The document outlines the objectives and details of immunization as part of community health nursing education, specifically focusing on the Expanded Program on Immunization (EPI) in Pakistan. It discusses types of vaccines, the importance of childhood immunization, and the target diseases preventable through vaccination, while also outlining the immunization schedule for children and women of childbearing age. The document further highlights the roles of various international health organizations in supporting immunization efforts and addresses potential adverse reactions to vaccines.

1. Mumtaz Ali Khan

2. From: Mumtaz Ali Khan
Mumtaz Ali Khan

3. Malakand College of Nursing
Subject: Community Health Nursing-II
Topic : Immunization and
Tropical Disease
Prepared by: Mumtaz Ali Khan
CHN-II Unit-II Part-1 BSN 5th Semester
Mumtaz Ali Khan

4. Objectives
 At the completion of this lecture, students
will be able to:
1) Define Immunization.
2) Overview of Expanded Program for
Immunization (EPI) in Pakistan.
3) Review different types of Immunity.
4) List seven childhood Communicable Diseases
covered by EPI.
5) Explain the types of vaccines.
Mumtaz Ali Khan

5. Objectives
6) Describe the importance of childhood
immunization in family context.
7) Discuss the process of cold chain.
8) Discuss the responsibilities of a nurse to
maintain cold chain.
9) Discuss the Family/Communities practices
towards immunization.
10) Health Education and Post Vaccination
teaching.
Mumtaz Ali Khan

6. What is Immunization
 Immunization is derived from a Greek word
‘immune’ means ‘ to be protected ’.
 Immunization, is the process by which an
individual's immune system becomes
stimulated against an agent called antigen.
 Immunization is a process of protecting an
individual from a disease through introduction
of a live , killed or partial component of the
invading organism into the individual system.
Mumtaz Ali Khan

7. What is Immunization
 Immunization is the process whereby a
person is made immune or resistant to an
infectious disease, typically by the
administration of a vaccine.
 Vaccines stimulate the body’s own immune
system to protect the person against
subsequent infection or disease. (WHO)
 Immunology: The study of the immune
system.
Mumtaz Ali Khan

8. Expanded Programme on
Immunization (EPI)
 Expanded program on immunization is
mainly designed for delivering vaccines to
children all over the world to control
potential health disorders.
 Established by world health organization
in 1974.
 It is a disease prevention activity aiming at
reducing illness, disability and mortality
from childhood diseases preventable by
immunization.
Mumtaz Ali Khan

9. Expanded Programme on
Immunization (EPI)
 Expanded program on immunization is
mainly designed for supplying vaccines to
children all over the world to control
potential health disorders.
 To protect children by immunizing them
against childhood tuberculosis, poliomyelitis,
diphtheria, pertussis, tetanus and measles.
 The program also vaccinates pregnant
women with tetanus toxoid vaccine to protect
the new born from neonatal tetanus.
Mumtaz Ali Khan

10. Expanded Programme on
Immunization (EPI)
 In 1974, the WHO launched its “ Expanded
program of immunization” (EPI) against
six most common preventable diseases:
(Diphtheria, pertussis, tetanus, polio,
tuberculosis, measles and recently added
pneumococcal vaccine).
 (EPI) established by world health
organization in 1974.
Mumtaz Ali Khan

11. Expanded Programme on
Immunization (EPI) in Pakistan
 In Pakistan it started as pilot / experimental
project in 1978.
 Integrated into regular Health Services 1983.
 It is a disease prevention activity aiming at
reducing illness, disability and mortality from
childhood diseases preventable by
immunization.
 These disease are referred as ‘9’ EPI target
diseases & cause million of illness, disabilities
& death each year.
Mumtaz Ali Khan

12. Expanded Programme on
Immunization (EPI) in Pakistan
 Later, with the support of development
partners, a number of new vaccines has been
developed.
 For Example:
 Hepatitis B, Haemophilus influenza type b
(Hib) and pneumococcal vaccine (PCV10)
were introduced in 2002, 2009 and 2012, and
inactivated polio vaccine in 2015,
respectively.
Mumtaz Ali Khan

13. Expanded Programme on
Immunization (EPI) in Pakistan
 It also aims to protect mothers and newborn
against tetanus.
 Immunizing children with these vaccines may
prevent up to 17% of childhood mortality in
Pakistan and help contribute towards
achieving Sustainable Development Goal (US-
SDG) reducing child morbidity and mortality.
 The programme also plans to introduce
rotavirus vaccine in 2017, which will prevent
one cause of fatal diarrhea due to rotavirus.
Mumtaz Ali Khan

14. International organization in Health
 WHO (World Health Organization).
 UNICEF (United nations international children’s
emergency Fund).
 DFID(Department for international development)
 JICA (Japanese international cooperation agency)
 USAID (United state agency for international
development).
 UNHR (United nation high commission for
refugees).
 GAVI (Global Alliance for vaccine &
immunization).
Mumtaz Ali Khan

15. 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.
Mumtaz Ali Khan

16. ‘9’ EPI Target Diseases
1) Poliomyelitis.
2) Neonatal Tetanus.
3) Measles.
4) Diphtheria.
5) Pertussis (Whooping cough).
6) Hepatitis –B.
7) Pneumonia.
8) Tuberculosis.
9) Haemophilus influenzae type b (Hib) +
Meningitis.
Mumtaz Ali Khan

17. The Objectives of EPI
 To achieve 100% coverage with all EPI
vaccines.
 Eradication of polio to maintain polio free
status.
 Elimination of measles.
 To Reduce Seroprevalence of HBsAg to <
1% among under five.
 Elimination of Neonatal Tetanus.
 To maintain zero level of diphtheria.
Mumtaz Ali Khan

18. The Objectives of EPI
 Prevention of severe forms of TB ( TB
meningitis & miliary TB).
 To reduce the incidence of whooping cough.
 To Reduce the incidence of Bacteria
Meningitis due to haemophelus influenza.
 To Maintain Immunization Safety.
 Prepare for introduction of new vaccines.
Mumtaz Ali Khan

19. Strategies of EPI
 Participate vaccination sessions with PHC
services.
 Appropriate measures to expand the
vaccination coverage of the eligible
population.
 Ensuring regular supply of effective vaccine.
 Strengthening the cold chain.
 Training of health personnel.
 Promotion of community participation.
 Incorporating health education activities
related to EPI.
Mumtaz Ali Khan

20. Targets of EPI
1) Under 5-years children.
2) Women in the child bearing age,
(Reproductive age) (15-45 years).
Mumtaz Ali Khan

21. Immunization
 Immunization is a process of protecting an
individual from a disease through introduction of
live, or killed or attenuated (weakened) organisms
in the individual system.
 Immunization against vaccine- preventable
diseases is essential to reduce the child mortality,
morbidity and disabilities condition.
 Goals of Immunization:
 Immediate: Prevention of disease in individuals.
 Ultimate: Eradication / elimination of disease
from the world.
Mumtaz Ali Khan

22. Vaccination versus Immunization
 Vaccination :
 Vaccination is a process of inoculating or
injecting the vaccine / antigen into the body
irrespective of sero conversion.
 Immunization :
 Immunization is the process of inducing
immune response in an individual either
humoral or cell mediated.
Mumtaz Ali Khan

23. Difference between
Vaccination & Immunization
Mumtaz Ali Khan

24. Immunizing agents
 Vaccine: Vaccine is an immuno-biological
substance designed to produce specific
protection against a given disease.
 Toxoid: Exotoxins produced by some bacteria
are detoxified and used in the preparation of
vaccine.
 Immunoglobulin: Sterile solution containing
antibodies from human blood.
 Antitoxin or Antisera: Solution of antibodies
derived from the serum of non-human sources.
Mumtaz Ali Khan

25. Mumtaz Ali Khan

26. Vaccine preventable diseases
 Vaccine preventable diseases includes: E.g. :
 Poliomyelitis.
 Neonatal Tetanus.
 Measles.
 Diphtheria.
 Pertussis (Whooping Cough).
 Hepatitis-B.
 Childhood Tuberculosis.
 These diseases are preventable and can be
eradicated like Smallpox, as very safe & effective
vaccines are available.
Mumtaz Ali Khan

27. What is Vaccine
 A vaccine is a immuno-biological
preparation that improves immunity to a
particular disease.
 A vaccine typically contains an agent that
resembles a disease-causing
microorganism, and is often made from
weakened or killed forms of the microbe,
its toxins or one of its surface proteins.
Mumtaz Ali Khan

28. Types of Vaccines
 Types of vaccines:
1. Live vaccines.
2. Inactivated (killed vaccines).
3. Toxoids.
4. Cellular fraction.
5. Combinations.
Mumtaz Ali Khan

29. Live attenuated Vaccines
1) Live attenuated vaccines are produced by
modifying a disease-producing virus or
bacteria in a laboratory.
 The resulting vaccine organism retains the
ability to replicate (grow) and produce
immunity, but usually does not cause illness.
 Live attenuated vaccines include BCG, Oral
polio, Measles, Mumps and Rubella, Yellow
fever etc.
Mumtaz Ali Khan

30. Inactivated / Killed Vaccines
 Organisms are killed or inactivated by heat or
chemicals but remain antigenic.
2) Inactivated vaccines can be composed of
either whole viruses or bacteria, or fractions
of either:
 Fractional vaccines are either protein-based
or polysaccharide-based.
 Protein-based vaccines include toxoids
(inactivated bacterial toxin), and subunit or
subvirion products.
Mumtaz Ali Khan

31. Inactivated / Killed Vaccines
 Most polysaccharide-based vaccines are
composed of pure cell-wall polysaccharide
from bacteria.
 Inactivated vaccines includes pertussis,
influenza, hepatitis B, Cholera , Rabies
Injectable polio , etc.
 Conjugate polysaccharide vaccines are those
in which the polysaccharide is chemically
linked to a protein.
 This linkage makes the polysaccharide a more
potent / effective vaccine.
Mumtaz Ali Khan

32. Toxoids Vaccines
 Toxoids Vaccines:
 Certain organism produce exotoxins.
 e.g. diphtheria and tetanus bacilli.
 The toxins produce in these organisms are
detoxicated and used in the preparation of
vaccines.
 The antibody produced neutralize the toxic
moiety produced during infection rather then
act upon the organism.
 These vaccine are safe and effective.
Mumtaz Ali Khan

33. Cellular Fraction Vaccines
 Cellular Fraction Vaccines:
 Some vaccine are prepared from extracted
cellular fraction,
 e.g. meningococcal, vaccine from the
polysaccharide part of the cell wall, the
pneumococcal vaccine from the
polysaccharide contained in the capsule of
the organism.
 These vaccine are safe and effective.
Mumtaz Ali Khan

34. Comparison of killed & live vaccine
Characteristics Killed Vaccine Live Vaccine
No of dose Multiple Single
Need for adjuvant Yes No
Duration of
immunity
Shorter Longer
Immunoglobulins
produced
IgG IgA & IgG
Stability at room
temperature
High Low
Mumtaz Ali Khan

35. Expanded Programme of
Immunization (EPI)
Schedule in Pakistan
Mumtaz Ali Khan

36. Mumtaz Ali Khan

37. Mumtaz Ali Khan

38. Mumtaz Ali Khan

39. Age of vaccination Type of vaccination Dose Mode of administration
At birth
BCG 0.05 ml right deltoid; intradermal
OPV0 2 drops Oral
6 weeks
OPV-I
Pneumococcal-I
Rotavirus-I
Pentavalent-I
0.5 ml Oral
Front outer side of the thigh
muscle (intramuscular)
OPV1 2 drops Oral
10 weeks Pneumococcal-II
Rotavirus-II
Pentavalent-Il
0.5 ml Front outer side of the thigh
muscle (intramuscular)
OPV-II 2 drops Oral
14 weeks
Pneumococcal-III
IPV I
Pentavalent-III
0.5 ml Front outer side of the thigh
muscle (intramuscular)
OPV-III 2 drops Oral
9 months
MR-I Typhoid
IPV – II
0.5 ml Upper right arm; subcutaneous
15 months
MR-II 0.5ml Upper right arm; subcutaneous
EPI Schedule
Mumtaz Ali Khan

40. s
AGE VECCINES
to be given
DOSE SITE ROUTE of
administration
At birth BCG
OPV-0
Hep B
0.05 ml
2 drops
0.5 ml
Deltoid
Rt Arm
Oral
Left thigh
Intra dermal
Oral
Intra dermal
At 6 weeks OPV-1
Rota virus -1
Pneumococcal-1
Penta velant-1
2 drops
2 drops
0.5 ml
0.5 ml
Oral
oral
Left thigh
Right thigh
Oral
Oral
I/M
I/M
At 10 weeks OPV-2
Rota virus-2
Pneumococcal-2
Penta velant-2
2 drops
2 drops
0.5 ml
0.5 ml
Oral
oral
Left thigh
Right thigh
Oral
Oral
I/M
I/M
Mumtaz Ali Khan

41. AGE VECCINES
to be given
DOSE SITE ROUTE of
administration
At 14 weeks OPV-3
IPV
Pneumococcal-3
Penta velant-3
2 drops
0.5 ml
0.5 ml
0.5ml
oral
Left thigh
Left thigh
Right thigh
Oral
i/m
i/m
i/m
At 9 months Measels-1 0.5 ml Left arm subcutaneous
At 15
months
Measles-2 0.5 ml Left arm subcutaneous
Mumtaz Ali Khan

42. Age of vaccination Type of vaccination Dose Mode of administration
At birth BCG 0.05 ml right deltoid; intradermal
OPV0 2 drops Oral
6 weeks DPT1-HepB1-Hib1 0.5 ml Front outer side of the thigh
muscle (intramuscular)
OPV1 2 drops Oral
10 weeks DPT2-HepB2-Hib2 0.5 ml Front outer side of the thigh
muscle (intramuscular)
OPV2 2 drops Oral
14 weeks DPT3-HepB3-Hib3 0.5 ml Front outer side of the thigh
muscle (intramuscular)
OPV3 2 drops Oral
9 months Measles vaccine-1 0.5 ml Upper right arm;
subcutaneous
15 months
(Booster)
Measles vaccine-2 0.5 ml Upper right arm;
subcutaneous
Mumtaz Ali Khan

43. EPI Schedule
At Birth
Vaccine Disease Type of
vaccine
Dose Rout of
administration
BCG TB Live
attenuated
variant
0.05 ml intradermal
OPV (0) Polio Live
Attenuated
2 Drops Oral
Mumtaz Ali Khan

44. EPI Schedule
06- weeks
vaccine Disease Type of Vaccine Dose Rout of vaccine
OPV (1) polio Live attenuated 2 drops Oral
HiB Hib disease Polysaccharide
conjugate
0.5ml IM thigh
HBV Hepatitis B Recombinant,
yeast
Derived HBs
antigen
0.5ml IM thigh
DPT Diphtheria
Pertussis
Tetanus
Toxoid
Toxoid
Killed Pertussis
0.5 IM thigh
Mumtaz Ali Khan

45. EPI Schedule
10 weeks
Vaccine Disease Type of vaccine Dose Rout of
administration
OPV(2) Polio Live
attenuated
2 drops Oral
HiB Hib
disease
Polysaccharide
conjugate
0.5mal IM thigh
DPT Diphtheria
pertussis
Tetanus
Toxoid
Toxoid
Killed pertussis
0.5ml IM thigh
Mumtaz Ali Khan

46. EPI Schedule
14 weeks
Vaccine Disease Type of vaccine Dose Rout of
administration
OPV (3) Polio Live attenuated 2 drops Oral
HiB Hib disease Polysaccharide
conjugate
0.5ml IM thigh
HBV Hepatitis B Recombinant,
yeast
Derived HBs
antigen
0.5ml IM thigh
DPT Diphtheria
pertussis
Tetanus
Toxoid
Toxoid
Killed pertussis
0.5ml IM thigh
Mumtaz Ali Khan

47. 09 Month
Vaccine The
Disease
Type of
the
Vaccine
Dose Mode of
administration
Measles Measles All
Live
attenuated
0.5ml Subcutaneous
Mumtaz Ali Khan

48. 15 Month
Vaccine The
Disease
Type of
the
Vaccine
Dose Mode of
administration
MMR Measles
Mumps
German
Measles
All
Live
attenuated
0.5ml Subcutaneous
Mumtaz Ali Khan

49. Immunization Schedule For Women of
Child Bearing Age
Dose Schedule
TT1 Any time at first contact or as
early as possible during
pregnancy
TT2 One month after the first
visit(TT1)
TT3 Six months after TT2 or during
subsequent pregnancy
TT4 One year after TT3 or during
subsequent pregnancy
TT5 One year after TT4 or during
subsequent pregnancy
Mumtaz Ali Khan

50. Hazards of Immunization
 No immune response is entirely free from the
risk of adverse reactions or remote squeal.
 The adverse reactions that may occur may be
grouped under the following heads:
1. Reactions inherent to inoculation or injection.
2. Reactions due to faulty techniques.
3. Reactions due to hypersensitivity.
4. Neurological involvement.
5. Inflammatory reactions.
6. Others etc.
Mumtaz Ali Khan

51. Common side effects of any
vaccine can include:
 Injection site reactions (pain, swelling and
redness).
 Mild fever.
 Shivering.
 Fatigue.
 Headache.
 Muscle and joint pain.
Mumtaz Ali Khan

52. Contraindications for Vaccines
 In very few conditions, vaccination is
contraindicated.
 All vaccines are contraindicated in those who
have had:
 An anaphylactic reaction to a previous dose.
 Inactivated or killed vaccines are contraindicated
in people with known allergy to vaccines.
 Live vaccines are contraindicated in pregnancy
and in those who are on systemic steroid therapy
or immunosuppressed for any reason.
 Avoid during acute pyretic diseases.
Mumtaz Ali Khan

53. Action for reactions after
Immunization
 Explain to mother that the reaction after BCG
vaccination should be small lump or papule
which will appear in the third or fourth week,
will form puss in sixth week this is normal.it
should not be touch or scratched.
 Small scar will appear at the end of 10 to12
weeks.
 Explain some of the more common reactions
such as fever, mild swelling and pain at the
vaccination spot.
Mumtaz Ali Khan

54. Mumtaz Ali Khan
Mumtaz Ali Khan

55. mumtazkmu@yahoo.com WhatsApp: 0342-9737417
Mumtaz Ali Khan