Expanded program on Immunization

Expanded program on Immunization

1. Tehseen Riaz Lecturer, Rashid Latif College of Pharmacy Expanded programme on immunization

2. Expanded programme on immunization (EPI) The Expanded Programme on Immunization (EPI)  is a disease prevention activity aiming at reducing illness, disability and mortality from childhood  diseases preventable by immunization. These diseases are referred as 8 EPI target diseases and cause millions of ailments, disabilities & deaths each year . • Poliomyelitis   • Neonatal Tetanus  • Measles  • Diphtheria  • Pertussis (Whooping Cough)  • Hepatitis-B  • Hib ( Haemophilus influenzae type b) meningitis and Pneumonia • Childhood Tuberculosis

3. History In May 1974, WHO officially launched a global immunization program, known as Expanded program on immunization (EPI) for the prevention and control of six major, killer diseases of children namely, tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles, all over the world because of the following reason: These childhood diseases are highly fatal Those children who recover will have permanent sequela ( abnormality) These diseases are responsible for increased morbidity and mortality among children. They are easily preventable by immunization Available vaccines are simple, safe, effective and affordable.

4. Historical development • Pilot Project 1978  • Integrated into regular Health Services 1983  • Accelerated Health Programme (AHP) 1985  • Addition of Vaccine for HepB 2002  • Addition of Vaccine for Hib Meningitis & Pneumonia 2008  • Addition of Pneumococcal 2012 The EPI Programme started in Pakistan in 1978 and is still continuing. Rota-virus Vaccine is planned in 2013

5. Objectives The overall objective of the EPI is reduction of mortality and morbidity from the eight EPI diseases by offering immunization services. The programme is evaluated at intervals of 2-3 years. Specific objectives of the Programme are as follows: Achievement of 90/80 % immunization coverage by 2010 Elimination of Neonatal Tetanus Elimination of Measles by 2010. Reduction of VPDs (vaccine preventable diseases) morbidity & mortality by 2/3rd by year 2015 as compared to 2000 as per MDG-4 (millennium development goal 4). Certification of Eradication of Poliomyelitis after being free for 3 years from polio Introduction of new vaccines in the EPI immunization Schedule i.e. Pneumococcal Vaccine in 2011 and Rota-virus Vaccine in 2013

6. EPI It was called EXPANDED because: Number of diseases covered are more (6 diseases). Services are extended to all corners of the world, irrespective of cast, creed, community and ability to pay for it. The child is immunized much before it is born (mother is immunized during pregnancy).

7. EPI The diseases are preventable and can be eradicated like Smallpox, as very safe & effective vaccines are available. Immunization is one of the most successful and cost effective health interventions. It has eradicated small pox, lowered the global incidence of polio so far by 99% and achieved dramatic reductions in illness, disability and death from diphtheria, tetanus, whooping cough and measles. It is a world-wide Programme being carried out in all countries assisted by WHO, UNICEF and other donor agencies. EPI program is run by the ministry of health (MOH) in close cooperation with WHO, UNICEF and other partners and implemented in each region by the regional health bureaus. WHO provides technical assistance to the ministry of health and assists in planning, resource mobilization and social mobilization . The global target of the Programme is to immunize over 95% of infants and child-bearing-age females.

8. Schedule of EPI in P akistan

9. Components of EPI • Routine Immunization       o Children – immunization with 8 EPI antigens        o Pregnant ladies by TT ( Tetanus toxide ) • Supplemental Immunization Activities(SIAs):      o Routine immunization does not ensure 100% coverage of the mobile population i.e. nomads, hard to reach areas / missed areas. So SIAs are scheduled to ensure coverage of this population / areas.        o NIDs ( supplementary immunization activities) / SNIDs ( supplementary immunization activities): children < 5 years receive polio drops (3-days campaign)  • Disease Surveillance       o To detect every case of target diseases, the suspected cases of seven VPDs (vaccine preventable diseases) are reported by health facilities to the district health authorities for immediate launching of the control measures.  • Mopping up        o Special campaigns 5-8 km around the infected locality to localize the disease and stop its transmission.

10. Concept and Importance of Vaccination Immunization It is the process by which vaccines are introduced into the body before infection sets in. Vaccines are administered to introduce immunity, thereby causing the recipient’s immune system to react to the vaccine that produces antibodies to fight infection. Vaccinations promote health and protect children from disease – causing agents. Infants and newborn need to be vaccinated at an early age since they belong to vulnerable age group

11. Cold chain Definition: It is a system of storage and transportation of the vaccines at recommended, low temperature (+2 to +8 ⁰C) all along from time and place of manufacture to the time and place of its use. Or Cold chain refers to the storage and transport equipment that enables vaccine to be kept at this temperature from the point of manufacture to the point of use in an immunization session or a clinic. The cold chain system is the life line of the immunization program.

12. IMPORTANCE Cold chain is necessary for vaccine’s transport because they are sensitive and loose their potency when exposed to heat and light. All the vaccines retain their potency at temperatures between +2⁰ and +8⁰C . A break in cold chain occurs if the temp goes above 8 ⁰C or falls bellow 2 ⁰C. The sensitivity of vaccines in descending order is as follows:

13. Name of vaccination Route of administration Sensitivity Storage condition Storage temp OPV Oral (live attenuated (OPV)) and inactivated polio vaccines (IPV) for IM, SC route. Highly sensitive These two can be stored at subzero temp for long term use. -15 to -25⁰ C. At freezer MV ( mmr for measles) IM, SC BCG (for tb ) Intradermal DPT IM “T” series vaccines are denatured at sub zero temp. +2 to +8 ⁰C. Body of fridge. TT (toxoid) Parentral Least sensitive

14. FEFO FEFO- “first expiry and first out” vaccine is practiced to ensure that all vaccines are utilized before its expiry date Proper arrangement of vaccines and labeling of vaccines expiry date are done to identify those near to expire vaccines Temperature monitoring of vaccines is done twice a day early in the morning and in the afternoon before going home.

15. Cold chain equipments Each level of facilities have cold chain equipment for use in the storage of vaccines . These consists of the following : Walk in coolers (WIC) Cold box Deep freezer Ice lined refrigerator (ILR) Refrigerator (conventional) Vaccine carrier

16. Cold chain equipments Walk in coolers (WIC ): These are air conditioned cold rooms, maintaining the temp between 2-8 ⁰C. Such rooms exist in vaccine institutes where vaccines are manufactured in on large scale. Cold box: It is a big rectangular box (90*60 cms ) made up of insulated material, lined with 24 ice packs which maintain the cold life inside the box for about 5 days. Such boxes are used to collect, store and transport large quantities of vaccines from one place to another by refrigerator vans. Ice packs: these are rectangular shaped, flat, plastic bottles, filled with water upto the neck. Water is frozen into ice and then it is called “ice packs”.it is used for lining the walls of cold boxes and vaccine carriers, as buffers to maintain cold life inside the equipment. Ice packs maintain cold life for 5 days in cold box and for 1 day in vaccine carrier is it is not opened.

17. Cold chain equipments Deep freezer: I t is a top opening refrigerator, which maintains the temp at -20 to -40 ⁰ C. It is used to store only OPV and MV for long term use and also prepare icepacks. T series vaccines are never stored because they will be denatured and BCG vaccine are not stored because the ampoule gives a crack. It has electrical connections. Ice lined refrigerator (ILR): I t is also a top opening refrigerator having single compartment for vaccine storage (0 to 8 ⁰ C) equipped with baskets and lined by preinstalled and water filled ice lining ready for use. It maintains cold life, during power failure upto 18-20 hrs /day. It works entirely as cold box with electrical connections. There are two types, one lined with ice tubes (Electrolux) and other with ice packs (vest frost). There is no freezer compartment in ILRs so it is not used to prepare ice packs.

18. Cold chain equipments Refrigerator (conventional): this is to provided to every primary health centre . Care should be taken so that the temperature doesn’t rise abov e 8 ⁰ C. Vaccine carrier: it is a square shaped box, made up of special insulated material, lined by 4 ice packs, one on each side, which maintains cold life for 24 hrs if not opened. It is used to carry small quantities of vaccines from the primary health center or sub center to the out reach station by the health worker. The T series of vaccines should not be in direct contact with the ice packs because they get frozen, and those vaccines are places inside a polythene bag and closed with rubber band.

19. THANK YOU