Extended Programme on Immunisation

Extended Programme on Immunisation (EPI) a programme of vaccination against six childhood diseases- diphtheria, pertussis (whooping cough), tetanus, tuberculosis, polio and measles. All of these diseases are preventable. The World Health Organisation has undertaken a programme for 'universal child immunisation' aimed at eradicating these diseases. In Bangladesh, only about 2% of children between the age of 12 and 23 months were immunised against these diseases. A programme was undertaken under the auspices of the WHO in the early 1980s which actually became fully operational in 1985. The programme called Expanded Programme on Immunisation achieved commendable success within just a few years with the result that by 1993 approximately 74% children were immunised and by 1998 the coverage reached nearly 85% for some of these vaccines.

Of the six EPI vaccines only the polio vaccine is oral while the others are injectible. The polio vaccine given during the EPI vaccination programme is the third of the three doses, the first two being given through a special programme of polio eradication which the government has undertaken since 1995. Two days are set every year as National Immunisation Days (NID), usually during the dry winter months to facilitate wide participation. Because of the EPI programme, Bangladesh today stands as an outstanding success story for universal childhood immunisation.

Disease Reduction Objectives To achieve interruption of indigenous wild poliovirus transmission by the end of 2000 and certification of polio eradication by December 2010; To sustain elimination of neonatal tetanus status nationally and in all districts; To reduce measles morbidity by 90% and mortality by 95% by 2010 compared with pre-vaccine era; To reduce the prevalence of HepB chronic infection (HbsAg) among 3-5-year old children by 80%, compared to the prevalence in the pre-vaccine era, by 2010; To eliminate vitamin A deficiency by 90% in children aged <5 years by 2010; Eliminate the risk of transmission of blood-borne infections associated with injections administered in the EPI program by 90% by 2010 (source' Medical Portal Bangladesh).

The country is maintaining polio free status now. There were stray cases of importation of wild polio virus in March 2006. Previously, Bangladesh was polio free since 22 August 2000.

The EPI programme in Bangladesh has been found to be highly cost-effective. Cost calculations that have been made by the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) suggest that the total cost for fully immunising a child with the EPI vaccines at present stands at $11.76 which is considerably lower than the developing country average of $15 per child. The current EPI cost represents approximately 0.06% of GDP. The per capita budget for health and family planning in Bangladesh today is about $3.5, far less than the EPI immunisation cost of $11.76 per child, but because of EPI activities the cost of each death prevented has been calculated to be about $136. [Zia Uddin Ahmed]