Terminologies:

Immunization – The process by which the vaccines are introduced into the body before infection sets in.
Vaccines – administered to induced immunity thereby causing the recipient’s immune system to react to
the vaccine that produces antibodies to fight infection.
Fully Immunized Child (FIC)– when a child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3
doses of HB and one dose of measles before a child’s first birthday.
First Expiry and First Out (FEFO) – vaccine is practiced to assure that all vaccines are utilized before its
expiry date
Cold Chain – a system for ensuring the potency of a vaccine from the time of manufacture to the time it is
given to an eligible client
Cold Chain Officer – person directly responsible for the cold chain management
Legal Mandate:
 P.D 996 - Providing for compulsory basic immunization for infants and children below 8 years
old
 R.A. 10152 – Mandatory Infants and Children Health Immunization Act of 2011
 R.A. 7846 – Compulsory immunization against Hepatis B for infants and children below 8 years
old
 P.D 996 - Providing for compulsory basic immunization for infants and children below 8 years
old”
Goal of EPI:
To reduce the morbidity and mortality among infants and children caused by the seven childhood
immunizable diseases.
Initially the Coverage of Vaccine-preventable diseases were only 6
1. TB
2. poliomyelitis
3. diphtheria
4. pertussis
5. tetanus
6. measles
R.A. 10152 –Mandatory Infants and Children Health Immunization Act of 2011 (Repealing for the purpose P.D. 996)
With the addition of:
7. Mumps
8. Rubella/German Measles
9. Hepatitis B
10. H. Influenza type B (HiB)
Such other types as may be determined by the Secretary of Health.
Government Hospitals and health centers to provide free mandatory basic immunization to infants and
children up to 5 years old.

EPI Expanded Programme on Immunization changed to NIP in 2016 which include a separate
annotation

 JE vaccine included in the recommended vaccine group

 Quadrivalent influenzae vaccine included in influenza vaccine recommendation
 Hib recommendation for high risk children included in vaccines for high risk/special groups

National Immunization Program:

A school-based immunization program to provide catch-up doses for school children and adolescents has
been established. Measles-Rubella (MR) and Tetanus-Diphtheria (Td) vaccines are administered to Grade
1 and Grade 7 students enrolled in public schools

The National Immunization Program (NIP) consists of the following antigens:

 BCG vaccine, single dose given at birth
 Monovalent Hepatitis B vaccine given at birth
 DPT-Hib-Hep B vaccine, 3 doses given at 6-10-14 weeks of age
 Oral Polio vaccine (OPV), 3 doses given at 6-10-14 weeks of age, a single dose of Inactivated Polio
vaccine (IPV) is given with the 3rd dose of OPV at 14 weeks
 Pneumococcal conjugate vaccine (PCV), 3 doses given at 6-10-14 weeks of age
 Rotavirus vaccine given at a minimum age of 6 weeks with a minimum interval of 4 weeks
between doses. The last dose should be administered not later than 32 weeks of age.
 Measles –containing vaccine (either monovalent measles vaccine or MMR) given at 9 months of
age
 Measles-Mumps-Rubella (MMR) vaccine given at 12 months of age
 Human Papillomavirus (HPV) shall be given to female children 9-10 years old at health facilities in
priority provinces. Quadrivalent HPV 2 doses are given at 0, 6 months
- Given subcutaneously
- Given at a minimum age of 9 months
- Children 9 months to 17 years of age should receive one primary dose followed by a
booster dose 12-24 months after the primary dose
- Individuals 18 years and older should receive a single dose only
 Japanese Encephalitis is endemic in the Philippines:
 JE is responsible for 7.4% to 40% of meningitis- encephalitis syndrome, it affects children
younger than 15 years old
- Given subcutaneously
- Given at a minimum age of 9 months
- Children 9 months to 17 years of age should receive one primary dose followed by a
booster dose 12-24 months after the primary dose
- Individuals 18 years and older should receive a single dose only

Concept and Importance of Vaccination

• Vaccines are administered to introduced immunity thereby causing the recipient’s immune
system to react to the vaccine that produces antibodies to fight infection.
• Vaccinations promote health and protect children from disease – causing agents.
• Infants and newborn need to be vaccinated at an early age since they belong to vulnerable
age group.

Routine Immunization Schedule for Infants

Antigen/Vaccine Minimum Age Number Minimum Interval Reason

at 1st dose of Doses between doses
BCG Birth or any 1 To protect the
time after birth possibility of TB
meningitis and other
TB infectious in
 which infants are
prone
DPT 6 weeks 3 4 weeks Reduces the chance
of severe pertussis
OPV 6 weeks 3 4 weeks Increased protection
against polio if given
earlier. Keeps the
Phil. polio free
Hepa B At birth 3 6 weeks interval An early start of
from first dose to Hepa B reduces the
second dose, and chance of being
8 weeks interval infected and
from second dose becoming carrier.
to third dose Prevent liver
cirrhosis and liver
cancer.
Measles 9 months At least 85% of
measles can be
prevented at this
age.

Schedule and Manner of Administration of Infants Immunization

Antigen Age Dose Route Site

BCG vaccine At birth 0.05 ml Intradermal Right deltoid region (arm)
Hepatitis B At birth 0.5 ml. Intramuscular Anterolateral thigh muscle
vaccine
DPT-Hepa B-Hib 6 weeks, 10 weeks, 0.5 ml Intramuscular Anterolateral thigh muscle
(Pentavalent) 14 weeks
Oral Polio Vaccine 6 weeks, 10 weeks, 2 drops Oral Mouth
14 weeks
Anti-measles 9-11 months 0.5 ml Subcutaneous Outer part of the upper
vaccine (AMV) arm
Measles-Mumps 12-15 months 0.5 ml Subcutaneous Outer part of the upper
Rubella Vaccines arm
(AMV2)
Rotavirus 6 weeks, 10 weeks

Vaccine, Contents and Form

Vaccine Content Form

BCG (Bacillus Calmette-Guerin) Live attenuated bacteria Freeze-dried. Reconstituted
with a special diluent
Hepatitis B vaccine RNA-recombinant using Cloudy, liquid, in an auto-
Hepatitis B surface antigen disable injection syringe if

DPT-Hepa-Hib (Pentavalent
Vaccine)
Oral Polio Vaccine
Anti-measles vaccine
Measles-Mumps-Rubella
Vaccine
Rotavirus Vaccine
Tetanus Toxoid
(HBs Ag)
Diptheria toxoid, inactivated
pertussis bacteria, tetanus
toxoid, recombinant DNA
surface antigen, and synthetic
conjugate of Haemophilus
influenzae B bacilli
Live, attenuated virus (trivalent)
Live, attenuated virus
Live, attenuated viruses
Live attenuated viruses
Weakened toxin
available
Liquid, in an auto-disable
injection syringe
Clear, pinkish liquid
Freeze-dried reconstituted with
a special diluent
Freeze-dried reconstituted with
a special diluent
Clear, colorless liquid in a
container with an oral
applicator
Sometime slightly turbid in
appearance: Clear colorless
liquid sometimes slightly turbid

Tetanus Toxoid Immunization Schedule Tetanus for Women

Vaccine Minimum Age/ Interval Percent Protection Duration of Protection

TT1 As early as possible
during pregnancy
TT2 At least 4 weeks later 80% Infants born to mother will be
protected from neonatal
tetanus
Gives 3 years protection for the
mother
TT3 At least 6 months later 95% Infants born to the mother will
be protected from neonatal
tetanus
Gives 5 years protection for the
mother
TT4 At least one year later 99% Infants born to the mother will
be protected from neonatal
tetanus
Gives 10 years protection for
the mother
TT5 At least one year later 99% Gives life time protection for
the mother
All infants born to that mother
will be protected.

Recommended Storage Temperature for EPI Vaccines

 Type of Vaccine
Oral Polio (live attenuated) -15 C to -25 C (at the freezer)
Most sensitive to heat Measles (freeze dried)

DPT/Hepatitis B
“D” toxoid which is a weakened
toxin”
Least sensitive to heat “P” Killed bacteria + 2 C to +8 C (in the body of the
“T” toxoid which is a weakened refrigerator)
toxin
BCG (freeze dried)
Tetanus toxoid

Vaccines Side Effects Management

Kock’s phenomenon: an acute
inflammatory reaction within 2-4 days
after vaccination; usually indicates
previous exposure to tuberculosis
BCG Deep abscess at vaccination site: almost
invariably due to subcutaneous or deeper
injection
Indolent ulceration: an ulcer which
persists after 12 weeks from vaccination
date
Glandular enlargement: enlargement of
lymph glands draining the injection site
Hepatitis B vaccine Local soreness at the injection site
DPT-Hepa B-Hib Fever that usually last for only 1 day.
(Pentavalent) Fever beyond 24 hours is not due to the
vaccine but other causes
Local soreness at the injection site
Abscess after a week or more usually
indicates that the injection was not deep
enough or the needle was not sterile
Convulsions: although very rare, may
occur in children older than 3 months,
caused by pertussis vaccine
OPV None
Anti-measles vaccine Fever 5-7 days after vaccination in some
children; sometimes there is a mild rash
MMR Local soreness, fever irritability, and
malaise in some children
No management is needed
Refer to the physician for
incision and drainage
Treat with INH powder
If suppuration occurs, treat as
deep abscess
No treatment is necessary
Advise parent to give antipyretic
Reassure parents that soreness
will disappear after 3-4 days
Incision and drainage may be
necessary
Proper management of
convulsion; pertussis vaccine
should not be given anymore
Reassure parents and instruct
them to give antipyretic to the
child
Reassure parents and instruct
them to give antipyretic to the
child
 Rotavirus vaccine Some children develop mild vomiting and Reassure parents and instruct
diarrhea, fever, and irritability them to give antipyretic and
ORESOL to the child
Tetanus toxoid Local soreness at the injection site Apply cold compress at the site.
No other treatment is need
Sources: Expanded Program on Immunization Manual, revised edition, 1995. DOH Republic of the Phil.;
Dept. Memorandum No. 2011-0157, Administration of Rotavirus vaccine for infants, and Ligtas Tigdas
ang Pinas Guide for Vaccination Team, DOH, 2011d

EPI COLD CHAIN and LOGISTICS

 The person directly responsible for cold chain management at each level is called the Cold
Chain Officer
 
Public Health Nurse is the Cold Chain Officer in the RHU/health center
 
• 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.
Components:
 Health Care
 Equipment - safe storage and transport vaccines
Procedures - manage the distribution and use of vaccines