2. Expanded program of Immunization (EPI)

3. Introduction The Expanded Program on Immunization (EPI) was established in 1974 depending on the success of the global smallpox eradication program, and to ensure that all children in all countries benefited from life-saving vaccines.

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

5. The objectives of EPI 1.To achieve 100% coverage with all EPI vaccines 2.To reduce the morbidity and mortality of the major six childhood diseases. (diphtheria, pertussis, tetanus, polio, tuberculosis and measles)

6. 3. Eradication of polio to maintain polio free status.

7. 4. Elimination of measles

8. 5.Elimination of Neonatal Tetanus

9. 6. To maintain zero level of diphtheria.

10. 7.Prevention of severe forms of TB ( TB meningitis &military TB). 12 year old girl with TB meningitis

11. 8. To reduce the incidence of whooping cough

12. 9. Reduce sero-prevalence of (HBsAg) to <1% among under five. HBV

13. 10.Reduce the incidence of Bacteria Meningitis due to haemophelus influenza 11.To maintain immunization safety. 12.To deliver an integrated immunization services through health centers, as primary health care service package 13.To prepare for introduction of new vaccines

14. Components The main components of a well functioning immunization system include: 1.Service delivery 2.Capacity to maintain vaccines at the right temperature (cold chain) 3.Distribute vaccines through the system in a timely manner (logistics); 4.Monitoring and surveillance 5.Trained health workers 6.Program planning and management.

15. Main facts about Immunization 1.Immunization prevents between 2-3 million deaths every year. 2. Over 1 million infants and young children die every year from pneumococcal disease and rotavirus diarrhea 3. Global measles mortality has declined by 74% 4. Polio cases have decreased by over 99%

16. Types of vaccines 1.Live vaccines 2.Attenuated live vaccines 3.Inactivated (killed vaccines) 4.Toxoids 5.Polysaccharide and polypeptide (cellular fraction) vaccines 6.Surface antigen (recombinant) vaccines.

17. Diseases covered by EPI Diphtheria Measles Mumps Rubella Pertussis Varicella Rota Tetanus Polio TB HBV Hib Pneumococcal conjugate Meningococcal conjugate quadrivalent.

18. EPI in KSA In 1979 The ministry of health in KSA have adopted a strategic step with the immunization of over 90% of the children in Saudi Arabia against infectious childhood diseases in the EPI system. T.B., Diphtheria, Tetanus neonatorum, whooping cough, measles, and poliomyelitis. Latter on the list included coverage against mumps, rubella, hepatitis B viral infections and hib……

19. Vaccination schedules -1991 -2002 -2008 -2013 The changes included in the new vaccination schedule reflect the efforts of continuous monitoring and evaluation of the previous system. It depended largely on the incidence of certain diseases and their impact. It also followed the most recent developments in the manufacturing and industry of vaccines internationally employed.

20. Recent schedule for Vaccination of Newborns in Saudi Arabia

24. Certain available vaccines and their routes of administration. Vaccine Type Route BCGLive attenuated Bacteria Intradermal DTP D&T = Toxoids P = inactivated bacteria Intramuscular Hepatitis B(HBV)Inactivated viral antigen Intramuscular Haemophilus Influenza b (Hib) Polysaccharide Intramuscular MMRLive attenuated viruses Subcutaneous OPVLive attenuated virus Oral

25. Contraindications of vaccination: Absolute: 1- History of anaphylactic reactions. 2- Subsequent doses of pertussis vaccines are absolutely contraindicated if the child gets (within 48 hours of vaccination ) Fever (40.5º), Collapse or shock. Convulsion with or without fever within 3 hours after vaccination. 3- HIV infection is an absolute contraindication to administration of live attenuated vaccines ( OPV & BCG), the only allowed one is measles vaccine.

26. Temporary: 1- Pregnancy. 2- Severe illness that needs hospitalization. 3- Immunosuppression. 4- Recent receipt of blood.

27. The Cold Chain Failure of a vaccine to protect an individual child may be due to a number of reasons. The vaccine may no longer be "antigenic" so that it does not stimulate the body to produce antibodies. With "live vaccines", which can occur if the vaccine is no longer alive. Most live vaccines are killed easily by changes of temperature, such as might occur if they are left out of the refrigerator for a long time.

28. Vaccines must be kept constantly cold throughout the chain of storage and transport which they have to pass through before reaching the child. Breaks in this "cold chain", as it has come to be called, may be due to corruption of a batch of vaccine delivery to a Ministry of Health depot or to a hospital or health center. It can happen as a result of the breakdown of the refrigerating system.

29. Cold chain It is the system of storage and transportation of the vaccine at low temperature (cold condition) from the manufacture till it is consumed

30. A typical cold chain Vaccine manufacturer Specialist pharmaceutical Distribution company Pharmacy/GP surgery/Clinic Patient Transportation in Refrigerated vans and/or cool boxes

31. The levels of cold chain

32. The equipment and tools The procedures The health staff The components of the cold chain -Refrigerators -Cold box -vaccine carrier. Ice packs

33. Vaccine Stability Sensitivity to HEAT 1.Oral Polio 2.BCG 3.Varicella 4.MMR 5.Hepatitis B 6.DT 7.HIB Sensitivity to COLD 1.HepB 2.HIB 3.Influenza 4.MMR 5.Varicella 6.BCG LEAST SENSITIVE MOST SENSITIVE Live vaccines are allowed to frozen. Killed vaccines are not allowed to be frozen

35. Live vaccines are also damaged by sunlight, which is especially likely to happen after they have been prepared (reconstituted) for injection in the clinic or at the school.

36. Even in the best circumstances, vaccines eventually lose their power and it is very important to look at the date of expiry on the container.

37. Strategies for service delivery The static immunization strategy. The National Immunization Days (NIDs). Mopping up Immunization (house to house). Outreach immunization

38. New vaccines to be proposed ? Schistosomiasis Cancer HIV/AIDS Malaria

39. THANKS