PAE504 — Child Health and Primary Care: Lecture Note

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la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: PAE 504 Course title: Child Health and Primary Care Course credit load: 3 Units Series 1: Immunisation and the National Programme on Immunisation • Part 1.1: Vaccine Types o Sub Part 1.1.1: General principles of immunisation o Sub Part 1.1.2: Live attenuated and inactivated vaccines o Sub Part 1.1.3: Subunit, toxoid, and conjugate vaccines • Part 1.2: Vaccine Storage and the Cold Chain o Sub Part 1.2.1: General principles of vaccine storage o Sub Part 1.2.2: The cold chain o Sub Part 1.2.3: Vaccine vial monitors and identifying compromised vaccines • Part 1.3: The National Programme on Immunisation and Schedule o Sub Part 1.3.1: Overview of the National Programme on Immunisation o Sub Part 1.3.2: The routine immunisation schedule o Sub Part 1.3.3: Contraindications and adverse events following immunisation • Part 1.4: National Immunisation Days and Implementation in Nigeria o Sub Part 1.4.1: National immunisation days o Sub Part 1.4.2: Implementation of immunisation in Nigeria o Sub Part 1.4.3: The role of outreach and community engagement • Part 1.5: Challenges Facing Immunisation in Nigeria o Sub Part 1.5.1: Logistical and health system challenges o Sub Part 1.5.2: Sociocultural and vaccine hesitancy challenges o Sub Part 1.5.3: Strategies to address challenges Introduction

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Picture a busy primary health centre on immunisation day, with mothers queuing patiently with their infants for the next round of scheduled vaccines, while a health worker carefully checks that the vaccine refrigerator has remained within the correct temperature range overnight. Immunisation remains one of the most cost-effective public health interventions available, preventing millions of childhood deaths each year, and this Series opens the PAE 504 course by building a thorough understanding of vaccines, their storage, and the National Programme on Immunisation in Nigeria. The aim of this Series is to equip you with the knowledge required to understand the types and storage of vaccines, the National Programme on Immunisation schedule, and the implementation and challenges of immunisation in Nigeria. This Series begins with vaccine types, before turning to vaccine storage and the cold chain. Next, we examine the National Programme on Immunisation and schedule, then National Immunisation Days and implementation in Nigeria, before concluding with the challenges facing immunisation in Nigeria. Series Learning Outcomes At the end of this Series, you should be able to: • SLO 1.1: describe the general principles of immunisation, • SLO 1.2: list and describe the types of vaccines used in childhood immunisation, • SLO 1.3: describe the requirements for vaccine storage and the cold chain, • SLO 1.4: describe the National Programme on Immunisation schedule in Nigeria, • SLO 1.5: describe the vaccines given at each point of the immunisation schedule, • SLO 1.6: describe National Immunisation Days and their purpose, • SLO 1.7: describe the implementation of immunisation programmes in Nigeria, • SLO 1.8: describe common contraindications and adverse events following immunisation, • SLO 1.9: list the challenges facing immunisation implementation in Nigeria, and • SLO 1.10: describe strategies to address these challenges.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1 Vaccine Types 1.1.1 general principles of immunisation Priming the immune system without causing disease Immunisation works by exposing the immune system to a vaccine antigen, derived from or resembling a specific pathogen, stimulating a protective immune response, including the production of antibodies and memory cells, without causing the actual disease itself, so that if the vaccinated individual is later exposed to the true pathogen, the immune system can respond rapidly and effectively, generally preventing or significantly reducing the severity of infection. Active immunisation, the basis of routine childhood vaccination, stimulates the individual's own immune system to produce this protective response, generally providing long-lasting protection, while passive immunisation, providing pre-formed antibodies directly, such as immunoglobulin, provides immediate but temporary protection, a distinction relevant to understanding the different roles these two approaches play in preventing infectious disease. Fill in the blank: Active immunisation stimulates the individual’s own immune system, generally providing ________ protection. 1.1.2 live attenuated and inactivated vaccines Live attenuated vaccines contain a weakened, but still living, form of the pathogen, which replicates within the vaccinated individual to a limited degree, generally producing a strong, long-lasting immune response, often after a single or few doses, though they are generally contraindicated in individuals who are significantly immunocompromised, given the small risk of the weakened organism causing disease in this group. Examples include the measles, oral polio, and BCG vaccines. Inactivated vaccines, by contrast, contain a pathogen that has been killed or otherwise rendered non-infectious, and are therefore safe for use in immunocompromised individuals, though they generally produce a weaker immune response than live vaccines, often requiring multiple doses and periodic booster doses to maintain adequate protection over time. Examples include the inactivated polio vaccine and most pertussis vaccine formulations. Fill in the blank: Inactivated vaccines contain a pathogen that has been ________ or otherwise rendered non-infectious.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1.1.3 subunit, toxoid, and conjugate vaccines Subunit vaccines contain only a specific component of the pathogen, such as a particular protein, rather than the whole organism, reducing the risk of vaccine-related side effects while still stimulating a protective immune response, and toxoid vaccines, a specific type of subunit approach, contain an inactivated bacterial toxin, stimulating antibodies against the toxin itself rather than the bacterium, as used in tetanus and diphtheria vaccines. Conjugate vaccines chemically link a polysaccharide antigen, which alone produces a poor immune response in young children, to a protein carrier, considerably improving the immune response in this age group, and are used for several important childhood vaccines, including Haemophilus influenzae type b and pneumococcal conjugate vaccine, both targeting bacteria with a polysaccharide capsule that would otherwise be poorly immunogenic in infants. Fill in the blank: Conjugate vaccines link a polysaccharide antigen to a protein ________ to improve the immune response in young children. Figure 1.1: A healthcare worker preparing a vaccine dose for administration. Pilot questions 1.1

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS 1. Describe how immunisation stimulates protective immunity. (Linked to SLO 1.1) 2. Distinguish active from passive immunisation. (Linked to SLO 1.1) 3. Describe live attenuated vaccines and give two examples. (Linked to SLO 1.2) 4. Describe inactivated vaccines and explain why they are safe in immunocompromised individuals. (Linked to SLO 1.2) 5. Describe conjugate vaccines and explain why they are used for certain childhood vaccines. (Linked to SLO 1.2) 1.2 Vaccine Storage and the Cold Chain 1.2.1 general principles of vaccine storage Most vaccines are biological products sensitive to temperature Most vaccines are biological products that lose their potency if not stored within a specific, correct temperature range, generally between 2 and 8 degrees Celsius for most routine childhood vaccines, and exposure to temperatures outside this range, whether too warm or, for some vaccines, freezing temperatures, can permanently and irreversibly reduce vaccine effectiveness, even if the vaccine appears entirely unchanged in appearance. Certain vaccines have specific storage requirements, such as some live attenuated vaccines requiring frozen storage at certain stages of the supply chain, while others, such as most diphtheria, tetanus, and pertussis-containing vaccines, are particularly sensitive to freezing and lose potency if inadvertently frozen, meaning correct storage requires specific knowledge of the particular requirements of each individual vaccine product used. Fill in the blank: Most routine childhood vaccines require storage between 2 and ________ degrees Celsius. 1.2.2 the cold chain The cold chain refers to the continuous, unbroken series of temperature-controlled storage and transport conditions required to maintain vaccine potency from the point of manufacture through national, regional, and local storage facilities, to the final point of administration to the child, with any break in this chain at any point risking permanent loss of vaccine effectiveness.

la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Maintaining the cold chain requires appropriate refrigeration equipment at each level of the supply chain, regular temperature monitoring, using devices such as temperature loggers or simple thermometers, and, particularly at the peripheral, facility level, reliable electricity supply or appropriate backup systems, such as solar-powered refrigeration, since inconsistent power supply remains a genuine, practical challenge to reliable cold chain maintenance in many settings. Fill in the blank: The cold chain refers to the continuous, unbroken series of temperature-controlled storage from manufacture to ________. 1.2.3 vaccine vial monitors and identifying compromised vaccines Vaccine vial monitors, a heat-sensitive label attached to certain vaccine vials, provide a simple, visual indication of whether a vaccine has been exposed to excessive cumulative heat over time, changing colour progressively as heat exposure accumulates, allowing health workers to identify a compromised vaccine even without detailed knowledge of the vial's specific storage history, an important practical tool given the imperfect cold chain conditions that can occur in some settings. Health

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