Principles of EPI
Epidemiological situation
- Mass approach
- Basic Health Service
The 7 immunizable diseases
- Tuberculosis
- Diptheria
- Pertussis
- Measles
- Poliomyelitis
- Tetanus
- 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 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 |
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.
