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Expanded Program of Immunization Dr. Faten M. Rabie

Expanded Program of Immunization Dr. Faten M. Rabie. Objectives of the lecture. 1- Scope of the program 2- Objectives of the EPI 3- Strategies of the program 4-The target population 5- Schedule of immunization in KSA 6- Dose, route of administration and type of each vaccine.

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Expanded Program of Immunization Dr. Faten M. Rabie

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  1. Expanded Program of ImmunizationDr. Faten M. Rabie

  2. Objectives of the lecture 1- Scope of the program 2- Objectives of the EPI 3- Strategies of the program 4-The target population 5- Schedule of immunization in KSA 6- Dose, route of administration and type of each vaccine. 7- Contraindications of vaccination 8- Estimation of the eligibles 9- Records and reports 10- Defaulter tracing 11- Cold chain

  3. 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.

  4. “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

  5. 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

  6. 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

  7. 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

  8. Targets • Under 5-years children. • Women in the child bearing age (15-45 years).

  9. Schedule of immunization • Type of the vaccine • Dose of each vaccine • Route of administration • Precautions of vaccination

  10. 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

  11. 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

  12. 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

  13. Periodicity of the supply Example: • 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

  14. Records and reports • Records are required for: • Monitoring of program progress. • Identification of defaulters. • Comparing with EPI-related disease situation.

  15. Types of records: • Yearly vaccination register- by age, sex, nationality and dosage numbers. • Daily vaccination register- with identifying family register number. • Follow up register. • Stock indent register. • Immunization card ( details of immunization and the date of next visit).

  16. 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.

  17. 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.

  18. Cold chain levels • The central level. • Regional level. • Primary health care center level.

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