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Epanded Program of Immunization

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Epanded Program of Immunization

Uploaded by

Hafsa Omer
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Expanded Program of

Immunization
Dr: Ali M. Bakheit
Intended learning outcomes
By the end of this lecture you should be
able to:
- Define immunization and vaccination
- Know the meaning of EPI and their objectives.
- Define Strategies for delivery of vaccines and
the difference between them.
- Contraindications of vaccines
- Precaution and side effects of vaccination
- Vaccination schedules in SUDAN
- What are the cold chain?
Definition of
Immunization
1- a process that increases an organism's
reaction to an antigen, thereby improving
the organism's ability to resist or
overcome infection.

2- a technique used to induce an immune


response to a specific disease in humans
by exposing the individual to an antigen
in order to raise antibodies to that
antigen.
Types of Immunization
1- Active immunization:
- stimulation with a specific antigen to
induce an immune response.

2- Passive immunization:
- administration of sensitized lymphoid cells
or serum from immune individuals to
previously non immune individuals.
What is
vaccine?
Vaccines: are microbial agents or
antigen products that stimulate the
immune response)

 3 types of microbiological preparations


are used for generation of protective
Immune response:

 Inactivated Vaccines
 Live, Attenuated Vaccines
 Toxoids
Types of Vaccines

 Inactivated Vaccines :
Produced by killing the microorganism
with chemicals or heat

 Live, Attenuated Vaccines


The organism is grown under special
laboratory conditions that cause it to
lose its virulence

 Toxoids
A toxoid is an inactivated toxin
produced by a microbe
The Expanded Program Of Immunization
(EPI)
“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
and spreading services to reach the less
privileged sectors of the society.
Targets are:
 Under 5-years children.
 Women in the child bearing age (15-45 years).
Objectives of the EPI
 To reduce the morbidity and mortality of
the major childhood diseases.
 To achieve 100% coverage for eligible
children by an ongoing integrated program
 To deliver an integrated immunization
services through health centers, as
primary health care service package
 To develop a surveillance system which
collect adequate information on the
diseases preventable by immunization
 To minimize the efforts and cost of
treatment
 To promote a new healthy generation
1- The static immunization strategy.
The strategies for vaccine delivery

2- The National Immunization Days


(NIDs).
3- Mopping up Immunization.
4- Outreach immunization.
1- The static immunization strategy

--- Advantages of integration of immunization


services through (MCH):

1-Available resources.
2- Cold Chain maintenance.
3- Save ,time, effort and money.
2- The National
Immunization Days
(NIDs):

--- It is periodic immunization of all the


eligible targets in a defined group over a
large geographic areas within a short
period of time. It is one of the strategies
for polio eradication.
3- Mopping up Immunization:
 It is house-to-house immunization with OPV in high risk
districts.
• It consists of two to three rounds 4-6 weeks apart .
• Each round should be completed within a short period of
time (3days).
• High risk districts are those:
- Where the wild polio virus is still circulating polio case in
the last 36 months) .

- With low immunization coverage.

- Transient population, with overcrowding poor sanitary


environment and low access to health services.
4- Outreach
immunization:
What is the difference between the NIDs and the
out reach Strategy?
 The outreach is carried for routine immunziation that is
compulsory for the targets in certain areas where:

- immunization services are not accessible.


- vaccination coverage is Low.
 The outreach is carried during any time without specific
duration.

Limitations:

(i) Expensive

(ii) Cold chain failure.

(iii) Difficulty to arrange the immunization schedule.


Missed opportunity
 It occurs when a child or a woman in child bearing
period comes to the health facility or outreach site and
does not receive any of the vaccine doses for which he
or she is eligible.

 The reasons for missed opportunity are:

 Health workers` practices.

 Logistical problems.

 Failure to administer simultaneously all the


vaccines for which the child is eligible.

 False contraindications to immunization.


Contraindications of vaccination

There are only 3 contraindications:


 Immune compromised child ( mainly
AIDS) → no BCG
 Child who develops convulsions after the
first dose of DPT → DT
 Severely ill child to the extent that he
urgently referred to the hospital

 IMMUNOCOMPROMISED

 Avoid MMR, measles (may be used in


HIV).
 Avoid OPV; use IPV for these children
and their household contacts.
False contraindications to immunization

Conditions that are wrongly considered as contraindications:
• Minor illness( respiratory tract infections ,diarrhea, fever < 38.5°C).
• Prematurely or small for date infants.
• Child being breast-fed.
• Family history of convulsion.
• History of jaundice at birth
• Chronic health problems: Malnutrition ,allergy, asthma, other
atopic manifestations, hay fever ,chronic diseases of heart, lungs,
kidney or liver, cerebral palsy & Down syndrome ,dermatoses, local
skin lesion.
• Treatment with antibiotics, low dose corticosteroids( local or
inhaled)
Side effects of some vaccines

 BCG:
- Local: Skin ulceration, regional lymphadenitis.
SC abscess.
- Generalized: Anaphylaxis,generalized BCG
infection.
 HBV: Pain, Arthralgia.
 Hib: Local pain and erythema, Mild
fever
 HAV: Local reactions, fever,
anaphylaxis.
Precautions
1- The only live attenuated vaccine given to
HIV child is measles.

2-Tetanus immunoglobulin (250 IU) must be


given to babies :
i) Born outside hospital in
unsanitary home conditions
ii) Seen within 10 days after birth.
ii) Whose mothers are not given two
documented doses of TT.

3-MMR vaccine is given not before the


12months not to be neutralized by maternal
antibodies.
Cold Chain system
Definition:

 It is all the people and equipments


necessary to keep vaccines safe
throughout their transfer from the
manufacturer to the child

Cycle of vaccine transfer:

 Manufacturer → Airport→ central vaccine


store→ regional vaccine store → district
store → health center → consumer
Cycle of vaccine transfer:
Components of the cold
chain
Cold box
1-
Refrigerator
Ice Packs

2- Cold Box

3- Vaccine
carriers

4- Ice packs Vaccine carrier


Arrangement of vaccines in the
refrigerator

• Polio vaccine & (live attenuated ones) is the


most sensitive vaccine to heat.
• Live attenuated vaccines are allowed to be
frozen (OPV, Measles, MMR and BCG).
• Inactivated vaccines must not be frozen ( DPT,
DT, , TT and HB) .
Arrangement of vaccines in the
refrigerator

 Freezer → Ice packs and ice cups

 Top shelf → oral polio + measles

 Middleshelf → BCG + DTP+ TT+ Hepatitis


B+ thermometer

 Bottom shelf → colored water bottle for


keeping temperature in electric power
failure
Rules for keeping vaccines in the refrigerator
 Arrange vaccines with air spaces in between

 Check the temp. everyday by the thermometer

 The optimum temp. is (0ºC - 8ºC)

 No vaccines in freezer or in the door

 No food or drink put in the refrigerator

 Keep the refrigerator door shut and use a lock


How can the cold chain be broken?

 Vaccinesleft in the airport for long


time without refrigeration

 Powerfailures can damage


vaccines in electric refrigerators

 leavingthe vaccines in direct


sunlight during an immunization
session
How to keep vaccines cold during the
immunization session?

 Aninsulated pot & ice box used to keep the


vaccine & diluents cold

 Sit in a cool place away from the sun

 BCG & measles vaccine are damaged by


sunlight (Usually put in colored vials
(brown)
What damages the vaccine?

1- Any defect in the cold chain.

2. Out date expiry

3- Using skin antiseptic at the site of injection

4. Using the reconstituted vaccine (MMR,


measles, BCG). after the recommended
period ( 6 hours).

5. Exposure of the vaccine to unacceptable


temperature during the immunization session.

6. Exposure of the vaccine to direct sunlight


(BCG).
How to identify failure of the vaccines
 Expiry date

 Color change for polio vaccine

 Shaking test: DPT vaccine spoiled by


freezing → on shaking→ turbidity→ if
left for 30 min a sediment is formed
in the bottom of the bottle
Immunization of mothers
If the pregnant mother not previously
immunized against tetanus toxoid (TT) She
receives:
(Two doses ⁄ S.C. ⁄ 4-6 weeks apart)
 1st dose: after the 1st trimester

 The last dose: at least a month before delivery

 If previously immunized: she receives a


booster dose
Safe vaccines during
pregnancy
 Recommended vaccines are:
1. Diphtheria, Tetanus,
2. Influenza
3. Hepatitis B.
4. Other vaccines, such as: Meningococcal
and Rabies may be considered

Contraindicated vaccines: (Live-virus


vaccines): MMR; Varicella, (BCG).
List the vaccinations of healthcare
workers

 Hepatitis B: 3 doses series (0,1,6 mo),

 Hepatitis A

 MMR: 2 doses, 4 weeks apart, SC.

 Influenza: 1 dose , IM.

 Varicella: 2 doses, 4 weeks apart, SC.

 Meningococcal : Give IM or SC.


Thank you

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