Ø EPI Routine Schedule of Immunization:

Immunization  Wednesday – designated immunization day in all parts of the country.

• Monthly – in a Barangay Health Station (BHS)
Ø Is the process by which vaccines are introduced into the body before the infection sets in. • Quarterly – in far flung areas
Ø It promotes health and protects children from disease-causing agents.
Updates
Vaccines
2012 - Rotavirus and Pneumococcal vaccines were introduced in the EPI. Immunization will
Ø The causative agent of a disease so modified as to be incapable of producing the disease be prioritized among the infants of families listed in the National Housing and Targeting
yet at the same time so little changed that it is able, when introduced into the body, to elicit System (NHTS) for Poverty Reduction nationwide.
production of specific antibodies against the disease. 2014 - Pneumococcal Conjugate Vaccine 13 was included in the routine immunization of EPI.
Ø These are always antigens, therefore they always induce active immunity when 2016 - the Expanded Program on Immunization had a transition to become the National
administered thereby causing the recipient’s immune system to react to the vaccine that Immunization Program (NIP). It includes immunizations of other populations such as senior
produces antibodies to fight infection, and are most useful in the prevention of disease. citizen immunization, school-age immunization, and adolescent immunizations.
2018 - there are a total of 13 recommended vaccinations on the updated childhood
EXPANDED PROGRAM ON IMMUNIZATION (EPI) immunization schedule for Filipino children, ages 0 to 18 years old. It's one less vaccine
compared to last year's — the dengue vaccine was removed.
Ø Launched in July 1976 by DOH in cooperation with the World Health Organization (WHO)
and UNICEF to ensure that infants/children and mothers have access to routinely
recommended infant/childhood vaccines.
Ø Vaccination among infants and newborns (0-12 months) against seven vaccine-
preventable diseases: tuberculosis, poliomyelitis, diphtheria, tetanus, pertussis, hepatitis
and measles.
Ø Presidential decree No. 996 (September 16, 1976). “Providing for compulsory basic
immunization for infants and children below eight years of age.”

Mandates

Ø Republic Act No. 10152 “Mandatory Infants and Children Health Immunization Act of
2011” Signed by President Benigno Aquino III in July 26, 2010. The mandatory includes basic
immunization for children under 5 including other types that will be determined by the
Secretary of Health.
EPI COLD CHAIN and LOGISTICS
Cold Chain Manager = Public Health Nurse
 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.
Vaccine can be stored in Refrigerator:
 Regional – 6 months § Municipal / City – 3 months
 Main Health Center – 1 month
Transport Box: 5 days
FEFO ( first expiry and first out ) vaccine is practiced to ensure that all vaccines are utilized
before its expiry date.
§ Proper arrangement of vaccines and labelling 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
General Principles in Vaccination
 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 levels.
 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/needle
and do not use the same arm or leg for more than one injection.
 Repeat BCG vaccination if the child does not develop a scar after the first
injection.
 It is safe and effective with mild side effects after vaccination. Local reaction,
fever, and systematic symptoms can result as part of the normal immune
response.
Contraindication to Immunization
 Anaphylaxis or severe hypersensitivity reaction to a previous dose of vaccine
is 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 children with an evolving neurological disease
(uncontrolled epilepsy or progressive encephalopathy).
 Do not give live vaccines like BCG to a individuals who are
immunosuppressed 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
The following are NOT contraindication. Infants with these conditions SHOULD be
immunized:
 Allergy or asthma ( except if there is a known allergy to a specific component of
vaccine mentioned above )
 Minor respiratory tract infection
  Diarrhea / vomiting COMMUNICABLE DISEASES
 Temp. below 38.5 C / low grade fever
 Family history of adverse reaction following immunization Incidence of diseases
 Family history of convulsions/seizures ü Known or suspected HIV infection with no 1. Epidemic diseases – occur in a greater number than what is expected in a specific area or
signs and symptoms of AIDS region over a specific time.
 Child being breastfed 2. Pandemic diseases - it is an epidemic that spreads over multiple countries or continents
 Chronic illness such as diseases of heart, lung, kidney or liver 3. Endemic diseases - present in a population or community at times. They usually involve
 Stable neurological condition such as cerebral palsy or Down’s few people during specific periods
 Syndrome ü Premature or low birthweight (vaccination should not be postponed ) 4. Outbreak - greater than the anticipated increase in the number of endemic cases. If not
 Recent or imminent surgery quickly controlled, can become an epidemic
 Malnutrition
 History of jaundice at birth COMMUNICABLE DISEASE
 An illness due to an infectious agent or its toxic products which is transmitted to a
>> Generally, one should be immunized unless the child is so sick that he needs to be person or animal directly or indirectly via of an intermediate animal host (vector),
hospitalized. vehicle (water, food, blood) or inanimate environment.
>> 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. CONTAGIOUS
- Diseases that can be easily transmitted from person to person

INFECTIOUS
- Are those disease not transmitted by ordinary contact but require a direct inoculation
through a break in the previously intact skin or mucous membrane.

The Infection Process Chain of infection

 Agent – protozoa, bacteria, virus, fungi
 Reservoir – natural habitat of the organism
 Portal of exit
 MOT
 Portal of entry
 Host
The Infection Process

1. Agent - ANY MICROBE CAPABLE OF PRODUCING DISEASE

a. Bacteria spherical – cocci rod – bacilli spiral – spirilli
b. Viruses – RNA or DNA
c. Rickettsiae – Gm (-) bacteria like organisms, like viruses they require host cell for
replication
d. Chlamidia – Like viruses, they are intracellular obligate bacteria, but susceptible to
antibiotics
e. Fungi (mycoses) – molds or yeast
f. Protozoa
g. Helminths – round, tape, flukes

Agent Pathogenicity – ability to cause disease

A. Virulence severity or harmfulness
B. Invasiveness (ability to enter and move through tissue) tendency to spread 4. Mode of Transmission
C. Elaboration of toxin
D. Viability- ability to survive outside the host Horizontal transmission
A. By Close Contact
2. Reservoir – AN ANIMAL OR PLANT IN WHICH AN INFECTIOUS AGENT LIVES AND 1. Direct contact ( person to person ) as in sexually transmitted disease
REPRODUCES IN SUCH A MANNER THAT IT CAN BE TRANSMITTED TO MAN (PRINCIPAL 2. Indirect contact ( usually an inanimate object) fomites
HABITAT) 3. Droplet spread - close range spray of contaminated droplets (from coughing, sneezing, or
a. Human talking by an infected person)
b. Animal B. Airborne Transmission results from inhalation of evaporated droplets suspended in
c. Non-animal – street dust, garden soil, lint from bedding. airborne dust particles or vapors
C. Vector borne Transmission when arthropods such as flies, mosquitoes, ticks transfers an
3. Portal of Exit from Reservoir - PATH OR WAY IN WHICH THE ORGANISMS LEAVES THE organism
RESERVOIR. THIS IS WHERE THE ORGANISMS GROW D. By Vehicle Route through contaminated items
a. Respiratory tract - most common in man 1. Food – salmonellosis
b. Gastrointestinal tract 2. Water – shigellosis, cholera
c. Genito-urinary tract 3. Drugs – bacteremia resulting from infusion of a contaminated infusion product
d. Open lesions 4. Blood – hepatitis B, AIDS
e. Mechanical escape - includes bite of insects
f. Blood - Vertical transmission – mother to child transmission through placenta
5. Portal of Entry of Organisms into Human - VENUE THROUGH WHICH THE ORGANISMS
GAIN ENTRANCE INTO THE SUSCEPTIBLE HOST
a. Respiratory tract
b. Gastrointestinal tract
c. Genitourinary tract
d. Direct infections of mucous membrane/skin
6. Susceptible host - age, nutritional status, host immune response
 Incubation period - time from infection until onset of symptoms
 Period of communicability - time a case is infectious to others
Immunization Immunity
- The condition of being protected against any particular disease
1. Active Immunity - Actual participation of an individual body tissue/ fluids in producing
immunity. Longer acting
2. Passive Immunity - Transfer of antibodies, antibodies not coming from individual self.
Short acting/temporary
Types of Immunity
1. Natural
a. Active immunity (NAI) - acquired through recovery from certain disease –
By nature ex. Person is infected with a disease like chicken pox
b. Passive- acquired through placental transfer
- Maternal transfer of antibodies - children below 6 months enjoys antibodies from mother
2. Artificial
a. Active immunity (AAI) acquired through administration of vaccines and toxoids
Vaccines – attenuated/ weakened microorganism
Given to stimulate body to produce antibodies and provide immunity against disease.
Toxoids – attenuated toxins (poisonous substances produce by microorganism)
b. Passive - acquired through an administration of an antitoxin, antiserum, convalescent
serum and gamma globulins
 Antitoxin- antibody capable of neutralizing specific toxins that are causative organisms of
disease
 Antiserum- serum that contains immunoglobulin from blood of humans or animals that
recovered from a certain disease when they developed certain antibodies against particular
antigens
3. Subclinical immunity – due to constant exposure to a certain disease. Thus Ab are
produce to counter act infection
Immunization
General contraindications to receiving an immunization include:
1. Severe febrile illness
2. An allergic reaction to previously administered immunization
3. Live vaccines are not administered to anyone with an altered immune system
Control and Management of Infection
Considerations before taking care of an infected person:
1. Know the causative agent
2. Know the body secretion that harbors the microorganism
3. Know the mode of transmission
A. Control aspect – to limit spread of infection
a. Quarantine – limitation of freedom of movement of a well person during the longest
incubation.
b) Isolation – separation of infected person during the period of communicability
1. Strict isolation- protection of other person
2. Reverse isolation – protection of the patient Control and Man
Guidelines for Isolation Precautions in Hospitals Developed by the Center for Disease
Control and Prevention (CDC)
1. Standard Precaution – are those designated for the care of all facility patients regardless
of their diagnosis or presumed infection
- The precaution applies to: blood, all body fluids, secretion and excretion except sweat;
mucous membranes, skin that isn’t intact
2. Transmission based precautions – instituted for patients who are known to be or
suspected of being infected with a highly transmissible infection
a. Airborne precaution – reduce the risk of airborne transmission of infectious agent
- use of special air handling and use of respiratory protection such as mask
b. Droplet precaution – reduce the risk of transmitting infectious agents through large
particle droplets
- large particle droplets don’t remain in the air and generally travel short distances (3ft)
- use of mask
A. CONCURRENT DISINFECTION- concurrent cleaning and sterilization of patient supplies and
equipment during hospitalization.
B. TERMINAL DISINFECTION- the disinfection and sterilization of patient supplies and
equipment after the patient is discharged from the unit or hospital.
 PROPHYLACTIC DISINFECTION – preventive measure to prevent spread of infection
Disinfectant - usually a chemical agent that destroys disease causing pathogens or other
harmful microorganisms, but might not kill bacterial spores.
- refers to substance applied to inanimate objects.
 Antiseptic - substance that prevents or arrests the growth of microorganisms.
Preparations applied topically to living tissues.
 Sterilization - process of complete destruction of all microorganisms and their bacterial
spores/endospores on a substance by exposure to physical or chemical agents
B. Preventive- prevent the recurrence of infection
a. Health teaching /education- so there will be a change in knowledge/skills/attitude

c. Contact precaution – decrease the risk of transmission by direct or indirect contact b. Immunization 3 laws implemented:
- Direct contact occur through patient care activities that require direct contact  PD 996 expanded program on immunization (EPI)
- Indirect contact involves coming in contact with a contaminated inanimate object  UN Goal (UCI) Universal Child ImmunizationProclamation # 6
- Use of gloves, a mask and a gown  National Immunization Day ( NID) –
 Proclamation # 46 All laws aimed to control the 7 childhood diseases of children TB,
3. Practice Medical Asepsis DPT, Polio, Hep B, Measles
 Hand washing  CDT Vaccine (Cholera/Dysentery/Typhoid) 6 months immunity – given only on
 Masking outbreaks.
 Gowning - Anti-rabies vaccine – animals are the targets
 Gloving
 Eye protection ( goggles) c. Environment Sanitation PD 856
 Environmental disinfection - Control of arthropods and rodents
- Also includes the submission of sex workers to examination versus
Disinfection GC- 2X/month
 Destruction of pathogenic microorganisms outside the body through direct physical or Syphilis – once a month
chemical means.