04/08/2304/08/23 11

Immunization in UgandaImmunization in Uganda

PRESENTER: Muyimbo TimothyPRESENTER: Muyimbo Timothy

MBchB111MBchB111

paed rotationpaed rotation

04/08/2304/08/23 22

04/08/2304/08/23 33

04/08/2304/08/23 44

Over view:Over view: DfnsDfns Cold chain and failure of the vaccine programmeCold chain and failure of the vaccine programme IntroductionIntroduction Types of immunityTypes of immunity Types of vaccinesTypes of vaccines MoaMoa Importance of immunizationImportance of immunization Childhood immunisable ds in UgChildhood immunisable ds in Ug Immunization scheduleImmunization schedule Other immedicable ds and routine drugsOther immedicable ds and routine drugs Constraints to immunizationConstraints to immunization Adverse effects of vaccinesAdverse effects of vaccines Cautions and C/IsCautions and C/Is conclusionconclusion

04/08/2304/08/23 55

Dfns:Dfns:

Immunization:Immunization: pcs of admin Abs or Ags to someone to make them pcs of admin Abs or Ags to someone to make them resistant to a particular ds.resistant to a particular ds.

Immune:Immune: means someone has the Abs to fight and kill means someone has the Abs to fight and kill microorganisms that cause a particular ds.microorganisms that cause a particular ds.

Immunity:Immunity: ability of the body to fight ds caused by a particular ability of the body to fight ds caused by a particular organismorganism

Vaccine:Vaccine: the formulation containing the Abs or Ags. (they are the formulation containing the Abs or Ags. (they are different from other drugs b’se they only survive under cold condtns different from other drugs b’se they only survive under cold condtns hence the need for the hence the need for the cold chaincold chain))

04/08/2304/08/23 66

Cold chain and failure of the vaccine programme :Cold chain and failure of the vaccine programme :

Dfn: cold chain refers to the transportation of vaccines from the Dfn: cold chain refers to the transportation of vaccines from the manufacturer to the client at the required temp.manufacturer to the client at the required temp.

This is applied to @ vaccine according to their sensitivity to heat, This is applied to @ vaccine according to their sensitivity to heat, live attenuated vaccines needing cooler temperatures live attenuated vaccines needing cooler temperatures

04/08/2304/08/23 77

Introduction:Introduction:

Greatest medical achievement in human history.Greatest medical achievement in human history. Has prevented many serious childhood ds.Has prevented many serious childhood ds. Small pox eradicated, polio is next, measles and neonatal tetanus Small pox eradicated, polio is next, measles and neonatal tetanus

are due for elimination thru immunization.are due for elimination thru immunization. This has saved many lives.This has saved many lives. Every one needs to support immunization!Every one needs to support immunization!

04/08/2304/08/23 88

Types of immunity:Types of immunity:

2 types, active or passive2 types, active or passive > active immunity; a person makes his own Abs against a ds.> active immunity; a person makes his own Abs against a ds. > passive immunity; ready made Abs are given to a person. > passive immunity; ready made Abs are given to a person. @ of the types can be either natural or artificial@ of the types can be either natural or artificial

□ □ herd immunity:herd immunity:

Protection of the minority unimmunised by the majority immunsed Protection of the minority unimmunised by the majority immunsed due to lack of ds reservoir in the popn.due to lack of ds reservoir in the popn.

04/08/2304/08/23 99

Types of vaccines:Types of vaccines:

1.1. Inactived whole orgs eg pertusis,IPVInactived whole orgs eg pertusis,IPV

2.2. Inactived toxins (toxoids) e.g tetanus ,diphtheriaInactived toxins (toxoids) e.g tetanus ,diphtheria

3.3. Polysaccharides from surface memb e.g pneumococcalPolysaccharides from surface memb e.g pneumococcal

4.4. Surface protein e.g influenza(haemagglutinin)Surface protein e.g influenza(haemagglutinin)

5.5. Live attenuated (weakened) vaccines e.g yellow fever, measles Live attenuated (weakened) vaccines e.g yellow fever, measles and BCGand BCG

04/08/2304/08/23 1010

MOA:MOA:

By prdtn of Abs , cell mediated responses later immunologic memory.By prdtn of Abs , cell mediated responses later immunologic memory. Immunologic memory enables the immune system to recognise and Immunologic memory enables the immune system to recognise and

rapidly respond to exposure to a natural infection at a later date and rapidly respond to exposure to a natural infection at a later date and thus to prevent or modify the ds thus to prevent or modify the ds

04/08/2304/08/23 1111

Importance of vaccination:Importance of vaccination:

1.1. Offers effective protection against some serious dsOffers effective protection against some serious ds

2.2. Prevents spread of dsPrevents spread of ds

3.3. Provides hope for eradicating or eliminating some imptnt dsProvides hope for eradicating or eliminating some imptnt ds

4.4. Saves many childrens’ livesSaves many childrens’ lives

04/08/2304/08/23 1212

04/08/2304/08/23 1313

Are these immunisable ds?Are these immunisable ds?

04/08/2304/08/23 1414

Childhood immunizable ds in Ug:Childhood immunizable ds in Ug:

Tb caused by M. tuberculosis, vaccine is BCGTb caused by M. tuberculosis, vaccine is BCG Poliomyelitis, crippling dse caused by polio virus, oral polio vaccine Poliomyelitis, crippling dse caused by polio virus, oral polio vaccine

givengiven Diphtheria, caused by corynebacteriae diphtheriae, vaccine is DPTDiphtheria, caused by corynebacteriae diphtheriae, vaccine is DPT Tetanus, caused by clostridium tetani, vaccine is TT a combtn in Tetanus, caused by clostridium tetani, vaccine is TT a combtn in

DPTDPT Hepatitis B ,caused by virus which affects liver, HepB vaccine is Hepatitis B ,caused by virus which affects liver, HepB vaccine is

givengiven Haemophilus influenza type B meningitis and pneumonia, Hib Haemophilus influenza type B meningitis and pneumonia, Hib

vaccine is givenvaccine is given Measles, caused by measles virus, measles vaccine is given.Measles, caused by measles virus, measles vaccine is given.

04/08/2304/08/23 1515

Childhood immunisable ds in Ug and vaccine summary:Childhood immunisable ds in Ug and vaccine summary:

Vac AgVac Ag dosagedosage dosesdoses Min Min interval interval 1.1 dose1.1 dose

Min age Min age at startat start

M o M o adminadmin

Site of Site of adminadmin

Storage Storage temptemp

remarksremarks

BCGBCG 0.05ml up 0.05ml up to 11/12to 11/12

0.1ml 0.1ml after after 11/1211/12

11 nonenone Birth or 1Birth or 1stst contact after contact after birthbirth

Intra dermalIntra dermal Rt upper Rt upper armarm

+2-+8+2-+8 Only use Only use diluent diluent provided.provided.

DPTDPT

Hep+HibHep+Hib

0.5ml0.5ml 33 4 weeks4 weeks After 6wks or After 6wks or 11stst contact contact after 6wksafter 6wks

I.MI.M Lt thigh Lt thigh upper outer upper outer aspectaspect

+2-+8+2-+8 Don’t freezeDon’t freeze

poliopolio 2 drops2 drops 33 4 weeks4 weeks Birth and Birth and 6wks or 16wks or 1stst contactcontact

oraloral mouthmouth +2-+8+2-+8 Use spare Use spare methodmethod

measlesmeasles 0.5ml0.5ml 11 nonenone 9/12 or 19/12 or 1stst contact after contact after 9/129/12

subcutsubcut Lt upper Lt upper armarm

+2+8+2+8 Only use Only use diluent diluent provided.provided.

04/08/2304/08/23 1616

Immunization schedule:Immunization schedule:

TimingTiming vaccinevaccine

birthbirth BCGBCG

Polio 0Polio 0

6 weeks6 weeks Polio 1Polio 1

DPT,HepB+Hib 1DPT,HepB+Hib 1

10 weeks 10 weeks Polio 2Polio 2

DPT,HepB+Hib 2DPT,HepB+Hib 2

14 weeks14 weeks Polio 3Polio 3

DPT,HepB+Hib 3DPT,HepB+Hib 3

9/129/12 measlesmeasles

04/08/2304/08/23 1717

Other immunisable ds and routine drugs:Other immunisable ds and routine drugs:

Other immunizable ds:Other immunizable ds: MumpsMumps RubellaRubella S. pnuemonae( pneumonia, meningitis, URTIs)S. pnuemonae( pneumonia, meningitis, URTIs) Papilloma virus( Ca,warts)Papilloma virus( Ca,warts) VZVVZV Other routine drugs:Other routine drugs: Vit AVit A Deworming (mebendazole)Deworming (mebendazole)

04/08/2304/08/23 1818

Constraints to immunization:Constraints to immunization:

Administrative challenges:Administrative challenges:• Lack of storage facilitiesLack of storage facilities• Inadequate transport facilitiesInadequate transport facilities• Lack of personnel to organise and manage programmesLack of personnel to organise and manage programmes• Inadequacies in supply of vaccinesInadequacies in supply of vaccines• Insecurity affecting out reach programmesInsecurity affecting out reach programmes Health care workers:Health care workers:o Lack of proper communication and adequate informationLack of proper communication and adequate informationo Staff shortage bse of too many other responsiblitiesStaff shortage bse of too many other responsiblitieso Lack of knowledgeLack of knowledge Community:Community: Poor community mobilizationPoor community mobilization Long distance to immunization centresLong distance to immunization centres Ignorance and some negative societal beliefs about vaccinesIgnorance and some negative societal beliefs about vaccines

04/08/2304/08/23 1919

Adverse effects of vaccines:Adverse effects of vaccines:

Signs of inflmnSigns of inflmn AnaphylaxisAnaphylaxis FaintingFainting Injection abscesses if sterility is neglectedInjection abscesses if sterility is neglected Vaccine assoc ds (VAD)Vaccine assoc ds (VAD) Hypersensitivity rxtnsHypersensitivity rxtns feverfever

04/08/2304/08/23 2020

Cautions and C/Is:Cautions and C/Is: Cautions:Cautions: Never use vaccine after their expiry datesNever use vaccine after their expiry dates Don’t use un labeled vaccinesDon’t use un labeled vaccines BCG not given to children with AIDSBCG not given to children with AIDS Open one vial at a time Open one vial at a time Opened vaccines should be used within 6 hrsOpened vaccines should be used within 6 hrs Don’t use frozen vaccinesDon’t use frozen vaccines Maintain cold chain systemMaintain cold chain system C/Is:C/Is: Previous anaphylaxis to vaccinesPrevious anaphylaxis to vaccines Vaccines cultured on egg to those who have had previous Vaccines cultured on egg to those who have had previous

anaphylaxis to egg cultured vaccines e.g influenza, yellow fever.anaphylaxis to egg cultured vaccines e.g influenza, yellow fever. Live vaccines in pts who are immunosupressed or pregnant. p’ple Live vaccines in pts who are immunosupressed or pregnant. p’ple

who had chemotherapy in last 6/12 and those taking high dose who had chemotherapy in last 6/12 and those taking high dose steroidssteroids

Postpone immum if child has a febrile illness. Postpone immum if child has a febrile illness.

04/08/2304/08/23 2121

Conclusion:Conclusion:

Immunization provides the most cost effective means of preventing Immunization provides the most cost effective means of preventing dsds

Vaccines are free of charge in all heath units in ugandaVaccines are free of charge in all heath units in uganda Only when a ds has completely been eradicated world wide can it’s Only when a ds has completely been eradicated world wide can it’s

vaccination safely be discontinuedvaccination safely be discontinued All children have a right to basic health care - immunization is one All children have a right to basic health care - immunization is one

basic heath carebasic heath care Immunization is safe and every infant should be immunised in order Immunization is safe and every infant should be immunised in order

to grow into healthy intelligent individuals.to grow into healthy intelligent individuals.

04/08/2304/08/23 2222

04/08/2304/08/23 2323