Expanded
Programme of
Immunization
EPI
Muqaddas Jamshaid
Senior Registrar Paediatrics
CMH Lahore Medical
College
LEARNING OBJECTIVES
• By the end of this session students will be able to know about
• The diseases included in EPI .
• Schedule of vaccines
• Doses and sites of administration of vaccine
Introduction
to the EPI
What is the EPI?
• Started in 1974
• Initiated by the WHO
• GAVI: Global Allinace for Vaccine Initiative
DISEASES INCLUDED IN EPI
TUBERCULOSIS
HEPATITIS B
POLIOMYELITIS
DIPHTHERIA
MEASLES
PNEUMONIA
Governmen
t issued EPI
cards
EPI Schedule
Overview of the EPI
schedule (Punjab)
Age Vaccine
Birth BCG, Hep B (0 dose), OPV (0 dose)
6 weeks Pentavalent 1, Pneumococcal 1, OPV 1,
Rotavirus 1
10 weeks Pentavalent 2, Pneumococcal 2, OPV 2,
Rotavirus 2
14 weeks Pentavalent 3, Pneumococcal 3, OPV 3, IPV 1
9 months Measles / Rubella (MR) 1, Typhoid, IPV 2
15 months Measles / Rubella (MR) 2
18 months DPT
Routes of administration
• Intradermal
• BCG
• Subcutaneous
• Measles/ Rubella (MR)
• Oral
• OPV
• Rota
• Intramuscular
• All the others
Doses of vaccines
• BCG
• 0.05 ml
• Rotavirus
• Entire vial
• OPV
• 2 drops
• All others
• 0.5 ml
Where are vaccines
administered?
• BCG
• Right upper deltoid
• Other injectable vaccines
• Anterolateral thigh
Individual vaccines
BCG
• Prevents Tuberculosis
• Most effective in first 2 years of life
• 50-80% protection from Meningeal / disseminated TB
• 50% protection from pulmonary TB
• Live vaccine
• Contraindications:
• Immunocompromised host
• Complications:
• Regional Lymphadenitis
• BCGiosis
• Osteomyelitis
• Disseminated BCG infection
Pentavalent
• Inactivated vaccine
• Components (DTP, Hib, Hep B)
• Diptheria
• Tetanus
• Pertussis
• Hepatitis B
• Haemophilus Influenza B
• Contraindications to giving DTaP (aPertussis)
component
• Seizures / encephalopathy in 7 days of
vaccine
• Fever > 40 degrees C, or uncontrollable
crying in 4 hours
Polio vaccines-
OPV
• OPV
• Live vaccine
• Advantages
• Gut immunity (IgA)
• Herd immunity
• Easy to administer
• Disadvantage
• Live vaccines
• Can cause VaPP
Polio vaccines-IPV
• Inactivated Polio vaccine
• Advantage
• Inactivated
• Cannot cause VaPP
Pneumococcal
vaccine
• Pnemococcal conjugate vaccine
• Protects against Streptococus Pneumoniae
• PCV13
• Inactivated
Hepatitis B
• Inactivated vaccine
Rotavirus vaccine
• Oral vaccine
• Prevents diarrhea from rotavirus infection
• Must complete vaccine series prior to 8 months of
age
• Contraindication
• Immune compromised
Measles / Rubella
• Live vaccine
• Contraindication
• Immune compromised
Typhoid
• Inactivated
• 9 months (1 dose)
Contraindications to
vaccines
Absolute contraindications to
vaccines
• Anaphylactic reaction to previous dose of same vaccine
Special mentions
• MR
• Rubella added with measles
• DTP
• Recent addition at 18 months of age
• Typhoid
• Added in Sindh EPI in 2019
• Added in Punjab EPI Dec 2020
• 1 dose at 9 months
Quiz
Q1
• A 7 month old previously unvaccinated child is brought by her mother.
What vaccines will you administer?
• A) Pentavalent, BCG, OPV, IPV, Pneumococcal, Rotavirus
• B) Pentavalent, OPV, IPV, Pneumococcal, Rotavirus
• C) Too late to give vaccines; will give measles at 9 months
• D) BCG, Hep B and OPV
Q1 (Answer)
• A 7 month old previously unvaccinated child is brought by her mother.
What vaccines will you administer?
• A) Pentavalent, BCG, OPV, IPV, Pneumococcal, Rotavirus
• B) Pentavalent, OPV, IPV, Pneumococcal, Rotavirus
• C) Too late to give vaccines; will give measles at 9 months
• D) BCG, Hep B and OPV
• E) Pentavalent, BCG, OPV, IPV, Pneumococcal, Rotavirus
Question 2
• Q2. Ennumerate the live attenuated vaccines?
• Answer:
• BCG
• OPV
• Rotavirus
• Measles/rubella
Question 3
• Q. A mother brings in her 3 month old child for routine vaccines. The
child has had a runnny nose, cough and low grade fever, all of which
are resolving. She is not on any medication. What will you advice the
mother to do about vaccinations?
• A) Postpone as she is unwell
• B) Administer the vaccines
• C) Administer only the inactivated vaccines
• D) 3 months is not the correct age for routine vaccines
Question 3 (Answer)
• Q. A mother brings in her 3 month old child for routine vaccines. The
child has had a runnny nose, cough and low grade fever, all of which
are resolving. She is not on any medication. What will you advice the
mother to do about vaccinations?
• A) Postpone as she is unwell
• B) Administer the vaccines
• C) Adminsiter only the inactivated vaccines
• D) 3 months is not the correct age for routine vaccines
Question 4
• Q. Which of the following is a live vaccine?
• A) Pentavalent
• B) Pneumococcal conjugate vaccine
• C) Rotavirus vaccine
• D) Hepatitis B
Question 4 (Answer)
• Q. Which of the following is a live vaccine?
• A) Pentavalent
• B) Pneumococcal conjugate vaccine
• C) Rotavirus vaccine
• D) Hepatitis B
