Pentavalent vaccine Introduction in UIP in India: Operational aspects

Hib vaccine introduction in India Planned for introduction in 2 states (KE, TN) as pentavalent vaccine (DPT+HepB+Hib); 10 dose liquid formulation to be used in these states; May be expanded to other states of the country later on. Impact study is also being planned in these states.

Hib as pentavalent vaccine: programmatic benefits Will reduce number of pricks from 9+1 (3 each for DPT, HepB and Hib and HepB birth dose) to 3+1, if given in combination Will not need additional cold chain space (in fact, reduced need, 6 doses will be replaced by 3 of pentavalent vaccine) New vaccine introduction provides the opportunity to strengthen the immunization service delivery

UIP Schedule in India BCG At birth or up to one year of age OPV 0 dose OPV ‘0’ dose: within 14 days of birth 6, 10 & 14 weeks (Booster at 16-24 months) Hepatitis B (Birth dose) At Birth or as early as possible within 24 hours DPT At 6, 10 & 14 weeks; DPT boosters at 16-24 months & at 5-6 Years. Hepatitis B 1, 2 & 3 At 6, 10, 14 weeks. Measles 1st dose at 9 completed months - 12 months. 2nd dose at 16-24 months (given up to 5 years, if not received earlier) Vitamin A (1st dose) (2nd to 9th dose) At 9 months with measles vaccination 16 months with DPT/OPV booster, then 1 dose every 6 months up to 5 years. Japanese Encephalitis 16 – 24 months (in endemic states after the campaign)

Hib Vaccine fits into UIP Schedule in India Age Vaccines Birth BCG, OPV-0, HepB 6 weeks DPT -1, OPV -1, HepB 10 weeks DPT -2, OPV -2, HepB 14 weeks DPT -3, OPV-3, HepB 9 months MCV1 16-18 months DPT booster-1, MCV2, OPV -4 5- 6 years DPT-2 Penta-1 + OPV-1 Penta-2 + OPV-2 Penta-3 + OPV-3 5 5 5

HepB birth dose Birth dose of HepB is given as early as possible but with in 24 hours; for all institutional deliveries; HepB birth dose will continue as earlier Stand alone HepB vaccine will be used for HepB birth dose; In May 2011, GoI adopted open vial policy for HepB birth dose and OPV zero dose. These vials can be used for 30 days, if kept properly in cold chain

Focus on birth dose of Hep B Labor room and nursery staff have a greater role Orientation to Obstetricians and the staff nurses needed Availability of vaccine round the clock close to the labor room Recording and reporting issues need to be addressed IEC material for use at institutions

DPT vaccines After introduction of pentavalent vaccines, DPT will continue to be used for booster doses, ANMs need to be sensitized

Pentavalent vaccine Pentavalent will replace the DPT and HepB vaccines at 6, 10 and 14 weeks of age. Standalone HepB vaccine will be used for birth dose DPT for 2 booster doses, as earlier There is no need of booster dose for Hib vaccine

“Phasing In” of Pentavalent vaccine It is recommended that the introduction of Hib as pentavalent vaccine should be gradually phased in the NIS by synchronizing it with OPV/ DPT schedule at 6 wks, 10 wk & 14 wks of age. Pentavalent vaccine schedule thus may be started with fresh batch of vaccinees for better compliance & utilization. Give pentavalent vaccine to only those children who are coming for first dose of DPT (Those coming for DPT2 or 3 should receive DPT only).

Recording and reporting RIMS and HMIS reporting should be continued as earlier HMIS does not capture HepB birth dose and MCV2, efforts are on to include these, For pentavalent vaccine, separate paper reports need to be sent to immunization division, MoHFW Track the wastage rate and provide regular monthly reports on stocks of pentavalent vaccine along with Dose wise coverage reports

Major activities prior to vaccine introduction

Macro-planning At State Level: Seek commitment and support from various departments and stakeholders Develop advocacy and social mobilization activity plan Prepare a training plan Disseminate immunization guidelines (e.g. injection safety, cold chain, AEFI surveillance) Develop plans for supervision, monitoring and evaluation, including providing of feedback.

Micro-planning At District, Sub-district levels: Revise micro-plans: use prescribed formats for UIP at each level Estimate: Calculate vaccine and logistics requirement at each level Cold chain: evaluate the availability and adequacy at all levels Indenting and delivery: ensure availability of required vaccine and other logistics needed to introduce the vaccine Modify and disseminate revised formats: reporting, recording and immunization card etc Trainings: health workers and staff at all levels Advocacy and social mobilization activities around the introduction of the new vaccine, Supervise and monitor.

Update Recording and Reporting Systems Vaccine stock forms and registers, Immunization cards and counterfoils MCH/Immunization Register UIP reporting formats (Tally Sheets, Monthly Progress Report at all levels) Monitoring Chart Supervisory checklists posted immunization schedules, (tin-plates, posters, wall paintings and billboards) materials for parents Computer databases

Prepare and Train Staff Target: District Immunization Officers (DIO), Medical Officers (MO), cold chain handlers, supervisors, data managers and frontline Health Workers (HW) Approach: Orientation of district-level trainers at the State level should be followed by the training of Medical Officers, supervisors and cold chain handlers. Finally, MOs should conduct sensitization of the frontline Health Workers. Integrate in all the training courses, review meetings etc. Resources: Operational guidelines for pentavalent vaccine introduction in the UIP Immunization Handbook for Health Workers Immunization Handbook for Medical Officers

Supervise and Monitor Supervise planning and implementation Schedule supervisory visits Monitor implementation Monitor vaccines and logistics supply Monitor vaccine utilization (coverage) Use reported coverage data Use RI monitoring data for appropriate actions.

Discussion

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