Expanded Program of Immunization Dr Faten M Rabie

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 only 3 contraindications: • • Immune compromised child ( mainly There are 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………………. . 50 l 1000 • 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.