# EPI Vaccinator Exam Study Guide & Mock Test Documentation

## Complete Pakistan EPI Routine Immunization Schedule (Updated)

| Age of Child | Vaccine Administered | Disease Prevented | Dose & Route | Injection Site |
|---|---|---|---|---|
| **At Birth** | BCG | Childhood Tuberculosis (TB) | 0.05 ml (if <1 month), Intradermal (ID) | Left Upper Arm (Deltoid) |
| **At Birth** | OPV-0 (Zero Dose) | Poliomyelitis | 2 Drops, Oral | Mouth |
| **At Birth** | Hepatitis B (Birth Dose) | Hepatitis B Infection | 0.5 ml, Intramuscular (IM) | Right Anterolateral Thigh |
| **6 Weeks** | OPV-1 | Poliomyelitis | 2 Drops, Oral | Mouth |
| **6 Weeks** | Pentavalent-1 (DTP-HepB-Hib) | Diphtheria, Pertussis, Tetanus, Hep B, Hib | 0.5 ml, IM | Left Anterolateral Thigh |
| **6 Weeks** | PCV-1 (Pneumococcal) | Pneumonia & Meningitis | 0.5 ml, IM | Right Anterolateral Thigh |
| **6 Weeks** | Rota-1 (Rotavirus) | Rotavirus Diarrheal Dehydration | 1.5 ml or 5 drops, Oral | Mouth |
| **10 Weeks** | OPV-2 | Poliomyelitis | 2 Drops, Oral | Mouth |
| **10 Weeks** | Pentavalent-2 | DTP, Hep B, Hib | 0.5 ml, IM | Left Anterolateral Thigh |
| **10 Weeks** | PCV-2 | Pneumonia & Meningitis | 0.5 ml, IM | Right Anterolateral Thigh |
| **10 Weeks** | Rota-2 | Rotavirus Diarrhea | 1.5 ml or 5 drops, Oral | Mouth |
| **14 Weeks** | OPV-3 | Poliomyelitis | 2 Drops, Oral | Mouth |
| **14 Weeks** | Pentavalent-3 | DTP, Hep B, Hib | 0.5 ml, IM | Left Anterolateral Thigh |
| **14 Weeks** | PCV-3 | Pneumonia & Meningitis | 0.5 ml, IM | Right Anterolateral Thigh |
| **14 Weeks** | IPV-1 (Inactivated Polio) | Poliomyelitis | 0.5 ml IM (or 0.1 ml ID) | Right Anterolateral Thigh / Deltoid |
| **9 Months** | Typhoid Conjugate (TCV) | Salmonella Typhi (Typhoid Fever) | 0.5 ml, IM | Right Anterolateral Thigh |
| **9 Months** | Measles-Rubella 1 (MR-1) | Measles & Rubella | 0.5 ml, Subcutaneous (SC) | Left Upper Arm |
| **9 Months** | IPV-2 | Poliomyelitis | 0.5 ml IM (or 0.1 ml ID) | Right Anterolateral Thigh |
| **15 Months** | Measles-Rubella 2 (MR-2) | Measles & Rubella | 0.5 ml, SC | Left Upper Arm |

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## Tetanus Toxoid / Td Schedule for Pregnant & Reproductive Age Women (15–49 Years)
- **TT1 / Td1**: At first contact or early in pregnancy.
- **TT2 / Td2**: At least 4 weeks after TT1 (gives 3 years protection).
- **TT3 / Td3**: At least 6 months after TT2 (gives 5 years protection).
- **TT4 / Td4**: At least 1 year after TT3 (gives 10 years protection).
- **TT5 / Td5**: At least 1 year after TT4 (gives lifetime protection during childbearing years).

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## Cold Chain Management & Temperature Monitoring
1. **Target Range**: All EPI vaccines must be stored and transported between **+2°C and +8°C**.
2. **Freeze-Sensitive Vaccines**: Never freeze Pentavalent, PCV, Td, Hepatitis B. If suspected of freezing, perform the **Shake Test**.
3. **Heat-Sensitive Vaccines**: OPV, Measles, BCG, and Yellow fever are most sensitive to heat. OPV can be stored at -20°C in national/regional cold stores, but +2°C to +8°C at health facility level.
4. **Vaccine Vial Monitor (VVM)**:
   - Square is whiter than circle: OK to use.
   - Square is still lighter than circle: OK to use (use first).
   - Square matches circle color: DISCARD immediately.
   - Square darker than circle: DISCARD immediately.
5. **Reconstitution Safety**:
   - BCG and Measles-Rubella vaccines are freeze-dried (lyophilized).
   - Must ONLY be reconstituted with the specific diluent provided by the same manufacturer.
   - Diluent must be cooled to +2°C to +8°C before mixing.
   - Reconstituted vaccines must be kept on a foam pad inside the vaccine carrier and **discarded after 6 hours** or at the end of the immunization session, whichever comes first.

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## High-Yield MCQs for EPI Vaccinator Test (NTS / STS Format)
1. **Q**: What is the correct temperature range for storing routine vaccines in an Ice-Lined Refrigerator (ILR)?
   - **A**: +2°C to +8°C.
2. **Q**: Which vaccine leaves a permanent scar on the upper arm?
   - **A**: BCG (Bacillus Calmette-Guérin).
3. **Q**: What route is used to administer the BCG vaccine?
   - **A**: Intradermal (ID) at a 10–15 degree angle using a 26G or 27G syringe.
4. **Q**: How many antigens are present in the Pentavalent vaccine?
   - **A**: 5 (Diphtheria, Pertussis, Tetanus, Hepatitis B, Haemophilus influenzae type B).
5. **Q**: Within how many hours must a reconstituted vial of Measles-Rubella vaccine be discarded?
   - **A**: 6 hours.
6. **Q**: At what age is the first dose of Measles-Rubella (MR-1) given in Pakistan's EPI schedule?
   - **A**: 9 months.
7. **Q**: Which test is performed to check if a freeze-sensitive vaccine has been damaged by sub-zero temperatures?
   - **A**: The Shake Test.
8. **Q**: How many total visits are required for a child to complete their routine immunization by 15 months?
   - **A**: 6 immunization visits (Birth, 6 weeks, 10 weeks, 14 weeks, 9 months, 15 months).

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