( PHI 208)-Reproductive and Child Health

An Assignment on Overall EPI (Expanded Program on
Immunization)
Course: PHI 208 Reproductive and Child Health
Submitted to Submitted by(Group-B)
Most. Zannatul Ferdous Arpita Chakrabarty(1599)
Lecturer Sayeda Sumaiya
Nahrin(1601)
Dept. Of Public Health and Informatics Rabeya Akter Mohua(1602)
Jahangirnagar University Fareha Hasan(1603)
Tasmiya Tabassum(1604)
1

Introduction
The Expanded Program on Immunization is a World Health Organization program with the goal
to make vaccines available to all children throughout the world.
‘Expanded’ means –
● Expanding the number of diseases to be covered
● Expanding the number of children and target population to be covered
● Expanding coverage to all corners of the country and spreading services to reach the less
privileged sectors of the society. (Masud & Navaratne, 2012)
Scope of EPI (Expanded Program on Immunization)
a) Experience with smallpox eradication program showed the world that immunization was
the most powerful and the cost-effective weapon against vaccine preventable diseases.
b) In 1974, the WHO launched its “Expanded Program of Immunization” (EPI) against six
most common preventable diseases (diphtheria, pertussis, tetanus, polio, tuberculosis,
measles and recently added pneumococcal vaccine). (Kaewkungwal et al., 2015)
History of EPI
The World Health Organization (WHO) initiated the Expanded Program on Immunization (EPI)
in May 1974 with the objective to vaccinate children throughout the world.
Ten years later, in 1984, the WHO established a standardized vaccination schedule for the
original EPI vaccines: Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP), oral
polio, and measles. Increased knowledge of the immunologic factors of disease led to new
vaccines being developed and added to the EPI’s list of recommended vaccines: Hepatitis B
(HepB), yellow fever in countries endemic for the disease, and Haemophilus influenzae
meningitis (Hib) conjugate vaccine in countries with high burden of disease.
In 1999, the Global Alliance for Vaccines and Immunization (GAVI) was created with the sole
purpose of improving child health in the poorest countries by extending 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 institutes, donor and implementing countries, the Bill
and Melinda Gates Foundation and The Rockefeller Foundation, the vaccine industry,
non-governmental organizations (NGOs) and many more. The creation of the GAVI has helped
2

to renew interest and maintain the importance of immunizations in battling the world’s large
burden of infectious diseases. In addition, the GAVI has set up specific milestones to achieve the
EPI goals: that by 2010 all countries have routine immunization coverage of 90% of their child
population, that HepB be introduced in 80% of all countries by 2007, and that 50% of the poorest
countries have Hib vaccine by 2005.(Sarkar et al., 2017)
Component of EPI
Routine Immunization:
❏ Children 0-23 months-immunization with & EPI antigens
❏ Pregnant ladies by TT
Supplemental Immunization Activities:
❏ Routine immunization does not ensure 100% coverage of mobile population
i.e. nomads, NAs, hard to reach areas/missed areas. So SIAs are scheduled to ensure
coverage of these areas/population.
❏ NIDs/SNIDs: Children<5 years receive polio drops (3-days campaign)
Disease Surveillance:
❏ To detect case target diseases, the suspected cases of seven VPDs are reported by health
facilities to the distinct heath authorities for immediate launching of the control measures.
Mopping Up:
❏ Special campaign to 5-8 km around the infected locality to localize the disease and stop
transmission. (Masud and Navaratne, 2012)
Goals of EPI:
Vaccination has prevented millions of deaths and disabilities in the Western Pacific Region.
However, inequitable access to vaccination remains a major problem in many countries. The
Expanded Programme on Immunization (EPI) unit aims to build a Region free from
vaccine-preventable diseases. This is achieved by supporting Member States to achieve the goals
of the Regional Framework for Implementation of the Global Vaccine Action Plan.
3

The immunization goals for the Western Pacific Region are:
● Sustaining polio-free status
● Eliminating maternal and neonatal tetanus
● Eliminating measles
● Accelerating control of hepatitis B
● Eliminating rubella
● Introducing new vaccines
● Meeting regional vaccination coverage targets
● Accelerating control of Japanese encephalitis.(Program & Office, 2016)
Evaluation of EPI:
In each country, immunization programs are monitored using two methods: an administrative
method and through community-based surveys. The administrative method uses 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 in areas where government services deliver the immunizations directly or where the
government supplies the vaccines to the clinics. In countries without the infrastructure to do this,
community-based surveys are used to estimate immunization coverage.
Community-based surveys are applied using a modified cluster sampling survey method
developed by the World Health Organization. Vaccine coverage is evaluated using a two-stage
sampling approach in which 30 clusters and seven children in 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 training. 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 reported
vaccine coverage (for example, from administrative reports) and is expected to estimate vaccine
coverage within 10 percent.
Surveys or questionnaires, though frequently considered inaccurate due to self-reporting, can
provide more detailed information than administrative reports alone. If home-based records are
available, vaccination status be determined and dates of vaccination can be reviewed to
determine if they were given at an ideal age and in appropriate intervals. Missed immunizations
can be identified and further qualified. Importantly, systems of vaccine delivery besides clinics
used for administrative evaluation can be identified and included in the analysis.(Dietz & Cutts,
1997)
4