IMMUNIZATION

2024
Definition
• Fully immunized child: A fully immunized child by one year is one
who has received all the prescribed antigens and at least one Vitamin
A dose under the national immunization schedule before the first
birthday.
• Defaulter: Person who starts but fails to complete the immunization
schedule for which they are eligible.
• Zero dose children: Are children who have not received any vaccine in
the EPI schedule, captured in the program as children who are eligible
but have not received the first dose of diphtheria-tetanus-pertussis
containing vaccine (Penta 1).
Definition

• KEPI: Kenya Expanded Programme On Immunization

• VACCINES:. They are substances prepared from micro-organisms

(germs or viruses), which are live vaccines (weakened) or killed
vaccines. When vaccines are given to someone, he/she develops
immunity to particular diseases. A vaccine is made of an organism or
a toxin which is either killed or attenuated
Definition

• IMMUNIZATION: Immunization is the process of introducing weakened or

killed germs (vaccines) into the body, which increase body immunity to
protect one from a particular disease.
• its introduction of a vaccine into a person’s body to protect him or her
against a particular disease.

ATTENUATED: Its When a vaccine is introduced into one’s body, the immune
system is stimulated to produce antibodies that protect against future
infections or severe disease
Definition
• Fully immunized person: A fully immunized person (other than an infant)
refers to an individual who has received all the prescribed vaccine antigens
and doses for the age group or, is beyond the ‘window period of efficacy’ of
an antigen - where only one dose is required(e.g. 10 days after receiving
yellow fever vaccine).
• National Vaccine and Immunization Program: This is the Division within the
Ministry of Health responsible for the provision and coordination of
vaccination services in Kenya.
• Under Immunised Children: Are children who have not received a vaccine
dose for which they are eligible (and may have started the schedule),
captured in the program as children who have missed the third dose of
diphtheria-tetanus-pertussis containing vaccine (Penta 3).
Definition
• IMMUNITY: Its the ability of the body to fight against certain disease organisms.

• ANTIGEN- Its any substance that causes your immune system to produce antibodies

against it. An antigen maybe a foreign substance from the environment such as

chemicals,bacteria,viruses,or pollen.

• ANTIBODY- its a protein produced by the body’s immune system when it detects

harmful substances, called antigens. examples of antigens include micro-organisims

(such as bacteria, fungi, parasites, and viruses).

Definition

• Vaccine Vial Monitor: The VVM is a heat-sensitive label attached to vaccine

vials which gradually and irreversibly changes color, from light to dark, as the

vaccine is exposed to heat.

• Cold-chain: It s a system of ensuring that vaccines are maintained at the
required low temperatures from the point of production until it reaches the
consumer. ( +2-+8) It refers to all the equipment, processes and mechanisms
used to store and transport vaccines from the producer to the user (including
vaccine carriers, cold-boxes, refrigerators, freezers and cold rooms) by air, road
and over water bodies.
Definition
• Dropout rate is found by comparing the number of infants who start the immunization
schedule with the number who complete it. Two measures of dropout rate are routinely used:
we refer to pentavalent 1and 3 and Pentavalent 1 and measles.

• Indicator:-something that shows what a situation is like or how it is changing.

• Micro-planning is a crucial aspect of development. The term micro-planning is used in many

different ways and in vastly divergent contexts. In fact, the term micro-planning remains rather
vague unless the actual level of planning is defined. Nowadays, a more fashionable term “area
planning” is often employed as a synonym of micro-planning. In essence, the term micro-
planning implies multi-level and decentralised planning approach to the overall development
of a country.
Definition
• Eradication :means that intervention measures are no longer
required, and the agent that previously caused the disease is no
longer present.
• Elimination of a disease: is when deliberate effort leads to local
infections being reduced to zero within a defined geographic area. A
disease can be eliminated from a specific region without being
eradicated globally.
Definition
• TARGET POPULATION”. The number of children/pregnant women
that need immunization in a catchments area.
• AEFI: This is a reaction that occurs in a client/patient following
vaccination that is considered to be related to the vaccine until
proved otherwise.
• CATCHMENTS AREA: is a term that refers to the geographical region
and the population within the region, that a health facility is
mandated to serve.
IMMUNIZATION SYSTEMS
DEFINITION
• Missed Opportunity- Occurs when a child or woman who is eligible
for vaccination visits a health facility but not vaccinated.
• WHO MDVP (multi- dose vial policy) applies to both liquid and
reconstituted vaccines, All liquid vaccine vials in which have VVM on
the label except PCV 10 with VVM on the cap (has no preservative)
Opened liquid multi-dose vials with VVM on the label can be used up
to a maximum of 4 weeks (28 days), provided the vaccine meets the
criteria:
MDVP
1. The expiry date on the vaccine has not passed.
2. The vaccines are stored under appropriate cold conditions (+2ºc to
+8ºC).
3. The vaccine vial septum has not been submerged in water and label
is intact
4. Aseptic technique has been used to withdraw each dose.
5. The VVM has not reached discard point (VVM is still in stage 1 or 2).
Definition
• Preservatives: Chemical additives to vaccines to ensure that they
remain microbiologically stable. That is, they prevent the growth of
microorganism and fungi during the long time of storage as well as
during its use (especially with multi-dose vials) e.g., formaldehyde,
phenol,Thimerosal, beta-propiolactone etc. Not all vaccines contain
preservatives
INTRODUCTION TO IMMUNIZATION
• Vaccination has been one of the most successful and cost effective public
health intervention in history, as exemplified by, the eradication of
smallpox, significantly lowering the prevalence of poliomyelitis, and the
dramatic reduction in morbidity and mortality from several other illnesses.
• The Ministry of Health is committed to the global goal of controlling,
eliminating and eradicating vaccine-preventable diseases in the country.
• The impact of immunization services in reducing child mortality and
morbidity in the country has been significant. It is through the efforts of
various stakeholders and County Governments as implementers that this
has been possible.
INTRODUCTION TO EPI
• The National Vaccines and Immunization Program was established in
1980, and currently provides 14 vaccines and 5 non-EPI vaccines
(Hepatitis B, Anti-snake venom, Anti-rabies, Yellow Fever and Typhoid
vaccines).
• These vaccines are provided to more than 1.5 million infants and a
similar number of Pregnant women and 700,000 young girls every
year through a network of 9,500 health facilities – Public, Private,
Faith based and NGOs, FREE OF CHARGE.
Introduction
• The Ministry of Health, through the National Vaccines and
Immunization Program, supported by experts in immunization, and in
consultation with various stakeholders, has updated the National
Immunization Policy Guidelines,
• To guide implementation of immunization at all levels,
• Ensure uniformity and standardization with the latest knowledge and
advancements, and
• Ensure all stakeholders are aligned on delivery of their mandates.
INTRODUCTION TO EPI
• The Kenya National Immunization Policy Guidelines (2023) have been
developed in line with the Constitution of Kenya 2010, the Kenya
Vision 2030 and the Kenya Health Policy 2014–2030.
• It is also aligned with Immunization Agenda 2030, the WHO Regional
Immunization Strategic Plan for Africa, and the Addis Ababa
Declaration on Immunization
Immunization Agenda 2030

• The Immunization Agenda 2030 (IA 2030) sets an ambitious, overarching global
vision and strategy for vaccines and immunization for the decade 2021–2030. It
draws on lessons learnt in the implementation of the immunization programs,
acknowledges the continuing and emerging challenges posed by infectious
diseases, and capitalizes on new opportunities to meet those challenges.

• The vision of the Immunization Agenda 2030 is a world where everyone,

everywhere, at every age fully benefits from vaccines for good health and well-
being.
Immunization Agenda 2030
• The Immunization Agenda 2030 (IA 2030) has three main impact
goals:

1. Reduce mortality and morbidity from vaccine-preventable diseases

for everyone throughout the life course.
2. Leave no one behind, by increasing equitable access and use of new
and existing vaccines.
3. Ensure good health and well-being for everyone by strengthening
immunization within primary health care and contributing to universal
health coverage and sustainable development.
Introduction/Background of EPI
• It is expected that every clinician and all other health care workers in
Public, Private and NGO health facilities adhere to this policy to
ensure high quality immunization services are offered equitably to all
those who are eligible for the various vaccination services as outlined
in the policy document.
• The Ministry of Health is committed to ensuring that this strategy is
implemented and adopted to the fullest, to protect the lives of our
population from vaccine preventable diseases.
• The Government of Kenya appreciates the impact of the immunization
Program since its launch, which has led to the elimination of the Maternal
Neonatal Tetanus, near eradication of Poliomyelitis and marked control of
measles.
• Currently more than 20 life threatening diseases can now be prevented by
immunization
• The global re-emergence of vaccine preventable diseases, such as wild polio, in
the face of less-than-optimal immunization coverage shows how important it is
to attain and maintain high vaccination coverage so as to achieve significant
herd immunity.
• It also underscores the continuing need to address other emerging vaccine
preventable diseases, such as COVID-19.
Introduction to EPI
• Immunization is a key component of the primary health care package.
• The Kenya National Immunization Policy Guidelines aim to improve
the quality of immunization and primary healthcare services by
enhancing uniform and standardized implementation, and by
anchoring quality practices and rational vaccine use.
• It also spells out the relevance of various vaccines and the roles of
healthcare workers in the delivery.
INTRODUCTION TO EPI
• AIMS OF EPI

1.Immunisation of at least 95% of all children fully before the age of 1

year

2. Eradication of poliomyelitis

3. Eradication of Neonatal tetanus

4. Control of measles.
Kenya National immunization
guidelines
• The Kenya Expanded Programme on Immunization (KEPI) was established in
1980 with the main aim of providing immunization against six killer diseases
of childhood (tuberculosis, diphtheria, pertussis, tetanus, measles and polio).
• It is now rebranded as the National Vaccines and Immunization Program
(NVIP)
NVIP Vision
• A Kenya free of Vaccine Preventable Diseases
NVIP Mission
• To save lives and protect people from vaccine preventable diseases by
promoting and guiding the provision of efficient, equitable, safe, and
effective high-quality immunization services to all Kenyans
NVIP Goal
The goal of the NVIP strategic plan is to increase and sustain high coverage and
equitable utilization of vaccines, reduce the number of zero-dose children and
ensure uninterrupted availability of high quality, safe and effective vaccines in a
sustainable manner.
NVIP Guiding Principles
• People centred
• National, county and community ownership-Immunization is key to achieving
universal health coverage (UHC) in Kenya. Unvaccinated children is a marker of
underserved communities and can direct Primary Health Care services to
unreached communities.
• Partnership based:
• Evidence driven:A robust monitoring and evaluation framework that generates
timely data for action is important for tracking and informing improvement areas
in program performance.
Portfolio of the National
Vaccines and Immunization
Program
1.Childhood vaccines including vaccines offered during adolescence
2. Tetanus and diphtheria (Td) for pregnant women and for trauma
3. COVID-19 Vaccines
4. Vaccinations for special groups including: Occupational risk groups like health
workers, health allied workers and veterinary workers, Food handlers, e.g., typhoid
vaccine and International travelers, e.g. yellow fever, meningitis.
5.Specialized products
• Rabies vaccine for animal (dog) bites
• Anti-venom for snake bite
• Immunoglobulins for hepatitis B, anti-D sera for rhesus O negative pregnant
women
Portfolio of the National
Vaccines and Immunization
Program
6.Outbreak response vaccinations including the following conditions
• Poliomyelitis
• Measles
• Meningitis
• Emerging/ re-emerging infections, e.g., influenzas, coronaviruses
7. Any other vaccines and other specialized products that may be
deemed essential for any sections of the Kenyan population.
Portfolio of the National
Vaccines and Immunization
Program
• The program links with the counties through the departments of
health and county health management team where the immunization
functions are in the docket of the County EPI focal persons supervised
by the County Director for Health.
• The county health departments have varied organograms where the
EPI program is represented at the county and sub county health
management teams through the respective EPI focal persons
General norms and guiding principles for programme implementation

1. Community participation and social mobilization

2. Integrated approach- immunization services should be provided as an integral
part of national family health programmes
3. Accessibility and equity
Provided to all target populations irrespective of ethnicity, gender or political and
religious affiliation.
4. Quality of services and safety consideration
5. coordination and leadership
6. Regulatory issues relating to immunization
a) Most countries in the African region do not manufacture vaccines hence:
Service delivery strategies and
innovative approaches

1. Immunization at static health facilities (fixed strategy)

2. Immunization delivery through outreach services

3. Mobile Teams

4. Immunization campaigns or supplementary immunization activities

SUPPLEMENTARY IMMUNIZATION

a. NIDs- designed to immunize all eligible children.

b. SNIDs- where a specific area is to be targeted, often for border districts with
higher risk of polio transmission.

c. Mopping up –specifically a house-to-house SNID in a focal area where polio

transmission is thought to be occurring

d. Short –interval additional dose (SIAD) – an intensified approach to deliver two

successive doses of vaccines within a period of a few days (usually less than 2
weeks)
SUPPLEMENTARY IMMUNUIZATION FOR MEASLES ELIMINATION

a) Catch up campaign- one dose for all children between 9 months to 14 years is given ,
regardless of vaccination or disease history.

b) Follow- up- campaign –one dose of measles vaccine to children born since the catch –
up campaign

c) Mopping up- where poor coverage was achieved in the catch-up or follow-up
campaign, or when epidemiology evidence suggests measles transmission is focalized.

d) Periodic intensification of routine immunization (PIRI)- reinforces routine

immunization and uses a second opportunity to immunize susceptible persons
remaining in the population and those never vaccinated.
Preventable childhood diseases
• Tuberculosis
• Poliomyelitis
• Measles
• Rota Virus
• Pneumonia
• Malaria
• Tetanus
• Diphtheria
• Whooping Cough
• Hepatitis B
• Read and Discuss in class
Vaccines provided against
Preventable childhood diseases-
Brainstorm in class
• Brainstorm in class
Assignment
1. Research on the types of Vaccines provided for childhood Diseases and Include:
• Vaccine Type
• Disease prevented
• Formulation
• Storage
• Schedules
• Dosage
• Route of administration
• Target Group
• Present in Class
Assignment
2. Research and make notes on the factors influencing immunization
coverage (immunization hesitancy).Base on literature review,
experience at work.
Hand in the written assignment
Vaccines
• Vaccine is a biological product made in, composed of, and/or tested
through living systems.
• Vaccines function by eliciting an immune response and are generally
for preventive use, although therapeutic uses are known (e.g., BCG
for vesicle cancer).
• Vaccines are one of the most cost-effective preventive interventions
globally. From the beginning of the 20th century the extensive use of
vaccines has resulted in significant reductions in the burden of many
diseases and the eradication of smallpox.
Vaccines
• A vaccine consists of many parts, one of which is the antigen, by
which it is often described, also referred to as the immunogen.
• A vaccine formulation contains other components such as diluents,
stabilizers, adjuvants, preservatives, buffers, surfactants, and
proprietary ingredients(such as viscosity controlling agents and
osmotic pressure controlling agents).
Vaccine properties
1.Efficacy - A vaccine’s efficacy refers to the rate of protection from infection
and/or disease under optimal Phase III clinical trial conditions. No vaccine is
100% protective. A vaccine’s efficacy may vary according to age of recipient,
immune status of an individual and nutritional status (especially
malnutrition).
A vaccine’s efficacy can be compromised by:
• Exposure to inappropriate temperatures (freezing or high temperatures),
• Wrong reconstitution methods (use of wrong diluent or use of warm
diluent)
• Wrong route of administration (e.g subcutaneous injection instead of intra
dermal injection)
Vaccine properties
2.Effectiveness - Effectiveness describes how well the vaccine reduces disease in
the overall population. This depends on the efficacy as defined in clinical trials
and characteristics of the general population, including how many people actually
get vaccinated, as well as whether they complete the full series of vaccinations.
3.Herd Immunity - When a large proportion of people in a community are
vaccinated against a disease (85%-90%), even those who are not vaccinated in
that community get some protection because of a phenomenon called herd
immunity.
• If enough people in the community are vaccinated, there is less chance of the
infection spreading from person to person, and unvaccinated individuals may be
less likely to get infected because there is a lower risk of exposure. However, if
too many people are unvaccinated, ‘herd immunity’ cannot occur.
Vaccine properties
4.Safety – Vaccines are generally safe when used as intended in that they do not
cause serious side effects. Common side effects include transient fevers and pain
at the injection site. However, there is always a risk of unusual or unexpected
reaction to a vaccine, so health workers have to be alert in case of any adverse
event following immunization (AEFI).
5.Stability - This refers to the ability of the vaccine to retain its efficacy under
various conditions and environments. Stability can be compromised by
• Contamination with bacteria during administration or reconstitution
• Changes in temperature
• Exposure to light (a few vaccines)
The stability of lyophilized (freeze-dried) vaccines deteriorates rapidly after
reconstitution and therefore no reconstituted vaccine should be used more than
six hours after reconstitution
Vaccine properties
5.Stability contd
• Neither should a reconstituted vaccine be returned to the refrigerator
for use later. All reconstituted vaccines should be discarded at the end
of every vaccinating session or after six hours – whichever comes first.
Vaccines continued
Incineration is the best method of destruction for vaccines as they are
biological products. Any suspicious vaccine vial/s should be
documented in the stock ledger:
• Stating the problem noted,
• Number of affected vials/doses,
• The batch number/s
All affected vials should then be referred to the supplier. Here, the
supplier may be the Sub County Public Health Nurse or procurement
agent.
VACCINE STORAGE AND MANAGEMENT
Essential Immunization Supplies
• The MOH through NVIP will continue to supply government
prescribed childhood and adult vaccines, to all public and government
supported immunizing health facilities and those run by other
organizations.
• County Governments will provide the refrigeration equipment, non-
reusable injection devices, safety boxes, monitoring tools, IEC
materials, cold chain equipment and spare parts in line with
specifications provided by NVIP and the WHO, and in line with the
Government laws on financing, procurement and disposal.
Essential Immunization Supplies
contd
• All other vaccines outside the government prescribed schedules such
as Measles Mumps Rubella (MMR), Hepatitis A, Meningococcal,
Varicella, Seasonal Influenza vaccines
• Must be licensed for use by the Pharmacy and Poisons Board,
conform to the Kenya National Drug Policy,
• Be documented in child vaccination records and reported through the
MOH NVIP routine immunization reporting system
Distribution of Vaccination
Supplies
• Vaccines coming into the country are received, stored and further
distributed across the country to the last mile through a four-tier
supply chain system.
• Vaccines should be bundled with other supplies (injection devices,
safety boxes etc) during distribution especially at the sub county.
• The effectiveness and success of KEPI in reducing the burden of
immunization preventable diseases depends on the quality of
vaccines at the point of use, which in turns reflects the usefulness
of the vaccine management system.

• In order to reduce mortality, morbidity and disability,

immunization session must safely administer potent vaccines to
susceptible children and women before they are exposed to
immunization preventable diseases.
The immunization programme aims at resolving vaccine and
management problems include:

1. Reduction of the incidences of overstocking or under stocking of

vaccines

2. Ensuring proper accountability for all vaccines at all levels

3. Reduction of vaccine wastages

TARGET SETTING

• Each Sub-county is expected to set targets for two population categories

• • Children less than 1year

• • Women of child bearing age

VACCINES FORECASTING

• In order to accurately estimate the vaccines, reliable data must be collected from
the health facilities to the districts. Having set the target number of children to be
vaccinated in the new-year, each health facility should forecast the number of
doses of vaccines required to reach all the target children and childbearing age
women.
Advantages of obtaining accurate forecasting
of vaccine needs

1. It leads to efficient management of vaccines and immunization sessions

2. It eliminates shortages or overstocking of vaccines

3. It improves vaccine use and reduction of wastages

4. It helps to monitor the progress of immunization in relation to target coverage

 The three methods commonly
used to estimate vaccine needs:

• 1. Target population

• 2. Previous consumption

• 3. Size of immunization sessions

• All facilities are required to estimate vaccine needs using the target
population method and if the Health facilities are sharing the same
population, previous consumption method would be suitable.
1. Target Population Method

• Target population is the number of children under one year and

women of childbearing age (15- 49 years old).

• To estimate vaccine needs on the basis of target population a number of

parameter are necessary, which are:

a. Target population

b. Immunization schedule

c. Immunization coverage target

d. Wastage rate and wastage factor

Immunization coverage target

• The national policy is to reach every child. The Immunization coverage target for
each antigen is depends on the health facility and district micro plans and work
plans respectively. These plans indicate the attainable percentage coverage at the
end of current year.
Vaccine wastage rate and wastage factor

• During immunization, the number of vaccine doses used is generally higher than the number of
individuals immunized. The number of doses in excess represents “lost doses “or vaccine
wastage.

• These may include:

• The remainder of doses discarded with vials after the immunization session

• Doses given outside the target

• Doses spoilt for one reason or the other e.g. VVM reached discard point,
breakdown in the cold chain, frozen DTP+ HepB and TT or removed labels.
• Doses from vials broken during transport and handling

• Missing doses from vaccine stock ledgers etc

• Number of unopened vaccines vials lost should be documented in the

ledger books to facilitate
Calculations of wastage rate and factor.

• Vaccine wastage can be explained into two ways:

1. Wastage rate

2. Wastage factor
 1. Vaccine wastage rate
• Vaccine wastage rate should be taken into account in the estimation of
vaccine needs. Knowing the wastage rates helps to determine the wastage
factor, which is one of the parameters used to estimate vaccine needs.

• Vaccine wastage rates are not standard. Every County and health facility
must calculate its monthly vaccine wastage rates of antigens and by the end
of year know their vaccine wastages, which would be used for estimation of
the vaccines.
Formula for Wastage rate (%)

wastage rate %: Doses used – doses administered x100

Doses used

• Doses used include vaccines administered and wasted doses

• Doses administered are doses which have been received by the targeted group.
• Example on wastage rate

• Kaibos health facility had 200 doses of BCG vaccine in the month
of July 2017 and immunized 150 children under one year.

• To calculate the vaccine wastage rate for Kaibos health facility

using the formula is as follows:
200 – 150 X 100 = 25%
200
 Wastage Factor

• Vaccines Wastage Factor is a multiplier used to order vaccines to

cater for the targeted population and wastage.

• The total number of vaccines supplied within given period is

referred to as 100% supply.
 Formula for calculating wastage
factor
100% supply
= Wastage Factor
(100% supply – Wastage Rate)

Using Kaibos Health Facility example the wastage Factor is

calculated as follows:
100 = 100 = 1.33
(100 - 25) 75
• In other terms, for every dose of a given antigen in the immunization schedule, we
must anticipate ,1.33 doses to take account of 25% wastage in the use of the vaccine.
 Calculating vaccine needs for a district
and health facility

• Using the above parameter the total annual vaccine doses are
estimated by use of the following

Formula:

• Target Population x immun. schedule x Wastage factor = Total Annual

doses

i.e T.p x immunization schedule x W.f = Total Annual doses

• Note: Target coverage for the health facility level is 100% this is in line in
reaching every child in the catchment area. Therefore the target coverage is 1

• Example 1: (health facility to be formulated after target setting example to

make it flow)

• Kaibos health facility in kapenguria sub-county has a total population of

350,000 in 2017. The children under one year comprise 4% and women of
childbearing age are 24% of the total population. The district vaccine manager
was to forecast and order for all the routine vaccine. During the previous year
the district immunized 10,000 children with BCG and had received 24,000
doses from the regional stores. The store had a balance of 4,000 doses of BCG
at the end of the year 2004.
• Using the Forecast Sheet (Annex xxx see table) the manager will
forecast and order on after the calculation
• Sequential calculations using the forecast sheet. See table

• A. The target population is calculated as follows:

• • Children under one year
• 4/100 x 350,000 = 14,000
• • Women of childbearing age
• 24/100 x 350,000 = 84,000

• B. Doses in immunization schedule for BCG is one dose

• C. Wastage Factor for BCG from the example above of kaibos Health facility is
1.33
• D. Total doses required for the district this year is calculated as follows:
• Target population x immunization schedule x wastage factor = 14,000 x 1 x
1.33 =18,620
The data required for estimating vaccines needs
on the basis of previous consumption are:

• a. Number of children immunized previously

• b. Wastage factor for the specific antigen

• c. Immunization schedule for the antigen.

ORDERING VACCINES

Steps in ordering Vaccines

• 1. Defining vaccine supply period

• 2. Calculating quantities of vaccine for a supply period

• 3. Calculating minimum stock level

• 4. Calculating maximum stock level

• 5. Calculating total quantities of vaccine to be ordered

Advantages of ordering
vaccines
• a. Prevent vaccine stock outs and overstocking.

• b. Prevent expiry of vaccine during their storage period.

• c. Ensures that the other appropriate supplies are “bundled” e.i. Safety boxes,

syringes and needles.

Calculating quantities of vaccine for a supply period

• The needs for a specific storage or supply period can be calculated as follows:
• Vaccines needs for the period = Annual vaccines needs X Supply period (in months)
• Number of months in year

• Using the formula:

• Qperiod = (Qyear/12) x Psupply

• Where,
• Qperiod = Vaccines needs for the period
• Qyear = Annual vaccines needs
• Psupply = Supply period (in months)
Example: using Kasei Health Facility CHECK
PGS 32/33 (greenbook)

• 14,000 x 1 x 1.33= 18,620 doses

• County calculations = 3/12 x 18,620 = 4,655doses
• Health facility calculations =1/12 x 18,620 = 1,552doses
 Calculating minimum stock level

• The “minimum stock” represents the minimum number of vaccine doses that should be in the
refrigerator

• on the arrival of the next supply consignment. The level of minimum stock is generally fixed at
25% of the total estimate of vaccines needs for a given supply period.

Using a formula

• Minimum stock = Vaccines needs for the period X 25 %

• mini =Qperiod x 25% (or 0.25)

• Note: the minimum stock takes into account the possible delays in supply as well as unexpected
increase in the population to be immunized (untargeted population, migration, etc.).
Calculating maximum stock
level
• The maximum stock is the maximum number of vaccine doses that should be found in the
refrigerator after a supply.

• Using the formula:

• Minimum stock = Vaccines needs for the period + Minimum stock

• maxi = Qperiod + Smini

• Example

• 4,655 + 1,164 = 5,819 doses

Calculating total quantities of vaccine to be ordered
• Once the order levels are determined, the vaccine quantities to be
ordered are calculated on the basis of the balance in stock at hand
and the maximum stock.
• The order may be based either on specific supply period (quarterly
for County and monthly for health facility) irrespective of the
consumption.
• A stock shortage may occur before the end of the period.
• It is therefore recommended that an order be placed as soon as the
stock of an antigen reaches the point where an order should be
placed
.
• General formula:
• Quantity to order = Maximum stock – stock at hand
• Qorder = Smaxi – Savailable
CONTROLLING VACCINE STOCKS

• 1. Receiving delivered vaccines and supplies

• 2. Storage, transport and handling of vaccines
• 3. Organizing vaccine distribution
• 4. Inventory of vaccine stocks
IMMUNIZATION SCHEDULE
• Age ANTIGEN
• At birth BCG and Birth OPV
• 6 weeks DPT/HepB/Hib 1 and OPV 1
• 8 weeks ROTA 1
• 10 weeks DPT/HepB/Hib2 and OPV2,
• 14 weeks DPT/HepB/Hib 3 and OPV 3
• 4 months ROTA 2
• 6 months VIT A , Rota 3
• 9 months Measles
• 9 months Yellow Fever (in the four endemic districts of Baringo,
Koibatek,Keiyo and Marakwet).
• 18 months 2nd measles
Vaccines and their administration sites

82
COLDCHAIN MANAGEMENT
Cold Chain Equipment

• The National Vaccines and Immunization Program endeavors to

provide to the Counties appropriate guidance and specifications for
cold chain equipment and strives to compile a national inventory
database of cold chain equipment in the Counties.
 Challenges in cold chain
• Frequent breakdown in cold chain due to lack of fuel or
spare parts

• Lack of planning for equipment

• Incorrect use of VVM as a management tool

• Lack of planning for emergencies

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Sensitivity of vaccines to freezing
and heat exposure

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Organizing the cold chain
Cold chain is a system of different elements i.e. human,
material and financial resources and certain norms and
standards to ensure high quality vaccines.

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Vaccine Supply Chain

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 Cold chain options

1. Fast cold chain

•Based on equipment that retains cold chain through pre-frozen

icepacks for transporting vaccines.

•It does not generate cold.

•Relies on speed, minimizing possible inconveniencies related to

stage, distribution and handling vaccines.

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 Fast cold chain

Works well in following conditions:

• Refrigeration at the health-centre level is not reliable

• Managerial capacity at the health centre is inadequate

• Reliable and not expensive distribution system in place

• Distance between levels of health systems are short

• Programme uses high-cost vaccines e.g. Hib and HepB

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2. Slow cold chain

Relies on cold-generating equipment

Recommended if:

• Refrigeration at health facility is reliable

• Managerial skills at health centre is adequate

• Vaccine distribution is expensive

• Distances between levels of health system is long

• Vaccines used in programme are not costly

• System uses ice-making equipment

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2. Slow cold chain

Relies on cold-generating equipment

Recommended if:

• Refrigeration at health facility is reliable

• Managerial skills at health centre is adequate

• Vaccine distribution is expensive

• Distances between levels of health system is long

• Vaccines used in programme are not costly

• System uses ice-making equipment

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