EXPANDED PROGRAM ON IMMUNIZATION

Prepared by: Rosechelle Siupan-Elarco,RN,MAN

The Expanded Program on Immunization (EPI) was established in

the Philippines by Pres. Marcos on the month of July, 1976, to
ensure that infants/children and mothers have access to routinely
recommended infant/childhood vaccines.
With the commitment of our country to Universal Child
Immunization (UCI) goal, acceleration of EPI coverage had began
in 1986
PD 996 : Providing for compulsory basic immunization for infants
and children below 8 years old
Objective:
To reduce the morbidity and mortality among infants and
children caused by the seven childhood immunizable diseases.
Seven (7) Childhood Immunizable Diseases
Tuberculosis ( Primary Complex if less than 3 years old )
Diphteria
Pertussis
DPT
Neonatal Tetanus
Poliomyelitis
Hepatitis B
Measles
Four Major Strategies
Sustaining high routine FIC coverage of at least 90% in all provinces
and cities.
Sustaining the polio free country for global certification.
Eliminating measles by 2008
Eliminating neonatal tetanus by 2008
Elements of EPI
Target Setting (main element)
Information, Education and Communication
Cold chain logistic management
Assessment and Evaluation of overall performance
Surveillance, Studies and Research

Concept and Importance of Vaccination

Immunization - is the process by which vaccines are introduced

1
into the body before infection sets in.

Vaccines are administered to introduced immunity thereby

causing the recipients immune system to react to the vaccine that
produces antibodies to fight infection.

Vaccinations promote health and protect children from

disease - causing agents.

Infants and newborn need to be vaccinated at an early

age since they belong to vulnerable age group.
General Principles in Vaccinating Children

It is safe and immunologically effective to administer all

EPI vaccines on the same day at different sites of the body.

The vaccination schedule should not be restarted from the

beginning even if the interval between doses exceeded the
recommended interval by months or year.

Giving doses of a vaccine at less than the recommended 4

weeks interval may lessen the antibody response. Lengthening
the interval between doses of vaccines leads to higher antibody
levels.

No extra doses must be given to children who missed a

dose of DPT/HB/OPV. The vaccination must be continued
as if no time had elapsed between doses.

Do not give more than one dose of the same vaccine to a

child in one session. Give doses of the same vaccine at the
correct intervals.

Strictly follow the principle of never, ever reconstituting the

freeze dried vaccine in anything other than the diluent supplied
with them.

If you are giving more than one vaccine, do not use the
same syringe and do not use the same arm or leg for more than
one injection.

False contraindications to immunization are children with

malnutrition, low grade fever, mild respiratory infections
and other minor illnesses and diarrhea should not be
considered a contraindication to OPV vaccination.
Repeat BCG vaccination if the child does not develop a scar after
the 1st injection.
Contraindication to Immunization
Anaphylaxis or severe hypersensitivity reaction to a previous dose of

vaccine is an absolute contraindication

subsequent doses of vaccine

to

Person with a known allergy to a vaccine component

should not be vaccinated.
DPT2 or DPT3 is not given to a child who has
convulsions or shock within 3 days after DPT1.
Vaccines containing the whole cell pertussis
component should not be given to a children with
an evolving neurological disease.
Do not give live vaccines like BCG to a individuals
who are immunosuppressed due to malignant
disease ( child with AIDS) , going therapy with
immunosuppressive agents or radiation.
A child with a sign and symptoms of severe
dehydration
Fever of 38.5 C and above
The following are NOT contraindication. Infants
with these conditions SHOULD be immunized:
Allergy or asthma ( except if there is a known allergy
to a specific component of vaccine mentioned
above)
Minor respiratory tract infection
Diarrhea
Temp, below 38.5 C
Family history of adverse reaction following
immunization
Family history of convulsions, seizures
Known or suspected HIV infection with no signs and
symptoms of AIDS
Child being breastfed
Chronic illness such as diseases of heart, lung,

Type of Vaccine

kidney or liver
Stable neurological condition such as cerebral palsy
or Downs Syndrome
Premature or low birthweight (vaccination should not
be
postponed)
Recent or imminent surgery
Malnutrition
History of jaundice at birth

Note:
If parent strongly objects to an
immunization for a sick infant, do not give it.
Ask the mother to comeback when child is
well.
EPI Routine Schedule
Every Wednesday is designated as
immunization day and is adopted in all part of the
country

FIC Fully Immunized Child when a child receives

one dose of BCG, 3 doses of OPV, 3 doses of DPT,
3 doses of HepB and one dose of measles before a
childs first birthday.

Storage Temp.
Hours of Life after
opening

Most Sensitive to
Heat

OPV
Measles

-15 to -25 C At
the freezer
8 hours

Hepa B
Most Sensitive to
Cold
Sensitive to
Sunlight and
Fluorescent light
Fluorescent light

DPT
T. Toxoid
BCG

2 to 8 C Body
of refrigerator

4 hours

Vaccine can be stored in Refrigerator:

Regional - 6 months
Municipal / City - 3 months Main Health Center - 1 months
Transport Box : 5 days
Note: 3 trip in transport box with the same vaccine discard it
FEFO ( first expiry and first out ) vaccine is practiced to ensure that all vaccines are utilized before its expiry
date.
Proper arrangement of vaccines and labeling of vaccines expiry date are done to identify those near to expire
vaccines

EPI VACCINES
BCG (Bacille Calmette-Guerin ) Vaccine
Type of Vaccine
Form of Vaccine
Minimum Age at 1st Dose

Freeze dried
Birth or anytime at birth
st
Number of Doses to Complete 1nd dose : at birth
2 dose: school entrance
the Immunization
Reason

BCG given at earliest possible age protects the possibility of

TB meningitis and other TB infectious in which infants are
prone.
20 ( 20 children )

Number of Doses per Ampule

Dosage
At birth : 0.05 ml At school entrance : 0.10 ml
Route of Administration
Site of Administration
Storage Temperature

Special Precautions

Side Effect

Intradermal ( a special syringe and needle is used for the

administration of BCG vaccine )
Right deltoid region of the arm
2 C to 8 C ( in the body or refrigerator )
Note: Freezing does not damage it but ampules may break.
Diluents should also be kept cold before using
Correct ID administration is essential. A special syringe and
needle is used for the administration of BCG vaccine
A wheal formation
Koch phenomenon ( inflammatory reaction 2-4 days )

Undesired Effect

Indolent ulceration
Abscess on the injection site
Enlarged lymph nodes
Note: Swollen glands or abscesses occur because an
unsterile needle or syringe was used, too much vaccine was
injected or most commonly, the vaccine was injected
incorrectly under the skin instead of its top layer.
Contraindication

Health Teaching

Immunosuppressed indvidual due to malignant disease ( child

with clinical AIDS ) ; therapy with immunosuppressive agent or
radiation.

Do not massage the area of inj ection

A scar will formed 12 weeks after injection
Repeat BCG vaccination if the child does not develop
a scar after first injection

DPT (Diphteria-Pertussis-Tetanus ) Vaccine

Type of Vaccine
Diphteria and Tetanus as toxiods which is a weakened toxin
Pertussis as killed whole-cell bacterium
Form of Vaccine
Liquid vaccine
Minimum Age at 1st Dose
6 weeks
Number of Doses to Complete 3
the Immunization
Interval
4 weeks / minimum of 28 days
Reason
An early start with DPT reduces the chance of severe
pertussis
20 or 10
Number of Doses per Ampule
Dosage
0.5 ml
Route of Administration
Intramuscular
Site of Administration
Upper outer portion of the thigh ( Vastus lateralis ) in infant ( R
-L-R)
Outer upper arm if older
Storage Temperature
2 C to 8 C ( in the body of refrigerator )
Note: DT component is damage by freezing P component
is damage by heat
Special Precautions
DPT not usually given over 6 years of age
Side Effect
Fever in the evening after receiving the injection.
Soreness, children may have pain, redness or
swelling at the injection site.
Contraindication
DPT2 or DPT3 is not given to a child who has
convulsions or shock within 3 days after DPT1.
Vaccines containing the whole cell pertussis
component should not be given to a children with an
evolving neurological disease.
Health Teaching
If the child has fever give paracetamol or any
appropriate antipyretic at the time and at four and
eight hours after immunization.
Alternating cold compress for 24 hours to warm
compress if there is pain and soreness .

OPV ( Oral Polio Vaccine)

Type of Vaccine
Form of Vaccine
Minimum Age at 1st Dose

Live attenuated vaccine

Liquid vaccine
6 weeks
Number of Doses to Complete 3
the Immunization
Interval
4 weeks / minimum of 28 days
Reason
The extent of protection against polio is increased the earlier
the OPV is given
20 ( 10 children )
Number of Doses per Ampule
Dosage
2 drop
Route of Administration
Oral
Site of Administration
Mouth
Storage Temperature
-15 C to -25 C ( at the freezer )
Note: It is easily damaged by heat but is not harmed by
freezing.
Special Precautions
Children known to have rare congenital immune deficiency
syndrome should receive IPV ( injectable polio vaccine )
rather OPV
Side Effect
Causes almost no side-effects. Less than 1% of the people
who receive the vaccine develop a headache, diarrhea or
muscle pain.
Contraindication
None
Health Teaching
Nothing by mouth (NPO) 30 minutes before and after
OPV.
Do not touch the tip dropper bottle to the tongue.

Hepatitis B Vaccine

Type of Vaccine
Form of Vaccine
Minimum Age at 1st Dose
Number of Doses to Complete
the Immunization

Monovalent vaccine contain only one antigen

Cloudy liquid vaccine
At birth
3

Interval

6 weeks interval from 1st dose to 2nd dose 8 weeks interval

from 2nd dose to 3rd dose

Reason

Number of Doses per Ampule

Dosage
Route of Administration
Site of Administration
Storage Temperature
Special Precautions

Side Effect

An early start of Hep B vaccine reduces the chance of being

infected and becoming a carrier. Prevent liver cirrhosis and
liver cancer
1 for single dose vial
10 for multi dose vial ( 10 children )
0.5 ml
Intramuscular
Upper outer portion of the thigh ( Vastus lateralis ) in infant
( with DPT: L - R - L )
2 C to 8 C ( in the body of refrigerator )
Note: Both heat and freezing damages the vaccine )
Birth dose must be given if there is a risk of perinatal
transmission.
Note : Combination vaccines should not be given at birth, only
monovalent HepB vaccine

Mild fever that lasts one to two days after injection

Soreness, children may have pain, redness or
swelling at the injection site.

Contraindication
Anaphylactic reaction such as severe rashes, difficulty in
breathing and choking to a previous dose.
Health Teaching

Measles Vaccine

If the child has fever give paracetamol or any

appropriate antipyretic at the time and at four and
eight hours after immunization.
Alternating cold compress for 24 hours to warm
compress if there is pain and soreness .

Type of Vaccine

Attenuated Measles Virus

Form of Vaccine
Minimum Age at 1st Dose

Freeze dried
9 months
6 months: if there is an epidemic

Number of Doses to Complete 1

the Immunization
Reason
Measles vaccine given at 9 months provide at least 85%
protection against measles infection.
When given at one year and older provides 95% protection.
Note: An infant with known or suspected HIV infection should
receive measles vaccine at 6 months and then again at 9
months
10 ( 10 children )
Number of Doses per Ampule
Dosage
0.5 ml
Route of Administration
Subcutaneous
Site of Administration
Outer part of the upper arm
Storage Temperature
-15 C to -25 C ( at the freezer )
Note: But can also be safely stored between 0 C to 8C until
its expiry date.
Diluents should also be kept cold before using.
Special Precautions
Birth dose must be given if there is a risk of perinatal
transmission.
Note : Combination vaccines should not be given at birth, only
monovalent HepB vaccine
Side Effect

Contraindication

Health Teaching

Fever that lasts one to two days after injection

Soreness, children may have pain, redness or
swelling at the injection site within 24 hours of
immunization. It usually resolve within two to three
days.
About 1 in 20 children develop a mild rash five to 12
days after receiving the vaccine. The rash usually
lasts about two days.

Severe reaction to previous dose

Pregnancy
Congenital or acquired immune disorder

If the child has fever give paracetamol or any

appropriate antipyretic at the time and at four and
eight hours after immunization.
Alternating cold compress for 24 hours to warm
compress if there is pain and soreness .
It also prevent diarrhea

Immunization Schedule For Infants Recommended By The EPI

AGE
Birth

6 weeks

10 weeks

14 weeks

OPV

DPT

BCG

9 months

HepB Option B
Option A
Measles

X
X

X
X

X
X

EPI ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

VACCINE

1. BCG

TARGET

Anytime at
Birth

DOSAGE

0.05ml

INTERVAL

Once

ROUTE

SITE

Intradermal (ID)

Right Deltoid

Assess for
Wheal formation

Left
Deltoid

School
Entrance

0.1ml

2. Hepa B

Anytime
at Birth

0.5ml

6 wks. Interval
from 1st dose to
2nd dose, then 8
weeks interval
From 2nd to 3rd
dose

Intramuscular
(IM)

Upper outer
Portion of the thigh

3. DPT

6 wks. Up
to 11 mos.

0.5ml

4 weeks x 3
doses

Intramuscular
(IM)

Upper outer portion of

the thigh

4. OPV

6 wks. Up
to 11 mos.

2 drops

4 weeks x 3
doses

Oral

Mouth

(Child must be PO
for 30 mins.)

(side of the cheek)

9 months

0.5ml

Once

Subcutaneous
(SQ)

Outer
Part of the upper arm

5. Measles

(if
epidemic
crisis, 6
mos.)

Tetanus Toxoid (TeTox) Vaccine

Type of Vaccine
Form of Vaccine
Minimum Age at 1st Dose
Number of Doses to
Complete the Immunization

Weakened toxin
Liquid vaccine
As early as possible during pregnancy
5 doses ( TeTox 1 - TeTox 5 )
TeTox 2 is the minimum required immunization during
pregnancy
10 or 20

Number of Doses per Ampule

Dosage
0.5 ml
Route of Administration
Intramuscular
Site of Administration
Outer upper arm
Storage Temperature
2 C to 8 C ( in the body of refrigerator ) Note: Never freeze
Side Effect

Contraindication
Health Teaching

Fever in the evening after receiving the injection.

Soreness, woman may have pain, redness or swelling
and warmth at the injection site.

Anaphylactic reaction to previous dose

NO MEDICATION FOR PREGNANT

For Pain cold compress 24 hrs to warm compress

Tetox Routine Immunization of Pregnant Women

Vaccine

Minimum
Interval

Percent
Protected

Duration of Protection

As early as possible
during pregnancy
4 weeks after TeTox 1

80%

infant will be protected by neonatal

TeTox 1

TeTox 2

tetanus

3 years protection for the mother

TeTox 3

6 months after TeTox 2

95 %

infant will be protected by neonatal

tetanus

5 years protection for the mother

TeTox 4

1 year after TeTox 3

99 %

infant will be protected by neonatal

tetanus

10 years protection for the mother

TeTox 5

1 year after TeTox 4

99 %

all infant born to that mother will be

protected

lifetime protection for the mother