TECHNOLOGY MISSION ON VACCINATION AND IMMUNIZATION OF VULNERABLE POPULATION, PARTICULARLY CHILDREN
Item
- Title
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TECHNOLOGY MISSION ON VACCINATION
AND IMMUNIZATION OF VULNERABLE
POPULATION, PARTICULARLY CHILDREN - extracted text
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TECHNOLOGY MISSION ON VACCINATION
AND IMMUNIZATION OF VULNERABLE
POPULATION, PARTICULARLY CHILDREN
WTfur qg crfran ^mr tfmw
110011
GOVERNMENT OF INDIA
MINISTRY OF HEALTH & FAMILY WELFARE
P. K. UMASHANKAR
Special Secretary
NEW DELHI-110011
FOREWORD
The Universal Immunization Programme, an effective intervention to prevent mortality and
morbidity of children and mortality of pregnant women, was launched on the 19th November, 1985 as
a "Living Hemorial to the memory of our late Prime Minister, Smt. Indira Gandhi".
The Programme
made a modest beginning by covering 30 districts in the country and catchment areas of 50 Medical
Colleges.
The Programme is being extended in phases and, at present, we are covering 182
districts and catchment areas of all the 108 Medical Colleges.
We hope to cover the entire
country by 1990. Having realised the tremendous impact this Programme can have on the health
status of the pregnant women and children of this country, the Government decided to have a
"Technology Mission on Vaccination and Immunization of Vulnerable Population specially children."
Broadly, the objectives of the Mission are to reduce morbidity and mortality of children
due to the six vaccine-preventable diseases, reduce mortality of pregnant women due to Tetanus and
to achieve self-sufficiency in vaccine production.
Under the umbrella of the Mission, all aspects
connected with the delivery of services, research and development on improved and new vaccines,
are also intended to be covered.
The Mission has been divided into two parts viz., Part-I, dealing with implementation of
the Programme and, the Part-II, dealing with the research and development of vaccines.
The first
part is being implemented by the Ministry of Health and Family Welfare is charged with the nodal
responsibility for this Mission.
This booklet on the "Technology Mission on Vaccination and Immunization of Vulnerable
Population specially children" is intended to give brief information on the components of the
Mission and this will form the basis for detailed write-ups on each component, later.
New Delhi
Dated: 1st September,
1987
Special Secretary
CONTENTS
PAGE
TO
FROM
1.
MINISTRY OF HEALTH 8 FAMILY WELFARE
1
—
2.
DEPARTMENT OF BIO-TECHNOLOGY
41
---- 61
40
TECHNOLOGY MISSION ON VACCINATION E IMMUNIZATION OF
VULNERABLE POPULATION, PARTICULARLY CHILDREN
NODAL AGENCY
:
MINISTRY OF HEALTH 6 FAMILY WELFARE
MINISTRY OF HEALTH g FAMILY WELFARE
SUB-MISSION-I
ADMINISTRATION OF VACCINES, MONITORING AND EVALUATION
SUB-MISSION-II
STORAGE AND DISTRIBUTION OF VACCINES
DEPARTMENT OF BIOTECHNOLOGY
SUB-MISSION-I
VACCINE PRODUCTION
SUB-MISSION-II
VACCINE RESEARCH AND DEVELOPMENT
OUTLINE
OBJECTIVE
COVERAGE
BASIC INFORMATION
STRATEGY
MANAGEMENT STRUCTURE
TARGETS
METHODOLOGY
SUBMISSIONS-ACTION CALENDER
ACCOMPLISHMENT
RESOURCES
MISSION OBJECTIVES
REDUCE MORBIDITY AND MORTALITY DUE TO DIPHTHERIA, PERTUSSISS, TETANUS,
POLIOMYELITIS, TUBERCULOSIS, MEASLES AND TYPHOID AMONG CHILDREN
ACHIEVE SELF SUFFICIENCY IN VACCINE PRODUCTION
COVERAGE
100% OF PREGNANT WOMEN WITH TETANUS TOXOIDE BY 1990
85% OF INFANTS WITH DPT, POLIO, MEASLES, BCG AND TYPHOID BY 1990.
BASIC INFORMATION IMR IN INDIA
150-
*-,
70
i/ An------- 1------ 1------- j------- 1-------,—j------- 1------ 1------- 1------ 1------- 1------- j-------]------ 1
75 76 77 78 79 80 81 82 83 84 85 86
87 88 89 90
INTERVENTIONS TO REDUCE IMR
♦
ANTENATAL CARE
- PERTINATAL CARE
*
IMMUNIZATION
*
FAMILY PLANNING + HIGHER AGE AT FIRST PREGNANCY
SPACING OF CHILDREN
SMALL FAMILY NORM
*
BREAST FEEDING AND INFANT NUTRITION
*
DRINKING WATER AND BETTER SANITATION
♦
CONTROL OF DIARRHOEA AND ORT
*
IMPROVED RURAL HEALTH CARE
♦
HEALTH EDUCATION AND FUNCTIONAL LITERACY
3
DEMOGRAPHIC ESTIMATES 1985
POPULATION
BIRTH RATE
7488 LAKHS
*
DEATH RATE
IMR.
11.7 PER THOUSAND
95 PER THOUSAND LIVE BIRTHS
*
NUMBER OF PREGNANT WOMEN
NUMBER OF INFANTS
ESTIMATED NUMBER OF INFANT
DEATHS IN ONE YEAR
258 LAKHS
245 LAKHS
*
*
*
*
32.7 PER 1000
22 LAKHS
INCIDENCE OF TARGET DISEASES - YEAR 1984
-
29718
*
NEONATAL TETANUS (TETANUS)
POLIO
*
MEASLES
-
190881
*
PERTUSSIS
-
189287
*
TUBERCULOSIS
-
987013
*
DIPHTHERIA
13111
*
TYPHOID
—
*
18040
306639
SOURCE
4
-
CBHI (REPORTED)
VACCINE PRODUCTION AND REQUIREMENT
( IN LAKHS )
VACCINE
PRODUCTION
REQUIREMENT
PUBLIC SECTOR
PRIVATE SECTOR (ANNL)
1987-88
1988-89
1989-90
1987-88 1988-89
D.P.T.
360
410
450
600
600
800
861
1046
1104
100
POLIO
-
-
10
-
-
-
861
1040
1104
100
BCG
600
600
600
-
-
-
215
261
276
25
T.T.
420
450
480
1000
1000
1200
738.40
1150
1171
100
D.T.
260
260
260
200
200
400
375
379
383
33
T.A.
74
74
74
-
-
-
376
379
383
33
220
313
331
—
MEASLES
UNICEF
ASSISTANCE
1989-90
1987-88 1988-89 1989-90 BUFFER
OPV IS PRODUCED IN HBPCL, BOMBAY FROM IMPORTED BULK CONCENTRATE
WASTAGE FACTOR - 25% FOR DPT, POLIO, TT, DT, TA AND BCG
- 50% FOR MEASLES
PRIVATE SECTOR MANUFACTURER IS ONLY SERUM INSTITUTE OF INDIA LTD,
PUNE.
THE OTHER PRIVATE MANUFACTURER, BIOLOGICAL E. WILL BE PRODUCING
DPT FROM 1987.
5
FACTORS AFFECTING IMMUNIZATION
1.
HUGE SIZE OF THE COUNTRY
2.
SIZE OF THE POPULATION
3.
POLITICAL WILL
4.
5.
POOR SOCIO ECONOMIC CONDITIONS
LOW LITERACY
6.
DIVERSE CLIMATE
7.
LACK OF ADEQUATE RESOURCES
8.
QUALITY OF VACCINES
PROBLEM
MAJOR STATES
UTTAR PRADESH
RAJASTHAN
MADHYA PRADESH
BIHAR
ORISSA
MINOR STATES
ARUNACHAL PRADESH
MIZORAM
NAGALAND
6
SIKKIM
AREAS
-
LOW COVERAGE
HIGH DROPOUT
STRATEGY
AREA SPECIFIC APPROACH - DISTRICT WISE EXPANSION
DISTRICTS
ACHIEVE 100% COVERAGE FOR PREGNANT WOMEN WITH T.T. VACCINE AND 85% COVERAGE FOR
INFANTS WITH DPT, BCG, POLIO, MEASLES AND TYPHOID VACCINE IN THE DISTRICT WHICH
IS TAKEN UP UNDER UNIVERSAL IMMUNIZATION PROGRAMME IN THAT PARTICULAR YEAR
SR.
NO.
YEAR
COVERAGE
OF DISTT.
1
2
3
4
5
1985-86
1986-87
1987-88
1988-89
1989-90
30
92
182
302
435 +
7
TARGETS
30
28
262422-
NO. OF PREG. WOMEN (In Millions)
NO. OF INFANTS (In Millions)
2018-
14-________ •—_______
BCG
1210-
8■
—-------■------ -""""^rT /
I
82-83
84-85
81-82
u
'
1
l
83-84
BCG WAS BEING ADMINISTERED
TO CHILDREN ABOVE ONE YEAR
PRIOR TO 1984-1985.
85-86
--- j------------- I------------- 1------------- 1---86-P.7
87-88
88-89
89-90
YEAR
------------------ >
MANAGEMENT STRUCTURE
9
ORG. STRUCTURE - MISSION DIRECTORATE (MINISTRY OF H. & F.W.)
10
ORGANISATIONAL
COMMUNITY HZ^LTH CxlL
<7/1. (First Fioor. St. fcteiks Road,
Banaalore - f G' 001.
STRUCTURE OF FIELD ORGANISATION (STATE)
3-5 Crores Pop.
20-30 Districts
20-30 Lacs Pop.
60-75 PHC
30,000 Pop.
6-7 Sub-Centres
5,000 Pop.
12
OPERATIONAL CONSTRAINTS
1.
INSUFFICIENT MOTIVATION
2.
INADEQUATE HEALTH INFRASTRUCTURE
3.
POOR LOGISTIC SUPPORT
4.
DEFICIENCY IN TRAINING
5.
WEAK SUPERVISION AND MONITORING
6.
IRREGULAR FLOW OF FUNDS
7.
CLASHING PRIORITY OF VARIOUS PROGRAMMES
8.
INACCESSIBILITY
13
METHODOLOGY
♦
ENSURE SUPPLY OF FULL REQUIREMENT OF VACCINE
*
ENSURE SUPPLY OF REQUIRED EQUIPMENT i.e. NEEDLES, SYRINGES, STERILIZING EQUIPMENT
*
ENSURE PROPER TRANSPORTATION AND STORAGE OF VACCINE AT AMBIENT TEMPERATURES
*
STRENGTHEN INFRASTRUCTURE
♦
TRAINING STAFF
*
MONITORING OF THE QUALITY OF VACCINATION
*
ENCOURAGE INDIGENISATION OF EQUIPMENT
*
PRODUCTION OF REQUIRED VACCINES
♦
CONCURRENT EVALUATION/INDEPENDENT EVALUATION
*
INVOLVE VOLUNTARY AGENCIES IN ENUMERATION AND ACTUAL VACCINATION
♦
COMMUNITY MOBILIZATION
*
DEVELOP EFFECTIVE I.E.C. ACTIVITY
♦
RESEARCH/DEVELOPMENT FOR IMPROVED VACCINES
14
SUBMISSION-1
ADMINISTRATION OF VACCINES, MONITORING AND EVALUATION
1.
PLANNING IMMUNIZATION
2.
IMMUNIZATION IN THE FIELD
3.
TRAINING
4.
MONITORING
5.
EVALUATION
6.
SURVEILLANCE
7.
COMMUNITY PARTICIPATION
15
1.
16
PLANNING IMMUNIZATION
Selection of districts to be taken
up under UIP for the years 1987-88,
1988-8'j, 1989-90
November, 1986/
May, 1987/
November, 1987
Estimation of targets for Infants
and Pregnant Women, district-wise
for 1987-88, 1988-89 and 1989-90
March, 1987/
June, 1987
December, 1987
Identify districts for special
consideration depending upon the
constraints for 1987-88, 1988-89
and 1989-90
May, 1987/
August, 1987/
June, 1988
IMMUNIZATION IN THE FIELD
17
3.
(i)
MONITORING
MONITORING OF PERFORMANCE IN DIP DISTRICTS
EVERY MONTH
(ii) PERFORMANCE FOR IMMUNIZATION (EPI)
(iii) FIELD VISITS - TECHNICAL/ADMINISTRATIVE OFFICERS
TRAINING PROGRAMME DURING VII-PLAN (1985-1990)
Training during *
1985-86
1986-87
1.
M.O's of PHC’s
1,988
21,666
2.
M P W’s
25,780
303,000
3.
Others
(Dias V.H. Guide
Anganwadi Worker etc.)
20,051
*
♦
18
Total to be Trained during
1985-1990
Figures Provisional
Other Workers are given 2 days
orientation training course.
No. of workers proposed to be
given this course has not been
fixed. States have been given
the discretion.
4.
(i)
(ii)
(iii)
(iv)
TRAINING SCHEDULE
Training to District Health Officer
for 1987-88 UIP Districts
April, 1987
National Planning Management
Course of EPI
April /November, 1987
National Refrigerator Repair
Technical Course
May/October, 1987
Training to District Health Officer
for 1988-89 UIP District
February/March, 1988
19
V
1
EVALUATION >
INTERNAL
‘
I.
CONCURRENT EVALUATION
I
I'.
EVALUATION BY INDEPENDENT BODY
[ .
CONCURRENT EVALUATION
j
*
IDENTIFY THE INSTITUTE/BODY WHICH WILL TAKE UP THIS EVALUATION
j
*
FORMATION OF CORE GROUP FOR1 EVALUATION1
*
SELECTION OF DISTRICT
*
DETERMINATION OF SAMPLE
,
DISTRIBUTION OF PROFORMA AND COLLECTION OF INFORMATION, COMPILATION AND TABULATION
‘
ANALYSIS
■
i
i
'
.
.
SURVEILLANCE
NO
21
6.
COMMUNITY PARTICIPATION
Increased community participation By Method and Group based approaches (requires consideration
at both levels, community and individual)
(i)
Method adopted:
Mass Media
Inter-personal efforts
Inter-personal communication
22
(ii)
Group based approach:
(1)
Health Workers and ICDS workers
(2)
Political and Social Leaders
(3)
Primary School Teachers and personnel of other Government Welfare Departments
(4)
Medical Students and Medical professionals
(5)
Organised and Co-operative Sectors
SUBMISSION - li
STORAGE AND DISTRIBUTION OF VACCINES
1.
PROCUREMENT OF VACCINES
2.
SUPPLY OF VACCINES
3.
STRENGTHENING OF COLD CHAIN
4.
PROCUREMENT AND DISTRIBUTION OF COLD CHAIN EQUIPMENTS
5.
MONITORING SUPPLY OF VACCINES COLD CHAIN EQUIPMENTS
6.
MONITORING OF COLD CHAIN
23
1.
SUPPLY OF VACCINES
VACCINES
(i)
Monthly review of the Vaccines supply
Every Month
(ii)
Procurement of Vaccines from Private
Sector for 1987-88
April / July /October /
December, 1987
(iii) Review supply of Polio Vaccine from
Public/Private Sectors for 1987-88
April/July /October /
December, 1987/February, 1988
(iv) Assessment of requirement of
Vaccines for 1987-88
September, 1987
Statewise allocation of Vaccines
for 1988-89
January, 1988
(vi) Procurement of Vaccines from Private
Sector for 1988-89
January, 1988
(v)
.24
2,
STRENGTHENINGOF COLD CHAIN
(1)
Assess requirement of UXC’s
February, 1987
(2)
Assess requirement for icelined
refrigerators for 1987-88/1988-89 and
1989-90
January, 1987/
May, 1987/
December, 1987
(3)
Assess requirement of cold boxes,
vaccine carriers, ice packs for
88/1988-89
1987and 1989-90
January, 1987/
May, 1987/
December, 1987
(4)
Assess requirement of refrigerated
vans and Mopeds for Institutes/
States for 1987-88/1988-89 and
1989-90
January, 1987/
May, 1987/
December, 1987
25
3.
Supply of ILRs, Vehicles, Health Education
material etc. to districts under UIP for
1987-88
April/June, 1987
Supply of ILRs, Vehicles, Health Education
material etc. to districts under UIP for
89
1988-
November/December , 1987
Supply of ILRs, Vehicle, Health Education
material etc. to districts under UIP for
90
1989-
May/July, 1988
4.
UNICEF Assistance-requirement of 1988-89
May; 1987
5.
UNICEF Assistance-requirement of 1989-90
November, 1987
6.
UNICEF Assistance-Supply of Equipment of
1988-89
November/December, 1987
UNICEF Assistance-Supply of equipment
of 1989-90
May/July, 1988
1.
2.
3.
7.
26
PROCUREMENT, DISTRIBUTION OF EQUIPMENT
MONITORING SUPPLY OF VACCINES, EQUIPMENT INCLUDING COLD CHAIN
1.
Despatch of Equipment from M.S.D., Bombay,
Madras and Calcutta
Every Month
Despatch of equipment directly as UNICEF
assistance to districts
Every Month
3.
Arrival report of equipment from districts
One time report on receipt
4.
Report on installation of icelined refri
gerators districtwise
As and when installed
Monthly return from districts regarding
working condition of refrigerators, ice
liners, Walk-in-Coolers
Every Month
2.
5.
6.
Collection of information and computerising
inventory control.
27
MONITORING OF COLD CHAIN - FOR VACCINES MANUFACTURED IN •• ‘
PUBLIC SECTOR UNDERTAKINGS IN INDIA
*
SYSTEM FOR RECORDING TEMPERATURE AT VARIOUS POINTS OF TIME IN TRANSIT FROM
THE MANUFACTURER TO STATE HEADQUARTERS
•
4 .
*
•
•
1 '
*
SYSTEM FOR MONITORING COLD CHAIN TO BE DEVISED AT THE STATE LEVEL
*
GOVERNMENT OF INDIA WILL MONITOR COLD CHAIN UPTO STATE LEVEL
*
STATE GOVERNMENT WILL MONITOR MAINTENANCE OF PROPER COLD CHAIN FROM THE
STATE HEADQUARTERS TO THE PHC LEVEL
*
- VACCINE PROCURED FROM PRIVATE SECTOR THROUGH DGSfiD -
*
THE SUPPLIER WILL GIVE INFORMATION IN PRESCRIBED PROFORMA FOR TEMPERATURES
AT VARIOUS POINTS OF TIME DURING TRANSIT FROM THE DISTRIBUTION POINT TO
STATE HEADQUARTERS
*
BEYOND THE STATE HEADQUARTERS THE COLD CHAIN MONITORING WILL BE DONE BY
STATE GOVERNMENT
, .
28
' •
•
JI,.
■ •
•
■
•
RESOURCES
1.
FINANCIAL OUTLAY
YEARWISE ESTIMATES EXPENDITURE
(RUPEES IN MILLION)
Non-Recurring
Recurring
142
1989-90
148
Total
535
390
486
1603
1985-86
55
1986-87
89
1987-88
1988-89
101
185
238
304
Towards vaccine
production
$$
262
240
327
405
532
634
2400
(Say Rs. 240.00 Crores)
29
2.
INFRASTRUCTURE
INFRASTRUCTURE FOR DELIVERY OF SERVICES
FORMATION
30
OPERATIONAL
(1986)
TO BE SET UP BY 1990
TOTAL
C.H.C.
767
1941
2708
P.H.C.
12314
9352
21666
SUB-CENTRE
89819
40181
130000
POST PARTUM CENTRE
1118
636
1754
MEDICAL COLLEGES
106
-
106
HOSPITAL-GOVERNMENT
3575
-
3575
OTHER
3459
-
3459
DISPENSARIES
21226
-
21226
3.
HUMAN RESOURCES
STAFF POSITION : KEY HEALTH WORKERS
STAFF
REQUIRED (By 1990)
APPOINTED (till 1986)
Multipurpose Worker (Female)
130,000
100,558
Multipurpose Worker (Male)
130,000
84,598
Female Health Assistant
21,666
16,894
Male Health Assistant
21.666
25,208
Dais
580,000
545,214
Village Health Guide
500,000
390,188
Anganwadi Workers
124,915
31
4.
UNIpEF COOPERATION
*
Incremental Capital and Operating Costs for UIP District Programme
Figures in 'OOO1
. (In US Dollars)
Capital
Year
1985
30 X 216
=
6,480
1986
60 X 216
=
12,960
Operating Cost
. Total . ..
6,480
30 x 26
=
780
1987
90 X 216
=
19,440
90 x 26
=
2.Q40
13,740
. ■ 11 . ■ ;
21,780
1988
120 X 216
=
25,920
180 x 26
=
4,680
30,600
1989
120 X 216
=
25,920
300 x 26
=
7,800
33,720
GRAND
TOTAL
420 X 216
=
90,720
600 x 26
=
15,600
106,320
..
32
*The Governments of Canada and Sweden have made available
supplementary funds for UIP through UNICEF as follows:
CIDA
USS 26 million
S1DA
USS 33 million
Moreover, Rotary International has agreed to supply
Oral Polio Vaccine with a value of USS 19 million, but
this is not included in this Table 4.
ACCOMPLISHMENTS
YEARWISE TARGETS AND ACHIEVEMENTS DURING
1981-82 TO 1989-90
(Figures in Millions)
Year
T.T. (PREG. WOMEN)
Achv.
1arget
% Achv.
Of Tg.
Target
1981-82
7.96
7.11
89.5
15.97
9.23
1982-83
9.00
7.64
84.9
13.97
1983-84
11.50
8.19
71.3
1984-85
13.0
9.27
1985-86
12.85
15.20
1986-87
(upto Jan. 87)
INFANTS
Achv. % Achv.
of Tg.
Target
POLIO
Achv.
57.9
2.40
2.93
123.8
10.34
74.00
5.24
4.55
87.00
15.0
11.13
76.70
7.30
7.90
105.9
71.3
14.5
12.34
85.10
12.00
9.76
81.33
9.31
72.5
14.04
13.34
95.0
14.04
11.98
85.3
7.99
74.2
15.30
3.41
76.6
15.30
7.96
71.8
1987-88
18.6
16.9
1988-89
21.9
17.7
1989-90
23.9
17.0
%Achv.
of Tg.
33
YEARWISE TARGETS AMD ACHIEVEMENT DURING 1981-82 TO 1986-87
(Figures in Million)
Tg.
D.T.
Achv.
% Achv.
T.T.(SC)
TYPHOID
%
Achv.
Achv.
TgT£^_ Achv. % Achv.
Year
Tg.
BCG
Achv.
1981-82
15.0
13.58
90.53
12.57
10.81
86.10
10.0
2.63
26.6
3.5
1.81
51.7
1982-83
15.0
13.93
92.87
12.50
10.25
32.0
10.0
5.02
50.8
5.0
3.11
62.2
1983-84
15.0
13.96
93.07
13.0
10.53
81.0
10.0
6.17
61.7
6.5
4.42
63.0
1984-85
14.3
12.32
84.97
13.0
11.33
37.2
11.0
7.27
66.1
8.0
6.12
76.5
1985-86
14.04
12.89
91.9
11.19
11.10
99.2
11.9
6.99
62.5
8.84 6.70
75.8
1986-87
15.30
' 8.80
80.3
% Achv.
(upto Jan., 87)
Contd
34
Contd
Yearwise Targets and Achievement during 1986-87 to 1989-90
Year
___________________ MEASLES
Tg.
Achv.
1986-87
(upto Jan., 87)
5.70
1987-88
10.0
1988-89
14.2
1989-90
18.3
1.11
________________
% Achv. of Tg.
30.2
. 35
TESTING AND QUALITY CONTROL OF VACCINES
IDENTIFY INSTITUTIONS/MEDICAL COLLEGES/LABORATORIES WHICH
CAN TAKE UP TESTING OF FIELD SAMPLES
May, 1987
ASSESS THE ADDITIONAL REQUIREMENT OF THESE CENTRES FOR MAKING
SUITABLE TO TAKE UP TESTING OF VACCINES
July, 1987
IDENTIFY THE STATES TO BE ASSOCIATED WITH THE SPECIFIC
IDENTIFIED INSTITUTE
August, 1987
(iv) DEVELOP REPORTING SYSTEMS OF TESTING OF FIELD SAMPLES IN
THESE IDENTIFIED INSTITUTES
July, 1987
(i)
(ii)
(ii)
(v)
36
USE COMPUTERISED M.I.S. FOR ANALYSIS OF TESTING RESULTS
September, 1987
INVOLVEMENT OF VOLUNTARY AGENCIES
I
IDENTIFY VOLUNTARY AGENCIES IN EACH rilSTRicT
TO SELECT SUCH AGENCIES WHICH CAN HELP IN DEMAND GENERATION, ENUMERATION
AND ACTUAL VACCINATION
IDENTIFY MAJOR VOLUNTARY AGENCIES SPARED OVER ACROSS THE COUNTRY/STATES
NUMBER OF DISTRICTS
IDENTIFY SUITABLE AGENCIES TO WORK IN URBAN SLUMS
PROVIDE FINANCIAL ASSISTANCE WHEREVER UNAVOIDABLE
37'
MANAGEMENT INFORMATION SYSTEM
COMPUTER TO BE USED FOR COMPILATION OF DATA AND INVENTORY CONTROL
MONITORING OF IMMUNIZATION
SURVEILLANCE
LOGISTICS OF EQUIPMENT INCLUDING COLD CHAIN
FINANCIAL CONTROL
SUPPLY OF VACCINES
EVALUATION REPORTS
Computer is needed at the State Headquarters/District Headquarters.
38
TECHNOLOGY MISSION ON
VACCINATION AND IMMUNIZATION OF
VULNERABLE SECTIONS OF POPULATION
ESPECIALLY CHILDREN
SUB-MISSIONS
I.
VACCINES PRODUCTION
II.
R&D FOR NEW VACCINES
DEPARTMENT OF BIOTECHNOLOGY
MINISTRY OF SCIENCE AND TECHNOLOGY
39
SUB-MISSION - I
PRODUCTION OF VACCINES
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OBJECTIVES
Modernization and capacity expansion in major public sector units to meet the EPI demands
for DPT, DT, TT, BCG and Typhoid vaccines.
To establish indigenous production capacities before 1990 for Measles, Polio and tissue
culture Rabies vaccine employing advanced technologies.
To undertake detailed evaluations including field trials of R-DNA hepatitis-B vaccine and
new pertussis vaccine and to set up indigenous production capacities for those vaccines
by 1990 or soon thereafter.
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SOME DESIRABLE CHARACTERISTICS OF VACCINES CONSIDERED
IN THE CHOICE OF VACCINES/PROCESS TECHNOLOGIES
High efficacy
(Minimum number of doses to ensure long lasting immunity, better sero-conversion
etc.)
safety and minimum side effects.
Long shelf life.
Heat stability.
Distribution through common cold chain.
Ease of application.
Adequate availability.
Ability to combine with other vaccines as vaccine "Cock tails" and
Low cost.
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DROP-OUT AND VACCINATION COVERAGE
DOSES/
VISITS
DROP-OUT
RATE
3
25%
100
56.25
3
20%
100
64.00
3
10%
100
81.00
3
’7.5%
100
85.50
4
5%
100
85.70
NUMBER OF RECIPIENTS
FIRST VISIT LAST VISIT
MINIMUM VACCINATION VISITS DURING FIRST YEAR - 4
Note:
The drop out rate in India is about 25%. Vaccines requiring multiple
doses calls for multiple visits/recalls, which results in a large cumu
lative drop out and low coverage. Vaccines requiring fewer doses
(ideally single shots) would greatly help improve the coverage.
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SOME SALIENT FEATURES OF VACCINE PRODUCTION STRATEGY
■
1
■
■
' '
»
■
1
Number of doses manufactured and schedule of production and supply to match
the estimated annual requirements of the EPI»
Quality of the products to meet strictly the standards set by the World Health
Organisation.
Quality of the products to be certified by a independent National Quality Control
and Standardization Laboratory.
The cost of indigenously producted vaccine to be internationally competitive and to
enhance the cost-effectiveness of the national programme.
The production units should have strong in house R
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D component.
TECHNOLOGIES FOR PRODUCTION OF VACCINES
MEASLES VACCINE
I.
II.
CHICK EMBRYO FIBROBLAST TECHNOLOGY
HUMAN DIPLOID CELL BASED CELL CULTURES
ORAL POLIO VACCINE
PRIMARY MONKEY KIDNEY CELL CUTURES
KILLED POLIO VACCINE
RABIES VACCINE
CONTINUOUS VERO CELL MICROCARRIER FERMENTATION
TECHNOLOGY
HEPATITIS-B VACCINE
R- DNA BASED YEAST/CHO CELL TECHNOLOGY
NEW PERTUSSIS VACCINE
MONO COMPONENT - TOXOID VACCINE (SUB UNIT VACCINE)
OR TWO COMPONENT - TOXOID AND FILAMENTOUS
HAEMAGLUTININ VACCINE (SUB UNIT VACCINE)
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PRODUCTION OF VACCINE - INDUSTRIAL PROJECT
STAGE - I
-
Live attenuated measles vaccine
25 Million doses
-
Oral Polio vaccine
100 Million doses
Killed polio vaccine
50 Million doses
Tissue culture rabies vaccine
5 Million doses
-
STAGE - II
—
R-DNA Hepatitis-B Vaccine
2 Million doses
-
Acellular pertussis vaccine
50-80 Million doses
EXPECTED DATES OF BULK INDIGENOUS PRODUCTION OF VACCINES
Measles vaccine
April 1989
Polio vaccine
January 1990
Rabies vaccine
January 1990
Hepatitis-B vaccine
December 1990 or soon thereafter.
New Pertussis vaccine
December 1990 or soon thereafter.
CAPACITY EXPANSION IN EXISTING UNITS
VACCINE
DPT
TETANUS
TOXOID
BCG
INSTITUTE
PRODUCTION
85-86
PLANNED
CAPACITY
89-90
%
EXPANSION
CRI, KASAULI
PI, COONOOR
HPCL, BOMBAY
13
9
6
20
15
10
54
67
67
TOTAL
28
45
61
CRI, KASAULI
PI, COONOOR
HBPCL, BOMBAY
22
6
8
22
10
14
—
67
75
TOTAL
36
46
21
BCG VACCINE
LABORATORY
MADRAS
16
22
27
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PROGRESS MADE
Two technical expert committees studied the vaccine requirements, state of the
art of technologies for vaccine production and recommended urgent steps to sqt
up indigenous RSD cum production facilities through transfer of most advanced
and appropriate technologies for:
-
Hyper attenuated measles vaccine
Injectible polio vaccine (Vero)
Inactivated tissue culture rabies vaccine 5
R-DNA Hepatitis - B vaccine.
An inter-ministerial negotiating committee finalised the technologies and terms and
conditions of transfer of technologies for, measles, rabies and polio vaccines.
Evaluation of technologies for hepatitis-B vaccines, oral polio vaccine and new
pertussis vaccines are in progress.
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SUB-MISSION - JI
R&D FOR NEW AND IMPROVED VACCINES
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SELECTED DISEASES FOR VACCINE R£D
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a)
Urban rabies with special reference to oral vaccine baits for canine rabies
control.
b)
Diarrhoeal diseases : Cholera, Shigellosis, Rotaviral diarrhoea, Salmonellosis.
c)
Typhoid
d)
Hepatitis-B
e)
hepatitis-N ANB
f)
Malaria and
g)
Pneumonia
OBJECTIVES
To set up, promote, undertake and monitor highly competitive R&D activities in
vaccinology with a view to develop new process technologies for new or improved
vaccines and vaccine cock tails such as:
R6Djprototype development and field evaluation of oral vaccines against cholera,
typhoid etc.
Development of stable and environmentally safe vaccine baits for canine rabies
control in India.
Epidemiological and etiological studies as well as vaccine development and
validation against hepatitis NANB and streptococeal pheumonia. 1
R8D and evaluation of new sub unit vaccines such R-DNA based and synthetic
vaccines»
Development of polyvalent vaccines and vaccine 'cock tails'.
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RABIES - PROJECTS AND INSTITUTIONS IDENTIFIED
Development of mass immunizing agents against canine rabies in India
- urban and rural.
Analytical typing and survey of street virus prevalence in India.
Studies on the substitution of the reactogenic equine hyperimmune
serum with other safer agents (interferon inducers)
Pasteur Institute, Coonoor.
National Institute of Virology, Pune.
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HEPATITIS: PROJECTS AND INSTITUTIONS IDENTIFIED
Study of the duration of efficacy 6 safety of genetically engineered
yeast vaccine as compared to plasma derived vaccine.
All India Institute of Medical Sciences, New Delhi.
National Institute of Virology, Pune.
Development of new recombinant vaccines for immunization against
viral hepatitis-B, rabies and malaria.
National Institute of Immunology, New Delhi.
Identification and characterisation of virus particle/particles causing
NANB hepatitis-detection of humoral immune responses, and development
of reagents and tests for specific diagnosis of NANB hepatitis.
All India Institute of Medical Sciences, New Delhi.
National Institute of Virology, Pune.
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PERTUSSIS AND OTHERS
R5D cum production, standardisation and quality control of acellular
pertussis vaccine in India.
Central Research Institute, Kasauli.
Pasteur Institute, Coonoor.
♦
Development of an evaluation unit at AIIMS for vaccines used in
children.
All India Institute of Medical Sciences, New Delhi.
DIARRHOEAL DISEASES (CONTD..)
Development of new vaccines against S. typhi.
All India Institute of Medical Sciences, New Delhi.
Studies on the development of an attenuated cholera vaccine.
Banaras Hindu University, Varanasi.
Studies on development of an effective vaccine against
shigellosis caused by Shigella dysenteriae.
National Institute of Cholera and Enteric Diseases, Calcutta.
DIARRHOEAL DISEASES: PROJECTS AND INSTITUTIONS IDENTIFIED
Study of rota viral infection and development of vaccines against
rota viral diarrhoea.
National Institute of Cholera and Enteric Diseases, Calcutta,
Director General of Health Services, Manipur.
Development of improved cholera vaccine (adhensive factor)
Central Drug Research Institute, Lucknow.
Jawaharlal Nehru University, New Delhi.
Research and Development of diagnostics and vaccine against
diarrhoegenic E .coli.
National Institute of Cholera and Enteric Diseases.
Improved diagnostic facilities for diarrhoeal diseases through
DNA probes.
National Cholera and Enteric Diseases, Calcutta.
Banaras Hindu University, Varanasi.
NOTES
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