EXPANDED PROGRAMME ON

IMMUNIZATION (EPI)
BY STEVE
• Immunization
• Process of protecting a person from a specific
disease
• Common terms;
• Immune- free from infection
• Immune status- degree to which a person is
immune from disease
• Immunity- ability of the body to resist micro-
organism
• Immunization status- degree to which the
process of making people immune has
progressed
• Vaccine-substance that is used to produce
immunity
• Vaccination- practical methods of immunization
• Mechanism of immunity;
• Immune system is a network of cells and
substances that respond to invasion of the body
by microorganisms;
• Formation of antibodies that circulate within the
body and get acts against antigens at every part
of the body, antibodies are produced by B-
lymphocytes that form hormonal immune system
• Other specialized T-lymphocytes and
macrophages circulate in the body and
destroy the invading microorganisms, this
form is called cell-mediated immune system
• Types of immunity;
• Active immunity; gain from;
• Suffering from the disease
• Giving vaccine (live attenuated
microorganism)
• It provide long life immunity
• Passive immunity gain by;
• Giving antibodies to the mother and passed to the
baby during Pregnancy and breastfeeding
• Passive immunity provide periodic immunity
during the first few weeks after birth
• Vaccine;
• BCG (Bacillus Chalmette Guerin)
• Oral Polio Vaccine/OPV
• DPT Vaccine
• Measles Vaccine
• TT Vaccine
•
• Classification of vaccine
• Life vaccine
• Dead vaccine
• Toxoids
• Life vaccine;
• Made from living but weakened microorganism of a specific
disease;
• They are;
• BCG
• OPV
• Measles vaccine;
• Dead vaccine;
• Made from dead microorganism of a specific disease;
• They are;
• Whooping cough vaccine in DPT
• Toxoids; vaccine made out of weakened toxins from micro
organism of a specific disease;
• TT
• Administration of vaccines;
• BCG
• Protection; tuberculosis
• Age given; at birth or 1st contact
• Dose; 0.05 ml 0-1 yr, 0.1 ml 1-5 yrs
• Number of dose; 1
• ROA; Intradermal
• Site of administration; left forearm, RSS
• Contraindication; children with AIDS or close to Tb Pts
• Side effects; fever and chronic ulcers
• OPV
• Liquid form
• Protection; poliomyelitis
• Age; at birth to 14 days OPV 0 (used as reference to
detect number of children born in hospital)
• At 6 wks OPV 1
• 10 wks OPV 2
• 14 wks OPV 3
• Dose; 2 drops
• ROA; Oral
• Site of administration; mouth
• Contraindication; diarrhoea and vomiting
• Side effect; none
• DPT
• Liquid form
• Protection; Diphtheria, pertussis and tetanus
• Age; 6 wks DPT 1
• 10 wks DPT 2
• 14 wks DPT 3
• Dose; 0.5 ml
• Number of dose; 3
• ROA; intramuscular
• Site of administration; outer upper aspect of left thigh
• Contraindication; fever
• Side effects; fever and injection abscess
• Measles vaccine
• Usually freeze dried
• Protection; Measles virus
• Age; 9 months, during outbreak of measles, it
can be given at 6 months and to be repeated
after one year
• Dose; 0.5 ml
• Number of dose; 1-2
• ROA; subcutaneous
• Site of administration; left upper arm( deltoid
muscle)
• Tetanus Toxoids vaccine (TTV)
• Liquid form
• Protection; tetanus
• Age;
• First contact TT 1,
• 4 wks after TT 1 …………….TT 2
• 6 months after TT 2……………..TT 3
• 1 yr after TT 3……………….TT 4
• 1 yr after TT 4……………….TT 5
• Dose; 0.5 ml
• Number of dose; 5, full protection
• Site of administration; left upper arm/deltoid muscle
• ROA; IM
• Indications; Women of reproductive age and Patients with bad wounds/
burns
• Contraindication; none
•
• VACCINE POTENCY AND COLD CHAIN
• Vaccine potency
• The organisms in the vaccine [antigens] are prepared
and stored under special conditions so that they keep
their antigenicity [power to stimulate the body to
produce antibodies]. This antigenicity is therefore
referred to as vaccine potency.
• Cold chain
• In order for the vaccines to retain their potency they
must be kept at the correct temperature all the time.
The cold chain therefore is a system by which vaccines
are kept at the correct temperature from the
manufacturer to the vaccinees at the immunization
session.
• The cold chain system therefore consists of;
• The people who organize and manage vaccines
• The equipment for storing and transporting vaccines.
• Procedures which guide in maintaining the cold chain system
•
• The People procure and pass on the vaccines from
• The manufacturers to the Central Medical stores
• Central medical stores to district/county medical stores
• District/county medical stores to Hospitals and health centres
• Hospitals/health centres to the static and mobile/outreach immunisation
sessions
• The cold chain equipment include;
• Deep freezers
• Cold boxes
• Refrigerators
• Vaccine carriers
• Ice packs
• Vaccine thermometers and monitors
• The procedures are set rules for;
• People and
• The equipment
•
• Reasons why maintaining cold chain is important
• Vaccines are different from other medical supplies in that they
are easily damaged and rendered impotent if the cold chain is
broken.
•
• Maintaining cold chain is important because;
• Damaged vaccine can not protect children and mothers against
disease
• It is a waste of time and money to use damaged vaccines
• It destroys people’s confidence if they are given impotent
vaccines and they end up developing diseases
•
• Ways of maintaining cold chain
• We have already said that vaccines are very delicate and get
damaged very easily. We have also seen the reasons why
maintaining cold chain is important in EPI. The following are
therefore ways of ensuring cold chain.
• Keep vaccines cold all the time.
• Keep vaccines away from sunlight and heat always.
• Pass vaccines from one cold chain equipment to the next very
quickly and properly. The quickest possible way should be used.
• Ensure that proper vaccines, in the proper quantities are taken
where they are needed at the right time. Ensure proper vaccine
packing whether in the fridge, cold box or vaccine carrier.
• Ensure proper cold chain equipment maintenance all the time.
Poor maintenance lead s to damage of equipment and break of
cold chain.
•
Correct storage and transport temperature ranges
for vaccines
• Vaccines are kept cold at various temperatures at
different places as illustrated below;
Recommended temperature
• Central medical stores 0 to +80C
• District medical stores 0 to +80C
• Hospitals, Health centers, +2to +80C
• Mobile clinics +2 to +80C
• Immunization sessions +2 to +80C
• THE COLD CHAIN EQUIPMENT
• Cold chain equipment consists of the following equipment
• A. At the Central Medical the cold chain equipment includes
• Refrigerators
• Refrigerated vehicles
• The cold boxes
• The vaccine carriers
• Dial thermometers
• Ice packs
• B. At the District Medical stores
• Refrigerators
• The cold boxes
• The vaccine carriers
• Dial thermometers
• Ice packs
• C. At Hospitals, Health Centres
• Refrigerators
• The vaccine carriers
• Dial thermometers
• Ice packs
• D. At the Immunisation sessions
• The vaccine carriers 0912428803.
• Dial thermometers
• Ice packs
• At the operational level, the following are the uses/maintenance tips of the Cold
Chain equipment.
•
• 1. The Refrigerators
• a) Uses; it is used for storing all vaccines at the static units, freezing ice for the ice
packs and keeping the frozen icepacks.
• b) Types of refrigerators include;
• Kerosene refrigerators
• Electrical refrigerators
• Gas/Electric
• Solar
•
• Maintenance
• A refrigerator of any make is maintained in the following ways;
• a) Checking and recording the temperature in the refrigerator.
• Your refrigerator will be supplied with dial or other types of thermometers
• Check and record refrigerator temperature in the morning and evening very day.
• Ensure that the temperature in the refrigerator is between +2 and +80C
• If you need to correct the refrigerator temperature, do so, and record what you have
done under action taken on the temperature chart.
• b) Packing the refrigerator
• It is very important that vaccines, their diluent and ice packs are
packed in proper parts of the refrigerators namely;
• i) The freezing compartment [ the coldest part of the refrigerator];
• Use this freezing compartment for preparing ice packs only
• Never store vaccines in the freezing compartment because freezing
damages them.
• The freezing compartment holds 4 or more icepacks at a time.
• NB. Freezing ice packs fully can take up to 2 days.
• ii) The vaccine compartment
• All vaccines should be stored in the vaccine compartment in neat
piles with some space between them.
• DPT/Hib/HepB and TT should be packed farthest from the freezer to
avoid freezing them
• Measles, BCG and Polio vaccines can be packed nearest to the
freezing compartment.
• Important rules for EPI refrigerators
• Whatever the refrigerator make/model
• Never keep food or drinks in the vaccine
refrigerator
• Ensure each vaccine is packed in the proper place
within the refrigerator
• For refrigerators with door shelves, do not keep any
vaccines on the door shelf or bottom shelf
• Check and record the refrigerator temperature
twice a day i.e. morning and evening.
• Keep careful record of the temperature readings on
the refrigerator record sheet for reference.
Proper care of the vaccine refrigerator involves;
• Keeping the refrigerators locked or in a locked room
• Ensure that the refrigerator room is well ventilated to avoid heat.
• Avoid direct sunlight into the refrigerator room. Use curtains where necessary.
• For electric refrigerators; have a permanent connection to the power supply.
Tape the plug to the electric socket and tape the switch in the `ON’ position to
prevent accidental switching off by someone else.
• Install the refrigerator at least 4inches [10cm] away from the wall to allow free
circulation of air from the motor or burner to escape.
• Ensure that the refrigerator is installed in a leveled position for proper
functioning. Some refrigerator have installed spirit level, in which case ensure
that the bubble is inside the circle. For refrigerators without the spirit level, use
a plump line or ordinary spirit level to position it.
• Keep refrigerator door or lid firmly closed. If ice or frost prevents the door from
closing, there will nor be adequate refrigeration inside and may compromise
the cold chain. It then must be defrosted.
• Gas or Kerosene refrigerators must not be placed in a draughty/windy room,
otherwise the flame may be blown out or burn improperly.
• GUIDELINES FOR THE MAINTENCE OF SPECIFIC REFRIGERATOR TYPES
• For Gas/Electric Refrigerators
• To change from electricity to Gas, do the following;
• Switch off the electrical supply to the refrigerator.
• Fit the gas regulator to the gas cylinder and lock it firmly in place.
• Turn on the gas supply to the refrigerator.
• Press the gas inlet button on the refrigerator for 30-60 second to allow
gas to flow to the on burner.
• Press the ignition button on the refrigerator two or three times to light
the burner.
• Check to ensure that the flame has lit correctly [giving a steady blue
flame]. If it has not lit repeat the above step until it lights.
• Check to ensure that there is no smell or sound of escaping gas from the
gas cylinder or refrigerator.
• NB. You should never use both gas and electricity on at the same time.
•
• To change from gas back to electricity
• Do the following;
• Turn off the gas supply at the gas cylinder
• Switch on the electricity supply
• Check to ensure that there is still gas in the gas cylinder by shaking it for
presence of liquid inside.
• It in doubt, have the gas cylinder for refilling at once.
•
• For the Gas only Refrigerators
• Always have one extra full gas cylinder on standby.
• When the gas cylinder in use becomes empty, change to the full one and send
the empty one for refilling immediately.
• Never allow anyone to use EPI gas for any other purpose. Keep both gas
cylinders under strict control.
• In the evening check to ensure that there is enough gas to last the night. If in
doubt, change to the full cylinder. One full gas cylinder usually lasts one month.
• When leaving the centre for a weekend, ensure that someone is left in charge or
that there is enough gas to last the period you will be away.
• Care of the gas burner on the Gas refrigerator;
• Check the burner every week to ensure that it is clean. Do this by looking at the flame.
If it is steady blue flame then the burner is clean.
• Change in flame colour or too much soot means the burner is dirty and hence needs
cleaning. In this case call the refrigerator technician at once, to have it cleaned.
•
• Changing the gas cylinder on a Gas Refrigerator
• Do the following;
• Turn off the gas on top of the gas cylinder
• Replace the empty gas cylinder with a full one
• Make sure you fit the gas regulator firmly and squarely onto the new cylinder.
• Turn on the gas
• Hold the gas inlet button on the refrigerator for 10-seconds to allow the gas to follow
to the burner.
• Relight the burner by pressing the ignition button two to three times.
• Check to ensure that the flame is burning correctly
• Check to ensure that there is no smell or sound of gas escaping from the gas cylinder
or the refrigerator.
• Send the empty gas cylinder for refilling immediately.
• How to defrost the Refrigerator
• Check every month to see that ice and frost does not accumulate above 1 cm
thickness. Ice and frost normally accumulate on the cooling surfaces of the
freezing compartment.
•
•
• When the ice and frost accumulates above 1 cm, do the following;
• Transfer all the vaccines from the refrigerator to a cold box or vaccine carriers.
• Switch off the refrigerator and open its the lid or door.
• Leave the lid or door open for about 30 minutes or until all the ice has
melted. Warning; Do not use any tool or sharp instrument to scrape off the
ice or frost.
• Wipe the moisture/water out the refrigerator dry using a towel. When the
inside is clean and dry, close the fridge, put the thermometer in and switch
on the power supply or light the gas.
• Wait until the temperature in the refrigerator drops to between +2 and +8 the
return the vaccines to the fridge.
• Return the Ice pack in the freezing compartment.
• Close the refrigerator firmly as usual.
• How to defrost the Refrigerator
• Check every month to see that ice and frost does not accumulate above 1 cm
thickness. Ice and frost normally accumulate on the cooling surfaces of the
freezing compartment.
•
•
• When the ice and frost accumulates above 1 cm, do the following;
• Transfer all the vaccines from the refrigerator to a cold box or vaccine carriers.
• Switch off the refrigerator and open its the lid or door.
• Leave the lid or door open for about 30 minutes or until all the ice has
melted. Warning; Do not use any tool or sharp instrument to scrape off the
ice or frost.
• Wipe the moisture/water out the refrigerator dry using a towel. When the
inside is clean and dry, close the fridge, put the thermometer in and switch
on the power supply or light the gas.
• Wait until the temperature in the refrigerator drops to between +2 and +8 the
return the vaccines to the fridge.
• Return the Ice pack in the freezing compartment.
• Close the refrigerator firmly as usual.
• Kerosene Refrigerator
• Maintenance of Kerosene refrigerators is as follows;
• Do the following on daily basis;
• Checking and recording the temperature inside the fridge in the morning and evening. It
should be between +2 and +80C.
• Checking the kerosene flame. It must burning a steady flame of constant size without smoking.
Adjust the flame size if necessary.
• Ensure that the kerosene tank has adequate fuel. Always use the filter provided when refilling
the tank.
• Weekly attention involves;
• Checking the freezer compartment for frost and defrosting when necessary.
• Counting the stock and ensuring that it agrees with your vaccine stock records.
• Cleaning the kerosene burner
• Cleaning the chimney and baffle thoroughly, brushing away all the soot and dirt.
• Monthly attention involves;
• Washing the kerosene tank using clean kerosene and refilling it after.
• Removing and cleaning the burner including the glass
• Checking the cooling system and cleaning it if it is dirty
• Checking the cabinet inside and outside for signs of damage. Repair or repaint as necessary.
• Reviewing the refrigerator record sheet for any record of faults or damage.
• Submitting a record sheet to the EPI supervisor.
•
• Electric refrigerators
• Daily attention involves;
• Checking and recording inside temperature morning and evening. It must be
between +2 and +80C.
• Noting any serious voltage fluctuations. If voltage fluctuations do occur,
switch off the fridge and switch on again when it stabilizes
• Weekly attention involves;
• Checking the freezer compartment and cabinet for ice and frost formation.
Defrost if necessary [frost of more than 1cm thickness].
• Counting the vaccine stock to ensure that it agrees with the stock card
record.
• Monthly attention involves;
• Checking the cooling surfaces and brushing away any dust and dirt which
could have gathered on them.
• Checking the cabinet inside and outside for any signs of damage or rust to
the paint work. Request for or carry out repainting or repairs if necessary.
• Noting on the refrigerator record sheet any faults or damages found and the
repairs done if any.
• Submiting your completed refrigerator record sheet to your supervisor.
• Solar Refrigerator [Model B.P. Solar]
• Daily attention
• Check and record the temperature inside the refrigerator in the morning and the evening.
• Check to ensure that only the recommended number or ice packs are kept in the freezer
section.
• Ensure that air can circulate freely around the refrigerator
• Ensure that the alarm on the front of the refrigerator is in the on position.
• If the temperature is falling below or rising above the recommended range, adjust the
thermostat accordingly. If this fails call the technician immediately.
• Weekly attention involves;
• Checking the freezer compartment and cabinet for ice and frost formation. Defrost if
necessary [frost of more than 1cm thickness].
• Counting the vaccine stock to ensure that it agrees with the stock card record.
• Inspecting the solar panels from a distance. If anything has fallen on or dropped from the
panels inform the technician immediately.
•
• Monthly attention involves;
• Checking the cabinet inside and outside for any signs of damage or rust to the paint work.
• Noting on the refrigerator record sheet any faults or damages found and the repairs done if
any.
• Submit your completed refrigerator record sheet to your supervisor.
• Using the Vaccine carrier
• Vaccine carriers are used to;
• Carry small quantities of vaccines from Health centres or vaccine stores
• Carry small quantities of vaccines from Health Centres to Immunisation clinics
or outreaches.
• Carry vaccines for one day only
• Keep vaccines cold during immunisation sessions
• Keeping vaccines temporarily when defrosting the refrigerator
•
• How to pack the Vaccine carrier
• Do as follows;
• Place fully frozen ice packs neatly around the inside walls of the vaccine carrier.
• Pack vaccines and their diluents in a small black polythene bag [usually
provided by EPI] and stack them in the carrier carefully. If no polythene bag,
place a sheet of paper between TT and DPT vaccine to prevent their contact
with ice packs.
• Place a thermometer inside the vaccine carrier on top of the vaccines.
• Securing the carrier lid tightly
• Keep the vaccine carrier in good condition by
• Cleaning the inside after each use
• Leaving it open when not in use so that it can dry out.
• Inspecting inside for signs of cracks frequently. If any cracks are detected, stop using
the carrier and send it back to the DMO for replacement.
• Keeping vaccine carriers out of direct sun light. Sunlight and heat can make the
vaccine carrier to crack.
• Do not mishandle the vaccine carrier e.g. by dropping it, as this can lead to damage
like cracking
•
• Ice packs
• An ice pack is a plastic bottle filled with water, and frozen in the refrigerator.
• To prepare ice packs for use you must;
• Fill the bottle with water but leave some space to allow for freezing.
• Screw up the lid tightly to prevent water leakage [check this by turning the ice pack
upside down].
• Slide the ice pack into the freezing compartment of the refrigerator
• Close the door of the freezing compartment securely
• Close the door/lid of the refrigerator securely
• Ice packs normally take 48 hours to freeze properly with most vaccine fridges.
• NB. Always have ice packs ready for use.
•
• To keep ice packs in good condition you should;
• Ensure that they filled with water
• Handle them carefully to prevent damage
• Inspect them for signs of leakage. If there is
leakage send the leaking one back to the
DMO/County Medical Officer for replacement.
• Keep icepacks away from sunlight always as it
can cause them to crack.
•
THANK YOU
FOR LISTENING