Expanded Program on Immunization (EPI)

Background

Although immunizations were given in The Bahamas from the early fifties, the Expanded Program on Immunization in The Bahamas commenced January 1961. The first National Immunization Schedule was published with the following vaccines being offered:

• 1^st DPT  at 1 month
• 2^nd and 3^rd doses at 4 weeks intervals
• Booster at 18 months
• Small pox at 12-15 months

Additional vaccines were added to the National Schedule as follows:

• In 1964, Polio following a polio outbreak.
• Antenatal tetanus was introduced in 1964.
• BCG to newborns was introduced in the 1960’s but was discontinued in May 1979.
• Measles Vaccine at 12 months of age was commenced in September 1975.
• Rubella to 10 year old girls commenced in 1979.
• MMR Vaccine was introduced in 1985
• Pneumococcal Conjugate, Seasonal Influenza, Pertussis and Varicella in 2012
• Rotavirus was introduced January 2017
• Over the years The National Immunization Schedule has been continuously revised to accommodate new and underutilized vaccines.

Objectives of (EPI) are as follows:

1. To protect children under one year of age against Diphtheria, Pertussis, Tetanus,(DPT) Haemophilus Influenza type b (Hib), Hepatitis B, Pneumococcus and Poliomyelitis.
2. To protect children at one year of age against Measles, Mumps and Rubella (MMR) and Varicella.
3. To protect school aged children(ten years and older) against Human Papillomavirus(HPV)
4. To maintain immunity levels against childhood diseases in nursery, pre-school, primary and secondary school aged children.
5. To protect pregnant women and newborns against Tetanus and Pertussis.
6. To protect Post-natal women against Measles, Mumps and Rubellaand prevent Congenital Rubella Syndrome (CRS) in the newborn.
7. To protect children, pregnant women, elderly, and persons with CNCDs, and the general public against Seasonal Influenza Virus.
8. To protect the elderly against Pneumococcal Disease

TABLE I: Recommended Vaccination Administration Schedule – All Ages

*FOOTNOTE (S):

1. As of October 1^st 2015 all infants will receive the first two doses of polio vaccine in the Injectable vaccine (age 2 and 4 months).
2. Do not re-start any vaccines or administer additional doses if an appointment is missed.
3. Obtain history of prior convulsions before administering vaccines.
4. Haemophilus Influenza type b (Hib) vaccine may be administered to children under age 2 years old in conjunction with DPT Hepatitis B and Polio for basic coverage.
5. Oral Polio (OPV) vaccine may be administered to HIV asymptomatic children.
6. MMR vaccine should be administered to women with Rubella negative or equivocal results during the postnatal period so as to prevent Congenital Rubella Syndrome in the next child.
7. Two doses of MMR should be administered to children and adults (not previously immunized) so as to maintain Measles eradication from this region.
8. Mantoux and MMR if needed should be given together or within 24 hours. If MMR is given first the client must wait 4 weeks before Mantoux is placed. If Mantoux is placed first wait until after results are read then give MMR. If Mantoux is positive do not give MMR must be seen at infectious disease clinic.
9. Children of Hepatitis B positive women can receive 4 doses of Hepatitis B vaccine. In place of the 2^nd dose of Hepatitis B vaccine at age 1 month they can be given 3 doses of Pentavalent vaccine as scheduled.
10. Children will be administered DPT (pediatric) with second booster.
11. The pregnant woman must receive Tdap at each pregnancy to protect the newborn against Pertussis.
12. ROTAVIRUS VACCINE- The maximum age for the first dose in the series is 14 weeks, 6days: vaccination should not be initiated for infants aged 15 weeks, 0 days and older. The maximum age for the final dose of ROTARIX is 24 weeks. For Rotaqex is 8 months
13. Children ages 9-12years of age (Grade 6) will receive three doses of HPV vaccine. The second dose two months after the first dose and the third dose six months later.
14. Meningococcal, Hepatitis A, and Pneumococcal Polysaccharide Vaccines are available for targeted groups
15. Pneumococcal Conjugate-13 is to be administered to persons 50 years and over followed by Pneumococcal  Polysaccarride-23 one year later  to prevent pneumococcal disease

15. RED BOOK recommendation for Rotavirus Vaccine

• Administer a series of RV vaccine to all infants as follows:
  1. If Rotarix is used, administer a 2–dose series at ages 2 and 4 months.
  2. If RotaTeq is used, administer a 3–dose series at ages 2, 4, and 6 months.
  3. If any dose in the series was RotaTeq or vaccine product is unknown for any dose in the series, a total of 3 doses of RV vaccine should be administered.

Catch–up vaccination:

• The maximum age for the first dose in the series is 14 weeks, 6 days; vaccination should not be initiated for infants aged 15 weeks, 0 days, or older.
• The maximum age for the final dose in the series is 8 months, 0 days.
• For other catch–up guidance, see Catch–up Schedule.

Copied from Red Book
15^th edition