EPI Objective:

To reduce the morbidity and mortality among infants and children caused by the seven childhood immunizable diseases.

Four Major Strategies

Sustaining high routine FIC coverage of at least 90% in all provinces and cities.
Sustaining the polio free country for global certification.
Eliminating measles by 2008.
Eliminating neonatal tetanus by 2008.

Elements of EPI

Target Setting (main element)
Information, Education and Communication
Cold chain logistic management
Assessment and Evaluation of overall performance
Surveillance, Studies and Research

Seven (7) Childhood Immunizable Diseases

Tuberculosis ( Primary Complex if less than 3 years old )
Diphteria
Pertussis
Neonatal
Tetanus
Poliomyelitis
Hepatitis
Measles

PD 996 : “ Providing for compulsory basic immunization for infants and children below 8 years old”

Concept and Importance of Vaccination

Immunization – is the process by which vaccines are introduced into the body before infection sets in.

Vaccines are administered to introduced 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.

General Principles in Vaccinating Children

It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body.
The vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or year.
Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the antibody response. Lengthening the interval between doses of vaccines leads to higher antibody levels.
No extra doses must be given to children who missed a dose of DPT/HB/OPV. The vaccination must be continued as if no time had elapsed between doses.
Do not give more than one dose of the same vaccine to a child in one session. Give doses of the same vaccine at the correct intervals.
Strictly follow the principle of never, ever reconstituting the freeze-dried vaccine in anything other than the diluent supplied with them.
If you are giving more than one vaccine, do not use the same syringe and do not use the same arm or leg for more than one injection.

Contraindication to Immunization

Anaphylaxis or severe hypersensitivity reaction to a previous dose of vaccine is an absolute contraindication to subsequent doses of vaccine
Person with a known allergy to a vaccine component should not be vaccinated.
DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. Vaccines containing the whole cell pertussis component should not be given to a children with an evolving neurological disease.
Do not give live vaccines like BCG to a individuals who are immunosuppressed due to malignant disease ( child with AIDS) , going therapy with immunosuppressive agents or radiation.
A child with a sign and symptoms of severe dehydration
Fever of 38.5 C and above

The following are NOT contraindication. Infants with these conditions SHOULD be immunized:

Allergy or asthma ( except if there is a known allergy to a specific component of vaccine mentioned above )
Minor respiratory tract infection
Diarrhea
below 38.5 C
Family history of adverse reaction following immunization
Family history of convulsions, seizures
Known or suspected HIV infection with no signs and symptoms of AIDS
Child being breastfed
Chronic illness such as diseases of heart, lung, kidney or liver
Stable neurological condition such as cerebral palsy or Down’s Syndrome
Premature or low birthweight (vaccination should not be postponed )
Recent or imminent surgery
Malnutrition
History of jaundice at birth

EPI Routine Schedule

Every Wednesday is designated as immunization day and is adopted in all part of the country.

FIC “Fully Immunized Child” when a child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HepB and one dose of measles before a child’s first birthday.

EPI COLD CHAIN and LOGISTICS

Cold Chain Manager = Public Health Nurse

Temperature monitoring of vaccines is done in all levels of health facilities to monitor vaccine temperature.
Temperature checking is done twice a day early in the morning and in the afternoon before going home.
Temperature is plotted every day in monitoring chart to monitor break in cold chain.

Most Sensitive to Heat

OPV (Oral Polio Vaccine) and Measles / Storage Temp: -15 to -25 C at the freezer / Hours of Life after opening : 8 hours

Most Sensitive to Cold

Hepa B, DPT (Diphteria-Pertussis-Tetanus) and Tetox / Storage Temp: 2 to 8 C Body of the refrigerator / Hours of Life after opening : 8 hours

Sensitive to Sunlight and Fluorescent light

BCG (Bacille Calmette-Guerin) / Storage Temp: 2 to 8 C Body of the refrigerator / Hours of Life after opening : 8 hours

Vaccine can be stored in Refrigerator:

Regional – 6 months
Municipal / City – 3 months
Main Health Center – 1 month

Transport Box : 5 days (Note: 3 trip in transport box with the same vaccine discard it.)

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

Vaccine Wastage

Wastage is defined as loss by use, decay, erosion or leakage or through wastefulness

Types of Vaccine Wastage

Vaccine wastage in unopened vials

Expiry
Heat exposure
Freezing
Breakage
Missing inventory
Theft
Discarding unused vials returned from
an outreach session

Vaccine wastage in opened vials

Discarding remaining doses at end of session
Not being able to draw the number of doses indicated on the label of a vial
Poor reconstitution practices
Submergence of opened vials in water
Suspected contamination
Patient reaction requiring more than one dose

Wastage Factor: ( constant )

DPT = 1.67
OPV = 1.67
Measles = 2
BCG = 2.5
HepB = 1.10
Tetox = 1.67