EPI Add- on Lecture notes

Giving BCG Vaccine:

1. Clean the injection site with alcohol sponge and let skin dry.
2. Secure the child’s arm with your left hand so that your hand is under and your thumb and finger come
around the arm and stretch the skin.
3. Hold the syringe in your right hand with the bevel and the scale pointing up towards you.
4. Lay the syringe and needle almost flat along the child’s arm.
5. Insert the tip of the needle into skin – just the bevel.
6. Keep the needle flat along the skin and the bevel facing upwards, so the vaccine only goes into the upper
layers of the skin.
7. Put your left thumb over the needle end to hold it in position.
8. Hold the plunger between the index and middle fingers of the right hand and slightly push the plunger in
with your right thumb.
9. If the vaccine is injected correctly into the skin, a flat wheal with the surface pitted like an orange peel
will appear at the injection site.
10. Withdraw needle gently.

Reminders:
 Note: Any remaining reconstituted vaccine must be discarded after 6 hours or at the end of the
immunization sessions, whichever comes first.
 The small raised lump appears at the injection site, usually disappears within 30 minutes. After 2 weeks,
a red sore forms that is about the size of the end of an unsharpened pencil.
 The sore remains for another two weeks and then heals, a small scar, about 5mm across remains.
 This is a sign that the child has been effectively immunized.
 Repeat BCG vaccination if the child does not develop a scar after the 1st injection, BCG vaccine is
moderately effective.
 It has a protective efficacy of: 50 % against any TB disease 64 % against TB meningitis 74 % against death
from TB

Giving DPT Vaccine

1. Instruct mother to hold the child across her knees so that her thigh is facing upwards.
2. Ask her to hold child’s leg.
3. Clean the skin with alcohol sponge and let skin dry.
4. Grasp the injection site with your thumb and index finger.
5. Quickly push the needle, going deep in to the muscle.
6. Slightly pull the needle back to be sure it is not into a vein.
7. Inject the vaccine, withdraw the needle and press the injection spot quickly with a piece of
cotton.

Giving Oral Polio Vaccine

1. Read the manufacturer’s instructions to determine number of drops to be given.
2. Use the dropper provided for.
Two types of OPV containers:
a. small plastic dropper bottles
b. glass vials with dropper in a separate plastic bag
3. Let the mother hold the child lying firmly on his back.
4. Open the child’s mouth by squeezing the cheeks gently between your fingers to make his lips
point upwards.
5. Put drops of vaccine straight from the dropper into the child’s tongue
 Do not let the dropper touch the child’s tongue.
6. Make sure that the child swallows the vaccine.
 If he spits it out, give another dose.
 If a child has diarrhea when you give OPV, administer an extra dose.
 A fourth dose at least four weeks after he or she has received the last dose in the
schedule.

Giving Hepatitis B Vaccine

1. Instruct mother to hold the child across her knees so that her thigh is facing upwards.
2. Ask her to hold child’s leg.
3. Clean the skin with alcohol sponge and let skin dry.
4. Grasp the injection site with your thumb and index finger.
 5. Quickly push the needle, going deep in to the muscle.
6. Slightly pull the needle back to be sure it is not into a vein.
7. Inject the vaccine, withdraw the needle and press the injection spot quickly
with a piece of cotton.

Reconstituting the Freeze Dried Measles Vaccine

Using a 10 ml. syringe fitted with a long needle, aspirate 5 ml of special diluent, from the
ampule.
Empty the diluent from the syringe into the vial with the vaccine.
Thoroughly mix the diluent and vaccine by drawing the mixture back into the syringe and
expelling it slowly into the vial several times.
Do not shake the vial.
Protect reconstituted measles vaccine from sunlight.
Wrap vial in foil.
Place the reconstituted vaccine in the slit of the foam provided in the vaccine carrier.

Giving Measles Vaccine

1. Instruct the mother to hold the child firmly.

2. Clean the skin with alcohol sponge and let the skin dry.
3. With the finger of one hand, pinch up the skin on the outer side of the upper arm.
4. Without touching the needle, push the needle into the pinched-up skin so that it is not pointing.
5. Slightly pull the plunger back to make sure that the vaccine is not injected into a vein.
6. Press the plunger gently and inject.
7. Withdraw the needle and press the injection spot quickly with a piece of cotton.