1. E.P.I

2. 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

3. 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

4. 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).

5. 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

6. 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

7. 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

8. EPI-Pak targets
5.8 Million children
5.9 Million pregnant women

9. 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, months;   TT
Tetanus toxoid
1st contact pregnancy; +1, +6 months; +1, +1 year;  

11. Disease Causative agent MOT Vaccine DOSE Route BCG 0.05ml I/D DPTTB
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

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

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

15. Fully immunized children coverage

16. Problems in achieving EPI targets in Pakistan

17. 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

18. 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

19. Cold chain

20. 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.

21. Cold Chain

22. 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:

23. Technical features that impact on vaccine storage and temperature monitoring

24. Vaccine carriers

26. 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

27. 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)

29. Dosage

30. Quiz: Immunization

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

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

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

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

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

36. Thank You