Aim & Objectives of Expanded Program on Immunization.

Dr. Owais Raza

Expanded Program on Immunization
‡ 1974, WHO launched EPI against six diseases
± Diphtheria ± Pertussis ± Polio ± Measles ± Tuberculosis ± Tetanus

‡ Other vaccines were added then

Expanded Program on Immunization
Expanded means«

³«

adding more disease controlling

antigens of vaccination schedules, extending to all corners of a country and spreading services to reach the less privileged sector of the country.

´

Aim
« is to make immunisation complementary to other Primary Health Care (PHC) services in order to reduce morbidity, mortality and disability from the vaccine preventable diseases of childhood.

Objectives
‡ Provide immunisation against the EPI targeted diseases and Tetanus toxoid for pregnant women or women of child ± bearing age. ‡ Promote immunisation programmes, including vaccine production and quality control. ‡ Intensify implementation of the immunization activities and sustainability within the framework of the maternal and child health services.

Target (WHO - 1974)

To immunize 80% of the world¶s children with 6 vaccines by 1990.

Strategy
‡ EPI should function through the integrated health service system. ‡ Immunization is a continuous program, that should continue indefinitely once started. ‡ Program should be economically possible, socially acceptable, operationally feasible and professionally rewarding. ‡ Program should have legislation. However, persuasion and education should be the first choice. ‡ Surveillance, recording and reporting system should be an integral part of the program

Strategy
‡ Internal support will be processed and channeled through National Coordinator of the program and the Federal Ministry of Health. ‡ Efficient management and supervision in the activities. ‡ Provisional authorities may develop: ± Stationary Health Units ± Outreach Stations ± Mobile Services ‡ There should be community participation.

EPI in Pakistan
‡ EPI was launched in Pakistan in 1978 with support from WHO and UNICEF. ‡ Program currently targets 8 vaccines preventable disease that is
± Polio ± Diphtheria ± Tetanus ± Pertussis ± Measles ± Tuberculosis ± Hepatitis B (2003) ± H. Influenza. (2008)

Objectives (2008)
‡ Reduction of mortality & morbidity in age 0 ± 11 months and women of child ± bearing age. ‡ 90% routine immunization coverage of all EPI antigens with at least 80% coverage in every district by 2012. ‡ Interruption of polio virus transmission by 2010. ‡ Elimination of Neonatal Tetanus by 2015. ‡ Reduction of measles mortality by 90% by 2010. ‡ Reduction of diphtheria, pertussis and childhood tuberculosis. ‡ Control of other diseases by introducing new vaccines (e.g. HepB, Hib)

EPI Strategies
‡ Developed in 1994«
± Eradication of poliomyelitis by the end of 2005
‡ ‡ ‡ ‡ NIDs Enhanced surveillance of AFP House ± to ± house immunization Cross border immunization

± Elimination of neonatal tetanus
‡ Campaign to immunize all women of child bearing age

± Supplementary dose of Vit. A (Immunization Plus)
‡ 6 ± 59 months ‡ NIDs & SNIDs with OPV

EPI service delivery
‡ ‡ ‡ ‡ Fixed centers Outreach clinics Mobiles teams NGOs / private practioners

Vertical program Vs. Horizontal program

EPI-Partners
‡ International
± ± ± ± ± ± ± ± ± WHO UNICEF Rotary International DFID (Department for International Development) JICA (Japanese International Cooperation Agency) CDC Atlanta USAID (United States Agency for International Development) UNHCR Global Alliance for Vaccines and Immunization (GAVI)

‡ National
± Government of Pakistan
‡ Provisional government ‡ District government

± NGOs

Years BCG 1996 78

% children fully Immunized DPT 66 POLIO 66 MEASLES 65

% Pregnant women immunized for tetanus 30 % Pregnant women immunized for tetanus 81

BCG DPT1 DPT3 POLIO3 MEASLES HepB3 2009 89 90 83 83 80 80

³Vaccine ± preventable disease rates in the United States are at very low levels. In 2007, only 43 cases of measles, 12 cases of rubella, no cases of diphtheria, 28 cases of tetanus, and no wild-type polio were reported to CDC.´

« then why continue?
³Given these immunization successes, one might question the continued interest in strategies to increase immunization levels.´

³«although levels of vaccine-preventable diseases are low, this should not breed complacency regarding vaccination. For several reasons ² including possible resurgence of disease, introduction of new vaccines, suboptimal immunization levels, cost-effectiveness, and gaps in sustainable immunization efforts ² the need to focus on immunization rates remains crucial.´

No child should be denied immunisation without serious thought as to the consequences, both for the individual child and for the community

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