IMMUNIZATION PROGRAMME IN

INDIA

DR. MAHESWARI JAIKUMAR

EDWARD JENNER

HISTORY• 14 May 1796 - Jenner inoculated

James Phipps, an 8 yr old boy with cowpox lymph taken from Sara Nelms, a milkmaid.

• Boy recovered after a brief illness

• Jenner inoculated pus taken from a small pox patient.

• Boy showed no reaction.

• Jenner recommended vaccination for prevention of smallpox

• Smallpox vaccination being a safe, simple, effective and inexpensive procedure, gained universal acceptance.

• Main instrument for eradication for smallpox at global level.

• Small pox has since been eradicated but Jenner lives for ever.

SMALL POX

• Small pox eradicated in 1977.

• IMMUNIZATION MOST POWERFUL & COST EFFECTIVE TOOL.

• The first vaccine having been sent by jenner himself and used in bombay in 1802.

• The pilot projects began during 1960.

• WHO certified India to be free of smallpox in march 1977.

• The global eradication of smallpox is arguably the greatest achievement of twentieth century medicine

VACCINE PREVENTABLE

DISEASES

VPD• An infectious disease for which an

effective preventive vaccine exists.

• If a person dies from it, the death is considered a vaccine-preventable death.

8 TARGETED VPDSDiphtheriaHepatitis B MeaslesPertusisPoliomyelitisTetanusTuberculosisJE

• DIPHTHERIA• PERTUSSIS• TETANUS• POLIO• TUBERCULOSIS• MEASLES

DIPHTHERIA

PERTUSSIS

PERTUSIS

TETANUS

POLIO

TUBERCULOSIS

MEASLES

MEASELS

MUMPS

CHIKEN POX

FULLY IMMUNIZED CHILD• A child who received One dose of

BCG, Three doses of DPT and OPV One dose of measles before one year of age.

• This gives a child the best chance for survival

MILESTONES IN THE IMMUNIZATION PROGRAM IN

INDIA• 1978: Expanded Program of Immunization

(EPI) introduced after smallpox eradication: BCG, DPT, OPV, Typhoid.

• Limited to mainly urban areas

• 1985 : Universal Immunization Program (UIP) introduced; Expanded to entire country; Measles added.

• 1990 : Vitamin-A supplementation.

• 1992: Child Survival and Safe Motherhood Program.

• 1995: Polio National Immunization Days.

• 1997: Reproductive and Child Health Program (RCH I).

• 2005 : RCH-II and the National Rural Health Mission (NRHM).

EXPANDED PROGRAMME ON IMMUNIZATION 1974

• 1974-

EXPANDED…• Adding more disease controlling

antigens to vaccination schedules.

• Extending coverage to all corners of a country.

• Spreading services to reach the less privileged sectors of the society

1978 – PRIMARY HEALTH CONCEPT

• ALMA – ATA declaration included immunization as one of the strategies for achieving HFA by 2000 AD.

• WHO named this immunization programme as EXPANDED PROGRAMME ON IMMUNIZATION.

• 1985 – UNICEF re named it as “UNIVERSAL IMMUNIZATION PROGRAMME”.

• There is no difference between both the prog.

• The goal was to achieve universal immunization by 1990.

• EPI is regarded as an instrument of UPI.

EPI IN INDIA 1978• The Govt of India launched it’s EPI in

1978.

• The objective was to reducing mortality, morbidity resulting from VPDs.

• To achieve a self sufficiency in vaccine production.

EPI IN INDIA 1978• BCG, OPV, DPT & Measles- under 5

children.

• TT- pregnant women.

• Typhoid added.

• OPV- 1979.

UNIVERSAL IMMUNIZATION PROG

• 1985 in remembrance of then Prime Minister, Indira Gandhi.

• The UIP was taken up in 1986 as National Technology Mission & became operational in all districts in the country during 1989-90.

• UIP become a part of the Child Survival and Safe Motherhood (CSSM) Programme in 1992 and Reproductive and Child Health (RCH) Programme in 1997.

COMPONENTS OF UIP1. Immunization of pregnant women

against tetanus.

2.Immunization of children in their first year of life against 6 VPDs.

2 COMPONENTS OF UIP

• 3. The aim was to achieve 100 % coverage of pregnant women with 2 doses of TT.

• & at least 85% coverage of children under one year (with 3 doses of DPT, OPV & one dose of BCG, One dose of MMR) by 1990

• UIP was first taken up in 30 selected districts & catchment areas of Medical Colleges.

• A technology Mission on Vaccination & Immunization of Vulnerable Population was set up to focus on all aspects of immunization activity.

OBJECTIVES• To increase immunization coverage.

• To improve quality of service.

• To achieve self sufficiency in vaccine production

• To train health personnel.

• To supply cold chain equipment and establish a good surveillance network.

• To ensure district wise monitoring

CHANNEL OF SERVICE PROVISION

• Immunization services are provided through the existing HCDS. (MCH centers, PHC, HSc, Hospitals, Dispensaries).

Though the target was 100% coverage no country in the world has reached the coverage figure.

Therefore it can be interpreted as “NO CHILD SHOULD BE DENIED OF IMMUNIZATION.”

STATUS OF VPD -INDIADISEASE 1987 2011 %

DECLINEPOLIMYELITIS 28,257 1 100

DIPTHERIA 12,952 4,233 62.3

PERTUSIS 163,786 3,909 76.13

NNT 11,849 734 93.8

MEASLES 247,519 33,634 86.41

PROGRAMME IMPLEMENTATION PLAN

• PIP was set to strengthen programme implementation.

COMPONENTS:

• 1.Support for alternative vaccines delivery from PHC to HSc & out reach sessions.

• 2.Deploying retired manpower to implement vaccination services in urban slums & underserved areas

3. Mobility support to Dist Immunization Officer.

4. Reviewing meeting at state level with the districts at 6 monthly intervals.

5. Training of ANM, cold chain handlers, mid level managers, refrigerator machines.

MOBILITY SUPPORT

6. Support mobilization by ASHAs, Self Help Groups.

7. Printing of immunization cards, monitoring sheets, cold chain chart vaccine inventory charts.

PULSE POLIO IMMUNIZATION

• 1995.

• Under 5 children.

• Additional oral polio drops administered in December & January.

STATUS FEB 2012• INDIA is removed from the

list of

“POLIO ENDEMIC COUNTRIES”