EXPANDED PROGRAM ON IMMUNIZATION Concept and Importance of Vaccination

1
Immunization - is the process by which vaccines are introduced
The Expanded Program on Immunization (EPI) was established in into the body before infection sets in.
the Philippines by Pres. Marcos on the month of July, 1976, to • Vaccines are administered to introduced immunity thereby
ensure that infants/children and mothers have access to routinely causing the recipient’s immune system to react to the vaccine that
recommended infant/childhood vaccines. produces antibodies to fight infection.
• Vaccinations promote health and protect children from
With the commitment of our country to Universal Child disease - causing agents.
Immunization (UCI) goal, acceleration of EPI coverage had began • Infants and newborn need to be vaccinated at an early
in 1986 age since they belong to vulnerable age group.

PD 996 : “ Providing for compulsory basic immunization for infants General Principles in Vaccinating Children
and children below 8 years old • It is safe and immunologically effective to administer all
EPI vaccines on the same day at different sites of the body.
Objective:
• The vaccination schedule should not be restarted from the
To reduce the morbidity and mortality among infants and
children caused by the seven childhood immunizable diseases. beginning even if the interval between doses exceeded the
recommended interval by months or year.
Seven (7) Childhood Immunizable Diseases • Giving doses of a vaccine at less than the recommended 4
• Tuberculosis ( Primary Complex if less than 3 years old ) weeks interval may lessen the antibody response. Lengthening
• Diphteria the interval between doses of vaccines leads to higher antibody
• Pertussis DPT levels.
• Neonatal Tetanus • No extra doses must be given to children who missed a
• Poliomyelitis dose of DPT/HB/OPV. The vaccination must be continued
• Hepatitis B as if no time had elapsed between doses.
• Measles • 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
Four Major Strategies correct intervals.
• Sustaining high routine FIC coverage of at least 90% in all provinces • Strictly follow the principle of never, ever reconstituting the
and cities. freeze dried vaccine in anything other than the diluent supplied
• Sustaining the polio free country for global certification. with them.
• Eliminating measles by 2008 • If you are giving more than one vaccine, do not use the
• Eliminating neonatal tetanus by 2008 same syringe and do not use the same arm or leg for more than
one injection.
Elements of EPI • False contraindications to immunization are children with
• Target Setting (main element) malnutrition, low grade fever, mild respiratory infections
• Information, Education and Communication and other minor illnesses and diarrhea should not be
• Cold chain logistic management considered a contraindication to OPV vaccination.
• Assessment and Evaluation of overall performance Repeat BCG vaccination if the child does not develop a scar after
the 1st injection.
• Surveillance, Studies and Research
Contraindication to Immunization
• Anaphylaxis or severe hypersensitivity reaction to a previous dose of Note:
vaccine is an absolute contraindication to subsequent doses of If parent strongly objects to an immunization for a sick
vaccine infant, do not give it. Ask the mother to comeback when child
is well.
• Person with a known allergy to a vaccine component should not be
vaccinated.
EPI Routine Schedule
• DPT2 or DPT3 is not given to a child who has convulsions or shock Every Wednesday is designated as immunization day and is
within 3 days after DPT1. Vaccines containing the whole cell pertussis
adopted in all part of the country
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) , FIC “Fully Immunized Child” when a child receives one dose of BCG,
going therapy with immunosuppressive agents or radiation. 3 doses of OPV, 3 doses of DPT, 3 doses of HepB and one dose of
• A child with a sign and symptoms of severe dehydration measles before a child’s first birthday.
• 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, kidney or liver
• Stable neurological condition such as cerebral palsy or Down’s
Syndrome
• Premature or low birthweight (vaccination should not be
postponed)
• Recent or imminent surgery
• Malnutrition
• History of jaundice at birth
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Type of Vaccine Storage Temp.

Hours of Life after
opening

OPV
Most Sensitive to -15 to -25 C At
Heat Measles the freezer

Hepa B 8 hours

DPT
Most Sensitive to 2 to 8 C Body
Cold T. Toxoid of refrigerator
Sensitive to 4 hours
Sunlight and BCG
Fluorescent light
Fluorescent light

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
 1
EPI VACCINES
BCG (Bacille Calmette-Guerin ) Vaccine
Type of Vaccine
Form of Vaccine Freeze dried
st
Minimum Age at 1 Dose Birth or anytime at birth
Number of Doses to Complete 1st dose : at birth
Live Bacterial
the Immunization 2nd dose: school entrance
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 Intradermal ( a special syringe and needle is used for the
administration of BCG vaccine )
Site of Administration Right deltoid region of the arm
Storage Temperature

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
Special Precautions Correct ID administration is essential. A special syringe and
needle is used for the administration of BCG vaccine

Side Effect 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
Immunosuppressed indvidual due to malignant disease ( child
with clinical AIDS ) ; therapy with immunosuppressive agent
or radiation.
Health Teaching
• 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 Live attenuated vaccine
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 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 “Monovalent vaccine” contain only one antigen

Form of Vaccine Cloudy liquid vaccine
Minimum Age at 1st Dose At birth
Number of Doses to Complete 3
the Immunization
Interval 6 weeks interval from 1st dose to 2nd dose 8 weeks interval
from 2nd dose to 3rd dose
Reason
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
Number of Doses per Ampule 10 for multi dose vial ( 10 children )
Dosage 0.5 ml
Route of Administration Intramuscular
Site of Administration Upper outer portion of the thigh ( Vastus lateralis ) in infant (
with DPT: L - R - L )
Storage Temperature 2 C to 8 C ( in the body of refrigerator )
Note: Both heat and freezing damages the vaccine )
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
• 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
• 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 .
Measles Vaccine
Type of Vaccine Attenuated Measles Virus
Form of Vaccine Freeze dried
Minimum Age at 1st Dose 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

• 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.
Contraindication
• Severe reaction to previous dose
• Pregnancy
• Congenital or acquired immune disorder
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 .
• It also prevent diarrhea
 Immunization Schedule For Infants Recommended By The EPI
AGE

Birth 6 weeks 10 weeks 14 weeks 9 months

BCG X

OPV X X X

DPT X X X

HepB Option B X X X

Option A X X X

Measles X
EPI ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

VACCINE TARGET DOSAGE INTERVAL ROUTE SITE

1. BCG Anytime at 0.05ml Once Intradermal (ID) Right Deltoid

Birth
Assess for Left
Wheal formation
School 0.1ml Deltoid
Entrance

2. Hepa B Anytime 0.5ml 6 wks. Interval Intramuscular Upper outer

at Birth from 1st dose to (IM) Portion of the thigh
2nd dose, then 8
weeks interval
From 2nd to 3rd
dose

3. DPT 6 wks. Up 0.5ml 4 weeks x 3 Intramuscular Upper outer portion of

to 11 mos. doses (IM) the thigh

4. OPV 6 wks. Up 2 drops 4 weeks x 3 Oral Mouth

to 11 mos. doses (Child must be PO (side of the cheek)
for 30 mins.)

5. Measles 9 months 0.5ml Once Subcutaneous Outer

(SQ) Part of the upper arm
(if
epidemic
crisis, 6
mos.)
 Tetanus Toxoid (TeTox) Vaccine

Type of Vaccine Weakened toxin

Form of Vaccine Liquid vaccine
Minimum Age at 1st Dose As early as possible during pregnancy
Number of Doses to 5 doses ( TeTox 1 - TeTox 5 )
Complete the Immunization 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
• Fever in the evening after receiving the injection.
• Soreness, woman may have pain, redness or swelling and
warmth at the injection site.
Contraindication • Anaphylactic reaction to previous dose
Health Teaching
• NO MEDICATION FOR PREGNANT
• For Pain cold compress 24 hrs to warm compress

Tetox Routine Immunization of Pregnant Women

Vaccine Minimum Percent Duration of Protection
Interval Protected
TeTox 1
As early as possible
during pregnancy
TeTox 2 4 weeks after TeTox 1 80%
• infant will be protected by neonatal
tetanus
• 3 years protection for the mother
TeTox 3 6 months after TeTox 95 %
2 • 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