The document summarizes the Expanded Programme on Immunization (EPI). It discusses that EPI is a global immunization program launched by the WHO in 1974 to prevent six major childhood diseases through vaccinations. The program aims to reduce illness, disability, and mortality from these preventable diseases. It outlines the eight diseases currently targeted and provides a brief history of EPI's development and objectives to achieve high immunization coverage rates and disease elimination goals. The document also discusses key aspects of EPI implementation including the vaccine schedule, supplemental immunization activities, disease surveillance, and the importance of maintaining the cold chain for vaccine effectiveness.

1. Tehseen Riaz
Lecturer,
Rashid Latif College of Pharmacy
Expanded programme on immunization

2. Expanded programme on immunization (EPI)
 The Expanded Programme 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.
 • Poliomyelitis
• Neonatal Tetanus
• Measles
• Diphtheria
• Pertussis (Whooping Cough)
• Hepatitis-B
• Hib (Haemophilus influenzae type b) meningitis and Pneumonia
• Childhood Tuberculosis

3. History
 In May 1974, WHO officially launched a global immunization
program, known as Expanded program on 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 because of the following reason:
1. These childhood diseases are highly fatal
2. Those children who recover will have permanent sequela (
abnormality)
3. These diseases are responsible for increased morbidity and
mortality among children.
4. They are easily preventable by immunization
5. Available vaccines are simple, safe, effective and affordable.

4. Historical development
 • Pilot Project 1978
• Integrated into regular Health Services 1983
• Accelerated Health Programme (AHP) 1985
• Addition of Vaccine for HepB 2002
• Addition of Vaccine for Hib Meningitis & Pneumonia 2008
• Addition of Pneumococcal 2012
 The EPI Programme started in Pakistan in 1978 and is still
continuing.
 Rota-virus Vaccine is planned in 2013

5. Objectives
 The overall objective of the EPI is reduction of mortality and morbidity
from the eight EPI diseases by offering immunization services. The
programme is evaluated at intervals of 2-3 years.
 Specific objectives of the Programme are as follows:
 Achievement of 90/80 % immunization coverage by 2010
 Elimination of Neonatal Tetanus
 Elimination of Measles by 2010.
 Reduction of VPDs (vaccine preventable diseases) morbidity & mortality
by 2/3rd by year 2015 as compared to 2000 as per MDG-4 (millennium
development goal 4).
 Certification of Eradication of Poliomyelitis after being free for 3 years
from polio
 Introduction of new vaccines in the EPI immunization Schedule i.e.
Pneumococcal Vaccine in 2011 and Rota-virus Vaccine in 2013

6. EPI
It was called EXPANDED because:
 Number of diseases covered are more (6 diseases).
 Services are extended to all corners of the world, irrespective of
cast, creed, community and ability to pay for it.
 The child is immunized much before it is born (mother is immunized
during pregnancy).

7. EPI
 The diseases are preventable and can be eradicated like Smallpox, as very
safe & effective vaccines are available.
 Immunization is one of the most successful and cost effective health
interventions.
 It has eradicated small pox, lowered the global incidence of polio so far by 99%
and achieved dramatic reductions in illness, disability and death from diphtheria,
tetanus, whooping cough and measles.
 It is a world-wide Programme being carried out in all countries assisted by
WHO, UNICEF and other donor agencies.
 EPI program is run by the ministry of health (MOH) in close cooperation with
WHO, UNICEF and other partners and implemented in each region by the
regional health bureaus.
 WHO provides technical assistance to the ministry of health and assists in
planning, resource mobilization and social mobilization.
 The global target of the Programme is to immunize over 95% of infants and
child-bearing-age females.

8. Schedule of EPI in Pakistan

9. Components of EPI
• Routine Immunization
o Children – immunization with 8 EPI antigens
o Pregnant ladies by TT ( Tetanus toxide)
• Supplemental Immunization Activities(SIAs):
o Routine immunization does not ensure 100% coverage of the mobile
population i.e. nomads, hard to reach areas / missed areas. So SIAs are
scheduled to ensure coverage of this population / areas.
o NIDs (supplementary immunization activities) / SNIDs (supplementary
immunization activities): children < 5 years receive polio drops (3-days campaign)
• Disease Surveillance
o To detect every case of target diseases, the suspected cases of seven VPDs
(vaccine preventable diseases) are reported by health facilities to the district
health authorities for immediate launching of the control measures.
• Mopping up
o Special campaigns 5-8 km around the infected locality to localize the
disease and stop its transmission.

10. Concept and Importance of Vaccination
 Immunization
 It is the process by which vaccines are introduced into the body
before infection sets in.
 Vaccines are administered to introduce immunity, thereby causing
the recipient’s immune system to react to the vaccine that produces
antibodies to fight infection.
 Vaccinations promote health and protect children from disease –
causing agents.
 Infants and newborn need to be vaccinated at an early age since
they belong to vulnerable age group

11. Cold chain
 Definition:
It is a system of storage and transportation of the vaccines at
recommended, low temperature (+2 to +8 ⁰C) all along from time and
place of manufacture to the time and place of its use.
Or
Cold chain refers to the storage and transport equipment that
enables vaccine to be kept at this temperature from the point of
manufacture to the point of use in an immunization session or a
clinic.
 The cold chain system is the life line of the immunization program.

12. IMPORTANCE
 Cold chain is necessary for vaccine’s transport because they are
sensitive and loose their potency when exposed to heat and light.
All the vaccines retain their potency at temperatures between +2⁰
and +8⁰C.
 A break in cold chain occurs if the temp goes above 8 ⁰C or falls
bellow 2 ⁰C.
 The sensitivity of vaccines in descending order is as follows:

13. Name of
vaccination
Route of
administration
Sensitivity Storage
condition
Storage temp
OPV Oral (live
attenuated (OPV))
and inactivated
polio vaccines
(IPV) for IM, SC
route.
Highly sensitive These two can be
stored at subzero
temp for long term
use.
-15 to -25⁰ C.
At freezer
MV (mmr for
measles)
IM, SC
BCG (for tb) Intradermal
DPT IM “T” series vaccines
are denatured at
sub zero temp.
+2 to +8 ⁰C.
Body of fridge.
TT (toxoid) Parentral Least sensitive

14. FEFO
 FEFO- “first expiry and first out”
 vaccine is practiced to ensure that all vaccines are utilized before
its expiry date
 Proper arrangement of vaccines and labeling of vaccines expiry
date are done to identify those near to expire vaccines
 Temperature monitoring of vaccines is done twice a day early in the
morning and in the afternoon before going home.

15. Cold chain equipments
 Each level of facilities have cold chain equipment for use in the
storage of vaccines. These consists of the following :
1. Walk in coolers (WIC)
2. Cold box
3. Deep freezer
4. Ice lined refrigerator (ILR)
5. Refrigerator (conventional)
6. Vaccine carrier

16. Cold chain equipments
 Walk in coolers (WIC): These are air conditioned cold rooms,
maintaining the temp between 2-8 ⁰C. Such rooms exist in vaccine
institutes where vaccines are manufactured in on large scale.
 Cold box: It is a big rectangular box (90*60 cms) made up of
insulated material, lined with 24 ice packs which maintain the cold
life inside the box for about 5 days. Such boxes are used to collect,
store and transport large quantities of vaccines from one place to
another by refrigerator vans.
 Ice packs: these are rectangular shaped, flat, plastic bottles, filled
with water upto the neck. Water is frozen into ice and then it is
called “ice packs”.it is used for lining the walls of cold boxes and
vaccine carriers, as buffers to maintain cold life inside the
equipment. Ice packs maintain cold life for 5 days in cold box and
for 1 day in vaccine carrier is it is not opened.

17. Cold chain equipments
 Deep freezer: It is a top opening refrigerator, which maintains the
temp at -20 to -40 ⁰C. It is used to store only OPV and MV for long
term use and also prepare icepacks. T series vaccines are never
stored because they will be denatured and BCG vaccine are not
stored because the ampoule gives a crack. It has electrical
connections.
 Ice lined refrigerator (ILR): It is also a top opening refrigerator
having single compartment for vaccine storage (0 to 8 ⁰C) equipped
with baskets and lined by preinstalled and water filled ice lining
ready for use. It maintains cold life, during power failure upto 18-20
hrs/day. It works entirely as cold box with electrical connections.
There are two types, one lined with ice tubes (Electrolux) and other
with ice packs (vest frost). There is no freezer compartment in ILRs
so it is not used to prepare ice packs.

18. Cold chain equipments
 Refrigerator (conventional): this is to provided to every primary
health centre. Care should be taken so that the temperature
doesn’t rise above 8 ⁰C.
 Vaccine carrier: it is a square shaped box, made up of special
insulated material, lined by 4 ice packs, one on each side, which
maintains cold life for 24 hrs if not opened. It is used to carry small
quantities of vaccines from the primary health center or sub center
to the out reach station by the health worker. The T series of
vaccines should not be in direct contact with the ice packs because
they get frozen, and those vaccines are places inside a polythene
bag and closed with rubber band.

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