by:

Rehab Badawi
Agenda
By the end of the presentation the attendee should be able to:
• Define vaccination and know how the vaccine work?
• Identify the aim of vaccination program and know how to evaluate the
immunization program.
• Enlist the types of vaccines.
• Recognize the Expanded Program of Immunization (EPI) in Egypt.
• Identify different types of vaccines of compulsory and noncompulsory
schedule of vaccines.
• Understand the contraindications of vaccination.
 VACCINATION
is the introduction of a substance (vaccine) into the body in
order to stimulate the production of antibodies against an
infection without causing the active infection.
Vaccination has been one of the most significant advances of
medical science, saving millions of lives
Aim of vaccination programs
1. To provide protection to vaccinated individuals.
2. To protect non vaccinated individuals through herd immunity.
Population immunity is the resistance of groups of people to the
spread of infection. High levels of immunity in the population
protect those who are not immune, e.g. those who miss out on
vaccination programs
Limitations of vaccination programs
1. Partial protection (some people fail to respond).
2. Waning levels of protection, for some infections need
boosters.
3. Some individuals (and groups of individuals) miss out on
vaccination as:
Migrants
• people with poor access to healthcare.
• People with different health beliefs
 Expanded Program of Immunization (EPI)
Definition: is a program adopted by World Health Organization
(WHO) since 1974 and includes child immunization & vaccination of
pregnant women.
In Egypt, a dedicated vaccination program was established in 1984
under the Ministry of Health. The program provides vaccinations for
10 infectious diseases as mandatory and free of charge for children
aged 0-18 months to ensure high coverage rates. The coverage rate
of the existing vaccination program in Egypt has greatly expanded
Scope for expansion:
Expanding the number of diseases to be covered.
Expanding the number of target population to be
immunized
Objectives:
1. Reduce mortality, morbidity and complications of major
preventable childhood diseases namely, poliomyelitis, hepatitis,
tuberculosis, influenza, diphtheria, pertussis, tetanus, measles,
mumps and rubella.
2. Reduce infant mortality & morbidities.
3. Development of surveillance system to collect adequate
information on immunization preventable diseases.
4. Minimize efforts, complication, and costs of treatment.
5. Eradication of some diseases in the same manner as smallpox
and poliomyelitis
Strategies of EPI:
1. Integrating vaccination session with other services e.g.
MCH to ensure availability.
2. Ensuring regular supply of viable vaccines.
3. Strengthening cold chain.
4. Pre-service and in service training of health personnel.
5. Health education.
6. Continuous monitoring and evaluation
Contraindications for immunization:
1. Absolute contraindication:
Immuno-compromised children.
2. Relative contraindication:
Very severely ill children who need hospitalization.
Children with hyperthermia above 40°C.
Children with convulsions do not take DPT, instead give DT.
Children with clinically apparent AIDS or immune deficiency disease
should not take BCG
Spoilage of vaccine:
1. All vaccines are expired after a certain time printed on each
vial.
2. Heat and sunlight damage any vaccine especially lives
attenuated ones e.g. BCG and Sabin.
3. Freezing damage killed vaccines e.g. pertussis, and toxoids e.g.
diphtheria and tetanus.
4. Disinfectants and antiseptics can damage vaccines e.g.
detergents and antibiotics such as streptomycin.
Evaluation of immunization program:
I. Weekly evaluation
Did you hold all immunization sessions that you planned?
Did you have enough vaccines?
Did you check the refrigerator every day and record the temperature?
Was all the refrigerator temperature in the safe range "zero - +8 °C?
Did you check the immunization status of all women of child-bearing
age and of all children "sick or well" who came to the clinic?
Did you then give the women and children all vaccines they need?
Did you inform them about the other immunizations that they will
need and tell them when to come back?
Did you have enough syringes and other equipment to give safe and
sterile injections?
II. Monthly evaluation: What percentage of monthly target children
received each vaccine?
Factors influencing achievement of high immunization coverage
Helpful government health department.
Health professionals’ acceptance and enthusiasm.
Surveillance of adverse events.
Continuous audit of vaccine uptake.
Adequate supplies and high-quality vaccines.
Adequate resources.
Accurate confirmation of infectious disease.
Public demand and acceptance.
Schedule of non - compulsory vaccination (occasional):
Food handlers:
• TAB vaccine against typhoid and paratyphoid and
Hepatitis A vaccine
Military groups:
• Meningococcal polysaccharide vaccine.
• Tetanus toxoid.
• BCG for non-reactors
International immunization:
• Cholera vaccine: for travelers coming from or going to endemic
area should have valid vaccination certificate (6 days to 6 months).
• Yellow fever vaccine: for travelers coming from or going to
endemic area should have valid vaccination certificate (10 days to
10 years).
• COVID vaccines become necessary for travelling between
different countries. Different vaccines present with different
effectiveness and protection periods.
Vaccination before pregnancy
Rubella/MMR, Hepatitis B, Varicella. Pregnant women should be
evaluated for immunity to rubella and varicella and be tested for the
presence of HBs Ag during every pregnancy. Non -pregnant women
who are vaccinated with live attenuated vaccines, should avoid
becoming pregnant for1 month after each injection
Vaccination of pregnant woman
Live, attenuated virus and bacterial vaccines generally are
contraindicated during pregnancy. Recommended vaccinations are
Tdap (tetanus, diphtheria, a cellular pertussis) and Influenza
(Inactivated)
Tetanus toxoid vaccine:
• Type: inactivated toxin adsorbed on albumin salt
• Dose, route:0.5 ml in upper left arm
• Time: after 1st trimester (Why?)
• 5 doses will give 100% immunity
• The 5 doses: 1st at any time of pregnancy after first
month,2nd after 4 weeks,3rd after6months.,4th after one
year, and the5th after one year.
• Effects: Mother protection against puerperal sepsis.
Infant; prevent tetanus neonatorum for five months.
Coverage rate of vaccine: Programs need to meet certain coverage
targets if they are effectively control or move towards elimination