Immunization in Practice: A Practical Guide for Health Staff

Building on the previous edition (2004) of Immunization in Practice (IIP), which has been translated and used throughout the world, this 2015 update of the World Health Organization (WHO)'s practical information guide is meant to support the work of those at the health facility and sub-national levels. Having as its intention to meet the demand to improve immunisation services of all kinds so as to reach more infants in a sustainable way, the IIP builds upon the experiences of polio eradication and thus includes material adapted from polio on planning, monitoring, and use of data.

It includes:

• Module 1: Target diseases and vaccines - lists diseases in alphabetical order. Where combination vaccines are recommended, their details are presented in summary tables. Different sections of this module introduce some of opportunities to promote integrated services and improve the overall health of recipients: human papillomavirus (HPV) vaccination as an opportunity to link to cervical cancer control and adolescent health services; Vitamin A supplementation as part of the Expanded Programme on Immunization (EPI) Plus; and pneumonia and diarrhoea control measures complementary to immunisation as part of the 2013 integrated Global Action Plan for Pneumonia and Diarrhoea.
• Module 2: The vaccine cold chain - provides practical guidance for workers at health facility level.
• Module 3: Ensuring safe injections - discusses practices to ensure safety of the child, the health worker, and waste handlers and the community.
• Module 4: Micro planning for reaching every community - starts with maps at district and health centre level, which should be updated to include all population centres and groups in the catchment area and to flag high-risk areas. It next describes how to identify priority, high-risk health centres, and communities based on numbers of unimmunised children. It then describes how to clarify barriers to service access and utilisation in priority communities and to make a workplan for solutions. It concludes with making a session plan and following up on defaulters.
• Module 5: Managing an immunisation session - discusses, as one step in this process, the communication needed throughout each encounter with caregivers during the session. For example, some tips include: "Working with different cultures often presents challenges and individual differences occur within any culture. For an individual health worker, it may help if they: understand their own attitude to immunization; maintain confidence in their ability to talk about the vaccines and the diseases they prevent; develop skills for giving one or more injections quickly, safely and with little discomfort; have a genuine interest in each individual; listen without judgement - immunization may challenge people's views of health and well-being; look beyond what is being said - the health worker should observe body language and ask questions to check understanding of what is being said and felt; check that the caregiver understands the information given, which should be accompanied by giving written and other reminders as appropriate for the situation; [and] remain patient and kind." A chart on page 13 of this 5th module lays out communication tips at each stage in the vaccination encounter.
• Module 6: Monitoring and surveillance - explains how to collect and report data for the monitoring of immunisation services and the surveillance of vaccine-preventable diseases and adverse events following immunisation (AEFI). The examples in this module show paper-based recording and reporting, but data collection principles apply to other modalities. While the use of electronic tools for district data monitoring is encouraged by WHO, their implementation and instructions for use will depend on national or central authorities and objectives.
• Module 7: Partnering with communities (see Related Summaries, below) - builds on the previous modules to provide additional details to guide health staff and communities as they work together to plan, provide services, promote these services, improve service quality, track eligible children, and address resistance to immunisation. "Partnering will and should be different in different places depending on local needs, resources and capabilities." It is based on the principle that when communities are involved in planning, providing and evaluating services, they will develop stronger trust and ownership of those services. Annex 7.1 provides advice for hosting community meetings, and annex 7.2 is a checklist for non-governmental organisation (NGO) involvement in immunisation.

Throughout, the publication presents numerous global recommendations and tools that can be useful at the local level, but users should use this guidance in conjunction with their own own country programme's guidance and tools.