Expanded program of Immunization (EPI)

Introduction

• The Expanded Program on Immunization (EPI) was established in 1974 depending on the success of the global smallpox eradication program, and to ensure that all children in all countries benefited from life-saving vaccines.

“Expanded” means:• 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

The objectives of EPI

1. To achieve 100% coverage with all EPI vaccines

2. To reduce the morbidity and mortality of the major six childhood diseases.

(diphtheria, pertussis, tetanus, polio, tuberculosis and measles)

3. Eradication of polio to maintain polio free status.

4. Elimination of measles

5.Elimination of Neonatal Tetanus

6. To maintain zero level of diphtheria.

7.Prevention of severe forms of TB ( TB meningitis

&military TB).

12 year old girl with TB meningitis

8. To reduce the incidence of whooping cough

9. Reduce sero-prevalence of (HBsAg) to <1%

among under five.

HBV

10. Reduce the incidence of Bacteria Meningitis due to haemophelus influenza

11.To maintain immunization safety.

12.To deliver an integrated immunization services through health centers, as primary health care service package

13.To prepare for introduction of new vaccines

Components The main components of a well functioning

immunization system include: 1. Service delivery2. Capacity to maintain vaccines at the right

temperature (cold chain)3. Distribute vaccines through the system in a

timely manner (logistics); 4. Monitoring and surveillance5. Trained health workers6. Program planning and management.

Main facts about Immunization1. Immunization prevents between 2-3 million

deaths every year.

2. Over 1 million infants and young children die every year from pneumococcal disease and rotavirus diarrhea

3. Global measles mortality has declined by 74%

4. Polio cases have decreased by over 99%

Types of vaccines1. Live vaccines2. Attenuated live vaccines3. Inactivated (killed vaccines)4. Toxoids5. Polysaccharide and polypeptide (cellular

fraction) vaccines6. Surface antigen (recombinant) vaccines.

Diseases covered by EPI

• Diphtheria• Measles• Mumps• Rubella• Pertussis• Varicella• Rota

• Tetanus• Polio• TB• HBV• Hib• Pneumococcal conjugate• Meningococcal conjugate

quadrivalent.

EPI in KSA

In 1979 The ministry of health in KSA have adopted a strategic step with the immunization of over 90% of the children in Saudi Arabia against infectious childhood diseases in the EPI system.

• T.B., Diphtheria, Tetanus neonatorum, whooping cough, measles, and poliomyelitis.

• Latter on the list included coverage against mumps, rubella , hepatitis B viral infections and hib……

Vaccination schedules-1991 -2002 -2008 -2013• The changes included in the new vaccination

schedule reflect the efforts of continuous monitoring and evaluation of the previous system.

• It depended largely on the incidence of certain diseases and their impact.

• It also followed the most recent developments in the manufacturing and industry of vaccines internationally employed.

Recent schedule for Vaccination of Newborns in Saudi Arabia

Certain available vaccines and their routes of administration.

Vaccine Type Route

BCG Live attenuated BacteriaIntradermal

DTP D&T = Toxoids

P = inactivated bacteria

Intramuscular

Hepatitis B(HBV) Inactivated viral antigen Intramuscular

HaemophilusInfluenza b(Hib)

Polysaccharide Intramuscular

MMR Live attenuated viruses Subcutaneous

OPV Live attenuated virusOral

Contraindications of vaccination:Absolute:1- History of anaphylactic reactions.

2- Subsequent doses of pertussis vaccines are absolutely

contraindicated if the child gets (within 48 hours of vaccination )

• Fever (40.5º) ,

• Collapse or shock .

• Convulsion with or without fever within 3 hours after

vaccination.

3- HIV infection is an absolute contraindication to administration of

live attenuated vaccines ( OPV & BCG), the only allowed one is

measles vaccine.

Temporary:

1- Pregnancy.

2- Severe illness that needs hospitalization.

3- Immunosuppression.

4- Recent receipt of blood.

The Cold Chain• Failure of a vaccine to protect an individual child may be

due to a number of reasons.

• The vaccine may no longer be "antigenic" so that it does not stimulate the body to produce antibodies.

• With "live vaccines", which can occur if the vaccine is no longer alive.

• Most live vaccines are killed easily by changes of temperature, such as might occur if they are left out of the refrigerator for a long time.

• Vaccines must be kept constantly cold throughout the chain of storage and transport which they have to pass through before reaching the child.

• Breaks in this "cold chain", as it has come to be called, may be due to corruption of a batch of vaccine delivery to a Ministry of Health depot or to a hospital or health center.

• It can happen as a result of the breakdown of the refrigerating system.

Cold chain

• It is the system of storage and transportation of the vaccine at low temperature (cold condition) from the manufacture till it is consumed

A typical cold chain

Vaccine manufacturer

Specialist pharmaceuticalDistribution company

Pharmacy/GP surgery/Clinic

Patient

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The levels of cold chain

The equipment and tools

The procedures

The health staff

The components of the cold chain -Refrigerators-Cold box-vaccine carrier.Ice packs

Vaccine Stability

• Sensitivity to HEAT1. Oral Polio 2. BCG3. Varicella4. MMR5. Hepatitis B6. DT 7. HIB

• Sensitivity to COLD1. HepB 2. HIB3. Influenza4. MMR5. Varicella 6. BCG

LEAST SENSITIVE

MOST SENSITIVE

Live vaccines are allowed to frozen.

Killed vaccines are not allowed to be frozen

• Live vaccines are also damaged by sunlight,

which is especially likely to happen after they

have been prepared (reconstituted) for

injection in the clinic or at the school.

• Even in the best circumstances, vaccines

eventually lose their power and it is very

important to look at the date of expiry on the

container.

Strategies for service delivery

• The static immunization strategy.

• The National Immunization Days (NIDs).

• Mopping up Immunization (house to house).

• Outreach immunization

New vaccines to be proposed

• ?• Schistosomiasis• Cancer• HIV/AIDS• Malaria

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