New Vaccine Introduction- Pentavalent

Pentavalent VaccineFive -in- one Pentavalent Vaccine

One vaccine against Five diseases

(DPT+ Hepatitis B +HiB)

1. Diphtheria2. Pertussis3. Tetanus4. Hepatitis B5. Haemophilus

Influenza B (HiB)

What is Hib? What diseases does it cause?

Hib is the abbreviation for Haemophilus influenzae type b, a gram negetive encapsulated cocco bacilus that causes severe infections, as listed below.

Bacterial meningitis – inflammation of the membranes that cover and protect the spinal cord and brain. It is a serious infection.

Pneumonia – inflammation of the lungs.

Epiglottitis – inflammation of the area around the vocal cords and obstruction of the airway. Septic arthritis – inflammation of the joints.

Septicaemia/Sepsis – presence of pathogenic bacteria in the blood. Rarely caused by HIB but always fatal

Cellulitis6%

Arthritis8% Bacteremia

2%

Meningitis50%

Epiglottitis17%

Pneumonia15%

Osteomyelitis2%

Haemophilus influenzae type bClinical Features

Key facts about 5th component of Pentavalent (HIB)

1. Globally, Hib kills more than 370,000 children under fiveevery year. Nearly 20% of symptomatic children die in India. Hib disease survivors are often permanently paralysed,become deaf or get brain damaged.

2. 3 primary dose usually confer protection for more than 15 years

3. Hib vaccine can prevent over a third of pneumonia cases and 90% of Hib meningitis cases.

4. Not a contraindication , rather specially indicated in case of Asplenia , Sickle cell anaemia , HIV & Other Immunodeficiency

Pentavalent Vaccine : Basic Information

• Site of injection: Same as DPT or Hep B vaccine- anterolateral aspect of mid-thigh in infants

• Dose: 0.5 ml dose of the vaccine administered intramuscularly.

• Route: Injected intramuscularly (I/M) using auto disable (AD) syringe

• Age group: 3 doses at 6, 10 and 14 weeks. No booster dose. • Formulation: It is a liquid vaccine so diluent is not required.• Presentation: 10-dose vial.• Storage: +2°C to +8°C in ILR; should not be frozen.

1 Pentavalent vaccine introduction and scale up.

Pentavalent vaccine introduced – 8 states

178.7 lakhs (1.78 crores) children vaccinated up to April 2014.

1

Pentavalent vaccine introduction proposed in Oct 2014 – 11 states

Pentavalent vaccine introduction proposed in Apr 2015 – 16 states

States Pentavalent introduction plan Oct 2014

1 Andhra Pradesh

2 Assam

3 Bihar

4 Chhattisgarh

5 Delhi

6 Jharkhand

7 Madhya Pradesh

8 Punjab

9 Rajasthan

10 Uttarakhand

11 West Bengal

• Pentavalent vaccine will replace DPT 1, 2, 3 and Hep 1, 2, 3 doses.• Hep B vaccine will be continued only as birth dose (within 24 hours)

in case of institutional deliveries. • DPT vaccine will be continued in the RI program as booster dose at 16-24 months and 5 years.• Once pentavalent vaccine reaches states , then existing DPT and

Hep B Vaccine stocks will need attention. • Infants that have already started with DPT vaccination will continue

and complete the schedule with DPT vaccine.• Upper age limit in UIP is 1 year• Interchangeability between licensed brands is acceptable • Open vial policy will be followed with pentavalent vaccine. VVM is

present on the vial.

Pentavalent Vaccine : Key points to Remember

Pentavalent vaccine is an expensive vaccine, minimize wastage .

District Hep B Wastage 2013-2014PURULIA 29UTTAR DINAJPUR 23.05BANKURA 22MURSHIDABAD 22KOLKATA 20.87KOCHBIHAR 20.61HOWRAH 20.0624-PARGANAS SOUTH 14.4PASCHIM MEDINIPUR 13.09NADIA 9.8MALDA 9.4HUGLI 1.724-PARGANAS NORTH 1.2JALPAIGURI 1

Some Common Block/PU level issues which need to be addressed before launching Pentavalent

• Incomplete RI micro planning- leading poor defaulter tracking & vaccine wastage

• Implementation of Open vial policy– Not universally followed according to guideline (Time/Date not written)

• Repair/ Maintenance of cold chain equipment system – slow response & irregular process

• Lagging of MCTS updating- connectivity problem/ ANMs are not updating the service/ Knowledge Gap

• Lack of accountable human resource & lack of Focus in Urban area

• Communication Plan preparations– Sensitization meeting under chairmanship of DM involving all

major Private Health facilities, Private Paediatrician & NGOs– Written communication/sharing IEC if needed specially who

has not been sensitized so far– Orientation of media by DM & CMOH (print, electronic, web

based)…. To prevent base less rumor. • Training preparations – Training of all medical officers and other health

personnel (BPHN/PHN, HWs, MOs, Supervisors, AYUSH)– Sensitize vaccine & cold chain handlers, data handlers,

frontline health workers - ASHA/ AWW.

Key preparatory activities prior to launch(Learnings from states that have already introduced vaccine).

• Strengthen AEFI surveillance– AEFI Committee formation– AEFI management Kit for all Blocks– Regular district level review meeting on RI (monthly DTFI)

• Micro planning preparations– Existing RI microplan– Very costly vaccine – so wastage should be minimized– No. of session should be guided by geographical distribution of

population & injection load (25-50/month for OR & 40-70/Month for SC)– Good AVD Plan- Daily vaccine return is mandatory– Block level Microplanning Meeting for Updating of MP ( in Standard

format)– By end of September - Vaccine & Logistic supply from state will be done

after submission of The Checklist.

We have to prevent the effect

of this type of baseless rumor

Simultaneously we have to arrange for the

circulation of the correct message to the

community

Thank you