EXPANDED PROGRAM ON IMMUNIZATION

The expanded program on immunization was launch in July 1976 by the department of health
in cooperation with the World Health Organization and the UNICEF.

Goal: To achieve the overall EPI goal of reducing the morbidity and mortality among children
against the most common vaccine-preventable diseases.

Laws related to Expanded Program on Immunization:

Presidential Decree 996 – the first law on Expanded Program on Immunization. It has the
original objective of reducing the morbidity and mortality among infants and children caused by
the seven childhood immunizable diseases.

Republic Act 10152 – also known as Mandatory Infants and Children Health Immunization
Act of 2011. It mandates basic immunization covering the vaccine preventable diseases. It
added the vaccines for mumps, hepatitis B, rubella, diseases caused by Haemophilus influenza
type B (Hib) and other diseases determined by the Department of Health (DOH) Secretary. This
law repealed PD 996.

Republic Act 7846 - compulsory immunization against hepatitis B for infants and children
below 8 years old. It also stated that Hepatitis B vaccine within 24 hours after birth of babies
from mothers with hepatitis B.

Specific goals:
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
4. To eliminate maternal and neonatal tetanus
5. To control diphtheria, pertussis, hepatitis B and German measles
6. To prevent extrapulmonary TB among children

Principles:
1. The program based on the epidemiological situation
2. The whole community rather than just the individual is to be protected, thus mass approach is
utilized
3. Immunization is a basic health service and such it is integrated in to the health services being
provided for by the Rural health Unit

Elements:
1. Target setting
2. Cold chain logistic management
3. Information, education and communication
4. Assessment and evaluation of the program’s overall performance
5. Surveillance, studies and research

Importance of vaccination:
1. Immunization is the process by which vaccines are introduced into the body before infection
sets in.
2. Vaccines are administered to promote immunity and to protect the children from disease-
causing agents

Schedule and manner of administration of infant immunization (EPI, Philippines)

ANTIGEN AGE DOSE ROUTE SITE
BCG At birth 0.05 ml ID (wheal, RIGHT deltoid
induration
 School-age 0.10 ml ID LEFT deltoid
Hepa B At birth, 6 weeks, 8weeks 0.5 ml IM Vastus lateralis
DPT-HepB-HiB 6 wks, 10 wks, 14 wks 0.5 ml IM Vastus lateralis
OPV (Sabin) 6 wks, 10 wks, 14 wks 2 gtts Oral Mouth
*IPV (Salk)
AMV 9-11 months 0.5 ml SQ Outer part of upper arm
MMR 12-15 months 0.5 ml SQ Outer part of upper arm
Rotavirus 6 weeks, 10 weeks 1.5 ml Oral Mouth

Side effect of vaccination and their management (EPI, Philippines)

Vaccines Side effects Management
BCG KOCH’S PHENOMENON No management
- Acute inflammatory reaction
DEEP ABSCESS AT VACCINATION SITE OR LYMPH NODES Incision and Drainage
INDOLENT ULCERATIONS INH powder
-Persists after 12 weeks
Ulcer more than 10 mm
GLANDULAR ENLARGEMENT Treat as deep abscess
HEPATITIS B LOCAL SORENESS No treatment is
Within 24 hours necessary
DPT-HepB-Hib FEVER Antipyretic
(Pentavalent) -usually one day TSB
LOCAL SORENESS No treatment
- At injection site 3-4 days
ABSCESS I and D
- An abscess that appear a week or more after is due to
wrong technique
CONVULSIONS Proper management
-very rare; 3 months of age Do not continue normal
course
OPV Usually none
AMV FEVER AND RASH Antipyretics
5-7 days after (1 week) TSB
MMR Local soreness, fever, irritability, malaise Antipyretics
Rotavirus Some children develop mild vomiting and diarrhea, fever Antipyretics
and irritability Oresol
Tetanus toxoid Local soreness at the injection site Apply cold compress on
site
No other treatment

Important considerations:

 Use only one sterile syringe per client.

 No need to restart a series of vaccination regardless of time or doses that have been missed in
between.
 All the EPI antigens are safe and effective when administered simultaneously, that is, during the
same immunization schedule but at different sites. However, it is not recommended to mix
vaccines in a single syringe. Moreover, if the site is of the same limb, the sites should be at
least 2.5-5 cm apart.
 OPV followed by Rotavirus vaccine and then other appropriate vaccines.
OPV is administered with a dropper. Do not let the dropper touch the child’s tongue.
 Only monovalent hepatitis B vaccine must be used for birth dose. Pentavalent vaccine must not
be used because DPT and Hib vaccine should not be administered at birth.
 In case, children who did not receive AMV1 or if the parent/caregiver forgets if the child
received such, AMV1 shall be given as soon as possible, followed by AMV2 one month after.
 All children entering day care centers/pre-school and Grade 1 shall be screened for measles
immunization. Children without vaccines shall be referred to nearest health facility.
 The first dose of Rotavirus vaccine is administered only to infants aged 6 weeks to 15 weeks.
Second dose is given only to infants aged 10 weeks up to a maximum of 32 weeks.
Vaccines, contents, form, exposure to heat and storage temperature
VACCINE CONTENTS FORM CONDITIONS STORAGE
WHEN EXPOSED TEMPERATURE
TO HEAT
BCG Live, attenuated, Freeze dried, Destroyed 0
2 to 8 C
bacteria reconstituted with
special diluent
Hepatitis B RNA-recombinant, Cloudy, liquid, in an Damaged by heat 0
2 to 8 C
vaccine using Hepatitis B auto-disable injection or freezing
surface antigen syringe if available
(HBs Ag)
DPT-HepB-Hib D-weakened toxin Liquid, in an auto- D-by heat/freeze 0
2 to 8 C
(Pentavalent P-inactivated disable injection
vaccine) bacteria syringe
T-weakened toxin
Recombinant DNA
surface antigen
Synthetic conjugate
of HiB bacilli
OPV Live, attenuated Liquid Easily destroyed by 0C
-15 to -25
virus heat, not by
freezing
AMV (AMV1) Live, attenuated Freeze dried, Easily destroyed by 0C
-15 to -25
virus reconstituted heat, not by
freezing
MMR (AMV2) Live, attenuated Freeze dried, Destroyed 0
2 to 8 C
virus reconstituted
Rotavirus Live, attenuated Liquid Destroyed 0
2 to 8 C
virus
TT Liquid Damaged by heat 0
2 to 8 C
or freezing

COLD CHAIN
 System used to maintain the potency of a vaccine from the time of manufacture to time it is
given

COLD CHAIN OFFICER

 Person directly responsible for cold chain management at each level is called Cold Chain officer.
At the RHU/health center, the public health nurse acts as the Cold Chain Officer.
 The officer is in charge of maintaining the cold chain equipment and supplies

** Please refer to the table above for the specific temperatures to maintain the potency of the
vaccines

Considerations to maintain potency:

1. Storage of vaccines should NOT exceed:
 6 months at regional
 3 months at provincial
 1 month at main health centers*
 Not more than 5 days at health centers
2. Use of boxes/carriers in transport
3. Observe the first expiry-first out (FEFO) policy
4. Reconstitute freeze-dried vaccines such as BCG, AMV, and MMR only with the diluents supplied
with them
5. Discard reconstituted freeze-dried vaccines 6 hours after reconstitution or at the end of the
immunization session, whichever comes sooner.
 6. Protect BCG from sunlight and Rotavirus from light.

Contraindications to immunization:
 There are no general contraindications to immunization of a sick child if the child is well enough
to be sent home.

Few absolute contraindications:

Do not give:
 Pentavalent vaccine/DPT to children over 5 years of age
Pentavalent vaccine/DPT to a child with recurrent convulsions or another active neurological
disease of the central nervous system
Pentavalent 2 or 3/DPT 2 or 3 to a child who has had convulsions or shock within 3 days of the
most recent dose.
 Rotavirus vaccine when the child has a history of hypersensitivity to a previous dose of the
vaccine, intussusceptions or intestinal malformation or acute gastroenteritis.
 BCG to a child who has signs and symptoms of AIDS or other immune deficiency conditions or
who are immunosuppressed.

False contraindications:
 Malnutrition: it is in fact, an indication
 Low-grade fever
Mild respiratory infection
 Diarrhea: Children with diarrhea and is scheduled for OPV, should receive one – but is not
counted. The child should return when the next dose of OPV is due.

EPI recording and reporting

 Fully immunized child (FIC) - who were given one dose of BCG, three doses of OPV, three doses
DPT and hepatitis B vaccine or three doses Pentavalent vaccine, and one dose anti-measles
vaccine before reaching one year old
 Completely immunized child (CIC) – refer to children who completed their immunization
schedule at the age of 12-23 months
 Child protected at birth (CPAB) – a term used to describe a child whose mother has received:
two doses of TT during this pregnancy, provided that the second dose was given at least a
month prior to the delivery; or at least three doses of TT anytime prior to pregnancy with this
child