The document discusses the objectives and strategies of the Expanded Program of Immunization (EPI) in Saudi Arabia. The EPI aims to reduce morbidity and mortality from six vaccine-preventable diseases through integrated immunization services. Key strategies include integrating vaccination with primary health care, ensuring regular vaccine supply and cold chain maintenance, training health workers, and monitoring coverage through record-keeping and reporting. The target populations are children under five and women of childbearing age.

1. Expanded Program
of
Immunization
Dr. Faten M. Rabie

2. Objectives of the
lecture
1- Scope of the program
2- Objectives of the EPI
3- Strategies of the program
4-The target population
5- Schedule of immunization in KSA
6- Dose, route of administration and type of
each vaccine.
7- Contraindications of vaccination
8- Estimation of the eligibles
9- Records and reports
10- Defaulter tracing
11- Cold chain

3. Scope of the EPI
Experience with smallpox eradication
program showed the world that
immunization was the most powerful and
cost-effective weapon against vaccine
preventable diseases.
In 1974, the WHO launched its “ Expanded
program of immunization” (EPI) against six
most common preventable diseases
(diphtheria, pertussis, tetanus, polio,
tuberculosis and measles.

4. “Expanded” means:
• Expanding the number of diseases
to be covered
• Expanding the number of children
and target population to be
covered
• Expanding coverage to all corners
of the country and spreading
services to reach the less
privileged sectors of the society

5. Objectives of the EPI
• To reduce the morbidity and mortality of
the major six childhood diseases.
• To achieve 100% coverage for eligible
children by an ongoing integrated program
• To deliver an integrated immunization
services through health centers, as
primary health care service package
• To develop a surveillance system which
collect adequate information on the
diseases preventable by immunization
• To minimize the efforts and cost of
treatment
• To promote a new healthy generation

6. Strategies of the EPI
• Integrate vaccination sessions with
PHC services
• Appropriate measures to expand the
vaccination coverage of the eligible
population
• Ensuring regular supply of potent
vaccine
• Strengthening the cold chain
• Training of health personnel
• Promotion of community
participation
• Incorporating health education
activities related to EPI

7. • Ensuring logistic support ( supplies and
equipments)
• Introducing a system for continuous
monitoring and periodic evaluation
• Undertaking operational research to
find out deficiencies and difficulties in
the program and suggest methods of
improvement

8. Targets
• Under 5-years children.
• Women in the child
bearing age (15-45 years).

9. • Schedule of immunization
• Type of the vaccine
• Dose of each vaccine
• Route of administration
• Precautions of vaccination

10. Contraindications of
vaccination
•
There are only 3 contraindications:
• Immune compromised child ( mainly
AIDS) → no BCG
• Child who develops convulsions after
the first dose of DPT → DT
• Severely ill child to the extent that
he urgently referred to the hospital

11. Estimation of eligibles
• The target population is estimated on the
basis of total population as registered
during survey and the increase in the
population on the basis of birth rate and
growth rate.
• Example:
• Annual growth rate …………………...4%
• Total registered population………...1000
• Birth rate………………………………..50l1000
• No. of expected births = 0-1
year…………….50

12. • No. in child bearing
age…………………….20%
• No. of pregnant women expected =
• no. of 0-1 year infant =…………..50
• No. of children under 2 years = double
the no. of infants…….= 100
• Estimated requirements of vaccine per
episode of supply (for each vaccine
calculated separately):
• Total number of children to be
vaccinated in one year x Number of
doses to be given + 10% wastage

13. Periodicity of the supply
Example:
• No. of children below 2 years of age:…..6126
• No. of children below 2 years already
immunized ……1126
• No. of eligible = 6126-1126 ……….=5000
• Proposed coverage………………...=85% = 4250
• No. of doses of given to each……….3
• Annual requirement …………….. …= 4250 x 3 +
10%= 12750 +1275 = 14025 doses
• Monthly doses……..= 14025 ÷ 12 = 1169 doses
• Convert doses into vials i.e if the vial contains
10 doses…………………………116 vial

14. Records and reports
•
Records are required for:
1. Monitoring of program progress.
2. Identification of defaulters.
3. Comparing with EPI-related
disease situation.

15. Types of records:
1. Yearly vaccination register- by age, sex,
nationality and dosage numbers.
2. Daily vaccination register- with
identifying family register number.
3. Follow up register.
4. Stock indent register.
5. Immunization card ( details of
immunization and the date of next visit).

16. Reports
• Monthly immunization report
showing total number of doses, age,
sex, nationality are sent in the first
week of each month.
• This information would form a strong
base for the development of a
surveillance system for EPI and EPI
related diseases.

17. Cold chain
• Cold chain is a system of storing,
transporting and distributing of
vaccines in the correct temperature
and way from the factory to the
vaccinated child.
• Cold chain is a corner stone of the
EPI, because the vaccine loses the
efficacy if incorrectly kept.

18. Cold chain levels
• The central level.
• Regional level.
• Primary health care
center level.