The document provides an overview of Pakistan's Expanded Program on Immunization (EPI). It discusses that EPI was launched in 1974 by WHO and aims to provide vaccines for six major diseases. Pakistan started EPI in 1978 with support from WHO and UNICEF. [END SUMMARY]

1. PRESENTED TO: MADAM TAHIRA SHAHEEN
PRESENTED BY: Ms. RASHIDA G.M
Ms. DONIAABBAS
15/08/2018
1made by Rashida GM (PGCN)

2. S/NO CONTENTS
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
Objectives
Introduction
Background
EPI in Pakistan
Diseases Covered by EPI
Focus & objectives of EPI
Health Education Activities
Implementation Strategy
Targets groups for immunization
EPI Schedule in Pakistan
Contraindications of Vaccination
General Hazards & Adverse Effects of Vaccines
Some Common Vaccines
Causes of Failure of OPV in Pakistan
Immunization for Travelers to endemic Area
Immunization for Pakistanis Travelling for Hajj
Evaluation of EPI in Pakistan
Summary
References
15/08/2018 2made by Rashida GM (PGCN)

3. At the end of this presentation participants will be able to know about:
 What is EPI, who launched it & how did it start in Pakistan?
 Which diseases are being covered by EPI & who are the target
groups?
 What are the points of focus & objectives of EPI?
 What health education activities & implementation strategies are
used?
 Which vaccines are used & what are their contraindication & general
hazards?
 Which EPI schedules are followed in Pakistan & what are causes of
failure of OPV?
 What are immunization recommendations for travelers to endemic
areas & those going for Hajj?
15/08/2018 3made by Rashida GM (PGCN)

4.  The Expended program on Immunization is a world Health
Organization Program with the goal to make vaccines
available to all children throughout the world
“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
15/08/2018 4made by Rashida GM (PGCN)

5.  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)
15/08/2018 5made by Rashida GM (PGCN)

6.  EPI was started by WHO in 1974.
 Pakistan started the program to control six communicable diseases by
conducting a field survey in June, July, 1978, with the help of WHO and
UNICEF.
 In 1982, review showed coverage of 2-6%, while the target was 50%.
 Government decided to accelerate the program.
 In 1988, the program was evaluated by an international review jointly
organized by the Government of Pakistan, WHO, UNICEF, USAID and
CDA.
 Immunization coverage of children 80%.
 Tetanus taxed coverage of women 42%.
 Hep B Was also Inducted In Pakistan EPI in August 2002 then Hib &
Pneumococcal Vaccines
 Now EPI is called Universal Child Immunization
15/08/2018 6made by Rashida GM (PGCN)

7. DISEASES
COVERED BY
(EPI)
Tuberculo
sis
Polio
Measles
Diphtheria
Pertussis
Tetanus
Hepatitis-B
Pneumococc
al Meningitis
Influenza
Diarrhoea
15/08/2018 7made by Rashida GM (PGCN)

8. TARGET
GROUPS
FOR
IMMUNIZ
ATION
All children under 1 year of age
Other children who
have not fully
immunized
women who are of child
bearing age (15- 49 years) but
not immunized against tetanus
Every pregnant wom
an for T.T
15/08/2018 8made by Rashida GM (PGCN)

9. The expanded immunization program, the WHO's initiative to
improve immunization coverage, focuses on the following four
items:
FOCUS OF EPI
Standardizing
immunization schedule
Promoting safe
injection technologies
Improving the stocking
and availability of
vaccines
Protecting vaccines'
potency through cold
chain management
15/08/2018 9made by Rashida GM (PGCN)

10. 1. To achieve 100% coverage for eligible children by
an ongoing integrated program
15/08/2018 10made by Rashida GM (PGCN)

11. 2. Eradication of polio to maintain polio free status.
15/08/2018 11made by Rashida GM (PGCN)

12. 3. Elimination of measles.
15/08/2018 12made by Rashida GM (PGCN)

13. 4. Elimination of Neonatal Tetanus .
15/08/2018 13made by Rashida GM (PGCN)

14. 5. Maintain zero level of diphtheria.
15/08/2018 14made by Rashida GM (PGCN)

15. 6. Reducing pertussis incidence to a
minimum level.
15/08/2018 15made by Rashida GM (PGCN)

16. •7. Reducing childhood TB incidence
12 year old girl with TB meningitis
15/08/2018 16made by Rashida GM (PGCN)

17. 8. Reduce Incidence of hepatitis B among under five
15/08/2018 17made by Rashida GM (PGCN)

18. 9- To Reduce the incidence of Bacterial Meningitis due to
haemophelus influenza.
15/08/2018 18made by Rashida GM (PGCN)

19. HEALTH EDUCATION ACTIVITIES
EPI messages are announced on
radio in Urdu and local
languages
Film on EPI is telecasted on TV
during peak hours
Newspaper, pamphlets, leaflet
and posters have been distributed
15/08/2018 19made by Rashida GM (PGCN)

20.  The eligible population should be immunized at every contact
with health services
 Vaccine should be stored at proper temperature
 The medical officers should keep record of children and
mother in register
 Any case of EPI diseases should be notified to DHO ( District
Health Officer)
 There are three positive contraindications for immunization:
 Child is very ill, requiring hospitalization
 BCG is not given to a child with AIDS
 Child previously showed hypersensitivity to DPT so DT is
given
15/08/2018 20made by Rashida GM (PGCN)

21. GENERAL
• Any acute
illness
• Severe
malnutrition
• In known case
of immune
deficiency
RELATED TO
GROUP OF
VACCINES
• During pregnancy
• During steroid
therapy
• During radiation
therapy
• During
administration of
anti-metabolites
INDIVIDUAL
VACCINES
• BCG-extensive
dermatitis
• Polio-diarrhea,
within 3 weeks of
tonsillectomy
• Pertussis-febrile
illness, convulsions
• Measles-
convulsions
15/08/2018 21made by Rashida GM (PGCN)

22. • Local Reaction:Pain,Swelling,redness
• General Reaction:Fever,malaise and headache
Reaction inherent
to inoculation
• Improper dose, improper site or route,
vaccine stored incorrectly.
Reaction due to Faulty
Techniques
• Serum sickness or anaphylactic reaction
may occur.
Reactions due to
Hypersensitivity
• Post-vaccination encephalitis and encephalopathy,
Guillani-Barre syndromeNeurological involvement
• Following DPT against diphtheria, polio
may occurProvocative Reactions
• Damage to the foetus
Others
15/08/2018 22made by Rashida GM (PGCN)

23. BCG
• Local
reaction
• Suppurative
lymphadenit
is
• Disseminate
d infection
• BCG osteitis
• Erythema
nodosum
• Excessive
ulceration
• Keloid
formation
MEASLES
• Moderate
fever with or
without rash
• Convulsions
• rhinopharyn
gitis
DIPHTHERIA
• Fever
• Granuloma
formation
PERTUSSIS
• Fever and
febrile
convulsions
• Sterile
injection
abscess
• Allergic skin
rash
• encephalitis
POLIO
VACCINE
• Killed
vaccine is
harmless
• Live
attenuated
vaccine type
three strain
of Sabin
vaccine may
undergo
spontaneous
mutation
causing
paralysis in
the
vaccinated
person
15/08/2018 23made by Rashida GM (PGCN)

24. BCG VACCINE DPT VACCINE
15/08/2018 24made by Rashida GM (PGCN)

25. MEASLES TETANUS TOXOID
15/08/2018 25made by Rashida GM (PGCN)

26. POLIO VACCINE
IPV OPV
MMR (Measles, Mumps,
Rubella)
15/08/2018 26made by Rashida GM (PGCN)

27. ORAL VACCINE
AGAINST TYPHOID
YELLOW FEVER
15/08/2018 27made by Rashida GM (PGCN)

28. AGE VACCINE DOSE ROUTE SITE TYPE
At Birth Polio-0
BCG
Hepatitis-B
2 Drops
0.1ml above1 month
0.05ml below 1 month
0.5ml
Oral
Intradermal
Intramuscular
Mouth
Rt. Deltoid
Ant.lat aspect of Rt thigh
Live
Live
Recombinant
At 6 weeks Polio-1
Pentavalent-1 (DPT, Hep.b,
Hib
Pneumococcal(PCV-10)-1
Rota-1
2 Drops
0.5ml
0.5ml
1.0ml
Oral
Intramuscular
Intramuscular
orally
Mouth
Ant.lat aspect of Rt thigh
Ant.Lat aspect of Lt.thigh
Mouth
Live
D & T = Toxoid
P= Killed
Hep.B= Recombinant
Hib= Conjugate
Recombinant
Live
At 10 weeks Polio-2
Pentavalent-2 (DPT, Hep.b,
Hib
Pneumococcal (PCV-10)-2
Rota-2
2 Drops
0.5ml
0.5ml
1.0ml
Oral
Intramuscular
Intramuscular
orally
Mouth
Ant.lat aspect of Rt thigh
Ant.Lat aspect of Lt.thigh
Mouth
Live
D & T = Toxoid
P= Killed
Hep.B= Recombinant
Hib= Conjugate
Recombinant
Live
At 14 weeks Polio-2
Pentavalent-3 (DPT, Hep.b,
Hib
Pneumococcal (PCV-10)-3
2 Drops
0.5ml
0.5ml
Oral
Intramuscular
Intramuscular
Mouth
Ant.lat aspect of Rt thigh
Ant.Lat aspect of Lt.thigh
Live
D & T = Toxoid
P= Killed
Hep.B= Recombinant
Hib= Conjugate
Recombinant
At 9 months Measles-1 0.5cc Subcutaneous Lt. Deltoid Live
At 15 months Measles-2 0.5cc Subcutaneous Lt. Deltoid Live
EPI SCHEDULE FOR CHILDREN IN PAKISTAN
15/08/2018 28made by Rashida GM (PGCN)

29. 15/08/2018 29made by Rashida GM (PGCN)

30. Lack of community participation
Related to health sector
Related to immunizing staff
Related to mode of administration
Related to mother
Related to child
Related to
vaccine
CAUSES OF FAILURE OF ORAL POLIO VACCINE IN PAKISTAN
15/08/2018 30made by Rashida GM (PGCN)

31. Within 10-12 weeks
after scar formation
10-12 days
After 3rd dose
 BCG
 MEASLES
 POLIO
 DPT
15/08/2018 31made by Rashida GM (PGCN)

32. MALARIA
CHOLERA
YELLOW
FEVER
HEPATITIS -A
• ADULTS 300mg once weekly 2
weeks before departure & 4
weeks after leaving
• CHILDREN 15mg/kg weekly
• Single I/M injection
• Valid upto 6 months
• Single I/M dose
• Valid for upto 10 years
• For stay less than 3 weeks:
immune s/globulin 0.02ml/k g.
I/M
• For stay more than 3 weeks:
immune s/globulin 0.06ml/k g
I/M
15/08/2018 32made by Rashida GM (PGCN)

33. MANDATORY OPTIONAL
a. Meningococcal Vaccine
b. Flu Vaccine
c. Polio Vaccine
a. Hepatitis A
b. Hepatitis B
c. Tetanus
d. pneumonia
15/08/2018 33made by Rashida GM (PGCN)

34. 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. However Punjab is the first
province to achieve elimination of maternal and neonatal tetanus in 2016.The current EPI coverage for fully immunized
based on PDHS (2012–2013) and PSLM (2014–2015) surveys is 65% and 88%, respectively.
Pakistan is third among countries with the most unvaccinated and under-vaccinated children. Of the 3.8 million infants who
did not receive their third dose of DTP3 vaccine in the Region in 2015, 40% of those were in Pakistan.
EVALUATION OF EPI IN PAKISTAN
15/08/2018 34made by Rashida GM (PGCN)

35. • Bijayalakshami Dash: A Comprehensive Textbook of
Community Health Nursing: 1st edition: 2017
• Dr. Muhammad Naveed Alam; Excel Community Medicine:
11th edition; 2017
• Muhammad Nauman Hashmi: Community Medicine Based on
J.E Park: 4th edition: 2012
• K.Park: Park’sTextbook of Preventive & Social Medicine:
23rd edition: 2015
15/08/2018 35made by Rashida GM (PGCN)

36. 15/08/2018 36made by Rashida GM (PGCN)