiment
began the immunization age.

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 Cont....
• The next major advance occurred almost 100
years later when Louis Pasteur, MD, showed
that disease could be prevented by infecting
humans with weakened germs.
• In 1885, Dr. Pasteur used a vaccine to
successfully prevent rabies in a boy named
Joseph Meister who had been bitten by a
rabid dog. By the mid-20th century, regular
progress in immunizations was made.
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 Cont....
• Jonas Salk, MD, and Albert Sabin, MD, made
what are perhaps the best known advances.
• They developed the inactivated polio vaccine
and live polio vaccine, respectively.
• These discoveries have saved countless
children worldwide from polio, a disease that
often left youngsters dependent on
wheelchairs or crutches for life.

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 GLOBAL INITIATIVE
• Since the discovery of vaccines,
developed countries had better access to
immunization than developing countries
• In May 1979, The World Health
Organization (WHO) initiated the
Expanded Program on Immunization
(EPI) with the aim to vaccinate children
throughout the world.

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 Ct……
• The Expanded Programme on Immunization
(EPI) is a global initiative of the World Health
Organization (WHO), whose objective is to
immunize all children worldwide against most
serious diseases.

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 Ct.....
• Few years later, in 1984, the WHO
established a standardized
vaccination schedule for the original
EPI vaccines: Bacillus Calmette-
Guérin (BCG), diphtheria-tetanus-
pertussis (DPT), oral polio, and
measles.
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 Ct..........
• Recently, there has been other vaccines that
have been developed due to identification of
new infections and increased technology.
• These new vaccines are Hepatitis B (HepB),
Haemophilus influenza (Hib),Pneumococcal
conjugate vaccine (PCV) and rota in countries
with high burden of disease.

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 DEFINITION OF IMMUNIZATION
• Immunization is the process of
reinforcing natural defences by providing
active artificial immunity to the mother
and the child.
• A vaccine is produced from an
attenuated, inactivated or killed form of
the virus or bacteria.

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 Cont....
• In addition, some vaccines are produced using
genetic engineering technologies,
e.g. recombinant DNA Hepatitis B vaccine
• Three main substances are used for the
production of vaccines:
1.LIVE microorganisms, e.g., weakened measles
and polio viruses or tuberculosis bacteria

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 Cont
2. KILLED microorganisms, e.g., pertussis
microorganisms used in DPT production
3. TOXOIDS, e.g., inactivated toxins such as
tetanus toxoid and diphtheria toxoid
• A vaccine is normally injected, or in some
cases may be given orally
• The vaccine provokes the development of
antibodies in the body.

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 Cont....
• Immunisation help saves lives, prevent serious
illness.
• It is recognised as one of the most effective
public health interventions available today.
• The success of the programme depends upon
the high immunisation coverage of the target
group, proper storage and handling of
vaccines and vaccine inventory management.

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 EPI CONDITIONS/ DISEASES IN
MALAWI
• Tetanus
• Measles
• Poliomyelitis
• Pertusis (whooping cough)
• Hepatis B

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 EPI DISEASES CT...
• Tuberculosis
• Diphtheria
• Bacterial meningitis
• Bacterial pneumonia
• Severe gastroenteritis causes by rota
viruses

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EPI VACCINES AVAILABLE IN MALAWI

• Oral Polio Vaccine (OPV)

• BCG (Bacillus Calmette Guerin)
• DPT-Hep B +Hib (pentavalent)
• Measles
• Rota virus vaccine
• Tetanus Toxoid
• Pneumococcal Conjugate Vaccine(PCV)
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 IMMUNIZATION SCHEDULE
VACCINE AT 6WKS 10WKS 14 WKS 9
BIRTH MONTHS
YES
BCG
OPV YES YES YES YES

YES YES YES

DPT-Hep B+Hib
MEASLES YES

ROTA VIRUS YES YES

VACCINE
YES YES YES
PCV
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 Abbreviations and acronyms
• BCG: Bacillus of Calmette Guiren
• DPT: Diphtheria, Pertusis, tetanus
• HepB: Hepatitis B
• Hib: Haemophilus influenza type B
• PCV: Pneumococcal Conjugate Vaccine
• TTV/ TD: Tetanus Toxoid vaccine
• DPT-HepB+Hib (pentavalent)

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 Cont
• MV: Malaria vaccine
• MR: Measles Rubella
• OPV: Oral Polio vaccine
• HPVV: Human Papilomma virus vaccine

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 Malawi Immunization schedule
Age Vaccine Route Site Doses

Right arm, at the 0.05ml for newborn

BCG Intradermal insertion of the and 0.1 ml for older
At birth
deltoid muscle children

OPV 0 Orally Mouth 2 drops

OPV 1 Orally 2 drops
Mouth
Rota1 1.5 ml

Anterolateral aspect
6 weeks Pentavalent 1
of the mid left thigh

Intramuscularly Anterolateral aspect 0.5 ml

PCV1 of the mid right
thigh
OPV2 Orally Mouth 2 drops
Rota2 Orally Mouth 1.5 ml

Anterolateral aspect
10 weeks Pentavalent 2
of mid left thigh
Intra muscularly Anterolateral aspect 0.5 ml
PCV2
of mid right thigh
 Orally Oral 2 drop
Anterolateral aspect
Pentavalent 3
of the mid left thigh
Intra muscularly Anterolateral aspect 0.5 ml
PCV3 of the mid right
thigh
Anterolateral aspect
of the mid right
IPV Intra muscularly thigh 0.5ml

5 months MV1
6 months MV2
Intra muscular Right upper thigh 0.5 ml
7 months MV3

9 months MR 1
Subcutaneous Left thigh 0.5 ml
15 months MR 2

22 months MV 4 Intra muscular Right upper thigh 0.5 ml

HPV vaccine vaccination (9 years old girls)

HPVV 1
Upper arm 0.5 ml
9years HPVV 2 (6 months Intra muscular
after HPVV1)

Td Vaccination ( Women of Child bearing Age)

Td 1 at contact

Td 2 (1 month after
Td 1)
Td 3 (6 months
15 – 45 years Intra muscular Right upper arm 0.5 ml
after Td 2)
Td 4 (1 year after
Td 3)
Td 5 ( 1 year after
Td 4)
 VIT A supplementation and TTV
• Vit. A :Children at 6 months and every 6
months up to 59 months
– Dose: 6-11 months 100 000 iu, 12-59 months;
200 000 iu Orally
• Vit A: Mother..within 2 weeks of delivery
– 200 000 iu Orally
• TTV : Women of reproductive age group
– Dose: 0.5ml IM on upper arm or buttock

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 Maintaining vaccine potency
• It is of no use to administer vaccines which
have lost potency.
• The efficacy of vaccines is dependent on
attitude and skills of health personnel and
vaccine storage equipment.
• The process of maintaining vaccine potency is
referred to as cold chain

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 COLD CHAIN
• Cold chain is the process of maintaining
the vaccines’ correct temperature from
the producer to the person being
vaccinated.
• Any vaccine exposed to wrong
temperatures will loose potency

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 Cont
• The “cold chain” includes all of the materials,
equipment and procedures used to maintain
vaccines in the required temperature range of
+2 °C to +8 °C from the time of manufacture
until the vaccines are administered to
individuals.

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• The cold chain system comprises three major
elements:
– Personnel, who use and maintain the equipment
and provide the health service;
– Equipment for safe storage and transportation of
vaccines; and
– Procedures to manage the programme and
control distribution and use of the vaccines.

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 Maintaining cold chain
Cold chain is maintained through:
•Correct and proper storage of vaccines in the
refrigerators
•Packing of vaccines in a vaccine carrier
•Conditioning frozen packs during
transportation
•Vaccine viral monitor
•Fridge/ freeze tag
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 cont
NOTE:
• Vaccine viral monitor : is a heat sensitive label
on the side of the top of a vaccine. It changes
colour (light purple to dark) when exposed to
unnecessary temp.
• Fridge tag: is a temperature monitoring device
for refrigerators.

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 Packing of vaccines in a
refrigerator
• All vaccines are kept at a temperature of +2
degrees Celsius to +8 degrees
• Do not add food consumables in a vaccine
refrigerator
• Vaccines with first expiry are used first and
then those with long expiry date last (Fefo)
• Keep space of about 2 cm between rows of
vaccines for easy air circulation

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 Maintenance of cold chain
• Pack all vaccines in a recommended fridges
with temperature recording devices
• Ice packs should be frozen
• Ensure adequate space for vaccines
• Refrigerators and freezers should be
positioned away from direct sunlight
• Consider number of clients requiring each type
of vaccines to avoid expiry due to overstock.
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 Cont
• Expired vaccines should be removed from the
refrigerator

• Use vaccine carriers with the lid closed during

transportation and temporary storage

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 COLD CHAIN EQUIPMENT
• Vaccine carriers
• Refrigerators
• Cool packs
• Thermometers and fridge tag
• Cold box

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 FACTORS WHICH CAN AFFECT
POTENCY OF VACCINES
• Exposure to heat /direct light
• Constant opening and closing of the
refrigerator.
• Interrupted electrical power supply or
gas/paraffin.
• Vigorous shaking
• Freezing

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 STORAGE OF VACCINES
• All vaccines are kept at +2 to +8 in the
refrigerator.
• In view of this, record the
temperature in the morning and
evening

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 RECONSTITUTION OF THE
VACCINE
• BCG and measles with the right diluents
• DPT-Hep B with Hib (pentavalent) but now
already reconstituted in a 10 dose vial

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CONTRAINDICATIONS FOR VACCINES

No serious contraindications, but

wherever possible children with
severe illness, fever of >39 degree
Celsius should not be vaccinated
until they improve.

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 Common side effects
• Fever
• Pain on the site

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 Cont
• All open vaccine vials should be discarded at
the end of the immunisation session except
for TTV and OPV
• Diluents should be parked with non-frozen
vaccines
• Replace ice packs once melt
• NEVER place vaccines on the door of the
refrigerator

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 Refrigerator organization
• Organize vaccine by product. Place vaccines of
the same type together.
• Leave space between the vaccine packages in
the refrigerator to allow air to circulate
• Protect vaccines from light. Storage of vaccines
in their original packaging will protect vaccines
from light.
• Diluents should be stored with vaccines and be
kept within +2 °C to +8 °C.
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 SAFE INJECTION PRACTICES
• Use one reconstitution syringe for
each vial
• Do not pre-refill the syringe with
vaccine
• Handle syringes and needles safely
• Position children correctly for
injections
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 REFERENCES
• EPI Malawi field manual, 2002.
• Government of Malawi, Field Manual for
PCV
• Government of Malawi HSA Training
Manual, 2009
• Government of Malawi, Field manual for
Introduction of Rotavirus vaccine, 2012
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