The Expanded Program On Immunization (EPI)

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The Expanded Program On Immunization(EPI)
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Bacille Calmette-Guérin (BCG) Vaccine

• Live attenuated vaccine
• Store at 0 to 8C
• Age at birth or 6 weeks
• Route of administration
• a single intra dermal injection over the deltoid
  muscle of the arm or left forearm .

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• At site of injection development of erythema and
  either a papule or ulceration, followed by a scar
  at the immunization site.

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• Bacille Calmette-Guérin (BCG) Vaccine
• Side effects
• Lymphadenitis
• Contraindication
• Immune deficiency diseases, including congenital
  immunodeficiency, HIV infection and impaired
  immune function secondary to treatment with
  corticosteroids, chemotherapeutic agents or
  radiation.

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ORAL POLIO VACCINE (OPV)

• Contents  Sabin attenuated polio virus (live
  attenuated vaccine)
• Ideal age of Initiating primary vaccination
• 6 week
• (an additional dose recommended at birth by
  W.H.O. OPV0)

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ORAL POLIO VACCINE (OPV)

• Boosters Two, at 1.5 years and between 4-5
  years.
• Dose 2 drops.
• Route of administration Oral.

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ORAL POLIO VACCINE (OPV)

• Contra Indications
• Immunocompromised host or household member.
• Side effects None.
• Complications Vaccine induced poliomyelites (one
  in 3 million vaccine)
• The dose of OPV given during an episode of
  diarrhea should not be counted and shoud be to
  given at the earliest opportunity

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ORAL POLIO VACCINE (OPV)
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Pentavalent Vaccine

• Contents Each 0.5 ml contains
•   Diphtheria toxoid, Tetanus toxoid, pertussis,
  Hepatitis B, Haemophilus influenzae b.
• The vaccine should not kept frozen or exposed to
  freezing
• Store at 2 to 8C
• Dose 0.5 ml.

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Pentavalent Vaccine

• Route of administration Deep intramuscular.
• Site of administration Anterolateral aspect of
  thigh.

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Pentavalent Vaccine

• Side effects Fever, local pain and swelling.
• Instruction to the mother after vaccination To
  give antipyretic (paracetamol) in case of fever.

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Complications Convulsions, shock, encephalitis.
Contra- Indications       a. Progressive
neurological disease. b. Uncontrolled
convulsions.        c. Severe reactions to
first or subsequent dose
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local reactions swelling,
redness, or pain at the injection site.
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Measles Vaccines

• Contents live attenuated measles virus grow in
  chick embryo cells.
• Store at 0 to 8C
• Ideal age of Primary vaccination
• 9 months.
• In epidemics household contacts should be
  between 6-9 months

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• Measles Vaccines
• Dose 0.5 ml.
• Route of administration Subcutaneous.
• Site of administration Upper arm or
  anterolateral aspect of
• thigh.
• .

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Measles

• Side effects Mild fever rash may appear
  after 5-7 days.
• Contra-Indications       
• Immuno compromised host.    
• Severe (anaphylactic) egg allergy.

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Rotavirus Vaccines

• Contains one strain of live attenuated
• rotavirus (type G1P8
• Store at (2-8o C) and protect from light

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Rotavirus Vaccine

• Dose 1.5 ml
• 2 doses
• minimum interval between doses is 4 week
• Age-
• beginning at 6weeks of age
• Early immunization is favoured with the first
  dose of rotavirus vaccine to be administered from
• 6 weeks of age, however, in order to benefit
  those who may come late infants can receive doses
• without age restriction. Because of the typical
  age distribution of rotavirus gastroenteritis
• ( rotavirus vaccination of children gt24 months of
  age is not recommended.

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Rotavirus VaccineContraindications

• Severe allergic reaction to a vaccine component
  or following a prior dose of vaccine

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Rotavirus VaccinePrecautions

• Altered immunocompetence
• History of intussusception

the decision to vaccinate if a precaution is
present should be made on a case-by-case risk and
benefit basis
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Rotavirus VaccineAdverse Reactions

• Vomiting
• Diarrhea
• Irritability
• Fever
• Serious adverse reaction None

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• Contraindications to vaccinations
• Absolute
• Temporary

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• Contraindications to live attenuated vaccines
• Absolute
• 1- History of anaphylactic reactions.
• 2- Subsequent doses of pertussis vaccines are
  absolutely contraindicated if the child gets
  (within 48 hours of vaccination )
• Fever (40.5º) ,
• Collapse or shock .
• Persistent crying for 3 hours without apparent
  cause.
• Convulsion with or without fever within 3 hours
  after
• vaccination.
• Give a single dose vaccine of diphtheria
  tetanus pediatric formula ( avoid pertussis
  component).

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Contraindications to live attenuated
vaccines Absolute 3- HIV infection is an
absolute contraindication to administration of
live attenuated vaccines ( OPV BCG).
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Temporary 1- Severe illness that needs
hospitalization. Deferred immunization till the
infant recovers and could be at discharge. 2-
Immunosuppression.
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The strategy for the vaccine delivery
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• The strategy for the vaccine delivery
• The fixed site strategy.
• Outreach site strategy.
• Mopping up Immunization.
• The National Immunization Days (NIDs).

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• 1. The fixed site strategy
• There is integration of immunization services
  through (MCH)
• Advantages-
• 1-Available resources.
• 2- Cold Chain maintenance.
• 3- Save ,time, effort and money.

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• 2.The out reach Strategy
• The outreach is carried for routine immunization
  that is compulsory for the targets in certain
  areas where
• - immunization services are not accessible.
• - vaccination coverage is Low.
• Limitations
• (i) Expensive
• (ii) Cold chain failure.
• (iii) Difficulty to arrange the immunization
  schedule.

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• (Outreach immunization

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• (3) Mopping up Immunization
• It is house-to-house immunization with OPV in
  high risk districts.
• High risk districts are those
• Where the wild polio virus is still circulating
• With low immunization coverage.
• Population, with overcrowding poor sanitary
  environment and low access to health services.

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(4) The National Immunization Days (NIDs) It is
periodic immunization of all the eligible targets
in a defined group over a large geographic areas
within a short period of time. It is one of the
strategy for polio eradication and tetanus
elimination.
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The cold chain
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The cold chain It is the system of
storage and transportation of the vaccine at low
temperature (cold condition) from the manufacture
till it is consumed.
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• The cold chain
• Polio vaccine is the most sensitive vaccine to
  heat.
• Live attenuated vaccines are allowed to be frozen
  (OPV, Measles and BCG).
• Inactivated vaccines must not be frozen ( DPT,
  DT, dT , TT and HB) .

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The levels of cold chain
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The administrative levels of cold chain according
to the duration of the storage and the
temperature required to keep the vaccine potent
The administrative level Storage period Temperature The vaccines
Central regional stores Maximum three months - 20 to- 30C OPV, Measles, MMR,BCG
Central regional stores Maximum three months 2 to 8C DPT, DT, dT, TT HB,Hib
Districts stores local immunization centers Maximum one month 0C to8C OPV, Measles, MMR, BCG
Districts stores local immunization centers Maximum one month 2 to 8C DPT, DT, dT, TT HB,Hib

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• The components of the cold chain

The equipment and tools
The health staff
The procedures
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• Refrigeration equipment
• Refrigerator
• Cold boxes
• Vaccine carriers
• The ice packs retained in the freezer
• -To stabilize the
  temperature of the refrigerator at the
• optimum level.
• - Fully frozen ice-packs
  are used for lining the vaccines
• carriers and the cold
  boxes during storing the vaccines

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Cold Chain Equipment

• The recommended
• equipment  typically used for vaccine
  storage are
• cold rooms,
• refrigerators and
• freezers. 

• For transporting vaccines
• equipment such as
• cold boxes,
• vaccine carriers and

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Cold chain equipment For vaccine storage
refrigerators
Cold room
Freezer
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Cold chain equipment for transporting vaccine
Vaccine carrier
Cold box
Ice bags
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Cold box

• ice Packs

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• Vaccine carrier

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Vaccine carrier
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• The refrigerator
• Placed in the coolest place of the health
  centers away from sunlight
• Well ventilated and adequate air circulation
  around it .
• Kept locked and open only when necessary.
• Ice packs are kept in the freezer.
• Its temperature is recorded twice daily.
• Both the monitor and thermometer are placed in
  the refrigerator.
• The temperature chart is stuck on the door
  outside the refrigerator.
• The diluents should be kept on the lowest shelf.
  
• Drugs, drinks or food must not be stored in the
  refrigerator

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Tools for monitoring the cold chain
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Tools for monitoring the cold chain 1- Cold
Chain Monitor Card. 2- Freeze Watch Indicator 3-
Cold Chain Refrigerator Graph 4- Vaccine Vial
Monitors 5- Shake Test
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8C
2C
Cold Chain Refrigerator Graph The vaccines are
stored in refrigerators, they are monitored twice
a day and readings are recorded on a chart to
ensure a safe temperature is maintained
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2-Cold Chain Monitor Card is used to show
cumulative exposure to Temp. above the safe range
during storage transportation.
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2-Cold Chain Monitor Card
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3-Vaccine vial monitors Every vial is also
shipped with a temperature-sensitive label, that
health workers monitor during vaccination
sessions.
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• SAFEIf the inner square is lighter than the
  outer ring and the expiration date is valid, the
  vaccine is
• usable

• SPOILEDIf the inner square matches or is darker
  than the outer ring, the vaccine must be
  discarded.

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• 4-The shake testDPT, hepatitis B and tetanus
  toxoid vaccines can all be damaged by freezing.
  By shaking two vials, side-by-side, one that
  might have been frozen and one that has never
  been frozen, health workers can determine if a
  vaccine has spoiled.

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What damage the Vaccines? 1. Any defect in the
cold chain. 2. Out date expiry. 3. Exposure of
the vaccine to unacceptable temperature
during the immunization session. 4. Exposure of
the vaccine to direct sunlight (BCG)
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Thank You