MANAGING AN

IMMUNIZATION SESSION

DR AMITA RAOOT
Learning Objectives
At the end of the unit, you should be able
to:
• Make preparations for conducting the
immunization sessions
• Conduct an immunization session using
the correct communication, assessment
and vaccine administration techniques
Contents:
 Preparing for an Immunization session
 Communicating with caregivers
 Assessing infants for vaccination and giving
vaccinations
 Closing the session and Recording data
 Using the immunization session checklist
 Preparing for the session
• During micro-planning you have already planned for the number of
sessions, location of session sites, number of beneficiaries expected and
the vaccines and logistics required. You know the names of the
ASHA/AWW responsible for mobilizing the beneficiaries to the session
site. In addition, before every session day you need to perform the
following tasks:
a) Select an appropriate session site
Ideally, it should be:
Easily accessible and identified - using the IEC posters / banner
at a visible point;
Located at the same place each time;
 In a clean area, out of sun and rain – no open air sites;
Having adequate space to accommodate beneficiaries before and
after being vaccinated; space for registration and recording.
 Quiet enough for health workers to be able to explain what they
are doing and to give advice.
 Select an appropriate session site
• Consider few points to see if the session site is GOOD. Does it have
the following:
• A waiting area for beneficiaries
• A separate area for you to vaccinate children – preferably out of
view of other beneficiaries
• Area for waiting after the vaccine is administered.
• Clean surroundings
How to get a good space for your RI session site:
In most situations the Anganwadi centre or the Sub-centre space is used
for immunization sessions.
During meetings with panchayat / ward always discuss the requirement
for a good session site.
Involve the ASHA/AWW/Link worker as they can also be local influencers
to support you.
Furniture like tables, chairs, benches and mats are to be sourced from
local areas / neighbours. This involves the community and creates a
supportive environment
 b) Arrange for the equipment and supplies required
Furniture Logistic Immunization Records

Furniture Logistics: Immunization records:

A table to keep vaccines • AD syringes • MCH card / immunization
and injection equipment • Metal file to open cards
A seat for a parent to sit ampoules • RCH register
while holding a child for • 5 ml disposable • IEC material – poster or
vaccination and a seat for syringes (mixing or banner
the HW reconstitution syringes) • Immunization tally sheets
 Bench for beneficiaries •Marker for writing date • Counterfoils
in waiting area and time on vaccine vials
Bench or mats for • Cotton swabs
Vaccine carrier with 4
beneficiaries after •Hub cutter
conditioned ice packs:
vaccination – post • Black and Red bags for
Paracetamol liquid or
vaccination area waste disposal
tablets
 2 small buckets for the •Anaphylaxis
Vaccines and diluents
red and black bags management kit
Vitamin A ,ORS, Zinc
Water for drinking • BP apparatus*
and IFA tablets*
Area for washing hands •Weighing machine*

*Items to be included when immunization session is part of

Village Health and Nutrition Day (VHND)
 Contd…

c) Prepare due list of beneficiaries and share

with AWW and ASHA for mobilizing
beneficiaries:
Counterfoils of immunization cards
MCH / Immunization register
 Register of AWW and ASHA
 Newborn tracking booklets of polio rounds
 Contd…

d) Arrange the vaccination session site

Place everything you need within reach. On the
table you should keep
•Vaccine carrier
•Hub Cutter
•Immunization cards and records
• Cotton swabs
Keep red and black bags near the table, for disposing
immunization waste. Also keep a bowl, water and soap for
washing your hands clean before beginning the
vaccination session and every time your hands come in
contact with any un-sterile surface.
 Contd…
e) Cold chain maintenance during the immunization
session
Check the vaccine carrier presence of four well-sealed
conditioned icepacks; diluents and usable VVM on all
vaccine vials.
Inspect vaccine vials for visible contamination, i.e. check
for any change in the appearance of vaccine, any floating
particles or cracks and leaks. DO NOT USE SUCH VIALS.
 Mark all vaccine vials with date and time of
opening at first use.
Note the name of the manufacturer, batch number and
expiry date of the vaccine and diluents in the tally sheet.
 Contd..

 ALWAYS VERIFY that you are USING THE

CORRECT VACCINE for administration.
 Always pierce the septum with a sterile needle
for drawing vaccine from the multi-dose vials
being used.
 OPV vial dropper should be recapped with
stopper (small cap) after each use, and kept on
the ice pack.
 Vials of DPT, Hep B, pentavalent, IPV, PCV and
TT should not be kept on the ice pack.
• Specific attention while implementing open vial
policy
• OVP is not applicable to vials of measles/MR,
Rotavirus, BCG and JE vaccine.
• Measles/MR, Rotavirus, BCG, and JE vaccine
should not be used beyond 4 hours of
reconstitution/opening under any circumstances.
• Rotavirus vaccine does not require reconstitution but
must not be used beyond 4 hours of opening.
• Discard such vials after 4 hours of reconstitution or at
the end of the session, whichever is earlier
 Communicating with caregivers
• Communication involves giving
information verbally (including the tone
of voice) and non-verbally (body
language).
• Most communication is non-verbal. It is
conveyed in many ways: posture, facial
expression, gestures, eye contact and
attitude. For example, welcoming
families to an immunization session
with a smile and a calm manner will
reassure those who may be afraid or
worried of injections.
 Communicating with each beneficiary
At the start: During assessment:
• Greet the caregiver 4 key messages
or parent in a USE local language.
friendly manner. Explain the need for the child/beneficiary to
Thank them for return as per the immunization schedule to be
coming for fully protected. Use the immunization card as an
vaccination and for instructional guide.
their patience if Tell the caregiver about next date
they had to wait. Ask the caregiver to repeat the date to be sure it
• Ask the caregiver if is understood
they have any Remind the caregiver to bring the immunization
questions or card
concerns and Inform them to always carry the immunization
answer them card. If they are travelling to other places during
politely the next vaccination date, inform them that they
can vaccinate their child / pregnant woman
anywhere in the country if they have the
vaccination card with them.
4 Key Messages
 After vaccination
• Ask the beneficiary to wait for 30 minutes to observe for any
adverse reactions.
• Remind the caregiver when to return with the infant.
• In the event of any out-of-stocks of vaccine at the time of the
session, inform the caregiver where and when to return for
the next doses.
• Remind the caregiver about other services given during
immunization session; for example, vitamin A supplementation
or tetanus toxoid for women
• If immunization campaigns are planned in the coming months,
inform the caregivers about the date of the campaign, what
vaccination is being given, and where the vaccination site will
be.
• Offer relevant print information to caregivers who are literate.
• Ask the caregiver if they have any questions or concerns and
 Assessing infants for vaccination

Assess eligibility for immunization

• Verify the infant’s age on the immunization card or ask the
caregiver in case the card is not available.
• Verify which vaccines the infant has received by reviewing
the immunization card or ask the caregiver in case the card is not
available. Fill a new card.
• ™™ If the infant is eligible for more than one type of vaccine, it is
safe to give the different vaccines at different injection sites during
the same session
• ™™ Never give more than one dose of the same vaccine at one
time.
• ™™ If the vaccine is overdue, do not restart the schedule. Simply
provide the next needed dose in the series.
• ™™ If there is a delay in starting the immunization schedule, give
the vaccine(s) and an appointment for the next dose at the
interval as recommended in the national immunization schedule.
 Assess possible contraindications
All infants should be immunized except in these situations:

• Do not give a vaccine if the infant has had anaphylaxis (a

serious allergic reaction) or other severe reaction to a
previous dose of the vaccine or a vaccine component.
• Do not vaccinate HIV-infected children with BCG vaccine. Do
not give measles- and/or mumps and/ or rubella containing
vaccines to cases of symptomatic HIV infections/AIDS.
• High fever (>38.5°C). Do not give a vaccine if the
caregiver objects to immunization for a sick infant after
explanation that mild illness is not a contraindication. Ask the
caregiver to come back when the infant is well.
• Vaccinate malnourished children as usual as they are more
likely than well-nourished children to die from vaccine-
preventable diseases.
 4) Giving vaccinations
Administer oral vaccines before
injectable vaccines
1. Position: Use the cuddle position on the
caregiver’s lap with the head supported
and tilted slightly back. Vaccinator stands
to one side
2. Administration: Open the infant’s mouth
by gently squeezing the cheeks between
your thumb and index finger using gentle
pressure. Firm squeezing can cause
distress.
3. ™™ For rotavirus vaccine, five drops and
for OPV, let two drops of vaccine fall from
the dropper onto the tongue. Do not let
the dropper touch the infant.
4. Disposal: Discard the used oral vaccine
vial into the red bag
 Positioning of the Child

Lying
Position

Straddle position

Upright Position
 Preparing to vaccinate

• Use aseptic technique to prepare vaccines:

• Start with hand washing – use soap and
water and dry your hands thoroughly
• Work on a clean table
• Prepare vaccines individually for each child;
do not prefill syringes.
• Try to talk to the caregiver while preparing
injections, as showing interest in the
caregiver is reassuring.
 Reconstitution of vaccines
• Vaccines that need to be mixed with diluent before use
are BCG, Measles/MR and JE vaccine. Use these
vaccines as per following instructions:
•Before reconstitution check that the vaccine is within the expiry date and
that VVM has not reached/crossed the discard point.
•When reconstituting, do so only with the diluent provided by
manufacturer for that batch of vaccine.
•Reconstitute the vaccine with diluent immediately before use.
•Reconstitute the vaccine even when only one eligible child is present.
• Write the date and time of reconstitution on the label of the vial
immediately following reconstitution.
• Use the reconstituted vials only for a single session; do not carry
them from one session to another, even if the session is close by.
•If any AEFI occurs following use of any vial, do not use that vial; mark it
and retain safely for AEFI investigation.
 Steps for reconstitution
1. Check for VVM on the cap of the vial. This VVM indicates
whether the dry vaccine is usable or not. Once reconstituted, VVM is of
not needed, as the vaccine has to be used within 4 hours.
2. Double check each vial/ampoule to make sure it is not past its expiry
date, and read the label carefully.
3. Open the vaccine vial. For a metal cap, use a file to lift the pre-cut
centre and bend it back; for a plastic cap, flip it off with your thumb or
slowly twist it depending on the specific instructions for the type of vial.
4. Open the glass ampoule (with diluent) by holding the ampoule between
the thumb and middle finger and supporting the top with the index
finger; scratch the ampoule neck with a file, then gently break off the
top, taking care to avoid injury from the sharp glass .If you injure
yourself, discard the ampoule since the contents may have been
contaminated. Cover the wound before opening a new ampoule.
5. Draw the entire diluent out with a new disposable reconstitution
(mixing) syringe and needle.
6. Insert the needle of the reconstitution (mixing) syringe into the vaccine
vial and empty all the diluent – depress the plunger slowly to avoid
frothing inside the vaccine vial.
 Contd…..

1. Remove the reconstitution needle and cut the mixing

syringe at the hub with a hub-cutter.
2. To mix the diluent and vaccine, shake the vial gently
by holding at the neck. Take care not to touch the
rubber membrane or opening.
3. Write the date and time of reconstitution on the vial
label.
4. Put the reconstituted vaccine vial in the foam pad of
your vaccine carrier.
5. Use the reconstituted vaccine, within four hours of
reconstitution. At the end of four hours, DO
6. NOT USE the vaccine. Reconstitute a new one if
needed
 Good Injection Technique
Summary of injection steps
1. Wash skin that looks dirty with water. Do not use alcohol to clean the skin
before giving vaccinations.
2. Hold the syringe barrel between the thumb, index and middle fingers. Do not
touch the needle.
3. For intradermal (ID) injections, gently stretch and support the skin with the
thumb and forefinger. Lay the syringe and needle almost flat along the infant’s
skin. Gently insert the needle into the top layer of the skin
4. For subcutaneous injections (SC), gently squeeze the skin. Insert the entire
needle at a 45-degree angle (towards the shoulder) with a quick, smooth action
5. For intramuscular injections (IM), gently stretch and support the skin
between thumb and forefinger. Push the entire needle in at a 90-degree angle
with a quick, smooth action
6. For all injections, depress the plunger slowly and smoothly, taking care not to
move the syringe around.
7. For all injections, pull the needle out quickly and smoothly at the same angle
that it went in.
8. For all injections, the caregiver may hold a clean swab gently over the site if it
bleeds after injection.
 Closing Immunization Session
After immunization session is over
• ™™ Segregate the vaccine vials (used and
unused) and keep these inside in a properly
sealed zipper pouch/bag in the vaccine carrier
under the cold chain and ensure that it delivered
at the designated vaccine/cold storage point.
• ™™Under no circumstances will the vaccine
carrier/vaccines be kept in the field at places
other than the designated cold-chain point such
as ANM/LHV/other HW/ASHA/AWW’s house, etc.
 Contd…

At the vaccine storage/cold-chain point at the end of

immunization day Cold Chain Handler should ensure
appropriate segregation of the vaccines into opened and
unopened vials, and follow the instructions as below:

Unopened vials
• If VVM is intact and in •™™ If VVM is not in usable
usable stage, retain the stage or there is
vial in ILR as per partial/complete defacement
guidelines, and issue of the label, retain the vial in
accordingly. a plastic box clearly marked
“Not to be used” in ILR.
Discard such vial after 48
hours or before the next
session, whichever is earlier.
 Opened vials
Open Vial Policy Applicable

NO YES

™(MCV/Rotavirus/BCG/ VVM Usable VVM NOT Usable

JE) OPV/DPT/HepB/ There is partial/
retain in a plastic box complete
pentavalent/ PCV/ IPV
defacement of the
clearly marked “Not Retain the vaccine vial in label, retain in a
to be used” in ILR. ILR as per guideline, plastic box clearly
subject to the condition marked “Not to
Discard these vials
that the vial is used within be used” in ILR.
after 48 hours or 28 days of opening (as These vaccine
before the next found from date marked on vials should be
session, whichever is the vial) and re-issue in the discarded after 48
next session after ensuring hours or before
earlier. In case of any
the next session,
reported AEFI, they will that it has not exceeded 28
whichever is earlier.
days after opening the vial.
not be discarded but
Retained for
investigation.
 Closing Immunization Session
Dispose of immunization waste safely
Follow the guidelines for safe disposal of immunization waste
as per guidelines.
Leave the site clean and tidy
Specifically after using an outreach site:
• ™™ Do not leave anything behind that might be a health
threat to the community.
• ™™ Clean and return tables, chairs and other equipment
to their owners.
• ™™ Thank the local people who have helped to organize
the session and remind them of the date of the next
session.
 Recording Data
• Accurate and reliable records are vital.
• During a session, individual immunization cards and health centre
records – such as registers, counter foils and tally sheets – have to
be completed.
Analyze the session due list and tally sheet
• After every RI session, try to address the following questions:
 Who are the children who were due for vaccination today but did
not turn up?
 Why did they not turn up?
 Who are the children we did not list for today’s session?
• Enlist all children who had not come in for the session conducted,
irrespective of the reason. After these names, enter the names of
children who will be due for any vaccine in the next session. Share
this list with the ASHA/AWW/LW so as to give them sufficient time to
visit these houses and use all possible methods to convince the
parents or ensure that the children are vaccinated at the fixed site at
the PHC or in the next session.
 THANK YOU
FOR
PATIENT HEARING