4. Introduction
Vaccine can be defined as whole or parts of
microorganisms administered to stimulate
development of immunity and thus prevent a specific
disease or a number of diseases.
Immunization- is the process of inducing immunity
against a specific disease.
Immunity being the ability to resist (infectious)
illness.
5. Intro contd
Active immunity-by administering a vaccine
or toxoid to stimulate the immune system to
produce a prolonged humoral and/or cellular
immune response.
Passive immunity-conferred through
administration of antibody-containing
preparations.(use of immunoglobulins).
6. Types of vaccines
Live attenuated: Cultured organisms that have
been altered so as to lose virulence but retain
antigenic properties
Virulence reduced by mutation, passage in
foreign host
E.g. BCG, Rabies, Polio,Measles,mumps,yellow
fever.
Killed: Dead organisms or antigenic part of an
organism. Cannot replicate but are still
antigenic. E.g. Cholera, Typhoid, Hepatitis B.
7. Types of vaccines contd
Toxoid: toxoid is a modified bacterial toxin that
is made nontoxic(detoxified) but is still able to
induce an active immune response against the
toxin since antigenic properties are retained.
e.g. Tetanus, Diptheria.
Subunit: protein subunit of an organism is
administered to induce an immmune response.
Examples include the subunit vaccine against
Hepatitis B virus that is composed of only the
surface proteins of the virus.
8. Types of vaccines contd
Conjugate: certain bacteria have polysaccharide
outer coats that are poorly immunogenic.
By linking these outer coats to proteins (e.g. toxins),
the immune system can be led to recognize the
polysaccharide as if it were a protein antigen.
This approach is used in the Haemophilus influenzae
type B vaccine.
9. 1974 -WHO Global EPI
In 1984, the WHO established a standardized
vaccination schedule for the original EPI vaccines:
Bacillus Calmette-Gu辿rin (BCG),
diphtheria-tetanus-pertussis (DPT),
oral polio, and
measles
In 1999, the Global Alliance for Vaccines and
Immunization (GAVI) was created with the sole
purpose of improving child health in the poorest
countries by extending the reach of the EPI.
Historical background
10. Historical background contd
When created GAVI set up specific milestones to
achieve the EPI goals:
That by 2010 all countries have routine
immunization coverage of 90% of their child
population.
That HepB be introduced in 80% of all countries by
2007 and that 50% of the poorest countries have Hib
vaccine by 2005.
11. Historical background contd
1980-KEPI (now KDVI)launched
Aim:
1980-immunize free of charge,all kenyan children
0-5yrs
1985-revised to focus on age 0-11mo and pregnant
women
Implementation-3 stages
Preparatory(1980-81)
Demonstration and pre-testing(1981-82)
Operational (1982-86)
12. Birth 6 weeks 10 weeks 14 weeks 9 months
BCG
OPV OPV OPV OPV
Hep B
HIB
DTP
Hep B
HIB
DTP
Hep B
HIB
DTP
PCV 10 PCV 10 PCV 10 Measles
Vitamin
A
6 months
KDVI SCHEDULE
13. Objectives of KDVI
Coverage
First 3yrs
75% for single shot antigens(BCG,Measles)
60%for multiple shots(DPT,Polio,TT)
After 3 yrs
>80% for all antigens
Cold chain system
Better vaccine storage and handling
Use of freezers,refrigerators,cold boxes
14. Training
Improve managerial skills of health workers
10 supervisors/district
2 vaccinators/immunization centre
Integration
KDVI with MCH services
Objectives of KDVI
15. Monitoring and evaluation
Routine immunization reporting system
Use of check lists during supervisory visits
Biennial evaluation by an external tean
Public motivation
Outreach activities
Public health education
Research
Operational research for better program mgt
Objectives of KDVI
16. Specific Objectives of DVI
To ensure quality immunization service delivery.
To ensure that 90% of vulnerable population is
protected against all vaccine preventable diseases,
through routine immunization services in 85 percent
of districts.
To sustain the interruption of wild polio virus
transmission in Kenya leading to polio free
certification.
To strengthen integrated vaccine preventable
disease surveillance in Kenya.
17. Specific objectives contd
To develop a sustainable training support
structure for immunization services providers
and regular curriculum updates for the medical
training institutions.
To ensure adequate and timely procurement and
distribution of cold chain equipment and the
immunization commodities
Availability of all vaccines at all levels
To reduce measles morbidity by 95 percent and
mortality by 90 percent.
18. Specific objectives contd
To develop a sustainable integrated health
communication support to the Division of Vaccines
and Immunization
Reduce incidence of neonatal tetanus to less than I
death per 1,000 live births with 100 percent
reporting rate.
Improve availability of emergency vaccination
services nationally
Initiate the vaccination of food handlers in primary
boarding schools as a routine Government of Kenya
supported vaccination exercise
19. Epidemiology
1/15 Children die annually from EPI-target diseases
in Africa.
400,000 become disabled annually.
Immunization coverage 12-23 mo(KDHS 2008/09)
Complete :77.4%(57% in 2003)
Incomplete:19.6%(37% in 2003)
Never :3%(7% in 2003)
Urban vs rural complete coverage:
81% vs 76%
20. Epidemiology contd
Specific vaccines coverage (KDHS 2008/09)
1) BCG-96%
2) First DPT,HepB,Hib dose-96%
1) Subsequent doses-86%
3) First polio dose-96%
1) Subsequent doses-88%
21. Epidemilolgy contd
Coverage by Province;
1. Central 86%
2. Rift valley 85%
3. Eastern 84%
4. Coast 76%
5. Western 73%
6. Nairobi 73%
7. Nyanza 65%
8. North Eastern 48%
22. COLD CHAIN SYSTEM
A system that aims to maintain the potency of
vaccines by transporting them at -15 to -25
(BCG,Measles,Polio) and 0 to 8 (DPT,TT,HB)degrees
celcius at central stores and 2-8 degrees celcius
thereafter.
It starts from the manufacturers level to the point it
reaches the consumer(baby).
Reverse cold chain is a system of storing and
transporting samples at recommended temperatures
from the point of collection to the laboratory.
23. Cold chain system contd
The cold chain system comprises three major
elements:
I. Personnel, who use and maintain the equipment and
provide the health service;
II. Equipment for safe storage and transportation of
vaccines; and
III. Procedures to manage the programme and control
distribution and use of the vaccines.
Competent personnel and efficient procedures
are a vitally important part of the cold chain
system
24. Procedure of Cold chain system
Manufacturers level
Check temperature BD
Record temp at discharge
Transport in refridgerated vehicle with refridgerated
containers to airport.
Airport(Discharge)
Check temp b4 loading onto plane
Container plugged onto planes power system to keep
freezing.
KDVI notified of expected arrival time.
25. Procedure of cold chain contd
Airport (Receiving)
KDVI refridgerated truck awaiting inside airport at
runway(no need to go thru customs)
Check temp at arrival
Offload into KDVI truck and transport to DVI central store
At KDVI central stores
Check temp at arrival
DVI send vaccines to peripheral regional stores at -15 to -
25 (BCG,Measles,Polio) and 0 to 8 (DPT,TT,HB)degrees
celcius in deep freezers.
26. Procedure of cold chain contd
At regional KDVI stores
Check temp at arrival
Maintain optimal vaccines temp
Transport to district stores at optimal temp in refridgerators
,deep freezers and cold boxes.
At district stores
Check temp at arrival
Vaccines taken to needed place(immunization centres)in
cold boxes or vaccine carriers at 2-8 degrees celcius temp.
<24 hrs storage in carriers(return to fridge)
BCG ,Measles vaccines discarded within 6 hrs of opening.
27. Monitoring cold chain
Shake test
compare normal vaccine against suspected vaccine
Shake both,let stay for 30mins
Affected vaccine forms granules/sediments at the
bottom of bottle.
Temp recording
Taken BD(morning and afternoon)
Should be 2-8 degrees celcius
28. Monitoring cold chain contd
Colour change of monitoring strips/cards
Heat sensitive
Irreversible Colour change at <10 and >34 degrees
Freeze watch
Small sealed ampoule filled with coloured liquid
Burst,stain background red if temp <-3 degrees
Useful in detecting vaccines that should not be
frozen.
29. Vaccine Vial Monitor(VVM)
Label containing a heat sensitive material placed on a vaccine vial
to register cumulative heat exposure over time.
Consist of inner square(heat sensitive) and outer circle (heat
insensitive)
The inner square is a lighter colour than the outer circle until the
temperature and/or duration of heat reaches a level known to
degrade the vaccine.
The inner square will continue to darken with heat exposure
Whenever the inner square matches or is darker than the outer
circle, the vial must be discarded.
30. Cold chain Equipments
Cold rooms
Refridgerators and Deep Freezers
Cold boxes
Vaccine carriers
Ice packs
Thermometers
31. Cold rooms
A specially built,thick-walled room which is
mechanically kept cold,temp being adjustable to
required level.
Packing:
Neatly on shelves
Store in order of expiry dates
Do not overstock(maintain adequate spacing to allow good
air circulation)
32. Cold rooms contd
Maintanence:
Daily;
Record temp
Functioning of temp recording sheet
Any unusual noise indicative of malfunction
At end of day,switch off lights and close door
securely.
33. Cold rooms contd
Weekly;
Change temp recording sheet
Temp alarm tested
Check standby generator(run for 5mins)
Monthly ;
Major check by maintenance technicians
Orders for spare parts required
34. Refrigerators/Freezers
Types :
Compression
Pump compresses refrigerant(cooling fluid),circulates it very
quickly giving off heat.
Greater cooling effect than absoption type.
Absorption
Heat circulates ammonia and water in sealed system of pipes
In evaporator,ammonia fluid turns into gas absorbing heat
from inside air.
35. Refrigerators/Freezers contd
Packing of vaccines in fridge:
Polio,measles,BCG vaccines in coldest part of fridge
DPT,TT and HB kept in middle shelves away from
evaporator,it may freeze them.
Ice packs and diluents-bottom shelves.
Newest vaccine placed on the right side of fridge
As routine,Use vaccine on left side first to ensure
oldest vaccine is used first(FIFO basis)
36. Refrigerators/Freezers contd
Maintenance
Do not operate on 2 sources of energy at same time
Check temp BD
Check burner flame is blue suggesting proper
functioning fridge
Check ice formation on evaporator.if thicker >6-
10mm, defrost the fridge. Thick frosting rises temp.
37. Cold boxes and vaccine carriers
Keep cold air inside and prevent warm air
from entering.
Frozen ice packs are lined in inner wall
DPT,TT Or HB vaccine wrapped in foam
material to avoid risk of freezing.
38. Ice packs
Plastic containers filled with water or jelly
Put into freezing compartment to freeze b4
being used in cold boxes and vaccine carriers
During vaccination session,vaccine vials are
placed on ice packs to avoidfrequent opening
of fridge,cold boxes and vaccine carriers.
39. VACCINE MANAGEMENT
Vaccine Procurement-(Handling and Storage)
2 levels:
Central vaccine store
Peripheral vaccine stores
40. Central vaccine store
Annual estimates for total vaccine requirements for the
whole country
Estimates based on previous years consumption plus
10% to cater for;
Shortages
Increase in population
Vaccine wastage
Order send to manufacturers thru UNICEF which
facilitates procurement of vaccines for the global EPI
program.
41. Peripheral vaccine stores
Calculation of vaccine requirements
Estimate population size
calculateTarget population
Estimate expected coverage
Calculate No. of doses o be given
Estimate wastage
Estimate freq of supply
Add reserve stock
