INTRODUCTION TO EPIVACCINESBY DR. KOMALFINAL YEAR MBBSLUMHSGroup A-6
The Expanded Program On ImmunizationThe Expanded Program On Immunization(EPI(EPI))
 Expanded program on Immunization (EPI) is a worldhealth organization program, with the goal to makevaccines available to...
 Experience with smallpox eradication program showed theworld that immunization was the most powerful and cost-effective ...
 Expanding the number of diseases to be covered Expanding the number of children and targetpopulation to be covered Exp...
Routine Immunization: Children 0-23 months – immunization with 8 EPI antigens Pregnant ladies by TT.Supplemental Immuniz...
1. To achieve 100% coverage with all EPI vaccines.
2. Eradication of polio to maintain polio free status.
3. Elimination of measles.
4. To Reduce Seroprevalence Of HBsAg to < 1%among under five.
5.Elimination of Neonatal Tetanus .
6. To maintain zero level of diphtheria.
7-Prevention of severe forms of TB ( TB meningitis &militaryTB).
8- To reduce the incidence of whoopingcough
9- To Reduce the incidence of Bacteria Meningitis due9- To Reduce the incidence of Bacteria Meningitis dueto haemophelus i...
10- To Maintain Immunization Safety.
11-To prepare for introduction of new vaccines
 Expanded program on immunization was launched in Pakistan in1978. The purpose of EPI is to initiate a collective effort...
 Reduction of mortality and morbidity resulting from 7 EPI targetdiseases by immunizing children of age 0-11months and wo...
EPI SCHEDULE
Diseases Type of vaccine Dose Rout of administration1-BCG2-HBVTBHepatitis BLive attenuated,variantRecombinant, yeastderive...
Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharid...
Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharid...
Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharid...
The disease Type of thevaccine DoseMode ofadministration1-MMR•Measles,•Mumps•GermanMeaslesAllLive attenuated0.5 ml Subcuta...
Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharid...
Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-MMR- Measles- Mumps- GermanMe...
BCG (At birth) BCG vaccine is live attenuated variant of 0.05ml ID injection inright deltoidIt is used because it is eff...
HB Vaccine: At Birth, 2ndand 6thmonth Recombinant, yeast derived HBs antigen 0.5 ml IM anterolateral of the thigh
OPV : (Sabin) At birth,6 weeks,10 weeks, and14weeksOPV live attenuated2 drops orallyIt prevents against paralytic poli...
Severe bacterial infection, particularly among infantsDuring late 19th century believed to cause influenzaImmunology and m...
Small child receiving Hibvaccine into the muscles ofthe thigh.Adolescent receiving Hibvaccine into the deltoid muscleof th...
DPT vaccine: 2nd, 4th,6th, 18thmonths & 4-6 years D T are Toxoid of Diphtheria and Tetanus and P, isKilled pertussis Wi...
•DPT:2nd, 4th ,6th, 18th months& 4-6 years•DT:No pertussis componentIt is given as subsequent doses to aninfant who showed...
At 6 weeks,10 weeks,14 weeks,18 months,5 years,10years.Tetanus toxoid(inactivated toxin with formaldehyde).Dose:0.5 ml ...
Diphtheria causes a thick covering in the back of the throat.It can lead to breathing problems, paralysis, heart failure,a...
Pertussis is a bacterial infection caused by Bordetella pertussis. The germ isspread when infected people cough or sneeze....
MMRVaccination: 9th,12thmonth& 4-6 yearsLive attenuated ( Three :measles, German measles&Mumps)0.5 mlSubcutaneous arm
Pneumonia — a bacterial infection in the lungs — is acommon complication from the flu. In addition to a flushot every fall...
Pneumococcal vaccines. (Minimum age: 6 weeks for pneumococcal conjugatevaccine [PCV]; 2 years for pneumococcal polysacchar...
 Acute diarrhoea is responsiblefor nearly 1.9 million deaths peryear in children under age five. Rotavirus is responsibl...
 Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV-1[Rotarix] and RV-5 [Rota Teq]) The maximum age for the firs...
 80.2 %( 0-11 months) children fully immunized (CES-2006). 35.8 Million Children immunized against measles through speci...
EPI
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EPI

  1. 1. INTRODUCTION TO EPIVACCINESBY DR. KOMALFINAL YEAR MBBSLUMHSGroup A-6
  2. 2. The Expanded Program On ImmunizationThe Expanded Program On Immunization(EPI(EPI))
  3. 3.  Expanded program on Immunization (EPI) is a worldhealth organization program, with the goal to makevaccines available to all children throughout the world.
  4. 4.  Experience with smallpox eradication program showed theworld that immunization was the most powerful and cost-effective weapon against vaccine preventable diseases. In 1974, the WHO launched its “ Expanded program ofimmunization” (EPI) against six most common preventablediseases (diphtheria, pertussis, tetanus, polio,tuberculosis, measles and recently added pneumococcalvaccine).
  5. 5.  Expanding the number of diseases to be covered Expanding the number of children and targetpopulation to be covered Expanding coverage to all corners of the countryand spreading services to reach the less privilegedsectors of the society.
  6. 6. Routine Immunization: Children 0-23 months – immunization with 8 EPI antigens Pregnant ladies by TT.Supplemental Immunization Activities: Routine immunization does not ensure 100% coverage of the mobilepopulation i.e. nomads, NAs, hard to reach areas / missed areas. So SIAsare scheduled to ensure coverage of this population / areas. NIDs / SNIDs: children < 5 years receive polio drops (3-days campaign)Disease Surveillance: To detect every case of target diseases, the suspected cases of sevenVPDs are reported by health facilities to the district health authorities forimmediate launching of the control measures.Mopping up: Special campaigns 5-8 km around the infected locality to localize thedisease and stop its transmission. 
  7. 7. 1. To achieve 100% coverage with all EPI vaccines.
  8. 8. 2. Eradication of polio to maintain polio free status.
  9. 9. 3. Elimination of measles.
  10. 10. 4. To Reduce Seroprevalence Of HBsAg to < 1%among under five.
  11. 11. 5.Elimination of Neonatal Tetanus .
  12. 12. 6. To maintain zero level of diphtheria.
  13. 13. 7-Prevention of severe forms of TB ( TB meningitis &militaryTB).
  14. 14. 8- To reduce the incidence of whoopingcough
  15. 15. 9- To Reduce the incidence of Bacteria Meningitis due9- To Reduce the incidence of Bacteria Meningitis dueto haemophelus influenza.to haemophelus influenza.
  16. 16. 10- To Maintain Immunization Safety.
  17. 17. 11-To prepare for introduction of new vaccines
  18. 18.  Expanded program on immunization was launched in Pakistan in1978. The purpose of EPI is to initiate a collective effort to reduce themortality results from the seven EPI target disease by immunizingchildren of the age 0-11 months and women of child bearing age. Although Pakistan has made impressive gains in increasing the EPIcoverage in the recent years ,the public awareness and thus publicsupport and participation in immunization derives of the ministry ofhealth, government of Pakistan needs to improve further to enableus to achieve the target set under the Millennium developmentalGoals.
  19. 19.  Reduction of mortality and morbidity resulting from 7 EPI targetdiseases by immunizing children of age 0-11months and women ofchild bearing age. 90% routine immunization coverage of all EPI antigens by 2012. Interruption of polio virus transmission by 2012 Elimination of the Neonatal Tetanus by 2015 Reduction of The Diphtheria, Pertusis, Childhood TB, by maximumlevel Control of the other diseases by Introduction of new vaccines EPI
  20. 20. EPI SCHEDULE
  21. 21. Diseases Type of vaccine Dose Rout of administration1-BCG2-HBVTBHepatitis BLive attenuated,variantRecombinant, yeastderived HBs antigen0.01ml0.5mlID injection in leftdeltoidIM thigh
  22. 22. Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharideconjugate0.5 ml IM thigh3-HBV Hepatitis B Recombinant, yeastderived HBs antigen0.5 ml IM thigh4-DPT DiphtheriaTetanusWhoopingcoughToxoid (D)Toxoid (T)Killed pertussis (P)0.5 ml IM thigh
  23. 23. Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharideconjugate0.5 ml IM thigh3-DPT DiphtheriaTetanusWhoopingcoughToxoid (D)Toxoid (T)Killed pertussis (P)0.5 ml IM thigh
  24. 24. Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharideconjugate0.5 ml IM thigh3-HBV Hepatitis B Recombinant, yeastderived HBs antigen0.5 ml IM thigh4-DPT DiphtheriaTetanusWhoopingcoughToxoid (D)Toxoid (T)Killed pertussis (P)0.5 ml IM thigh
  25. 25. The disease Type of thevaccine DoseMode ofadministration1-MMR•Measles,•Mumps•GermanMeaslesAllLive attenuated0.5 ml Subcutaneous
  26. 26. Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-HiB Hib disease polysaccharideconjugate0.5 ml IM thigh3-DPT DiphtheriaTetanusWhoopingcoughToxoid (D)Toxoid (T)Killed pertussis (P)0.5 ml IM thigh
  27. 27. Diseases Type of vaccine Dose Rout ofadministration1-OPV Polio Live attenuated 2 drops oral2-MMR- Measles- Mumps- GermanMeaslesAllLive attenuated 0.5 ml IM thigh3-DPT DiphtheriaTetanusWhoopingcoughToxoid (D)Toxoid (T)Killed pertussis (P)0.5 ml IM thigh
  28. 28. BCG (At birth) BCG vaccine is live attenuated variant of 0.05ml ID injection inright deltoidIt is used because it is effective in reducing the severity of TBmeningititis and miliary TB
  29. 29. HB Vaccine: At Birth, 2ndand 6thmonth Recombinant, yeast derived HBs antigen 0.5 ml IM anterolateral of the thigh
  30. 30. OPV : (Sabin) At birth,6 weeks,10 weeks, and14weeksOPV live attenuated2 drops orallyIt prevents against paralytic polio.It provides rapid immunity within 1week.
  31. 31. Severe bacterial infection, particularly among infantsDuring late 19th century believed to cause influenzaImmunology and microbiology clarified in 1930s The type of Hib vaccine is inactivatedpolysaccharide conjugated vaccine. It is made by joining of the polysaccharideof Hib bacterium and protein carrier. Give all infants, including prematureinfants, a primary series of Hib vaccinebeginning at the age of 2 months. Do not administer Hib prior to six month ofthe age, because it will induce immunologictolerance to further dose of Hib vaccine.
  32. 32. Small child receiving Hibvaccine into the muscles ofthe thigh.Adolescent receiving Hibvaccine into the deltoid muscleof the arm.
  33. 33. DPT vaccine: 2nd, 4th,6th, 18thmonths & 4-6 years D T are Toxoid of Diphtheria and Tetanus and P, isKilled pertussis With dose 0.5 ml ,IM thigh
  34. 34. •DPT:2nd, 4th ,6th, 18th months& 4-6 years•DT:No pertussis componentIt is given as subsequent doses to aninfant who showed severe adverse effectsdue to pertussis component.•dT:No pertussis component.A small dose of diphtheria toxoid is givenat school entry or after the age of six years.
  35. 35. At 6 weeks,10 weeks,14 weeks,18 months,5 years,10years.Tetanus toxoid(inactivated toxin with formaldehyde).Dose:0.5 ml I/MTwo 0.5 ml doses I/M injection administered at 4-8weeks interval 3rddose after 1 year.
  36. 36. Diphtheria causes a thick covering in the back of the throat.It can lead to breathing problems, paralysis, heart failure,and even death. There are several combination vaccinesused to prevent diphtheria: DTaP, DT, and Td.
  37. 37. Pertussis is a bacterial infection caused by Bordetella pertussis. The germ isspread when infected people cough or sneeze.Available Vaccines:No pertussis-only vaccine is available. The pertussis vaccine is available as:DTaP (Diphtheria Toxoid-Tetanus Toxoid-acellular Pertussis vaccine)DTaP in combination with Haemophilus influenzae type b (Hib) vaccineDTaP in combination with hepatitis B and inactivated polio vaccinesDTaP in combination with Hib, hepatitis B and inactivated polio vaccinesTdap (Tetanus Toxoid reduced-Diphtheria-acellular Pertussis vaccine)
  38. 38. MMRVaccination: 9th,12thmonth& 4-6 yearsLive attenuated ( Three :measles, German measles&Mumps)0.5 mlSubcutaneous arm
  39. 39. Pneumonia — a bacterial infection in the lungs — is acommon complication from the flu. In addition to a flushot every fall, its a good idea to get a once-in-a-lifetimepneumococcal vaccine.
  40. 40. Pneumococcal vaccines. (Minimum age: 6 weeks for pneumococcal conjugatevaccine [PCV]; 2 years for pneumococcal polysaccharide vaccine [PPSV]).• Administer 1 dose of PCV to all healthy children aged 24 through 59 monthswho are not completely vaccinated for their age.• For children who have received an age-appropriate series of 7-valentPCV (PCV7), a single supplemental dose of 13-valent PCV (PCV13) isrecommended for:— All children aged 14 through 59 months— Children aged 60 through 71 months with underlying medical conditions.• Administer PPSV at least 8 weeks after last dose of PCV to children aged 2years or older with certain underlying medical conditions, including a cochlearimplant
  41. 41.  Acute diarrhoea is responsiblefor nearly 1.9 million deaths peryear in children under age five. Rotavirus is responsible for asmuch as one fourth of thesecasualties, almost all of whichoccur in developing countries.
  42. 42.  Rotavirus (RV) vaccines. (Minimum age: 6 weeks for both RV-1[Rotarix] and RV-5 [Rota Teq]) The maximum age for the first dose in the series is 14 weeks, 6days; and 8 months, 0 days for the final dose in the series.Vaccination should not be initiated for infants aged 15 weeks, 0days or older. If RV-1 (Rotarix) is administered at ages 2 and 4 months, adose at 6 months is not indicated.
  43. 43.  80.2 %( 0-11 months) children fully immunized (CES-2006). 35.8 Million Children immunized against measles through specialcampaign in 2008. TT Immunization to target women (15-49 yrs.) in 6 high risk Districts inPunjab. Vitamin-A supplementation –twice a year with coverage >95%. Storage capacity enhanced for the buffer stocks of all vaccines for theperiod of 3 months.  Improved monitoring & supervision through Provision of 59 single cabin vehicles for DO(H) under GAVI.Provision of 3652 motorcycles to EPI staff under GAVI.Provision of cold chain equipment to 8 flood hit districts.Capacity building of health managers and EPI staff, (17,804).Orientation training workshops for medical officers LHVs, LHWs, etc.Training of health personnel for cold chain repair and maintenance.Training workshops for vaccine stock management carried out in alldistricts during 2010, 2011 and 2012.
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