PRINCIPLES OF EPI

• EPIDEMIOLOGICAL SITUATION
• MASS APPROACH
• BASIC HEALTH SERVICE
THE 7 IMMUNIZABLE DISEASES
 TUBERCULOSIS (PRIMARY COMPLEX IF LESS THAN 3 YEARS OLD)
 DIPHTHERIA
 PERTUSSIS
 MEASLES
 POLIOMYELITIS
 TETANUS
 HEPATITIS B
TARGET SETTING

INFANTS 0-12 MONTHS

PREGNANT AND POST PARTUM WOMEN
SCHOOL ENTRANTS/ GRADE 1 / 7 YEARS OLD
OBJECTIVES OF EPI

TO REDUCE MORBIDITY AND MORTALITY RATES AMONG INFANTS AND CHILDREN FROM SIX CHILDHOOD
IMMUNIZABLE DISEASE
ELEMENTS OF EPI
oTARGET SETTING
oCOLD CHAIN LOGISTIC MANAGEMENT- VACCINE DISTRIBUTION THROUGH COLD CHAIN IS DESIGNED TO
ENSURE THAT THE VACCINES WERE MAINTAINED UNDER PROPER ENVIRONMENTAL CONDITION UNTIL THE
TIME OF ADMINISTRATION.
oINFORMATION, EDUCATION AND COMMUNICATION (IEC)
oASSESSMENT AND EVALUATION OF OVER-ALL PERFORMANCE OF THE PROGRAM
oSURVEILLANCE AND RESEARCH STUDIES
CONCEPT AND IMPORTANCE OF
VACCINATION
IMMUNIZATION – IS THE PROCESS BY WHICH VACCINES ARE INTRODUCED INTO THE BODY BEFORE
INFECTION SETS IN.
 VACCINES ARE ADMINISTERED TO INTRODUCED IMMUNITY THEREBY CAUSING THE RECIPIENT’S IMMUNE
SYSTEM TO REACT TO THE VACCINE THAT PRODUCES ANTIBODIES TO FIGHT INFECTION.
 VACCINATION PROMOTE HEALTH AND PROTECT CHILDREN FROM DISEASE-CAUSING AGENTS.
 INFANTS AND NEWBORN NEED TO BE VACCINATED AT AN EARLY AGE SINCE THEY BELONG TO VULNERABLE
AGE GROUP.
ADMINISTRATION OF VACCINES
Form & # of
Vaccine Content Route
Dosage Doses
BCG (Bacillus Freeze dried
Live attenuated
Calmette Infant- 0.05ml 1 ID
bacteria
Guerin) Preschool-0.1ml

DPT
(Diphtheria DT- weakened toxin
liquid-0.5ml 3 IM
Pertussis P-killed bacteria
Tetanus)

OPV (Oral
weakened virus liquid-2drops 3 Oral
Polio Vaccine)

Hepatitis B Plasma derivative Liquid-0.5ml 3 IM

Measles Weakened virus Freeze dried- 0.5ml 1 Subcutaneous

 SCHEDULE OF VACCINES
Interval between
Vaccine Age at 1st dose Protection
dose
BCG is given at the earliest possible
age protects against the possibility of
BCG At birth TB infection from the other family
members

An early start with DPT reduces the

DPT 6 weeks 4 weeks chance of severe pertussis

The extent of protection against polio

OPV 6weeks 4weeks is increased the earlier OPV is given .

@birth,6th week,14th An early start of Hepatitis B reduces

Hepa B @ birth the chance of being infected and
week becoming a carrier.

At least 85% of measles can be

Measles 9m0s.-11m0s. prevented by immunization at this age.
6 MONTHS – EARLIEST DOSE OF MEASLES GIVEN IN CASE OF OUTBREAK
9MONTHS-11MONTHS- REGULAR SCHEDULE OF MEASLES VACCINE
15 MONTHS- LATEST DOSE OF MEASLES GIVEN
4-5 YEARS OLD- CATCH UP DOSE
FULLY IMMUNIZED CHILD (FIC)– LESS THAN 12 MONTHS OLD CHILD WITH COMPLETE IMMUNIZATIONS
OF DPT, OPV, BCG, ANTI HEPATITIS, ANTI MEASLES.
TETANUS TOXOID IMMUNIZATION
Minimum age Duration of
Vaccine % protected
interval Protection

• SCHEDULE FOR WOMEN TT1 As early as possible 0% 0

TT2 4 weeks later 80% 3 years

TT3 6 months later 95% 5 years

1year later/during next

TT4 99% 10 years
pregnancy

TT5 1 year later/third pregnancy 99% Lifetime

• THERE IS NO CONTRAINDICATION TO IMMUNIZATION EXCEPT WHEN THE CHILD IS IMMUNOSUPPRESSED
OR IS VERY, VERY ILL (BUT NOT SLIGHT FEVER OR COLD). OR IF THE CHILD EXPERIENCED CONVULSIONS
AFTER A DPT OR MEASLES VACCINE, REPORT SUCH TO THE DOCTOR IMMEDIATELY.
• MALNUTRITION IS NOT A CONTRAINDICATION FOR IMMUNIZING CHILDREN RATHER; IT IS AN INDICATION
FOR IMMUNIZATION SINCE COMMON CHILDHOOD DISEASES ARE OFTEN SEVERE TO MALNOURISHED
CHILDREN.
COLD CHAIN UNDER EPI
COLD CHAIN IS A SYSTEM USED TO MAINTAIN POTENCY OF A VACCINE FROM THAT OF MANUFACTURE TO THE
TIME IT IS GIVEN TO CHILD OR PREGNANT WOMAN.
THE ALLOWABLE TIMEFRAMES FOR THE STORAGE OF VACCINES AT DIFFERENT LEVELS ARE:
6MONTHS- REGIONAL LEVEL
3MONTHS- PROVINCIAL LEVEL/DISTRICT LEVEL
1MONTH-MAIN HEALTH CENTERS-WITH REF.
NOT MORE THAN 5DAYS- HEALTH CENTERS USING TRANSPORT BOXES.
MOST SENSITIVE TO HEAT: FREEZER (-15 TO -25 DEGREES C)
 OPV
 MEASLES
SENSITIVE TO HEAT AND FREEZING (BODY OF REF. +2 TO +8 DEGREES CELSIUS)
 BCG
 DPT
 HEPA B
 TT
USE THOSE THAT WILL EXPIRE FIRST, MARK “X”/ EXPOSURE, 3RD- DISCARD,
TRANSPORT-USE COLD BAGS LET IT STAND IN ROOM TEMPERATURE FOR A WHILE BEFORE STORING DPT.
HALF LIFE PACKS: 4HOURS-BCG, DPT, POLIO, 8 HOURS-MEASLES, TT, HEPA B.
FEFO (“FIRST EXPIRY AND FIRST OUT”) – VACCINE IS PRACTICED TO ASSURE THAT ALL VACCINES ARE
UTILIZED BEFORE THE EXPIRY DATE. PROPER ARRANGEMENT OF VACCINES AND/OR LABELING OF
VACCINES EXPIRY DATE ARE DONE TO IDENTIFY THOSE NEAR TO EXPIRE VACCINES.
• THE EXPANDED PROGRAM ON IMMUNIZATION (EPI) IN VIETNAM BEGAN IN 1981 AND REACHED A 87%
NATIONAL COVERAGE RATE IN 1987. TO INVESTIGATE THE VACCINATION COVERAGE AND TRENDS IN TIME
OF THE EPI IN VIETNAM, 2 VACCINE COVERAGE CLUSTER SURVEYS HAVE BEEN CONDUCTED IN 2003 AND
2009. INFORMATION ON EPI-VACCINE COVERAGE IN CHILDREN (AGED 0–23 MONTHS – 7 Y OF AGE), IN
WOMEN OF CHILDBEARING AGE AND IN PREGNANT WOMEN, WAS COLLECTED THROUGH ‘30 CLUSTER
SURVEYS’ IN 2003 AND 2009 (ACCORDING TO THE WORLD HEALTH ORGANIZATION (WHO)
METHODOLOGY) AND THROUGH ROUTINE ANNUAL EPI COVERAGE REPORTS FOR THE PERIOD 2001–2008.
 VIETNAM IS A COUNTRY IN TRANSITION, WITH AN ESTIMATED 90 MILLION INHABITANTS (2012), A
LARGE BIRTH COHORT (1.4 MILLION BIRTHS/YEAR) AND A HIGH MORTALITY AMONG CHILDREN UNDER THE
AGE OF 5 (MORTALITY RATE OF 22/1000 LIVE BIRTHS). AROUND 69% OF THE POPULATION LIVES IN THE
RURAL AREAS. OVER THE PAST YEARS, VIETNAM HAS ACHIEVED SIGNIFICANT IMPROVEMENTS IN PUBLIC
HEALTH. THE HEALTH CARE ADMINISTRATION IS ORGANIZED IN A 3-LEVEL SYSTEM. THE TERTIARY LEVEL IS
THE MINISTRY OF HEALTH (MOH), WHICH FORMULATES AND EXECUTES HEALTH POLICY AND PROGRAMS IN
THE COUNTRY. AT PROVINCIAL LEVEL THERE ARE 63 PROVINCIAL HEALTH BUREAUS, WHICH FOLLOW MOH
POLICIES, BUT ARE ORGANIC PARTS OF THE PROVINCIAL LOCAL GOVERNMENTS UNDER THE PROVINCIAL
PEOPLE'S COMMITTEES (PPCS). THE PRIMARY LEVEL, OR BASIC HEALTH NETWORK, INCLUDES DISTRICT
HEALTH CENTERS, COMMUNE HEALTH CENTERS AND VILLAGE HEALTH WORKERS.
• THE YEARLY COVERAGE OF THE EPI FOR INFANTS IN THE PERIOD 2001 – 2008 WAS HIGHER THAN 90%
COUNTRY-WIDE, ACCORDING TO ROUTINELY COLLECTED COVERAGE DATA.

• TIMELINESS (AGE-APPROPRIATENESS) OF THE VACCINATION CANNOT BE CALCULATED FROM THESE

ROUTINE COVERAGE DATA.

• IN BOTH CLUSTER SURVEYS, MOST PROVINCES HAD HIGH COVERAGE RATES (OVER 93 %) OF FULLY
IMMUNIZED CHILDREN BY ONE YEAR OF AGE. THE CALCULATED CRUDE NATIONAL ESTIMATE FOR FULL
IMMUNIZATION RATES OF CHILDREN, WAS 96% FOR THE 2003 CLUSTER SURVEY AND 95.2% FOR 2009.
Table 2. Population groups for investigation of immunization history
The 2003 survey The 2009 survey
Group Assessment Population to Number of Population to Number of
be investigated persons (total) be investigated persons (total)
1 Immunization 12–23 months (cohort 7 per cluster 12–23 months (cohort 10 per cluster
coverage of children 2002) (commune); 210/ 2007) (commune)/
under one year of age province (1260/ 6 300/province (1800/
provinces) 6 provinces)
2 Hepatitis B 0–23 months (cohort 14 per cluster 12–23 months (cohort 10 per cluster
vaccination 2002–2003)* in 2003 (commune); 420/ 2007) (commune); 300/
the age category was province (2520/ 6 province (1800/ 6
broadened for provinces) provinces)
hepatitis B.

3 Measles 16 months – 10 y of 10 per cluster NA NA

immunization during age (cohort 2002) (commune);
the national measles 300/province (1800/
campaign 6 provinces)
4 Measles 2 NA NA 7 y of age (cohort 10 per commune;
2007) 300/ province (1800/
6 provinces)
5 Tetanus Toxoid (TT) Mother of children 7per cluster Mother of children 10 per cluster;
immunization among aged 0–11 months (commune); 210/ aged 0–11 months 300/province (1800/
pregnant women and (cohort 2003) province (1260/ 6 (cohort 2008) 6 provinces)
infants protected at provinces)
birth
DTP
• A DTP STOCK PILE PROBLEM AFFECTED THE RATE OF INFANTS RECEIVING DTP UNDER ONE YEAR OF AGE IN
2002. DTP DOSE 3 VACCINE COVERAGE DECREASED FROM 96.2% (2001) TO 74.8% AS MEASURED BY ROUTINE
DATA COLLECTION; CHILDREN WHO MISSED DTP IN 2002 RECEIVED IT DURING ROUTINE VACCINATION IN
2003, AND THE COVERAGE RATE RECOVERED TO 99.0% IN 2003.

MEASLES
• SIMILARLY, IN 2007, THERE WAS A 10% DECLINE IN THE NATIONAL COVERAGE RATE OF MEASLES VACCINE FROM
93.0% TO 83.0% FOR CHILDREN AT 9 MONTHS OF AGE, WHICH COULD BE EXPLAINED BY A STOCKPILE
PROBLEM. IN BOTH CLUSTER SURVEYS IN 2003 AND 2009, COVERAGE OF MEASLES DOSE 1 EXCEEDED 90%.

• IN 2002–2003, A MASS CAMPAIGN OF MEASLES VACCINATION IN CHILDREN FROM 9 MONTHS TO 10 Y OF AGE

WAS IMPLEMENTED NATIONWIDE. THE MEASLES VACCINE COVERAGE DURING THE SECOND DOSE CAMPAIGN IN
2002–2003 WAS 95.8% WHEN MEASURED ON CARD ONLY (95.2% – 96.5%) AND 97.4% (96.9% – 97.9%)
MEASURED THROUGH CARD + HISTORY IN THE 2003 SURVEY.
CONCLUSION

DESPITE SOME ISOLATED LOWER VACCINE COVERAGE RATES, VACCINE COVERAGE OF MOST ANTIGENS IN
VIETNAM IN THE PERIOD 2001–2008 REACHED THE TARGETS SET BY VIETNAMESE EPI FOR FULLY
IMMUNIZED CHILDREN BY 1 Y OF AGE (90%), FOR TT2 PLUS FOR PREGNANT WOMAN (80%) AND FOR CBAW
(90%). THIS IS CONFIRMED BY 2 CLUSTER SURVEYS PERFORMED ACCORDING THE WHO METHODOLOGY,
HOWEVER, SOME ELEMENTS FOR IMPROVEMENT ARE IDENTIFIED IN THE PRESENT ANALYSIS.