Expanded Program
of
Immunization
Dr. Faten M. Rabie
Objectives of the
lecture
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
1-
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 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
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.