Pentavalent vaccine Introduction in UIP
in India:
Operational aspects
New Vaccine Introduction in immunization program
Hib vaccine introduction in India
• Planned for introduction in 2 states (KE, TN) as
pentavalent vaccine (DPT+HepB+Hib);
• 10 dose liquid formulation to be used in these
states;
• May be expanded to other states of the country
later on.
• Impact study is also being planned in these
states.
New Vaccine Introduction in immunization program
Hib as pentavalent vaccine:
programmatic benefits
• Will reduce number of pricks from 9+1 (3
each for DPT, HepB and Hib and HepB birth
dose) to 3+1, if given in combination
• Will not need additional cold chain space (in
fact, reduced need, 6 doses will be replaced
by 3 of pentavalent vaccine)
• New vaccine introduction provides the
opportunity to strengthen the immunization
service delivery
New Vaccine Introduction in immunization program
UIP Schedule in India
BCG
At birth or up to one year of age
OPV 0 dose
OPV ‘0’ dose: within 14 days of birth
6, 10 & 14 weeks (Booster at 16-24 months)
Hepatitis B (Birth dose)
At Birth or as early as possible within 24 hours
DPT
At 6, 10 & 14 weeks;
DPT boosters at 16-24 months & at 5-6 Years.
Hepatitis B 1, 2 & 3
At 6, 10, 14 weeks.
Measles
1 dose at 9 completed months - 12 months.
nd
2 dose at 16-24 months (given up to 5 years, if not received earlier)
st
Vitamin A (1 dose)
(2nd to 9th dose)
At 9 months with measles vaccination
16 months with DPT/OPV booster, then 1 dose every 6 months up to 5
years.
Japanese Encephalitis
16 – 24 months (in endemic states after the campaign)
st
New Vaccine Introduction in immunization program
Hib Vaccine fits into UIP Schedule in India
Age
Vaccines
Birth
BCG, OPV-0, HepB
6 weeks
DPT -1, OPV -1, HepB
Penta-1 + OPV-1
10 weeks
DPT -2, OPV -2, HepB
Penta-2 + OPV-2
14 weeks
DPT -3, OPV-3, HepB
Penta-3 + OPV-3
9 months
MCV1
16-18 months
DPT booster-1, MCV2, OPV -4
5- 6 years
DPT-2
5
New Vaccine Introduction in immunization program
HepB birth dose
• Birth dose of HepB is given as early as possible but
with in 24 hours; for all institutional deliveries;
• HepB birth dose will continue as earlier
• Stand alone HepB vaccine will be used for HepB
birth dose;
• In May 2011, GoI adopted open vial policy for HepB
birth dose and OPV zero dose.
• These vials can be used for 30 days, if kept properly
in cold chain
New Vaccine Introduction in immunization program
Focus on birth dose of Hep B
– Labor room and nursery staff have a greater role
– Orientation to Obstetricians and the staff nurses
needed
– Availability of vaccine round the clock close to
the labor room
– Recording and reporting issues need to be
addressed
– IEC material for use at institutions
New Vaccine Introduction in immunization program
DPT vaccines
• After introduction of pentavalent vaccines,
DPT will continue to be used for booster
doses,
• ANMs need to be sensitized
New Vaccine Introduction in immunization program
Pentavalent vaccine
• Pentavalent will replace the DPT and
HepB vaccines at 6, 10 and 14 weeks of
age.
• Standalone HepB vaccine will be used for
birth dose
• DPT for 2 booster doses, as earlier
• There is no need of booster dose for Hib
vaccine
New Vaccine Introduction in immunization program
“Phasing In” of Pentavalent vaccine
• It is recommended that the introduction of Hib as
pentavalent vaccine should be gradually phased
in the NIS by synchronizing it with OPV/ DPT
schedule at 6 wks, 10 wk & 14 wks of age.
• Pentavalent vaccine schedule thus may be
started with fresh batch of vaccinees for better
compliance & utilization.
• Give pentavalent vaccine to only those children
who are coming for first dose of DPT (Those
coming for DPT2 or 3 should receive DPT only).
New Vaccine Introduction in immunization program
Recording and reporting
• RIMS and HMIS reporting should be continued
as earlier
• HMIS does not capture HepB birth dose and
MCV2, efforts are on to include these,
• For pentavalent vaccine, separate paper reports
need to be sent to immunization division,
MoHFW
• Track the wastage rate and provide regular
monthly reports on stocks of pentavalent vaccine
along with Dose wise coverage reports
New Vaccine Introduction in immunization program
Major activities prior to vaccine
introduction
New Vaccine Introduction in immunization program
Macro-planning
At State Level:
– Seek commitment and support from various
departments and stakeholders
– Develop advocacy and social mobilization activity
plan
– Prepare a training plan
– Disseminate immunization guidelines (e.g. injection
safety, cold chain, AEFI surveillance)
– Develop plans for supervision, monitoring and
evaluation, including providing of feedback.
New Vaccine Introduction in immunization program
Micro-planning
At District, Sub-district levels:
– Revise micro-plans: use prescribed formats for UIP at each
level
– Estimate: Calculate vaccine and logistics requirement at each
level
– Cold chain: evaluate the availability and adequacy at all levels
– Indenting and delivery: ensure availability of required vaccine
and other logistics needed to introduce the vaccine
– Modify and disseminate revised formats: reporting,
recording and immunization card etc
– Trainings: health workers and staff at all levels
– Advocacy and social mobilization activities around the
introduction of the new vaccine,
– Supervise and monitor.
New Vaccine Introduction in immunization program
Update Recording and Reporting Systems
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Vaccine stock forms and registers,
Immunization cards and counterfoils
MCH/Immunization Register
UIP reporting formats (Tally Sheets, Monthly Progress
Report at all levels)
Monitoring Chart
Supervisory checklists
posted immunization schedules, (tin-plates, posters, wall
paintings and billboards)
materials for parents
Computer databases
New Vaccine Introduction in immunization program
Prepare and Train Staff
Target: District Immunization Officers (DIO), Medical Officers (MO), cold
chain handlers, supervisors, data managers and frontline Health Workers
(HW)
Approach: Orientation of district-level trainers at the State level should be
followed by the training of Medical Officers, supervisors and cold chain
handlers.
Finally, MOs should conduct sensitization of the frontline Health Workers.
Integrate in all the training courses, review meetings etc.
Resources:
– Operational guidelines for pentavalent vaccine introduction in the UIP
– Immunization Handbook for Health Workers
– Immunization Handbook for Medical Officers
New Vaccine Introduction in immunization program
Supervise and Monitor
– Supervise planning and implementation
– Schedule supervisory visits
– Monitor implementation
– Monitor vaccines and logistics supply
– Monitor vaccine utilization (coverage)
– Use reported coverage data
– Use RI monitoring data for appropriate actions.
New Vaccine Introduction in immunization program
Discussion
New Vaccine Introduction in immunization program
Thanks for your attention
New Vaccine Introduction in immunization program