May 1974 EPI-Pak, 1976 Establishment of vaccination schedule -

1984 GAVI-Global Alliance for Vaccine &

Immunization is a public-private global health partnership committed to saving children’s lives and protecting people’s

health by increasing access to immunization in poor countries. launched in 2000

Since health is a provincial subject, the DG, Health Services and EDOs Health are ultimately responsible for programme implementation and administration.

The main provincial responsibilities are:

Planning, finance, implementation and administration at provincial level

Collection of vaccines/syringes/needles from the Federal EPI Cell for further distribution to the districts

Repair and maintenance of cold chain equipment

Monitoring, evaluation and reporting

Supervision at all EPI service delivery level

Training of all EPI workers except Mid-level Managers

Repair and maintenance of vehicles

The Programme is being supervised by

the National, Provincial and district staff

at every level in the country.

The focal point for the EPI is the District

Officer Health Preventative (DOH) or district EPI Coordinator (DEC).

Full immunization of children under one year of age in every district

Global eradication of poliomyelitis

Reduction in maternal and neonatal tetanus

Cut half number of measles-related deaths

80% coverage in every district by 2012.

Interruption of polio virus transmission by 2010.

Elimination of Neo-natal tetanus by 2015.

Reduction of measles mortality by 90% by 2010 as compared to 2000 level.

Reduction of diphtheria, pertussis and childhood tuberculosis to a minimum level.

Control of other diseases by introducing new vaccines in EPI

Exclusive Immunization provider Private sector- 3% 6000 fixed centres > million outreach and mobile

vaccination sessions/year > 10 000 vaccinators 6000 LHV’s 100,000 LHWs

5.8 Million children 5.9 Million pregnant women

Source: WHO

Bacille Calmette-Guérin vaccine

birth;  

DPT HibHep(Pentavalent 2009)

Diphtheria and tetanus toxoid with whole cell pertussis, Hib and HepB vaccine

6, 10, 14 weeks;  

OPV Oral Polio Vaccine Birth, 6, 10, 14 weeks

Measles Measles vaccine 9, 12-23 months;  

TT Tetanus toxoid 1st contact pregnancy; +1, +6 months; +1, +1 year;  

DiseaseDisease Causative agentCausative agent MOTMOT VaccineVaccine DOSEDOSE RouteRoute

TBTB M.TuberculosisM.Tuberculosis Droplet infection Droplet infection and droplet and droplet nuclei nuclei

BCGBCG 0.05ml0.05ml I/DI/D

DiphtheriaDiphtheria Corynebacterium Corynebacterium diphtheriae diphtheriae

Droplet infection Droplet infection & droplet nuclei & droplet nuclei

DPTDPT 0.5ml0.5ml I/MI/M

PertussisPertussis Bordetella Bordetella pertussispertussis Droplet infection Droplet infection & droplet nuclei & droplet nuclei

DPTDPT 0.5ml0.5ml I/MI/M

PolioPolio PoliovirusPoliovirus Fecal-oral route/ Fecal-oral route/ water borne water borne

OPVOPV 2 drops2 drops OralOral

MeaslesMeasles Paramyxo VirusParamyxo Virus Direct contact Direct contact Resp dropletResp droplet

MeaslesMeasles 0.5ml0.5ml SubcutaneousSubcutaneous

Hep BHep B Hepatitis BHepatitis B virus virus Blood or body Blood or body fluidsfluids

Hep BHep B 10mcg10mcg I/MI/M

meningitismeningitis Haemophilus Haemophilus influenzae type B influenzae type B (HiB) (HiB)

Resp. routeResp. route PentavalenPentavalentt

0.5ml0.5ml I/MI/M

Problems in achieving EPI targets in Pakistan

Inadequate service delivery long distance to EPI centres Lack of awareness of immunization

benefits unaffordable cost to reach the centres unavailability of vaccinators EPI centre- 1 in 10 UC in Punjab and 2

vaccinator in, in each UC Political commitment

Canadian International development Agency (CIDA)

Department for International Development [DFID]

GAVI Japan International Cooperation

Agency (JICA) Rotary International UNICEF United States Agency for

International Development (USAID) WHO World Bank

Cold chain

What is cold chain? The term cold chain is the name given to

the system of transporting and storing vaccines within the safe temperature range of 2ºC - 8ºC.

The cold chain involves all the people, equipment and procedures which ensure that an effective vaccine reaches the people who need it - usually children.

The cold chain system comprises three major elements:

· Personnel, who use and maintain the equipment and provide the health service;

· Equipment for safe storage and transportation of vaccines; and

· Procedures to manage the Programme and control distribution and use of the vaccines.

Competent personnel and efficient procedures are a vitally important part of the cold chain system:

Technical features that impact on vaccine storage and temperature monitoring

Vaccine carriers

Vaccines can become less effective or even lose their effectiveness altogether if they:

Get too hot Freeze exposed to light

DO NOT FREEZE THESE VACCINES–DTP (Diphtheria-tetanus- pertussis vaccine "Triple antigen")–CDT (Combined diphtheria-tetanus vaccine)–ADT (Adult diphtheria-tetanus vaccine)–TT (Tetanus toxoid) · –Hib vaccines– Hepatitis B Vaccine ·–Hepatitis A Vaccine– Monovalent pertussis vaccine–Influenza vaccine

DO NOT EXPOSE THESE VACCINES TO LIGHT:–BCG Vaccine –MMR (measles/mumps/rubella) vaccine –Oral poliomyelitis vaccine (OPV)