EXPANDED
PROGRAM ON
IMMUNIZATION
EXPANDED PROGRAM ON IMMUNIZATION
This was launched in July 1976 by
the Department of Health in
cooperation with the World Health
Organization and the UNICEF
OBJECTIVE:
To reduce the morbidity and
mortality among infants and
children caused by the seven
immunizable diseases
THE EPI TARGET
DISEASES
MEASLES
TUBERCULOSIS
DIPHTHERIA
PERTUSSIS
POLIOMYELITIS
NEONATAL TETANUS
HEPATITIS B
LEGAL BASIS
PD No. 996 (September 16, 1976)
Providing for compulsory basic
immunization for infants and
children below eight years old
RA 7846 (December 30, 1994)
An Act requiring for the
compulsory immunization against
hepatitis B for infants and children
below eight years old
PRINCIPLES OF EPI
- ased on epidemiological situation
- ass approach is utilized
- mmunization is a basic health
service
ELEMENTS OF EPI
Target-setting
e
Information, education and
communication
Cold chain logistics and
management
Assessment and evaluation of the
program’s overall performance
Surveillance, studies and research
GENERAL
PRINCIPLES
ON
IMMUNIZATION
It is safe and
immunologically effective
to administer EPI vaccines
on the same day at
different sites of the body
Measles vaccine should be
given as soon as the child is 9
months old, regardless of
whether other vaccines will be
given on that day
The vaccination schedule
should not be restarted from
the beginning even if the
interval between doses
exceeded the recommended
interval by months or years
FALSE CONTRAINDICATIONS
TO VACCINATION
Moderate fever
Malnutrition
Mild respiratory infection
Cough
Diarrhea
Vomiting
It is safe to have mild side
effects after vaccination.
Local reaction, fever and
systemic symptoms can
result as part of the normal
immune response
Strictly follow the principle
of never, ever
reconstituting the freeze
dried vaccines in anything
other then the diluent
supplied with them
Use one syringe,
one needle per
child during
vaccination.
FULLY IMMUNIZED CHILD
One dose of BCG
3 doses of OPV
3 doses of DPT
3 doses of Hepatitis B
One dose of Measles
Before the child’s first birthday
EPI VACCINES AND
ITS CHARACTERISTICS
Types/Form of Storage
Vaccines Temperature
Most Oral polio vaccine -15°C to -25°C
sensitive to
heat (live attenuated) (at the freezer)
(OPV) Measles (freeze
dried)
Least DPT +2°C to +8°C
Sensitive
to heat Hepatitis B (body of the
refrigerator)
(TT) BCG (freeze dried)
Tetanus Toxoid
PROPER STORAGE: store vaccines
in refrigerators
DURATION:
RHO 3° Given 6 months
MHO / PHO 2° Given 3 months
BHS / RHU 1° Given 1 month
ADMINISTRATION OF
VACCINES
BCG VACCINE
Age
At birth
Dosage
0.05 cc
Route
Intradermal
Site
Right deltoid
BCG VACCINE
Age
School
entrants
Dosage
0.1 cc
Route
Intradermal
Site
Left deltoid
Wheal
Soreness and inflammation
Abscess
Ulceration
Scar
KOCH’S PHENOMENON
Acute
inflammatory
reaction
Appears within 2-
4 days of
vaccination
Not serious and
disappears rapidly
COMPLICATIONS OF BCG VACCINATION
DEEP ABSCESS – due to
injecting the vaccine too
deeply
EXCESSIVE ULCERATION –
ulcer present for more
than 12 weeks and more
than 10 mm in diameter
GLANDULAR
ENLARGEMENT – glands
draining at injection site
may enlarge
KELOID – thickened
protruding scar
Repeat BCG
vaccination if the
child does not
develop a scar after
the 1 injection.
st
Live vaccines like BCG
vaccine must not be
given to individuals who
are immunosuppressed
due to malignant
disease.
ORAL POLIO VACCINE
Age
6 – 10 – 14 weeks
Dosage
2 gtts
Route
Per orem
Site
Mouth
ORAL POLIO VACCINE
Only vaccine with
no side-effects
Instruct mother to
keep the child on
NPO for 30 minutes
after OPV
administration
If child spits it out,
give another dose
HEPATITIS B VACCINE
Age
0 – 6 – 14 weeks
Dosage
0.5 cc
Route
Intramuscular
Site
Thigh
HEPATITIS B VACCINE
Side-effects:
Soreness and
inflammation
Management:
Paracetamol RTC
DPT VACCINE
Age
6 – 10 – 14 weeks
Dosage
0.5 cc
Route
Intramuscular
Site
Thigh
DPT VACCINE
Side-effects: Fever
Management:
Paracetamol RTC
DPT 2 is
contraindicated for
a child who has
had convulsions
within 3 days of the
1st DPT dose
Giving doses of a vaccine
at less than the
recommended 4 weeks
interval may lessen the
antibody levels
Lengthening the interval
between doses of vaccines
leads to higher antibody
levels
MEASLES VACCINE
Age
9 months
Dosage
0.5 cc
Route
Subcutaneous
Site
Deltoid
MEASLES VACCINE
Side-effects:
Fever and mild
rashes
Management:
Paracetamol RTC
(fever);
Diphenhydramine
(rashes)
Let’s integrate!
SITE OF INJECTION
BCG
DPT
OPV
Hepa B
Measles
Tetanus
SITE OF INJECTION
BCG
DPT
OPV
Hepa B
Measles
Tetanus
SITE OF INJECTION
BCG
DPT
OPV
Hepa B
Measles
Tetanus
ROUTE OF INJECTION
BCG
DPT
OPV
Hepa B
Measles
Tetanus
ROUTE OF INJECTION
BCG
DPT
OPV
Hepa B
Measles
Tetanus
ROUTE OF INJECTION
BCG
DPT
OPV
Hepa B
Measles
Tetanus
DOSAGE
BCG
DPT
OPV 0.1 cc
Hepa B
Measles
Tetanus
DOSAGE
BCG
DPT
OPV
Hepa B
Measles
0.5 cc
Tetanus
MOST SENSITIVE TO HEAT
BCG
DPT
OPV
Hepa B
Measles
Tetanus
LEAST SENSITIVE TO HEAT
BCG
DPT
OPV
Hepa B
Measles
Tetanus
NUTRITION
PROGRAM FOR
FILIPINOS
GOAL:
Improve quality of
life of Filipinos
through better
nutrition, improved
health and
increased
productivity
MALNUTRITION
It is a
pathological
state resulting
from a relative or
absolute
deficiency or
excess of one or
more essential
nutrients
CAUSES OF MALNUTRITION
Non-breastfeeding or
early weaning
Dependence on artificial
feeding
Absence of or
inadequate
complementary feeding
Lack of or inadequate
skill in managing diarrhea
at home
MARASMUS
Muscle wasting due to
starvation
Extreme malnutrition
and emaciation
(especially among
children) from
inadequate intake of
food or malnutrition
Due to a diet with a
deficiency in protein
and carbohydrates
MARASMUS
More frequent in
children younger
than 5 years
Can occur across
all age groups
Causes: infection,
nutrition and socio-
economic factors
SIGNS AND SYMPTOMS
Old man’s face
Shrunken wasted
appearance
Extreme growth
failure
Marked wasting of
muscles and
subcutaneous fat
Apathy (children
seem to let
themselves die)
KWASHIORKOR
Diseases that occur
when the first child is
displaced from the
breast by another child
Due to a diet which is
very low in protein
It is not starvation but is
due to an imbalanced
diet
Common among
toddlers, 1 to 3 years old
KWASHIORKOR
Occurs most
commonly in:
Areas of famine
Limited food supply
Low levels of
education
Inadequate
knowledge of proper
diet
SIGNS AND SYMPTOMS
Moon face
Facial edema
Protuberant
belly
Growth failure
Irritability
Lethargy or
apathy
SIGNS AND SYMPTOMS
Hair: changes
from black to
brown, or brown
to yellow, thinning
and brittle
Dermatosis,
dryness of skin and
desquamation
INTERVENTIONS TO PREVENT OR CONTROL
MALNUTRITION
Regular
complementary
feeding of protein
powders
Appropriate
home
management for
diarrhea
MICRONUTRIENT SUPPLEMENTATION
One of the interventions to:
Address the health and nutritional
needs of infants and children
Improve their growth and survival
Araw ng Sangkap Pinoy (ASAP) –
Garantisadong Pambata (GP)
-(twice-a-year distribution of
Vitamin A capsules)
FOOD FORTIFICATION
Food Fortification Act of 2000
Mandatory fortification of staple
food:
Flour (Iron and Vitamin A)
Cooking oil (Vitamin A)
Refined sugar (Vitamin A)
Rice (Iron)
Sangkap Pinoy Seal
Voluntary fortification of
processed foods
COMMON NUTRITIONAL
DISEASES
Vitamin A
Iron
Iodine
XEROPHTHALMIA
SIGNS AND
SYMPTOMS:
Mild irritation of
the eye
Foreign body
sensation
Sensitivity to light
Difficulty seeing
at night
TREATMENT OF VITAMIN A DEFICIENCY
INFANTS PRE-SCHOOLERS
SCHEDULE 12-83 MONTHS
6-11 MONTHS
GIVE TODAY 100, 000 IU 200, 000 IU
GIVE 100, 000 IU 200, 000 IU
TOMORROW
GIVE AFTER 100, 000 IU 200, 000 IU
TWO WEEKS
IRON DEFICIENCY ANEMIA
IRON SUPPLEMENTATION for pre-school and
school children
Target Preparation Dose/duration
Children 1-5 Syrup • 1 tbsp OD for 3
years old containing 30 months
mg elemental • 30 mg once a
iron / 5 ml week for 6
months
Children 6-11 Syrup • 2 tbsp once a
years old who containing 30 day for 6
are anemic mg elemental months
and iron / 5 ml
underweight
IRON SUPPLEMENTATION
Target Preparation Dose/duration
Adolescent Tablet with 60 • One tablet OD
Girls (10-19 mg elemental
years old) iron with 400
mcg folic acid
Older persons Tablet with 60 • One tablet OD
mg elemental
iron with 400
mcg folic acid
IODINE DEFICIENCY (GOITER)
IODINE SUPPLEMENTATION
Target Preparation Dose/durati
on
Women 15- Iodized oil 1 capsule
45 years old capsule with for 1 year
Children of 200 mg
school age iodine
Adult males
ENVIRONMENTAL
HEALTH AND SANITATION
ENVIRONMENTAL HEALTH
Branch of public health
that deals with the study
of preventing illnesses by
managing the
environment and
changing people’s
behavior to reduce
exposure to biological
and non-biological agents
of disease and injury
ENVIRONMENTAL SANITATION
The study of all factors
in man’s physical
environment, which
may exercise a
deleterious effect on
his health, well-being
and survival
IMPORTANCE OF ENVIRONMENTAL
SANITATION
It promotes health
It prevents disease
transmission
It eliminates
breeding places of
insects and
rodents that carry
the germs
ENVIRONMENTAL SANITATION
Water Supply Sanitation
Solid Waste
Management
Food Sanitation
Insect and Vermin
Control
Excreta and Sewerage
Disposal
Housing and Public
Places Sanitation
Environmental Protection
ENVIRONMENTAL AND OCCUPATIONAL HEALTH OFFICE
(EOHO)
Under the National Center
for Disease Prevention and
Control Program of the DOH
Responsible for the
promotion of healthy
environmental conditions
and prevention of
environmental related
diseases through
appropriate sanitation
strategies
STRATEGIES
Water quality
surveillance
Evaluation of food
establishments
Proper solid and liquid
waste management
Sanitation of public
places
Sanitation management
of disaster areas
Diarrheal diseases: ranked
first in the leading causes of
morbidity among the general
population
SANITATION-RELATED
DISEASES
Tuberculosis
Intestinal parasitism
Schistosomiasis
Malaria
Dengue
Filariasis
APPROVED TYPES
OF WATER SUPPLY
FACILITY
LEVEL 1 – POINT SOURCE
- Protected well/spring
with an outlet without
distribution system
- Serves around 15 to 25
households
- Should not be more than
250 meters from its
farthest user
- Yield or discharge from
40 to 140 liters per
minute
LEVEL 2 – COMMUNAL FAUCET SYSTEM /
STAND POSTS
- Composed of a source,
a reservoir, a piped
distribution network and
communal faucets
- Located not more than
25 meters from farthest
house
- Average of 100
households, with one
faucet per 4 to 6
household
LEVEL 3 – WATERWORKS SYSTEM / INDIVIDUAL
HOUSE CONNECTIONS
- A system with a
source, a reservoir,
a piped distribution
network and
household taps
- Suited for densely
populated urban
areas
UNAPPROVED TYPES OF WATER
SUPPLY
Open dug
wells
Unimproved
springs
Wells that
need priming
DISINFECTION OF WATER SUPPLY SOURCES ARE REQUIRED
ON THE FOLLOWING:
Newly constructed water supply
facilities
Water supply facility that has been
repaired/improved
Water supply sources found to be
positive bacteriologically by
laboratory analysis
Container disinfection of drinking
water collected from a water facility
that is subject to recontamination
like open dug wells, unimproved
springs and surface water
METHOD OF WATER DISINFECTION
Boiling: minimum of 3 minutes
to maximum of 10 minutes,
average 5 minutes
Sterilization: 30 minutes after
water starts to boil
Filtration: use of filter paper or
cotton cloth to separate solid
particle from liquid water
METHOD OF WATER DISINFECTION
Coagulation/Flocculation: uses
aluminum crystal that collects or
absorbs particles from the liquid
part and becomes slimy
Chlorination: use 100% pure
concentrated chlorine
Flouridation: adding flouride to
prevent dental caries and whitens
enamel of teeth
SAFETY OF DRINKING WATER
Rural Sanitary Inspector: permit
for deep well construction
Secretary of Health (or his
representative): certification of
potability of an existing water
source
Sanitary Engineer: examination
of drinking water
APPROVED TYPES
OF TOILET FACILITY
LEVEL 1
Non water carriage
toilet facility
Ex. Pit latrines, reed
odorless earth closet
Toilets requiring
small amt of water
Ex. Pour flush, aqua
privies
LEVEL 2
Water-
sealed
Flush type
Septic
vault/Tank
disposal
LEVEL 3
Water carriage
types of toilet
facilities
Connected to
septic tanks
Connected to
sewerage system
or treatment plants
