The Expanded Program On
Immunization
(EPI)
Bacille Calmette-Guérin (BCG)
Vaccine:
Live attenuated vaccine
Store at 0° to 8°C
Age : at birth or 6 weeks
Route of administration:
a single intra dermal injection over the deltoid
muscle of the arm or left forearm .
At site of injection: development of erythema
and either a papule or ulceration, followed by a
scar at the immunization site.
Bacille Calmette-Guérin (BCG) Vaccine:
Side effects:
Lymphadenitis
Contraindication:
 Immune deficiency diseases, including congenital
immunodeficiency, HIV infection and impaired immune
function secondary to treatment with corticosteroids,
chemotherapeutic agents or radiation.
ORAL POLIO VACCINE (OPV)
Contents: Sabin attenuated polio virus (live
attenuated vaccine)
Ideal age of Initiating primary vaccination:
6 week
(an additional dose recommended at birth by
W.H.O. OPV0)
ORAL POLIO VACCINE (OPV)
Boosters: Two, at 1.5 years and between 4-5
years.
Dose: 2 drops.
Route of administration: Oral.
ORAL POLIO VACCINE (OPV)
Contra – Indications:
Immunocompromised host or household
member.
Side effects: None.
 Complications: Vaccine induced
poliomyelites (one in 3 million vaccine)
 The dose of OPV given during an episode of
diarrhea should not be counted and shoud
be to given at the earliest opportunity
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ORAL POLIO VACCINE (OPV)
Pentavalent Vaccine
Contents: Each 0.5 ml contains:
Diphtheria toxoid, Tetanus toxoid, pertussis,
Hepatitis B, Haemophilus influenzae b.
The vaccine should not kept frozen or exposed to
freezing
Store at 2° to 8°C
Dose: 0.5 ml.
Pentavalent Vaccine
Route of administration: Deep intramuscular.
Site of administration: Anterolateral aspect of
thigh.
Pentavalent Vaccine
Side effects: Fever, local pain and swelling.
Instruction to the mother after vaccination:
To give antipyretic (paracetamol) in case of
fever.
Complications: Convulsions, shock,
encephalitis.
Contra- Indications:
a. Progressive neurological disease.
b. Uncontrolled convulsions.
c. Severe reactions to first or subsequent dose
local reactions:
swelling, redness, or pain at the injection site.
Measles Vaccines
Contents: live attenuated measles virus grow in chick
embryo cells.
Store at 0 to 8°C
Ideal age of Primary vaccination:
9 months.
In epidemics & household contacts should be between
6-9 months
Measles Vaccines
Dose: 0.5 ml.
Route of administration: Subcutaneous.
Site of administration: Upper arm or anterolateral aspect of
thigh.
.
Measles
Side effects: : Mild fever & rash may appear
after 5-7 days.
Contra-Indications:
Immuno compromised host.
Severe (anaphylactic) egg allergy.
Rotavirus Vaccines
Contains one strain of live attenuated
rotavirus (type G1P[8]
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o
Store at (2-8 C) and protect from light
Rotavirus Vaccine
Dose: 1.5 ml
2 doses
minimum interval between doses is 4 week
Age:beginning at 6weeks of age
Early immunization is favoured with the first dose of rotavirus vaccine to
be administered from
6 weeks of age, however, in order to benefit those who may come late 
infants can receive doses
without age restriction. Because of the typical age distribution of rotavirus
gastroenteritis
( rotavirus vaccination of children >24 months of age is not recommended.
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Rotavirus Vaccine
Contraindications
Severe allergic reaction to a vaccine
component or following a prior dose of
vaccine
Rotavirus Vaccine
Precautions*
Altered immunocompetence
History of intussusception
*the decision to vaccinate if a precaution is present should be made on
a case-by-case risk and benefit basis
Rotavirus Vaccine
Adverse Reactions
Vomiting
Diarrhea
Irritability
Fever
None Serious adverse reaction
Contraindications to vaccinations:
•Absolute
•Temporary
Contraindications to live attenuated vaccines:
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 .
•Persistent crying for 3 hours without apparent cause.
•Convulsion with or without fever within 3 hours after
vaccination.
Give a single dose vaccine of diphtheria + tetanus pediatric formula
( avoid pertussis component).
Contraindications to live attenuated vaccines:
Absolute:
3- HIV infection is an absolute contraindication to administration of
live attenuated vaccines ( OPV & BCG).
Temporary:
1- Severe illness that needs hospitalization.
Deferred immunization till the infant recovers and could
be at discharge.
2- Immunosuppression.
The strategy for the vaccine delivery
The strategy for the vaccine delivery:
(I) The fixed site strategy.
(II)Outreach site strategy.
(III) Mopping up Immunization.
(IV)The National Immunization Days (NIDs).
1. The fixed site strategy:
There is integration of immunization services through (MCH):
Advantages:1-Available resources.
2- Cold Chain maintenance.
3- Save ,time, effort and money.
2.The out reach Strategy
 The outreach is carried for routine immunization that is compulsory
for the targets in certain areas where:
- immunization services are not accessible.
- vaccination coverage is Low.
Limitations:
(i) Expensive
(ii) Cold chain failure.
(iii) Difficulty to arrange the immunization schedule.
(Outreach immunization
(3) Mopping up Immunization:
•
It is house-to-house immunization with OPV in high risk districts.
• High risk districts are those:
•
Where the wild polio virus is still circulating
• With low immunization coverage.
• Population, with overcrowding poor sanitary environment
and low access to health services.
(4) The National Immunization Days (NIDs):
It is periodic immunization of all the eligible targets in a defined
group over a large geographic areas within a short period of time. It
is one of the strategy for polio eradication and tetanus elimination.
The cold chain
The 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.
The cold chain:
• Polio vaccine is the most sensitive vaccine to heat.
• Live attenuated vaccines are allowed to be frozen (OPV,
Measles and BCG).
• Inactivated vaccines must not be frozen ( DPT, DT, dT , TT
and HB) .
The levels of cold chain
The administrative levels of cold chain according to the
duration of the storage and the temperature required to keep
the vaccine potent
The administrative
level
Central & regional
stores
Districts stores&
local immunization
centers
Storage
period
Temperature
Maximum - 20° to- 30°C
three months
+2° to +8°C
Maximum
one month
0°C to+8°C
+2° to +8°C
The vaccines
OPV, Measles,
MMR,BCG
DPT, DT, dT,
TT& HB,Hib
OPV, Measles,
MMR, BCG
DPT, DT, dT,
TT& HB,Hib
The components of the cold chain :
The equipment and tools
The health staff
The procedures
Refrigeration equipment:
 Refrigerator
 Cold boxes
 Vaccine carriers
 The ice packs retained in the freezer
-To stabilize the temperature of the refrigerator at the
optimum level.
- Fully frozen ice-packs are used for lining the vaccines
carriers and the cold boxes during storing the vaccines
Cold Chain Equipment
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The recommended
equipment typically
used for vaccine storage
are :
cold rooms,
refrigerators and
freezers.
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For transporting vaccines
equipment such as
cold boxes,
vaccine carriers and
Cold chain equipment
“For vaccine storage”
refrigerators
Freezer
Cold room
Cold chain equipment
“for transporting vaccine”
Vaccine carrier
Cold box
Ice bags
Cold box
ice Packs
Vaccine carrier
Vaccine carrier
The refrigerator :
• Placed in the coolest place of the health centers away from sunlight
• Well ventilated and adequate air circulation around it .
• Kept locked and open only when necessary.
•Ice packs are kept in the freezer.
• Its temperature is recorded twice daily.
• Both the monitor and thermometer are placed in the refrigerator.
• The temperature chart is stuck on the door outside the refrigerator.
• The diluents should be kept on the lowest shelf.
• Drugs, drinks or food must not be stored in the refrigerator
Tools for monitoring the cold chain
Tools for monitoring the cold chain:
1- Cold Chain Monitor Card.
2- Freeze Watch Indicator
3- Cold Chain Refrigerator Graph
4- Vaccine Vial Monitors
5- Shake Test
+8°C
+2°C
Cold Chain Refrigerator Graph
The vaccines are stored in refrigerators, they are monitored twice a day
and readings are recorded on a chart to ensure a safe temperature is
maintained
2-Cold Chain Monitor
Card: is used to show
cumulative exposure to
Temp. above the safe
range during storage&
transportation.
2-Cold Chain Monitor Card:
3-Vaccine vial monitors:
Every vial is also shipped with a
temperature-sensitive label, that health
workers monitor during vaccination
sessions.
SAFE
If the inner square is
lighter than the outer
ring and the expiration
date is valid, the
vaccine is
usable
SPOILED
If the inner square
matches or is darker
than the outer ring,
the vaccine must be
discarded.
4-The shake test
DPT, hepatitis B and
tetanus toxoid vaccines
can all be damaged by
freezing. By shaking two
vials, side-by-side, one
that might have been
frozen and one that has
never been frozen, health
workers can determine if a
vaccine has spoiled.
What damage the Vaccines?
1. Any defect in the cold chain.
2. Out date expiry.
3. Exposure of the vaccine to unacceptable temperature
during the immunization session.
4. Exposure of the vaccine to direct sunlight (BCG)