Expanded Program of Immunization

Dr. Faten M. Rabie

Objectives of the lecture

1 -Scope of the program2 -Objectives of the EPI

3 -Strategies of the program4-The target population

5 -Schedule of immunization in KSA6 -Dose, route of administration and type of

each vaccine.7 -Contraindications of vaccination

8 -Estimation of the eligibles9 -Records and reports

10 -Defaulter tracing11 -Cold chain

Scope of the EPI

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 and measles.

“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 and spreading services to reach the less privileged sectors of the society

Objectives of the EPI

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

• To achieve 100% coverage for eligible children by an ongoing integrated program

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

• To develop a surveillance system which collect adequate information on the diseases preventable by immunization

• To minimize the efforts and cost of treatment• To promote a new healthy generation

Strategies of the EPI• Integrate vaccination sessions with PHC

services• Appropriate measures to expand the

vaccination coverage of the eligible population

• Ensuring regular supply of potent vaccine• Strengthening the cold chain• Training of health personnel• Promotion of community participation• Incorporating health education activities

related to EPI

• Ensuring logistic support ( supplies and

equipments)

• Introducing a system for continuous

monitoring and periodic evaluation

• Undertaking operational research to find

out deficiencies and difficulties in the

program and suggest methods of

improvement

Targets

•Under 5-years children.

•Women in the child bearing

age (15-45 years).

•Schedule of immunization

•Type of the vaccine

•Dose of each vaccine

•Route of administration

•Precautions of vaccination

Contraindications of vaccination

•There are only 3 contraindications:

• Immune compromised child ( mainly

AIDS) → no BCG• Child who develops convulsions after

the first dose of DPT → DT• Severely ill child to the extent that he

urgently referred to the hospital

Estimation of eligibles• The target population is estimated on the

basis of total population as registered during survey and the increase in the population on the basis of birth rate and growth rate.

• Example:• Annual growth rate …………………...4%• Total registered population………...1000• Birth rate………………………………..50l1000• No. of expected births = 0-1

year…………….50

• No. in child bearing age…………………….20%• No. of pregnant women expected = • no. of 0-1 year infant =…………..50• No. of children under 2 years = double the

no. of infants…….= 100• Estimated requirements of vaccine per

episode of supply (for each vaccine calculated separately):

• Total number of children to be vaccinated in one year x Number of doses to be given + 10% wastage

Periodicity of the supplyExample:• No. of children below 2 years of age:…..6126• No. of children below 2 years already

immunized ……1126• No. of eligible = 6126-1126 ……….=5000• Proposed coverage………………...=85% = 4250• No. of doses of given to each……….3• Annual requirement …………….. …= 4250 x 3

+ 10%= 12750 +1275 = 14025 doses • Monthly doses……..= 14025 ÷ 12 = 1169

doses• Convert doses into vials i.e if the vial

contains 10 doses…………………………116 vial

Records and reports

•Records are required for:

1. Monitoring of program progress.

2. Identification of defaulters.

3. Comparing with EPI-related disease

situation.

Types of records:

1. Yearly vaccination register- by age, sex, nationality and dosage numbers.

2. Daily vaccination register- with identifying family register number.

3. Follow up register.4. Stock indent register.5. Immunization card ( details of

immunization and the date of next visit).

Reports

• Monthly immunization report showing total number of doses, age, sex, nationality are sent in the first week of each month.

• This information would form a strong base for the development of a surveillance system for EPI and EPI related diseases.

Cold chain

• Cold chain is a system of storing, transporting and distributing of vaccines in the correct temperature and way from the factory to the vaccinated child.

• Cold chain is a corner stone of the EPI, because the vaccine loses the efficacy if incorrectly kept.

Cold chain levels

•The central level.

•Regional level.

•Primary health care

center level.