EXPANDED

PROGRAMME
FOR
IMMUNIZATION
BMK
GENERAL OBJECTIVE

 Atthe end of the discussion

students should be able to
acquire knowledge and
understanding on expanded
programme for
immunization.
Specific Objectives

Expanded Programme
for immunization.
Explain the back ground
of Expanded Programme
for Immunization (EPI)
Specific objectives……

 Discuss the Immunization

guidelines and schedule
 Identifythe Target groups for
vaccination
 Describe the Vaccination
schedule
Specific objectives……

 Explain
the Administration of
vaccines.
 Discussthe Side effects of
vaccines.
 Discuss School health and
nutrition programme.
Divisions of Immunity
Types of immunization

There are two types of

immunizations which are:
 Passive immunization
 Active immunization
Types of immunization

 Passive immunization:
 Itis acquired through
transfer of antibodies or
activated T-cells from an
immune host.
 Itis short lived—usually
lasting only a few months.
Types of immunization

 Active immunization
 This happens automatically
when a person gets an infection
and develops his own
antibodies.
 Isinduced in the host itself by
antigen and lasts much longer,
sometimes lifelong.
BACK GROUND OF EPI IN
ZAMBIA

 Expanded programme on
immunization dates back to 1975.
 High Vaccine coverage has been
achieved over the years, as indicated
in routine reporting (MoH, ZDHS)
 This has resulted in the reduction of
reported cases and deaths due to the
vaccine preventable diseases.
Back Ground of EPI in
Zambia

 Universal Childhood Immunization (UCI)

Programme introduced in1984
 The immunization manual has been
revised five times; the first one being in
1982, 1985, th1992, 2002 and in 2008.
 The aim was to incorporate
technological developments offering
opportunities for increasing the cost
effectiveness of immunization services.
Technological developments and
innovations

 There has been improvement on

injection safety and waste
disposal by:
- Introduction of Auto-Disable
Syringes (AD),
- Use of safety boxes and
incinerators.
Technological developments and
innovations

 Introduction of new vaccines:

- Starting with ten (10) doses
tetravalent: DPT-Hib. Previously
there was only a trivalent.
- Followed by the two dose
pentavalent: DPT-HepB + Hib.
- Then the mono dose, fully liquid
Pentavalent: DPT-HepB Hib
Technological developments
and innovations

 Tentravalent Vaccine is a combination of

three vaccines –in-one that prevents
Diphtheria, Tetanus and whooping cough
(Pertusis) and haemophilus influenza all
through a single dose.
 Pentavalent vaccine is a combination of
five vaccines-in-one that prevents
diphtheria, tetanus, whooping cough,
hepatitis b and haemophilus influenza
type b, all through a single dose.
Technological developments and
innovations

 Introduction of systems
strengthening approaches:
- Reaching Every District (RED)
Strategy-This is a strategy to
achieve the goal of 80%
immunization coverage in all
districts and 90% nationally in
all WHO member states.
Technological developments
and innovations

- GAVI Global Alliance for Vaccination

and Immunizations Health System
Strengthening which aims to achieve
and sustain increased immunization
coverage through strengthening
capacity of health system to provide
immunizations and other health
services with a focus on child and
maternal.
Technological developments and
innovations

 Integration of other child survival

programmes such as
- Growth monitoring and promotion
- Vitamin A supplementation
- De-worming, re-treatment/distribution of
insecticide Treated Nets (ITNs),
 Integrated Management of Childhood
illnesses (IMCI) and Early Infant Diagnosis of
HIV.
GOALS OF THE IMMUNIZATION
PROGRAMME

 Protect more people by use of safe

and effective vaccines.
 Accelerate the reduction of morbidity
and mortality from vaccine
preventable diseases.
 Strengthen immunization programme
financing and sustain the introduction
of additional vaccines.
GOALS.....

 Strengthen EPI Disease

Surveillance in the context of
overall improvement of national
health information system.
 IntegrateEPI with other
Interventions in the context of
strengthening the Health
System
Immunization
Strategies
 Immunisation strategies

 Strategy A – Static
 Strategies B- Mobile units (Immunizations
carried out 12km outside the facility)

 Strategy C – School Health services

(targeting school going children

 Strategy D – TT Immunisation (targets

women of child bearing age)
Immunization
Strategies
 REDstrategy ( to increase
vaccination coverage in districts )
Strategy A- Static

 Thisis done at the static unit or

at the health facility, which has
a refrigerator and provides MCH
services.
 Multiple
vaccines such as BCG,
OPV, DPT + Hib-HepB, PCV,
Rota and measles can be given
on the same visit.
Strategy A- Static

 Alleligible children should be

given immunisation at every
contact with a health facility if
they come for under 5 services
Strategy B – Mobile units

 This strategy provides health

services to the communities
living outside a 12 Km radius
from the health facility.
 Itis carried out either by foot,
bicycle, motor cycle or vehicle.
Strategy B – Mobile units

 The schedule for outreach should be

planned in such a way to cover the
target population within the target
age, period and available resources.
 All vaccines given in strategy A which
are BCG, OPV, DPT + Hib+HepB, PCV,
Rota and Measles should be given in
this strategy to all eligible children
Strategy C – School Health services

 In school health services, only

susceptible children are immunised
against measles that is if they were
not immunised.
 Tetanus Toxoid is given to those 15
years and more.
 BCG is given to those without a scar to
the first dose
Strategy D – TT
Immunisation

 This strategy provides immunisation for women in

the child bearing age especially those who are
pregnant.
 They should be given immunisation whenever
they visit the health facility for any reason like:
 At family planning
 At curative services
 For under 5 clinic (when they bring children)
 At school health services
Strategy D – TT
Immunisation

 TT doses received through school

health services should be included
in the required 5 doses.
 Ifa woman reports having
received at least 2 TT doses during
the previous pregnancy (ies), start
counting the dose from TT 3.
Immunization Guidelines

 Optimal response to a vaccine

depends on multiple factors;
- Type of vaccine,
- Age of the recipient
- Immune status of the recipient.
Immunization Guidelines

 Recommendations for the age at which

vaccines are administered are influenced by;
- Age-specific risks for disease.
- Age-specific risks for complications.
- Age-specific responses to vaccination.
- potential interference with the immune
response by passively transferred maternal
antibodies.
Immunization Guidelines

 Vaccines are recommended

for members of the
youngest age group at risk
for experiencing the disease
for which efficacy and
safety have been
demonstrated.
Target groups for vaccinations

 Children 0-18 months

 Pregnant and Post Partum Women
 School Entrants/ Grade 1 / 7 years old
 Women of child bearing age 15-49
years
 Cross boarder travellers
Immunizable Diseases

 Tuberculosis
 Polio
 Pertusis
 Dephthelia
 Tetanus
 Measles
 Hepatitis B
 Haemophilus influenza type B
 Yellow fever
 Rota virus.
vaccination schedule

 A vaccination schedule is a series of

vaccinations, including the timing of
all doses, which may be either
recommended or compulsory,
 Over the past two decades, the
recommended vaccination schedule
has grown rapidly and become more
complicated as many new vaccines
have been developed.
 Childhood Immunizations
vaccine Disease

BCG TB

OPV Poliomyelitis

DPT+Hep B + Hib Diphtheria, tetanus, pertusis,

hepatitis, influenza
PCV Pneumonia

Rota Diarrhoea

Measles Measles
Vaccine Age Dose Route Site

BCG At birth or at 0.05 mls < 1 Intra left fore arm

first contact yr 0.1 mls > Dermal
1 yr

Rota 1 At 6 weeks 1.5mls orally mouth

Rota 2 At 10 weeks 1.5mls orally mouth

(interval of 4
weeks)
Vaccine Age Dose Route Site

OPV 0 From birth to 2-3 drops Orally Mouth

13 days of
age
OPV 1 At 6 weeks 2-3 drops Orally Mouth

OPV 2 At 10 weeks 2-3 drops Orally Mouth

(interval of 4
weeks)
OPV 3 At 14 weeks 2-3 drops Orally Mouth
(interval of 4
weeks)
OPV 4 At 9 mths if 2-3 drops Orally Mouth
OPV 0 was
missed
vaccine Age Dose Route Site

DPT + Hib 1, At 6 weeks 0.5 mls Intra Lateral left thigh

HEP B 1 Muscular

DPT + Hib 2, At 10 weeks 0.5 mls Intra Lateral left thigh

HEP B 2 (interval of 4 Muscular
weeks)
DPT + Hib 3, At 14 week s 0.5 mls Intra Lateral left thigh
HEP B 3 (interval of 4 Muscular
weeks)
Measles 1 At 9 months 0.5 mls Sub cutaneosly Deltoid muscles
of the left upper
arm

Measles 2 At 18 months 0.5 mls Sub cutaneosly Deltoid muscles

of the left upper
arm
Vaccine Age Dose Route Site

PCV 1 At 6 weeks 0.5mls Lateral

Intra
Right thigh
Muscular

PCV 2 At 10 0.5mls Lateral

Intra
weeks Right thigh
(interval Muscular
of 4
weeks)

PCV 3 At 14 week 0.5mls Lateral

Intra
s (interval Right thigh
of 4 Muscular
weeks)
Adulthood Immunizations

 Tetanustoxoid protects
against tetanus
 Yellow
fever protects
against yellow fever
Vacci Age Dose Route Site
ne
TT 1 At first contact or as early 0.5 Intra Deltoid muscle
as possible in first trimester mls Muscular on the upper
arm
TT 2 At least 4 weeks after TT 1 0.5 Intra Deltoid muscle
mls Muscular on the upper
arm
TT 3 At least 6 months after TT 2 0.5 Intra Deltoid muscle
or during subsequent mls Muscular on the upper
pregnancy arm

TT 4 At least 1 year after TT 3 or 0.5 Intra Deltoid muscle

during subsequent mls Muscular on the upper
pregnancy arm

TT 5 At least 1 year after TT 4 or 0.5 Intra Deltoid muscle

during subsequent mls Muscular on the upper
Administration of vaccines

 Some vaccines are in powder

form and must be dissolved in
the diluent supplied with them.
 while
others come in liquid form
and will not need a diluent.
 Therefore,
there is a need to
prepare some vaccines before
immunization.
Preparation of Vaccines

 Preparing Polio and Rota Vaccine:

 If a dropper is separate, attach it securely to
the vial (bottle).
 Keep polio vaccine shaded from sunlight
during the immunisation session.
 Place the vial on a frozen ice pack or
 place it in the hole of the sponge placed at
the mouth of a vaccine carrier, to maintain
the temperature.
Preparation of Vaccines
Preparation of Vaccines
Preparation of Vaccines

 Preparing DPT, PCV and TT

vaccines:
 DPT and TT vaccines come in liquid form.
 You will not need to dissolve or mix
them. Remove metal top from the vial
 Draw 0.5ml into the sterile syringe
 Remove bubbles
 Keep the vaccines shaded from light.
Preparation of Vaccines
Preparation of Vaccines

 Preparing BCG and Measles

vaccine:
 These two come with diluent.
 Dilute when you have the required
number of children to reduce
wastage i.e
 BCG-at least 15-20 children
 Measles –at least 8-10 children
Preparation of Vaccines
Preparation of Vaccines
Important points to
remember:

 Never take two vials of the same vaccine

out of the vaccine carrier at the same
time.
 Do not mix vaccines until mothers and
children are present.
 Mix one vial of a particular vaccine at a
time
 Keep opened vials of polio, measles, and
BCG vaccines on a frozen ice pack or use
the sponge in the vaccine carrier.
Important points to
remember:

 Their temperature must be carefully

maintained.
 Open the vaccine carrier only when
necessary.
 After preparing vaccines, the next
step is to administer them. Before
administering vaccines you should
always remember the following
important points.
Important points to
remember:

 Use one sterile syringe and needle

per vaccine (antigen) per child or
mother.
 Avoid holding loaded syringes in your
hands for long so as not to expose
vaccine to heat or direct sunlight.
 Inform each parent what type of
vaccine you are giving the child, the
possible reactions to it.
Important points to
remember:

 What to do about the reactions, and

when to bring the child back for more
immunisation.
 Listen to parents and encourage
questions.
 Remove any child’s clothes that are
in your way when vaccinating.
Administering Oral Polio Vaccine:

 Itis nice to remember that Polio

vaccine is made up of three
polio viruses and the oral polio
vaccine is given three times to
enable each of the three viruses
to stimulate the production of
antibodies.
Administering Oral Polio Vaccine:

 Ask the child's mother

whether the child has
diarrhoea.
 If"yes" note this on the child's
card and tell the mother that
this dose of polio needs to be
repeated after one month.
Administering Oral Polio Vaccine:

 Use the dropper or device supplied

with the vaccine.
 If the child will not open his mouth,
gently squeeze his cheeks to open his
mouth.
 Put 2 drops of vaccine on the child's
tongue.
 Fill in the Immunization Tally Sheet
appropriately.
Administering Rota Vaccine:

 Use the dropper or device supplied

with the vaccine.
 If the child will not open his mouth,
gently squeeze his cheeks to open his
mouth.
 Put 1.5mls of vaccine in the child's
mouth.
 Fill in the Immunization Tally Sheet
appropriately.
Administering BCG
vaccine

 Clean the skin with cotton wool soaked in

clean water and let it dry.
 Hold the middle of the child's upper left arm
firmly with your left hand.
 Hold the syringe by the barrel with the
milliliter scale upward and the needle
pointing in the direction of the child's
shoulder.
 Do not touch the plunger.
Administering BCG
vaccine

 Point the needle against the skin,

barrel turned up, about 3cm above
your thumb. Gently insert its tip into
the upper layer of the skin.
 Make sure that the needle is in the skin
(intradermal) and not under the skin
 For children above 11 months of age,
inject 0.1 ml. For children under 11
months of age, inject 0.05 ml.
Administering BCG
vaccine

 If the vaccine is injected correctly into

the skin, a wheal, with the surface
pitted like an orange peel, will appear
at the injection site.
 An indication that the vaccine has been
injected incorrectly is that the plunger
will move much more easily when the
needle is injected under the skin than
when it is injected in the skin.
Needle Position and Depth of Insertion
Administering BCG
vaccine

 If there is no local reaction, re-

immunise the child.
 Tell the mother that in 7 days a small
sore will appear at the place where
the injection was given.
 The sore might ooze a bit and will
last for 6 to 8 weeks.
Administering BCG
vaccine

 Keep the baby's arm clean with soap and

water.
 Do not put medicine or dressing on the sore.
 The sore will not hurt, and it will heal by
itself.
 Change the syringe and needle after each
antigen (vaccine) and each child.
 Fill in the Immunization Tally Sheet in BCG
section.
Administering DPT vaccine

 DPT vaccine is a Killed vaccine and it is

called Pentavalent vaccine.
 Killed vaccines are given three times
because they do not stimulate the body to
produce antibodies as well as the live
vaccines.
 When the second and the third doses are
given, the body’s memory of the earlier dose
quickly leads into production of more
antibodies.
Administering DPT vaccine

 The most common adverse reactions after

Hib vaccination are
 Local reactions: swelling, redness, or pain at
the injection site.
 Fever also can occur in as many as 5% of
recipients.
 Fever usually starts within the 1st 24 hours
of vaccination and may last for 2 to 3 days.
Administering DPT vaccine

 These reactions can be treated with a non-

aspirin pain reliever, if needed.
 The main contraindication to Hib
vaccine:
 Severe allergic reaction
- Do not give Hib-containing vaccine to anyone
who has had a prior severe allergic reaction
to a dose of Hib vaccine or to a component in
the vaccine.
Administering DPT vaccine

 Persons who are severely allergic to

diphtheria toxoid, meningococcal
vaccine, or tetanus toxoid also may
be sensitive to a particular Hib
vaccine because of the protein
carriers used to create the conjugate
vaccines.
Administering DPT vaccine

 Givehealth advice about

DPT. Tell the mother that:
DPT may cause some
tenderness at the place
the injection was given
This tenderness will go
away after a few days.
Administering DPT vaccine

 DPT may cause fever but the

fever will subside in 24 hours.
 Teach the mother how to care for
a child with fever.
 Fill
in the Immunization Tally
Sheet appropriately.
 Use another needle and syringe to
vaccinate the next child.
Administering PCV vaccine

 Asfor DPT but inject on the

right thigh
Administering Measles Vaccine

 Draw 0.5 ml dose of the mixed

measles vaccine.
 Ask the mother to expose the child's
left upper arm and hold the child
firmly to restrict his movement
 Clean the injection site with a cotton
swab moistened with clean water,
and let it dry.
Administering Measles
Vaccine

 With the fingers of one hand, pinch the skin

on the outer side of the upper arm.
 Hold the syringe at an acute angle to the
child's arm.
 Inject the vaccine subcutaneously.
 Withdraw the needle.
 If a drop of blood appears, wipe it off with a
cotton swab.
 Fill in the Immunization Tally Sheet
appropriately.
Administering Measles
Vaccine

 Tell the mother that

 Some children have a mild rash
after 7 to 10 days of getting
measles vaccine.
 This rash is mild and it will show
that the vaccine is working very
well.
Administering Tetanus Toxoid Vaccine
(TT)

 Tetanus toxoid is administered to pregnant

women and those who are within child
bearing age from 15 to 49 years even when
they are not pregnant.
 Give TT injection intramuscularly on the
outer side of the upper arm or outer aspect
of the thigh, whichever of the two sites the
woman prefers.
 Fill in the Immunization Tally Sheet
appropriately.
Administering Tetanus Toxoid Vaccine
(TT)

 Tellthe woman that Tetanus

Toxoid can cause some fever for
a few hours and some
tenderness at the site where the
injection was given for a few
days.
 Adverse effects for vaccines.

 BCG vaccine - Fever

 DPT vaccine - Fever, chills and irritability
 Hepatitis Vaccine - Fatigue, headache, nausea and
myalgia
 Haemophillus influenza vaccine - Fever, malaise and
myalgia
 Measles vaccine - Fever and rash
 Polio vaccine - Adverse effects are rare.
 Tetanus Toxoid vaccine - Fever, chills, malaise and
myalgia.
The RED strategy

 Reaching Every District (RED) is the

name given to a strategy of district
capacity building to address common
obstacles to increasing immunization
coverage, with a focus on planning
and monitoring.
The RED strategy

 The first steps in developing the RED

strategy were taken in July 2002 at a
meeting of immunization partners,
who identified common obstacles and
ways to improve access to
immunization, in order to achieve the
global immunization goal 80%
coverage in all districts, and 90%
nationally by 2010.
The Five RED Operational Components

1. Planning and management of

resources
2. Re-vitalising outreach services
3. Linking services with communities
4. Supportive supervision
5. Monitoring and use of data for
action
RED Operational Components

 Planning and management of

resources
 The district micro plan is the key to
the RED strategy.
 The micro plan should be based upon
a local situation analysis which
involves every health facility and
through them the community that
they serve.
RED Operational Components

 At the national level, there is a responsibility

to ensure the needed financial and human
resources are available to the district,
 While the district must ensure the resources
are efficiently used, through regular
monitoring and adjusting the micro plan.
 Continuing to fund the RED strategy for more
than the first year of implementation is vital
for sustainability of coverage increase.
RED Operational Components

 Re-vitalising outreach services

 In many countries a large proportion
of the population can only be reached
regularly though outreach sessions.
 Outreach is any delivery strategy that
requires health facility staff to leave
their facility to deliver immunization.
RED Operational Components

 Ideally a minimum of four contacts per year

are required to fully immunize an infant.
 For some communities, access can only be
provided irregularly, and may require
mobile teams to provide outreach, which
will involve resources beyond the health
facility and district level.
 Outreach sessions, especially mobile teams
present opportunities to provide other
interventions with immunization.
RED Operational Components

Linking services with communities

 Involving the community with the planning
and delivery of the service will encourage
community ownership and improve
attendance.
 Identifying community volunteers providing
them with a role, such as follow up of
defaulters, and holding regular meetings is
an important step towards building a link
with the community.
RED Operational Component

 Supportive supervision
 Supportive supervision implies providing on site
training to health workers at the time of a
supervisory visit, or at regular district meetings.
 To be supportive, supervisors should make regular
schedules for visits, help to solve problems locally
and follow up regularly with supply and resource
issues.
 Supervisors will themselves need training to
adapt their own approaches to supervision.
RED Operational Components

 Monitoring and use of data for action

 Monitoring and use of data for action
implies not only the timely collection of
data at district level, but the use of the
data to solve problems.
 Some simple tools, including wall charts
that display access and utilization need
little training, but are very useful to take
action according to monthly progress.
RED Operational Components

 Not only do districts collect coverage

data, but also a large amount of other
information, including logistics, supply,
surveillance, all of which should be used
to improve the immunization system.
 Some qualitative data may not be
available in regular reports and may
need to collected though supervisory
visits.
COLD CHAIN

 Cold Chain is a system used to maintain

potency of a vaccine from that of
manufacture to the time it is given to child or
pregnant woman. Or
 “Cold chain” refers to the process used to
maintain optimal conditions during the
transport, storage , and handling of vaccines,
starting at the manufacturer and ending with
the administration of the vaccine to the
client.
Equipment used in the cold chain

 Thermometer: is used for monitoring

temperature
 The packs: are used for keeping vaccines cool
in cold boxes and cold boxes or vaccine
carriers there by maintaining their temperature
 Vaccine carriers: are small coxes used for
collection of small quantities of vaccines for a
health centre or for an out reach activity
 Refrigerator: to keep vaccines cool
Refrigerator Maintenance

 Check and record temperature twice daily (4

to 8 °C)
 Put a small bottle or cup in the freezer and
check daily to ensure that it is frozen
 Defrost refrigerator
 For paraffin refrigerator, add fuel to the fuel
tank to keep it full or 3 quarters full
 Check the flame to be sure it is burning
Management of vaccine and supplies

 Ordering Vaccines
 Why forecast for vaccine needs
 Accurate forecasting of vaccine
needs is essential to ensure that the
right amount of vaccine and injection
equipment as well as safety boxes
are available to vaccinate all eligible
clients at a given geographical region
Management of vaccine and supplies

 Efficient forecasting allows not only

efficient management of logistics but
also efficient immunisation services
 Forecasting also allows for a proper
schedule of delivery into management
quantities to be established
 Further more, it ensures an adequate
buffer stock to meet the unexpected
needs
How to forecast vaccine needs

There are three methods for calculating vaccine

needs
 Target population method
 Consumption method
 Vaccination session method
 All these methods depend on the availability
of data target population method is often
used to estimate vaccine needs
COLD CHAIN

 The optimum temperatures:

- Refrigerated vaccines between +2°C
and +8°C.
- Frozen vaccines is -15°C or lower.
- In addition, protection from light is a
necessary condition for some
vaccines.
COLD CHAIN

 The allowed timeframes for the storage

of vaccines at different levels are:
- 6months- Regional Level
- 3months- Provincial Level/District Level.
- 1month-main health centers.
- Not more than 5days for health centers
using transport boxes.
COLD CHAIN

 Most sensitive to heat: Freezer (-15

to -250C)
 OPV, Measles
 Sensitive to heat and freezing
(body of ref. +2 to +8 degrees Celsius)
 BCG, DPT, Hepatitis B, TT
 Use those that will expire first, mark
“X”/ exposure, 3rd- discard.
COLD CHAIN

 Transport
- use cold bags let it stand in room
temperature for a while before
storing DPT.
 Half life packs:
- 4hours-BCG, DPT, Polio,
- 8 hours-measles, TT, Hepatitis B.
COLD CHAIN

 FEFO (“first expiry and first out”) is

practiced to assure that all
vaccines are utilized before the
expiry date.
 Proper arrangement of vaccines
and/or labeling of vaccines expiry
date are done to identify those near
to expire vaccines.
IMPORTANCE OF MAINTAINING THE COLD CHAIN

 Vaccines are sensitive biological

products which may become less
effective, or even destroyed, when
exposed to temperatures outside the
recommended range.
 Cold-sensitive vaccines experience
an immediate loss of potency
following freezing.
IMPORTANCE OF MAINTAINING THE COLD
CHAIN

 Repetitive exposure to heat

episodes results in a cumulative
loss of potency that is not
reversible.
 There is a need to ensure that
an effective product is being
used.
IMPORTANCE OF MAINTAINING THE COLD
CHAIN

 Vaccine failures caused by

administration of compromised
vaccine may result in the re-
emergence or occurrence of vaccine
preventable disease.
 Careful management of resources is
important.
 Vaccines are expensive and can be in
short supply.
IMPORTANCE OF MAINTAINING THE COLD
CHAIN

 Loss of vaccines may result in the

cancellation of immunization clinics resulting
in lost opportunities to immunize.
 Revaccination of people who have received
an ineffective vaccine is professionally
uncomfortable and may cause a loss of
public confidence in vaccines and/or the
health care system.
THE EFFECTIVE COLD
CHAIN

 Three main elements combine to

ensure proper vaccine transport,
storage, and handling.
- Trained personnel
- Transport and storage equipment
- Efficient management procedures
method of testing vaccine potency

THE SHAKE TEST

 The “shake test” is one method used
as an indicator that a liquid vaccine
was inappropriately frozen.
 A positive shake test is the formation
of granular particles which show up
in the liquid upon shaking the
vaccine after the vaccine was frozen
and then thawed.
The Shake Test

 DPT, hepatitis B and tetanus toxoid

vaccines can be damaged by
freezing.
 Take two DPT vials, one that you
think might have been frozen and
another from the same manufacturer
which you KNOW has never been
frozen.
The Shake Test

 Shake both vials.

 Look at the vaccine inside the two
vials.
 Let the sediment settle for 15-30
minutes.
 Again look at the vaccine inside the
two vials.
The Shake Test
The Shake Test

 The shake test is not a reliable

method of testing vaccine potency
because a positive shake test may or
may not occur after a liquid vaccine
has been frozen.
BUDGETING AND SUPPLY

 An uninterrupted supply of injection

equipment is essential for the safety
of immunizations.
 A reserve stock of disposable
injection equipment amounting to at
least 10% of the quantity used in
each supply period should be kept at
central and intermediate stores.
BUDGETING AND SUPPLY

 At peripheral stores the reserve stock

should be sufficient for at least one
month of immunization activities.
 A stock of reusable syringes and
needles should be maintained which
equals 10% more than the largest
number of injections given in a single
session.
BUDGETING AND SUPPLY

 There should be sufficient fuel for

sterilization and adequate spare
parts for the maintenance of steam
sterilizers.
 Puncture-resistant containers should
be provided in sufficient quantities to
all health units for the collection and
incineration of contaminated syringes
and needles.
BUDGETING AND SUPPLY

 A distribution system should be

established for all injection
equipment which is the same as that
for vaccines, involving:
 A timetable of regular supply dates.
 An estimate of routine needs based
on rates of use.
BUDGETING AND SUPPLY

 planning
of needs for special
immunization activities.
A record of current stock levels.
BUDGETING AND SUPPLY

 An adequate budget should be

established one year in advance for
the supply of sufficient injection,
sterilization and disposal equipment
to
 cover routine immunization, special
immunization activities and, if
necessary, the replenishment of
reserve stocks.
Group Assignment

1. Explain the following immunization strategies

i. Strategy A- static
ii. Strategies B- Mobile units
iii. Strategy C – School Health services
iv. Strategy D – TT Immunisation
2. You are giving a health talk to mothers at a named clinic. Your
topic of discussion is importance of childhood immunisations.
A. Define immunization
B. i. Explain the five target groups for immunization
ii. Mention five reguirements needed during an immunization
session
Group Assignment

C. Discuss the immunization schedule stating the

following:
i. Vaccine
ii. Route
iii. Dosoge
iv. Frequency
v. Disease being prevented
D. Explain five ways of ensuring potency of vaccines
that are administered at the health center.