Introduction

Expanded Programme on Immunization (EPI) Pakistan provides vaccination against e

ight diseases to children through Routine Immunization (RI) and Supplemental Imm
unization Activities (SIAs) against polio, measles and Tetanus. The target group
s are children upto 1 year age for routine immunization, 5 years age for polio e
radication, 9 month to 13 years age for measles elimination and child bearing ag
e women for Tetanus.
The goal of the programme is to support provinces and districts to provide high
quality immunization services that will prevent mortality, morbidity and disabil
ity due to Vaccine Preventable Diseases (VPDs) and contribute to the strengtheni
ng of national health systems and the attainment of health Millennium Developmen
t Goals (MDGs). Priority interventions include expanding the implementation of t
he “Reaching Every Union Council” approach, capacity building, enhancing community p
articipation, effective vaccine and logistics management, case-based surveillanc
e, ensuring sufficient and sustainable funding, and strengthening partnerships f
or immunization.
The programme has taken several steps and major public health problems of the co
untry are being undertaken to improve health outcomes including introduction of
pentavalent vaccine combination of 5 antigens against Diphtheria, pertussis, tet
anus, Hepatitis B and haemophilius influenza type b and 2nd dose opportunity of
measles in the country in 2009.
Reported routine vaccination coverage in 2008 was BCG 92%, Polio 75%, Combinatio
n of DPT& HepB 68%, measles 79% and TT 50% whereas the coverage in 2009 was BCG
93%, Polio 86%, Pentavalent 86%, Measles 85% and TT 55%. The programme brought n
ew innovations to cover missed children and women in 2009 and held immunization
month in October and gave all vaccinations during campaign against Tetanus in 6
districts of Punjab and in mother & child health week.
EPI Pakistan held 6 Nation-wide campaigns, 5 sub nationwide campaigns against po
lio in 2009. In addition, rapid case response vaccination activities were also h
eld in a drive to eradicate polio. Overall campaigns coverage in every round was
above 90% in the country but coverage variation in districts. In last nationwid
e campaign in 2008, 56% districts achieved 90% coverage which was gradually incr
eased and 82% districts gave >90% coverage as per finger marking evaluation. In
addition, three rounds of TT vaccination to child bearing age women against teta
nus held in 6 districts of southern Punjab in 2009 and coverage of each round wa
s above 90%.
Vaccine-preventable diseases (VPDs) account for a high burden of childhood morbi
dity and mortality in the country. All AFP surveillance indicators were met whic
h were thoroughly reviewed on weekly basis only 89 polio cases were detected in
2009 mostly from security risk areas including 20 polio cases from Swat and 15 c
ases from Bajour. Measles case based surveillance was also launched in 2009 and
detected measles cases mostly from Karachi and some districts of Balochistan.
At present, interruption of polio transmission, elimination of measles and neona
tal tetanus are the main priorities for EPI Pakistan. Availability of adequate r
esources and efficient management for proper utilization of the resources are th
e key challenges for EPI Pakistan to achieve its goal. With Government commitmen
t and ownership and adequate support from EPI partners, Pakistan can achieve the
EPI targets set at the regional and global level in the interest of the childre
n of Pakistan.
Objective
1. Protecting all eligible children against: Childhood Tuberculosis, Poliom
yelitis, Diphtheria, Pertussis, Tetanus, Hepatitis B. Haemophilus Influenza Type
b and Measles.
2. Protecting all pregnant ladies with Tetanus Toxoid and their neonates ag
ainst neo-natal tetanus.
3. Disease eradication, elimination, reduction and control plans developed
and approved for implementation
4. Protecting children less than 5 years against complications and mortalit
y of diarrhea through proper case management and other potential preventive inte
rventions.
5. Protecting susceptible children against complications of measles through
administering additional dose of vaccine during Supplemental Immunization Activ
ities (SIAs).
6. Protecting all Women of Child bearing Age in the High Risk and Intermedi
ate Risk Areas with Tetanus Toxoid against maternal and neo-natal tetanus (MNT).
7. Protecting children (06m-5y) months against complication of vitamin A de
ficiency through administering of Vitamin-A capsules.
Targets
The basic target of the program is the reduction of morbidity and mortality resu
lting from the eight EPI target diseases by immunization of children of less tha
n one year of age and pregnant women. The specific targets are in line with the
emerging global priorities:
1. 90% routine immunization coverage of all EPI antigens with at least 80%
coverage in every district by 2010 and the coverage will be sustained for reachi
ng MDG 4 and 5 by 2015.
2. Indigenous wild Polio virus transmission interrupted by 2011 and same st
rategy will continue till certification i.e. 2014
3. 90% reduction in measles morbidity and mortality compared to the 2000 le
vel to reach elimination status by 2010 and will maintain the status till 2015.
4. Elimination of Neonatal Tetanus by 2012 and maintain the elimination sta
tus till 2015.
5. Inclusion of Pneumococcal (PCV10) vaccine by 2011 and Rotavirus vaccine
by 2013 in routine childhood immunization schedule.
6. Appropriate sharps waste management in every district by 2012.
7. Establishing Integrated Vaccine Preventable Disease (VPD) surveillance s
ystem including measles case-based surveillance system by 2010 and will continue
.
8. Attainment of WHO-UNICEF effective vaccine management certificate for Fe
deral EPI store by 2010 and for provincial stores by 2012.

Expanded Program on Immunization

From Wikipedia, the free encyclopedia
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The Expanded Program on Immunization is a World Health Organization program with
the goal to make vaccines available to all children throughout the world.
Contents
[hide]
• 1 History
• 2 Implementation
• 3 Evaluation
• 4 Results
• 5 References
• 6 External links
[edit] History
The World Health Organization (WHO) initiated the Expanded Program on Immunizati
on (EPI) in May 1974 with the objective to vaccinate children throughout the wor
ld. Ten years later, in 1984, the WHO established a standardized vaccination sch
edule for the original EPI vaccines: Bacillus Calmette-Guérin (BCG), diphtheria-te
tanus-pertussis (DPT), oral polio, and measles. Increased knowledge of the immun
ologic factors of disease led to new vaccines being developed and added to the E
PI’s list of recommended vaccines: Hepatitis B (HepB), yellow fever in countries e
ndemic for the disease, and Haemophilus influenzae meningitis (Hib) conjugate va
ccine in countries with high burden of disease.[1]
In 1999, the Global Alliance for Vaccines and Immunization (GAVI) was created wi
th the sole purpose of improving child health in the poorest countries by extend
ing the reach of the EPI. The GAVI brought together a grand coalition, including
the UN agencies and institutions (WHO, UNICEF, the World Bank), public health i
nstitutes, donor and implementing countries, the Bill and Melinda Gates Foundati
on and The Rockefeller Foundation, the vaccine industry, non-governmental organi
zations (NGOs) and many more. The creation of the GAVI has helped to renew inter
est and maintain the importance of immunizations in battling the world’s large bur
den of infectious diseases.[2]
The current goals of the EPI are: to ensure full immunization of children under
one year of age in every district, to globally eradicate poliomyelitis, to reduc
e maternal and neonatal tetanus to an incidence rate of less than one case per 1
,000 births by 2005, to cut in half the number of measles-related deaths that oc
curred in 1999, and to extend all new vaccine and preventive health intervention
s to children in all districts in the world.
In addition, the GAVI has set up specific milestones to achieve the EPI goals: t
hat by 2010 all countries have routine immunization coverage of 90% of their chi
ld population, that HepB be introduced in 80% of all countries by 2007 and that
50% of the poorest countries have Hib vaccine by 2005.[3]
[edit] Implementation
In each of the United Nations’ member states, the individual national governments
create and implement their own policies for vaccination programs following the g
uidelines set by the EPI. Setting up an immunization program is multifaceted and
contains many complex components including a reliable cold chain system, transp
ort for the delivery of the vaccines, maintenance of vaccine stocks, training an
d monitoring of health workers, outreach educational programs to inform the publ
ic, and a means of documenting and recording which child receives which vaccines
.
Each distinct region has slightly varying ways of setting up and implementing th
eir own immunization programs based on their existing level of health infrastruc
ture. Some areas will have fixed sites for vaccination: healthcare facilities su
ch as hospitals or health posts that include vaccination along with many other h
ealth care activities. But in areas where the number of structured health facili
ties is small, mobile vaccination teams consisting of staff members from a healt
h facility can deliver vaccines straight to individual towns and villages. These
‘outreach’ services are often scheduled throughout the year. However, in especially
under-developed countries where proper communication and infrastructure is abse
nt, cancellation of the planned immunization visits leads to deterioration of th
e program. A better strategy in such countries is the ‘pulse immunization’ technique
, where ‘pulses’ of vaccines are given to children in annual vaccination campaigns.[
1][3]
Additional strategies are needed if the area of the immunization program consist
s of poor urban communities because such areas tend to have low uptake of vaccin
ation programs. Door-to-door canvassing, also referred to as channeling, is used
to increase uptake in such hard to reach groups. Finally, periodic national lev
el mass vaccination campaigns are being increasingly included in the immunizatio
n programs.[3]
[edit] Evaluation
In each country, immunization programs are monitored using two different methods
: an administrative method and through community-based surveys. The administrati
ve method involves using immunization data from public, private, and NGO clinics
. Thus the accuracy of the administrative method is limited by the availability
and accuracy of reports from these facilities. This method is easily performed i
n areas where the government services deliver the immunizations directly or wher
e the government supplies the vaccines to the clinics. In countries without the
infrastructure to do this, community based surveys are used to estimate immuniza
tion coverage.[3]
Community-based surveys are applied using a modified cluster sampling survey met
hod developed by the World Health Organization. Vaccine coverage is evaluated us
ing a two-stage sampling approach in which 30 clusters and seven children within
each cluster are selected. Health care workers with no or limited background in
statistics and sampling are able to carry out data collection with minimal trai
ning.[3][4] Such a survey implementation provides a way to get information from
areas where there is no reliable data source. It is also used to validate report
ed vaccine coverage (for example, from administrative reports) and is expected t
o estimate vaccine coverage within 10 percent.[3]
Surveys or questionnaires, though frequently considered inaccurate due to self-r
eporting, can provide more detailed information than administrative reports alon
e. If home based records are available, not only can vaccination status be deter
mined but also dates of vaccination can be reviewed to determine if vaccinations
were given at an ideal age and in appropriate intervals. Missed immunizations c
an be identified and further qualified. Importantly, other systems of vaccine de
livery besides clinics used for administrative evaluation can be identified and
included in analysis.[3]
[edit] Results
Prior to the initiation of the EPI, child vaccination coverage for tuberculosis,
diphtheria, pertussis, tetanus, polio and measles was estimated to be fewer tha
n 5 percent. Now, not only has coverage increased to 79 percent,[5] but it has a
lso been expanded to include other vaccinations such as for hepatitis B, Haemoph
ilus influenza B, rubella, tetanus and yellow fever. The impact of increased vac
cination is clear from the decreasing incidence of many diseases. For example, m
easles deaths decreased by 60% worldwide between 1999 and 2005, and polio, altho
ugh missed the goal of eradication by 2005, has decreased significantly as there
were less than 2000 cases in 2006