epi

INTRODUCTION TO EPI VACCINES BY DR. KOMAL FINAL YEAR MBBS LUMHS Group A-6

The Expanded Program On ImmunizationThe Expanded Program On Immunization(EPI(EPI))

Expanded program on Immunization (EPI) is a world health organization program, with the goal to make vaccines available to all children throughout the world.

Experience with smallpox eradication program showed the world that immunization was the most powerful and cost-effective weapon against vaccine preventable diseases.

In 1974, the WHO launched its “ Expanded program of immunization” (EPI) against six most common preventable diseases (diphtheria, pertussis, tetanus, polio, tuberculosis, measles and recently added pneumococcal vaccine).

Expanding the number of diseases to be covered

Expanding the number of children and target population to be covered

Expanding coverage to all corners of the country and spreading services to reach the less privileged sectors of the society.

Routine Immunization: Children 0-23 months – immunization with 8 EPI antigens Pregnant ladies by TT.

Supplemental Immunization Activities: Routine immunization does not ensure 100% coverage of the mobile population i.e. nomads, NAs, hard to reach areas / missed areas. So SIAs are scheduled to ensure coverage of this population / areas. NIDs / SNIDs: children < 5 years receive polio drops (3-days campaign)

Disease Surveillance: To detect every case of target diseases, the suspected cases of seven VPDs are reported by health facilities to the district health authorities for immediate launching of the control measures.

Mopping up: Special campaigns 5-8 km around the infected locality to localize the disease and stop its transmission.

1. To achieve 100% coverage with all EPI vaccines.

2. Eradication of polio to maintain polio free status.

3. Elimination of measles.

4. To Reduce Seroprevalence Of HBsAg to < 1% among under five.

5.Elimination of Neonatal Tetanus .

6. To maintain zero level of diphtheria.

7-Prevention of severe forms of TB ( TB meningitis &military

TB).

8- To reduce the incidence of whooping cough

9- To Reduce the incidence of Bacteria Meningitis due 9- To Reduce the incidence of Bacteria Meningitis due to haemophelus influenza.to haemophelus influenza.

10- To Maintain Immunization Safety.

11-To prepare for introduction of new vaccines

Expanded program on immunization was launched in Pakistan in 1978.

The purpose of EPI is to initiate a collective effort to reduce the mortality results from the seven EPI target disease by immunizing children of the age 0-11 months and women of child bearing age.

Although Pakistan has made impressive gains in increasing the EPI coverage in the recent years ,the public awareness and thus public support and participation in immunization derives of the ministry of health, government of Pakistan needs to improve further to enable us to achieve the target set under the Millennium developmental Goals.

Reduction of mortality and morbidity resulting from 7 EPI target diseases by immunizing children of age 0-11months and women of child bearing age.

90% routine immunization coverage of all EPI antigens by 2012. Interruption of polio virus transmission by 2012 Elimination of the Neonatal Tetanus by 2015 Reduction of The Diphtheria, Pertusis, Childhood TB, by maximum level Control of the other diseases by Introduction of new vaccines EPI

EPI SCHEDULE

Diseases Type of vaccine Dose Rout of administration

1-BCG

2-HBV

TB

Hepatitis B

Live attenuated, variant

Recombinant, yeast derived HBs antigen

0.01ml

0.5 ml

ID injection in left deltoid

IM thigh


1-OPV Polio Live attenuated 2 drops oral

2-HiB Hib disease polysaccharide conjugate

0.5 ml IM thigh

3-HBV Hepatitis B Recombinant, yeast derived HBs antigen

0.5 ml IM thigh

4-DPT Diphtheria TetanusWhooping cough

Toxoid (D) Toxoid (T)Killed pertussis (P)

0.5 ml IM thigh




0.5 ml IM thigh



0.5 ml IM thigh




0.5 ml IM thigh

3-HBV Hepatitis B Recombinant, yeast derived HBs antigen

0.5 ml IM thigh



0.5 ml IM thigh

The disease Type of the vaccine Dose

Mode of administration

1-MMR •Measles,•Mumps•German Measles

AllLive attenuated

0.5 ml Subcutaneous




0.5 ml IM thigh

3-DPT Diphtheria Tetanus

Whooping cough

Toxoid (D) Toxoid (T)

Killed pertussis (P)0.5 ml IM thigh



2-MMR- Measles

- Mumps

- German

Measles

All Live attenuated 0.5 ml IM thigh



0.5 ml IM thigh

BCG (At birth) BCG vaccine is live attenuated variant of 0.05ml ID injection in right deltoid It is used because it is effective in reducing the severity of TB meningititis and miliary TB

HB Vaccine: At Birth, 2nd and 6th month Recombinant, yeast derived HBs antigen 0.5 ml IM anterolateral of the thigh

OPV : (Sabin)

At birth,6 weeks,10 weeks, and14 weeksOPV live attenuated 2 drops orallyIt prevents against paralytic polio.It provides rapid immunity within 1 week.

Severe bacterial infection, particularly among infantsDuring late 19th century believed to cause influenzaImmunology and microbiology clarified in 1930s

The type of Hib vaccine is inactivated polysaccharide conjugated vaccine.

It is made by joining of the polysaccharide of Hib bacterium and protein carrier.

Give all infants, including premature infants, a primary series of Hib vaccine beginning at the age of 2 months.

Do not administer Hib prior to six month of the age, because it will induce immunologic tolerance to further dose of Hib vaccine.

Small child receiving Hib vaccine into the muscles of the thigh.

Adolescent receiving Hib vaccine into the deltoid muscle of the arm.

DPT vaccine: 2nd, 4th ,6th, 18th months & 4-6 years

D T are Toxoid of Diphtheria and Tetanus and P, is Killed pertussis

With dose 0.5 ml ,IM thigh

•DPT: 2nd, 4th ,6th, 18th months& 4-6 years

•DT: No pertussis component

It is given as subsequent doses to an infant who showed severe adverse effects

due to pertussis component. •dT: No pertussis component.

A small dose of diphtheria toxoid is given at school entry or after the age of six years.

At 6 weeks,10 weeks,14 weeks,18 months,5 years,10 years.Tetanus toxoid(inactivated toxin with formaldehyde).Dose:0.5 ml I/MTwo 0.5 ml doses I/M injection administered at 4-8 weeks interval 3rd dose after 1 year.

Diphtheria causes a thick covering in the back of the throat. It can lead to breathing problems, paralysis, heart failure, and even death. There are several combination vaccines used to prevent diphtheria: DTaP, DT, and Td.

Pertussis is a bacterial infection caused by Bordetella pertussis. The germ is spread when infected people cough or sneeze.

Available Vaccines:No pertussis-only vaccine is available. The pertussis vaccine is available as:DTaP (Diphtheria Toxoid-Tetanus Toxoid-acellular Pertussis vaccine)DTaP in combination with Haemophilus influenzae type b (Hib) vaccineDTaP in combination with hepatitis B and inactivated polio vaccinesDTaP in combination with Hib, hepatitis B and inactivated polio vaccinesTdap (Tetanus Toxoid reduced-Diphtheria-acellular Pertussis vaccine)

MMR Vaccination:

9th,12th month& 4-6 years

Live attenuated ( Three : measles, German measles& Mumps)

0.5 ml

Subcutaneous arm

Pneumonia — a bacterial infection in the lungs — is a common complication from the flu. In addition to a flu shot every fall, it's a good idea to get a once-in-a-lifetime pneumococcal vaccine.

Pneumococcal vaccines. (Minimum age: 6 weeks for pneumococcal conjugate vaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV]).

• Administer 1 dose of PCV to all healthy children aged 24 through 59 months who are not completely vaccinated for their age.

• For children who have received an age-appropriate series of 7-valent PCV (PCV7), a single supplemental dose of 13-valent PCV (PCV13) is recommended for:— All children aged 14 through 59 months— Children aged 60 through 71 months with underlying medical conditions.

• Administer PPSV at least 8 weeks after last dose of PCV to children aged 2 years or older with certain underlying medical conditions, including a cochlear implant

Acute diarrhoea is responsible for nearly 1.9 million deaths per year in children under age five.

Rotavirus is responsible for as

much as one fourth of these casualties, almost all of which occur in developing countries.

Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV-1 [Rotarix] and RV-5 [Rota Teq])

The maximum age for the first dose in the series is 14 weeks, 6 days; and 8 months, 0 days for the final dose in the series. Vaccination should not be initiated for infants aged 15 weeks, 0 days or older. If RV-1 (Rotarix) is administered at ages 2 and 4 months, a dose at 6 months is not indicated.

80.2 %( 0-11 months) children fully immunized (CES-2006). 35.8 Million Children immunized against measles through special campaign in 2008. TT Immunization to target women (15-49 yrs.) in 6 high risk Districts in Punjab. Vitamin-A supplementation –twice a year with coverage >95%. Storage capacity enhanced for the buffer stocks of all vaccines for the period of 3 months. Improved monitoring & supervision through Provision of 59 single cabin vehicles for DO(H) under GAVI.Provision of 3652 motorcycles to EPI staff under GAVI.Provision of cold chain equipment to 8 flood hit districts.Capacity building of health managers and EPI staff, (17,804).Orientation training workshops for medical officers LHVs, LHWs, etc.Training of health personnel for cold chain repair and maintenance.Training workshops for vaccine stock management carried out in all districts during 2010, 2011 and 2012.

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