Expanded Program on Immunization

(EPI)
 EPI was established in 1976
 Reducing the morbidity and mortali
mortality
ty among
children against the most common vaccine-
 preventable diseases
 Supporting Legislation:

 R.A. 10152, also known as Mandatory Infants and

Children Health Immunization Act of 20112011
 R.A. 7846 provided for compulsory immunization

against hepatitis B for infants and children below 8

years old
 

Specific Goals of EPI

1. To immunize all infants/children against the most common
vaccine-preventable diseases.
2. To sustain the polio-free status of the Philippines.
3. To eliminate measles infection. Presidential Proclamation
 No. 4, s. 1998 launched the Philippine Measles Elimination
Campaign
Campa ign (Office
(Office of the Presiden
President,
t, 1998
1998).
).
4. To eliminate maternal and neonatal tetanus.
tetanus . Presidential
 Proclamation No. 1066, s. 1997 declared a national neonatal
tetanus elimination campaign starting 1997 (Office of the
President, 1997).
5. To control diphtheria,
diphth eria, pertussis, hepatitis B and German

6.
measles.
To prevent extra pulmonary tuberculosis among children.
 

Immunization Schedule

Antigen Age Dose Route Site

Intradermal Right deltoid
BCG vaccine At birth 0.05 ml. region (arm)

Anterolateral
Hepatitis B vaccine At birth 0.5 ml. Intramuscular  
thigh muscle
DPT-HepB-Hib 6 weeks, 10 weeks, Anterolateral
(Penta
(Pentavale
valent
nt vacc
vaccine
ine)) 14 weeks 0.5 ml. Intramuscular  
thigh muscle

Oral polio vaccine 6

14weeks,
weeks10 weeks, 2 drops Oral Mouth

Anti-
Anti- mea
measles
sles vaccine
vaccine Outer part of
(AMV1) 9-11 months 0.5 ml. Subcutaneous
upper arm
Measles-mumps-
Outer part of
rubella vaccine 12-15 months 0.5 ml. Subcutaneous upper arm
(AMV2)
Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml. Oral Mouth
 

Side Effects and Adverse Reactions of

Immunization
Vaccines Side Effects Management
Koch’s phenomenon: an acute inflammatory reaction within 2 to 4
days after vaccination; usually indicates previous exposure to  No management
management is needed.
tuberculosis.
Deep abscess at vaccination site; almost invariably due to
Refer to the physician for incision and drainage.
BCG subcutaneous or deeper injection.
Indolent ulceration: an ulcer which persists after 12 weeks from
Treat with INH powder.
vaccination date.
Glandular enlargement: enlargement of lymph glands draining the
If suppuration occurs, treat as deep abscess.
injection site.
Hepatitis B
Local soreness at the injection site. No treatment is necessary.
vaccine
Fever that usually lasts for only 1 day. Fever beyond 24 hours is not
Advise mother to give antipyretic.
due to the vaccine but to other causes.
DPT-HepB- Reassure mother that soreness will disappear
Local soreness at the injection site.
Hib after 3 to 4 days.
(Pentavalent Abscess after a week or more usually indicates that the injection was
Incision and drainage may be necessary.
vaccine) not deep enough or the needle was not sterile.
Convulsions: although
although very rare, may oc
occur
cur inchildren older than 3 Proper management of convulsions; pertussis
months; caused
caused by pertussis vaccine. vaccine should not be given anymore.
OPV  None
Anti- mea
measles
sles Fever 5 to 7 day
dayss after vaccination in some children.
children. Sometimes, Reassure the mother and instruct her to give
vaccine there is a mild rash. antipyretic
antipyretic to the child.

MMR  Local soreness, fever, irritability, and malaise in some children. Reassure the mother and instruct her to give
antipyretic
antipyretic to the child.
 Rotavirus Some children develop mild vomiting and diarrhea, fever and Reassure the mother and instruct her to give
vaccine irritability. antipyretic
antipyretic and Oresol to the child.
Tetanus Apply cold compress at the site. No other
 

EPI Vacc
accin
ines
es
Vaccine Contents Form
BCG (Bacillus Calmette- Freeze-dried, reconstituted
Freeze-dried,
Live, attenuated bacteria
Guerin) with a special diluent

Cloudy, liquid, in an auto-

Cloudy,
RNA-recombinant, using Hepatitis B
RNA-recombinant,
Hepatitis B vaccine disable injection syringe if
surface antigen (HBs Ag)
available

Diphtheria toxoid, inactivated pertussis

DPT-HepB-Hib recombinant DNA Liquid, in an auto-disable
 bacteria, tetanus toxoid, recombinant
(Pentavale
(Pentavalent
nt vacci
vaccine)
ne) surface antigen, and synthetic conjugate of injection syringe
Haem
Ha emophi
ophilus
lus inf
influe
luenza
nzaee B bac
bacill
illii

Oral polio vaccine Live, attenuated virus (trivalent) Clear, pinkish liquid
Anti-
Anti- meas
measles
les vacci
vaccine
ne Freeze-dried, reconstituted
Freeze-dried,
Live, attenuated virus
(AMV1) with a special diluent
Measles-mumps-rubella Freeze-dried, reconstituted
Freeze-dried,
Live, attenuated viruses
vaccine (AMV2) with a special diluent

Clear,, colorless liquid, in a

Clear
Rotavirus vaccine Live, attenuated virus container
applicator with an oral
 Tetanus toxoid Weakened toxin Clear, colorless liquid

Contraindications to Immunization

 In general, there are no contraindications to immunization of a sick

child if the child is well enough to go home
 Absolute contraindications  –  DO NOT GIVE:
 Pentava
Pentavalent
lent vaccine/DPT
vaccine/DPT to
 children over 5 years of age (DOH, 2003a);

 a child with recurrent convulsions or another active neurological

disease of the central nervous system (WHO, 2005a);
 Pentava
Pentavalent
lent vaccine 2 or 3/DPT
3/DPT 2 or DPT 3 to a child who hahass had
convulsions or shock within 3 days of the most recent dose (WHO,
2005a);
 Rotavirus vaccine when the child has a history of hypersensitivity to a
 previous dose of the vaccine, intussusceptions or intestinal
malformation, or acute gastroenteritis (DOH, 2012b); and
 BCG to a child who has signs and symptoms of AI AIDS
DS or other immune
deficiency
deficiency conditions
conditions or who are immunosuppresse
immunosuppressed
d (DOH,
(DOH, 2003a).
 

Target Setting and Vaccine

Requirement
 Vaccine requirement is calculated based on target
population size.
 The nurse uses the following
following formulas to estimate
target population size:
 Estimated number of infants = total population x
2.7%;

 Estimated number of 12-59 month-old children =

total population x 10.8%; and
 Estimated number of pregnant women = total
population x 3.5%.
 

Maintaining the Potency of EPI Vaccines

To be potent, vaccines must be properly stored,

stor ed, handled and transported
1. Maintain the Cold Chain
 The cold chain is a system for ensuring the potency of a vaccine from the time of
manufacture to the time it is given to an eligible client
 In RHU, PHN is the Cold Chain Officer
2. Observe the first expiry-first
expiry-first out (FEFO) policy
3. Comply with recommended duration of storage and transport
transport
4. Take note if the vaccine container has a vaccine vial monitor (VVM) and act
accordingly.
 The VVM is a round disc of heat-sensitive material placed on a vaccine vial to
register cumulative heat exposu
exposure
re
5. Abide by the open-vial policy of the DOH
6. Reconstitute freeze-dried vaccines ONLY with the diluents supplied with them
7. Discard reconstituted freeze-dried vaccines six hours after reconstitution or at
the end of the immunization session, whichever comes sooner
 8. Protect BCG and Rotavirus vaccine from sunlight

> Transport: Tools: Vaccine carriers:

carrier s: Cold
Co ld
dogs
Black  – 5 cold dogs
White  – 4 cold dogs
Cold Chain Box :
 

EPI Recording and Reporting

 Accomplished using the Field Health Service Information System (FHSIS)
1. (FIC)
Fully immunized children (FIC)
a) BCG
b) 3 doses of OPV
c) 3 doses of DPT
d) hepatitis B vaccine
vaccine or 3 doses of Pentavalent
Pentavalent vaccine
e) one dose of anti-measles vaccine before reaching one year of age
2. Completely immunized children
 completed their immunization schedule at the age of 12 to 23 months
3.
Child protected at birth (CPAB))
bir th (CPAB
 is a term used to describe a cchild
hild whose mother has received
a) 2 doses of tetanus toxoid
toxoid during this pregnancy
pregnancy,, provided that the
second dose was given at least a month prior to delivery, OR
b) at least 3 doses of tetanus tox
toxoid
oid anytime prior to pregnancy with this
child