Cold Chain

Cold ChainCold Chain

Dr Ravindra Singh

Department of Community medicine

S N Medical College, Agra, U P

Cold ChainCold Chain

The Cold Chain is a system of storing The Cold Chain is a system of storing and transporting vaccines at and transporting vaccines at recommended temperatures from the recommended temperatures from the point of manufacture to the point of use.point of manufacture to the point of use.

Vaccine SensitivitiesVaccine Sensitivities

Vaccine DamageVaccine Damage

The physical appearance of the vaccine The physical appearance of the vaccine may remain unchanged even after it is may remain unchanged even after it is damaged.damaged.

However, the loss of potency due to However, the loss of potency due to either exposure to heat or cold is either exposure to heat or cold is permanent and can not be regained.permanent and can not be regained.

Checking for heat damageChecking for heat damageThe Vaccine Vial Monitor (VVM): The Vaccine Vial Monitor (VVM): A VVM is a label containing a heat-A VVM is a label containing a heat-

sensitive material which is placed on a sensitive material which is placed on a vaccine vial to register cumulative heat vaccine vial to register cumulative heat exposure over time.exposure over time.

The combined effects of time and The combined effects of time and temperature cause the inner square of the temperature cause the inner square of the VVM to darken gradually and irreversiblyVVM to darken gradually and irreversibly..

Before opening a vial, check the status of Before opening a vial, check the status of the VVM.the VVM.

Does a VVM measure vaccine Does a VVM measure vaccine potency ?potency ?

No, the VVM does not directly measure vaccine potency No, the VVM does not directly measure vaccine potency

It gives information about the main factor that affects potency: It gives information about the main factor that affects potency: heat exposure over a period of time. heat exposure over a period of time.

The physical appearance of the vaccine may remain The physical appearance of the vaccine may remain unchanged even after it is damaged. unchanged even after it is damaged.

However, the loss of potency due to either exposure to heat or However, the loss of potency due to either exposure to heat or cold is permanent and cannot be regained.cold is permanent and cannot be regained.

The VVM does not, however measure exposure to freezing The VVM does not, however measure exposure to freezing that contributes to the degradation of freeze-sensitive that contributes to the degradation of freeze-sensitive vaccines.vaccines.

FREEZE DAMAGEFREEZE DAMAGE Hepatitis B, DPT, DT, and TT vaccines lose Hepatitis B, DPT, DT, and TT vaccines lose

their potency if frozen.their potency if frozen.

Freezing dissociates the antigen from the Freezing dissociates the antigen from the adjuvant alum thus interfering with the adjuvant alum thus interfering with the immunogenicity of the vaccine. Moreover, the immunogenicity of the vaccine. Moreover, the risk of adverse events following immunization, risk of adverse events following immunization, such as sterile abscesses, may increase.such as sterile abscesses, may increase.

Therefore, always store 'T-series' vaccines Therefore, always store 'T-series' vaccines (DPT, DT, TT) and Hep.B vaccine between (DPT, DT, TT) and Hep.B vaccine between +2°C and +8°C.+2°C and +8°C.

FREEZE DAMAGEFREEZE DAMAGE Diluents must be cooled for at least 24 hours Diluents must be cooled for at least 24 hours

before use to ensure that vaccines and before use to ensure that vaccines and diluents are at +2°C and +8°C when being diluents are at +2°C and +8°C when being reconstituted.reconstituted.

If the vials are found to be frozen or contain If the vials are found to be frozen or contain floccules, discard the vials. Conduct the shake floccules, discard the vials. Conduct the shake test if you suspect that vials could have been test if you suspect that vials could have been frozen.frozen.

Shake TestShake Test Step 1- prepare a frozen control sample by Step 1- prepare a frozen control sample by

freezing the vial until the contents are solid.freezing the vial until the contents are solid. Step 2- choose a test sample.Step 2- choose a test sample. Step 3- shake the control & test sample for Step 3- shake the control & test sample for

10-15 second.10-15 second. Step 4- allow to rest both vials by placing Step 4- allow to rest both vials by placing

them on a table.them on a table. Step 5- compare sedimentation rate of both Step 5- compare sedimentation rate of both

vials, if the sedimentation rate is similar the vials, if the sedimentation rate is similar the test vial has probably been damaged by test vial has probably been damaged by freezing and should not be used.freezing and should not be used.

Shake TestShake Test

REMEMBERREMEMBER

Do not keep in the cold chain, any Do not keep in the cold chain, any vials that are expired, frozen or with vials that are expired, frozen or with VVMs beyond the discard point, as VVMs beyond the discard point, as they may be confused with those they may be confused with those containing potent vaccines. Keep containing potent vaccines. Keep them in the red bag for disinfection them in the red bag for disinfection and disposal.and disposal.

Cold Chain EquipmentCold Chain Equipment

Cold chain equipment, both Cold chain equipment, both electrical and non-electrical, is used electrical and non-electrical, is used for storing vaccines and/or for storing vaccines and/or transporting them at appropriate transporting them at appropriate temperatures.temperatures.

EquipmentsEquipments Walk in Freezers (WIF)Walk in Freezers (WIF)-They are located at state, regional & district -They are located at state, regional & district

head quartershead quarters- Meant to store OPV in bulk & to freeze ice Meant to store OPV in bulk & to freeze ice

packspacks- Maintain temperature -20Maintain temperature -20°C. °C.

Walk in cold rooms (WIC)-Walk in cold rooms (WIC)-- They are located at regional level.They are located at regional level.- Meant to store vaccines upto 3months & Meant to store vaccines upto 3months &

serve 4-5 Districtsserve 4-5 Districts- Maintain temperature +2 to +8Maintain temperature +2 to +8°C. °C.

Summary of cold chain equipmentSummary of cold chain equipmentEquipmentEquipment TemperatureTemperature Storage CapacityStorage Capacity

ElectricalElectrical

Deep freezer Large(300 ltr)Deep freezer Large(300 ltr) -15 to -25-15 to -25°C°C 200 ice packs or 200 ice packs or OPV stocks for 3 OPV stocks for 3 month(1,20,000-month(1,20,000-1,80,000)1,80,000)

ILR Large (300/240ltr)ILR Large (300/240ltr) +2 to + 8+2 to + 8°C°C BCG, DPT, TT, BCG, DPT, TT, Measles, Hep. B Measles, Hep. B stock for 3 months stock for 3 months (60,000 doses)(60,000 doses)

Deep freezer small (140ltr)Deep freezer small (140ltr) -15 to -25-15 to -25°C°C 100 ice packs100 ice packs

ILR Small(140 ltr)ILR Small(140 ltr) +2 to +8+2 to +8°C°C BCG, DPT, TT, BCG, DPT, TT, Measles, Hep. B Measles, Hep. B stock for 1 stock for 1 month(25,000 month(25,000 doses)doses)

Summary of cold chain equipmentSummary of cold chain equipment

EquipmentEquipment TemperatureTemperature Storage CapacityStorage Capacity

NonelectricalNonelectrical

Cold Box large (20 ltr)Cold Box large (20 ltr) +2 to + 8+2 to + 8°C°C All vaccines are stored All vaccines are stored for transport or power for transport or power failure(72-96 ice packs)failure(72-96 ice packs)

Cold Box small (5ltr)Cold Box small (5ltr) +2 to + 8+2 to + 8°C°C All vaccines are stored All vaccines are stored for transport or power for transport or power failure(36 ice packs)failure(36 ice packs)

Vaccine Carrier (1.7 ltr)Vaccine Carrier (1.7 ltr) +2 to + 8+2 to + 8°C°C All vaccines are carried All vaccines are carried for 12 hrs (4 ice packs & for 12 hrs (4 ice packs & 20 vials)20 vials)

Keep all Electrical Cold Chain Keep all Electrical Cold Chain equipmentequipment

At least 10 cm away from wallsAt least 10 cm away from walls Protected from rain or flooding and away Protected from rain or flooding and away

from direct sunlightfrom direct sunlight Level and on wooden blocksLevel and on wooden blocks Properly connected to one Voltage Properly connected to one Voltage

stabilizer per equipmentstabilizer per equipment Locked and keys accessible to Locked and keys accessible to

designated personneldesignated personnel

DEEP FREEZERS DEEP FREEZERS (DFs)(DFs) Maintain a cabinet temperature betweenMaintain a cabinet temperature between -15-15°C °C to -25to -25°°CC Store OPV and prepare ice packs at the Store OPV and prepare ice packs at the

district level. district level. At the PHC level, Deep freezers are At the PHC level, Deep freezers are

used only for preparation of ice packs used only for preparation of ice packs and are not to be used for storing UIP and are not to be used for storing UIP vaccines. vaccines.

About 20-25 icepacks can be prepared by About 20-25 icepacks can be prepared by a 140 Liter DF in 24 hours with at least 8 a 140 Liter DF in 24 hours with at least 8 hours of continuous electricity supply. hours of continuous electricity supply.

ICE LINED REFRIGERATORS ICE LINED REFRIGERATORS (ILRs):(ILRs): Maintain a cabinet temperature between +2Maintain a cabinet temperature between +2°°C to +8C to +8°°CC

used to store all UIP vaccines at the PHC level.used to store all UIP vaccines at the PHC level.

ILRs are lined with ice packs filled with water which ILRs are lined with ice packs filled with water which

freezes and keeps the internal temperature at a safe freezes and keeps the internal temperature at a safe level despite electricity failure. level despite electricity failure.

ILRs can keep vaccine safe with as little as 8 hours ILRs can keep vaccine safe with as little as 8 hours continuous electricity supply in a 24-hour period. continuous electricity supply in a 24-hour period.

Since ILRs are top-opening, they can hold the cold air Since ILRs are top-opening, they can hold the cold air inside better than a front-opening refrigerator. inside better than a front-opening refrigerator.

VACCINE VANSVACCINE VANS:: Are insulated vans used for transporting Are insulated vans used for transporting

the vaccines in bulk. the vaccines in bulk. The vaccines should be transported to the The vaccines should be transported to the

last cold storage point only through last cold storage point only through vaccine vans.vaccine vans.

Vaccines should be transported only in Vaccines should be transported only in Cold boxes with the desired number of Cold boxes with the desired number of conditioned ice packs.conditioned ice packs.

COLD BOXESCOLD BOXES

Are insulated boxes, used for Are insulated boxes, used for transportation and emergency storage of transportation and emergency storage of vaccines and icepacks.vaccines and icepacks.

Place conditioned ice packs at the bottom Place conditioned ice packs at the bottom and sides of the cold box before loading and sides of the cold box before loading the vaccines in cartons or polythene bags.the vaccines in cartons or polythene bags.

COLD BOXESCOLD BOXES Always keep a thermometer inside the cold Always keep a thermometer inside the cold

box.box.

Do not place DPT, DT, Hep B and TT vials Do not place DPT, DT, Hep B and TT vials in direct contact with conditioned ice packs.in direct contact with conditioned ice packs.

Do not place weights or other cold boxes Do not place weights or other cold boxes on the lid since it will damage the rubber on the lid since it will damage the rubber seal.seal.

COLD BOXCOLD BOX

VACCINE CARRIERSVACCINE CARRIERS With 4 conditioned ice packs, maintain the inside With 4 conditioned ice packs, maintain the inside

temperature between +2temperature between +2°°C to +8C to +8°°C for 12 hours, if not C for 12 hours, if not opened frequently. opened frequently.

They are used for carrying vaccines (16-20 vials) and They are used for carrying vaccines (16-20 vials) and diluents from PHCs to session sites.diluents from PHCs to session sites.

Never use day carriers which contain 2 ice packs for Never use day carriers which contain 2 ice packs for routine immunization.routine immunization.

Never use any screw driver or any other sharp shaft to Never use any screw driver or any other sharp shaft to open the lid of vaccine carrier.open the lid of vaccine carrier.

VACCINE CARRIERSVACCINE CARRIERS

Ensure the return of unused vaccine Ensure the return of unused vaccine vials from session sites to the PHC on vials from session sites to the PHC on the same day in the cold chain the same day in the cold chain through alternate vaccine delivery. through alternate vaccine delivery. Keep a unused vaccines that can be Keep a unused vaccines that can be used in subsequent sessions. Discard used in subsequent sessions. Discard vaccines that have been returned vaccines that have been returned unopened. Do not keep any used vials unopened. Do not keep any used vials in the cold chain.in the cold chain.

Correct packing of the vaccine Correct packing of the vaccine carriercarrier1.1. Prepare ice packs for freezing-Prepare ice packs for freezing--Fill ice pack with water to mark.-Fill ice pack with water to mark.-DO NOT ADD SALT TO WATER-DO NOT ADD SALT TO WATER-Fit the stopper & screw on the cap tightly-Fit the stopper & screw on the cap tightly-Make sure the ice pack does not leak.-Make sure the ice pack does not leak.-Wipe the ice pack dry & place in the deep freezer.-Wipe the ice pack dry & place in the deep freezer.2. 2. Condition frozen Ice pack-Condition frozen Ice pack- - Place frozen ice packs in the open till they ‘sweat’ - Place frozen ice packs in the open till they ‘sweat’

(some condensation or droplets of water).(some condensation or droplets of water).- Check if an ice pack has been conditioned by shaking - Check if an ice pack has been conditioned by shaking

it & listening for water.it & listening for water.

3. 3. Pack the vaccine carrier-Pack the vaccine carrier- - Place four conditioned ice pack against the sides of Place four conditioned ice pack against the sides of

the carrier.the carrier.- Place the plastic bag containing all vaccines & diluents Place the plastic bag containing all vaccines & diluents

in the centre of the carrier.in the centre of the carrier.

4. 4. Remember to-Remember to--collect vaccines in the carrier on the session day -collect vaccines in the carrier on the session day

(vaccine carriers not store vaccines effectively beyond (vaccine carriers not store vaccines effectively beyond 12 hrs.).12 hrs.).

-Do not drop or sit on vaccine carrier.-Do not drop or sit on vaccine carrier.-Do not leave in sunlight, keep in shade.-Do not leave in sunlight, keep in shade.-Do not leave the lid open once packed.-Do not leave the lid open once packed.

ICE-PACKSICE-PACKS Are plastic containers filled with water. Are plastic containers filled with water. These are frozen in the deep freezer and when These are frozen in the deep freezer and when

placed in nonelectrical cold chain equipment placed in nonelectrical cold chain equipment such as vaccine carriers and cold boxes, help such as vaccine carriers and cold boxes, help increase the holdover time.increase the holdover time.

The most common cause of exposure of freeze The most common cause of exposure of freeze sensitive vaccines to freezing temperatures is sensitive vaccines to freezing temperatures is the failure to correctly condition ice packs prior the failure to correctly condition ice packs prior to transport. to transport.

Condition IcepacksCondition Icepacks

Conditioning prevents freezing of freeze- Conditioning prevents freezing of freeze- sensitive vaccines. When icepacks are sensitive vaccines. When icepacks are removed from a freezer, at say - 25°C, they removed from a freezer, at say - 25°C, they need to be kept at room temperature for long need to be kept at room temperature for long enough to allow the temperature of the ice at enough to allow the temperature of the ice at the core of the icepack to rise to 0°C. This the core of the icepack to rise to 0°C. This process is called conditioning.process is called conditioning.

An ice pack is adequately conditioned as soon An ice pack is adequately conditioned as soon as beads of water cover its surface and the as beads of water cover its surface and the sound of water is heard on shaking it.sound of water is heard on shaking it.

Ice PackIce Pack

Immunization servicesImmunization servicesStrategy-Strategy-

1.1. Routine immunization-Routine immunization-

a. At health centrea. At health centre

b. In field- at fixed day & fixed site or placeb. In field- at fixed day & fixed site or place

Health centre will fix the periodicity depending upon Health centre will fix the periodicity depending upon the no. of children/ doses i.e. daily or on alternate the no. of children/ doses i.e. daily or on alternate day, while at village level/ outreach visits, it is once day, while at village level/ outreach visits, it is once in a month by health workers (ANM)in a month by health workers (ANM)

2. 2. Special immunization campaigns-Special immunization campaigns- IPPI , NIDs IPPI , NIDs

National Immunization National Immunization ScheduleSchedule For InfantsFor Infants – –At birth -BCG, OPV (zero dose)At birth -BCG, OPV (zero dose)At 6 weeks -BCG (if not given at birth)At 6 weeks -BCG (if not given at birth)

DPT-1,OPV-1,Hep B-1*DPT-1,OPV-1,Hep B-1*At 10 weeks -DPT-2,OPV-2,Hep B-2*At 10 weeks -DPT-2,OPV-2,Hep B-2*At 14 weeks -DPT-3,OPV-3,Hep B-3*At 14 weeks -DPT-3,OPV-3,Hep B-3*At 9 months -Measles, Vit –A^At 9 months -Measles, Vit –A^At 16-24 months -DPT & OPV boosterAt 16-24 months -DPT & OPV boosterAt 5-6 Years -DPT(2doses if not given earlier at anAt 5-6 Years -DPT(2doses if not given earlier at an

interval of 1month)interval of 1month)At 10 & 16 years -TTAt 10 & 16 years -TT*- In some disricts*- In some disricts^- in every 6 month till 5years of age^- in every 6 month till 5years of age

National Immunization National Immunization ScheduleSchedule

For pregnant females-For pregnant females-

Early in pregnancy -TT- 1/boosterEarly in pregnancy -TT- 1/booster

(during 1(during 1stst visit) visit)

One month after TT-1 - TT-2 One month after TT-1 - TT-2

Doses & site/route Doses & site/route 1. BCG - 0.1ml given I/D1. BCG - 0.1ml given I/D 2. OPV - 2drops given oral2. OPV - 2drops given oral 3. DPT - 0.5 ml given I/M3. DPT - 0.5 ml given I/M 4. Hep B - 0.5 ml given I/M4. Hep B - 0.5 ml given I/M 5. Measles -0.5ml given S/C5. Measles -0.5ml given S/C 6. Vit A - <1yr ½ spoon6. Vit A - <1yr ½ spoon

>1yr 1 spoon>1yr 1 spoon 7. TT - 0.5 ml given I/M7. TT - 0.5 ml given I/M

How to hold a immunization How to hold a immunization sessionsession In the field (outreach)In the field (outreach)

- Sessions should be held regularly at fixed day Sessions should be held regularly at fixed day & fixed site and in the shade.& fixed site and in the shade.

- Sufficient no. of syringes & needles s/be Sufficient no. of syringes & needles s/be available also the vaccines, and start giving available also the vaccines, and start giving vaccine when sufficient no. of children are vaccine when sufficient no. of children are collected.collected.

- Do not return the child unimmunized for minor Do not return the child unimmunized for minor reasonsreasons

- Opened vials should not be used on next day/ Opened vials should not be used on next day/ sessionsession

- Return the unopened vials in cold chain.Return the unopened vials in cold chain.

- Vaccines are issued to S/C or ANM on same Vaccines are issued to S/C or ANM on same day.day.

- Check that all the 4 icepacks are fully frozen, Check that all the 4 icepacks are fully frozen, first wipe the ice pack, keep diluent also.first wipe the ice pack, keep diluent also.

- Scheduled session should not be cancelled Scheduled session should not be cancelled unless there is some emergency.unless there is some emergency.

- Report the serious side effects to PHC.Report the serious side effects to PHC.

- Do not open the vaccine carrier until necessary. Do not open the vaccine carrier until necessary.

- Do not sit over it, close the lid tightly.Do not sit over it, close the lid tightly.

- Only AD syringes are used now.Only AD syringes are used now.

- Reconstituted measles vaccine should be used - Reconstituted measles vaccine should be used with in 4 hrs & BCG vaccine with in 3 hrs.with in 4 hrs & BCG vaccine with in 3 hrs.

- Diluents of vaccine should be kept separate Diluents of vaccine should be kept separate from other drugs.from other drugs.

- Check the diluents & see that it should be at Check the diluents & see that it should be at low temp. before mixing.low temp. before mixing.

- Keep the vials on the ice pack during session.Keep the vials on the ice pack during session.

- At PHC or district, follow the principle of first At PHC or district, follow the principle of first come, first issue of vaccine.come, first issue of vaccine.

- Issuing of amount of vaccine should be based Issuing of amount of vaccine should be based on the no. of doses to be consumed which can on the no. of doses to be consumed which can be calculated.be calculated.

Adverse Events following Adverse Events following Immunization (AEFI)Immunization (AEFI) As no vaccine is 100 % effective, none is As no vaccine is 100 % effective, none is

without risk & severe life threatening events without risk & severe life threatening events can occur but extremely rare. They are-can occur but extremely rare. They are-

- Anaphylactic shock.Anaphylactic shock.- CNS complication – due to pertusis antigen.CNS complication – due to pertusis antigen.- Lymphadenitis d/t BCG.Lymphadenitis d/t BCG.- Abscess d/t faulty techniques.Abscess d/t faulty techniques.- Traumatic neuritis - nerve injury by injection.Traumatic neuritis - nerve injury by injection.- Accidental use of another drug. Accidental use of another drug.

Toxic shock syndrome (TSS)-Toxic shock syndrome (TSS)-

-due to use of measles vaccine which has been -due to use of measles vaccine which has been contaminated by unsterlized needle for taking contaminated by unsterlized needle for taking out the vaccine from the vials and vial being out the vaccine from the vials and vial being used later on same day or next day.used later on same day or next day.

- Cause is the growth of staphylococcus aureus.- Cause is the growth of staphylococcus aureus.

Symptoms- watery diarrhoea, vomiting & high Symptoms- watery diarrhoea, vomiting & high fever within few hours of giving such vaccine. fever within few hours of giving such vaccine. progress to hypotensive shock & death with in progress to hypotensive shock & death with in 48 hours. CFR is very high.48 hours. CFR is very high.

ManagementManagement- TSS is an emergency and no time - TSS is an emergency and no time should be lost in taking the patient to a hospital. should be lost in taking the patient to a hospital. before thatbefore that

1. A broad spectrum antibiotic &1. A broad spectrum antibiotic &2. I.V. fluids s/be started2. I.V. fluids s/be started

Management in hospital include-Management in hospital include-- I.V. fluidsI.V. fluids- AntibioticsAntibiotics- SteroidsSteroids- AntipyreticsAntipyretics- Supportive therapy.Supportive therapy.If no improvement shift to ICU.If no improvement shift to ICU.

Planning of an Planning of an Immunization sessionImmunization session

The building block of planning for routine The building block of planning for routine immunization is the sub-center microplan, immunization is the sub-center microplan, which is compiled at the PHC and further which is compiled at the PHC and further at the district level.at the district level.

Components of the Immunization Micro plan

At sub center Level-At sub center Level- An estimation of beneficiaries An estimation of vaccines, and logistics A work plan, including:-Who will provide the services?-Who will assist in provision of the services (AWW,

ASHA, Social mobilizers, Gram Panchayat members, NGOs etc)

-Where will the services be provided (selection of sites)?

-When will the services be provided (planning of sessions)?

At sub center /PHCAt sub center /PHC Medical officer has the responsibility for

development of action plan preparation.

The health personnel (ANM) should formulate the micro plan at least annually.

An Area Map (with villages, hamlets, hard to reach areas) at the SC-level will be prepared.

For the block level, the map includes SC boundaries, with alternate vaccine delivery routes and

Vaccine storage points.

At PHC/DistrictAt PHC/District

A plan for Supervision should be ready.

A budget that includes the costs of transport, meetings, social mobilization and other activities.

IEC and Training Plans should be prepared.

Guidelines while preparing Guidelines while preparing action plans action plans

Prepare list of villages and hamlets in the Prepare list of villages and hamlets in the area.area.

Prepare an operational map showing Prepare an operational map showing population & distance from health facility.population & distance from health facility.

Estimate total no. of beneficiaries.Estimate total no. of beneficiaries.

Remember to follow “fixed day & fixed site principle”

Immunization sessions are organized on Wednesdays & Saturdays.

The session on Ist Wednesday of each month should be organized at the sub center.

All attempts should be made to ensure that no All attempts should be made to ensure that no planned sessions are cancelled ,In case planned sessions are cancelled ,In case because of any reason the planned session is because of any reason the planned session is not held, it should be conducted on the next not held, it should be conducted on the next working day.working day.

Consult the AWW, ASHA, TBAs, PRI and the community leaders to select accessible immunization session sites (government buildings such as SCs or AWCs).

RememberRemember All vaccines should be available during All vaccines should be available during

the immunization session.the immunization session.

No child should be returned due to No child should be returned due to nonavailability of vaccines (missed nonavailability of vaccines (missed opportunity)opportunity)

RememberRemember

A child can be given more than one A child can be given more than one vaccine at the same session such as vaccine at the same session such as BCG, DPT, OPV and measles, if BCG, DPT, OPV and measles, if previous ones were missed, but at previous ones were missed, but at different sites & with different syringes & different sites & with different syringes & needles.needles.

No child should be returned un-No child should be returned un-immunized just to reduce wastage rates immunized just to reduce wastage rates of vaccines.of vaccines.

Estimating beneficiaries for Estimating beneficiaries for immunization programme immunization programme

Total live births in the area= Population of the areaTotal live births in the area= Population of the area× birth rate× birth rate 10001000

Estimated pregnant women in the area= Total live births in theEstimated pregnant women in the area= Total live births in the area+10% of live birthsarea+10% of live births(add 10% for pregnancy wastage in the form of abortions & still (add 10% for pregnancy wastage in the form of abortions & still

births)births)

Total no. of infants dying = total live births in the areaTotal no. of infants dying = total live births in the area× IMR× IMR during one yearduring one year

Infants alive at one year of age= Total live births in the area-Infants alive at one year of age= Total live births in the area- infants dying during one yearinfants dying during one year

Estimation of number of Estimation of number of contactscontacts

Each visit to the immunization site for Each visit to the immunization site for vaccination is called a “contact”.vaccination is called a “contact”.

Minimum four contacts (three contacts for Minimum four contacts (three contacts for BCG,DPT & polio and one contact for BCG,DPT & polio and one contact for measles) are required for one child to receive measles) are required for one child to receive the complete series of vaccination, so the total the complete series of vaccination, so the total number of contacts will be four times the number of contacts will be four times the number of children in the target population.number of children in the target population.

In case if zero polio dose is given within first 15 In case if zero polio dose is given within first 15 days of life the no. of contacts should be five.days of life the no. of contacts should be five.

Calculations for total vaccine Calculations for total vaccine requirments for each requirments for each immunization are as follows-immunization are as follows-=total infants & pregnant women=total infants & pregnant women× no. of doses of × no. of doses of

vaccines× WMFvaccines× WMF WMF is wastage multiplication factor, it is the WMF is wastage multiplication factor, it is the

maximum vaccine wastage allowed. Under new maximum vaccine wastage allowed. Under new guidelines WMF is 1.33 for all the vaccines. guidelines WMF is 1.33 for all the vaccines. WMF is a WMF is a maximum available wastage. This does not mean that maximum available wastage. This does not mean that wastage to WMF level should be taken for granted. All wastage to WMF level should be taken for granted. All efforts should be made to minimize wastage of efforts should be made to minimize wastage of vaccine as far as possible.vaccine as far as possible.

Estimation of AD syringes Estimation of AD syringes requirement requirement

Total no. of injections=total no. of pregnant womenTotal no. of injections=total no. of pregnant women× no.× no.

of doses of each vaccine of doses of each vaccine The calculation of AD syringes is as follows-The calculation of AD syringes is as follows-

BeneficiaryBeneficiary Vaccine & dosesVaccine & doses Required Required ADSADS

Pregnant Pregnant womenwomen

TT- 2 dosesTT- 2 doses 22

ChildrenChildren BCG- 1 doseBCG- 1 dose 11

DPT-3doses+1booster=4dosesDPT-3doses+1booster=4doses 77

Measles-1doseMeasles-1dose

DT-1doseDT-1dose

TT-1 doseTT-1 dose

Thus requirement of ADS 0.5 ml is 9 (7 injections for Thus requirement of ADS 0.5 ml is 9 (7 injections for each child & 2 injections for each mother) like wise each child & 2 injections for each mother) like wise for BCG inoculation,1 ADS 0.1ml is required.for BCG inoculation,1 ADS 0.1ml is required.

A wastage factor if 10% is added to above A wastage factor if 10% is added to above estimation to take care of wasting of syringes due to estimation to take care of wasting of syringes due to locking or breakage.locking or breakage.

New 5 ml disposable syringes are required every New 5 ml disposable syringes are required every time mixing diluents to measles or BCG vaccine.time mixing diluents to measles or BCG vaccine.

Here again a wastage factor of 10 % is applicable.Here again a wastage factor of 10 % is applicable.

Thank Thank

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