Pentavalent vaccine Introduction in UIP in India: Operational aspects

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

5. Hib Vaccine fits into UIP Schedule in India Penta-1 + OPV-1 Penta-2 + OPV-2 Penta-3 + OPV-3 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