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E.P.I
Expanded Program on
Immunization
Objective:
To reduce the morbidity and
mortality among infants and children
caused by the seven childhood
immunizable diseases.
Elements of EPI
Target Setting (main element)
Information,
Education
and
Communication
Cold chain logistic management
Assessment and Evaluation of
overall performance
Surveillance, Studies and Research
General Principles in
Vaccinating Children
It is safe and immunologically
effective to administer all EPI
vaccines on the same day at different
sites of the body.
The vaccination schedule should
not be restarted from the beginning
even if the interval between doses
exceeded the recommended interval
by months or year.
Giving doses of a vaccine at less
than the recommended 4 weeks
interval may lessen the antibody
response. Lengthening the interval
between doses of vaccines leads to
higher antibody levels.
No extra doses must be given to
children who missed a dose of
DPT/HB/OPV. The vaccination
must be continued as if no time had
elapsed between doses.
Contraindication to
Immunization
Anaphylaxis
or
severe
hypersensitivity reaction to a
previous dose of vaccine is an
absolute
contraindication
to
subsequent doses of vaccine
Person with a known allergy to a
vaccine component should not be
vaccinated.
DPT2 or DPT3 is not given to a
child who has convulsions or shock
within 3 days after DPT1. Vaccines
containing the whole cell pertussis
component should not be given to a
children with an evolving
neurological disease.
Do not give live vaccines like BCG
to
a
individuals
who
are
immunosuppressed due to malignant
disease ( child with AIDS) , going
therapy with immunosuppressive
agents or radiation.
A child with a sign and symptoms
of severe dehydration
Fever of 38.5 C and above
Most Sensitive to
Heat
Most Sensitive to
Cold
Sensitive to Sunlight
and Fluorescent light
Type of Vaccine
Storage Temp.
OPV
Measles
Hepa B
DPT
Tetox
BCG
-15 to -25 C
At the freezer
Hours of
Life after
opening
8 hours
2 to 8 C
Body of
refrigerator
4 hours
FEFO ( first expiry and first out ) vaccine is practiced to ensure that all
vaccines are utilized before its expiry date.
Proper arrangement of vaccines and labeling of vaccines expiry date are done to
identify those near to expire vaccines
Vaccine Wastage
Wastage is defined as loss by use, decay, erosion or leakage or through
wastefulness
Wastage rate = Doses supplied doses administered
Doses supplied
x 100
=
=
=
=
=
=
1.67
1.67
2
2.5
1.10
1.67
Target Setting
Steps and examples in calculating vaccine requirements
Steps
BCG
Infant
DPT Hep B
3,000
3,000
3,000
3,000
90
90
90
105
TVR = EP x number
of doses
90
270
270
210
2.5
1.67
1.1
1.67
AVR = TVR x WF
225
451
297
351
20
10 or
20
1 or 10 10 or 20
12
46 or
23
297 or
30
36 or 18
MVR = AVR / 12
months
19
38
25
29
MVA = AVA / 12
4 or 2
25 or
2.5
3 or 1.5
Formula
Total Population
( TP )
e.g 3,000
Determine the
Eligible Population
( EP )
EP = TP x 3%
(Infants/Children)
Mothers
Tetox
EP = TP x 3.5 %
( Mothers )
Required number of
doses to immunize a
child/ mother
Determine the total
vaccine required
( TVR )
Wastage Factor
( WF )
Calculate the
Annual Vaccine
doses required
( AVR )
Number of doses per
ampule/vial
Determine Annual
Vaccine
Ampule/Vial
required ( AVA )
Caculate the
Monthly Vaccine
doses Required
( MVR )
Determine Monthly
Vaccine
Ampule/Vial
required ( MVA)
AVA = AVR / # of
doses per
ampule/vial
EPI VACCINES
Special Precautions
Side Effect
Undesired Effect
Contraindication
Health Teaching
Live Bacterial
Freeze dried
Birth or anytime at birth
1st dose : at birth
2nd dose: school entrance
BCG given at earliest possible age protects the
possibility of TB meningitis and other TB infectious in
which infants are prone.
20 ( 20 children )
At birth : 0.05 ml
At school entrance : 0.10 ml
Intradermal ( a special syringe and needle is used for
the administration of BCG vaccine )
Right deltoid region of the arm
2 C to 8 C ( in the body or refrigerator )
Note: Freezing does not damage it but ampules may
break.
Diluents should also be kept cold before using
Correct ID administration is essential. A special
syringe and needle is used for the administration of
BCG vaccine
A wheal formation
Koch phenomenon ( inflammatory reaction 2-4 days )
Indolent ulceration
Abscess on the injection site
Enlarged lymph nodes
Note: Swollen glands or abscesses occur because an
unsterile needle or syringe was used, too much vaccine
was injected or most commonly, the vaccine was
injected incorrectly under the skin instead of its top
layer.
Immunosuppressed indvidual due to malignant disease
( child with clinical AIDS ) ; therapy with
immunosuppressive agent or radiation.
Do not massage the area of injection
A scar will formed 12 weeks after injection
Repeat BCG vaccination if the child does not
develop a scar after first injection
Note:
Any remaining reconstituted vaccine must be discarded after 6 hours or at the end
of the immunization sessions, whichever comes first.
The small raised lump appears at the injection site, usually disappears within 30
minutes.
After 2 weeks, a red sore forms that is about the size of the end of an unsharpened
pencil.
The sore remains for another two weeks and then heals, a small scar, about 5mm
across remains. This is a sign that the child has been effectively immunized.
Repeat BCG vaccination if the child does not develop a scar after the 1st injection
BCG vaccine is moderately effective. It has a protective efficacy of:
50 % against any TB disease
64 % against TB meningitis
74 % against death from TB
Form of Vaccine
Minimum Age at 1st Dose
Number of Doses to
Complete the Immunization
4 weeks / minimum of 28 days
Interval
An early start with DPT reduces the chance of severe
Reason
pertussis
20 or 10
Number of Doses per
Ampule
0.5 ml
Dosage
Intramuscular
Route of Administration
Upper outer portion of the thigh ( Vastus lateralis ) in
Site of Administration
infant ( R L R )
Outer upper arm if older
2 C to 8 C ( in the body of refrigerator )
Storage Temperature
Note: DT component is damage by freezing
P component is damage by heat
DPT not usually given over 6 years of age
Special Precautions
Side Effect
Fever in the evening after receiving the injection.
Soreness, children may have pain, redness or
swelling at the injection site.
Contraindication
DPT2 or DPT3 is not given to a child who has
convulsions or shock within 3 days after DPT1.
Vaccines containing the whole cell pertussis
component should not be given to a children with an
evolving neurological disease.
Health Teaching
If the child has fever give paracetamol or any
appropriate antipyretic at the time and at four and
eight hours after immunization.
Alternating cold compress for 24 hours to warm
compress if there is pain and soreness .
Special Precautions
Side Effect
Contraindication
Health Teaching
10
Hepatitis B Vaccine
Type of Vaccine
Form of Vaccine
Minimum Age at 1st Dose
Number of Doses to
Complete the Immunization
Interval
Reason
Side Effect
Contraindication
Health Teaching
11
Measles Vaccine
Type of Vaccine
Form of Vaccine
Minimum Age at 1st Dose
Number of Doses to
Complete the Immunization
Measles vaccine given at 9 months provide at least
Reason
85% protection against measles infection.
When given at one year and older provides 95%
protection.
Note: An infant with known or suspected HIV infection
should receive measles vaccine at 6 months and then
again at 9 months
10 ( 10 children )
Number of Doses per
Ampule
0.5 ml
Dosage
Subcutaneous
Route of Administration
Outer part of the upper arm
Site of Administration
-15 C to -25 C ( at the freezer )
Storage Temperature
Note: But can also be safely stored between 0 C to 8C
until its expiry date.
Diluents should also be kept cold before using.
Birth dose must be given if there is a risk of perinatal
Special Precautions
transmission.
Note : Combination vaccines should not be given at
birth, only monovalent HepB vaccine
Side Effect
Fever that lasts one to two days after injection
Soreness, children may have pain, redness or
swelling at the injection site within 24 hours of
immunization. It usually resolve within two to three
days.
About 1 in 20 children develop a mild rash five to
12 days after receiving the vaccine. The rash usually
lasts about two days.
Contraindication
Severe reaction to previous dose
Pregnancy
Congenital or acquired immune disorder
Health Teaching
If the child has fever give paracetamol or any
appropriate antipyretic at the time and at four and
eight hours after immunization.
Alternating cold compress for 24 hours to warm
compress if there is pain and soreness .
It also prevent diarrhea
12
6 weeks
10 weeks
14 weeks
OPV
DPT
BCG
HepB
Option B
Option A
Measles
9 months
X
X
X
X
X
X
13
Contraindication
Health Teaching
Weakened toxin
Liquid vaccine
As early as possible during pregnancy
5 doses ( TeTox 1 TeTox 5 )
TeTox 2 is the minimum required immunization
during pregnancy
10 or 20
0.5 ml
Intramuscular
Outer upper arm
2 C to 8 C ( in the body of refrigerator )
Note: Never freeze
Fever in the evening after receiving the injection.
Soreness, woman may have pain, redness or
swelling and warmth at the injection site.
Anaphylactic reaction to previous dose
NO MEDICATION FOR PREGNANT
For Pain cold compress 24 hrs to warm compress
Minimum
Interval
As early as
possible during
pregnancy
4 weeks after
TeTox 1
Percent
Protected
TeTox 3
6 months after
TeTox 2
95 %
TeTox 4
99 %
TeTox 5
99 %
TeTox 1
TeTox 2
80%
Duration of Protection
14