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.