Expanded Program for Immunization (EPI) Principles of EPI include: 1. Epidemiological situation 2. Mass approach 3. Basic Health Service The 7 Immunizable Diseases are: 1. Tuberculosis 2. Diphtheria 3. Pertussis 4. Measles 5. Poliomyelitis 6. Tetanus 7. Hepatitis B ADMINISTRATION OF VACCINES Number of Content Form & Dosage Doses Freeze dried; Live attenuated Infant – 0.05 ml 1 bacteria Pre-school – 0.1 ml DT- weakened toxin; Liquid – 0.5 ml 3 P-killed bacteria Weakened virus Liquid – 2 drops 3 Plasma derivative Liquid – 0.5 ml 3 Freeze dried – Weakened virus 1 0.5ml Vaccine BCG DPT OPV Hepa B Measles Route ID IM Oral IM SQ SCHEDULE OF VACCINES Vaccine Age at 1st dose Interval between Dose Protection BCG At birth DPT 6 weeks 4 weeks DPT OPV 6 weeks 4 weeks At birth, 6th week, 14th week Poliomyelitis Hepa B At birth Hepa B Measles 9 mos. – 11 mos. Measles 6 months – earliest dose of measles given in case of outbreak 9 months-11 months – regular schedule of measles vaccine 15 months – latest dose of measles given 4-5 years old – catch up dose Fully Immunized Child (FIC) – less than 12 months old child with complete immunizations of DPT, OPV, BCG, anti-Hepatitis and antiMeasles Vaccine Minimum Age Interval % Protected 0% Duration of Protection 0 TT1 As early as possible TT2 4 weeks later 80% 3 years TT3 6 months later 1 year later or during next pregnancy 1 year later or third pregnancy 95% 5 years TT4 99% 10 years TT5 99% Lifetime There is no contraindication to immunization except when the child is immunosuppressed or is very, very ill (but not slight fever or cold). Or if the child experienced convulsions after a DPT or measles vaccine, report such to the doctor immediately. Malnutrition is not a contraindication for immunizing children rather; it is an indication for immunization since common childhood diseases are often severe to malnourished children. Cold Chain under EPI: Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is given to child or pregnant woman. The allowable timeframes for the storage of vaccines at different levels are: 6 months – Regional Level 3 months – Provincial Level or District Level 1 month – main health centers with refrigerator Not more than 5 days – health centers using transport boxes. Most sensitive to heat: Freezer (-15 to -25 degrees C) OPV Measles Sensitive to heat and freezing: Body of Refrigerator (+2 to +8 degrees C) BCG DPT Hepa B TT Use those that expire first, mark “X” or exposure, 3rd – discard. Transport – use cold bags; let it stand in room temperature for a while before storing DPT. Half life packs: 4 hours – BCG, DPT, Polio; 8 hours – Measles, TT, Hepa B. FEFO (“first expiry and first out”) – vaccine is practiced to assure that all vaccines are utilized before the expiry date. Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near to expire vaccines.