This document discusses Pakistan's Expanded Program of Immunization (EPI). It began in 1976 with the goal of preventing six major childhood diseases. However, Pakistan has yet to reach targets for polio eradication and measles. The document outlines the EPI vaccination schedule, types of vaccines including live attenuated, inactivated, subunit, and toxoid vaccines. It also discusses the importance of maintaining the cold chain for vaccine storage and transportation from manufacture to use.

1. EXPANDED PROGRAM OF
IMMUNIZATION
Lecturer : Dr. Sana Murtaza
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2. OBJECTIVES
 To learn about EPI and current
situation of EPI in Pakistan
 To understand mechanism of Cold
Chain and maintenance of vaccines
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Today’s Situation
 10.5 million infant and childhood deaths
each year in the developing world
 70% are due to five conditions:
pneumonia, diarrhea, measles, malaria,
and malnutrition.
 Two thirds of neonatal mortality occur in
the first week of life, of these two thirds
die within the first 24 hours of life

4. Current situation in Pakistan
Despite significant efforts by the Government and its
partners, Pakistan’s immunization indicators have yet to
reach the expected benchmarks.
The key goals of polio eradication, and measles, have not
been achieved.
Punjab is the first province to achieve elimination of maternal
and neonatal tetanus in 2016
Pakistan is third among countries with the most unvaccinated
and under-vaccinated children
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Definition
 Immunization: A process by which a person
becomes protected against a disease
through vaccination
 Vaccination is the administration of antigenic
material (the Vaccine) to produce immunity to a
disease.

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Vaccination
 Vaccination (Latin: vacca—cow) is so
named because the first vaccine was
derived from a virus affecting cows, which
provides a degree of immunity to
smallpox.

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 Under Global Smallpox Eradication Program, it was experienced
that immunization is the most powerful and cost effective
weapon for the prevention and control and even eradication of a
disease.
 So in May 1974, WHO officially launched a global immunization
program, known as Expanded Program of Immunization (EPI) for
the prevention and control of six major, killer diseases of
children, namely tuberculosis, diphtheria, pertussis, tetanus,
poliomyelitis and measles, all over the world.
Expanded Programme Of
Immunization (EPI)

8. Expanded Programme of Immunization
The EPI in Pakistan was initiated in 1976.
Was launched at federal level in 1978.
Was Established nation-wide by 1981.
The program currently targets seven vaccine preventable diseases i.e.
• Tuberculosis,
• Diphtheria ,
• Pertusis,
• Tetanus,
• Poliomyelitis
• Heapitis B
• Measles ,
• HIB

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EPI Vaccination Schedule
AGE Vaccines to be given Route of
administration
At Birth BCG, OPV Intra dermal, oral
At 6 Weeks OPV 1 ,DPT 1
HBV-1 ,Hib 1
Intra muscular
Oral
At 10 Weeks OPV 2, DPT 2 HBV-
2
, Hib 2
Intra muscular
Oral
At 14 Weeks OPV-3, DPT-3 , HBV-3
, Hib-3
Intra muscular
Oral
At 9 completed
months
Measles Sub Cutaneous
At 9 months with
measles vaccine
Vitamin – A (1st dose) Oral
Immunization Schedule for Infants:
Recommended by WHO - Expanded Program on Immunization

10. Passive vs active immunity
Passive Active
MEANS OF
ACQUISITION
Receiving preformed
antibodies
Exposure to exogenous
antigens
ONSET Rapid Slow
DURATION Short span of antibodies
(half-life = 3 weeks)
Long-lasting protection
(memory
EXAMPLES IgA in breast milk,
maternal IgG crossing
placenta, antitoxin,
humanized antibody
Natural infection, vaccines,
toxoid
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11. VACCINATION Induces an active immune
response (humoral and/or cellular) to specific pathogens.
VACCINE
TYPE
DESCRIPTION PROS/CON S EXAMPLES
Live
attenuated
vaccine
Microorganism
loses its
pathogenicity but
retains capacity
for transient
growth within
inoculated host.
Pros: induces
strong, often
lifelong immunity.
Cons: may revert
to virulent form
Adenovirus
Typhoid (Ty21a, oral),
Polio (Sabin),
Varicella (chickenpox),
Smallpox, BCG, Yellow
fever, Influenza
(intranasal),
MMR,
Rotavirus
Attention Teachers!
Please Vaccinate
Small, Beautiful Young
Infants with MMR
Regularly!
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12. Vaccination (continue)
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VACCINE
TYPE
DESCRIPTION PROS/CON S EXAMPLES
Killed or
inactivated
vaccine
Pathogen is
inactivated by
heat or
chemicals.
Maintaining
epitope structure
on surface
antigens is
important for
immune
response.
Pros: safer than
live vaccines.
Cons: weaker
immune
response; booster
shots usually
required.
Hepatitis A, Typhoid
(Vi polysaccharide,
intramuscular),
Rabies, Influenza,
Polio (SalK)
A TRIP could Kill you

13. Vaccination (continue)
VACCINE
TYPE
DESCRIPTION PROS/CON S EXAMPLES
Subunit Includes only the
antigens that
best stimulate
the immune
system
Pros: lower
chance of adverse
reactions.
Cons: expensive
HBV,
Streptococcus
pneumoniae,
acellular
pertussis (aP),
Haemophilus
influenzae type
b.
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14. Vaccination (continue)
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VACCINE
TYPE
DESCRIPTION PROS/CON S EXAMPLES
Toxoid Denatured
bacterial toxin
with an intact
receptor binding
site. Stimulates
the immune
system to make
antibodies
Pros: protects
against the
bacterial toxins.
Cons: antitoxin
levels decrease
with time, may
require a booster
Clostridium tetani,
Corynebacterium
diphtheriae

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COMBINATIONS
 When more than one kind of immunizing agent is included in
the vaccine it is called a mixed or combined vaccine.
 Combined vaccines simplify administration, reduce cost.
 Examples are DPT, DT, DP, DPT and Typhoid vaccine, MMR,
 DPTP(DPT plus inactivated Polio).

16. IMMUNIZING AGENTS
The immunizing agents may be classified as
 Vaccines.
 Immunoglobulins.
 Antisera.

17. ANTISERA OR ANTITOXIN
 Materials prepared in the animals.
 Passive immunization is achieved by
administration of Antisera.
 Antitoxins prepared from non human sources
against Tetanus, Diphtheria, Botulism, Gas
gangrene and snake bite.

18. COLD-CHAIN
It is a system of storage and
transportation of the vaccines at
recommended, low temperature (+2 to
+8°C) all along from the time and place
of the manufacture to the time and
place of its use.
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20. Effective Cold Chain Management for
Distribution of COVID-19 Vaccines
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