Community Health Nursing

EXPANDED PROGRAM ON IMMUNIZATION

Expanded Program on Immunization (EPI)

• EPI was established in 1976 to ensure that

infants/children and mothers have access to
routinely recommended infant/childhood vaccines
• Reducing the morbidity and mortality 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 2011
– R.A. 7846 provided for compulsory immunization
against hepatitis B for infants and children below 8
years old
Expanded Program on Immunization (EPI)
(continued)
• 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 (Office of the President, 1998).
4. To eliminate maternal and neonatal 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, pertussis, hepatitis B and German
measles.
6. 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 (Pentavalent
vaccine) 6 weeks, 10 weeks, 14 Anterolateral
weeks 0.74 ml. Intramuscular thigh muscle

6 weeks, 10 weeks, 14
Oral polio vaccine weeks 2 drops Oral Mouth

Anti- measles vaccine

(AMV1) 9-11 months 0.5 ml. Subcutaneous Outer part of
upper arm
Measles-mumps-rubella
vaccine 12-15 months 0.5 ml. Subcutaneous Outer part of
upper arm
Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml. Oral Mouth
VACCINES
 EPI Vaccines
Vaccine Contents Form
BCG (Bacillus Calmette- Live, attenuated bacteria Freeze-dried, reconstituted
Guerin) with a special diluent

RNA-recombinant, using Hepatitis B surface Cloudy, liquid, in an auto-

Hepatitis B vaccine antigen (HBs Ag) disable injection syringe if
available

Diphtheria toxoid, inactivated pertussis

DPT-HepB-Hib (Pentavalent bacteria, tetanus toxoid, recombinant DNA Liquid, in an auto-disable
vaccine) surface antigen, and synthetic conjugate of injection syringe
Haemophilus influenzae B bacilli

Oral polio vaccine Live, attenuated virus (trivalent) Clear, pinkish liquid
Anti- measles vaccine Live, attenuated virus Freeze-dried, reconstituted
(AMV1) with a special diluent
Measles-mumps-rubella Live, attenuated viruses Freeze-dried, reconstituted
vaccine (AMV2) with a special diluent
Clear, colorless liquid, in a
Rotavirus vaccine Live, attenuated virus container with an oral
applicator
Tetanus toxoid Weakened toxin Clear, colorless liquid
Maintaining the Potency of EPI Vaccines

To be potent, vaccines must be properly stored, 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 out (FEFO) policy
3. Comply with recommended duration of storage and 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 exposure
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
9. Protect OPV and Measles vaccine from heat
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:
– Pentavalent 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);
– Pentavalent vaccine 2 or 3/DPT 2 or DPT 3 to a child who has 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 AIDS or other
immune deficiency conditions or who are immunosuppressed
(DOH, 2003a).
 EPI Recording and Reporting

• Accomplished using the Field Health Service Information

System (FHSIS)
1. Fully immunized children (FIC)
a) BCG
b) 3 doses of OPV
c) 3 doses of DPT
d) hepatitis B vaccine or 3 doses of 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)
• is a term used to describe a child whose mother has received
a) 2 doses of tetanus toxoid during this pregnancy, provided that the
second dose was given at least a month prior to delivery, OR
b) at least 3 doses of tetanus toxoid anytime prior to pregnancy with this
child
Overview of Integrated Management Of
Childhood Illness (IMCI)

• (IMCI) strategy offers simple and effective

methods for child survival, healthy growth
and development and is based on the
combined delivery of essential interventions
at community, health facility and health
systems levels
• IMCI process includes preventive as well as
curative measures to address the most
common conditions that affect young
children
 IMCI Case Management

• IMCI clinical guidelines are meant to be

used by the health worker in the
management of sick children from age 1
week up to 5 years
• IMCI case management process involves the
following elements: ASSESS, CLASSIFY,
IDENTIFY, TREAT, COUNSEL and FOLLOW-UP
IMCI Process