immunisation against child killer diseases

1. IMMUNIZATION AGAINST
CHILDHOOD KILLER DISEASES
Ms Jane Muhindo Dip Clin Med, Dip
Palliative care, BSc. HCMTC &
MA.HPM

2. Learning objectives
At the end of this session, you are expected to:
• Explain the type of immunity
• List childhood immunizable diseases & types
of Vaccines
• Describe the role of UNEPI in Uganda
• Understand cold chain management

3. Introduction to the Body’s immune
system
• The immune system is a system that fights
attacks by foreign agents entering the body.
• An antigen is any substance from outside the
body that elicits an immune response e.g.
viruses, bacteria, foreign proteins etc
• The immune system is capable of recognizing
the body’s own cells, because each cell has a
specific marker (Major Histocompatibility
Antigen or MHC).

4. Introduction to the Body’s immune
system cont
• Any cell not having this marker is treated as
foreign and destroyed.
• However sometimes the immune system breaks
down and starts attacking body self cells,
resulting into autoimmune diseases e.g. diabetes,
degenerative arthritis etc.
• Parts of the immune system are antigen specific.
They recognize and mount an even stronger
attack to the same antigen next time. This is
underlying basis for vaccines.

5. Types of Immunity
• Immunity can be natural or artificial; innate (in
born) or acquired; active or passive.
• Innate Immunity:
– Is what a human being is born with and is non
specific. All antigens are attacked equally. It is
genetically based and can be passed on to the
offspring.

6. Types of Immunity cont
• Examples include surface barriers or mucosal
immunity such as:
• Skin
• Saliva, tears, nasal secretions have an enzyme
called lysozyme which kills bacteria.
• Stomach has hydrochloric acid and protein
digesting enzymes which also kill bacteria.

7. Types of Immunity cont
Adaptive Immunity: is often sub-divided into two
major types depending on how the immunity was
introduced.
• Active natural immunity: Results from contact
with an infection, develops slowly, is long term
and antigen specific.
• Active artificial immunity (Immunization):
Develops slowly, lasts for several years and is
antigen specific to the antigen for which the
immunization was given.

8. Adaptive immunity cont
• Passive natural immunity: (Transplacental or
mother to child): develops immediately, is
temporary and affects all antigens to which
the mother has immunity.
• Passive artificial (Injection of gamma
globulin): Develops immediately, is temporary
and affects all antigens to which the ‘donor’
has immunity.

10. Vaccination (Immunization)
• The goal of all vaccines is to promote a
primary immune reaction so that when the
organism is again exposed to the antigen, a
much stronger secondary immune response
will be elicited.

11. Childhood Immunizable Diseases &
Types of Vaccines
• EPI (Expanded Programme for Immunization)
Vaccines: The following immunizations shall
be given routinely to all children in Uganda by
their first birth day according to the schedule:

13. • DPT-Hep B +Hib is a pentavalent vaccine,
effective against 5 diseases: Diphtheria,
Pertussis, Tetanus, Hepatitis B, and
haemophilus influenza type B.

14. UGANDA MINISTRY OF HEALTH/UNEPI
NATIONAL IMMUNIZATION SCHEDULE

15. UGANDA MINISTRY OF HEALTH/UNEPI
NATIONAL IMMUNIZATION SCHEDULE cont

16. • Tetanus toxoid (TT) shall be given routinely to
all women of child bearing age (15-45 years)
according to the vaccine schedule.

17. THE UGANDA NATIONAL EXPANDED PROGRAMME
FOR IMMUNIZATION (UNEPI)
• Roles of UNEPI:
• The central UNEPI division initiates, develops
and disseminate EPI policy and standards. The
central division shall provide districts with
updated guidelines/protocol for the EPI
programme and shall monitor and ensure
adequate and correct utilization of distributed
guidelines at the district level.

18. Roles of UNEPI cont:
• Central UNEPI division forecasts and procures the
right and adequate EPI vaccines and supplies on
an annual basis according to the national EPI
policy.
• Estimates for ordering vaccines and supplies shall
be based on projected target populations,
coverage targets, estimated vaccine wastage
rates and balances in stock and should allow for
the presence of a buffer stock and the start of
each supply period equivalent to 25% of the
expected usage.

19. Roles of UNEPI cont:
• Supply of EPI vaccines and supplies to districts on a
monthly basis according to demand and known
balance in stock.
• Maintenance of a central vaccine store capable of
storing vaccines at the recommended temperatures:
– Measles, polio and BCG shall be kept at -20oC to + 8o C.
– DPT, DPT-HepB, Hib and TT shall be kept at + 2oC to + 8oC.
– DPT-HepB, DPT and TT shall not be frozen. Currently
UNEPI is using the lyophilized Hib vaccine which can be
frozen.

20. Roles of UNEPI cont:
• Central UNEPI division shall carry out technical
support supervision, monitoring and provide
feedback to each district at least once every
quarter.
• Monitor and follow up reports of adverse
events following immunization (AEFI) within a
period not exceeding 14 days following
notification of such events.

21. Roles of UNEPI cont:
• Carry out potency testing of viral vaccines for
every consignment received and field potency
testing at least once every 6 months for
quality control purposes.
• Conduct surveillance at the national, level for
diseases targeted for eradication, elimination
and control (polio, measles and neonatal
tetanus), using integrated disease surveillance
and response strategy (IDSRS).

22. Roles of UNEPI cont:
• Conduct internal program review annually and
external program reviews, needs assessment
and coverage surveys at least once every 5
years.
• Continuously advocate for EPI, identify
barriers to utilization of services and support
districts to conduct social mobilization
strategies and grass root level.

23. MINIMUN SUPPLIES TO DISTRICTS
• Vaccines (according to the national protocol)
• Auto Disable (AD) syringes (0.05 ml to 0.8 ml)
• Gas cylinders and gas
• Cotton wool
• Mixing needles and syringes (2 ml + 5 ml).
• Child health and TT cards
• Tally sheets
• Supplies control cards
• Vaccine and injection material control book.

24. FOLLOW UP TASKS AND ACTIONS FOR REPORTING OF
ADVERSE EVENTS FOLLOWING IMMUNIZATION
• Type, batch no., expiry date, manufacturer of
the vaccine.
• Possible attributable causes.
• Ensure proper management of AEFI (Adverse
Events Following Immunization).
• Minimize reoccurrence.
• Minimize impact of events on the programme.

25. Roles of the District Health Authorities
Planning
• District/Health Sub district shall have a
documented annual and quarterly integrated
health plan that includes immunization
activities and which includes the following:
– Forecasting, requisitioning, storage and
distribution of supplies and vaccines to all
immunization units.

26. Immunization activities cont
– Collection, analysis, use and dissemination of
immunization information with feedback to lower
levels (sub-counties, health sub districts and
health facilities).
– Static and outreach immunization services to
ensure regular services.
– Technical support supervision.
– Cold chain repair and maintenance.

27. Immunization activities cont
– Advocacy and social mobilization through various
channels.
– Capacity building within the district.
– Coordination of all partners and sectors within the
district.
– Identification of barriers to utilization of
immunization and their solutions.

28. Roles cont
• DHMT (District Health Management Team) has role of
dissemination of EPI Policy and standards to the
political and administrative leaders at district and
lower levels.
• Storage of vaccines at the district/HSD vaccine store,
at between + 2oC to +8oC, at all times. However
measles and oral polio vaccines may be kept at the
District store at temperatures ranging from -20 oC to
+8oC. NB: Do not freeze DPT-HepB and TT vaccines.
• Districts/HSD reviews vaccine requirements using
target population estimates, usage and stock
balances.

29. Roles cont
• Vaccine distribution to all health units carrying out
immunization on a monthly basis and ensure no stock
outs or excesses.
• District/HSD ensures an uninterrupted supply of gas
and other sources of energy to maintain EPI charges.
Key tasks include:
– Record and monitor use of gas
– Collect empty cylinders for refilling prior to arrival
of vaccine track.
– Maintain inventory on working status of
equipment.

30. Roles cont
• All districts/HSDs to give feedback on
immunization activities to districts and sub
county political and administrative officials on
the following:
– Coverage rates by sub counties and HSDs.
– Drop out rates by sub counties and HSDs.
– Functional outreaches coverage.
– Status of mobilization of outreaches, difficult to reach
communities, groups against immunizations and
specific rumours.
– Funding for immunization.

31. COLD CHAIN MANAGEMENT
• The cold chain is a system of maintaining
vaccine potency right from manufacturers,
central vaccine store, district vaccine store,
HSD store, health static units up to the time
the vaccine is administered to the recipients.

32. COLD CHAIN MANAGEMENT cont
• UNEPI ensures availability of necessary cold
chain equipment at all levels which meet the
recommended WHO standards. The cold chain
equipment are used exclusively for
transportation, storage and distribution of EPI
vaccines and freezing icepacks.

33. COLD CHAIN MANAGEMENT cont
• Mechanisms for monitoring vaccine potency
consist of cold chain monitors, vaccine vial
monitors, alcohol thermometers or any other
appliances as may be determined by the
programme from time to time and in
accordance with the level of service delivery.

34. •The end