The Expanded Program On The Expanded Program On ImmunizationImmunization

(EPI)(EPI)

ImmunizationImmunization

Immunization is the a process where by a Immunization is the a process where by a person is made immune or resistant to an person is made immune or resistant to an

infection, typically by administration ofinfection, typically by administration of

vaccinesvaccines

Immunization is a proven tool for controlling Immunization is a proven tool for controlling and elimination life-threatening infectious and elimination life-threatening infectious

diseasedisease ..

The Expanded Program Of ImmunizationThe Expanded Program Of Immunization

(EPI)(EPI)The Expanded Programme on Immunization The Expanded Programme on Immunization

(EPI) was established in 1974 through a World (EPI) was established in 1974 through a World Health Assembly resolution Health Assembly resolution toto build on build on the the success of the global smallpox eradication success of the global smallpox eradication programme, and to programme, and to ensure that ensure that all children in all children in all countries benefited from life-saving all countries benefited from life-saving vaccinesvaccines

ObjectivesObjectivesThe expanded immunization program, the who's initiative to improve immunization coverage, focuses on the following four items:4

Standardizing immunization schedules Promoting safe injection technologies Improving the stocking and availability of vaccines Protecting vaccines' potency through cold chain

management  

The objectives of EPI:The objectives of EPI:

1.1. To increase coverage of immunization To increase coverage of immunization for eligible children.for eligible children.

2. To reduce the incidence of immunizable 2. To reduce the incidence of immunizable diseases among children below five years of diseases among children below five years of age.age.

55

Eradication of polio to maintain polio free status.

Elimination of measles.

Reduce Incidence of

hepatitis B

among under five.

HBV

Elimination of Neonatal Tetanus .

Maintain zero level of diphtheria.

Prevention of severe forms of TB ( TB meningitis &military

TB).

12 year old girl with TB meningitis

reduce the incidence of whooping cough.

Reduce the incidence of Bacteria Meningitis due to Reduce the incidence of Bacteria Meningitis due to haemophelus influenzahaemophelus influenza

3. Promoting safe injection techniques4. Improve the stocking and availability of vaccines5.Protecting vaccine potency through cold chain management6.To prepare for introduction of new vaccines

The immune systemThe immune systemImmunity: Ability of an organism to recognize Immunity: Ability of an organism to recognize and defend itself against and defend itself against specificspecific pathogens or pathogens or antigensantigens..

Immune Response: Involves production of Immune Response: Involves production of antibodies and generation of specialized antibodies and generation of specialized lymphocytes against specific antigenslymphocytes against specific antigens..

Antigen: Molecules from a pathogen or foreign Antigen: Molecules from a pathogen or foreign organism that provoke a specific immune organism that provoke a specific immune

responseresponse . .

Types of ImmunityTypes of Immunity-:-:

Innate or natural Immunity: Innate or natural Immunity: Immunity an organism is born withImmunity an organism is born with . .

Acquired Immunity:Acquired Immunity:

Immunity that an organism Immunity that an organism developsdevelops during lifetime during lifetime..

May be acquired naturally or artificiallyMay be acquired naturally or artificially..

Types of Acquired ImmunityTypes of Acquired ImmunityI. Naturally Acquired Immunity: Obtained in theI. Naturally Acquired Immunity: Obtained in the course of daily lifecourse of daily life..Two typesTwo types-:-:

A. Naturally Acquired Active ImmunityA. Naturally Acquired Active Immunity : : AntigensAntigens or pathogens enter body naturally or pathogens enter body naturally . .

Body generates an immune response to antigensBody generates an immune response to antigens..

..

Types of Acquired ImmunityTypes of Acquired Immunity

B. Naturally Acquired Passive ImmunityB. Naturally Acquired Passive Immunity : :AntibodiesAntibodies pass from mother to fetus via placenta or pass from mother to fetus via placenta or

breast feedingbreast feeding. . No immune response to antigensNo immune response to antigens..Immunity is usually Immunity is usually short-livedshort-lived (weeks to months) (weeks to months)..Protection until child’s immune system developsProtection until child’s immune system develops..

Types of Acquired Immunity (Continued)Types of Acquired Immunity (Continued)

II. Artificially Acquired Immunity: Obtained by II. Artificially Acquired Immunity: Obtained by receiving a vaccine or antibodiesreceiving a vaccine or antibodies..

11 . .Artificially Acquired Active ImmunityArtificially Acquired Active Immunity : :

Antigens are introduced in vaccines (Antigens are introduced in vaccines (immunizationimmunization)) . .

Body generates an immune response to antigensBody generates an immune response to antigens..

Types of Acquired Immunity (Continued)Types of Acquired Immunity (Continued)..

22 . .Artificially Acquired Passive ImmunityArtificially Acquired Passive Immunity : :

Antibodies are introduced into body by injectionAntibodies are introduced into body by injection . .Snake antivenom injection from horses or rabbitsSnake antivenom injection from horses or rabbits..

Immunity is short lived (half life three weeks)Immunity is short lived (half life three weeks)..Host immune system does not respond to antigensHost immune system does not respond to antigens..

What is a VaccineWhat is a Vaccine??

A vaccine is a non-pathogenic antigen that A vaccine is a non-pathogenic antigen that mimics a particular pathogen in order to elicit mimics a particular pathogen in order to elicit an immune response as if that actual pathogen an immune response as if that actual pathogen were in the body.were in the body.

Types of vaccinesTypes of vaccines

1.1. Live, Attenuated VaccinesLive, Attenuated Vaccines

-Viral such as measles, mumps, rubella, -Viral such as measles, mumps, rubella, oral polio and rota virusoral polio and rota virus

-Bacterial such as BCG-Bacterial such as BCG

2. Inactivated Vaccines2. Inactivated Vaccines

Types of vaccinesTypes of vaccines2. Inactivated Vaccines2. Inactivated VaccinesA. Whole cell vaccineA. Whole cell vaccine

--ViralViral

-Bacterial-Bacterial

B. FractionalB. Fractional1-Protein based1-Protein based

ToxoidToxoid

Subunit Subunit

2-Polysaccharide based2-Polysaccharide basedPurePure

conjugateconjugate

Types of vaccinesTypes of vaccines2. Inactivated Vaccines2. Inactivated VaccinesA.A. Whole cell vaccine Whole cell vaccine

-Viral such as Hepatitis A, polio and rabies -Viral such as Hepatitis A, polio and rabies

-Bacterial such as Pertussis -Bacterial such as Pertussis

Types of vaccinesTypes of vaccines2. Inactivated Vaccines2. Inactivated VaccinesA. Whole cell vaccineA. Whole cell vaccine

--ViralViral

-Bacterial-Bacterial

B. FractionalB. Fractional1-Protein based1-Protein based

Toxoid such as diphtheria, tetanus Toxoid such as diphtheria, tetanus

Subunit such as hepatitis B Subunit such as hepatitis B

2-Polysaccharide based2-Polysaccharide basedPure such as pneumococcal and meningococcal vaccinesPure such as pneumococcal and meningococcal vaccines

conjugate such as Haemophilus influenzae type B vaccineconjugate such as Haemophilus influenzae type B vaccine. .

Attenuated vaccine

Inactivated Vaccines

Vaccine doseLowHigh

Antibody persistence

LongShort

Booster neededInfrequentlyFrequently

Types of vaccinesTypes of vaccines

1.1. Live, Attenuated VaccinesLive, Attenuated Vaccines

Live, attenuated vaccines contain a version of the living Live, attenuated vaccines contain a version of the living microbe that has been weakened in the lab so it can’t microbe that has been weakened in the lab so it can’t

cause diseasecause disease . .

They elicit strong immune system response and often confer They elicit strong immune system response and often confer lifelong immunity with only one or two doseslifelong immunity with only one or two doses..

Types of vaccinesTypes of vaccines

Live, Attenuated VaccinesLive, Attenuated Vaccines live, attenuated vaccines usually need to be live, attenuated vaccines usually need to be refrigeratedrefrigerated to stay to stay

potent.potent. Live, attenuated vaccines are relatively Live, attenuated vaccines are relatively easy to create for certain easy to create for certain

virusesviruses. Viruses are simple microbes containing a small number of . Viruses are simple microbes containing a small number of genes, genes,

Live, attenuated vaccines are more Live, attenuated vaccines are more difficult to create for bacteriadifficult to create for bacteria. . Bacteria have thousands of genes and thus are much harder to Bacteria have thousands of genes and thus are much harder to

people who have damaged or weakened immune systems, such as people who have damaged or weakened immune systems, such as people who undergone chemotherapy or people who undergone chemotherapy or have HIV, can not be have HIV, can not be given live vaccines.given live vaccines.. .

Types of vaccinesTypes of vaccines

Inactivated VaccinesInactivated Vaccines Scientists produce inactivated vaccines by killing the Scientists produce inactivated vaccines by killing the

disease-causing microbe with disease-causing microbe with chemicals, heat, or chemicals, heat, or radiation. radiation.

Inactivated vaccines usually Inactivated vaccines usually don’t require don’t require refrigerationrefrigeration, and they can be easily stored and , and they can be easily stored and transported in a freeze-dried form, which makes them transported in a freeze-dried form, which makes them accessible to people in developing countries. accessible to people in developing countries.

Types of vaccinesTypes of vaccines

Inactivated VaccinesInactivated Vaccines Most inactivated vaccines, however, stimulate a Most inactivated vaccines, however, stimulate a

weaker immune system response than do live weaker immune system response than do live vaccines.vaccines.

So it would likely take several additional doses, or So it would likely take several additional doses, or booster shots, to maintain a person’s immunity. booster shots, to maintain a person’s immunity.

Types of vaccinesTypes of vaccines

Protein basedProtein basedSubunit VaccinesSubunit Vaccines

Instead of the Instead of the entire microbe, subunit vaccines include entire microbe, subunit vaccines include only the antigens that best stimulate the immune systemonly the antigens that best stimulate the immune system..

This make the chances of This make the chances of adverse reactions adverse reactions to the vaccine to the vaccine are lowerare lower . ...

Types of vaccinesTypes of vaccines

subunit vaccines can be made in one of two wayssubunit vaccines can be made in one of two ways::

1.1. They can They can grow the microbe grow the microbe in the laboratory and then use in the laboratory and then use chemicals to break it apart chemicals to break it apart and gather the important antigens. and gather the important antigens.

22..They can They can manufacture the antigen manufacture the antigen molecules from the microbe molecules from the microbe using using recombinant DNA technologyrecombinant DNA technology . .

Vaccines produced this way are called “recombinant subunit Vaccines produced this way are called “recombinant subunit vaccines.” such as hepatitis B virus vaccinevaccines.” such as hepatitis B virus vaccine....

Types of vaccinesTypes of vaccines

Scientists inserted hepatitis B genes that code for Scientists inserted hepatitis B genes that code for important antigens into common baker’s yeast. important antigens into common baker’s yeast. The yeast then produced the antigens, which The yeast then produced the antigens, which the scientists collected use in the vaccinethe scientists collected use in the vaccine

Types of vaccinesTypes of vaccines

Protein based VaccinesProtein based VaccinesToxoid VaccinesToxoid Vaccines

These vaccines are used when a bacterial toxin is the These vaccines are used when a bacterial toxin is the main cause of illnessmain cause of illness . .

Toxins are inactivate by treating them with Toxins are inactivate by treating them with formalinformalin . .

Vaccines against diphtheria and tetanus are examples of Vaccines against diphtheria and tetanus are examples of toxoid vaccinestoxoid vaccines . .

Types of vaccinesTypes of vaccines

Pure Pure polysaccharides.polysaccharides. Vaccines Vaccines

Some bacterium possess an outer coating of sugar molecules called Some bacterium possess an outer coating of sugar molecules called polysaccharidespolysaccharides..

vaccine is made up of long chain of sugar molecules vaccine is made up of long chain of sugar molecules

infant’s immune system can not recognize to the polysaccharidesinfant’s immune system can not recognize to the polysaccharides . .

Types of vaccinesTypes of vaccines

Conjugate VaccinesConjugate Vaccines

Some bacterium possess an outer coating of sugar molecules called Some bacterium possess an outer coating of sugar molecules called polysaccharidespolysaccharides..

When making a conjugate vaccine, scientists link antigens or toxoids When making a conjugate vaccine, scientists link antigens or toxoids from a microbe that an from a microbe that an infant’s immune system can recognize to infant’s immune system can recognize to

the polysaccharidesthe polysaccharides . .

•The vaccine that protects against Haemophilus influenzae

type B (Hib) is a conjugate vaccine.

•It is made by joining a piece of the polysaccharide capsule

that surrounds the Hib bacterium to a protein carrier.

•This joining process is called conjugation.

IMMUNIZATION SCHEDULE IN SUDAN IMMUNIZATION SCHEDULE IN SUDAN

Under one yearUnder one year

VaccineVaccineSCHEDULE

BCGAt birth

OPV0At birth

Pentavalente 1(DPT + HB + H),OPV1

6 weeks

, PentavalenteDPT + HB + Hib) ,OPV2

10 weeks

Pentavalente(DPT + HB + Hib),OPV3

14 weeks

MeaslesNine month

التطعيم. 11 التطعيم. كرت كرت

IMMUNIZATION SCHEDULE IN SUDAN IMMUNIZATION SCHEDULE IN SUDAN

Women in Child bearing ageWomen in Child bearing age

DOSEDOSESCHEDULE

TT1Any time at first contact or as early as possible during pregnancy

TT2One month after the first visit(TT1)

TT3Six months after TT2 or during subsequent pregnancy

TT4One year after TT3or during subsequent pregnancy

TT5One year after TT4or during subsequent pregnancy

DiseasesType of vaccineDoseRout of administration

1-BCG

2-HBV

TB

Hepatitis B

Live attenuated, variant

Recombinant, yeast derived HBs antigen

0.05ml

0.5 ml

ID injection in left forearm

IM thigh

Diseases Type of vaccine DoseRout of administration

3-OPV PolioLive attenuated2 dropsoral

Diseases Type of vaccine DoseRout of administration

HiBHib diseasepolysaccharide conjugate

0.5 mlIM thigh

HBVHepatitis BRecombinant, yeast derived HBs antigen

DPTDiphtheria TetanusWhooping cough

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

Pentavalent Vaccine

The disease

Type of the vaccineDose

Mode of administration

MeaslesLive attenuated0.5 mlSubcutaneous

BCG (At birth)

•Live attenuated variant. •0.05ml .

•ID injection in left forearm

local reactions : swelling, redness, or pain at the injection site.