Immunization In Practice
Participant Manual
Ministry of Health
September, 2023
,Table of Contents
Acknowledgement v
Preface viii
Acronyms x
Introduction to the manual xii
Chapter 1: Introduction to vaccines preventable diseases and their vaccines 1
1.1. Vaccine preventable diseases and its characteristics 3
1.2. Vaccine types and their characteristics 9
1.2.1. Routinely provided vaccines in Ethiopia 9
1.2.2. Vaccines provided for emergency or outbreak response in Ethiopia and potential to be routinized 19
1.2.3. Vaccine not introduced and in pipeline. 23
1.3. Chapter Summary 28
Chapter 2: Vaccine and Cold Chain Management 29
2.1. Introduction to Vaccine and Cold Chain Management 31
2.2. Forecasting vaccines and related supplies 31
2.2.1. Methods of Vaccines and Related Supply Forecasting 31
2.2.2. Forecasting vaccines and supplies for Special conditions: 39
2.3. Vaccines stock management 40
2.3.1. Stock level at Health Facility 40
2.3.2. Ordering/Requesting Vaccines and related supplies 43
2.3.3. Receiving Vaccines & related supplies at Health Facility levels 46
2.3.4. EPI vaccines and injection materials stock recording book (Ledger Book) 47
2.3.5. Vaccine distribution to EPI Room & Health Post 50
2.4. Monitoring Vaccine Wastage 51
2.4.1. Vaccine wastage calculations at health facility level: 53
2.4.2. Multi-dose Vial Policy (MDVP) 54
2.5. Cold chain equipment and management 55
2.5.1. Introduction: the cold chain system 55
2.5.2. Types of Cold Chain Equipment 56
2.5.3. Cold chain management 64
2.6. Temperature Monitoring 70
2.6.1. Temperature sensitivity of Vaccine 70
2.6.2. Temperature monitoring devices 72
2.6.3. Monitoring vaccine refrigerator temperature 75
2.6.4. The Shake Test 80
2.7. Basic maintenance of cold chain equipment 84
i
, 2.7.1. Defrosting vaccine refrigerators 84
2.7.2. Applying preventive maintenance of solar powered refrigerators 85
2.7.3. Cold chain Contingency Plan 86
2.7.4. Cold chain equipment Inventory: 89
2.8. Chapter summary 91
Chapter Three: Demand Promotion and Risk/Crisis communication 93
3.1. Basics of Communication 95
3.1.1. Communication 95
3.1.2. Effective communication 95
3.1.3. Why is effective communication important? 95
3.1.4. Principles of effective communication contain five C’s: 95
3.1.5. Terminologies/Operational definitions 96
3.2. Communication gaps and barriers in immunization 96
3.3. Demand Promotion and Communication Strategies and Approaches 97
3.3.1. Demand promotion strategies 97
3.3.2. Demand promotion approaches 101
3.4. Risk and Crisis communication 111
3.4.1. Risk communication 111
3.4.2. Crisis communication: 111
3.4.3. Crisis management in Immunization 111
3.4.4. Role of Health Care workers during immunization crisis 113
3.4.5. Monitor the impact of the crisis management 113
3.4.6. Crisis management checklist 109
3.5. Chapter summary 114
Chapter Four: Planning and coordination 115
4.1. Immunization program coordination mechanism 117
4.2. Micro-plan development process 118
4.2.1.a Catchment Area mapping 122
4.2.1.b Targeting Setting 124
4.2.2. Problem Analysis and Prioritization 124
4.2.3. Analysis of PHCU catchment area immunization data 127
4.2.4. Identifying barriers to access and utilization 129
4.2.5. Identifying solutions and preparing a work plan 129
4.3. Immunization Session Plan Preparation 130
4.4. Chapter Summary 137
Chapter Five: Injection safety and waste Management 138
5.1. Safe injection practice 140
ii
, 5.1.1. Measures to ensure injection safety. 141
5.1.2. Preventing needle-stick injuries. 142
5.2. Waste management Practices 143
5.2.1. Introduction of waste management practices 143
5.2.2. Health-care waste categories and risks 143
5.2.3. Segregation and collection of waste 144
5.2.4. Waste Transport within health-care facilities 145
5.2.5. Waste storage requirements 145
5.2.6. Waste Disposal options 145
5.3. Chapter summary 147
Chapter Six: Immunization service delivery 148
6.1. Immunization service delivery strategies 150
6.2. Preparing for immunization session 153
6.2.1. Plan the immunization session 153
6.2.2. Preparing for immunization session 153
6.2.3. Prepare the session site 153
6.2.4. Prepare vaccines and injection supplies basic list including prepare supplementary materials and
154
equipment
6.3. Communicating accurate information 158
6.4. Assessing infants/targets for vaccination 159
6.4.1. Assessing eligible for vaccination & assess possible contraindications 159
6.5. Administering the vaccines 161
6.5.1. Preparing to vaccinate 164
6.5.2. Reconstituting vaccines 164
6.5.3. Making vaccination easier and more comfortable; 165
6.5.4. Good general technique 166
6.5.5. Positioning the infant for vaccination 166
6.5.6. Administering the vaccine & Video Session 167
6.6. Recording data 172
6.7. Closing the session 172
6.8. Chapter summary 177
Chapter Seven: Vaccine Preventable Diseases and AEFI Surveillance 179
7.1. Vaccine preventable Disease surveillance 181
7.1.1. Concept of VPD Surveillance 181
7.1.2. Case definitions of VPDs 182
7.1.3. Function/Steps of VPD Surveillance 184
7.2. Adverse event following immunization 188
iii
Participant Manual
Ministry of Health
September, 2023
,Table of Contents
Acknowledgement v
Preface viii
Acronyms x
Introduction to the manual xii
Chapter 1: Introduction to vaccines preventable diseases and their vaccines 1
1.1. Vaccine preventable diseases and its characteristics 3
1.2. Vaccine types and their characteristics 9
1.2.1. Routinely provided vaccines in Ethiopia 9
1.2.2. Vaccines provided for emergency or outbreak response in Ethiopia and potential to be routinized 19
1.2.3. Vaccine not introduced and in pipeline. 23
1.3. Chapter Summary 28
Chapter 2: Vaccine and Cold Chain Management 29
2.1. Introduction to Vaccine and Cold Chain Management 31
2.2. Forecasting vaccines and related supplies 31
2.2.1. Methods of Vaccines and Related Supply Forecasting 31
2.2.2. Forecasting vaccines and supplies for Special conditions: 39
2.3. Vaccines stock management 40
2.3.1. Stock level at Health Facility 40
2.3.2. Ordering/Requesting Vaccines and related supplies 43
2.3.3. Receiving Vaccines & related supplies at Health Facility levels 46
2.3.4. EPI vaccines and injection materials stock recording book (Ledger Book) 47
2.3.5. Vaccine distribution to EPI Room & Health Post 50
2.4. Monitoring Vaccine Wastage 51
2.4.1. Vaccine wastage calculations at health facility level: 53
2.4.2. Multi-dose Vial Policy (MDVP) 54
2.5. Cold chain equipment and management 55
2.5.1. Introduction: the cold chain system 55
2.5.2. Types of Cold Chain Equipment 56
2.5.3. Cold chain management 64
2.6. Temperature Monitoring 70
2.6.1. Temperature sensitivity of Vaccine 70
2.6.2. Temperature monitoring devices 72
2.6.3. Monitoring vaccine refrigerator temperature 75
2.6.4. The Shake Test 80
2.7. Basic maintenance of cold chain equipment 84
i
, 2.7.1. Defrosting vaccine refrigerators 84
2.7.2. Applying preventive maintenance of solar powered refrigerators 85
2.7.3. Cold chain Contingency Plan 86
2.7.4. Cold chain equipment Inventory: 89
2.8. Chapter summary 91
Chapter Three: Demand Promotion and Risk/Crisis communication 93
3.1. Basics of Communication 95
3.1.1. Communication 95
3.1.2. Effective communication 95
3.1.3. Why is effective communication important? 95
3.1.4. Principles of effective communication contain five C’s: 95
3.1.5. Terminologies/Operational definitions 96
3.2. Communication gaps and barriers in immunization 96
3.3. Demand Promotion and Communication Strategies and Approaches 97
3.3.1. Demand promotion strategies 97
3.3.2. Demand promotion approaches 101
3.4. Risk and Crisis communication 111
3.4.1. Risk communication 111
3.4.2. Crisis communication: 111
3.4.3. Crisis management in Immunization 111
3.4.4. Role of Health Care workers during immunization crisis 113
3.4.5. Monitor the impact of the crisis management 113
3.4.6. Crisis management checklist 109
3.5. Chapter summary 114
Chapter Four: Planning and coordination 115
4.1. Immunization program coordination mechanism 117
4.2. Micro-plan development process 118
4.2.1.a Catchment Area mapping 122
4.2.1.b Targeting Setting 124
4.2.2. Problem Analysis and Prioritization 124
4.2.3. Analysis of PHCU catchment area immunization data 127
4.2.4. Identifying barriers to access and utilization 129
4.2.5. Identifying solutions and preparing a work plan 129
4.3. Immunization Session Plan Preparation 130
4.4. Chapter Summary 137
Chapter Five: Injection safety and waste Management 138
5.1. Safe injection practice 140
ii
, 5.1.1. Measures to ensure injection safety. 141
5.1.2. Preventing needle-stick injuries. 142
5.2. Waste management Practices 143
5.2.1. Introduction of waste management practices 143
5.2.2. Health-care waste categories and risks 143
5.2.3. Segregation and collection of waste 144
5.2.4. Waste Transport within health-care facilities 145
5.2.5. Waste storage requirements 145
5.2.6. Waste Disposal options 145
5.3. Chapter summary 147
Chapter Six: Immunization service delivery 148
6.1. Immunization service delivery strategies 150
6.2. Preparing for immunization session 153
6.2.1. Plan the immunization session 153
6.2.2. Preparing for immunization session 153
6.2.3. Prepare the session site 153
6.2.4. Prepare vaccines and injection supplies basic list including prepare supplementary materials and
154
equipment
6.3. Communicating accurate information 158
6.4. Assessing infants/targets for vaccination 159
6.4.1. Assessing eligible for vaccination & assess possible contraindications 159
6.5. Administering the vaccines 161
6.5.1. Preparing to vaccinate 164
6.5.2. Reconstituting vaccines 164
6.5.3. Making vaccination easier and more comfortable; 165
6.5.4. Good general technique 166
6.5.5. Positioning the infant for vaccination 166
6.5.6. Administering the vaccine & Video Session 167
6.6. Recording data 172
6.7. Closing the session 172
6.8. Chapter summary 177
Chapter Seven: Vaccine Preventable Diseases and AEFI Surveillance 179
7.1. Vaccine preventable Disease surveillance 181
7.1.1. Concept of VPD Surveillance 181
7.1.2. Case definitions of VPDs 182
7.1.3. Function/Steps of VPD Surveillance 184
7.2. Adverse event following immunization 188
iii
