Overview on NIS

Dr. Anil Ku. Agrawal

Asst. Professor
Community Medicine
 Presentation outline

• What is NIS?
• Different vaccines given under NIS
• What is Cold chain
• Different cold chain equipments
• Different immunization Waste & its
management
• National Immunization Schedule- It is a
series of vaccination including the timing of all
doses which may be either recommended or
compulsory depending on the country of
residence.
 National Immunization Schedule
Age Vaccines

Pregnant Women Td (2 doses/Booster)

Birth BCG, OPV-O, Hep B

6 weeks Pentavalent vaccine-1, Rotavirus vaccine-1, OPV -1, IPV-1

10 weeks PV-2, RVV-2, OPV-2

14 weeks PV-3, RVV-3, OPV-3, IPV-2

9 -12 months MR-1 (Measles & Rubella), Vitamin A (1ml), JE*-1

16-24 months DPT booster, OPV – Booster, MR-2, Vitamin A (2ml), JE*-2

5 -6 years DPT Booster 2

10 years Td

16 years Td
 If a dose is missed……..

• Give the dose at the next opportunity

irrespective of the time gap
• Do not start the schedule all over again
 Tetanus diphtheria (Td)
• Intramuscular – upper arm – 0.5 ml
• Pregnancy – 2 doses - 1st dose as early as
possible and second dose after 4 weeks of first
dose and before 36 weeks of pregnancy
• Pregnancy – booster dose (before 36 weeks of pregnancy)
– If received 2 Td doses in a pregnancy within
last three years.
• Td booster for both boys and girls at 10 years
and 16 years
• No Td required between two doses in case of
injury
 BCG

• At birth or as early as possible till one year of

age
• 0.1 ml (0.05ml until one month of age)
• Intra-dermal
• Left upper arm
 Hepatitis B
• Birth dose – within 24 hours of birth
• 0.5 ml
• Intramuscular
• Antero-lateral side of mid-thigh
 OPV
• Zero dose – within first 15 days of birth
• 2 drops
• Oral
• First, second and third doses at 6, 10 and 14
weeks with PV-1, 2 and 3
• OPV booster with DPT booster at 16-24
months
 Pentavalent vaccine

• Three doses at 6, 10 and 14 weeks with OPV-

1, 2 and 3
• 0.5 ml
• Intra-muscular
• Antero-lateral side of mid-thigh
 Rotavirus vaccine

• First, second and third doses at 6, 10 and 14

weeks with PV-1, 2 and 3
• 5 drops
• Oral
 IPV
• Two doses at 6 and 14 weeks (with PV, RVV
& OPV-1and 3)
• 0.1 ml
• Intra-dermal
• Right upper arm
 Measles Rubella
• At completed 9 to 12 months
• Second dose at 16-24 months
• 0.5 ml
• Sub-cutaneous
• Right upper arm
• Along with Vitamin A (1st dose) – 1ml (1 lakh
IU) - oral
 DPT

• One booster at 16-24 months (antero-lateral

side of mid-thigh) and second booster at 5-6
years (upper arm)
 Japanese Encephalitis

• 9-12 months & 16-24 months

• 0.5 ml
• Subcutaneous
• Left upper arm
 Vitamin A
• 1st dose – 1 ml (1 lakh IU) - along-with MR
first dose
• Oral
• Subsequent 8 doses (2 ml or 2 lakh IU) every
six months till 5 years of age starting with
DPT first booster at 16-24 months
• Use only plastic spoon provided with Vitamin
A solution.
• The Cold Chain is a system of storing and
transporting vaccines at recommended
temperatures from the point of manufacture to
the point of use.
 Why have the Cold Chain?

If vaccines are exposed to excessive

Heat Cold

Light

they may lose their potency or effectiveness.

Vaccine potency once lost cannot be restored.
 Heat sensitivity

• BCG (after reconstitution) MOST SENSITIVE

• OPV
• Rotavirus vaccine
• Measles Rubella (before and after
reconstitution)
• Pentavalent vaccine
• DPT
• BCG (before reconstitution)
• Td
• Hepatitis B
LEAST SENSITIVE
Vaccine Vial Monitor(VVM)
VVM is a label containing heat sensitive
material that is placed on a vaccine vial to
register heat exposure over time

Vaccine vial
monitor
Vaccine vial
monitor
• Combined effects of time and temperature cause
the inner square to darken gradually and
irreversibly
• VVM does not directly measure the vaccine
potency but gives info about the main factor that
affects potency
 Sensitivity from Freezing

MOST SENSITIVE

• Hepatitis B

• Td

• DPT

• Pentavalent vaccine
LEAST SENSITIVE
 LIGHT SENSITIVITY
• BCG and Measles Rubella vaccines are light-
sensitive, so they are supplied in amber-
coloured vials.
• Therefore, they need to be kept away from
light.
 Cold chain storage equipment
Electrical:
1. Walk in cold rooms
2. Deep freezers
3. Ice lined refrigerators
Non-electrical:
1. Vaccine vans
2. Cold boxes
3. Vaccine carriers
4. Ice packs
1.Walk in cold rooms(WIC)
At regional level
Storage up to 3 months

2.Deep freezers

At district & PHC levels

Temp :- -15oc to -25oc
At PHC, used only for the
preparation of ice packs
DF
3.Ice lined refrigerators(ILR)

Both at district and PHC

levels
Temp :- +2oc to +8oc
ILR’s are top opening, can
hold cold air inside better
than front opening
refrigerators
 1. Vaccine Vans
• are insulated vans used for transporting the
vaccines in bulk.
• Vaccines should be transported only in Cold
boxes with the desired number of conditioned
ice packs.
 2.Cold Boxes

• Used for transportation of

vaccines
• Store vaccines and icepacks
in emergency X
• Place conditioned ice-packs
at the bottom and sides
before loading vaccines.
• Keep a thermometer inside
the cold box.
 3.Vaccine carriers

• Used for carrying vaccines

(16-20 vials) and diluents
from PHC to the outreach
session sites.
• With 4 conditioned icepacks
maintain inside temperature
of 2-80C for 12 hours.
• Close the lid of the carrier
tightly.
 4. Ice packs
• are plastic containers filled with water.
• These are frozen in the deep freezer and when placed
in nonelectrical cold chain equipment such as vaccine
carriers and cold boxes, help increase the holdover time.
 LET THE WASTE OF THE “SICK”
NOT CONTAMINATE THE LIVES
OF
“THE HEALTHY”

THANK YOU

9/18/2019 37
• Hepatitis B, DPT and TT vaccines lose their
potency if frozen.
• Freezing dissociates the antigen from the
adjuvant alum thus interfering with the
immunogenicity of the vaccine.
• Moreover, the risk of AEFI such as sterile
abscesses, may increase.
• Conduct Shake test.
• Take a vial of vaccine of the same batch number
and from the same manufacturer as the vaccine
you want to test.
• freeze the vial until the contents are solid, then
let the vial thaw by keeping it at room
temperature until it becomes liquid. Label the vial
as control.
• Hold the control and test samples together in the
same hand and shake vigorously for 10 to 15
seconds.
• Place both the vials on a table & look for
sedimentation.
• If the test sample shows a slower
sedimentation rate than the control sample,
the test sample has most probably not been
frozen and can be used.
• If the sedimentation rate is similar or more,
the vial has probably been damaged by
freezing and should not be used.
Vaccine Never Frozen Vaccine Frozen and thawed
Immediately after shaking

Clear Liquid with gross

Cloudy and turbid granuals. Vaccine is
liquid, with no destroyed.
sedimantation.

30 Minutes after shaking

A little clear liquid Mostly clear

liquid
Most of the liquid is turbid
without any sedementation
Thick sediments. Vaccine is
Minimal destroyed
sedementation

UTILIZE DO NOT