1. Expanded Program of Immunization (EPI)

2. Definition It is program adopted by WHO since l974, it includes child immunization & vaccination of pregnant women. Objectives of EPI 1.↓ incidence of target diseases ( T.B. –Poliomyelitis – Diphtheria – Pertussis – Tetanus - Hepatitis B – Measles – Mumps - Rubella) and Vit. A deficiency. 2.↓ mortality rates from these diseases 19 January 2016 2 Public Health and Community Medicine Department Mansoura Faculty of Medicine

3. 3 Strategy A. Child immunization The following is the Egyptian immunization schedule, EPI, MOH, 2009: At birth (zero dose)OPV (Sabin) BCG 2 drops 0.1 ml Oral ID, upper left arm 2 nd, 4 th, 6 th months (1 st, 2 nd,3 rd doses) OPV (Sabin), DPT HB vaccine 2 drops 0.5 ml Oral IM, Outer left mid-thigh IM, Outer right mid-thigh 9 th monthVitamin A OPV (Sabin) Capsule 2 drops Squeezed in mouth Oral 12 th monthMMR OPV (Sabin) 0.5 ml 2 drops S.C Oral 18 monthOPV (Sabin) DPT MMR Vitamin A 2 drops 0.5ml 2 capsules Oral I.M S.C Squeezed in mouth School entry Age (5-6 years) OPV (Sabin) DT BCG Meningococcal vaccine 2 drops 0.5ml 0.1 ml 0.5ml Oral I.M ID, upper left arm (for tuberculin nonreactors) S.C

4. Schedule of non compulsory vaccinations 1. Pregnant women :Tetanus toxoid: 2. Food handlers : - TAB vaccine against typhoid and paratyphoid. - Hepatitis A vaccine. 3. Military groups: - Tetanus toxoid - Meningococcal polysaccharide vaccine - BCG for non reactors. 4. International Immunization: *Cholera vaccine: for travelers coming from or going into endemic area &should have valid vaccination certificate (6 days-6months). *Yellow fever vaccine: for travelers coming from or going to endemic area (Yellow fever belt) -validity (10days -10 years). 19 January 2016 4 Public Health and Community Medicine Department Mansoura Faculty of Medicine

5. B. Vaccination of the pregnant women 19 January 2016 5 Public Health and Community Medicine Department Mansoura Faculty of Medicine DoseTimeEffectivenessPeriod of protection TT1 -------------------------- Zero-------------- TT2 4 weeks after TT1 80%3 years TT3 6 months after TT2 or next pregnancy 95%5 years TT4 1 year after TT3 or next pregnancy 95%10 years TT5 1 year after TT4 or next pregnancy 99%Life long

6. T.T is given during pregnancy to protect the mother against puerperal tetanus and the baby against tetanus neonatorum. The first dose of T.T is given after 1st trimester to avoid false beliefs that T.T cause abortion. 19 January 2016 6 Public Health and Community Medicine Department Mansoura Faculty of Medicine

7. Def. of vaccines: Weapons to prevent diseases, made of microorganisms (similar to ones cause diseases) or of toxins produced by the microorganisms (antigenic non toxigenic) that cannot harm people. Types of vaccines: 1.Live attenuated vaccine : - BCG vaccine. - Polio vaccine (Sabin). - Measles vaccine 2. Killed vaccines: -Pertussis vaccine - Salk vaccine. 3. Toxoids: -Diphtheria toxoid. - Tetanus toxoid. 4. Recombinant DNA technique vaccine: Hepatitis B vaccine

8. Contraindications for immunization All vaccines should be given on schedule, even when a child has a low - grade fever, a mild cold, diarrhea or other mild illness. If a child has diarrhea when you give OPV, administer an extra dose (see before). DPT vaccine should NOT be given to children over 5 years or to children suffered a severe reaction to a previous dose of this vaccine ( shock or convulsions ) Instead, D.T may be given. BCG vaccine should not be given to children who have signs and symptoms of AIDS. 19 January 2016 8 Public Health and Community Medicine Department Mansoura Faculty of Medicine

9. What damages vaccines? All vaccines lose potency after expiry date. Heat & sunlight damage vaccines especially living attenuated e.g. BCG. Freezing damage toxoid & killed vaccines. Disinfectants or antiseptics such as detergents and antibiotics such as streptomycin on BCG. 19 January 2016 9 Public Health and Community Medicine Department Mansoura Faculty of Medicine All vaccines lose potency after expiry date. Heat & sunlight damage vaccines especially living attenuated e.g. BCG. Freezing damage toxoid & killed vaccines. Disinfectants or antiseptics such as detergents and antibiotics such as streptomycin on BCG.

10. How can you differentiate between D.P.T vaccines damaged by freezing and other never frozen before? 19 January 2016 10 Public Health and Community Medicine Department Mansoura Faculty of Medicine Vaccine never frozen Vaccine frozen and thawed Immediately after shaking Smooth cloudyShow granular particles 15-30 m after sharking Clear with no sediment Clear with thick sediment

12. Injection sites 19 January 2016 12 Public Health and Community Medicine Department Mansoura Faculty of Medicine

13. Summary of injection sites 19 January 2016 13 Public Health and Community Medicine Department Mansoura Faculty of Medicine VaccineRoute of administration Injection site BCGStrict I.DUpper left arm DPTI.MOuter mid-thigh ( left ) OPVOralMouth HBVI.MOuter mid-thigh ( right ) MMRSCUpper right arm Tetanus toxoidI.MOuter, upper ar m