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Diseases & Vaccines / Vaccine-Preventable Diseases in EPI-SA

EXPANDED PROGRAMME ON IMMUNISATION

The expanded programme on immunisation (EPI) was established by the World Health Organisation in 1974 to develop and expand immunisation programmes for vaccine-preventable diseases, throughout the world. When the programme was started, less than 5% of children were being immunised against initial EPI target diseases, viz. polio, measles, tetanus, pertussis, diphtheria and tuberculosis. In the beginning, immunisation programmes were limited to urban areas in industrialised countries. In 1977, the goal was set to make immunisation available to every child by 1990. To attain these objectives the WHO set about improving the health system infrastructure and improving vaccination coverage in all countries of the world. The levels of immunisation coverage globally, now stand at around 80% for children under 1 year of age.

The success of the EPI represents a major public health achievement, but much remains to be done. Though not an EPI target disease, the eradication of smallpox by immunisation in 1977 represents what can be achieved with a dedicated disease eradication programme. This led to the World Health Assembly declaring in 1988 that they aimed at eradicationg polio by the year 2000. The target was not met. By 2002, polio had been eliminated in all but 6 countries of the world. Unfortunately, a setback occurred in August 2003 when Nigeria, one of the remaining countries with circulating wild poliovirus, suspended polio vaccination leading to a polio epidemic that has led to wild poliovirus been re-established in Sudan, Chad, Ivory Coast, and Burkina Faso, and the Nigeria poliovirus has since been linked to outbreaks in 9 countries including Yemen and Indonesia. 

Even with these successes, worldwide, over 3 million children die prematurely annually due to vaccine-preventable diseases. Recently, additional vaccines have been added to the EPI schedule: Haemophilus influenza b for all countries, and for endemic countries, either hepatitis B vaccine or yellow fever vaccine, or both.

The new South African EPI (EPI-SA) schedule effective from  April 2009 and method of vaccine administration

AGE	VACCINE	ROUTE OF     ADMINISTRATION
Birth	BCG   TOPV	Intradermal injection to right upper arm   Drops by mouth
6 weeks	TOPV   RV   DTP-IPV/Hib   Hepatitis B    PCV7	Drops by mouth   Liquid by mouth   Intramuscular injection to the left thigh   Intramuscular injection to the right thigh   Intramuscular injection to the right thigh
10 weeks	DTP-IPV/Hib   Hepatitis B	Intramuscular injection to the left thigh   Intramuscular injection to the right thigh
14 weeks	RV   DTP-IPV/Hib   Hepatitis B   PCV7	Liquid by mouth   Intramuscular injection to the left thigh   Intramuscular injection to the right thigh   Intramuscular injection to the right thigh
9 months	Measles    PCV7	Intramuscular injection to the left thigh   Intramuscular injection to the right thigh
18 months	DTP-IPV/Hib  Measles	Intramuscular injection to the left arm   Intramuscular injection to the right arm
6 years  (both boys and girls)	Td	Intramuscular injection to the left arm
12 years  (both boys and girls)	Td	Intramuscular injection to the left arm

   
BCG   – Bacilli Calmete-Guerin (Anti-tuberculosis vaccine)
TOPV – Trivalent oral polio vaccine
DTP-IPV/Hib  –  Diphtheria, tetanus, pertussis vaccine, inactivated polio vaccine, Haemophilus influenza type b vaccine
Td     – Tetanus and diphtheria vaccine
RV     - Rotavirus vaccine
PVC₇ - 7-valent pneumococcal vaccine 

New Schedule (pdf, 287 kb)