Expanded Program for Immunization (EPI)

Principles of EPI
  1. Epidemiological situationEPI
  2. Mass approach
  3. Basic Health Service
The 7 immunizable diseases
  1. Tuberculosis
  2. Diptheria
  3. Pertussis
  4. Measles
  5. Poliomyelitis
  6. Tetanus
  7. Hepatitis B
Target Setting
  • 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
Infant- 0.05mlPreschool-0.1ml
 1  ID
 DPT (Diphtheria Pertussis Tetanus) DT- weakened toxin

P-killed bacteria

 liquid-0.5ml  3  IM
 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

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)
    • OPV
    • Measles
  • Sensitive to heat and freezing (body of ref. +2 to +8 degrees Celsius)
    • BCG
    • DPT
    • Hepa B
    • TT
  • 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.