IMMUNIZATION, EXPANDED PROGRAM ON IMMUNIZATION AND COLD CHAIN

INTRODUCTION
An immunization program, also known as a vaccination program, is a public health initiative designed to protect individuals from infectious
diseases by administering vaccines. These programs aim to reduce the incidence and severity of vaccine-preventable diseases, ultimately
improving overall population health. India's Universal Immunization Programme (UIP) is one of the world's largest public health programs,
providing free vaccinations against 12 vaccine-preventable diseases. Immunization programs are essential public health interventions aimed at
protecting individuals, especially children, from vaccine-preventable diseases. These programs are a cornerstone of global health efforts,
contributing to reduced mortality and morbidity. The goal is to achieve high vaccination coverage and eliminate or control targeted diseases.

DEFINITION
According to the World Health Organization (WHO), immunization is the process of making a person resistant to a disease, typically
through the administration of a vaccine. Vaccines stimulate the body's immune system to protect against future infection or disease,
potentially preventing diseases, disabilities, and deaths from vaccine-preventable diseases .(VPDs)
 According to national health mission Full immunization, in the context of childhood vaccines, generally means a child has received all the
recommended doses of vaccines according to the national immunization schedule within the first year of life.

OBJECTIVE
Reduce Mortality and Morbidity:
The core objective is to protect children and pregnant women from vaccine-preventable diseases like measles, polio, tetanus, etc., by
ensuring they receive timely and complete vaccinations.
 Achieve High Immunization Coverage:
The program strives to achieve and maintain high immunization coverage rates, ideally 90% or more, to establish herd immunity and
interrupt disease transmission.
 Expand Vaccine Coverage:
UIP continually works to introduce new vaccines as they become available and are deemed necessary, expanding the list of preventable
diseases covered.
 Ensure Vaccine Safety and Quality:
This includes maintaining a robust cold chain system to ensure vaccines are stored and transported at the correct temperature, as well as
proper administration practices.
 Strengthen Disease Surveillance:
Monitoring disease outbreaks and vaccine-preventable diseases is crucial to identify and respond to outbreaks promptly.
 Foster Community Trust:
Open communication, community engagement, and addressing any concerns about vaccines are essential for building trust and ensuring
high participation rates.
 Improve Service Quality:
UIP focuses on improving the quality of immunization services, including training healthcare professionals, enhancing logistics, and
strengthening infrastructure.
 Establish Reliable Cold Chain:
A reliable cold chain system is vital for maintaining the potency of vaccines from the manufacturer to the point of use.
 Achieve Self-Sufficiency in Vaccine Production:
Efforts are made to increase domestic vaccine production to ensure a reliable and sustainable supply.
 Eradicate Polio and Eliminate Neonatal Tetanus:
 Specific goals like polio eradication and elimination of neonatal tetanus are key components of the UIP.

TYPES OF IMMUNIZING AGENT

 1. Vaccines:
These are designed to trigger the body's immune system to produce antibodies against a specific disease-causing agent (pathogen). Vaccines
can be:
 Live, attenuated vaccines : Contain weakened versions of the pathogen (e.g., measles, mumps, rubella vaccine).
 Inactivated vaccines: Contain killed pathogens (e.g., inactivated polio vaccine, influenza vaccine).
 Subunit vaccines: Contain specific parts of the pathogen (e.g., pertussis vaccine).
 Toxoid vaccines: Use inactivated toxins produced by bacteria (e.g., tetanus and diphtheria toxoids).
 mRNA vaccines: Contain messenger RNA that instructs cells to produce a specific viral protein to trigger an immune response (e.g., COVID-
19 vaccines).
 Viral vector vaccines: Use a modified harmless virus to deliver genetic material from the target pathogen.
Immunoglobulins (antibodies):
These provide temporary, passive immunity by directly injecting antibodies (e.g., normal human immunoglobulin, specific
immunoglobulins for diseases like rabies ).
Antisera:
These are derived from animals or humans that have been previously exposed to a pathogen and contain antibodies against it. They offer a
short-term, passive immunity (e.g., tetanus antitoxin).
Active vs. Passive Immunity:
 Active immunity:
Developed by the body's own immune system in response to exposure to an antigen (e.g., through vaccination ong-lasting protectionr natural
infection). It provides lo.
 Passive immunity:
Acquired by receiving pre-formed antibodies (e.g., from mother to child, or through injection of immunoglobulins or antisera). It provides
immediate, but short-lived, protection.

NATIONAL IMMUNIZATION SCHEDULE

The National Immunization Schedule in India provides a framework for vaccinating infants, children, and pregnant women against
preventable diseases. It's part of the Universal Immunization Programme (UIP), a government initiative aimed at protecting children from
vaccine-preventable diseases. The schedule outlines the recommended vaccines, dosage, route, and timing for each dose.

Key components of the National Immunization Schedule:

 Vaccines:
The schedule includes vaccines against diseases like polio, diphtheria, pertussis, tetanus, measles, rubella, tuberculosis, hepatitis B, rotavirus
diarrhea, meningitis, and pneumonia caused by Hemophilus influenzae type B.
 Age-based schedule:
The schedule specifies when each vaccine should be administered, starting from birth to adulthood.
 Route of administration:
Vaccines are administered through various routes, including oral, intramuscular, and subcutaneous injections.
 Free vaccines:
Under the UIP, all vaccines included in the schedule are provided free of cost to children and pregnant women.
 Selected districts/states:
Certain vaccines like Rotavirus and PCV may be available in selected states or districts as per specific program guidelines.
 Pregnant women:
The schedule also includes vaccination recommendations for pregnant women, such as tetanus toxoid (TT0 )

National Immunization Schedule

The following schedule has been recommended by the Ministry of Health and Family Welfare, Govt. of India and is one of the most widely followed by the child health care providers.
Maximum
Vaccine When to give Dose Route Site
age

For Pregnant Women

Tetanus & adult Diphtheria Upper

early pregnancy -- 0.5ml intra muscular
(Td -1) arm

Tetanus & adult Diphtheria (Td 4 weeks after Upper

-- 0.5ml intra muscular
-2) 1st dose of Td* arm

If received 2 Td
doses in a
Tetanus & adult Diphtheria (Td Upper
pregnancy -- 0.5ml intra muscular
booster) arm
within the last
3yrs
 For Infants

At birth or as
0.1ml (0.05ml Left
BCG (Bacillus Calmette early as At birth till
until 1month Intra-dermal
Guerin) possible till 1 one year Upper
age)
year of age Arm

At birth or as Antero-
At birth
early as lateral
Hepatitis B - Birth dose within 24 0.5 ml Intra-muscular
possible within side of
hours
24 hours mid-thigh

At birth or as
Within the
early as
Oral Polio Vaccine (OPV) -0 first 15 2 drops Oral Oral
possible within
days
first 15 days

6 weeks, 10
Oral Polio Vaccine (OPV) - Till 5 years
weeks & 14 2 drops Oral Oral
1,2,3, of age
weeks

Right
Inactivated Polio Vaccine (IPV) 6 weeks & 14 1 year of
0.1 ml Intra-dermal Upper
1&2 weeks age
arm

Antero-
Pentavalent vaccine 6 weeks, 10
1 year of lateral
(Diphteria, Pertussis, Tetanus, weeks & 14 0.5 ml Intra-muscular
age side of
Hepatitis B, Hib)- 1, 2 & 3 weeks
mid-thigh

At 6 weeks, 10 5 drops
Rotavirus Vaccine (RVV) 1, 2 1 year of
weeks & 14 (lyophilized Oral Oral
&3 age
weeks vaccine)

Antero-
At 6 weeks, 14
Pneumococcal Conjugate 1 year of lateral
weeks & 9 0.5 ml Intra-muscular
Vaccine (PCV) 1, 2 & Booster age side of
months
mid-thigh

9 completed
months - to 12
months. Give 5 years of Right
Measles-Rubella (MR) 1 0.5 ml Sub-cutaneous
up to 5yrs if not age upper arm
received at 9 -
12 months age

At 9 completed 5 years of 1ml (1lakh

Vitamin A (1st dose) Oral Oral
months age IU)

Left upper
Subcutaneous arm
At 9 completed
Japanese Encephalitis (1st 15 years of (live vaccine) Antero-
months - 12 0.5 ml
Dose)*** age Intramuscular lateral
months
(killed) side of
mid thigh

For Children and adolescents

 Antero-
Diphtheria Pertussis Tetanus 7 years of lateral
16- 24 months 0. 5 ml Intra- muscular
(DPT) booster 1 age side of
mid-thigh

Right
5 years of
MR 2 16-24 months 0.5 ml Sub-cutaneous Upper
age
arm

5 years of
OPV Booster 16-24 months 2 drops Oral Oral
age

Left
Japanese Encephalitis***(if 15 years of
16-24 months 0.5 ml Sub-cutaneous Upper
applicable) age
Arm

18 months (2nd
dose). Then,
one dose every 5 years of 2 ml (2 lakh
Vitamin A***(2nd to 9th dose) Oral Oral
6 months upto age IU)
the age of 5
years.

Diphtheria Pertussis Tetanus 7 years of Upper

5- 6 years 0.5 ml Intra-muscular
Booster (DPT) booster 2 age arm

10 years &16 16 years of

Tetanus & adult Diphtheria 0.5 ml Intra-muscular Upper
years age

CONTRAINDICATION OF VACCINNATION
General contraindications for vaccination include severe allergic reactions (anaphylaxis) to a previous vaccine dose or its
components, severe immunodeficiency, and moderate to severe acute illness with or without fever. Live vaccines are generally
contraindicated in severely immunocompromised individuals. Pregnancy is also a contraindication for some live vaccines.

1. Anaphylaxis:
 A severe, potentially life-threatening allergic reaction (anaphylaxis) to a previous dose of a vaccine or any of its components is a
contraindication for receiving that specific vaccine again.
 This is usually due to a component of the vaccine, such as gelatin or neomycin, and can include components used in the manufacturing
process.
2. Immunocompromised Individuals:
 Individuals with severe immunodeficiency, including those with hematologic or solid tumors, AIDS, symptomatic HIV, or those receiving
high-dose immunosuppressive therapy, should not receive live vaccines due to the risk of unchecked infection.
 Live vaccines are attenuated, meaning they contain a weakened version of the virus or bacteria.
 Examples of live vaccines include measles, mumps, rubella (MMR), varicella, and zoster.
 3. Pregnancy:
 In general, women who are pregnant should not receive live vaccines due to the theoretical risk to the fetus.
 However, if the risk of exposure to a disease is significant, the benefits of vaccination may outweigh the potential risks.
 For example, in certain situations, pregnant women may be vaccinated against poliomyelitis.
4. Moderate to Severe Acute Illness:
 Vaccination should be postponed for individuals with moderate to severe acute illnesses, with or without fever.
 This is to avoid masking or confusing the symptoms of the illness with vaccine side effects.
5. Other Considerations:
 A history of intussusception (a type of bowel obstruction) is a contraindication for rotavirus vaccines.
 Encephalopathy (brain disease) occurring within 7 days of a pertussis-containing vaccine, not attributable to another cause, is a
contraindication for further pertussis-containing vaccines.
 Individuals with a family history of congenital or hereditary immunodeficiency should be evaluated to determine if they can safely receive
vaccinations.
 Some precautions, like administering measles vaccine to someone with passive immunity from a blood transfusion, may warrant delaying
vaccination.
6. Precautions:
 Precautions are conditions that might increase the risk of a reaction or interfere with the vaccine's effectiveness, but not to the same degree as
a contraindication.
 For example, administering a measles vaccine to someone with passive immunity from a blood transfusion may be a precaution.
 Vaccination should be deferred when a precaution is present.

REACTION OF VACCINE

Common Reactions:
 Injection Site Reactions: Pain, redness, swelling, or itching at the injection site are the most common reactions and typically resolve within a
few days.
 Mild Fever: A low-grade fever (below 102°F or 38.9°C) can occur, usually within 24-48 hours of vaccination.
 Other Symptoms: Fatigue, headache, muscle aches, and chills are also possible.
Serious Reactions (Rare):
 Severe Allergic Reactions (Anaphylaxis): This is a very rare but potentially life-threatening reaction that can include difficulty breathing,
swelling of the face and throat, a fast heartbeat, a rash, and dizziness.
 Other Serious Events: These can include seizures, prolonged crying (in infants), or fainting.
 Managing Reactions:
 Injection Site:
Apply a cool compress to the injection site, and consider over-the-counter pain relievers if needed.
 Fever:
Ensure adequate hydration, dress lightly, and consider fever-reducing medication as directed by a healthcare professional.
 Severe Reactions:
Seek immediate medical attention if you experience symptoms of a severe allergic reaction.
Important Considerations:
 Vaccines are very safe, and the benefits of vaccination far outweigh the risks of side effects.
 Vaccine side effects are usually mild and short-lived.
 If you have concerns about potential reactions, talk to your healthcare provider.
 It's important to report any serious adverse events following immunization to the appropriate authorities

EXPANDED PROGRAM ON IMMUNIZATION/UNIVERSAL IMMUNIZATION PROGRAMS

The Expanded Programme on Immunization (EPI), now known as the Universal Immunization Programme (UIP), is a global initiative aimed
at providing free vaccines to children and pregnant women against vaccine-preventable diseases. Initially launched by the World Health
Organization (WHO) in 1974, it evolved into the UIP in India in 1985, expanding its reach beyond urban areas. Since the launch of the
programme, the implementation of immunization activities has been carried out by the provinces themselves. The role of federal cell was only
restricted to the provision of policy and technical guidelines, coordination for international assistance, surveillance and monitoring.
Additionally, the programme also facilitated provincial health departments by procurement and supply of requisite vaccines and other
logistics. In pursuance of 18th Constitutional Amendment, Ministry of Health was abolished and vertical Programmes including EPI were
devolved to provinces. However, the Council of Common Interests (CCI) in its meeting held on 28th April 2011 inter-alia decided that the
Federal Government will continue to finance these programmes till the next National Finance Commission (NFC) award. Accordingly, the
federal EPI cell continues to be financially supported through the federal PSDP regularly at the 2010-11 levels. The resources provided
therein are primarily used to procure and supply the vaccines, syringes, safety boxes and other logistics needed by the provincial and areas to
vaccinate their target populations. Nevertheless, the provinces and areas through respective EPI programme units are themselves responsible
to manage the operational cost of the immunization activities at the provincial and district levels.
 KEY ASPECTS OF EPI/UIP
Global Initiative:
EPI was launched by WHO to ensure all children had access to life-saving vaccines.
 National Program:
In India, it was initially named the Expanded Programme on Immunization (EPI) and later became the Universal Immunization Programme
(UIP).
 Target Population:
The program focuses on protecting children and pregnant women against vaccine-preventable diseases.
 Free Vaccines:
UIP provides free vaccination against 12 vaccine-preventable diseases in India, including Diphtheria, Pertussis, Tetanus, Polio, Measles,
Rubella, severe form of Childhood Tuberculosis, Hepatitis B, Meningitis & Pneumonia caused by Hemophilus Influenza type B.
 Cost-Effectiveness:
Immunization is recognized as one of the most cost-effective public health interventions.
 Part of Larger Programs:
In India, UIP is an integral part of the National Rural Health Mission (NRHM) since 2005.
 Disease Reduction:
The program has significantly contributed to reducing the mortality rate from vaccine-preventable diseases.
 Global Impact:
EPI has played a crucial role in saving lives and improving health worldwide.

Targeted 9 Vaccine Preventable Diseases

 Poliomyelitis
 Neonatal Tetanus
 Measles
 Diphtheria
 Pertussis (Whooping Cough)
 Hepatitis-B
 Hib Pneumonia
 Meningitis
  Childhood Tuberculosis


OBJECIVES OF EPI

1. Disease Prevention: To significantly reduce the incidence of vaccine-preventable diseases such as measles, polio, diphtheria, tetanus,
pertussis, hepatitis B, and Haemophilus influenzae type b (Hib).
2. Universal Vaccination Access: To ensure that all children, regardless of their socio-economic status, geographic location, or other barriers,
have access to essential vaccines.
3. Increase Coverage Rates: To achieve high vaccination coverage rates, typically aiming for at least 90% coverage in target populations,
which is essential for the effectiveness of herd immunity.
4. Strengthen Health Systems: To enhance the capacity and infrastructure of healthcare systems to deliver immunization services effectively,
including training healthcare workers and improving supply chains for vaccines.
5. Community Awareness and Education: To promote awareness and understanding of the benefits of vaccination among communities,
combating misinformation, and encouraging parents to immunize their children.
6. Monitor and Evaluate Immunization Programs: To implement systems for monitoring vaccine uptake and adverse events, assessing the
efficacy of vaccination strategies, and making data-driven decisions to improve Zthe program.
7. Integration with Other Health Services: To integrate immunization with other health initiatives, such as maternal and child health
programs, to promote comprehensive healthcare approaches.
8. Preparedness for Outbreaks: To enhance readiness and response to outbreaks of vaccine-preventable diseases, ensuring rapid vaccination
campaigns can be mobilized when needed.

COMPONENT OF EPI

 Vaccine Procurement and Supply:

This involves selecting appropriate vaccines, ensuring a reliable supply chain, and managing vaccine storage and distribution through a cold
chain system.
 Service Delivery:
This includes routine immunization services for infants, children, and women, as well as supplemental immunization activities like
campaigns to reach specific populations or geographic areas.
 Disease Surveillance:
Monitoring vaccine-preventable diseases is crucial to identify areas with low coverage, track disease outbreaks, and evaluate the impact of
the immunization program.
 Information, Education, and Communication (IEC):
Public awareness campaigns and community engagement are essential to promote vaccine acceptance and address vaccine hesitancy.
 Management and Training:
 Effective program management, including logistics, data collection, and training of healthcare workers, is vital for efficient and equitable
vaccine delivery.
 Monitoring and Evaluation:
Regular assessments of immunization coverage, disease surveillance data, and program performance help identify areas for improvement
and ensure program effectiveness.
 Vaccine Safety:
Implementing measures to ensure vaccine safety, including adverse event reporting and response, is a critical component of the EPI.
 Policy and Planning:
Developing clear policies, setting targets, and creating a framework for program implementation are essential for achieving desired
outcomes.
 Community Participation:
Engaging communities in the planning and implementation of immunization programs is vital for building trust and ensuring that services
are accessible and acceptable.

CONCEPT AND IMPORTANCE OF VACCINATION

Concept of Vaccination:
 Stimulating the Immune System:
Vaccines work by introducing antigens (components of a pathogen) to the immune system. This triggers the production of antibodies and
other immune responses, training the body to recognize and fight off the real pathogen if encountered later.
 Types of Vaccines:
Vaccines can contain weakened or inactive pathogens, parts of pathogens (like proteins), or even genetic material (like mRNA).
 Active vs. Passive Immunity:
Vaccination primarily induces active immunity, where the body produces its own antibodies and immune cells. In some cases, passive
immunity can also be conferred through vaccines that provide pre-formed antibodies.
 Individual Protection:
Vaccines reduce the risk of contracting the targeted disease, or lessen its severity if infection does occur.
 Herd Immunity:
When a large portion of the population is vaccinated, it can create herd immunity, protecting even those who cannot be vaccinated (e.g.,
infants, people with certain medical conditions).
Importance of Vaccination:
 Disease Prevention:
 Vaccines are a highly effective way to prevent a wide range of infectious diseases, many of which can be serious or even fatal.
 Public Health:
Widespread vaccination programs have led to the eradication or significant reduction of diseases like smallpox, polio, and measles.
 Reduced Healthcare Burden:
By preventing illness, vaccines reduce the number of doctor visits, hospitalizations, and overall healthcare costs.
 Community Protection:
Vaccination protects not only the individual but also those around them, especially vulnerable populations who may be more susceptible to
disease.
 Economic Benefits:
Healthy individuals are more productive, contributing to a stronger economy.
In essence, vaccination is a cornerstone of public health, offering a safe and effective way to protect individuals, communities, and future
generations from the devastating effects of infectious diseases

COLD CHAIN

A cold chain in vaccination refers to the system of storing and transporting vaccines at recommended temperatures, from the point of
manufacture to the point of administration. This is crucial because vaccines are sensitive to temperature fluctuations and can lose their
effectiveness if exposed to temperatures outside the recommended range. Maintaining the cold chain ensures that vaccines remain potent and
effective when administered to patients.

DEFINITION

A system of storing and transporting the vaccine, at a low temperature from the place of manufacture to the actual vaccination site is called
cold chain.

IMPORTANCE OF COLD CHAIN

1. Maintaining Vaccine Potency:
 Temperature Sensitivity:
Vaccines are biological products that are highly sensitive to temperature fluctuations. Exposure to temperatures outside the recommended
range, either too high or too low, can degrade the vaccine and reduce its ability to protect against disease.
 Irreversible Damage:
 Once a vaccine loses its potency due to improper temperature exposure, it cannot be restored. This means that vaccines that have been
compromised by the cold chain are essentially useless and can't provide protection.
2. Ensuring Effective Immunization:
 Preventing Vaccine Failure:
When vaccines are stored and transported correctly, they are more likely to be effective in stimulating an immune response in the body,
leading to successful immunization.
 Avoiding Disease Outbreaks:
If vaccines lose potency, it can lead to a higher risk of vaccine-preventable diseases, potentially causing outbreaks and jeopardizing public
health.
3. Critical Components of the Cold Chain:
 Refrigeration Equipment:
This includes refrigerators, freezers, and ice-lined refrigerators, which are essential for maintaining the required temperature range.
 Vaccine Carriers and Ice Packs:
These are used for transporting vaccines to immunization sites, ensuring they stay within the temperature range during transit.
 Temperature Monitoring:
Regular monitoring of temperature using thermometers and data loggers is crucial to identify and address any deviations from the
recommended range.
4. Importance in Different Settings:
 Global Immunization Programs:
The cold chain is particularly important in resource-limited settings where access to reliable electricity and transportation can be
challenging.
 Specific Vaccines:
Some vaccines are more sensitive to temperature fluctuations than others, requiring extra care in storage and handling. For example,
Hepatitis B vaccine is destroyed if frozen.
Disease Prevention:
Effective cold chain management is critical for protecting individuals and communities from vaccine-preventable diseases, reducing
morbidity and mortality.
 Cost-Effectiveness:
Maintaining the cold chain ensures that vaccines are not wasted due to improper storage, which can be a significant cost saving in the long
run.

COMPONENT OF COLD CHAIN

 1. EQUIPMENTE:
 Storage:
This includes various types of refrigeration units like walk-in coolers, walk-in freezers, ice-lined refrigerators, and deep freezers, as well as
cold boxes and vaccine carriers.
 Transportation:
This involves temperature-controlled vehicles, cold packs, and insulated containers for transporting vaccines.
2. TRAINED PERSONNEL:
 Vaccine and Cold Chain Handlers:
Individuals responsible for the proper storage, handling, and distribution of vaccines at each stage of the cold chain.
 Management:
Personnel trained in cold chain management procedures, including monitoring temperatures, maintaining equipment, and ensuring efficient
operations.
3. MANAGEMENT PROCEDURE:
 Stock Management:
Procedures for tracking and managing vaccine inventory, including expiry dates and stock rotation.
 Temperature Monitoring:
Regular monitoring of vaccine storage and transportation temperatures to ensure they remain within the recommended range.
 Equipment Maintenance:
Regular maintenance and servicing of cold chain equipment to prevent breakdowns and ensure optimal performance.
 Emergency Preparedness:
Protocols for handling power outages, equipment failures, and other emergencies that could compromise the cold chain .

TYPES OF EQUIPMENT

1.Active Cold Chain Equipment:

 Refrigerators:
Used for storing items at temperatures between 2°C and 8°C, often including ice-lined refrigerators for maintaining consistent temperatures
even during power outages.
 Freezers:
Used for storing items at lower temperatures, such as deep freezers for vaccines and laboratory freezers for scientific samples.
 Walk-in Cold Rooms & Freezers:
Large, temperature-controlled rooms for bulk storage of perishable goods, essential for larger operations like hospitals or distribution
centers.
 Refrigerated Vans & Trucks:
Vehicles equipped with refrigeration units to transport goods over long distances.
2.Passive Cold Chain Equipment:
 Cold Boxes:
Insulated containers designed to maintain temperature using ice packs or dry ice, used for short-term storage and transport.
 Vaccine Carriers:
Smaller, portable insulated containers specifically designed for carrying vaccines and diluents, often used during vaccination campaigns.
 Insulated Containers:
Various types of containers designed to maintain temperature, including those used for shipping goods long distances.
 Ice Packs & Dry Ice:
Cooling elements used to maintain temperature within passive containers.
3. Other Important Equipment:
 Temperature Monitoring Systems:
Devices that track and record temperatures throughout the cold chain, ensuring products remain within acceptable ranges.
 Vaccine Vial Monitors:
Labels that change color to indicate the cumulative heat exposure of a vaccine, indicating whether it is still viable.
 Loggers:
Devices that record temperature data over time, providing a history of temperature conditions during storage and transport

CONCLUSION
Maintaining a proper cold chain is crucial for effective immunization programs, as it ensures vaccines retain their potency from
manufacturing to administration. Cold chain management involves the storage and transportation of vaccines within a specific temperature
range, as temperatures outside this range can render vaccines ineffective. Therefore, a robust cold chain system, including equipment
maintenance, staff training, and reliable power supply, is essential for maximizing the benefits of immunization and protecting populations
from vaccine-preventable diseases.

BIBLIOGRAPHY
PARUL DUTTA “TEXT BOOK OF PEDIATRIC NURSING “ 4TH EDITION YR 2018 PAGE NO. 35-43.
2 .MOSBY “TEXT BOOK OF COMPREHENSIVE REVIEW OF NURSING 20TH EDITION, PUBLISHED BY ELSEVIER,YR 2013
PAGE NO 27,28,82-85.
3. MUTHUVENKAPPACHALAM SHRINIWASAN “ TEXT BOOK OF TARGET HIGH ,YR 2017,4TH EDITIIN,CBS PUBLISHER AND
DITRIBUTER ,PAGE NO. 571-572.
4. RIMPLE SHARMA “TEXT BOOK OF PEDIATRIC NURSING “4TH EDITION ,YR 2024,PAGE NO. 85-89.
NET REFFERENCE
5. https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
6. https://www.cdc.gov/vaccines/index.html
7. https://www.unicef.org/supply/cold-chainp
 SANDIPANI ACADEMY
PENDRI (MASTURY) BILASPUR (C.G.)
M. SC. NURSING IST YEAR

SUBJECT – CHILD HEALTH NURSING

SEMINAR ON
IMMUNIZATION, EXPANDED PROGRAM ON IMMUNIZATION AND COLD CHAIN

SUBMITTED TO SUBMITTED BY
MS. MAMTA VISHVAKARMA MRS. NAINCY JINIT
ASSOCIATE PROFESSOR M.SC. NURSING 1ST YEAR
 SANDIPANI ACADEMY
PENDRI (MASTURY) BILASPUR (C.G.)
M. SC. NURSING IST YEAR

SUBJECT – CHILD HEALTH NURSING

SEMINAR ON
MATERNAL HEALTH AND ITS INFLUENCE ON CHILD HEALTH ANTENATAL ASPECT
OF PREVENTIVE PEDIATRICS
 SUBMITTED TO SUBMITTED BY
MS. MAMTA VISHVAKARMA MRS. NAINCY JINIT
ASSOCIATE PROFESSOR M.SC. NURSING 1ST YEAR
 MATERNAL HEALTH AND ITS INFLUENCE ON CHILD HEALTH ANTENATAL ASPECT
OF PREVENTIVE PEDIATRICS

INTRODUCTION
1. Maternal health focuses on the well-being of women during pregnancy, childbirth, and the postpartum period. It encompasses a woman's
physical and mental health throughout these stages, aiming to ensure a healthy and positive experience for both mother and child. This
includes addressing potential health issues that can arise before, during, or after pregnancy, such as diabetes, high blood pressure, or
depression. It encompasses a broad range of factors that affect the well-being of mothers and their newborns. The significance of maternal
health extends beyond individual health, as it impacts family dynamics, community well-being, and population growth. Addressing maternal
health is crucial for reducing maternal and infant mortality and morbidity rates. Complications during pregnancy and childbirth can lead to
severe health issues for both mothers and their newborns. Addressing maternal health is crucial for reducing maternal and infant mortality and
morbidity rates. Complications during pregnancy and childbirth can lead to severe health issues for both mothers and their newborns.

DEFINITION