EPI Vaccination Program

1. Expanded Immunization
Program

2. What is Expanded Program of
Immunization (EPI)?
• The Expanded Program on Immunization (EPI) is a disease
prevention activity aiming at reducing illness, disability and
mortality from childhood diseases preventable by immunization.
• These diseases are referred as 8 EPI target diseases and cause
millions of ailments, disabilities & deaths each year.
1. Poliomyelitis
2. Neonatal Tetanus
3. Measles
4. Diphtheria
5. Pertussis (Whooping Cough)
6. Hepatitis-B
7. Hib Pneumonia & Meningitis
8. Childhood Tuberculosis
• Universal immunization for all children by 1990; an essential
element of the WHO strategy to achieve health for all by 2000.
• First established in 1978

3. Why is immunization important?
• Immunization is a proven tool for controlling and even
eradicating infectious diseases
• An immunization campaign carried out by the World Health
Organization (WHO) from 1967 to 1977 resulted in the
eradication of smallpox. When the programme began, the
disease still threatened 60% of the world's population and
killed every fourth victim
• 1000 deaths in less than 5 year children will daily occur in
Pakistan, if EPI is discontinued
• Immunization is one of the most successful and cost
effective health interventions

4. Disease Cause of infection Vaccine Type Doses Age of Administration Route of Administration
Childhood
T.B
Bacteria BCG Live 1 Soon after Birth Intra-dermal
Poliomyelitis Virus OPV
[Temp Sensitive]
-20 C
Live
Attenuated
4 OPV-0 : Soon after Birth
OPV-1: 6 wks
OPV-2 : 10 wks
OPV-3 : 14 wks
Orally
Diphtheria Bacteria Pentavalent
Vaccine
[DTP + Hep B +
Hib]
D & T : Toxoid
P : Killed
3 Penta-1 : 6wks
Penta-2 : 10 wks
Penta-3 : 14 wks
Intra - Muscular
Pertussis Bacteria
Hepatitis B Virus Hep B :
Recombinant
Hib :
Conjugate
Hib Pneumonia and
meningitis
Bacteria
Measles Virus Measles [Temp
Sensitive]
-20 C
Live 2 Measles - 1: 9 mo
Measles - 2 : 15 mo
Sub - Cutaneous

5. Diphtheria
In Urdu Diphtheria is known as Khunnaaq
• Causative Agent : Corynebacterium
Diphtheria
• Diagnostic feature : Leathery, raised
greyish-green membrane on tonsils
firmly adherent and is surrounded by a
zone of inflammation
• Prevention : Active immunization
• Carriers : Convalescent Carriers
What is a convalescent carrier? : a person
who is clinically recovered from an
infectious disease but still capable of
transmitting the infectious agent to
others.

6. Pertussis (whooping cough)
Pertussis in Urdu is known as Kaali Khansi
Why is it called whooping cough? : cough with
loud crowing inspiration
• Causative agent : Bordetella pertussis
• Stages of infection :
1. Catarrhal Stage - conjunctivitis, rhinitis,
unproductive cough
2. Paroxysmal Stage – severe bouts of cough
and whoop
3. Convalescent stage - decreased cough
• Route of infection : People with whooping
cough usually spread the disease by coughing
or sneezing while in close contact with others,
who then breathe in the bacteria that cause
the disease
• Complications : bronchitis, Broncho-
pneumonia and bronchiectasis

7. Tetanus
Tetanus is known in urdu as Tashannaj
• Infective agent : Clostridium tetani
• Reservoir : Soil and dust and is not transmitted
from man to man
• Prevention : Active Immunization
How is tetanus in neonates prevented : By giving 2
tetanus injections to pregnant females 1 month
apart in their 2nd trimester
• Life long prevention of tetanus :
• 0 day 1st dose
• After 1 month 2nd dose
• After 6 month 3rd dose
• After 1 year 4th dose
• After 5 years 5th dose
Booster dose is provided after every 10 years

8. Measles
• Measles in urdu is called Khasra
• Causative agent : RNA virus of paramyxovirus group
• Clinical Features : Fever, respiratory catarrhal symptoms
[runny/blocked nose, sneezing, itchy nose and difficulty breathing],
Koplik spots and rash
What are Koplik Spots : small, bluish spots 1- 2 mm with a red
background on buccal mucosa
• Complications : pneumonia, otitis media, diarrhea, encephalitis
• Common cause of death : death usually results from superimposed
infection e.g. pneumonia
• Vaccine needs to be stored and transported at -20 C
• Why is measles given at 9 months : before 9 months, mothers
antibodies protect the child
• Can be given separately or in combination with MMR [Measeles,
mumps, rubella] at 12 – 15 months of age
• Contraindication for immunization : Hypersensitivity to eggs or
neomycin

9. Mumps
Mumps in urdu is known as Kan Pairay
• Causitive agent : Paramyxovirus parotiditis
• Mode of Transmission : Droplet infection
• Clinical Features : Painful swelling of one or
both parotid glands
• Most common complications :
Meningioencephalitis and Orchitis
• Rare complication : Sensorineural deafness

10. Rubella
Rubella in urdu is known as Bara khasra
• Causative Agent : RNA virus [toga virus group]
• Mode of Transmission : Droplet Infection
What is congenital Rubella? : infection that is
contracted in 1st trimester and leads to congenital
abnormalities of the fetus
• Prevention of Rubella : Active immunization of
pre-shoolers 12-15 mo and then again at 4 years
of age.
• Combined with mumps and measles vaccine
• Why is it given in combination of MMR vaccine
[known as triple vaccine] : Because it is most
cost effective
• What is the difference between Triple Vaccine
and Trivalent Vaccine? : Triple vaccine is against
three different diseases and Trivalent vaccine is
against three different strains of same disease
[e.g. OPV for polio]

11. Tuberculosis
• Tuberculosis in urdu is known as Sil or Tap-e-
diq
• Causative agent : Mycobacterium
tuberculosis
• Mode of Transmission : Droplet infectioin
• Signs and Symptoms of disease : productive
cough, fever with chills, night sweats
• Vaccine : Live [freeze dried] vaccine given
intra dermally soon after birth called Bacille
Calmette-Guerin (BCG)

12. Poliomyelitus
• Causative agent : polio virus type -1, type -2 and type -3
• Reservoir : Man is the only reservoir
• Mode of transmission : 1. Feco oral 2. Droplet infection
• Prevention : Oral Polio Vaccine at birth then at 6, 10, 14 weeks
• Two kinds of Vaccines : Inactivated Polio Vaccine and Oral Polio
Vaccine
• IPV :
• first introduced in 1955 and is
• produced from wild-type poliovirus strains of each serotype that
have been inactivated (killed) with formalin
• It can be administered alone or in combination with other vaccines
• Adverse events following administration of IPV are very mild and
transient
• OPV :
• first introduced in 1961 and
• consists of a mixture of the three live attenuated poliovirus
serotypes (Sabin types 1, 2 and 3), selected for their lower
neurovirulence and reduced transmissibility
• Following oral administration OPV strains produce a local immune
response in the lining of the intestines which is the primary site for
poliovirus replication. Mucosal immunity decreases the replication
and excretion (shedding) of the virus, and thus provides a potential
barrier to its transmission.
• This mechanism, combined with the ease of oral administration and
the very low cost of the vaccine, have made it the vaccine of choice
for the global eradication programme

13. OPV
• Prevention : Safe and clean water and proper disposal of feces
• Benefits of Oral Polio Vaccine : Once the virus strains multiply in the
host and induce immunity, they are also excreted and spreads to
household contacts and in the community thus even no vaccinated
people become immunized
• Vaccine is stored at : -20 C
• Side affects : Extremely rare to get disease from vaccine [1 case per
2.6-5 million doses of OPV ]
• If a mother complains that her children get diarrhea and she wont
allow for the vaccine, you must still administer it as there is no
evidence of diarrhea following OPV

14. Hepatitis B
• Hep B in Urdu is known as Bara or Kala Yarkaan
• Mode of Transmission :
• Blood transfusion
• sharing of needles
• sexual transmission
• vertical transmission [from mother to child]
• Prevention : Vaccination at 6, 10, 14 weeks after
birth
• Baby born to a known Hep B Mother : Baby
should be given Hep B immunoglobulins. Two
doses 30 days apart
• Hep B Vaccine : Hepatitis B vaccines (HBV) are
composed of highly purified preparations of
hepatitis B "surface" antigen (HBsAg)
• Given as Pentavalent [along with DPT and Hib
vaccine] given at 6, 10, 14 weeks.

15. H Influenza type B
• Haemophilus influenzae type b (Hib) disease
is a serious disease caused by bacteria.
• Hib disease is the leading cause of bacterial
meningitis among children under 5 years old
Symptoms:
• Fever.
• Headache.
• Stiff neck.
• Nausea with or without vomiting.
• Photophobia (eyes being more sensitive to
light)
• Altered mental status (confusion)