Title: Vitamin A deficiency (VAD) and “EPI Plus”
Course: Level 3 - Immunization > Section: Antiviral vaccines

Immunisation not only protects infants from several vaccine-preventable diseases, but the immunisation service also provides a platform for delivering other health interventions, a strategy is commonly known as "EPI plus." Other interventions that can be integrated with the immunisation services include Vitamin A supplementation; insecticide-treated bed nets for malaria prevention and de-worming.

The most success has been achieved with integrating Vitamin A supplementation with routine immunisation services. Any immunisation contact is an opportunity to screen mothers and infants for eligibility to receive Vitamin A, particularly if immunisations have been delayed, and the child is six months or older.

Vitamin A is a substance that is required by the human body to strengthen resistance to infection, increases a child's chances of surviving an infection, promotes growth, and protects the transparent part of the eye, called the cornea. If a person does not have enough Vitamin A in his or her body, the person may have the difficulty of seeing in dim light which called night blindness (see it in details on nutrition module study session 1 and 2).

Vitamin A should be given routinely every six months. If a child has not previously received a vitamin A supplement, it should be given at the same time as the measles vaccine. This is because measles increases the risk of blindness due to vitamin A deficiency. Vitamin A is supplied in capsules of 100,000 IU (international units, which is the standard measurement for vitamin doses). Each capsule has a nipple at one end. The drops are given by cutting across the middle of the nipple with scissors and immediately squeezing the drops into the childss mouth (Figure 3.3 below). Vitamin A drops are also given in Child Health Days to ensure the dose is repeated every six months, until the child reaches five years.

The routine dose of vitamin A for a child aged 6-11 months is the drops from one capsule (100,000 IU); the drops from two capsules (200,000 IU) are given to children aged 12-59 months at regular intervals, every six months. These doses ensure that all children are fully protected from the harmful effects of vitamin A deficiency.

Figure 3.3. A child receives vitamin A drops at a scheduled immunisation clinic while he will also receive measles vaccine. (Photo: UNICEF Ethiopia/IndriasGetachew).

Table 3.3. Vitamin A Doses for the Management of Infants Who Have Measles Infections

Age | Immediately on diagnosis | After 24 hours | Follow-up
Infants less than six months old | 50,000 IU | 50,000 IU | Third dose is given two to four weeks later if there are still signs of vitamin A deficiency
Infants aged 6-11 months | 100,000 IU | 100,000 IU
Aged 12 months and over | 200,000 IU | 200,000 IU