Principles of EPI
- Epidemiological situation
- Mass approach
- Basic Health Service
The 7 immunizable diseases
- Hepatitis B
- Infants 0-12 months
- Pregnant and Post Partum Women
- School Entrants/ Grade 1 / 7 years old
Objectives of EPI
- To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease
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
Administration of vaccines
|Vaccine||Content||Form & Dosage||# of Doses||Route|
|BCG (Bacillus Calmette Guerin)||Live attenuated bacteria||Freeze dried
|DPT (Diphtheria Pertussis Tetanus)||DT- weakened toxin
|OPV (Oral Polio Vaccine)||weakened virus||liquid-2drops||3||Oral|
|Hepatitis B||Plasma derivative||Liquid-0.5ml||3||IM|
|Measles||Weakened virus||Freeze dried- 0.5ml||1||Subcutaneous|
Schedule of Vaccines
|Vaccine||Age at 1st dose||Interval between dose||Protection|
|BCG||At birth||BCG is given at the earliest possible age protects against the possibility of TB infection from the other family members|
|DPT||6 weeks||4 weeks||An early start with DPT reduces the chance of severe pertussis|
|OPV||6weeks||4weeks||The extent of protection against polio is increased the earlier OPV is given.|
|Hepa B||@ birth||@birth,6th week,14th week|| An early start of Hepatitis B reduces
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Expanded Program for Immunization (EPI)
the chance of being infected and becoming a carrier.
|Measles||9m0s.-11m0s.||At least 85% of measles can be prevented by immunization at this age.|
- 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||Minimum age interval||% protected||Duration of Protection|
|TT1||As early as possible||0%||0|
|TT2||4 weeks later||80%||3 years|
|TT3||6 months later||95%||5 years|
|TT4||1year later/during next pregnancy||99%||10 years|
|TT5||1 year later/third pregnancy||99%||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:
- 6months- Regional Level
- 3months- Provincial Level/District Level
- 1month-main health centers-with ref.
- Not more than 5days- Health centers using transport boxes.
- Most sensitive to heat: Freezer (-15 to -25 degrees C)
- Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
- Hepa B
- 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.