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 bacteriaFreeze 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.