ROUTINE IMMUNIZATION IN INDIA

Routine Immunization Programme

• Immunization Programme is one of the key interventions for protection of children from life threatening conditions, which are preventable. It is one of the largest immunization programme in the world and a major public health intervention in the country.
• Immunization Programme in India was introduced in 1978 as Expanded Programme of Immunization (EPI)
• The programme gained momentum in 1985 and was expanded as Universal Immunization Programme (UIP) to be implemented in phased manner to cover all districts in the country by 1989-90.
• UIP become a part of Child Survival and Safe Motherhood Programme in 1992 Since, 1997, immunization activities have been an important component of National Reproductive and Child Health Programme and is currently one of the key areas under National Rural Health Mission (NHM) since 2005
• Under the Universal Immunization Programme, Government of India is providing vaccination to prevent seven vaccine preventable diseases i.e.
  • Diphtheria, Pertussis, Tetanus, Polio, Measles, severe form of Childhood Tuberculosis and Hepatitis B
• The vaccination schedule under the UIP is:
  • BCG (Bacillus Calmette Guerin) 1 dose at Birth (upto 1 year if not given earlier)
  • DPT (Diphtheria, Pertussis and Tetanus Toxoid) 5 doses; Three primary doses at 6,10,14 weeks and two booster doses at 16-24 months & 5 Years of age
  • OPV (Oral Polio Vaccine) 5 doses; 0 dose at birth, three primary doses at 6,10 and 14 weeks and one booster dose at 16-24 months of age
  • Hepatitis B vaccine 4 doses; 0 dose within 24 hours of birth and three doses at 6, 10 and 14 weeks of age.
  • Measles 2 doses; first dose at 9-12 months and second dose at 16-24months of age
  • TT (Tetanus Toxoid) 2 doses at 10 years and 16 years of age
  • TT – for pregnant woman two doses or one dose if previously vaccinated within 3 Year
• In addition, Japanese Encephalitis (JE vaccine) vaccine was introduced in 112 endemic districts in campaign mode in phased manner from 2006-10 and has now been incorporated under the Routine Immunization Programme
• ~26 million new born are targeted for vaccination each year through ~9 million immunization session held annually
• There are ~25,000 cold chain points in the country to store vaccine under required temperature
• The Full Immunization coverage as assessed by various surreys are as below:

  Source	Coverage Evaluation Survey (CES)	District Level Household Survey (DLHS)
  Time Period	2009	DLHS 3 (2007-08)
  Full Immunization	61.0	53.5
  BCG	86.9	86.7
  OPV3	70.4	65.6
  DPT3	71.5	63.4
  Measles	74.1	69.1
  No Immunization	7.6	4.6

  (Figures are in %)
• The total financial outlay for Routine Immunization Programme for 2011-12 was Rs 631.6 crore. This includes cost for vaccine, syringes, cold chain and operational cost provided to the sates/UTs under PIP.

The Universal Immunization Programme is possibly the longest and one of the biggest public health intervention measures undertaken in India. To improve immunization coverage in the country various initiatives have been undertaken since the inception of the programme in 1985; key inputs being strengthening and expanding the cold chain system, establishing a network of outreach immunization sites, alternate vaccine delivery model, capacity building of health functionaries and medical officers and intensified polio control measures. Introduction of new and underutilized vaccines, drafting of the national vaccine policy, tracking of beneficiaries through the Maternal and Child Tracking system are some of the recent developments. However in spite of more than 25 years since inception the programme is still adversely impacted by challenges across key thematic areas of programme management, cold chain and vaccine management, recording and reporting and injection safety. To further strengthen and improve service delivery 2012-13 has been declared as the “Year of Intensification of Routine Immunization” with the objective of improving immunization coverage rates across poor performing districts and states so as to attain Global Immunization Vision and Strategy goals of 90% coverage at national and more than 80% coverage at district level. Key activities planned during the year include sustained advocacy at all levels, improved communication and social mobilization, robust and regular program reviews, comprehensive microplanning, strengthening cold chain and vaccine logistics system, special catch up rounds through immunization weeks, piloting the teeka express, improved surveillance systems, strengthened partnerships and operational research activities. The current review pertains to the existing scenario of Universal Immunization Program in the country with impetus on the existing challenges, progress achieved till date as a result of various measures and initiatives undertaken and activities lined up as a part of year of intensification of Routine Immunization.

Source- 

http://nrhm.gov.in/nrhm-components/rmnch-a/child-health-immunization/immunization/background.html

http://www.iapsmupuk.org/journal/index.php/IJCH/article/view/247

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