NATIONAL VACCINES AND IMMUNIZATION PROGRAM (NVIP)

TYPHOID CONJUGATE VACCINE ROUTINE INTRODUCTION

TRAINING
DATE:
VENUE:
 Training Outline
❖ Module 1: Background and Introduction

❖ Module 2: Rationale of TCV Introduction

❖ Module 3: TCV Vaccine Eligibility and Contraindications

❖ Module 4: TCV Vaccine Attributes Storage and Logistics

❖ Module 5: TCV Service Delivery

❖ Module 6: TCV Vaccine Safety and Waste Management

❖ Module 7: TCV Vaccine Monitoring and Evaluation

❖ Module 8: TCV Social Behaviour Change Communication

National Vaccines and Immunization Program

 MODULE 1

BACKGROUND AND INTRODUCTION

 Presentation Outline

• Objectives

• Typhoid disease overview

• Risk factors for Typhoid fever

• Prevention and treatment of Typhoid fever

• Surveillance of Typhoid fever in Kenya

National Vaccines and Immunization Program

 Objectives of the module

• Describe Typhoid fever disease

• Outline the risk factors for Typhoid fever

• Describe the prevention and treatment of Typhoid fever

• To understand antimicrobial resistance for S. typhi

• Highlight typhoid fever surveillance in Kenya

 Typhoid Disease Overview
● Typhoid fever is a highly contagious acute generalized infection
spread by feacally contaminated food and water

● It is caused by a highly virulent and invasive enteric

bacterium, Salmonella typhi (S. typhi)

● It is of serious public health concern and is endemic in many

countries in Asia and Africa including in Kenya
● Most at risk populations include:

• people lacking access to safe water & adequate sanitation

• children under the age 15 years of age

• elderly and immunocompromised individuals

 Transmission of Typhoid Fever
• Typhoid fever is transmitted through the faecal-
oral route
• It is highly contagious with an incubation period
of between 7–14 days
• People with typhoid fever carry Salmonella typhi
in their bloodstream and intestinal tract
• Infected individuals can pass the bacteria through
their faeces long after treatment even up to to 1
year
• Transmission can occur through:
• Consumption of contaminated food or water from
inadequate hygiene and sanitation measures
• Contamination of the environment( water sources
polluted by sewage, inadequately treated piped water,
crops fertilized by human faeces) High risk environments for typhoid fever

National Vaccines and Immunization Program

 Signs & Symptoms of Typhoid Fever
Typhoid patients may experience a wide • Severe cases may lead to serious
range of symptoms including: complications or even death
• Common serious complications
• Persistent high fever include intestinal bleeding,
• Abdominal discomfort intestinal perforation, and brain
• Malaise injury
• Headache
• Fatality rates in typhoid fever
• Constipation/ diarrhea range from 1-4% in treated cases
Others may be asymptomatic, but still and 10-20% in untreated cases
transmit typhoid • The highest fatality rates are
reported in children <4 years of
age

National Vaccines and Immunization Program

 Diagnosis of Typhoid
The gold standard for Typhoid fever diagnosis in Kenya is isolation of S. Typhi by blood
culture.

Due to antimicrobial resistance, routine antimicrobial susceptibility testing (AST) should

be done in all confirmed cases prior to treatment to guide the choice of antibiotic

Blood culture system Antimicrobial susceptibility testing

 Treatment of Typhoid
• Typhoid fever should be treated with appropriate antibiotics

• S. typhi bacteria are increasingly becoming antimicrobial resistant

(AMR) to different antibiotics (including ampicillin,
chloramphenicol, trimethoprim sulfamethoxazole, fluoroquinolones
and cephalosporins) since the late 1980s
• The choice of treatment should be guided by appropriate
antimicrobial susceptibility testing to guide the choice of antibiotic
due to widespread multidrug resistance.

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 S. Typhi Antimicrobial Resistance in Kenya
• AMR has become a major threat to the treatment of Typhoid fever in Kenya where
there is increasing antibiotic resistance to antibiotics that are commonly used to
treat typhoid.
• Data from Kenya showed S. typhi multidrug resistance to ampicillin, cotrimoxazole and
chloramphenicol, and reduced susceptibility to Ciprofloxacin in 67% of the cases(Muturi. P et
al, 2024).
• Typhoid conjugate vaccines(TCV)are a crucial tool to combat drug resistant
typhoid
• Data from Pakistan found that TCV are 97% effective against MDR and XDR
typhoid

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 Prevention of Typhoid
Typhoid prevention and control needs an integrated strategy approach including:
• Use of safe drinking water and adequate sanitation- The risk of typhoid fever can be
reduced by improvements to water supplies, such as chlorination
• Handwashing
• Health education
• Appropriate hygiene among food handlers
• Immunization-Typhoid vaccination can greatly reduce typhoid burden

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 Surveillance of Typhoid Fever in Kenya
• Typhoid Fever is a priority disease for surveillance in Kenya as provided under
the Integrated Disease Surveillance and Response, Technical Guidelines, 3rd
edition
• Typhoid fever Case definition:
⮚Suspected case: Any person with gradual onset of steadily increasing and then persistently
high fever, chills, malaise, headache, sore throat, cough, and, sometimes, abdominal pain and
constipation or diarrhea.
⮚Confirmed case: Suspected case confirmed by isolation of Salmonella typhi from blood,
bone marrow, bowel fluid or stool.
• Cases should be monitored & reported weekly through the weekly IDSR reporting
form, MOH 505
• The form is filled at health facility level, then submitted to the Sub county Disease
Surveillance Coordinator, who feeds it into KHIS.
• Typhoid fever surveillance data in Kenya is suboptimal. There is need to
strengthen routine surveillance of Typhoid fever in Kenya.

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 Ministry of Health

MODULE 2

RATIONALE OF TYPHOID CONJUGATE VACCINE

INTRODUCTION
 Presentation Outline

• The burden of Typhoid fever

• Rationale and evidence for Typhoid Conjugate Vaccine (TCV)

introduction in Kenya

National Vaccines and Immunization Program

 Objectives

• Demonstrate the burden of Typhoid burden- global and local

• Explain the rationale and evidence for Typhoid Conjugate Vaccine

(TCV) introduction in Kenya

National Vaccines and Immunization Program

 Global Disease Burden
Globally, there are an estimated 9 million new cases of typhoid fever and
approximately 110,000 fatalities each year (2019 data).
Mostly in resource-poor settings in parts of sub-Saharan Africa and Asia
 The Burden of Typhoid in Kenya
• The exact burden of Typhoid disease in Kenya is unknown due to diagnostic and
surveillance challenges
• Typhoid is easily confused with a wide range of commonly febrile illness, such as malaria,
influenza, and dengue fever leading to low detection, testing and confirmation of Typhoid
• The suboptimal surveillance data and poor access to confirmatory diagnostic tests(blood
culture),often leads to underreporting and inappropriate diagnosis and treatment.

• Despite the suboptimal reporting of data, there have been high cases and sporadic
outbreaks of typhoid fever across the country.
• A ten year study in the informal settlements of Nairobi Kenya(2010-2019) showed an overall
typhoid incidence of 95 cases per 100,000 persons-year of observation.(Galgalo et al, 2018)

• The burden has especially been high in urban informal settlements and rural areas
with poor WASH infrastructure. Typhoid is however not a reserve of Urban poor
populations alone
 The Burden of Typhoid fever in Kenya
TCV CASES REPORTED 2019-2025
6000

5000
❖ Most counties have
reported typhoid fever
4000 through the IDSR
❖ Typhoid burden data is
3000 suboptimal due to
diagnostic and reporting
2000 challenges

1000

• There is suboptimal surveillance data for Typhoid fever due to gaps in diagnosis, confirmation and reporting.
Blood culture is the gold standard, but most health facilities lack the capacity to do the test due
to factors such as lack of lab reagents, low HCW capacity among others
 Rationale for Introduction of Typhoid Vaccines
• Typhoid fever is a significant public health concern in Kenya with the highest burden being
children under 15 years, and the highest fatality rates in children under 5 years.
• The burden is underestimated due to challenges with diagnosis, confirmation and reporting
( The recommended confirmatory test for Typhoid fever in Kenya is the blood culture which
is often unavailable)
• Kenya has an increasing emergence and spread of antimicrobial resistant(AMR)
Salmonella typhi which poses a significant challenge to treatment
• Due to the high burden of typhoid in Kenya, suboptimal WASH infrastructure and the
increasing AMR, there is need for an effective tool, such as the typhoid vaccine to reduce
transmission.
• Typhoid vaccines are proven effective tools to reduce typhoid fever transmission
• Evidence of impact from other countries like Nepal, Pakistan and Zimbabwe have shown
significant reduction in cases following TCV roll out.
• The introduction of TCV into RI schedule for children at 9m will reduce morbidities,
mortalities associated with Typhoid fever as well as help in curbing the growing concern of
antimicrobial resistance.

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 Typhoid Conjugate Vaccines
21

• Kenya National Immunization Technical Advisory Group (KENITAG)

recommended the introduction of TCV into the routine immunization schedule,
to be given as a single dose to children at 9 months of age

• TCV was selected among the existing formulations of Typhoid vaccines because
of its suitability for use in younger children < 2 years of age

• TCV can safely be co-administered with other vaccines given at 9m including

Measles –Rubella, Yellow Fever and Malaria vaccines
Comparing Typhoid Vaccines
 Key Messages
• Typhoid fever is a highly infectious disease caused by an enteric bacterium, Salmonella
Typhi. It is transmitted via the faecal-oral route by contamination of food and water

• Children under 15 are at highest risk for typhoid fever with the highest fatality rates are
reported in children <5 years of age.

• It can be treated with appropriate antibiotics, though there is increasing antibiotic

resistance

• Typhoid conjugate vaccines are a safe and effective tools against Typhoid fever and in the
long term, AMR

• Long term improvement in WASH infrastructure and other prevention practices

alongside vaccines are crucial for effective prevention and control of typhoid and other
enteric infections
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 Thank you
for your attention!

National Vaccines and Immunization Program

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 MODULE 3

ELIGIBILITY AND CONTRAINDICATIONS

 Presentation outline

• Objectives

• Eligibility and contraindications for TCV vaccination

• Kenya immunization schedule

26

National Vaccines and Immunization Program

 Objectives

• Describe a child who is eligible for TCV vaccine

• Describe the contraindications for TCV vaccine

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National Vaccines and Immunization Program

 Eligibility and contraindications for TCV vaccination

• 9 months old child

Eligibility • Can be co-administered with other vaccines
like malaria, yellow fever and MR

Absolute • Hypersensitivity to any component of the

contraindications typhoid vaccine

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 Kenya Immunization schedule
Vaccine Disease Doses Age of Site/ route of Remarks
administration administration
BCG Tuberculosis (TB) 1 dose At birth Intradermal injection, upper Scar
mid left hand formation
OPV Polio 4 doses At birth, 6wks, 10wks, Oral, 2 drops Extra doses
14wks during
campaigns
Pentavalent Diptheria, Pertusis, 3 doses 6wks, 10wks, 14wks Intramuscular injection, upper None
Tetanus, Hepatitis, outer left thigh
Infuenza
PCV 10 Pneumonia 3 doses 6wks, 10wks, 14wks Intramuscular injection, upper None
outer right thigh
ROTA Rotavirus disease 3 doses 6wks, 10wks, 14wks Oral, 5 drops Don’t start
after 1 year
IPV Polio 1 dose 14wks Intramuscular injection, upper None
outer right thigh
Vitamin A Blindness 1 dose 6 months Oral, 100,000 IU capsule Given after
every 6
months until 5
 Kenya Immunization schedule
Vaccine Disease Doses Age of Site/ route of Remarks
administration administration

MR Measles 2 doses 9 and 18 months Subcutaneous injection, upper, Extra doses during
Rubella outer right hand campaigns, special needs
children to consult nurse
TCV Typhoid 1 dose 9 months Intramuscular injection, upper, Introduced into the
disease outer left thigh national routine
immunization schedule
YF Yellow fever 1 dose 9 months Intramuscular injection, upper, 4 endemic counties
outer left hand
RTS,S Malaria 4 doses 6, 7, 9 and 24 Intramuscular injection, upper, 8 endemic counties
months outer left hand
HPV Cervical 2 doses 10 – 14 years Intramuscular injection, upper, Special needs children to
cancer outer left hand consult nurse
Td Tetanus 5 doses Pregnant women Intramuscular injection, upper, 1st pregnancy, 2 doses
outer left hand Subsequent pregnancies, 1
dose
COVID-19 SARS COV2 2 doses Above 12 years Intramuscular injection, upper, Booster doses
 Thank you
for your attention!

National Vaccines and Immunization Program

31
TCV SUPPLY CHAIN AND LOGISTICS

Module 4

32
 Presentation outline
• Typhoid conjugate vaccine attributes
• Multi dose vial policy
• TCV cold chain requirements
• Monitoring vaccine potency
• TCV storage
• The shake test
• Vaccine stock management
• Supply chain data management
• Summary
 Objectives

○ Describe Typhoid conjugate vaccine (TCV) attributes

○ Describe vaccine cold chain/storage and handling requirements
○ Describe the vaccines management including planning and
documentation across all supply levels
Typhoid conjugate vaccine attributes

• Clear to slightly turbid liquid

• Has no diluent
• Vaccine Vial Monitor on the label
• Dose – 0.5 ml, Intramuscular (IM) use only
• 5 doses per vial
• Heat and freeze-sensitive.
• DO NOT FREEZE
• Stored at a temperature range of +2⁰C to +8⁰C
• Follows the multidose dose vaccine vial
policy

National Vaccines and Immunization Program

 Multi dose vial policy
6

• TCV is a liquid vaccine with the VVM mounted on the body of the vial. Therefore
MDVP applies

• It should be used within 28 days of opening (28-day rule) if the following

conditions are met:
• The expiry date of the vaccine has not passed
• The vaccines are stored under appropriate cold chain +2°C to +8°C
• The vaccine vial septum has not been submerged in water
• Sterile technique has been used to withdraw all doses
• VVM has not reached discard point

NOTE: The date and time of opening the vial must be written on the vial
National Vaccines and Immunization Program
 TCV cold chain requirement

• TCV - like any other vaccine - should be stored in cold chain

• Cold chain i s a system used for storing and transporting vaccines at

recommended temperatures from the manufacturer to administration

• Temperature monitoring ensures vaccine potency and safety

• TCV should be stored and transported at +2⁰C to +8⁰C at all levels of vaccines
supply chain

• Do not freeze TCV vaccine

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 Cold chain system

Cold chain system of ensuring

safety and potency of vaccines
from the manufacturer to the
point of use-

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 Vaccine storage and temperature requirements
Vaccine National Regional Sub County Health Facilities
Up to 12 Up to 3 Up to 3 months 1 month
months months

OPV -25oC to -15oC

Rotavirus -25oC to -15oC +2oC to +8oC

Measles Rubella (MR), BCG, -25oC to -15oC +2oC to +8oC
Yellow Fever Or +2oC to +8oC
DTP/HEP+HIB, IPV, PCV,
HPV, Td, Malaria, Covid 19, +2oC to +8oC
Typhoid Conjugate
Vaccine (TCV)
 Monitoring vaccine potency
• Vaccine Vial Monitor (VVM)
• A label with a heat-sensitive material, placed on a vial to register cumulative
heat exposure
How it works:
• USE vaccine when the square is white (Stage 1)
• USE FIRST when the square is lighter than the
circle (Stage 2)
• DISCARD when the square is the same colour as
the circle (Stage 3)
• DISCARD when the square is darker than the
circle (Stage 4).
 Cold Chain Equipment (CCE) Management
Ensure:
• Calculated and adequate CCE capacity to store TCV alongside other routine
vaccines
• That preventive maintenance is regularly conducted as planned for Optimal CCE
functionality
• Good air circulation around the refrigerator
• The refrigerator is clean and dry
• Engagement of Medical Engineers in cold chain equipment maintenance
• Documentation of all actions /interventions taken
• Defrosting in case of frost formation of more than 3mm

In case of refrigerator malfunction, refer to the contingency plan

 Contingency plan
• Ensure an emergency preparedness plan is in
place for vaccines in case of power or
equipment failure
• The plan should be available and easily
accessible (displayed near the CCE)
• It should contain:
• Emergency contact list of SCPHN or SCEPI,
BIOMED, KPLC etc
• Alternative storage locations (Name of facility,
Contact)
• Emergency transport arrangements (Available
passive cold box or container, rider, driver)
 Temperature excursion response
Follow the procedure below:
1. In case of power or CCE failure, quickly troubleshoot to identify the cause
2. Ensure the vaccines are kept at appropriate temperatures, pack vaccines, move
the vaccines to an alternative CCE as quickly as possible using cold boxes or
vaccine carrier(s).
3. Do NOT Freeze Typhoid Conjugate Vaccine. If freezing is suspected, Do
NOT use the vaccines;. Label the vaccines “Do Not Use” and quarantine them
at +2⁰C to +8⁰C and report to the Sub County EPI.
4. “Shake Test” should be done at the sub county level. Suspected frozen vaccines
should be stored under strict cold chain until the shake test is conducted
5. Record Temperature appropriately on the temperature monitoring chart
TCV Storage: Place your vaccines correctly in the refrigerator

• Use a temperature monitoring device at all times

• Place the temperature monitor on the yellow tray
• Maintain temperature between +2oC to +8oC
• Store vaccines in the appropriate vaccine tray
• Label open vials appropriately (refer to MDVP guidelines)
• Ensure regular maintenance of the refrigerator
• In case this refrigerator is not maintaining proper temperatures, implement the following steps;
1. Transfer vaccines to nearest working refrigerator

2. Call (write name and telephone no. below)

HF in-charge ________________________________

SCPHN _____________________________________

CC Technician _______________________________
ALWAYS MONITOR AND RECORD TEMPERATURES DAILY; MORNING AND EVENING.
 Vaccine Arrangement – Chest opening fridge
Horizontal/ Chest opening
Vial once opened
refrigerator
PCV10
RED TRAY TCV & PCV 10 – Return
TCV
Pentavalent – Return
Pentavalent & HPV ORANGE TRAY
HPV - Discard

TT/Td/IPV/ & YELLOW TRAY

TT/Td- Return
COVID19 IPV- Return
COVID19 - Discard
Rotavirus Vaccine GREEN TRAY Rota - Discard

BCG- Discard
BCG & MR BLUE TRAY
MR- Discard
OPV & Yellow Fever PURPLE TRAY
OPV – Return
Vaccine YF - Discard

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 Vaccine arrangement in the refrigerator: vertical
arrangement
• Arrange the vaccines in trays to allow free air
circulation
• Keep a ‘USE FIRST’ box for vaccines taken out of
the CCE and returned unused. To be used first in the
next session
• Vaccines with early expiration dates should be kept
in front to be used FIRST.
• Vaccines with VVM in Stage 2 should be used first.
• Vaccine at Discard point should be kept outside the
cold, ready for disposal. TCV

• Place TCV vials together with PCV10 vaccines

 When to suspect freezing

i. When the freeze alarm has been registered in the fridge tag
ii. Presence of particulate matter in the vial
iii. When the vaccines are exposed to sub zero temperatures for more
than one hour.

When this is confirmed, and freezing suspected the sub county

manager should conduct a shake test
 The Shake Test

• The “shake test” helps to

determine whether
liquid vaccines (Penta,
PCV, TCV & Td) have
been frozen

48
 The Shake Test - Video

• Click to play the video

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 Vaccine stock management

• Encompasses the processes needed to ensure a continuous supply of vaccines in the

right quantity and quality throughout the vaccine supply chain

• It involves forecasting needs, procurement, proper storage, distribution, accurate

recording and monitoring of vaccine stock and related supplies to meet
immunization program needs

• Aims to:
• Ensure proper accountability for all vaccines at all levels
• Reduction of vaccine wastages
• Reduction of incidences of overstocking or understocking
 Step 1: Forecasting and Quantification

• Various methods can be used to forecast the demand for vaccines and supplies
including:
a) Demographic (Target Population)

b) Past Consumption

c) Size of Vaccination Sessions

• Forecasting can be done using one or a combination of these methods,
depending on the quality of data and capacity

• Combining different forecasting methods can improve the accuracy of the final
forecast
 Target Population Method

• Requires 4 Parameters
i. Target Population (TP): Children <1 Women of Child Bearing Age (WCBA)
ii. Immunization Schedule for each Vaccine (antigen)
iii. Immunization Coverage (target coverage)
iv. Wastage Rate and Wastage Factor (WF)

• Formula:
(TP x Immunization Schedule x Coverage x WF )+ buffer

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 Target Population Requirements…
Immunization Schedule – Doses Required/Antigen
Vaccines Number of Doses
BCG 1
OPV 4
Pentavalent 3
PCV 3
Rota 2
IPV 1
TCV 1
MR 2
Yellow Fever 1
TD for pregnant women 2
HPV 1
Malaria 2
COVID-19 2
 Target Population Requirements…
Vaccine Wastage
• Accounts for “lost doses” due to breakages, peeled labels, VVM discard changes,
frozen vials, MDVP, over-age vaccinations etc

Two types of vaccine wastage

Open Vial Wastage
• Primarily related to packing format. Once opened vaccine vials are to be discarded
after a specific duration
• More common in SDP, towards the end of a campaign

Closed Vial Wastage

• Occurs due to both expiry and loss of product integrity along the supply chain due
to non compliance with storage temperature and other distribution requirements
 Wastage Rate/Wastage Factor…

Formula: Vaccine Wastage Rate (WR)

(Doses used – Doses administered) * 100

Doses used

Formula: Wastage Factor (WF)

100% supply = 1 / (1-WR)
100% supply – VWR

• Example: Wastage Rate = 60%, Wastage Factor = 100 / (100-60) = 2.5

•55
NVIP Recommended WRs and WFs for Routine Immunization

BCG OPV DPT PCV MR ROTA HP IP TD YF Malar Covid- TCV

V V ia 19

WR 80% 20% 20% 10% 50 5% 5% 10 20 5% 10% 10% 10%

% % %
WF 5 1.25 1.25 1.11 2 1.05 1.05 1.11 1.2 1.0 1.11 1.11 1.11
5 5

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 Estimating vaccine needs
Target population
• Expected 90% coverage Total Population

Parameters:
• Target population: TCV (9 months ) Target Population

• Wastage rate: 10% • TCV -9 months

• Wastage factor = 100 / (100 – Wastage Rate)

• Immunization Schedule – 1
• Coverage – 100% target population
Formula: Target population X Schedule X Coverage X Wastage Factor
 Exercise 1

• Using your county target population for TCV, fill in the forecasting sheet
provided

• Your counties/ subcounty/ health facility TCV annual vaccine needs

• Your vaccine needs for 1 & 3 months supply period
• The maximum stock for 1 & 3 month period with 25% buffer

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59
2A: VACCINE FORECASTING SHEET
NAME OF DEPOT/COUNTY/SUB COUNTY/ FACILITY………………………………....…………………………….....… YEAR……………………………
VACCINE: BCG bOPV IPV DPT HEP B+Hib PCV 10 ROTA MR YELLOW FEVER HPV Td TCV

1. ANNUAL VACCINE NEEDS (DOSES) BASED ON TARGET POPULATION (ALL CHILDREN UNDER 0-11,12-59 MONTHS OF AGE; 10 YEAR OLD GIRLS,PREGNANT WOMEN)
[A] Target population 1,000 990 990 990 990 990 990 990 990 990 990
[B] Doses in immunization schedule 10 4 1 3 3 2 2 1 2 3 1
[C] Expected Coverage 95% 90% 90% 90% 90% 90% 90% 90% 90% 90% 90%
[D] Wastage factor 5 1.25 1.25 1.25 1.11 1.05 2.5 2 1.05 1.25 1.05
[E] Total dose required this year = (A x B x C x D) 47,500 4,455 1,114 3,341 2,967 1,871 4,455 1,782 1,871 3,341 936

2. QUANTITY FOR SUPPLY PERIOD (DOSES) SUPPLY PERIOD: HF = 1 MONTH; SUB COUNTY STORE = 3 MONTHS; REGIONAL STORE= 3 MONTHS NATIONAL STORE= 6 MONTHS
[F] Supply period (months) 3 3 3 3 3 3 3 3 3 3 3
[G] Supply period (years) (F/12) 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25 0.25
[H) Total doses required for supply period (E X G) 11,875 1,114 278 835 742 468 1,114 446 468 835 234

3. MINIMUM STOCK (DOSES) ANY TIME YOUR STOCK REACH THIS LEVEL, YOU MUST REORDER IMMEDIATELY
[I] Reserve stock proportion = (25%) 25% 25% 25% 25% 25% 25% 25% 25% 25% 25% 25%
[J] Minimum or Reserve stock = (H x I) 2,969 278 70 209 185 117 278 111 117 209 58

4. MAXIMUM STOCK (DOSES) YOUR STOCK CEILING, NEVER STOCK MORE THAN THIS AT ANY POINT IN TIME
[K] Maximum stock (H+J) 14,844 1,392 348 1,044 927 585 1,392 557 585 1,044 292

5 SYRINGES AND SAFETY BOXES

TOTAL RUP 0.05ml AD 0.5ml AD syringe
Syringes & safety boxes syringe + syringe + needle + needle
Safety box
[L] Wastage factor for syringes 1.11 1.11 1.11 1.11 1.11 1.11 1.11 1.11 1.11
RUP syringe + ndl 2ml ( L* K/N) 824
RUP syringe + ndl 5ml 155 62 32 216
0.05ml AD syringe + ndl (A x B x C x G x L)+reserve stock (I) 3,295 3,295
0.5ml AD syringe + ndl (A x B x C x G x L)reserve stock (I) 309 927 927 618 309 618 927 309 4,636
Safety Box 81
[M] Maximum stock 216 3,295 4,636 81
6. QUANTITY TO BE ORDERED (DOSES) YOU MUST CALCULATE THIS EVERY TIME YOU WANT TO ORDER VACCINES
[N]Doses in vial/ Syringes in a box (only for rounding off) 20 10 10 10 4 1 10 10 1 20 10 100 100 100 1
BCG bOPV IPV DPT HEP PCV 10 ROTA MR YELLOW HPV Td TCV TOTAL RUP 0.05ml AD 0.5ml AD Safety box
[O] Quantity in stock at this time in doses ( Physical Count) 3,300,000 2,200,000 800,000 2,402,000 1,700,000 680,000 1,680,000 80,000 59,000 2,031,160 1,680,000 10 10 10 1
[P] Quantity to order (doses) (K-N) or (M-O for syringes) - - - - - - - - - - - 200 3,300 4,600 80

COMPILED BY…………………………....………………………………..…. DESIGNATION…............................................................................... SIGNATURE………………………..........................

DATE……………………………………
 Step 2: Ordering vaccines

• Ordering is triggered when stock level falls to the re-order level

• Order quantities are informed by the stock on hand, consumption trend, minimum
and maximum stock levels established for your facility

• Policy: Ordering frequency at HF is monthly, at subcounty and RVS is quarterly.

• Place an Order using the Ordering Form

Note: The process should be repeated based on policy ordering

frequency for equivalent supply period

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 Calculating order quantities
• Determine the following
• Utilization/consumption during the previous month
• Balance on hand
• Quantity used = Balance at the beginning of the month + Received during the
month – Closing balance

• Quantity to order = (Maximum Stock – Balance in Store)

• Order quantities can also be equal to doses utilized in the month if the consumption
is stable

• Use the order sheet provided to place your order

 Vaccine order form

TCV

62
 Receiving and storage
Receiving Vaccines Vaccine Storage

• Check quantity against the parking slip & type of • Systematically arrange vaccines and
vaccines and other supplies supplies
• Check VVM and record
• Place FT2 and vaccine in central area of the
unit
• Check for damages, opened packaging

• Count quantities to ensure consistency with • Organize and label vaccine in racks/trays
records that allow air circulation

• Register all accepted stocks in the vaccine stock • Use vaccine with the shortest shelf-life first,
ledger even if it arrived last (FEFO/ FIFO)
• Date, number of doses, batch/lot number,
VVM, expiry date

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 Issue and use
4

• Follow the first expiry, first out • Check and record details, in the
(FEFO) procedure during use vaccine ledger every time they
leave the storage point for use at
the session sites
• Follow the FIFO principle if all
the vaccines and supplies are of
the same shelf-life • Conduct a physical count
monthly/before placing an order
• Check the status of randomly
selected vials for intact labels, • Ensure that is adequate stock
expiry date, VVM and freezing before any vaccination session

National Vaccines and Immunization Program

 Vaccine Stock Ledgers

• Open a new vaccine stock ledger book

and record all TCV transactions

• Record the transactions in both TCV

ledger book and Chanjo eLMIS

TCV TCV

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How to fill vaccine stock ledger

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 Parts of Vaccine Stock Ledger Book
Ministry of Health
National Vaccines and Immunization Program
VACCINE STOCK LEDGER
VACCINE STORAGE LEVEL (Health Facility, Sub-county, County, Regional, National)_____________________________________________________________
ANTIGEN/ DILUENT_______________________________________________________________________________________________________________
Vaccines/Diluents
Date Vaccine Quantity in doses Vaccine Information Diluent Quantity in doses Diluent information Remarks
To/from
Receipts Receipts
Issues Losses Issues Losses
/Returns /Returns
Source/Destination Received Issued Discarded VVM Lot/Batch Expiry Vaccine Received Issued Discarded Diluent
name Stage
No. Date Expiry
(1,2,3,4)
Balance in Lot/Batch No. Balance in
Date
doses doses

NB: use red ink for incoming stocks and blue ink for outgoing stocks
All losses should be described in the "Remarks" column e.g expired, breakage, vvm discard point (3,4)

67
 Handling expired vials
• Use appropriate tools to identify the expired vaccines: ledger books, order sheets,
Chanjo eLMIs
• Remove the vaccine from the refrigerator and count
• Place them in a container/box clearly marked: ‘EXPIRED VACCINE FOR
DISPOSAL – DO NOT USE’
• Store the container/box appropriately and follow the waste management and
disposal guideline
• Record the expired vaccine in the ledger book and Chanjo eLMIS
• Prepare a Loss and adjustment report, Destruction and waste tracking forms

Institute measures to minimize loss due to expiries such as use of FEFO

Principle and good vaccine stock management practices
68
 Handling broken vials
• Write down the number of broken vials and the batch number(s) and put
them to one side

• If vials have been contaminated with spilled vaccine, write down the number
affected

• Place the broken and contaminated vials in a closed leak-proof plastic

container and treat the contents with disinfectant

• Clearly mark the container: ‘DAMAGED VACCINE FOR DISPOSAL– DO

NOT USE’’

69
 Good stock management practices

• Store the TCV doses in the top most tray (RED)

• Always arrange First-Expiry-First-Out (FEFO) and First-In-First-Out (FIFO)
• Always use VVM Stage 2 FIRST
• Keep vaccines arranged by expiry date
• Review stock levels before ordering
• Use appropriate documentation tools
• Remove expired vaccines from the cold chain and label them clearly for
disposal

70
 Supply chain data management

• Update Vaccine ledger books • Assess consumption

• Conduct monthly stock count • Determine session requirements
• Monitor temperature logs/charts • Reconcile stock imbalances
• Document Vaccination on tally sheets • Conduct corrective and
• Generate wastage reports preventive equipment
maintenance;
 Summary

• TCV is a liquid vaccine with the VVM on the label

• TCV once opened can be used for 28 days; important to ensure adherence to
multi dose vial policy
• TCV is stored at temperature +2°C to +8°C; remember it should NEVER be
frozen
• Order, receive, and issue vaccines using tools provided
• Resolve CCE issues promptly
• Document all TCV transactions using the appropriate documents accurately
• Ensure availability of adequate cold chain storage
72
 Thank you
for your attention!

National Vaccines and Immunization Program

 MODULE 5

SERVICE DELIVERY
 Presentation outline
• Objectives

• Introduction

• Immunization service delivery strategies

• Critical immunization service delivery activities

• Case scenarios

• Summary

75
 Objectives

1. Describe service delivery strategies

2. Explain critical immunization activities before, during and after
immunization session
3. Describe vaccine administration process
4. Describe safe injection practices
 Introduction

• Immunization service delivery refers to the planning, organization and

implementation of activities that ensure vaccines are provided effectively and
safely
• Sessions should be arranged and organized in such a way that they are
convenient, available and comfortable for the caregiver to encourage
subsequent visits
• For this to be realized, the manager should make sure that logistics required
are available and the environment is safe
 Immunization service delivery strategies
Permanent Fixed Sites Outreach/ Mobile Sites
• Public, private, FBO and • Established sites in
NGO/CBO immunizing communities, to ease access to
facilities the services
• Operate for few hours then
move to another place
• Considerations include, low
coverage, densely populated
locations, remote and areas of
poor access

78
National Vaccines and Immunization Program
 Permanent fixed sites
Refers to stationery location that is continuously operational for immunization
services as follows;
• Space and equipment for screening, registration, immunizing and recording,
area for weighing babies and charting their growth
• A table for vaccines, emergency tray and injection equipment
• A chair on which a client/caregiver can sit while waiting for immunization
• A chair for the health worker
• Space where clients can wait before/after being immunized and health
education bay

79
 Outreach and mobile site sessions
• Are held in a location other than a health facility
• The sites will be linked to health facilities

NB. Should be planned for at the beginning of the year during annual
microplanning
Good client flow and set up at outreach and mobile sites
 Activities at service delivery points
*Screening for
eligibility We encourage
screening of all
*Registration of children for eligibility
biodata in at all service delivery
permanent register points within the health
and MCH facility *Observation
handbook area

1 2 3

*Educate the caregiver on the vaccine

*Vaccine administration
*Documentation in tally sheet, MCH handbook
and permanent register
*Give a return date
 Critical immunization service delivery activities

STEP 1 STEP 2 STEP 3

After the actual

Before clients come During an actual vaccination
for immunization vaccination process (ending the session
of the day)
 Step 1: Before immunization

i. Setting up an immunization session

ii. Conditioning the ice packs
iii. Recording the refrigerator temperatures
iv. Selecting and removing vaccines for use

84
 i. Setting up an
immunization session

• In a clean area not directly exposed to

sunlight, rain or dust

• Easily accessible to clients but arranged

well to avoid crowding around the
immunization station

• Estimate your vaccine needs for the day

including outreach and mobile
vaccination sessions where applicable

National Vaccines and Immunization Program 85

ii. Conditioning the frozen
ice-packs

• Remove frozen ice packs from the

freezing compartment at least 30
minutes before the session begins

• Condition the ice packs by allowing

them to sit at room temperature until
the ice begins to melt and water starts
to form inside or use chilled water
packs.

N/B - Conditioning ice-packs before the

session prevents freezing vaccines.
86
iii. Record refrigerator
temperature

• Record the morning refrigerator

temperature reading on the
temperature recording sheet

NB: Minimize the number of

times the refrigerator door is
opened (ideally morning and
evening)

87
 iv. Selecting and removing the
vaccines for use
• Opened, followed by unopened vaccine
vials that had been taken for immunization
sessions (including outreach and mobiles
sessions) and then returned to the
refrigerator
• Vaccines with VVMs that have started to
change (stage 2)
• FEFO
• The oldest vaccines that have not yet passed
their expiry dates
• Remove adequate vaccine doses for the day
and record in the ledger book.
• Discard vaccines without labels, expired,
VVM stage 3 & 4
USE FIRST
88
 Stages of vaccine vial monitors (VVM)
• USE VIAL WHEN; the square is white
(stage 1) OR lighter than the circle
(stage 2)

• DISCARD VIAL WHEN; the square is as

dark as the circle (stage 3) OR darker
than the circle (stage 4)

89
National Vaccines and Immunization Program
VACCINE ARRANGEMENT:CHEST OPENING FRIDGE
TCV - Return

90
Vertical fridge
arrangement
Loading the vaccine carrier
• Place conditioned ice-packs or chilled
packs in the vaccine carrier (do not
freeze the vaccine)
• Place the vaccines and close the lid
tightly.
• During immunization sessions, keep
opened vials inserted through the
foam pad

N/B- Foam pad keeps vaccines inside the

carrier cool while providing a place to
hold and protect vials in use.
92
 Good Vs Bad Practice
During an immunization session, vials are protected from heat and wetness for a
longer period of time if they are inserted in a foam pad.
 Step 2: During immunization
• Invite the client/ caregiver to the immunization area
• Greet the client/ caregiver in a friendly way, and compliment her/him on
bringing the child/coming for immunization and offer a seat
• Screen and assess the client’s eligibility for TCV vaccines, and determine all
other vaccines the client is eligible for and advice accordingly
• Explain to the client/ caregiver about the vaccine (possible side effects and
report any incident of concern)
 Step 2 cont..
• Position the client appropriately
• Observe IPC – practice hand hygiene
• Remove the vaccine from the vaccine carrier
• Label vial with the date of opening (MDVP) for discard after 28days
• Prepare the vaccine and withdraw into a syringe
• Administer the vaccine

95
 Administration of TCV Vaccine
Safe injection practices are intended to prevent transmission of infectious diseases
among patients; between patients & health care providers; and prevent harm to other
people.
• Every injection must be safe:
• For the vaccine recipient – use sterile needle & sterile AD syringe of the
appropriate size
• For the health worker – avoid needle-stick injuries and contamination (do not
recap the syringe)
• For the community – dispose used injection equipment correctly
• When administering multiple injections for a child with missed vaccines on the same
limb, separate injection site by 2.5 cm (approximately 2 fingers width).

96
 Cont..
• The auto-disable (AD) syringe is recommended for administering
vaccines in EPI.

• Use 0.5ml sterile packed syringe and needle for each injection

• Loading the sterile syringe with 0.5 ml dose

• Remember to put the vial back onto the foam pad after drawing the vaccine

• Instruct the client/ caregiver to hold the child well, restrict movement and expose the
upper, outer quadrant of the left thigh OR the left deltoid muscle for those
24 – 59 months where applicable.
 Cont..
• Clean the site with a dry cotton swab.
• Divide the left thigh into three parts, support the upper, outer quadrant left
thigh muscle and hold the syringe at a 90° angle (intramuscular) to the site.

NOTE: TCV should never be given I.V, S.C or on the gluteal muscle

• DO NOT TOUCH THE NEEDLE.

• Push the needle into the skin. Push the plunger gently and inject the vaccine.
Administering vaccine – site and route

National Vaccines and Immunization Program

Summary of vaccine administration steps

100
 Step 3: After vaccination
• Observe waste segregation;
• Dispose used needles and syringe immediately into a safety box.
• Dispose the empty vials in the yellow bin.
• Dispose of general waste in the black bin.
• Document appropriately in the tally sheet, MCH handbook, permanent register
(MOH 510)

101
 Step 3: After vaccination
• Thank the client/ caregiver for coming for vaccination.
• Respond to any concerns and matters raised by the client/caregiver.
• Remind them of the next return date.
• Observe the client for 15-30 mins

102
 Practices at the end of the day:
1. Return both opened and unopened vials (including from outreach and
mobile sites) to the fridge for first use in the next immunization session

2. Record all returned unopened vials in the vaccine ledger

3. Clean the ice packs, vaccine carriers and leave the carrier open and
inverted for next use

4. Return the ice packs into the refrigerator

103
 Practices at the end of the day:
5. Record the evening refrigerator temperature on the temperature recording
sheet

6. Vials and other waste must be disposed appropriately as per IPC guidelines

7. If the safety box is ¾ full, close it and place in the waste holding area
awaiting collection

8. Summarize daily data from tally sheet (MOH 702) including data from
outreach and mobile sites, into summary sheets (MOH 710)

9. Leave the MCH/vaccination room (including outreach and mobile sites) tidy
104
Case scenarios

105
 What Should You Do in this Scenario?

A 9-month-old child in a yellow

fever endemic region is brought
to the health facility for routine
immunization.
 Answer

Appreciate the caregiver for bringing the child for

immunization services

Administer Yellow fever (IM, left, outer deltoid)

and TCV (IM, upper, outer left thigh) vaccines

Tally TCV and yellow fever vaccination in tally

sheet
Record TCV and yellow fever vaccination in MCHB
handbook and the permanent register and give
return date
 What Should You Do in this Scenario?

A 10 month old child in

Vihiga county who has never
received any antigen since
birth is brought to your
health facility.
 Answer

Appreciate the caregiver for bringing the child

for immunization services

Administer – BCG, OPV1, Penta1, PCV10 first

dose, IPV, malaria1, Rota1, MR1, TCV and
vitamin A (100,000IU)

Tally all antigens in the tally sheet

Record all vaccinations in the MCHB
handbook and the permanent register

Give a 4 week return date

Attach a CHP to the household for follow up
 Summary
• Ensure cold chain is maintained. DO NOT FREEZE THE VACCINE.
Store the vaccine with PCV10 in the refrigerator.
• TCV vaccine is administered on the upper, outer quadrant of the left
thigh muscle at a 90° angle (intramuscular) to the site. TCV vaccine
should never be given I.V, S.C or on the gluteal muscle.
• Any opened TCV vaccine vial should be labeled with date and time of
first use, returned to the fridge at the end of the session and used first
in the next immunization session.
• Always segregate your waste - Dispose used needles and syringes
immediately into a safety box, empty vials and other waste in the
yellow bin/bin liner and general waste in the black bin/bin liner
 Thank you
for your attention!

National Vaccines and Immunization Program

Parting shot

Let’s stop the transmission of typhoid

disease through quality vaccination practices during routine
immunization.

112
 MODULE 6

HEALTH CARE WASTE MANAGEMENT

 Presentation Outline

1. Learning Objectives
2. Definition of Health Care Waste
3. Types of Waste
4. Importance of Health Care Waste
5. Key Steps in Health Care Waste Management
6. Key Messages

National Vaccines and Immunization Program

 Learning Objectives

• To sensitize healthcare workers at all levels on proper immunization waste

management practices
▪ Define healthcare waste and identify its various types and categories

▪ Explain the importance of proper healthcare waste management

▪ Describe the key steps involved in effective immunization waste

management

▪ Demonstrate awareness of appropriate waste segregation and disposal

practices

115
 Definition of Health Care Waste

Healthcare waste:

• Is any solid, liquid or gaseous waste generated by i.e. health facilities, research
institutions, laboratories among others

• May also includes waste from minor or scattered sources, such as home-based
healthcare e.g. injections

116
 Types of Waste

Non-hazardous (General Waste)

o Comparable to domestic waste
o Constitutes 75-85% of waste generated in a
health facility

Hazardous waste
o Associated with some health risks
o Constitutes 10-15% of waste generated in a
health facility
 Importance of Healthcare Waste Management

• Minimize waste-related health risks, including disease transmission

• Protect waste handlers from hazards
• Reduce environmental pollution (air, water, land)
• Lower waste management costs
• Promote resource recovery (reduce, reuse, recycle)
• Control pests like insects and rodents
• Prevent nuisance (odor, unsightliness)
• Stop scavenging by animals and humans
• Enhance aesthetics for a pleasant hospital environment

118
Key Steps in Proper Vaccination Waste Handling

Generation
Containment
(minimize i.e
Segregation (Handling and
order what you
Storage)
need)

Collection and
Disposal Treatment Transportation
 Waste Segregation

Open vials should be discarded in a separate yellow bin liner

that is well labelled
 Waste storage

• Store waste temporarily ‒ before on-site

disposal or off-site transport
• Always separate non-risk and hazardous
waste to prevent cross-contamination
• Avoid waste accumulation—dispose it of
regularly

National Vaccines and Immunization Program

 Key Messages

1 2 3 4
Prevent infections and Segregate waste at Dispose of used syringes Seal and dispose of
protect the environment source using color- immediately in safety safety boxes when ¾
through proper waste coded bins boxes—no recapping full; never sort sharps
handling manually
End of module

Thank you for your

attention
ADVERSE EVENTS FOLLOWING
IMMUNIZATION (AEFI)
 Presentation Outline

1. Learning Objectives
2. Introduction and definition of AEFI
3. Classification of AEFIs by severity and clinical features
4. Categorization by cause
5. AEFI Identification, Reporting, and Investigation process
6. Key Messages

National Vaccines and Immunization Program

 Learning Objectives
• To equip healthcare workers with the skills to identify, manage,
report and investigate AEFIs in accordance with national guidelines

i. Define Adverse Events Following Immunization (AEFI) and

classify them by severity and clinical features
ii. Differentiate AEFIs based on their underlying causes
iii. Describe the national procedures for identifying, reporting,
and investigating AEFIs
iv. Recognize common gaps in AEFI management and apply
recommended solutions
 Definition of AEFI

An adverse event following immunization is

• Any unwanted or unexpected medical occurrence
• which FOLLOWS immunization
• May or may not be caused by the vaccine
• may be an unfavorable or unintended sign, abnormal laboratory finding,
symptom or disease
 Categories of AEFI

AEFI can be categorized in terms of —

1. Cause of the AEFI
2. Intensity of the AEFI (mild, moderate, severe)
3. Outcome of the AEFI(serious, non-serious)
4. Duration of onset after administration of the vaccine (immediate onset,
delayed onset)
 Classification of AEFI by Cause
5
1 2 3 4
Vaccine product- Vaccine quality Immunization Immunization
defect-related related anxiety-related Coincidental
related
event

An AEFI that is An AEFI that is

An AEFI that is An AEFI that is
caused or caused by
caused or precipitated by a An AEFI
caused by something other
precipitated by a vaccine that is due than the vaccine
to one or more Inappropriate arising from product,
vaccine due to one quality defects of immunization
vaccine handling, anxiety about
the vaccine product error or
or more of the including its prescribing or immunization
administration the
anxiety
inherent properties device as provided administration
immunization
by the
of the vaccine manufacturer

product

Cluster of AEFI: Two or more cases of the same adverse event related in time, place or vaccine
administered
 AEFI by Outcome (serious)
A Serious AEFI may result in: Wrong injection site
• Results in death also that result in
injection site swelling
• Requires inpatient hospitalization
• Persistent or significant disability Stevens-Johnson
Syndrome (SJS) - severe
ulceration, crusting, and
• Is life-threatening inflammation of the lips
and oral mucosa
• Congenital abnormalities
BCG Vaccine-Induced
Injection Site Ulcer or
Abscess

45
8
Typical AEFIs Following Typhoid Conjugate Vaccine

Less Common Events (<1%) Systemic Reactions

• Rash or itchiness • Low-grade fever (4–10%)
• Transient dizziness • Irritability, fatigue, headache
• Fussiness or persistent crying (in • Muscle/joint aches in older children
infants) • Mild GI upset (nausea, diarrhea) –
• Monitor and report if it persists >3 days uncommon

Local Reactions (Occur in 3–5%) Intervention

• Pain or tenderness at injection site • Reassure caregivers
• Swelling or redness (usually mild) • Advise symptomatic relief (e.g.,
• Resolves within 48 hours paracetamol for fever)
• Monitor and report if it persists >3 days

Typbar-TCV has demonstrated a strong safety profile

 Preparedness to Respond to AEFI
Each team should have at least:

i. An emergency plan of action

ii. Well-equipped emergency tray

Adrenaline injection 2 amps

iii. Complete emergency kit for each fixed post/ designated health facility

iv. AEFI reporting forms

• Keep children at site for 15 – 30 minutes after vaccination for observation

• Each county/sub-county to constitute a team to monitor and investigate AEFI

 Emergency Tray

Emergency tray contents Adrenaline Dosing

1. Adrenaline (at least 2 ampules ) 0.01ml/kg up to a maximum of 0.5
2. Cannular ml injected intramuscularly
3. Syringes and needles Children under 3 years: 0.1 ml
4. Ambu Bag-with mask
Children 4-5 years: 0.2 ml
5. Clean gloves
6. Swabs
7. Stethoscope
8. Paracetamol
 Responding and Reporting AEFI
• Manage the patient per presentation, refer promptly if need be Client and
Caregivers
• Reassure the caregiver (Public)
*271#
• Fill the AEFI Report form (in triplicate)-Facility, Sub-county and
County/National
• Submit to Sub-County Officer/PHN/SCMOH/SCHRIO/National
• Sub County to upload to PvERS within 24 hours:
[Link]
• Serious AEFI (death, life-threatening or clusters)
• Report immediately by phone as the form is being filled
• Document in the Tally Sheet, MCH Booklet & MOH 710 summary for monthly upload

Note: Reporting an AEFI does NOT imply causation by vaccine or vaccinator

 Timely AEFI Reporting a by Caregiver

• If an AEFI occurs at home, encourage the caregiver report

immediately by phone, in person to the nearest health facility or self reporting
via the PvERS USSD code *271#

• Conduct regular health talks at vaccination sites and during community

outreach to inform caregivers about:
oExpected or anticipated vaccine reactions (e.g., mild fever,
pain at injection site)
oWhen and how to seek medical help
oThe importance of reporting any unusual symptoms post-
vaccination
 Filling the AEFI reporting form at vaccination site
The following should be clearly capture on the AEFI form:
• Client information
• Well described Immunization event(s)
• Indicate the dose number and not the quantity administered (e.g. dose
1,2,3,4)
• Adverse event(s) description
• Relevant medical and treatment history and relevant medical/clinical
reports attached(if any)
 AEFI Form

• Ensure all the fields are

completely and
accurately filled with
clinical notes and
incidence report to
facilitate quality
investigation and causality
assessment
• Inform your supervisor
and/or AEFI focal person
Immediately
▪ ( Phone call) and complete
the reporting form within
24 hours

National Vaccines and Immunization Program

 Case study

On 5th July 2025, at 10:30 am, approximately 30 minutes after receiving Typhoid
Conjugate Vaccine (TCV), 1st dose of Measles Rubella and second of Malaria RTSS
vaccine, Achieng Ochola (9 months old old Female), developed a high-grade fever of
39.5°C, swelling around the eyes and lips, and experienced difficulty in breathing.
She was promptly managed at Upendo Health Centre (KMFL Code: 38672) with 0.1
ml of intramuscular adrenaline, placed on oxygen support, and urgently referred to
Mwangaza County Referral Hospital. At the referral facility, the child was stabilized,
admitted for observation, and made a full recovery within 48 hours.
 Questions

1. Fill out the AEFI Reporting Form using the information above

2. Identify the type of the AEFI

3. Discuss how you would initiate the investigation and follow-up

communication
 Additional details
Vaccination Details Patient Demographic Information Reporting Health Worker
• Health Facility: Upendo • Name: Achieng Ochola Details
Health Centre • Age: 12 months • Name: Mary Wanjiru
• IP Number: IP/2025/LC-084
• KMFL Code: 38672 • Designation: Registered Nurse
• Address: Pamoja Village
• Sub-County: Mazuri Sub- • Ward: Tumaini Ward • Facility: Upendo Health Centre
County • Sub-County: Mazuri • Email:
• County: Lengo County • County: Lengo [Link]@[Link]
• Parent/Guardian Name: Beatrice • Phone Number: +254 722 456
Ochola 789
• Phone Number: +254 712 678 900

Diluent Batch
Vaccine Batch Number Expiry Date Diluent Expiry Manufacturer
Number
TCV (Typbar-TCV) MR-2458K 31-Aug-2025 Not applicable Not applicable Kenya Biovax
MR (Measles- Serum Institute of
MR-1156V 30-Nov-2025 DIL-MR/1156V 30-Nov-2025
Rubella) India
RTS,S (Malaria DIL-
RTS-07KLM21 31-Dec-2025 31-Dec-2025 GSK / PATH
Vaccine) RTS/07KLM21
Answer 1
• Ensure the
AEFI form is
completely
and
accurately
filled
 Answer 2: Type of AEFI

Serious AEFI — based on the criteria:

o Life-threatening symptoms (difficulty breathing)

o Required urgent medical intervention
o Resulted in hospitalization
 Answer 3: How to initiate investigation and follow up

Initiation of Investigation Follow-Up Communication

• Notify the Sub-County EPI team immediately • Upload the report to PvERS within 24
• Constitute an AEFI investigation team as per hours and document in relevant data
national guidelines tools (tally sheet, MCH booklet)
• Collect relevant data: vaccination records, • Sensitize facility staff on the case and
vial/batch, storage conditions, and patient reinforce emergency response
history protocols.
• Conduct interviews with the caregiver and • Share findings with the county health
healthcare staff who administered the vaccine management team ( If not
• Retrieve and examine the vaccine vial for any participated)
abnormalities • Provide regular updates and feedback
• Complete the AEFI investigation form and to the caregiver on the child’s condition
submit it to the county and national level and outcome
 AEFI Reporting Pathway
MOH Director General

MAH
Sponsors

MOH 710
 AEFI Investigation

AEFI investigation is a simple assessment to a more rigorous fact finding of a

reported serious AEFI that aims to:
• Confirm the diagnosis of AEFI reported
• Identify the risk factors
• Identify & address immunization errors
• Decision-making
• Inform Communication
• Causality assessment
• Inform Research*
 AEFI Cases to be investigated

• All suspected AEFI cases must be reported – both serious and non-serious
o Non-serious AEFI do not need to be investigated

• The following suspected AEFI must be investigated

• Appears to be a serious event (as defined by WHO) of known or unknown

cause;

• Belongs to a cluster of AEFI;

• Is a previously unrecognized event associated with an old or newly
introduced vaccine;
• Involves an increased number or rates of known causes;
• Causes significant parental or public concern
 Composition of AEFI investigation team
. County Health Management Sub-county Health Management

1. County Director of Health [Link] County Medical Officer of Health

2. County EPI Logistician 2. Sub County EPI Logistician

3. County Health Records Information Officer 3. Sub County Health Records Information Officer

4. County Disease Surveillance Coordinator 4. Sub County Pharmacists/ PV

[Link] Pharmacists/PV 5. Sub County Disease Surveillance

6. Sub County Health Promotion Officer

6. County Health Promotion Officer

7. Physican/Clinician 7. Physican/Clinician

8. County Community Focal Person 8. Sub County Community Focal Person

 Roles in AEFI Surveillance
• Caregiver • Sub-county
• Healthcare worker • County
• National
1 2
AEFI
Detection Investigation
Notification & Analysis
Reporting

4 3
Feedback Causality
Assessment

• Client/Caregiver • National vaccine

• Sub-county safety Advisory
• County Committee
• National (NVSAC)

148
 Key Messages

Always manage Report serious AEFIs

and report all AEFIs AEFIs can be
immediately by phone
promptly ( Serious and categorized by cause,
and upload to PvERS
non-serious) severity, and outcome
within 24 hours

Ensure teams are equipped Maintain proper

with emergency supplies and documentation and
AEFI reporting tools communicate clearly with
caregivers to build trust
“ You need not be certain…Just
be suspicious”

Report all SUSPECTED

AEFI
End of module

Thank you for your

attention
 MODULE 7
RECORDING, REPORTING AND MONITORING OF
TYPHOID VACCINATION DATA
 Presentation Outline

How to use the TCV vaccination documentation tools

1

What is the process of monitoring Typhoid

2
Vaccination Coverage?

3 What Is the process for AEFI monitoring and

reporting?

97
National Vaccines and Immunization Program
 Learning objectives

• Define process of recording of TCV vaccine coverage data

• Describe the reporting of TCV vaccine coverage data
• Describe the monitoring of TCV vaccine coverage at service
delivery level

96
National Vaccines and Immunization Program
Data Recording And Reporting Procedure

Key steps Tools

1 Register each eligible child into the permanent register Immunization Permanent register

2 Record the data of child in the MCH Handbook MCH Handbook

3 Vaccinate the child then tally Immunization Tally sheet

4 Summarize the sub-totals of children vaccinated per

vaccine dose Immunization Monthly summary

5 Report the sub-totals to the sub county at the end of the

sheet

month

15
National Vaccines and Immunization Program 5
 Tool 1: Mother and Child Handbook

MCHB COVER PAGE MCHB

Key Point
• New MCH Handbook will have a
section for TCV documentation
Tool 2: Immunization permanent register (MOH 510)

• It is a permanent record for every child

• It helps health care providers keep track of the immunization services offered
to each child
• It provides important information for the guardians in case of follow up

National Vaccines and Immunization Program

157
 Contents of an Immunization Permanent Register

Key information

• Serial number
• Child number (unique identification)
• Name of Child
• Date of Birth
• Gender
• Name of parent(s)/care giver, telephone number /landmark
• Vaccinations /Vit A provided

National Vaccines and Immunization Program

158
Immunization Permanent Register

National Vaccines and Immunization Program

159
Instructions Page for Immunization Permanent
register(MOH-510)

National Vaccines and Immunization Program

Cont.…Instructions Page for Immunization Permanent
register(MOH-510)
Serial Number
• This is sequential Number that describes the workload of the facility from its
inception written serially 1, 2,3…In a new year the serial number continues while
the year changes e.g., 312/2024 to 313/2025

Child Number
• This is the unique number given once for the lifetime of the child i.e. the child’s
Identity – ID in health e.g. Child No. 001/25.
• The page number on the permanent register should be indicated on the MCH
Handbook for ease of reference

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Immunization Permanent register(MOH-510)

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 Tool 3: Immunization Tally sheet (MOH702)

• It's used by health care providers to Tally every time they administer a dose of
vaccine.
• Mark appropriately according to age of the child.
• At the end of each session, total the number of specific antigen administered
and transfer to summary sheet
• A new tally sheet should be used at start of each month

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Immunization Tally Sheet

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Immunization Tally Sheet

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 Tallying Process
• Vaccinate the child, then tally using the tally sheet
• Tally each child vaccinated by crossing out the zero diagonally

• Correctly capture the under 1 and above 1 year in their respective

rows

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 Tool 4: Immunization Summary Sheet (MOH 710)

• It is used by the health care providers to summarize the daily tallies at the end of the
day.
• The summary sheet is filled in duplicate. One copy remains at the health facility and
the other copy is taken to the sub county office on the 5th of every month.

It has 3 sections:
• Doses given
• Cold Chain, Logistics and Vaccine Stockouts
• Commodity management section.

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Immunization Summary Sheet

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Immunization Summary Sheet

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 Immunization Summary Sheet

Section C

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Data Entry of TCV in KHIS
Key Points
• Data entry is done
at the facility level
by the HRIO by 5th
of every month
• It's expected by
15th all the reports
have been
uploaded into
KHIS
• It's important to
observe the
completeness,
accuracy and
timeliness of all
data uploaded into
the KHIS

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 Defaulter Tracking
Definition of Defaulter

• A person who starts but fails to complete the immunization schedule for which they are eligible.

Methods of Tracking Defaulters

• Immunization permanent register(Primary source)

• Review registers on monthly basis to identify infants who may have failed to receive subsequent
doses of vaccine they are due for
• Mother child booklet
• Screened all children who come facility to check out immunization status
• Screening – defaulter tracking in other facility departments (outpatient, inpatients) and use of
community health promoters

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Defaulter Tracking Register

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 AEFI Reporting Form

⚫ AEFI report should contain

⚫ Reporter details

⚫ Patient details

⚫ Details of the event

⚫ Details of the vaccine

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Vaccine management
tools
 Vaccine Ledger Book
Ministry of Health
National Vaccines and Immunization Program
VACCINE STOCK LEDGER
VACCINE STORAGE LEVEL (Health Facility, Sub-county, County, Regional, National)____________________________________________________________
ANTIGEN/ DILUENT_______________________________________________________________________________________________________________
Vaccines/Diluents
Date Vaccine Quantity in doses Vaccine Information Diluent Quantity in doses Diluent information Remarks
To/from
Receipts Receipts
Issues Losses Issues Losses
/Returns /Returns
Source/Destination Received Issued Discarded VVM Lot/Batch Expiry Vaccine Received Issued Discarded Diluent
name Stage
No. Date Expiry
(1,2,3,4)
Balance in Lot/Batch No. Balance in
Date
doses doses

NB: use red ink for incoming stocks and blue ink for outgoing stocks
All losses should be described in the "Remarks" column e.g expired, breakage, vvm discard point (3,4)
 Vaccine Ordering Sheet

TCV

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Vaccine Forecasting Sheet

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 Summary
• Monitoring and reporting of TCV vaccine coverage is crucial for evaluating the
performance of the immunization program.

• Vaccine coverage should be monitored with a set of tools including Immunization

Permanent Register, Immunization Tally Sheet, and Immunization
Summary Sheet.

• The Target Population for TCV is under 1 year and the vaccine will be given at 9 months.

• Report any AEFI using AEFI Reporting form, PvERS, USSD Code *271#

• Data entry to be done at the facility level by the HRIO by 5th of every month

• All the reports to be uploaded into KHIS by 15th of every month.

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 Thank you
for your attention!

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 MODULE 8

SOCIAL BEHAVIOR CHANGE

COMMUNICATION
 Presentation Outline
• Objectives
• Introduction
• Importance of SBC For TCV Introduction
• ACSM Strategies
• Triple A Communication
• Role of Health care workers and CHPs in TCV Introduction
• Common Community Concerns and suggested Responses
• Risks and Crisis Communication
• Key Messages TCV into Routine Immunization

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 Objectives
● To explain the importance of Social and Behaviour Change (SBC) in driving demand for TCV
● Demonstrate application of Triple A communication approach to promote TCV at community
and facility levels.
● To understand the roles of health care workers and community health promoters (CHPs)
in TCV introduction.
● To address common community concerns and misconceptions about TCV and provide
culturally sensitive, evidence-based responses.
● Demonstrate application of risk and crisis communication principles to manage vaccine-
related rumours or adverse events.
● Promote key messages that integrate TCV into routine immunization, reinforcing its
importance alongside other childhood.

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 Introduction
Why We Need the Typhoid Vaccine (TCV);

● Typhoid fever mainly affects ● Vaccination is the

best protection
children, with the highest risk of
death in those under five.

● Treatment is costly, and drug- ● SBC helps communities

resistant strains are harder to understand, accept, and
manage. Climate change and create demand for the
crowded areas increase its spread. typhoid vaccine.

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Importance of SBC for Typhoid vaccine Introduction
● Creates public awareness and demand for Typhoid vaccination
● Educates the public on typhoid diseases and benefits of
vaccination
● Build trust among the community so as to promote the uptake
of the Typhoid vaccine into routine immunization
● Addresses resistance and hesitancy due to misconceptions,
misinformation, myths, disinformation and rumors
● Promotes active participation of stakeholders
● Promotes positive health-seeking behavior among the
caregivers for optimal uptake of Typhoid vaccine

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 SBC Strategies
Advocacy
● Use of local influencers and opinion leaders (chiefs, elders, religious leaders)

● Community-level advocacy with local leaders, school heads, and religious institutions

Communication
● Dissemination of information to communities through interpersonal communication (IPC)
● Community dialogue sessions and barazas
● Local media engagement (radio talk shows, vernacular radio spots)
● Debunking misinformation through CHPs during household visits and community meetings
● Use of IEC materials (posters, leaflets, flipcharts) tailored to local languages
● Integration of TCV messaging into existing health outreach activities (e.g., MCH, WASH)

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 SBC Strategies Contd.
To support the rollout of TCV into routine immunization, the following SBC strategies have been
identified for use by healthcare workers to enhance community awareness, acceptance, and
demand for the vaccine.

Social and Behavior Change (SBC):

● Identify and respond to common concerns, misinformation, disinformation, rumors
or hesitancies in the community.

Social Mobilization
● Actively involve local communities, and grassroots networks to build trust, drive demand,
and encourage participation in the TCV introduction.
● Engagement of youth groups and peer educators in message dissemination
● Social mobilization through market days and places of worship
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Triple A communication to deliver Key messages to
stakeholders

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Advise client;

● Inform communities on what typhoid fever is — a serious illness caused by

Salmonella Typhi, often spread through contaminated food and water.
● Share the common signs and symptoms of typhoid, such as prolonged
fever, headache, weakness, stomach pain, loss of appetite, and sometimes
rashes.
● Emphasize the importance of handwashing, drinking safe water, proper
food handling, and improved sanitation as key measures to prevent
typhoid.
● Inform caregivers that the TCV is a safe and effective vaccine that protects
against typhoid fever.
● Specify who is eligible for the vaccine — children aged 9 months. Encourage
parents and caregivers to bring their eligible children for typhoid
vaccination.

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● Encourage parents and caregivers to express their concerns.
Listen attentively and provide clear, honest information to
address their worries.
● Like any other vaccine some people may experience slight pain
or swelling at the injection site. These side effects are usually
mild and go away on their own.
● If your child develops a fever or shows any signs of illness after
vaccination, visit your nearest health facility immediately for
management.
● Reassure them that the vaccine is safe, effective, and an
important step in protecting children from typhoid disease.

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 ● Ensure all scheduled vaccines are received on time for full
protection.

● Remind the caregiver of the return date and record it in the

Mother and Child Health Handbook.

● Keep all health records safe and up to date.

● Encourage them to bring the health record book to every
visit—even if they missed a previous appointment.

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Role of Health Care Worker in
TCV Introduction
Healthcare workers (HCWs) are a credible and
trusted source of health and immunization
information.

Therefore, they should:

● Advocate for the introduction of the Typhoid Conjugate Vaccine (TCV) into the routine
immunization schedule.
● Clearly explain the rationale for TCV introduction on, including its public health benefits.
● Address any concerns or misconceptions the public may have about the vaccine.
● Sustain demand for TCV by promoting an introduction approach to routine immunization.
● Actively engage stakeholders to support and ensure the successful rollout of TCV introduction.
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Role of Community Health Promoters
● Educating caregivers on the importance of TCV
vaccination, how it prevents typhoid disease, and
the eligible age group.
● Mobilizing eligible children to receive the TCV
vaccination.
● Assure caregivers that it is safe for children to
receive multiple vaccines (MR, TCV, Malaria,
Yellow Fever) during a single visit.
● Screening and referring all eligible children for
vaccination.
● Referring adverse events following immunization
(AEFI) to the nearest health facility.
 Role of Community Health Promoters

● Encouraging caregivers to continue practicing other preventive measures, such as

regular handwashing.
● Addressing and countering misinformation, myths, misconceptions,
disinformation, and rumors about vaccines.
● Reassuring parents and caregivers that the typhoid vaccine is safe,
effective, and essential for protecting their children.
 Common community concerns and suggested
responses
Concern Suggested response

Vaccine safety concerns TCV vaccines are approved by WHO and Ministry of Health. They are safe for your child

Fear of side effects Most children may get a mild fever or mild swelling at the injection site which goes away
quickly. Serious effects are very rare.

Religious objections TCV vaccines do not contain any harmful or forbidden substances. Many religious leaders
support this campaign in order to protect life

Cultural beliefs TCV vaccination are the best way to protect our children’s health. They do not go against
our traditions at all

Misinformation/rumors There are many false messages about vaccines TCV included. Always trust information
from health workers

Access/distance issues We are bringing TCV vaccination closer to you. Please go to the nearest health facility to get
your child vaccinated

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How Healthcare Workers Should Communicate During
an AEFI
• Stay Calm and Professional
• Report the AEFI Promptly
• Fill the AEFI form and report to the relevant
• Show empathy and confidence.
(Subcounty,County and National) authorities
• Avoid panic — your reaction influences immediately.
others.
• Inform the caregiver that the AEFI will be
followed up.
• Reassure the Caregiver or Parent
• Be Honest but Reassuring • Provide Follow-Up Information
• Use clear, simple language: • Let the caregiver know what steps will be taken
“We understand your concern. This next and who to contact.
sometimes happens and we are here to
help.”
• Provide Feedback to the Community
As soon as feedback has been brought the health
• Provide Immediate Care worker should Notify the community Health
• Prioritize the child’s well-being. Promoter so that accurate and consistent information
• Ensure the AEFI is managed as per can be shared with the community, address concerns,
guidelines (e.g., refer if necessary). and prevent the spread of misinformation.

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 Key Messages

● Emphasize the importance of ● Inform caregivers that ● Reassure them that the
handwashing, drinking safe the TCV is a safe and vaccine is safe, effective,
water, proper food handling, effective vaccine that and an important step in
and improved sanitation as key protects against typhoid protecting children from
measures to prevent typhoid. fever. typhoid disease.

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Visit Vaccines Kenya Social Media Handles

@Vaccines Kenya across all social media platforms

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 Thank you
for your attention!

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