Help to teach and guide on the , immunization programme

1. EXPANDED PROGRAMME IN
IMMUNISATION
J. NKOLE
CUST

2. Introduction
• The Expanded Program on Immunization is a World
Health Organization program with the goal to make
vaccines available to all children throughout the world.
• The World Health Organization (WHO) initiated
the Expanded Program on Immunization (EPI) in
May 1974 with the objective to vaccinate children
throughout the world.

3. Introduction cont’d
• In 1999, the Global Alliance for Vaccines and
Immunization (GAVI) was created with the
sole purpose of improving child health in the
poorest countries by extending the reach of
the EPI.

4. The current goals of the EPI
i. To ensure immunization of children under one
year of age in every district.
ii. To globally eradicate poliomyelitis.
iii.To reduce maternal and neonatal tetanus to an
incidence rate of less than one case per 1,000
births by 2005, to cut in half the number of
measles-related deaths that occurred in 1999.

5. Introduction cont’d
iv. To extend all new vaccines and
preventive health interventions to children in
all districts in the world.

6. REVIEW OF IMMUNOLOGY
• Immunology deals with the defense
mechanisms including all physical, chemical
and biological properties of the organism that
help it to combat its susceptibility to foreign
organisms, material, etc.
• There are two types of components that are
involved in immunity. These are:

7. Non-specific component or innate immunity.
Specific component or adaptive immunity
• The non-specific components act either as
barriers or as eliminators of wide range of
pathogens irrespective of antigenic
specificity.

8. • Other components of the immune system
adapt themselves to each new disease
encountered and are able to generate
pathogen-specific immunity.

9. • Nonspecific immunity or innate immunity is
the natural resistances with which a person is
born.
• It provides resistances through several
physical, chemical and cellular approaches.
Microbes first encounter the epithelial layers,
physical barriers that line skin and mucous
membranes.

10. • Subsequent general defences include secreted
chemical signals (cytokines), antimicrobial
substances, fever, and phagocytic activity
associated with the inflammatory responses.

11. • Specific immunity or Adaptive immunity
consists of two responses which are;
Humoral response
Cell mediated response

12. • Humoral immune system
• The is the first way of the body’s response to
antigens and it happens through substances
called antibodies which circulate within the
body and can act against antigens at sites very
far from where they were originally produced
• Antibodies are produced by special cells called
B-lymphocytes which are within the lymphatic
tissues of the body.

13. • They are complex chemical substances called
immunoglobulins which match the particular
antigen they were made for just a key
matches one particular lock only.

14. • Cell mediated immune system
• This is the second way of the body’s response
to antigens and it happens through other
special cells called T-lymphocytes and
macrophages that circulate through the body
and destroy micro-organisms or other cells
that the micro-organisms may have invaded.
The special T-cells are tuned in the same way
as antibodies to a particular infecting germ.

15. • The response to specific antigens by both
systems is the reason why immunity
developed against one disease, such as
measles vaccine does not protect against
other diseases such as poliomyelitis or
pneumonia. Memory recall protects the body
against subsequent attacks by the same
antigens, whether germs or poisons.

16. • If a person is exposed again to an infection he
has already had or been vaccinated against,
the body will quickly recall the cells and make
more antibodies to neutralize the toxins or
fight off the micro-organisms and prevent the
establishment and spread of the infection
again.

17. • Adaptive immunity is often sub-divided into
two major types depending on how the
immunity was introduced.
Naturally acquired immunity which occurs
through contact with a disease causing agent,
when the contact was not deliberate.
Artificially acquired immunity which develops
only through deliberate actions such as
vaccination.

19. Types of immunization
• Immunization is the process by which an
individual's immune system becomes fortified
against an agent (known as the immunogen)
or it is the process of protecting a person from
a specific disease. There are two types of
immunizations which are:
Passive immunization
Active immunization

20. • Passive immunization: This is the transfer of
active humoral immunity in the form of ready-
made antibodies, from one individual to
another Or it is the acquisition of readily
formed antibodies ( Transplacental
transmission, immunoglobulin
administration).

21. • Active immunization: this is stimulating the
immune system to produce antibodies and
cellular elements against an infectious agent.
• This happens automatically when a person is
exposed to an infection/antigen and develops
his own antibodies. It is induced in the host
itself by antigen and lasts much longer,
sometimes lifelong.

22. Immunization guidelines and
schedule
• Optimal response to a vaccine depends on
multiple factors, including the type of vaccine,
age of the recipient, and immune status of
the recipient.
• Recommendations for the age at which
vaccines are administered are influenced by
age-specific risks for disease, age-specific
risks for complications, age-specific
responses to vaccination, and potential
interference with the immune response by
passively transferred maternal antibodies.

23. • Vaccines are recommended for members of
the youngest age group at risk for
experiencing the disease for which efficacy
and safety have been demonstrated.

24. Target Groups for Vaccination
• Children under five years
• School aged children
• Pregnant women
• Women of child bearing age (15 – 49yrs)
• Special at risk groups (e.g. Travellers)

25. IMMUNISATION SCHEDULE IN ZAMBIA

26. VACCINE DOSAGE AGE FOR
VACCINATI
ON
No
Doses
ROUTE/
RECOMME
NDED SITE
INTERVAL
BTN DOSES
TARGET
AGAINST
BCG 0.05ml < 1
year
0.1ml > 1
year.
At Birth
Or 1st
contact
Once Intradermal
in the
upper outer
aspect of
the left
lower arm
- Tuberculosi
s
OPV
(1,2,3)
OPV 0
OPV 4
2-3 drops At 6 weeks,
10 weeks,
14 weeks
0 – 13 days
At 9
months
4 doses Orally 4 weeks Polio
DPT-HepB-
Hib -1, 2, 3
0.5mls At 6 weeks,
10 weeks,
14 weeks
3 doses Intramuscul
ar injection
into the
4 weeks Diptheria
Pertussis
Hepatitis B

27. VACCINE DOSAGE AGE FOR
VACCINATI
ON
No
Doses
ROUTE/
RECOMME
NDED SITE
INTERVAL
BTN DOSES
TARGET
AGAINST
Rotarix 1.5mls At 6 weeks
10 weeks
2 oral 4weeks diarrhoea
PCV 0.5Mls At 6 weeks,
10 weeks,
14 weeks
3 Intramuscul
arly in the
upper outer
quadrant of
the right
thigh.
4 weeks Forms of
pneumoco
ccal
diseases
eg
Meningitis
pneumoni
a and
bacteraem
ia.
Measles 0.5mls 9 months
18 months
2 Subcutaneo
us injection
9 months. Measles

28. VACCINE DOSAGE AGE FOR
VACCINAT
ION
No
Doses
ROUTE/
RECOMM
ENDED
SITE
INTERVAL
BTN
DOSES
TARGET
AGAINST
TT 0.5Mls 5 Intra
muscular
injection
into the
deltoid
muscle of
the upper
arm
Tetanus

29. Bacillus Calmette-Guerin (BCG)
• It is a frozen dried powder which is
reconstituted with sterile diluent before
it can be injected.
• Only the diluent that comes with the
particular batch of vaccine must be used.
• BCG immunization at birth will reduce
the sickness and death from Tuberclosis;
miliary or disseminated TB and TB
meningitis among children

30. Storage of BCG Vaccine
• Can be safely stored and transported
between +2 and +8 degrees Celsius
• BCG should never be exposed to sunlight
• BCG is more heat stable before
reconstitution but less stable after
reconstitution
• Reconstituted BCG must be discarded
after six hours.

31. contraindications
• Persons with impaired immunity
• Symptomatic HIV infection
• Known HIV infection

32. Administering BCG
• Check the label that it is correct vaccine
• Check vaccine vial monitor
• Check expiry date of the vaccine and
diluent
• Check that it is the right diluent
• Reconstitute the vaccine
• Check the volume of the diluent that you
reconstitute with the vaccine

33. • Draw up all the diluent into mixing syringe
• Empty the diluent into the vaccine ampoule
• Mix vaccine and diluent by withdrawing
vaccine and diluent slowly into the
reconstitution syringe and then injecting it
back
• Do not shake the vaccine, as this may
damage it

34. Normal reaction
• There should be a flat-topped swelling in
the skin at the injection site looking like a
mosquito bite, with small pits.
• This usually disappears within 30 minutes
• After approximately two weeks, a red
sore develops which is around 10mm in
diameter.

35. • The sore remains for another two weeks
and then heals
• A small scar about 5 mm across, remains
• This is a sign that the child has been
effectively immunised with BCG

36. Vaccination for Pentavalent
DPT-HepB-Hib
• D – Diphtheria
• P – Pertussis
• T – Tetanus
• HepB – Hepatitis B
• Hib – Haemophilus influenza type B

37. • The vaccine contains weakened DPT-
HepB-Hib and killed pertussis bacteria
• It is a liquid vaccine, which has to be
injected

38. Storage of DPT-HepB-Hib vaccine
• It should be stored and transported
between +2 to 8 Degrees celsius
• It freezes at temperatures below +2
Degrees Celsius and gets irreversibly
damaged
• Use the shake test to test whether the
vaccine has been frozen

39. Administration DPT-HepB-Hib
• Check the label that it is the correct vaccine
• Check the expiry date for the vaccine
• Check to make sure the vaccine has not been
frozen
• Check the VVM status ( vaccine vial monitor)
• Shake the bottle gently.
• Using a 0.5ml draw 0.5ml of the vaccine
• Tap the syringe to remove any air in the
syringe so that the dose is accurate before
removing the needle

40. Side effects
• Fever: advise the mother that some
children may have fever and are irritable
after receiving the vaccine
• Local soreness: some children may get
red, tender lump at the site of the
injection that is not serious and needs no
treatment

41. Oral Polio Vaccine (OPV)
• The vaccine contains a live, attenuated
(weakened) virus
• It is damaged more easily by heat than
the other vaccines
• Can be frozen without being damaged

42. Storage of Polio Vaccine
• At central level between -15 and -25
degrees Celsius
• At health centre level between +2 and +8
degrees Celsius.

43. Administration of OPV
• Check the label that it is the correct
vaccine
• Check the expiry date
• Check the VVM to make sure the vaccine
has not been exposed to too much heat.
• Check the number of drops needed for
one dose with this vial.
• Let the mother hold the child firmly,
sitting up so that he does not aspirate the
vaccine

44. • Open the child’s mouth by squeezing the
mouth gently between your fingers
• Let the correct number of drops of vaccine
fall from the dropper onto the child’s tongue
• Make sure that the child swallows the
vaccine
• If he/she spits it out, give another dose
NB: if the child has diarrhoea, give the vaccine anyway
but give an extra dose 4 wks after you finish the
normal course. Do not record the dose given during
diarrhoea episode.

45. Measles Vaccination
• The vaccine is a live attenuated (weakened)
form of the virus that causes measles
• It is a freeze – dried and has to be
reconstituted before injection
• ONLY use the diluent that comes from the
same vaccine manufacturer to reconstitute
the vaccine.
• Maternal antibodies to measles last longer than
other antibodies, so immunization against
measles is often not effective before the nine
months of age

46. • In most developing countries, children are
vaccinated against measles at 9 months of
age, when maternally derived protection
declines from maternal antibodies.
• However, it is recommended that all children
have two opportunities for measles
immunization to reduce the number of both
unvaccinated children and those who are
vaccinated but fail respond to the vaccine. (
failing to form antibodies).

47. oThe second opportunity for measles
immunization plays an important
role in increasing the proportion of
the population with lifelong
protection against measles, as
boosting through natural infection
gradually disappears.

48. Storage of measles vaccine
• At central, provincial and district stores
the vaccine should be kept between -15
and -25 degrees Celsius
• At the health centre level between +2 and
+8 degrees Celsius
• The diluents should not be frozen, but
cooled immediately prior to use so it
doesn’t neutralize the measles.

49. Administering Measles Vaccine
• Check the label that it is the correct
vaccine
• Check expiry date
• Reconstitute the vaccine in the same way
as BCG vaccine
• Fill the syringe
• Give the vaccine subcutaneously
• Inject into the outer part of the child’s
upper left arm

50. Side effects from measles vaccination
Fever and rash
• Tell the mother that the child may have a
fever for one to three days about a week
after the vaccination and that
• Sometimes there is a mild measles rash.
• Reassure the mother that it is much
milder than the disease and goes away by
itself

51. Rotarix vaccine
• Children infected with rotaviruses during
the first 3 months of life are
asymptomatic.
• Those infected for the first time after the
age of 3 months are usually symptomatic.
• It is a live attenuated rotavirus vaccine.

52. • The one in use in Zambia is a called
Rotarix
• Dose – 1.5mls
• Route – orally
• 1st dose is given at 6 weeks
• 2nd dose is given at 10 weeks

53. PNEUMOCOCCAL CONJUGATE
VACCINE.
• The pneumococcal vaccine protects
children younger than 2 years old.
• It protects against severe forms of
pneumococcal disease, such as
meningitis, pneumonia and
bacteraemia.

54. • It will not protect against these
conditions if they are caused by
agents other than pneumococcus.

55. administration
• PVC for infant use are given by
intramuscular injection in a dose of
0.5ml.
• The primary series consists of 3 doses
at intervals of at least 4 weeks,
starting at the age of six weeks or
later, although some some countries
use a schedule with two doses in
infancy, and a third dose at or 12
months.

56. • PVC can be co-administered with other
EPI vaccines.
• The vaccine cannot be mixed with other
vaccines in the same syringe and
therefore, the injection should be given in
a different injection site- right thigh.
• PVC has been proven safe and well
tolerated even among children infected
with HIV.

57. Storage of the vaccine
• PVC should be stored and transported
between 2-8 ċ.
• Liquid vaccines, including the
pneumococcal vaccine, must not be
frozen.
• Liquid vaccines lose their potency and
provide no protection against the
disease, if frozen.

58. Cont.
• If there is doubt, the ‘shake test’ can be
performed to check whether any of these
vaccines have been frozen.
• If in doubt, shake the sample for 10-15
seconds and thereafter allow to rest.
• If there are some sediments at the bottom
of the vial then the vaccine was once
frozen.

59. Tetanus Toxoid vaccine
• Tetanus toxoid (TT) consists of a
toxoid (an anti – toxin neutraliser)
• It is the same tetanus toxoid as
contained in the DPT-HepB-Hib
vaccine
• The vaccine is given to women of
child bearing age to prevent
neonatal tetanus.

60. Storage of TT vaccine
• It should be stored and transported
between +2 and +8.
• TT is destroyed by freezing
• The shake test will confirm if TT has been
frozen or not
• A woman who has had five doses can be
considered to have life long protection
• Tetanus doses received during childhood
can be counted in the TT schedule

61. TT Dose Contact
TT1 At first contact
TT 2 At least 4 weeks after TT 1
TT 3 At least 6 months after TT2
TT 4 Atleast after 1 year after TT3
TT 5 At least 1 year after TT 4