Name: Kainaat Khan Date: 17-01-2021

Roll No: 145

Community Medicine Assignment

Q1. A. Describe EPI program of Pakistan?
EPI which stands for Expanded Program of Immunization was introduced by WHO in 1974.
After initial surveying in 1978 the program was rolled out in Pakistan in 1979 with the help
of UNICEF and WHO to cover six communicable diseases. It was initially an independent
vertical project, however, in 1982 when target coverage of 50% was not reached the
Government stepped in and accelerated the program. It is a continuous program with
community support, regular system management, implementation, training, reporting and
evaluation.
The immunization coverage of children in approximately 80% while that of Tetanus Toxoid
coverage of Women in approximately 42%.
EPI is now known as Universal Child Immunization, it covers:
● TB
● Polio
● Measles
● Diphtheria
● Pertussis
● Tetanus
● Hepatitis B
● Pneumococcal Meningitis
● Influenza

WHEN AGE VACCINES

At birth At birth BCG, OPV-0, Hep B
2nd Visit 6 weeks OPV-I, Pentavalent-I,
Pneumococcal-I, Rota
virus- I
3rd Visit 10 weeks OPV-II, Pentavalent-II,
Pneumococcal-II, Rota
virus II
4th Visit 14 weeks OPV-III, Pentavalent-III,
Pneumococcal-III, IPV
5th Visit 9 Months Measles-I
6th Visit 15 Months Measles-II
 Tetanus Toxoid for Women of Childbearing Age
TT1 As early as possible
TT2 One Month after TT1
TT3 6 Months after TT2
TT4 One year after TT3
TT5 One Year after TT4

Q1.B. Do you think COVID Vaccine can be incorporated in this EPI program? Explain
your answer with detailed justification?
The addition of the Covid Vaccine to the EPI program at the moment seems improbable and
impractical. Currently there are 2 available manufacturers of the vaccine Pfizer and Moderna,
the Pfizer vaccine requires refrigeration at temperatures far below that of most vaccine and
would therefore require special equipment, and while the Moderna vaccine does not require
the same temperature maintenance, it is yet to be commercially available. The current
economic constraints of the country should also be taken into consideration, the addition of
the Covid Vaccine to the EPI program would put immense strain on an already struggling
economy.
The vaccine while required at this very moment shows no indication to be added to the EPI
Program or to be administered on a yearly basis to the Populus as a whole. There is also
indication that the vaccine could be mutating and that it could very well circumvent the
current vaccine making it obsolete.
Taking these points into consideration the vaccine should not be added to the EPI program, at
least not until further research and indications prove otherwise.
Q.2 Write down the control measures for Malaria & Dengue fever for city Karachi.
Control Measures for Malaria:
Measures applied by individuals: Using repellents, Protective Clothing, Screening of houses,
Domestic sanitation, intermittent drying of water containers, spraying of domestic spaces,
drainage of standing water.
Measures applied by the community: Building of homes in sanitary areas, spraying the area,
environmental sanitation, proper sewerage systems and drainage of standing water, water
management.
Control Measures for Dengue:
Measures applied by individuals: Usage of mosquito nets and mosquito repellents, proper
covering of the body (especially arms and legs), keep water containers covered and sanitize
regularly.
Measures applied by the community: Spraying of areas, water sanitation and management,
adequate sewerage and drainage systems.
Q.3 Describe the prevention & control for the following diseases:
Tetanus: Prevention: Tetanus vaccine (provided via EPI program)
Control:
● Thoroughly clean the wound after injury,
● adrenaline and a steroid in case of anaphylactic reaction,
● 0.05ml ATS S/C as a test dose
● No reaction (half hour observation) give 1500 IU ATS, S/C
● In case of reaction, give TIG, I/M
● In case of tetanus spasm give muscle relaxant
● General Patient Care (bed rest, avoidance of stimulus, patent airways, adequate fluid
and caloric plan, good nursing care)
POLIO: Prevention: The best method of prevention is immunization all infants by 6
months.
Control: The best method of control is Herd Immunity to reduce transmissibility to
susceptible individuals who can’t be vaccinated.
Chicken Pox: Prevention: Immunoglobulins- Varicella Zoster Immunoglobulin 1.25-
5ml I/M given within 72 hours of exposure.
Vaccine- live attenuated, proven effective.
Control:
● Tetracycline to prevent secondary infection.
● Notification of Health Authority
● Isolation from school after eruption appears for 1 week.
● Avoid contact with susceptible individuals.
● 21 days of observation of those who came in contact with the child.
Measles: Prevention: Live vaccine (offered in EPI program)
Control:
● Notification of Health Authority
● Isolation for 1 week after rash first appears and 14 days isolation from school and
susceptible individuals.
● Through cleaning and fumigation of room
● Immunization of contacts within 2 days of exposure
● Investigations of contacts under 3 years of age
● Investigations of source of infection
Mumps: Prevention: Vaccination (provided in EPI program)
Control: Herd Immunity that occurs via vaccination of children according to the EPI
program.