1. Pentavalent vaccine Introduction in UIP in India:
Operational aspects

2. 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.

3. 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

4. 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 months)
Hepatitis B (Birth dose)
At Birth or as early as possible within 24 hours
DPT
At 6, 10 & 14 weeks;
DPT boosters at 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 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)

5. 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

6. 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

7. 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

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

9. 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

10. “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).

11. 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

12. Major activities prior to vaccine introduction

13. 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.

14. 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.

15. 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

16. 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

17. 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.

18. Discussion

19. Thanks for your attention