Polio immunization india_2013
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This document summarizes the program structure and strategies for supplementary immunization activities in India to eradicate polio. It describes: 1) The administrative structure of the immunization program from the minister down to vaccinators and supervisors at the district level. 2) Key eradication strategies including two nationwide immunization rounds called National Immunization Days and monthly sub-national rounds in high-risk states. 3) Implementation of National Immunization Days involves immunizing 172 million children across 209 million households using 2.3 million vaccinators and 155,000 supervisors deployed.
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Anatomy of the Larynx
Larynx is a cartilaginous structure located in the **anterior neck** at the level of **C3C6 vertebrae**.
* Also called the **voice box**responsible for **phonation**, **airway protection**, and **breathing regulation**.
**Cartilages of the Larynx**
**Unpaired Cartilages:**
1. **Thyroid cartilage**:
* Largest cartilage; forms the **Adams apple (laryngeal prominence)**.
* Composed of two laminae that fuse anteriorly.
2. **Cricoid cartilage**:
* Ring-shaped; **only complete ring** around the airway.
* Located below thyroid cartilage; articulates with thyroid & arytenoid cartilages.
3. **Epiglottis**:
* Leaf-shaped elastic cartilage.
* Covers the laryngeal inlet during swallowing.
**Paired Cartilages:**
1. **Arytenoid**:
* Pyramid-shaped; sit on top of cricoid.
* Attach vocal cords and muscles.
2. **Corniculate**:
* Small cartilages sitting atop the arytenoids.
3. **Cuneiform**:
* Embedded in the aryepiglottic folds; provide structural support.
**Intrinsic Muscles of the Larynx**
> Responsible for controlling **vocal cord movement**.
| Muscle | Action | Nerve Supply |
| **Cricothyroid** | Tenses vocal cords | External laryngeal nerve |
| **Thyroarytenoid** | Relaxes vocal cords | Recurrent laryngeal nerve |
| **Posterior cricoarytenoid** | Abducts vocal cords (opens glottis) | Recurrent laryngeal nerve |
| **Lateral cricoarytenoid** | Adducts vocal cords | Recurrent laryngeal nerve |
| **Transverse & oblique arytenoids** | Closes the posterior glottis | Recurrent laryngeal nerve |
| **Vocalis** | Fine-tunes pitch | Recurrent laryngeal nerve | **Nerve Supply*
* **Motor**:
* All intrinsic muscles (except cricothyroid): **Recurrent laryngeal nerve** (branch of vagus nerve).
* Cricothyroid: **External branch of superior laryngeal nerve**.
* **Sensory**:
* Above vocal cords: **Internal branch of superior laryngeal nerve**.
* Below vocal cords: **Recurrent laryngeal nerve**.
**Blood Supply**
* **Superior laryngeal artery** (branch of superior thyroid artery).
* **Inferior laryngeal artery** (branch of inferior thyroid artery).
**Laryngeal Cavity & Folds**
Divided into 3 regions:
1. **Vestibule** from inlet to vestibular folds (false cords).
2. **Ventricle** between vestibular and vocal folds.
3. **Infraglottic cavity** below vocal cords to trachea.
**Vocal folds (true cords)** involved in sound production.Viddha karma in Ayurveda-Dr Mahesh Kumar.pdf
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Polio immunization india_2013
- 1. Program Structure Minister Centre Secretary Ops Group Chief Minister State Chief Secretary Principal Secretary, H&FW District Magistrate Chief Medical Officer District Medical Officers Supervisors Vaccinators
- 2. Supplementary Immunization Activities in India Strategy and Implementation
- 3. Key Eradication Strategy IMMUNISATION is one of the key strategies Every year : Two nation-wide immunisation rounds called National Immunisation Days are held Almost every month immunisation rounds called Sub National Immunization Days are held in states and areas at risk of polio (UP, Bihar and Delhi and Mumbai and their surrounding areas) 2 drops of OPV given to children under 5 yrs
- 4. SIAs in India During each NID : 172 million children immunized 209 million houses visited by vaccination teams 2.3 million vaccinators deployed 155,000 supervisors deployed
- 5. Vaccine Vial Monitor (VVM) on each vial to assure quality vaccine is delivered The square is lighter than the circle. If the expiry date is not passed, use the vaccine The square is lighter than the circle. If the expiry date is not passed, use the vaccine The square matches the circle. Do not use the vaccine. Inform your supervisor The square is darker than the circle. Do not use the vaccine. Inform your supervisor
- 6. Strategy for NIDs Booth Day on Day 1 (Sunday)
- 7. Vaccinators go house to house & look for unimmunised children from day 2 to 6
- 8. Vaccination Teams H-T-H Each team is composed of 23 members Vaccinator Record-keeper/guide Local community
- 9. Vaccinators need good inter personal communication skills to enable entry into households to accurately determine the number of < 5 year children for vaccination
- 10. After vaccinating Marking left little finger with indelible ink marker pen Filling newborn booklet & tally sheet House marking
- 11. Marking Houses P All 0-59 month children of this house Date got OPV dose of this round and no child is left or no 0-59 month child in this house X One or more 0-59 month child of this Date house did not get OPV dose of this round: child is absent or house is locked or uncooperative family
- 12. House markings T. No. 5 T. No. 5 Team No. P 67 X 68 House No. 21/1/13 21/1/13 Date of visit Houses marked with chalk or geru
- 13. House Marking Each Household marked Revisits to X houses also marked
- 14. Programme focus :Repeated visits to households to ensure all children get OPV First visit by A team Revisit late afternoon on same day Visit by (biphasic supervisor activity) B team visit Repeated visits on following day
- 15. Programme focus : newborns
- 16. Coverage of children in transit Vaccination teams deployed to cover children in transit bus stands, highways, markets etc. 450 teams in running trains on major routes 5 million children in transit immunized in UP, Bihar, Additional teams at Mumbai each round platforms
- 17. Transit Teams Proactively seek & immunize children in transit
- 18. Mobile teams One or two member vaccination teams on two wheelers to immunize children at brick kilns, construction sites, isolated nomadic populations, hard to reach areas like river banks, orchards etc. Teams visit each site twice during each round due to frequent turnover of families
- 19. Programme focus : Migrant population at 1. Brick Kilns 2. Construction sites 3. Slums 4. Nomads
- 20. Programme focus :Access compromised areas in Bihar
- 21. Thank You