E.P.I

History May 1974 EPI-Pak, 1976 Establishment of vaccination schedule -1984 GAVI-Global Alliance for Vaccine & Immunization is a public-private global health partnership committed to saving children’s lives and protecting people’s health by increasing access to immunization in poor countries. launched in 2000

Programme responsibilities at provincial level Since health is a provincial subject, the DG, Health Services and EDOs Health are ultimately responsible for programme implementation and administration. The main provincial responsibilities are: Planning, finance, implementation and administration at provincial level Collection of vaccines/syringes/needles from the Federal EPI Cell for further distribution to the districts Repair and maintenance of cold chain equipment Monitoring, evaluation and reporting Supervision at all EPI service delivery level Training of all EPI workers except Mid-level Managers Repair and maintenance of vehicles

Supervisory Management The Programme is being supervised by the National, Provincial and district staff at every level in the country. The focal point for the EPI is the District Officer Health Preventative (DOH) or district EPI Coordinator (DEC).

EPI Goals Full immunization of children under one year of age in every district Global eradication of poliomyelitis Reduction in maternal and neonatal tetanus Cut half number of measles-related deaths

Objective 80% coverage in every district by 2012. Interruption of polio virus transmission by 2010. Elimination of Neo-natal tetanus by 2015. Reduction of measles mortality by 90% by 2010 as compared to 2000 level. Reduction of diphtheria, pertussis and childhood tuberculosis to a minimum level. Control of other diseases by introducing new vaccines in EPI

EPI Programme Exclusive Immunization provider Private sector- 3% 6000 fixed centres > million outreach and mobile vaccination sessions/year > 10 000 vaccinators 6000 LHV’s 100,000 LHWs

EPI-Pak targets 5.8 Million children 5.9 Million pregnant women

EPI Schedule OPV Oral Polio Vaccine Birth, 6, 10, 14 weeks Source: WHO Bacille Calmette-Guérin vaccine birth;   DPT HibHep (Pentavalent 2009) Diphtheria and tetanus toxoid with whole cell pertussis, Hib and HepB vaccine 6, 10, 14 weeks;   OPV Oral Polio Vaccine Birth, 6, 10, 14 weeks Measles Measles vaccine 9, 12-23 months;   TT Tetanus toxoid 1st contact pregnancy; +1, +6 months; +1, +1 year;  

Disease Causative agent MOT Vaccine DOSE Route BCG 0.05ml I/D DPT TB M.Tuberculosis Droplet infection and droplet nuclei BCG 0.05ml I/D Diphtheria Corynebacterium diphtheriae Droplet infection & droplet nuclei DPT 0.5ml I/M Pertussis Bordetella pertussis Polio Poliovirus Fecal-oral route/ water borne OPV 2 drops Oral Measles Paramyxo Virus Direct contact Resp droplet Subcutaneous Hep B Hepatitis B virus Blood or body fluids 10mcg meningitis Haemophilus influenzae type B (HiB) Resp. route Pentavalent

Number of reported cases Diphtheria. 34 Measles. 863 Pertussis Number of reported cases Diphtheria 34 Measles 863 Pertussis 164 Polio   89 Tetanus (neonatal) 781 Tetanus (total) 816 Source: WHO 2009

Population data (in thousands) Total population. 180'808 Live births Population data (in thousands)   Total population 180'808 Live births 5'403 Pop. < 5 years 24'121 Pop. < 15 years 66'781 Female 15-49 years 44'582 Source: WHO 2009

Fully immunized children coverage

Problems in achieving EPI targets in Pakistan

Problems in achieving EPI targets Inadequate service delivery long distance to EPI centres Lack of awareness of immunization benefits unaffordable cost to reach the centres unavailability of vaccinators EPI centre- 1 in 10 UC in Punjab and 2 vaccinator in, in each UC Political commitment

International Collaboration Canadian International development Agency (CIDA) Department for International Development [DFID] GAVI Japan International Cooperation Agency (JICA) Rotary International UNICEF United States Agency for International Development (USAID) WHO World Bank

Cold chain

What is cold chain? The term cold chain is the name given to the system of transporting and storing vaccines within the safe temperature range of 2ºC - 8ºC. The cold chain involves all the people, equipment and procedures which ensure that an effective vaccine reaches the people who need it - usually children.

Cold Chain

Cold chain system The cold chain system comprises three major elements: · Personnel, who use and maintain the equipment and provide the health service; · Equipment for safe storage and transportation of vaccines; and · Procedures to manage the Programme and control distribution and use of the vaccines. Competent personnel and efficient procedures are a vitally important part of the cold chain system:

Technical features that impact on vaccine storage and temperature monitoring

Vaccine carriers

REMEMBER - All vaccines can be safely kept in the temperature range 2ºC - 8ºC. Vaccines can become less effective or even lose their effectiveness altogether if they: Get too hot Freeze exposed to light

DO NOT FREEZE THESE VACCINES DTP (Diphtheria-tetanus- pertussis vaccine "Triple antigen") CDT (Combined diphtheria-tetanus vaccine) ADT (Adult diphtheria-tetanus vaccine) TT (Tetanus toxoid) · Hib vaccines Hepatitis B Vaccine · Hepatitis A Vaccine Monovalent pertussis vaccine Influenza vaccine DO NOT EXPOSE THESE VACCINES TO LIGHT: BCG Vaccine MMR (measles/mumps/rubella) vaccine Oral poliomyelitis vaccine (OPV)

Dosage

Quiz: Immunization

1.  A child's temperature should be checked routinely before vaccinations are administered?

2. What if the patient comes late for measles vaccine?

3. Can BCG vaccine be given any time during infancy if missed at birth?

4. How many doses of OPV are recommended for children <5years of age?

What about if a 3 year old child came with no vaccination at all?

Thank You