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2.1-Expanded Programme on Immunization

The Expanded Programme on Immunization (EPI) aims to provide universal immunization coverage to prevent vaccine-preventable diseases, particularly for children and women. Established by WHO in 1974, the program has evolved to include various vaccines and aims to reduce childhood mortality rates in Pakistan. Despite challenges, EPI continues to work towards improving vaccination rates and integrating immunization with primary health care services.

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4 views

2.1-Expanded Programme on Immunization

The Expanded Programme on Immunization (EPI) aims to provide universal immunization coverage to prevent vaccine-preventable diseases, particularly for children and women. Established by WHO in 1974, the program has evolved to include various vaccines and aims to reduce childhood mortality rates in Pakistan. Despite challenges, EPI continues to work towards improving vaccination rates and integrating immunization with primary health care services.

Uploaded by

saleha
Copyright
© © All Rights Reserved
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Expanded Programme on

Immunization
Immunization

Also called vaccination or inoculation,

A method of stimulating resistance in the human body to specific diseases using


microorganisms—bacteria or viruses—that have been modified or killed.

It is a process whereby a person is made immune or resistant to an infectious


disease, typically by the administration of vaccine. Vaccine stimulates the body
defense system against the respective infectious agent or disease.
Immunization in Practice is intended for the health workers who deliver
immunization services to the children and women of the world. By observing
the procedures described in this manual they will be directly involved in efforts
aimed at:

• Ensuring vaccine quality at the point of use;

• Ensuring the safety of injections.


• Prevention of the disease is the need of the day.

• The morbidity and mortality caused by a disease and rising cost of


treating them requires us to focus more on their prevention.

• It is the effective public health intervention that had the greatest impact on
the health of public.

• Every year millions of children are saved just because of immunization.


History
• The World Health Organization (WHO) initiated the Expanded Program on
Immunization (EPI) in May 1974 with the objective to vaccinate children
throughout the world.

• Ten years later, in 1984, the WHO established a standardized vaccination


schedule for the original EPI vaccines: Bacillus Calmette Guérin (BCG),
diphtheria-tetanus-pertussis (DPT), oral polio, and measles.
• Later on new vaccines being developed and added to the EPI’s list of
recommended vaccines: these include Hepatitis B (Hep-B) and Haemophilus
influenza meningitis (Hib) conjugate vaccine in countries with high burden of
disease.

• In 1999, the Global Alliance for Vaccines and Immunization (GAVI) was
created with the sole purpose of improving child health in the poorest countries by
extending the reach of the EPI.

• In 2006, combination Tetravalent combo vaccine was introduced replacing


separate DPT and Hepatitis B vaccine which was later in 2008 switched to the
Pentavalent (DPT-Hep B-Hib) vaccine with addition of the new Hib vaccine.
• EPI Pakistan also introduced Rota virus vaccine in 2013 which prevent
diarrhea due to Rotavirus. All the new vaccines together may avert 17%
of the childhood mortality in Pakistan.

• EPI also adopted new technology to make immunization safer and more
client compliant. Since 2002, to prevent the risk of blood borne diseases,
EPI is using Auto-disable (AD) Syringes for all its immunization
injections for all clients and safety box for proper disposal of the sharp
wastes.
Vision:
A vision is a broad, aspirational statement that describes the desired future state or
outcome that an individual or organization aims to achieve.

“The Expanded Program on Immunization envisions “to achieve the universal


immunization coverage leaving no one behind to die from a vaccine preventable
disease” (mortality from vaccine preventable disease should be less than 1 % of the
total child mortality).”
Goal:
Goals are specific, measurable targets or achievements that support the realization
of the vision. They are more concrete and focused than visions
“The goal of the EPI is to reduce the infant and childhood mortality and morbidity
linked with vaccine preventable diseases, as per EPI’s schedule, and to limit other
infectious diseases (epidemics and pandemics) through emergency vaccination
drives.”
Programme objectives:

“Objectives are precise, actionable steps or strategies designed to accomplish specific goals.
They are even more specific and detailed than goals.”

The objectives of the EPI are to:

• affirm the commitment of the Government of Pakistan to provide safe, effective and cost-
effective vaccination against vaccine preventable diseases;

• set national standards and guidelines for immunization aligned with the global goals and
evidence base, and encourage the generation of local evidence for vaccination against
vaccine preventable diseases.
• The Pakistan EPI programme has adopted its goals and strategies in accordance
with priorities set at the global and regional level. The National Immunization
Technical Advisory Group (NITAG), was established in 2008, by the Ministry of
Health in accordance with WHO guidelines. A programme policy/guideline
document was developed in 2015 with the support of partners. The document lays
out policy direction and guidelines for involvement of lady health workers in
immunization service delivery, and in the area of the private sector’s role in
immunization.
• The new immunization policy envisages Pakistan’s Vision 2025 by
addressing its key goal - to reduce infant mortality rate from 74 to less
than 40 (per 1000 births) and reduce maternal mortality rate from 276 to
less than 140 (per 1000 births) and continue reducing the infant mortality
rate through immunization targets and activities in order to achieve SDG 3
for the country.
• Achieving routine coverage of Penta 3 more than 98% at provincial and at least 90%
in all districts.

• Interrupting indigenous circulation of measles virus by 2024.

• Interrupting polio circulation by 2023.

• Decreasing deaths caused by tetanus from 0.03 to 0.01 per 10,000 newborn by 2024.

• To introduce the new available vaccines based on evidence and epidemiological data
complying to vaccine regulatory system of the country.

• To strengthen the VPDs surveillance in order to provide complete and timely


information backed with strong monitoring system for continuous improvement
• To integrate EPI with Primary Health Care within a more comprehensive service
delivery program (e) To institute robust vaccine supply chain system ensuring
availability of potent vaccines

• To enable the communities in enhancing their understanding and ownership of the


value of vaccination, and demand vaccination as their right and responsibility.

• To enhance facility-based vaccination with timely and effective AEFI


management and improve immunization waste management system.

• To achieve sustainability in financing and resource mobilization for various


immunization interventions in a timely and efficient manner.
Current situation:

Despite significant efforts by the Government and its partners, Pakistan’s


immunization indicators have yet to reach the expected benchmarks. The key goals
of polio eradication, and measles, have not been achieved. However Punjab is the
first province to achieve elimination of maternal and neonatal tetanus in 2016.The
current EPI coverage for fully immunized based on PDHS (2012–2013) and PSLM
(2014–2015) surveys is 65% and 88%, respectively.
There are now 13 vaccines (antigens) recommended by WHO for the EPI
programme. They are:

Bacillus Calmette Guérin (BCG), diphtheria, pertussis, tetanus, Haemophilus


influenzae type B (Hib), Hepatitis B (HepB), polio, measles, rubella,
pneumococcal disease (PNC), rotavirus (Rota), human papillomavirus (HPV), and
COVID-19 (for adults).

Committed to its goal of universal access to all relevant vaccines for all at risk, EPI
continues to work in synergy with other public health programmes to control
infectious diseases and achieve better health for all populations everywhere.

In 2024, it will be 50 years since the Expanded Programme on Immunization (EPI)


was initiated.
Working Mechanism:

• The Program adopted fixed site and outreach vaccination strategies for routine
EPI service delivery to reach all targeted children and women.

• Implement supplementary immunization campaigns as per need and priority

• EPI fixed sites are located in all public sector health facilities and few private
hospitals in Punjab. A field force of around 4000 vaccinators working as outreach
worker at UC level work as per their micro plan through out-reach kit stations in
catchment population.
• Services:
Program aims to immunize 3.39 million targeted children annually against vaccine
preventable diseases. Currently, it includes vaccination against 12 fatal
Childhood diseases like Tuberculosis, Poliomyelitis, Diphtheria, Pertussis,
Hepatitis-B, Meningitis, Pneumonia, Tetanus, Measles, Rubbela, Diarrhea, and
Typhoid. Approximately the same number of pregnant women are vaccinated
against Tetanus (TT)

• VPD Surveillance & Response System:

4275 VPD surveillance sites in Punjab


Programme responsibilities at Federal Level:

National Programme manager in assistance is responsible for all supportive actions


of the cell i.e. storage, monitoring, administration, finance & health education.

While WHO technical staff which is also playing an imp role at federal level is
responsible for overall planning, policy making, strategies, purchasing & training.
Programme responsibilities at Provincial Level

• Provincial level officers are responsible for planning, finance, implementation &
administration at district level. Collection of stock i.e. syringes, vaccines &
needles from the FEDRAL EPI CELL for further distribution to the districts.
Repair & Maintenance, supervision, monitoring, evaluation, and reporting of cold
chain is also under provincial level. For the training of vaccinators small training
setup is held up by the EPI Director or DG Health Officer.
Storage of the vaccine

• Store at 2° to 8°C
• Shake vial vigorously before withdrawal and use.
• Do not use if re-suspension does not occur with vigorous shaking.
• The vaccine should be administered shortly after withdrawal from the
vial.
• What is EPI? Discuss vaccines used under EPI schedule.

• https://www.who.int/teams/immunization-vaccines-and-biologicals/e
ssential-programme-on-immunization
• https://pshealthpunjab.gov.pk/Home/VerticalProgramImmunization#:
~:text=The%20Expanded%20Programme%20on%20Immunization,%2
C%20pertussis%2C%20tetanus%20and%20measles
.
• https://www.emro.who.int/pak/programmes/expanded-programme-
on-immunization.html

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