Managing introduction of new vaccine(s) into national EPI

1、who/v so cannot be put in refrigerators whose temperatures may reach zero or lower who/v&b/avi managing introduction of new vaccine(s) into national epi lvaccine formulation & presentation- hib hib vaccine is known as a conjugate vaccine as the bacterial capsular polysaccharide material is linked to

2、 tetanus toxoid, diphtheria toxoid, a diphtheria-like protein, or a mix of proteins from other bacteria many different formulations of hib vaccine are produced every year who/v&b/avi managing introduction of new vaccine(s) into national epi lfollowing are some of the formulations liquid hib vaccine

3、(monovalent) liquid hib & dtp vaccines in combination liquid hib & hepb vaccines in combination lyophilized (ie freeze-dried) hib vaccine with saline diluent (monovalent) lyophilized hib vaccine that mixes with liquid dtp, dtp/hepb, dtp/ipv, dtap, or dtap/ipv in combinations who/v&b/avi managing int

4、roduction of new vaccine(s) into national epi lvaccine formulation & presentation- hib the pentavalent (dtp-hepb+hib) uses liquid dtp-hepb as diluent the pentavalent is a two dose preparation every vial of the pentavalent requires two ads and one reconstitution syringe and because the diluent is dtp

5、-hepb, and hepb cannot be frozen, pentavalent vaccine should never be frozen who/v&b/avi managing introduction of new vaccine(s) into national epi lphasing in without catch-up there are two options: l (1) give the new vaccine only to those who come in for their first immunization visit (starting at

6、a given point of time) or l (2) give the new vaccine to every child presenting for immunization visits (in spite of likely incomplete vaccination of some children with hepb & hib most countries awarded vaccine fund support opted for (2) who/v&b/avi managing introduction of new vaccine(s) into nation

7、al epi lphasing in with catch-up phasing in with catch-up: in this case the child receives a full dtp series and a full hepb & hib series at the same time, particularly for hepb, catch-up for older children and those at high risk may be carried out who/v&b/avi managing introduction of new vaccine(s)

8、 into national epi lphasing in with catch-up it will require monovalent vaccine for hepb and hib side by side with combinations containing dtp- greater potential for programme errors it will also require a more sophisticated information system to be able to identify the right child for the right vac

9、cination who/v&b/avi managing introduction of new vaccine(s) into national epi lphasing in catch-up requires more technical skills in the programme to manage the complexities of having two groups of children receiving different vaccines ltherefore, the general recommendation is to proceed without ca

10、tch-up who/v&b/avi managing introduction of new vaccine(s) into national epi lvaccine administration including reconstitution- tetravalent the tetravalent (dtp-hepb) is a liquid formulation and does not require reconstitution or any additional injection equipment than what dtp normally requires the

11、tetravalent is injected, intramuscularly, in the antero-lateral aspect of the thigh of infant the dose is 0.5 ml who/v&b/avi managing introduction of new vaccine(s) into national epi lvaccine administration including reconstitution- tetravalent do not inject in the buttock, fat reduces efficacy of t

12、he hepb vaccine do not use the arm of the infant, the muscle mass is too small do not use tetravalent for hepb birth dose who/v&b/avi managing introduction of new vaccine(s) into national epi lvaccine administration including reconstitution- pentavalent the pentavalent is lyophilised (freeze- dried)

13、 hib that uses liquid dtp-hepb as diluent the dtp-hepb must be drawn from the vial using a reconstitution syringe and put in the vial containing the lyophilised hib. ensure that the entire content of the dtp- hepb is drawn and put in the hib vial shake well before use- check for impurities who/v&b/a

14、vi managing introduction of new vaccine(s) into national epi lvaccine administration including reconstitution - pentavalent the dose is 0.5 ml it is injected, intramuscularly, in the anterolateral aspect of the thigh of the infant do not inject in the buttock, fat reduces efficacy of the hepb vaccin

15、e do not use the arm of the infant, the muscle mass is too small who/v&b/avi managing introduction of new vaccine(s) into national epi lstorage temperature and shelf life hepatitis b vaccine and any of its combination should never be frozen while dtp freezes at around -50 c, hepb freezes at -0.50 c

16、hepb vaccine and its combinations must be stored between +20 c to +80 c the shelf life of tetravalent & pentavalent, if stored at the correct temperature, is at least 2 years who/v&b/avi managing introduction of new vaccine(s) into national epi lindications all infants under 1 year of should receive

17、 a full series of immunization with hepb and hib vaccines lcontraindications a child with known history of severe allergic reaction to previous injection with dtp, hepb or hib hiv positive status is not a contraindication who/v&b/avi managing introduction of new vaccine(s) into national epi lsafety-

18、 hepb hepatitis b vaccine is safe. mild transient side effects may occur sometimes- soreness at injection site, fatigue, headache, irritability, fever serious allergic reactions are rare, eg, hives ( 1 in 600,000 vaccinated cases) there is no evidence of any association of hepb vaccine with multiple

19、 sclerosis & other chronic diseases who/v&b/avi managing introduction of new vaccine(s) into national epi lsafety- hib hib vaccine is very safe mild side effects such as redness, swelling, pain at injection site may occur in about 25% of children vaccinated irritability and fever occur even less com

20、monly who/v&b/avi managing introduction of new vaccine(s) into national epi lmultidose vial policy who multi-dose open vial policy applies for vials of dtp, tt, hepb and opv if lthe expiry date has not passed lthe vaccines are stored under correct cold chain conditions lthe vaccine vial septum has n

21、ot been submerged in water laseptic technique has been used to withdraw all doses lthe vvm, if attached, has not reached discard point who/v&b/avi managing introduction of new vaccine(s) into national epi lmultidose vial policy who guidelines apply to hib as follows: lall liquid formulations of hib

22、contain preservative and can be used in subsequent immunization sessions lthe freeze-dried (lyophilised) pentavalent preparation contains no preservative, and after reconstitution, must be discarded at the end of session or within six hours, whichever comes first (the same as for measles, bcg and ye

23、llow fever) ltherefore, open vial policy cannot be applied to pentavalent vaccine who/v&b/avi managing introduction of new vaccine(s) into national epi linjection safety all vaccine fund eligible countries will receive auto-disable syringe for all immunization injections ads cannot be reused no reca

24、pping of needles ads, after use, are to be put in safety boxes, the boxes when full are to be either burnt, incinerated or buried who/v&b/avi managing introduction of new vaccine(s) into national epi lcold chain both the tetravalent & pentavalent must be stored at +20 c to +80 c these vaccine should

25、 never be frozen do not keep vials in direct contact with ice packs, eg use brown paper to wrap vaccine vials before placing on ice pack or ensure that the ice packs have water around the ice (shake to see if you can hear water sloshing around in the ice pack) who/v&b/avi managing introduction of ne

26、w vaccine(s) into national epi lcold chain do not store the pentavalent & tetravalent or other hepb vaccines in freezers if you must, readjust the thermostat so that they do not freeze even so, do not place these vaccine in direct contact with the bottom or sides of the freezers (for top opening) or

27、 close to the freezer compartment (for front opening) who/v&b/avi managing introduction of new vaccine(s) into national epi lwastage reduction the priority is to reach every child and to reduce missed opportunities, but wastage can be reduced even within the framework of this policy careful planning

28、 & ordering vaccine can reduce wastage proper storage and proper handling will reduce waste correct reconstitution and correct administration can minimise waste wastage must be monitored and reported who/v&b/avi managing introduction of new vaccine(s) into national epi lbirth dose for hepb in all co

29、untries, priority is to achieve highest coverage with hepb vaccination series of all infants in countries with high perinatal transmission (eg south-east asia) and where most births take place in health facilities, delivering a birth dose may be appropriate who/v&b/avi managing introduction of new v

30、accine(s) into national epi lrevision of forms many forms will need revision to include details of new vaccines additional forms may need to be introduced revision must be planned well ahead of actual introduction health workers must be familiarised with the revised forms and new forms/registers who

31、/v&b/avi managing introduction of new vaccine(s) into national epi ltraining of health workers if you are introducing only the tetravalent, not much training of health workers will be required but with pentavalent vaccine, at least one round of good training before the actual introduction of the new

32、 vaccine, followed by close supervision in the initial phase of introduction are important who/v&b/avi managing introduction of new vaccine(s) into national epi ltraining of health workers training of health workers must emphasise on operational aspects and important dos and donts for the management

33、 of the new vaccines a standardised training material is essential to maintain uniformity & quality of training simple reference materials such as wall charts, posters etc. are useful supervision, supervision, supervision who/v&b/avi managing introduction of new vaccine(s) into national epi ladvocac

34、y & social mobilisation why advocacy is necessary lto inform policy makers so that government commitment is realised lto build coalitions for strong partnership among stakeholders lto inform health professionals so that they are aware of the issues and needs and obtain their support lto inform the g

35、eneral public and combat effectively rumours & deliberate disinformation campaigns who/v&b/avi managing introduction of new vaccine(s) into national epi ladvocacy & social mobilisation how to launch an effective advocacy strategy lidentify issues for policy actions lidentify knowledge gaps (among he

36、alth professionals, development partners, lay public) ldevelop a strategic plan to meet those needs luse media (tv, newspapers, radios) to disseminate information luse as advocates influential groups, community leaders, religious leaders who/v&b/avi managing introduction of new vaccine(s) into national epi ladvocacy & social mobilisation tools and resources needed for an effective advocacy campaign la strong advocate, if you can get your countrys leader to express support, nothing like it lposters, pa