EXPANDED PROGRAM ON IMMUNIZATION

Rationale
The Expanded Program on Immunization (EPI) was established in 1976 to ensure that infants/children
and mothers have access to routinely recommended infant/childhood vaccines.
Six vaccine-preventable diseases were initially included in the EPI:
tuberculosis,
poliomyelitis,
diphtheria,
tetanus,
pertussis and
measles.
Program Objectives/Goals:
Over-all Goal:
To reduce the morbidity and mortality among children against the most common vaccine-preventable
diseases.
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 extra pulmonary tuberculosis among children.

Mandates
Republic Act No. 10152 “Mandatory Infants and Children Health Immunization Act of 2011 Signed by
President Benigno Aquino III in July 26, 2010. The mandate includes basic immunization for children
under 5 including other types that will be determined by the Secretary of Health.
PD 996 – Compulsory Basic Immunization to all Children before reaching 8 years old

Strategies:
Conduct of Routine Immunization for Infants/Children/Women through the Reaching Every Barangay
(REB) strategy
REB strategy, an adaptation of the WHO-UNICEF Reaching Every District (RED), was introduced in 2004
aimed to improve the access to routine immunization and reduce drop-outs.
There are 5 components of the strategy, namely: data analysis for action, re-establish outreach services,
, strengthen links between the community and service, supportive supervision and maximizing
resources.

Supplemental Immunization Activity (SIA)

Supplementary immunization activities are used to reach children who have not been vaccinated or
have not developed sufficient immunity after previous vaccinations.
It can be conducted either national or sub-national –in selected areas.
Strengthening Vaccine-Preventable Diseases Surveillance
This is critical for the eradication/elimination efforts, especially in identifying true cases of measles and
indigenous wild polio virus
Procurement of adequate and potent vaccines and needles and syringes to all health facilities
nationwide

Elements of EPI
Target Setting
Cold chain Logistic Management- Vaccine distribution through cold chain is designed to ensure that the
vaccines were maintained under proper environmental condition until the time of administration.
Information, Education and Communication (IEC)
Assessment and evaluation of Over-all performance of the program
Surveillance and research studies

General Principles in Vaccinating Children

It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites
of the body
The vaccination schedule should not be restarted from the beginning even if the interval between doses
exceeded the recommended interval by months or year
Giving doses of a vaccine at less than the recommended 4 weeks interval may lessen the antibody
response. Lengthening the interval between doses of vaccines leads to higher antibody level.
No extra doses must be given to children who missed a dose of DPT/HB/OPV. The vaccination must be
continued as if no time had elapsed between doses.
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 correct intervals
Strictly follow the principle of never, ever reconstituting the freeze dried vaccine in anything other than
the diluent supplied with them
If you are giving more than one vaccine, do not use the same syringe and do not use the same arm or leg
for more than one injection

Contraindication to Immunization
Anaphylaxis or severe hypersensitivity reaction to a previous dose of vaccine in an absolute
contraindication to subsequent doses of vaccine
Person with a known allergy to a vaccine component should not be vaccinated
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 child with an evolving
neurological disease
Do not give live vaccines like BCG to an individual who are immunosuppresed due to malignant disease
(child with AIDS), going therapy with immunosuppressive agents or radiation
A child with a sign and symptoms of severe dehydration
Fever of 38.5 C and above
Infants with these conditions SHOULD be immunized: (not a contraindication)
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 convulsions, seizures
Family history of adverse reaction following immunization
Known or suspected HIV infection with no signs and symptoms of AIDS
Child being breastfed
Chronic illness such as diseases of the heart, lung, kidney or liver
Stable neurological condition such as cerebral palsy or Down’s syndrome
Premature or low birth weight (vaccination should not be postponed)
Recent or imminent surgery
Malnutrition
History of jaundice at birth
Note: if parent strongly objects to an immunization for a sick infant, do not give it. Ask the mother to
comeback when child is well EPI routine schedule – every Wednesday is designated as immunization day
and is adopted in all part of the country

FIC – “Fully Immunized Child” when a child receives 1 dose of BCG, 3 doses of DPT, HBV and 1 dose of
measles before a child’s first birthday
6 months – earliest dose of measles given in case of outbreak
9months-11months- regular schedule of measles vaccine
15 months- latest dose of measles given
4-5 years old- catch up dose

Cold Chain under EPI

Cold Chain is a system used to maintain potency of a vaccine from that of manufacture to the time it is
given to child or pregnant woman.
Temperature monitoring of vaccines is done in all levels of health facilities to monitor vaccine
temperature
Temperature checking is done twice a day early in the morning and in the afternoon before going home
Temperature is plotted every day in monitoring chart to monitor break in cold chain

The allowable timeframes for the storage of vaccines at different levels are:
6months- Regional Level
3months- Provincial Level/District Level
1month-main health centers-with ref.
Not more than 5days- Health centers using transport boxes.
Note: 3 trips in transport box with the same vaccine – discard it
Most sensitive to heat: Freezer
 (-15 to -25 degrees C)
OPV
Measles
Sensitive to heat and freezing
(body of ref. +2 to +8 degrees Celsius)
BCG
DPT
Hepa B
TT
Use those that will expire first, mark “X”/ exposure, 3rd- discard,
Transport-use cold bags let it stand in room temperature for a while before storing DPT.
Half life packs: 4hours-BCG, DPT, Polio, 8 hours-measles, TT, Hepa B.
FEFO (“first expiry and first out”) - vaccine is practiced to assure that all vaccines are utilized before the
expiry date.
Proper arrangement of vaccines and/or labeling of vaccines expiry date are done to identify those near
to expire vaccines

Vaccine Wastage
Wastage is defined as loss by use, decay, erosion or leakage or through wastefulness
Wastage rate =
Doses supplied – doses administered x 100
Doses supplied
Types of Vaccine Wastage In Unopened Vials
Expiry
Heat exposure
Freezing
Breakage
Missing inventory
Theft
Discarding unused vials returned vials returned from an outreach session
In opened vials
Discarding remaining doses at end of session
Not being able to draw the number of doses indicated on the label of a vial
Poor reconstitution practices
Submergence of open vials in water
Suspected contamination
Patient reaction requiring more than one dose

Role in improving delivery of immunization in the community

 Active master list of infants eligible for vaccination in the community
 Immunize infants following the recommended immunization schedule, route of administration,
correct dosage and following the proper cold chain storage of vaccines
 Observe aseptic technique on immunization and use one syringe and one needle per child. This
reduces blood-borne diseases and promote safety
 Disposed used syringes and needles properly by using collector box and disposing it in the septic
vault to prevent health hazard
 Inform, educate, communicate with the parents
 to create awareness and motivate to submit their child for vaccination
 to provide health teachings on the importance and benefits of immunization,
importance of follow-up dose to avoid defaulters and normal course of vaccine
 to inform immunization schedule as adopted by local units
 Conduct health visits in the community to assess other health needs of the community and be
able to provide package of health services to targets
 Identify cases of EPI target diseases per standard case definition
 Manage vaccines properly by following the recommended storage of vaccines
 Record the children given with vaccination in the Target Client list and GECD/GMC or any
standard recording from utilized
 Submit report and record of children vaccinated, cases and deaths on EPI diseases, vaccine
received and utilized and any other EPI related reports
 Identify and actively search cases and deaths of EPI target diseases following standard case
definition