Expanded Program on Immunization (EPI)

Objective:
• To reduce infant mortality and morbidity through decreasing the
prevalence of the seven (7) immunizable diseases:
1. Pulmonary Tuberculosis
2. Diphtheria
3. Pertussis
4. Tetanus
5. Polio
6. Measles
7. Hepatitis B
 ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS
VACCINES MINIMUM AGE NUMBER OF MINIMUM INTERVAL REASON
@ 1ST DOSE DOSES BETWEEN DOSES

BCG Birth or anytime 1 BCG given at the earliest possible age

after birth protects against the possibility of
infection from other family members
DPT 6 weeks 3 4 weeks An early start with DPT reduces the
chance of severe pertussis.

OPV 6 weeks 3 4 weeks The extent of protection against polio is

increased the earlier the OPV is given.

Hepatitis B 6 weeks 3 4 weeks An early start of hepatitis B reduces the

chance of being infected and becoming a
carrier.
Measles 9 months 1 At least 80% of measles can be prevented
by immunization at this age.

Note: BCG immunization shall be given to school entrants in both private and public schools regardless whether there is the
presence of a BCG scar or not.
 The Fully Immunized Child
A fully immunized child is one who has received ALL of the
following:
1. One dose of BCG at birth or anytime before reaching 12
months.
2. Three doses of DPT, hepatitis B, and polio with at least a
four-week interval between each dose, the first dose given six
weeks after birth or thereafter, as long as the third dose is
given before the child reaches 12 months of age.
3. One dose of measles vaccine at the age of nine months or
before 12 months
 FREQUENTLY ASKED QUESTIONS
Q: What if the child failed to return after the first dose of the vaccine (DOH),
can we still give it?
A: YES. It is a must to complete the doses.
Q: Is it necessary to repeat the first dose?
A: NO. Just give the remaining doses that were not given.
REMEMBER THE PRINCIPLE: Even if the interval exceeded that of the
expected interval, continue to give the doses of the vaccine.
Q: Up to what age can we give the immunization?
A: Before the child reaches 6 years old.
 FREQUENTLY ASKED QUESTIONS
Q: Is there any contraindications to giving DPT, OPV and Hep B?
A: There is none, EXCEPT when the child has had convulsions upon giving the
first dose of DPT. Mothers must be advised that the incident of CONVULSIONS
upon giving the first dose of DPT MUST BE REPORTED.
Q: What if the child has a fever of 38. 5C or less, mild respiratory infections
and diarrhea, should the child be given the vaccine?
A: The abovementioned conditions are NOT TO BE CONSIDERED AS
CONTRAINDICATIONS to immunization. Thus, vaccine can still be given.
Q: What if the child is malnourished?
A: MALNUTRITION is not a contraindication, but rather an indication for
immunization since the common childhood diseases are often severe in
malnourished children.
 ADMINISTRATION OF VACCINES
VACCINE DOSE ROUTE OF SITE OF ADMINSITRATION
ADMINSITRATION

BCG Infants: 0.05ml Intradermal (ID) Right deltoid region of the arm

School Entrants: 0.10ml Intradermal (ID) Left deltoid region of the arm

DPT, Hep B 0.5ml Intramuscular (IM) Upper, outer portion of the thigh

Polio 2 drops or depending on Oral Mouth

manufacturer’s
instructions

Measles 0.5ml Subcutaneous Outer part of the upper arm

Tetanus Toxoid 0.5ml Intramuscular Deltoid region of the upper arm

 NORMAL COURSES AND EFFECTS OF VACCINE
VACCINE
BCG
WHEAL – Raised by
injection; disappears in
about 30 minutes
SMALL RED TENDER
SWELLING – about 10mm
across, appears at the
injection site after
approximately 2 weeks.
After 2 to 3 weeks, the
swelling becomes a small
ABSCESS, which then
ulcerates.
ULCER – heals by itself and
leaves a scar
SCAR FORMATION – about
12 weeks
SIDE EFFECTS MANAGEMENT
KOCH’S PHENOMENON No management needed.
• An acute inflammatory reaction, appearing
within 2 to 4 days of vaccination
DEEP ABSCESS AT VACCINATION SITE OR Incision and drainage.
LYMPH NODES
• Almost invariable due to subcutaneous or
deeper injection.
INDOLENT ULCERATION Treat with INH powder.
• An ulcer which persists after 12 weeks from
date of vaccination or an ulcer more than
10mm deep.
GLANDULAR ENLARGEMENT If suppuration occurs, treat
• The glands draining the injection site may it as a deep abscess.
become enlarged.
VACCINE SIDE EFFECTS MANAGEMENT

DPT FEVER
• Many children develop fever after injection, which lasts
Advise mother to give antipyretic or
sponge with tepid water.
only for one day. Fever that lasts more than 24 hours after
a dose of DPT is not due to the vaccine but to other causes.

LOCAL SORENESS Reassure mothers that this needs no

• Some children have pain and/or swelling in the area treatment and will disappear within
where injection was given. If this starts early after the 3 to 4 days
injection, then it is only due to the vaccine.

ABSCESS Incision and drainage is necessary.

• An abscess that appears a week or more after the injection
is due to a wrong technique. Either the vaccine was not
injected deep enough or the needle was not sterile.

CONVULSIONS If convulsions occur, give proper

• Convulsions are very rare and occur more in children management and do not continue
above three months of age. This is due to the pertussis the normal course.
component of the vaccine.
 VACCINE SIDE EFFECTS MANAGEMENT

POLIO Usually none.

HEPATITIS B LOCAL SORENESS

• Some infants may develop soreness at the injection site,
No treatment needed.

but this will go away within 24 hours.

MEASLES FEVER AND RASH

• Children may develop a fever after 5 to 7 days from the
Reassure the mother and advise her
to give antipyretic to the child or
time of vaccination. The fever lasts from only 1 to 7 days. sponge with tepid water.

TETANUS PAIN, REDNESS AND SWELLING

• There is usually pain, redness and swelling at the injection
No treatment needed.

TOXOID site.
TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN
VACCINE MINIMUM TIME PERCENT DURATION OF PROTECTION
INTERVAL PROTECTION

As early during
pregnancy as possible
TT1
At least one month later 80 • Infants born to the mother will be protected from
neonatal tetanus
TT2 • Give 3 years protection for the mother
At least 6 months later 95 • Infants born from the mother will be protected from
neonatal tetanus
TT3 • Give 5 years protection for the mother
At least 1 year later 99 • Infants born from the mother will be protected from
neonatal tetanus
TT4 • Give 10 years protection for the mother
At least 1 year later 99 • Gives lifetime protection for the mother
• All infants born to that mother will be protected
TT5
 COLD CHAIN
• A system used to maintain the potency of a vaccine from the time of manufacture to the time it is
given to the child or the pregnant woman.
1. Storage of vaccines should NOT exceed:
- 6 months at the regional level
- 3 months at the provincial level/district level
- 1 month at the main health centers (with refrigerators)
- not more than 5 days at health centers
2. Transport of vaccines; use transport boxes or vaccines carriers.
3. Handling of vaccines: once opened or reconstituted, vaccines must be placed in a special cold pack
during immunization sessions.
4. DISCARD:
- BCG vaccines after 4 hours
- DPT, Polio, Measles and Tetanus Toxoid vaccines after 8 hours or at the end of a working day.
 EPI VACCINES: CONTENTS, FORMS, EXPOSURE TO CERTAIN
CONDITIONS
VACCINE CONTENTS FORM CONDITIONS WHEN EXPOSED STORAGE
TO HEAT TEMPERATURE

Live, attenuated Freeze-dried and to be Destroyed by heat, sunlight, not 2 to 8C (body of the
BCG bacterial vaccine reconstituted with a destroyed by freezing refrigerator)
special diluent
D- weakened toxin Liquid D-destroyed by freezing / heat 2 to 8C (body of the
DPT P-killed bacteria P-damaged by heat refrigerator)
T-weakened toxin T-damaged by heat & freezing
Live, attenuated Liquid Easily damaged by heat, not -15 to -25C (freezer)
POLIOVACCINE virus destroyed by freezing

MEASLES Live, attenuated Freeze dried and to be Easily damaged by heat, not -15 to -25C (freezer)
VACCINE virus reconstituted with a destroyed by freezing
special diluent
TETANUS Weakened toxin Liquid Damaged by heat freezing 2 to 8C (body of the
TOXOID refrigerator)

HEPATITIS B Plasma-derived Liquid Damaged by heat freezing 2 to 8C (body of the

END