Expanded Program for Immunization (EPI)

Principles of EPI 1. 2. 3. School Entrants/ Grade 1 / 7 years old Epidemiological situation Mass approach Basic Health Service Objectives of EPI To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease

The 7 immunizable diseases 1. 2. 3. 4. 5. 6. 7. Tuberculosis Diptheria Pertussis Measles Poliomyelitis Tetanus Hepatitis B

Elements of EPI Target Setting Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the vaccines were maintained under proper environmental condition until the time of administration. Information, Education and Communication (IEC) Assessment and evaluation of Over-all performance of the program Surveillance and research studies

Target Setting Infants 0-12 months Pregnant and Post Partum Women

Administration of vaccines Vaccine Content BCG (Bacillus Calmette Guerin) Live attenuated bacteria

Form & Dosage Freeze dried Infant- 0.05ml Preschool-0.1ml liquid-0.5ml

# of Doses 1 ID

Route

DPT (Diphtheria Pertussis Tetanus) OPV (Oral Polio Vaccine) Hepatitis B Measles Schedule of Vaccines Vaccine BCG

DT- weakened toxin P-killed bacteria weakened virus Plasma derivative Weakened virus

IM

liquid-2drops Liquid-0.5ml Freeze dried- 0.5ml

3 3 1

Oral IM Subcutaneous

Age at 1st dose At birth

Interval between dose

Protection

DPT OPV Hepa B

6 weeks 6weeks @ birth

BCG is given at the earliest possible age protects against the possibility of TB infection from the other family members 4 weeks An early start with DPT reduces the chance of severe pertussis 4weeks The extent of protection against polio is increased the earlier OPV is given. @birth,6th week,14th week An early start of Hepatitis B reduces the chance of being infected and becoming a carrier. At least 85% of measles can be prevented by immunization at this age.

Measles

9m0s.-11m0s.

6 months earliest dose of measles given in case of outbreak 9months-11months- regular schedule of measles vaccine 15 months- latest dose of measles given 4-5 years old- catch up dose

 Fully Immunized Child (FIC)- less than 12 months old child with complete immunizations of DPT, OPV, BCG, Anti Hepatitis, Anti measles. Tetanus Toxiod Immunization Schedule for Women Vaccine TT1 TT2 TT3 TT4 TT5 Minimum age interval As early as possible 4 weeks later 6 months later 1year later/during next pregnancy 1 year later/third pregnancy % protected 0% 80% 95% 99% 99% Duration of Protection 0 3 years 5 years 10 years Lifetime

There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately. Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common childhood diseases are often severe to malnourished children.

Cold Chain under EPI

Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. The allowable timeframes for the storage of vaccines at different levels are: o 6months- Regional Level o 3months- Provincial Level/District Level o 1month-main health centers-with ref. o Not more than 5days- Health centers using transport boxes. Most sensitive to heat: Freezer (-15 to -25 degrees C) o OPV o Measles Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius) o BCG o DPT o Hepa B o TT Use those that will expire first, mark X/ exposure, 3rd- discard, Transport-use cold bags let it stand in room temperature for a while before storing DPT. Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B. FEFO (first expiry and first out) - vaccine is practiced to assure that all vaccines are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.