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3 Strategy A. Child immunization The following is the Egyptian immunization schedule, EPI, MOH, 2009: At birth (zero dose)OPV (Sabin) BCG 2 drops 0.1 ml Oral ID, upper left arm 2 nd, 4 th, 6 th months (1 st, 2 nd,3 rd doses) OPV (Sabin), DPT HB vaccine 2 drops 0.5 ml Oral IM, Outer left mid-thigh IM, Outer right mid-thigh 9 th monthVitamin A OPV (Sabin) Capsule 2 drops Squeezed in mouth Oral 12 th monthMMR OPV (Sabin) 0.5 ml 2 drops S.C Oral 18 monthOPV (Sabin) DPT MMR Vitamin A 2 drops 0.5ml 2 capsules Oral I.M S.C Squeezed in mouth School entry Age (5-6 years) OPV (Sabin) DT BCG Meningococcal vaccine 2 drops 0.5ml 0.1 ml 0.5ml Oral I.M ID, upper left arm (for tuberculin nonreactors) S.C
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Expanded Program of Immunization (EPI)
Expanded Program of Immunization (EPI)
Definition It is program adopted by WHO since l974, it includes child
immunization & vaccination of pregnant women.
Objectives of EPI 1. ↓ incidence of target diseases ( T.B. –Poliomyelitis –
Diphtheria – Pertussis – Tetanus - Hepatitis B – Measles – Mumps - Rubella) and Vit. A deficiency.
2. ↓ mortality rates from these diseases
May 3, 2023 2Public Health and Community Medicine Department Mansoura Faculty of Medicine
3
Strategy A. Child immunization The following is the Egyptian immunization schedule, EPI, MOH, 2009:
At birth (zero dose) OPV (Sabin)BCG
2 drops0.1 ml
OralID, upper left arm
2nd , 4th , 6th months(1st , 2nd,3rd doses)
OPV (Sabin), DPTHB vaccine
2 drops0.5 ml0.5 ml
OralIM, Outer left mid-thighIM, Outer right mid-thigh
9th month Vitamin AOPV (Sabin)
Capsule2 drops
Squeezed in mouthOral
12th month MMROPV (Sabin)
0.5 ml2 drops
S.C Oral
18 month OPV (Sabin)DPTMMRVitamin A
2 drops0.5ml0.5ml2 capsules
OralI.MS.CSqueezed in mouth
School entry Age (5-6 years)
OPV (Sabin)DTBCGMeningococcal vaccine
2 drops0.5ml0.1 ml0.5ml
OralI.MID, upper left arm (for tuberculin nonreactors)S.C
Schedule of non compulsory vaccinations 1. Pregnant women :Tetanus toxoid: 2. Food handlers : - TAB vaccine against typhoid and paratyphoid. - Hepatitis A vaccine. 3. Military groups: - Tetanus toxoid - Meningococcal polysaccharide vaccine - BCG for non reactors. 4. International Immunization: *Cholera vaccine: for travelers coming from or going into endemic area &should have valid vaccination certificate (6 days-6months). *Yellow fever vaccine: for travelers coming from or going to endemic area (Yellow fever belt) -validity (10days -10 years).
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Public Health and Community Medicine Department Mansoura Faculty of Medicine
B. Vaccination of the pregnant women
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Mansoura Faculty of Medicine
Dose Time Effectiveness Period of protection
TT1 -------------------------- Zero --------------
TT2 4 weeks after TT1 80% 3 years
TT3 6 months after TT2 or next pregnancy
95% 5 years
TT4 1 year after TT3 or next
pregnancy 95% 10 years
TT5 1 year after TT4 or next pregnancy
99% Life long
• T.T is given during pregnancy to protect the mother against puerperal tetanus and the baby against tetanus neonatorum.
• The first dose of T.T is given after 1st trimester to avoid false beliefs that T.T cause abortion.
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Public Health and Community Medicine Department Mansoura Faculty of Medicine
Def. of vaccines: Weapons to prevent diseases, made of microorganisms (similar to ones cause
diseases) or of toxins produced by the microorganisms (antigenic non toxigenic) that cannot harm people.
Types of vaccines:1.Live attenuated vaccine : - BCG vaccine. - Polio vaccine (Sabin). - Measles vaccine2. Killed vaccines:
-Pertussis vaccine - Salk vaccine. 3. Toxoids: -Diphtheria toxoid. - Tetanus toxoid.
4. Recombinant DNA technique vaccine: Hepatitis B vaccine
Contraindications for immunization• All vaccines should be given on schedule, even when a child
has a low - grade fever, a mild cold, diarrhea or other mild illness.
• If a child has diarrhea when you give OPV, administer an extra dose (see before).
• DPT vaccine should NOT be given to children over 5 years or to children suffered a severe reaction to a previous dose of this vaccine ( shock or convulsions ) Instead, D.T may be given .
• BCG vaccine should not be given to children who have signs and symptoms of AIDS.
May 3, 2023 8Public Health and Community Medicine Department
Mansoura Faculty of Medicine
What damages vaccines?• All vaccines lose potency after expiry date.• Heat & sunlight damage vaccines especially
living attenuated e.g. BCG. • Freezing damage toxoid & killed vaccines. • Disinfectants or antiseptics such as detergents
and antibiotics such as streptomycin on BCG.
May 3, 2023 9Public Health and Community Medicine Department
Mansoura Faculty of Medicine
• All vaccines lose potency after expiry date.• Heat & sunlight damage vaccines especially
living attenuated e.g. BCG. • Freezing damage toxoid & killed vaccines. • Disinfectants or antiseptics such as detergents
and antibiotics such as streptomycin on BCG.
How can you differentiate between D.P.T vaccines damaged by freezing and other never frozen before?
May 3, 2023 10Public Health and Community Medicine Department Mansoura Faculty of Medicine
Vaccine never frozen
Vaccine frozen and thawed
Immediately after shaking
Smooth cloudy Show granular particles
15-30 m after sharking
Clear with no sediment
Clear with thick sediment
Injection sites
May 3, 2023 12Public Health and Community Medicine Department Mansoura Faculty of Medicine
Summary of injection sites
May 3, 2023 13Public Health and Community Medicine Department Mansoura Faculty of Medicine
Vaccine Route of administration
Injection site
BCG Strict I.D Upper left arm
DPT I.M Outer mid-thigh ( left )
OPV Oral Mouth
HBV I.M Outer mid-thigh ( right )
MMR SC Upper right arm
Tetanus toxoid I.M Outer, upper ar
m
