Expanded Program for Immunization (EPI)

Principles of EPI

To reduce morbidity and mortality rates among infants and children from six childhood immunizable disease

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

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

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.

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 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.