Dr.Murali VallipuranathanMBBS, PGD (Population Studies), MSc, MD (Community Medicine), FCCPConsultant Community Physician

WORLD IMMUNIZATION WEEK 2016

Theme 2016

Historical Background

A significant breakthrough came in 1796 when British physician Edward Jenner discovered that he could immunize patients against smallpox by inoculating them with material from cowpox sores.

A mosaic from the early 14th century shows a man infected with smallpox, a once-common disease that killed millions during the Middle Ages. The mosaic is located inside Kariye Mosque, also known as Church of Christ the Savior in Chora, in Istanbul, Turkey.

Historical Background (continued)

In 1885 Louis Pasteur created the first successful vaccine against rabies.

generation of vaccines for use in humans

1798 Smallpox 1885 Rabies 1897 Plague 1923 Diphtheria 1926 Pertussis 1927 Tuberculosis (BCG) 1927 Tetanus 1935 Yellow Fever

generation of vaccines for use in humans

After World War II 1955 Injectable Polio Vaccine (IPV) 1962 Oral Polio Vaccine (OPV) 1964 Measles 1967 Mumps 1970 Rubella 1981 Hepatitis B

Historical Background (continued)

In 1954 Jonas Salk introduced an injectable vaccine containing an inactivated virus to counter the epidemic of poliomyelitis.

Poliomyelitis is an infectious viral disease that sometimes results in paralysis of the muscles involved in breathing. In the early half of the 20th century, paralytic patients were treated using an iron lung, or respirator, a large cylinder that encased the patient in an airtight seal. Motors in the iron lung forced air in and out of the patient’s lungs, providing lifesaving support until recovery and rehabilitation restored the ability to breathe unaided. There is still no cure for polio, although effective vaccination programs have virtually eradicated polio in most industrialized nations.

Historical Background (continued)

Subsequently, Albert Sabin developed an oral vaccine containing a live weakened virus.

Since the introduction of the polio vaccine, the disease has been nearly eliminated in many parts of the world.

1979 Worldwide Vaccinations Eliminate SmallpoxAfter two years without a reported case, the World Health Organization announces that smallpox is eradicated. Smallpox is an often-fatal, highly contagious, viral disease once fairly prevalent around the world.

Sri Lankan situationYear Milestone

1802 Vaccination against smallpox was introduced

1886 Vaccination against smallpox re-introduced under the Vaccination Ordinance

1949 BCG vaccination introduced against tuberculosis

1961 Triple vaccination introduced against diphtheria, whooping cough and tetanus

1962 Oral Polio Vaccine introduced

1963 BCG vaccination of newborn introduced

Sri Lankan situation (continued)

Year Milestone

1969 Tetanus Toxoid administration to pregnant mothers introduced

1978 Launching of the Expanded Programme on Immunization (EPI)

1981 Revision of the immunization schedule and the introduction of a modified list of contraindications

1984 Measles vaccination introduced

1985 Strengthening of cold chain and logistics in EPI

Sri Lankan situation (continued)

Year Milestone

1989/90 Achievement of Universal Childhood Immunization (UCI) with 80% coverage of all infants with the vaccines of EPI

1991 Revision of Tetanus Toxoid schedule

1995 First National Immunization Days (NIDs)

1996 Immunization against rubella commenced

2000/01 Revision of immunization schedule and introduction of Measles Rubella vaccine

2003 Introduction of Hepatitis B vaccine

2008 Introduction of Hib containing Pentavalent vaccine

Success of EPI Programme• Last case of polio in 1993

• Near elimination of tetanus and neonatal

tetanus cases

• Zero incidence of diphtheria since 1995

• Near elimination of measles cases

• Reduction of incidence of whooping

cough

• Near elimination of Congenital rubella

syndrome

Last child afflicted with polio in Sri Lanka -1993

Trends in maternal and infant mortality 1940- 2009

Achievements of the Immunization Programme

Global Eradication of smallpox Eradication of poliomyelitis in several countries and elimination in

other countries. Reduction of morbidity and mortality due to vaccine preventable

diseases.

Therapeutic Vaccines Identification of specific tumor antigens provide immune

targets for which immunogenic vaccines may conceivably be

designed. Examples: Leukemia

Breast cancer

Melanoma

Prostate cancer

Colon cancer

Vaccines against autoimmune diseases

22

Conclusions1.Immunization programme will be continuously overburdened with newer and efficient vaccines added against more diseases coverage of increasing population 2. Health care systems of the developing countries will be finding it more difficult to

maintain the immunization programmes3. Global effort and peaceful atmosphere is needed to achieve eradication4. Global effort and newer strategies are needed to reduce the cost of the vaccines

and to control diseases more effectively

0-4 weeks BCG Before leaving hospital, preferably within 24 hours of birth.If a scar is not present 2nd dose could be offered after 6months, up to 5 years

Immunization schedule in Sri Lanka 2016

Red indicates mandatory vaccines used in the government sectorBlue indicates optional vaccines used in the private sector

On completion of

2nd Month Polio & Pentavalent (DTP-HepB-Hib) (1st dose)Pneumococcal VaccineRota virus vaccine

For a defaulter or for an un-immunized child minimum of 6-8 weeks gap between doses is adequate

4th Month Polio & Pentavalent (DTP-HepB-Hib) (2nd dose)Pneumococcal VaccineRota virus vaccine

Preferably 6-8 weeks after 1st dose

6th Month OPV & Pentavalent (DTP-HepB-Hib) (3rd dose)Pneumococcal VaccineRota virus vaccine

Preferably 6-8 weeks after 2nd dose

Immunization schedule 2016 (continued)

9th Month MMR ( 1st Dose ) On completion of 9 months

IN SECOND YEAR OF LIFE

At 12 months A dose of Live JE Vaccine On completion of 1st year

At 18 months Polio & DTP (4th dose) Hepatitis B + HibChicken Pox (2 doses) Hepatitis A (2 doses)

On completion of 18th month

Immunization schedule 2016(continued)

PRE SCHOOL GOING AGE

At 3 years MMR (2nd Dose)Typhoid

On completion of 3rd year

SCHOOL GOING AGE

At 5 years Polio & DT (5th dose) On completion of 5th year

In School

At 12 years aTd (adult Tetanus diphtheria)Human Papilloma Virus (3 doses)

On completion of 11th year

Immunization schedule 2016(continued)

PREGNANT WOMENA. 1st Dose Tetanus Toxoid During 1st pregnancy, after 12 weeks of POAB. 2nd Dose Tetanus Toxoid During 1st pregnancy,6-8 weeks after the

1stdose

C. 3rd Dose Tetanus Toxoid During 2nd pregnancy, after 12 weeks of POAD. 4th Dose Tetanus Toxoid During 3rd pregnancy, after 12 weeks of POAE. 5th Dose Tetanus Toxoid During 4th pregnancy, after 12 weeks of POAF. One booster dose of Tetanus Toxoid (TTb)

Tetanus Toxoid During 1st pregnancy with a written evidence of previously being immunized with 6 doses of Tetanus Toxoid as per National EPI schedule (3 doses of DPT in infancy + DPT at 18 months + DT at 5 years + aTd at 12 years) during childhood and adolescent and a gap of 10 years or more after the last Tetanus Toxoid containing Immunization.

Immunization schedule 2016(continued)

FEMALES IN THE CHILD-BEARING AGE GROUP

15-44 years Rubella containing vaccine (MMR)

One dose of MMR vaccine should be given to all females between 15 and 44 years of age, who have not been immunized with rubella containing vaccines earlier.

Immunization schedule 2016(continued)

Thank you