KEPI VACCINES.

OYUGI RAWLINGS OCHIENG

H31/34796/2013
SIMWA MORRIS ADAMS
H31/35740/2013
Objectives
• Type of antigen
• Formulation
• Storage condition (to be covered under cold chain)
• Dose of antigen
• When given
• Route of administration
• Efficacy
• Side effects
• Contraindications
• National coverage
• Missed opportunities in immunization
• National immunization days (NIDs)
Introduction
• KEPI stands for Kenya Expanded Immunization Programme. It was
adopted in 1980 by the Ministry of Health (MOH) with the aim of
immunizing , free of charge all Kenyan children 0-5yrs(Revised in
1985 to focus on children 0-11 months) and all pregnant women.
• It was to reduce morbidity, mortality and disability from the 6
common childhood diseases- tuberculosis, polio, diphtheria,
whooping cough, tetanus, and measles.
• The programme was to be offered in governmental and non
governmental health facilities and the mode of approach was to be
motivation rather than coercion.
Ministry of Health National policy Guidelines on Immunization 2013
Cont…
• In 1977, World Health Assembly(WHA) set the year 1990 as
the target date for Universal Child Immunization(UCI)
aiming to immunize all the children in the world against the
six childhood diseases.
• The Government of Kenya is a signatory to the Alma Ata
World Health Assembly declaration in 1978 that formed the
basis for the launching of Expanded Programmes on
Immunization in many parts of the world.
Ministry of Health National policy Guidelines on Immunization 2013
Definition
• Vaccination: The process of administering a vaccine or manipulation
of the immune system to induce protective immunity.
• Antigen: Substance usually a protein that is capable of eliciting an
immune response. The antigens that cause disease are called
pathogens.
• Immunogenicity: The inherent ability of an antigen to induce an
immune response.
• Antibody: A protein produced by plasma cells in response to an
antigen.
Immunization Manual for Medical and Nursing Students
Bacillus Calmette–Guérin (BCG) vaccine
• Type of antigen: live attenuated vaccine developed from Mycobacterium Bovis.
• Formulation: Multidose freeze dried and liquid formulation vaccine
• Dose: 0.05ml for infants less than 1year and 0.1ml for infants greater than 1yr
• When Given: At Birth /first point of contact with the health facility before 59 months
• Route of administration :Intradermal (in the upper outer aspect of the forearm at
the junction).
• Efficacy:60 to 80%
• Side effect: Moderate cervical or axillary lymphadenopathy, induration, local
abscesses, persistent ulcer & osteomyelitis.
• Contraindication: Symptomatic HIV, and cancer.

National policy guidelines on immunization 2013

 Polio Vaccine.
Type of antigen: Live attenuated(OPV) and killed(IPV)
Formulation: Liquid
• trivalent OPV-serotype 1,2 &3- routine immunization.
• bivalent OPV-serotype 1&3- mostly during outbreaks.
• Monovalent OPV- serotype 1 or 3- mass vaccination campaigns.
• IPV -serotype 1,2&3
Dose of antigen:2 drops OPV and 0.5ml for IPV
When given: At birth,6,10,and 14 weeks or first point of contact with the health facility.
Route of administration: Oral for OPV and IM for IPV (thigh)
Efficacy:72 to 98%
Side effect: Vaccine Associated Paralytic Polio (VAPP), Circulating Vaccine Derived Polio Virus
(cVDPV).
Contraindication: None.
IPV
• IPV is the killed polio virus vaccine. It is recommended due to its
inability to potentiate polio disease. However, for countries which
have a risk of transmission of the wild poliomyelitis, it is strongly
recommended that OPV be used as it is more immunogenic than the
Inactivated Polio Virus (WHO).
• IPV is safe to administer in children with immune deficiency disease
or those taking immunosuppressive therapy since it contains no live
polio virus.
• IPV can be combined with DPT to form a quadruple vaccine and
increase immunization rates in areas where OPV take rate is low.

WHO
MEASLES & RUBELA
Type of antigen: Live Attenuated Vaccines
Formulation: Freeze Dried
Dose of antigen:0.5ml
When given: 9 &18 months; At 6 months when there is an outbreak/sero+ve or
first point of contact with the health facility
Route of administration: Subcutaneous injection over the deltoid Muscle in the
left arm
Efficacy:85%
Side effect: Febrile seizure, meningitis, Encephalitis, Encephalopathy (within 30
days). Others-Thrombocytopenia &joint stiffness.
Contraindications: Severe allergic reaction after a prior dose of vaccine
 PENTAVALENT
Type of antigen: Adsorbed toxoids of C.diptheriae and C.Tetani
:Recombinant Hepatitis b Vaccine
:H.Infuenza type B conjugated capsular polysaccharide
:Inactivated whole cell Bordetella pertussis
Formulation: liquid
Storage condition: It should NEVER be frozen
Dose of antigen:0.5ml
When given:6,10 &14 weeks of life
Route of administration: IM at the upper, lateral of the child’s thigh(left)
Contraindications: Never given at birth
Tetanus
• Neonatal tetanus has been on the decline in Kenya over the last decade
due to the 5 Tetanus Toxoid (5-T.T.) vaccination schedule introduced in
2002
• A childhood immunization schedule of five doses is recommended. --
• primary series of three doses of DTP (DTwP or DTaP) should be given in infancy
• with a booster dose of a tetanus toxoid containing vaccine at 4–7 years
• and another booster of TT in adolescence, at age 12–15 years.
Those who have received the primary series plus two booster doses, the last of
which given in early adulthood, are unlikely to require further doses.
•  New born can be protected from neonatal tetanus during the 1st 6wks of
life through vaccination of pregnant women using 5-T.T
Tetanus
ADDED VACCINES
• Since 2001, the Ministry of Health has endorsed the introduction of four new vaccines
namely:
• In 2001:
• • Yellow fever in 2 counties of the country
• • Hepatitis B vaccine
• • Haemophilus Influenza type B vaccine

• In 2011 : Pneumococcal conjugate vaccine

• July 2013:Measles vaccine second dose
• 1 July 2014:Rotavirus vaccine

Immunization policy and guideline 2013

YELLOW FEVER
YF is given routinely to children in Baringo, Keiyo, Koibatek and Marakwet Districts. Its
also given to travelers leaving the country due to historical occurrence of yellow fever in
Kenya in 1992.
Type of antigen: Live attenuated virus derived from Embroyonated chicken eggs
Formulation: Freeze dried
Dose of antigen:0.5ml
When given:9 months or at 6 months incase of an outbreak
Route of administration: Subcutaneously
Efficacy:90-98%
Side effect: Considered to be one of the safest but headache & low grade fever present
Contraindications: Children < 6 months,egg allergy, Symptomatic HIV individual
 PNEUMOCCOCAL
Type of antigen: 10 Valent pneumococcal conjugate vaccine. It is a decavalent
vaccine- it protects against 10 serotypes. It is not a live bacteria. It contains a
polyscharride conjugated to a carrier protein making them stimulate the immune
response better and makes protection last longer.
Formulation: Liquid
Storage condition: +2 to +8oC. It should NEVER be frozen.
Dose of antigen: 0.5 mls
When given: 6, 10, and 14 weeks.
Route of administration: IM into anterolateral aspect of right thigh.
Efficacy:
Side effect: Redness and tenderness at site of administration.
Contraindication: History of severe reaction to first dose.
http://www.immune.org.nz/sites/default/files/resources/Written
%20Resources/VaccinePneumococcal20170807V01Final.pdf
ROTAVIRUS
Type of antigen: 2 types live attenuated vaccine. Monovalent (Rotarix) &
Pentavalent(Rota Teq). Rotarix is used in the KEPI schedule.
Formulation: Liquid
Storage condition: It should NEVER be frozen
Dose of antigen:1.5mls
When given:6&10wks. All doses should be completed before a child is 32 weeks
of age
Route of administration: Oral
Efficacy:74% against Rotavirus GE /96-100% against severe Rota V
Side effect: diarrhea, vomiting, irritability, low risk of intussusception
Contraindication:Hx of intussusception
Summary of KEPI Vaccines (1).

Immunization Manual for Medical and Nursing Students

Summary of KEPI Vaccines (2).

Immunization Manual for Medical and Nursing Students

Summary of KEPI Vaccines (3).

Immunization Manual for Medical and Nursing Students

Tetanus
Cold Chain Storage of Vaccines
Cold Chain Storage of Vaccines
NATIONAL COVERAGE
• According to the KDHS 2014, the childhood vaccination (children aged 12-23
months) coverage was at 79% slightly higher than the 77 percent observed
in the 2008-09 KDHS.
• The coverage is highest in central province (90%) and lowest in North
Eastern region with only 51% of the children being fully immunized.
• There is no difference in the coverage rates between male and female
children.
• Immunization coverage increases with increasing mother’s education; more
than three-quarters of children whose mothers have completed primary or
higher education are fully immunized, as compared with 55% of children
whose mothers have no education.
Cont…..

OPV 1 coverage is lower

because most children are born
out of hospitals and end up not
receiving it. It is never given
once missed unlike BCG.
Kdhs 2014
MISSED OOPRTUNITIES IN
IMMUNIZATION
• A missed opportunity for vaccination (MOV) refers to any contact with
health services by an individual (child or person of any age) who is
eligible for vaccination (e.g. unvaccinated or partially vaccinated and
free of contraindications to vaccination), which does not result in the
person receiving one or more of the vaccine doses for which he or she
is eligible.
• Beyond improving immunization coverage, the aim of reducing MOV
is to improve health service delivery and promote synergy between
programmes.

http://www.who.int/immunization/programmes_systems/policies_strategies/MOV/en/
MISSED OPPORTUNITIES IN
IMMUNIZATION

http://www.who.int/immunization/programmes_systems/policies_strategies/MOV/en
/
Cont.…….
• To limit Missed Opportunities for Vaccination, health workers should:

1. Check children and women’s vaccination status during a visit to the health facility
or an outreach site regardless of the reason for the visit.
2. Give children and women all vaccines due.
3. Eliminate false contraindication for vaccination such as vaccines being laced with
hormones causing infertility
4. Open a multi-dose vial of a lyophilized vaccine even for a single child.
5. Avoid scheduling of vaccination services
6. Encourage eligible women and caregivers of eligible children to carry the MCH
booklet during every visit for checking by the health worker for vaccination status
NATIONAL IMMUNIZATION DAYS
(NIDS)
• National immunization days (NIDs) originated as one-day mass polio
vaccination campaigns across the developing world.
• NIDs, which still take place in many countries, are supplementary and do
not replace routine immunization.
• Their original aim was to prevent the spread of polio by immunizing all
children under the age of five, regardless of their previous polio vaccination
history.

https://www.unicef.org/sowc08/docs/sowc08_panel_2_2.pdf
References
• https://www.unicef.org/sowc08/docs/sowc08_panel_2_2.pdf
• http://www.who.int/immunization/programmes_systems/policies_str
ategies/MOV/en/
• https://dhsprogram.com/pubs/pdf/fr308/fr308.pdf
• https://www.mchip.net/sites/default/files/mchipfiles/Immunization%
20Manual%20for%20Medical%20and%20Nursing%20Students%20_fi
nal%20smaller.pdf
• http://e-cavi.com/wp-content/uploads/2014/11/KENYA-NATIONAL-P
OLICY-ON-IMMUNIZATION-2013.pdf
References
• http://www.immune.org.nz/sites/default/files/resources/Written
%20Resources/VaccinePneumococcal20170807V01Final.pdf