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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5470_Библиотеки_им_академика_М_И_Перельмана.pdf
73Preventive Healthcare
Vaccines under the Universal Immunization Programme
(UIP)
Under UIP, the following vaccines are provided:
1. BCG (Bacillus Calmette-Guerin).
2. DPT (diphtheria, pertussis, and tetanus toxoid).
3. OPV (oral polio vaccine).
4. Measles.
5. Hepatitis B.
6. TT (tetanus toxoid).
7. Japanese Encephalitis (JE) vaccination.
8. HiB containing Pentavalent vaccine (DPT + HepB + Hib)
(in selected states).
The National Immunization Schedule is given in Table 2.4
Table 2.4: National Immunization Schedule
When to give Vaccine
At birth BCG, OPV, hepatitis B
At 6 weeks DPT, OPV, hepatitis B, HIB B, Rota V,
flPV, PCV
At 10 weeks DPT, OPV, hepatitis B, HiB B, Rota V
14 weeks DPT, OPV, hepatitis B, HIB B, Rota V,
fIPV, PCV, IPV
9 months Measles/MR, vitamin A (1Lac IU), PCV
booster, JE1
16–24 months DPT booster, OPV booster, measles 2nd
dose/ MR 2nd dose, JE2
One dose every 6 months Vitamin A (2 Lac IU) (2nd to 9th dose)
up to the age of 5 years
5–6 years DPT 2nd booster
10 years and 16 years TT
For pregnant women
Early in pregnancy TT-1
4 weeks after TT-1 TT-2
If received 2 TT doses in TT-booster
pregnancy within the
last 3 years
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Contraindications
Vaccines are contraindicated under the following conditions:
1. Pregnancy: All live vaccines are contraindicated except
yellow fever.
2. Lactation: All vaccines are safe during lactation except
yellow fever.
3. HIV: All live vaccines are contraindicated. All the vaccines
except OPV and measles vaccines are contraindicated in
the HIV-positive newborn.
4. Premature and underweight infant: Hepatitis B vaccine is
contraindicated in premature and underweight (less than
2 kg) babies.
5. Epilepsy: Pertussis is contraindicated.
Adverse Events
Adverse events following immunization are as follows:
1. The ideal observation time after immunization of a child is
30 minutes.
2. Hepatitis B: Sensitivity reactions and shock.
3. Measles: Toxic shock syndrome (TSS)
4. Rota V: Intussusception (a serious condition in which part
of the intestine slides into an adjacent part of the intestine).
5. Measles: Febrile seizures
6. Pertussis: Persistent crying hypotension hyper-responsive
episodes
7. MMR, hepatitis B: Thrombocytopenia
Cold Chain
It is the process of maintaining the temperature of the vaccine
from the point of manufacturing to the point of administration.
Vaccines must be continuously stored in a limited temperature
range—from the time they are manufactured until the moment
of vaccination. This is because temperatures that are too high
or too low can cause the vaccine to lose its potency, i.e. its ability
to protect against disease). Once a vaccine loses its potency, it
cannot be regained or restored.
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1. Ice Lined Refrigerator (ILR)
It is used to store vaccines at the Public Health Centre (PHC)
level. It maintains the temperature between +2°C and +8°C. In
this vaccines can be stored for up to 1 month. The minimum
electricity required per day is eight hours and if there is no
electricity it can maintain the temperature of all the vaccines
for five days.
Fig. 2.6: Ice lined refrigerator
2. Vaccine Carrier
Vaccine carriers are insulated containers that, when lined with
coolant packs, keep vaccines and diluents cold during
transportation. Vaccine carriers are smaller than cold boxes are
easier to carry when walking. These products are used for
transporting vaccines from health facilities with refrigeration
to outreach immunization sessions where refrigeration and ice
are not available. Vaccine carriers are typically carried by a
single health worker traveling on foot or by other means, where
the combined journey time and immunization activity may
range from a few hours to a whole day. The vaccine storage
capacity of vaccine carriers is between 0.8 and 3.4 liters.
Vaccine carriers can be grouped into two range categories:
1. Short range: With a minimum cold life of 15 hours at
43°C ambient temperature.
2. Long range: With a minimum cold life of 30 hours at
43°C ambient temperature.
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Cold boxes, vaccine carriers, and coolant packs are used for
keeping vaccines cold during transportation. In comparison
with cold boxes, vaccine carriers have a smaller volume,
suitable for use by health workers during immunization
campaigns and outreach services. As these are passive devices,
coolant packs are used as accessories for both cold boxes and
vaccine carriers to provide cooling capacity for a limited period.
A vaccine carrier is used to transport vaccines from the Public
Health Centre to the site of immunization and sub-centers. It
is a non-electric instrument with four ice packs inside it. A
maximum of 16 to 20 boxes can be stored and it can maintain
temperature for 24 to 48 hours.
3. Fully Ice Pack
It is the smallest component of the cold chain. It is used at the
immunization session-level. Two vaccines are kept in two holes
inside the ice pack. The horizontal mark indicates the water
filling level.
Fig. 2.7: Vaccine carrier
Fig. 2.8: Fully ice pack
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4. Dial Thermometer
This is used to monitor the temperature of the cold chain,
especially at PHC inside ILR. It is based on the principle of
thermocouples. Temperature is monitored twice a day. An
alcohol stamp thermometer is more sensitive but a dial
thermometer is easier to use.
Vaccine Vial Monitors (VVMs)
A VVM is a label containing a heat-sensitive material. It is
placed on vaccine vials. It has an outer blue circle and an inner
white square. The change in color of the square inside the circle
indicates the effectiveness of the vaccines. If the temperature
is maintained properly, the inner white square always remains
white. If the temperature is not maintained at 2° to 8°C, inner
white squares start to change in color. The vaccine can be used
if the inner square is lighter than the outer circle. If the color of
the inner square is darker than the circle then the vaccine must
be discarded.
Fig. 2.9: Vaccine vial monitoring
ENVIRONMENT AND HEALTH
Introduction
A state of complete health means a state of complete physical,
mental, and moral well-being of individuals. This requires a
balance of the internal environment of a man himself and the
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external environment in which he lives. Very frequently the
key occurrence, prevention, and control of diseases lie in the
environment.
Environment means the air, water, and land in which
humans, animals, plants, and all other organisms live together.
Sanitation is defined as ‘the control of all those factors in the
environment, which may cause an ill effect on physical
development, health and survival of man’. The term sanitation
aims to prevent diseases and promote health. Besides food,
water, housing, and clothing, sanitation is an important factor
in the environment. Improper sanitation, non-availability of
adequate safe water and its disposal, air pollution, industrial
pollution, and increasing population all are posing serious
threats to the healthy environment. Therefore, attainment of a
healthy environment is becoming more and more complex.
India is still lagging behind many countries in the field of
environmental health.
Water Pollution
Water pollution is a serious problem in India. The common
impurities polluting water are described below.
A. Inorganic Impurities
1. Suspended impurities: These include sand, mud, silt, chalk,
etc., and can be removed by sedimentation or alum
precipitation. These impurities affect the gastrointestinal
tract and can even cause diarrhea.
2. Dissolved impurities: These include:
i. Gases like CO
2
and H
2
S, which make water acidic.
ii. Salts like carbonates, chlorides, calcium, and
magnesium sulfate. These produce temporary and
permanent hardness. Hard water may cause dyspepsia
and diarrhea and also difficulty in cooking and
washing.
iii. Iron resulting from the rusting of pipes produces
dyspepsia and constipation
iv. Zinc, which causes constipation.
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v. Lead, which causes lead poisoning.
vi. Fluorine, which causes fluorosis and enamel mottling.
B. Organic Impurities
Organic impurities are due to:
i. Human activities: Sewage, which contains decomposable
organic matter and pathogenic agents.
ii. House waste and droppings.
iii. Industrial and trade wastes contain toxic agents like
synthetic organic chemicals.
Hazards of Polluted Water
These are of two types:
i. Biological hazards: These lead to water-borne diseases like
typhoid, cholera, dysentery, polio, etc.
ii. Chemical Hazards: Chemical pollutants include acids, dyes,
detergents, solvents, cyanides, heavy metals, nitrogenous
substances, leaching agents, pigments, and other toxic
substances. Some contaminants like pesticides, herbicides,
fungicides, polymers, plastic ingredients, and heavy
metals are carcinogenic and mutagenic.
The Prevention and Control of Water Pollution Act, 1974
was enacted to safeguard against these serious hazards of
polluted water. Several other legislations have also been
implemented in this regard.
Importance of Safe Drinking Water
There is no life without water. This is the reason why men
preferred to settle near water sources, i.e. near rivers, lakes,
etc. Water is an essential and predominant constituent of living
cell protoplasm. It is a necessary vehicle for all the metabolic
processes. Water constitutes nearly two-thirds of the total body
weight, 79% of blood, 80% of brain fluid, and 10% of bones. It
is required for domestic, public, agricultural, and individual
purposes. The supply of safe and potable drinking water to
the country is of greatest importance in maintaining positive
health measures. Water free from pathogenic agents, and
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harmful substances, pleasant to taste and usable for domestic
purposes is called potable water.
Water-borne diseases: 20% of all diseases are water-
associated. The classification of water-borne diseases is given
in Table 2.5.
Table 2.5: Classification of water-borne diseases
Agent Diseases caused
Viral Infective hepatitis, poliomyelitis, gastroenteritis
Bacterial Diarrhea, dysentery, cholera, enteric fever,
gastroenteritis, typhoid and paratyphoid
Protozoal Amoebiasis, giardiasis
Helminthic Round worm, whipworm, threadworm,
hydated diseases
Spirochetal Weil’s disease
Through cyclops Guinea worm infection
Through snails Schistosomiasis
Air Pollution
Air is essential for life. Unlimited relatively clean air is necessary
for comfortable and healthy living. While air performs many
useful functions like supplying oxygen for respiration,
regulation of body temperature, etc., polluted air spreads
various diseases and their agents. Rapid industrialization and
inadequate sanitation are the chief factors in polluting air.
The average composition of air includes oxygen (20.95%),
nitrogen (78 to 79%), carbon dioxide (0.03 to 0.04%), water
vapors and ammonia (% varies with temperature); argon, neon,
krypton, helium, and bacteria, spores, etc. (traces).
The term air pollution is applicable when there is an excessive
concentration of foreign matter in the outdoor atmosphere,
which is harmful to humans or the environment. In the true
sense, there is no pure air and hence air pollution is a serious
health hazard throughout the world. In India, Delhi is supposed
to be the most polluted city in terms of dust concentration in
the air.
81Preventive Healthcare
The chief impurities in the air are:
1. Dust, fumes, mist, vapors.
2. Harmful gases from industrial sources.
3. Decomposed organic matter giving off ammonia and
H
2
S with offensive odour.
4. Infectious agents, e.g. bacteria, moulds, fungi, and
pollens.
Sources of Air Pollution
1. Automobile combustion and incomplete fuel combustion
give off CO
2
, CO, Gasoline, oxide, etc. in metropolitan
cities.
2. Industrial and other commercial processes dealing with
combustion processes in cities.
3. Domestic fuel burning.
4. Decomposed organic matter from refuse and dead
vegetation.
5. Pollution from natural sources, e.g. dust, pollen, bacteria,
and fungi.
6. Insecticide and pesticide sprays used in agriculture.
7. Radioactive material disposal.
Hazards of Polluted Air
The most prominent hazards of polluted air are:
1. Adverse effects on the respiratory system.
2. Increase in morbidity and mortality.
3. Chronic bronchitis and carcinoma of the lungs.
4. Reduction of atmospheric visibility.
5. Adverse effects on animal and plant life in the long run.
6. General ill effects like headache, giddiness, depression,
loss of appetite, and lassitude.
Purification of air: Purification of air occurs in the natural
course also because:
1. The wind dilutes, sweeps away, or aspirates the impurities
and gets replaced by pure air.
2. The rain washes the air and removes gases and suspended
impurities.
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3. Oxygen and ozone oxidize the organic matter present in
the air.
4. Plants absorb CO
2
and give off oxygen in sunlight.
5. Sun affects the temperature, pressure, and volume of air.
6. Changing weather and other climatic and meteorological
factors affect the direction and velocity of air movements
over vast areas.
Indicators of air pollution: General indicators of air
pollution helpful in assessing the extent of pollution are:-
1. Estimate of suspended particles in air (μg/cu m of air).
2. Smoke index expressed as coh units/1000 linear feet of air
sample filtered through a standard paper tape and its
density recorded with a photoelectrometer.
3. Amount of CO
2
, CO, NO
2
, lead and other oxides.
In the pharmaceutical industry clean air, free from particles
and bacteria is obtained by the use of HEPA (high efficiency
particulate air) filters and laminar flow stations. This is essential
in the production areas for parenteral preparations.
The National Environmental Engineering Research Institute
(NEERI) at Nagpur has been established by WHO as the
regional center for monitoring and study of air pollution.
Similar laboratories are also established in Mumbai, Delhi,
Kolkata, Chennai, Hyderabad, Kanpur, Jaipur and
Ahmedabad.
Prevention and Control
Air pollution has global significance due to serious health
effects, both immediate and long-term. For prevention and
control of air pollution, WHO has recommended the following
measures:
i. Containment: It means preventing the mixing of toxic
pollutants into the air by the use of engineering methods
such as enclosure, ventilation, and air cleaning. Arrestors
can be used to remove the contaminants from the air.
ii. Replacement: It means replacing a process contributing to
air pollution with a non-polluting process, e.g. using
electricity in place of coal or natural gas.