2. Objectives
10/1/2023
BY:Tamene F.
2
At the end of this session, learners are expected to
Define immunization
Describe the different types of vaccines
Identify different vaccine preventable diseases
Discuss EPI schedules
Discuss vaccine storage & handling
Discuss EPI in Ethiopia
3. Background
10/1/2023
BY:Tamene F.
3
Vaccine-preventable diseases are responsible for nearly
20% of the 8.8 million deaths/year among children <5
years.
WHO launched EPI in 1974 to develop and expand
immunization programs around the world
In 1974, <5% of children were immunized in their first
year against 6 targeted diseases
By 2005, 80% of children immunized in their first year
against 6 targeted diseases.
4. Cont…
10/1/2023
BY:Tamene F.
4
Original six basic EPI vaccines for developing countries
are BCG, Polio, Diphtheria, Pertussis, Tetanus &Measles
Vaccinations are one the most successful and cost-
effective public health investments.
1980, global smallpox eradication achieved.
1988, polio targeted for global eradication with infections
falling by 99%.
Immunization prevents many diseases
5. Brain storming questions
10/1/2023
BY:Tamene F.
5
I. What does Expanded refers to?
II. What is vaccine?
III. What is immunity?
IV. What is the difference b/n immunization &
vaccination?
6. Definition
10/1/2023
BY:Tamene F.
6
“Expanded” means, expanding the;
Number of diseases to be covered
Number of children and target population to be
covered
Coverage to all corners of the country and
spreading services to reach the less privileged
sectors of the society
7. Cont…
10/1/2023
BY:Tamene F.
7
Vaccine is an immune biological substances which
produce specific protection against a given disease.
Stimulates active production of protective antibody
Immunity is the body's ability to fight off harmful
micro-organisms(pathogens)that invade it.
8. Vaccination
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BY:Tamene F.
8
Vaccination is a method of giving antigen to stimulate
the immune response through active immunization.
Immunization is the process by which an individual's
immune system becomes fortified against an agent
(known as the immunogen) through either active or
passive immunization
9. Types of immunity
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BY:Tamene F.
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1. Congenital or innate or non-specific immunity.
It is the natural resistance of body e.g. skin, WBC
etc.
2. Acquired or specific immunity
A. Active acquired immunity
B. Passive acquired immunity
10. 10/1/2023
BY:Tamene F.
10
A. Active acquired immunity
Resistance developed in response to stimulus by an antigen
(infecting agent or vaccine) and is characterized by the
production of antibodies by the host.
B. Passive acquired immunity
Immunity conferred by an antibody produced in another
host.
It may be acquired naturally or artificially (through an
antibody-containing preparation).
11. Active acquired immunity
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BY:Tamene F.
11
Two types
a. Naturally acquired active Immunity.
-The child makes immunity after exposure to a
disease.
b. Artificial acquired active Immunity.
-The child makes anti bodies after
administration of antigen (vaccine).
12. Passive acquired immunity
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BY:Tamene F.
12
Two types
a. Natural-acquired passive immunity
Trans placentaly transferred maternal antibodies in the
body of the child.
b. Artificial acquired passive immunity.
Formed antibodies are administered to the child.
e.g. T.A.T
13. Have you heard about herd immunity?
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BY:Tamene F.
13
When most of the people in a community are immune to
particular infection, natural transmission is inhibited.
So, minorities are immune to that particular infection & this
type of immunity is herd immunity.
It works in infections transmitted from person to person.
14. Types of vaccine
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BY:Tamene F.
14
1. Live vaccines
Live vaccines are made from live infectious agent
without any amendment.
The only live vaccine is “Variola” small pox vaccine,
made of live vaccinia cow-pox virus (not Variola virus)
which is not pathogenic but antigenic.
15. 2.Attenuated live vaccine
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BY:Tamene F.
15
A vaccine that contains a microorganism in live but
attenuated form.
It will be unable to replicate enough to cause illness, but
will still provoke an immune response that can protect
against future infection.
eg, OPV, BCG, measles
16. 3.Inactivated / Killed Vaccines
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BY:Tamene F.
16
Are created by inactivating a pathogen, typically using heat or
chemicals such as formaldehyde or formalin.
This destroys the pathogen’s ability to replicate, but keeps it “intact”
so that the immune system can still recognize it.
“Inactivated” is generally used rather than “killed” to refer to viral
vaccines of this type are generally not considered to be alive.
E.g. Inactivated poliovirus vaccine
17. 4. Toxoids
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BY:Tamene F.
17
Some bacterial diseases are not directly caused
by a bacterium itself, but by a toxin produced by
the bacterium.
Eg tetanus symptoms caused a neurotoxin
produced by Clostridium tetani, not Clostridium
tetani it self.
A toxin that has been treated to weaken its
toxic effects but retain its
antigenicity(inactivation).
Toxoids can actually be considered killed or
inactivated vaccines, but are sometimes given
their own category to highlight the fact that they
contain an inactivated toxin, not an
inactivated form of bacteria.
18. 5. Conjugate (polysaccharide ) vaccine
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BY:Tamene F.
18
Conjugate vaccines are made using pieces
from the coats of bacteria.
These coats are chemically linked to a
carrier protein(binding the capsule with a
carrier protein) and the combination is used as
a vaccine.
e.g. the pneumococcal conjugate vaccine and
Hib vaccine
Their efficacy and safety appear to be high
19. 6. Surface antigen (recombinant) vaccines.
10/1/2023
BY:Tamene F.
19
A gene coding for a vaccine protein is inserted into
another virus, yeast or into producer cells in culture.
The recombinant vector(eg.yeast) that is gnomically
modified will express that particular antigen.
The antigen is then extracted from the vector to be served
as vaccine.
Eg Cloning HBsAg gene in yeast cells.
HBsAg produced is then used for vaccine preparations.
Their efficacy and safety also appear to be high
20. Vaccine preventable diseases
10/1/2023
BY:Tamene F.
20
Tuberculosis
Pertussis/whooping
cough
Measles
Tetanus
Diarrhea
Poliomyelitis
Hepatitis -B
Pneumonia
Diphtheria
Heamophillus
influenza type B
21. Forms of vaccines
10/1/2023
BY:Tamene F.
21
Powder form = BCG and measles dilute 1ml and 5ml
respectively
Liquid form = polio, pentavalent , TT, Rota
22. Schedules of Vaccination
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BY:Tamene F.
22
How many times should a child go for Immunization?
Vaccination Schedule may vary from nation to nation.
Vaccination schedule depends on geographic, economic
and prevalence of specific diseases .
A child should be taken for immunization six times to
complete the immunization.
24. Schedule….
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BY:Tamene F.
24
Vaccine Dose Route ,site No. of dose
/age
Side effect
BCG <1yr 0.05ml
>1yr 0.1 ml
ID, right upper
arm
1/at birth or
at any age
- Local
inflammation
- Small scar
- Deep abscess
OPV 2 Drops PO ,mouth 4/at birth,
6,10,14 weeks
None
DPT- HBV-HIB
(pentavalent)
0.5 ml IM, left upper
anterior thigh
3/6 wks,10
wks, 14 wks
Fever, local
swelling,
sometimes
convulsion
Measles 0.5 ml Sc, Left upper
arm
2/at 9&15
months or
later
Fever, rash
25. Scheme of immunization
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BY:Tamene F.
25
Primary vaccination
One dose vaccines (BCG, mumps, rubella, yellow
fever)
Multiple dose vaccines (polio, measles, DPT,
hepatitis B, Hib)
Booster vaccination
To maintain immunity level after it declines &after
some time has elapsed (DT, MMR, OPV).
26. Commonly Used Vaccines
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BY:Tamene F.
26
Polio-Vaccine
Has clear pink or pale orange liquid.
Has comes in small bottle with dropper cap.
Has damaged very quickly by heat than other vaccines.
Does not damaged by freezing.
Vaccine available in two forms:
– Live attenuated virus given by mouth (Sabin)
– Killed virus given by injection (Salk)
Three doses to infants at 6, 10, and 14 weeks of age(salk)
27. Measles vaccine
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BY:Tamene F.
27
Freeze-dried preparation of live attenuated virus
To use the vaccine, mix the dry vaccine with diluent’s
water(reconstitute before use)
Is easily damaged by heat.
Reconstituted vaccine losses its potency very quickly, you
must use it in same immunization session, or throw it out.
Administered by sub-cutaneous injection at 9 and 15
months of age.
In most developed countries, measles is combined with
mumps and rubella (MMR) and is administered around 12-
15 months.
Second dose at 4-6 years of age
28. BCG vaccine
10/1/2023
BY:Tamene F.
28
First used in 1921 as freeze-dried live
attenuated vaccine of Mycobacterium bovis
Is damaged most easily by sun light.
Given on lateral aspect of arm, at the deltoid
insertion
To be given intradermal(0.05ml)
Good evidence for also protecting against
Mycobacterium leprae (leprosy)
Often causes a scar at the injection site
29. Vaccination for Diphtheria, Tetanus and Pertussis
10/1/2023
BY:Tamene F.
29
Triple Antigen ( DTP )
Contains Toxoids of Diphtheria and Tetanus,
Pertussis component contains whole cell
preparation from Bordetella pertussis.
Intramuscular injection in outer mid-thigh for
infants and outer upper arm for children and
adults
Vaccine must NOT be frozen; store at 2-8 degrees
Celsius
Administer three primary DTP doses (usually at
6, 10, 14 weeks) and one DTP booster (18
months to 6 years)
30. Hepatitis B vaccine
10/1/2023
BY:Tamene F.
30
Protects against Hepatitis B virus (HBV)
Recombinant DNA or plasma-derived antigen
vaccine
All infants should receive 1st dose of hepatitis
B vaccine within 24 hours after birth
To be given intramuscular with 0.5ml
Dosing schedule requires three doses
Must NOT be frozen, store between 2-8
degrees Celsius
31. Heamophillus influenza type b(Hib) vaccine
10/1/2023
BY:Tamene F.
31
Hib polysaccharides conjugated with either
diphtheria or tetanus toxoids.
Administered by intramuscular injection.
Three doses during infancy normally with
DPT.
Pneumococcal vaccine
Capsular polysaccharide antigens from
different subtypes of S. pneumonia.
Administered by IM injection.
32. Rotavirus Vaccine
10/1/2023
BY:Tamene F.
32
Started in November 2013 in Ethiopia
This is a live attenuated vaccine
Given by mouth.
Can be given at the same time as first and second
Pentavalent vaccines
Two doses: at six and ten weeks and 6 months for third
dose (if needed)
Maintain an interval of 4 weeks between doses
Protect against diarrheal diseases
The vaccine comes in 2 brands, Rotateq(2ml)
and Rotarix (1ml).
33. Vaccination
10/1/2023
BY:Tamene F.
33
First dose of vaccine should be given before 15 weeks
Second dose has to be given before 32 weeks
16 weeks is too late for 1st dose and 33 weeks is too late for
2nd dose
Rota 1
Rota 2
6
Birth 10 15 32
weeks
34. Acceptable proof of immunization
10/1/2023
BY:Tamene F.
34
BCG scar on the right upper arm
Immunization card
35. Contra -indications to Vaccination
10/1/2023
BY:Tamene F.
35
Do not give vaccines to acutely ill patients.
Avoid giving live vaccines to immuno suppressed
patients and pregnant women
Avoid all types of vaccines in the first Trimester of
pregnancy
In HIV patients do not give BCG vaccine
36. Precaution for vaccines
10/1/2023
BY:Tamene F.
36
a. All vaccine to be stored at +2c0 to 8c0.
b. Vaccine storage time at health center is up to 1 mo.
c. Measles & polio can be kept frozen.
d. Never freeze pentavalent or tetanus vaccine.
e. Keep diluents & vaccines in refrigerator
37. Vaccine Storage and Handling
10/1/2023
BY:Tamene F.
37
Vaccines prevent serious, sometimes fatal diseases
Improper S&H=reduced vaccine effectiveness=
inadequate protection against disease
It is better NOT to vaccinate than to administer a dose
of vaccine that has been mishandled.
38. Cold chain
10/1/2023
BY:Tamene F.
38
Is an equipment that ensure vaccine potency by keeping vaccine
cold from the point of manufacture to the point of
administration.
Manufacturer to airport; cold storage at airport,correct
temperature from airport to storage in central, regional and
district stores and in health centers
Transported at the correct temperature to outreach sites
Kept at correct temperature during immunization sessions
Check the temperature twice daily at the morning & evening
39. Cold chain cont …
10/1/2023
BY:Tamene F.
39
Equipments and people together that keep vaccines
cold during their journey
Equipment for cold chain includes:
Refrigerator
Cold boxes
Vaccine carriers
Ice packs
Thermo-meter
40. Cold box:
10/1/2023
BY:Tamene F.
40
A cold box is an insulated container that can be
lined with ice-packs to keep vaccines cold during
transportation (from two to seven days).
Cold boxes are used to collect and transport
monthly vaccine supplies from district stores to the
health facility.
They are also used to store vaccines when the
refrigerator is out of order or being defrosted and
for outreach and mobile sessions.
41. Vaccine carriers
10/1/2023
BY:Tamene F.
41
Similar with cold boxes, but smaller .
They are easier to carry if walking.
Do not stay cold as long as a cold box – maximum for 48
hours with the lid closed.
Vaccine carriers are used to transport vaccines and
diluents to outreach sites immunization sessions.
Vaccine carriers are also used to store vaccines when
the refrigerator is out of order or is being defrosted.
42. Ice-packs
10/1/2023
BY:Tamene F.
42
Ice-packs are flat, square plastic bottles that are
filled with water and frozen.
Ice-packs are used to keep vaccines cool inside
the vaccine carrier or cold box.
The number of icepacks required for a cold box
or vaccine carrier varies.
43. What damages a vaccine?
10/1/2023
BY:Tamene F.
43
Vaccines are sensitive biological products.
Some vaccines are sensitive to freezing, some to
heat and others to light
Heat and sunlight damage all vaccines, but live
attenuated vaccine ( BCG, measles and polio)
most sensitive
• BCG most sensitive to sunlight
• Polio most sensitive to heat
Freezing damage (pentavalent , TT)
44. Compartment of refrigerator for vaccine
10/1/2023
BY:Tamene F.
44
Highest coldness
Top compartment = measles and polio
Middle compartment = BCG
Lower compartment = pentavalent and TT
4th compartment (if available) for distilled water
Lowest coldness
45. Vaccines sensitive to heat
10/1/2023
BY:Tamene F.
45
Most sensitive
OPV
Measles
BCG
TT
pentavalent
least
sensitive
46. Vaccines sensitive to cold
10/1/2023
BY:Tamene F.
46
Most sensitive
Pentavalent
TT
Least
sensetive
47. Vaccine Vial Monitoring(VVM)
10/1/2023
BY:Tamene F.
47
Every vial is shipped with a temperature-sensitive label,
that health workers monitor during vaccination
sessions.
If the inner square is lighter than the outer ring and the
expiration date is valid, the vaccine is safe
If the inner square matches or is darker than the outer
ring, the vaccine must be discarded
50. EPI in Ethiopia
10/1/2023
BY:Tamene F.
50
In Ethiopia, routine immunization was launched in
1980
The schedule was revised in 1986 to include only
infants under one year in line with the global target
Pneumococcal conjugate Vaccine (PCV) 10 and
rotavirus vaccine were introduced in 2011 and 2013,
51. Cont…
10/1/2023
BY:Tamene F.
51
Over the five years (2015-2019), the country plans to
introduce inactivated polio Virus, measles-rubella,
meningitis and yellow fever vaccines into the routine
EPI schedule for children under one year of age.
The introduction of human papilloma virus, and
Tetanus, Diphtheria (Td) vaccines is planned for girls
between 9 and 13 years old.
52. National Immunization Policy
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BY:Tamene F.
52
The Ethiopian immunization policy was updated in
2007.
Children of under-one year of age and women of
reproductive age group (15-49 years age) are the targets
for the EPI vaccines (BCG, Measles, DPT-HepB-Hib or
penta-valent vaccine, OPV,Rota and TT vaccine in
Ethiopia respectively).
53. Cont…
10/1/2023
BY:Tamene F.
53
Schedule for ten EPI vaccines for children and tetanus
immunization for WCHA in Ethiopia strictly follows the
WHO recommendations for developing countries.
Booster doses for measles vaccine are included in
routine EPI for childhood immunization& there are
periodical supplemental doses for polio.
Vitamin A supplementation is integrated also both with
routine EPI.
54. 10/1/2023
BY:Tamene F.
54
Age Vaccination/antigen Vitamin A WCBA(15-
49yrs&pre
gnant
Minimal interval for TT
At birth Polio-o & BCG TT1 At first contact during
pregnancy or all WCBA
(15-49years )
Six weeks DPT1-HepB- Hib,
PCV -1, polio-1
&Rota.v1
TT2 At least 1month after TT1
10 weeks DPT2-HepB- Hib ,
PCV-2 & polio-2,
Rota .v 2
TT3 At least 6month after TT2
14 weeks DPT3-HepB- Hib ,
PCV-3 & polio-3
TT4 At least 1year after TT3
9 months Measles 1st dose of
Vit.A
TT5 At least 1year after TT4
With in 2
weeks of
delivery(p
ost natal
