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Objectives: Within 20 - 30minutes of lecture, the class would be able to: Recall what is Expanded Program for Immunization

n (EPI) Familiarize the different routine immunization schedule for infants and women Identify the different EPI vaccines and its characteristics Identify the role of a nurse in improving the delivery of immunization services in the community Know the different essential maternal and child health service package.

Strategy: Lecture Discussion Contents: 1. Expanded Program On Immunization y The Concept And Importance Of Vaccination y y y y y EPI Routine Schedule of Immunization Routine Immunization Schedule for Infants Tetanus Toxoid Immunization Schedule for Women The EPI Vaccines and its Characteristics Role of a Nurse in improving the Delivery of Immunization Services in the Community

2. Essential Maternal And Child Health Service Package

EXPANDED PROGRAM ON IMMUNIZATION Children need not die young if they receive complete and timely immunization. Children who are not fully immunized are more susceptible to common childhood diseases. The Expanded Program on Immunization is one of the DOH Programs that has already been institutionalized and adopted by all LGUs in the region. Its objective is to reduce infant mortality and morbidity through decreasing the prevalence of seven (7) immunizable diseases (TB, diphtheria, pertussis, tetanus, polio, measles and hepatitis B) The Expanded Program on Immunization (EPI) in the Philippines began in July 1979. And, in 1986, made a response to the Universal Child Immunization goal. The four major strategies include: 1. Sustaining high routine Full Immunized Child (FIC) coverage of at least 90% in all provinces and cities, 2. Sustaining the polio-free country for global certification 3. Eliminating measles by 2008, 4. Eliminating neonatal tetanus by 2008. The Concept and Importance of Vaccination Immunization is a process by which vaccines are introduced in to the body before infection sets in. vaccines are administered to induce immunity thereby causing recipients immune system to react to the vaccine that produces antibodies to fight infection. Vaccinations promote health and protect children from disease causing agents. Several general principles which apply in vaccinating children:

Because measles kills, every infant needs to be vaccinated against measles at the age of 9 months or as soon as possible after 9 months as part of the routine infant vaccination schedule. It is safe to vaccinate a sick child who is suffering from a minor illness (cough, cold, diarrhea, fever or malnutrition) or who has already been vaccinated against measles.] If the vaccination schedule is interrupted, it is not necessary to restart. Instead, the schedule should be resumed using minimal intervals between doses to catch up as quickly as possible. Vaccine combinations (few exceptions), antibiotics, low-dose steroids (less than 20 mg per day), minor infections with low fever (below 38.5 Celsius), diarrhea, malnutrition, kidney or liver disease, heart or lung disease, non-progressive encephalopathy, well controlled epilepsy or advanced age, are not contraindications to vaccination. Contrary to what the majority of

doctors may think, vaccines against hepatitis B and tetanus can be applied in any period of the pregnancy.

There are very few true contraindication and precaution conditions. Only two of these conditions are generally considered to be permanent: severe (anaphylactic) allergic reaction to a vaccine component or following a prior dose of a vaccine, and encephalopathy not due to another identifiable cause occurring within 7 days of pertussis vaccination. Only the diluent supplied by the manufacturer should be used to reconstitute a freeze-dried vaccine. A sterile needle and sterile syringe must be used for each vial for adding the diluent to the powder in a single vial or ampoule of freeze-dried vaccine. The only way to be completely safe from exposure to blood-borne diseases from injections, particularly hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) is to use one sterile needle, one sterile syringe for each child.

EPI Routine Schedule of Immunization Every Wednesday is designated as immunization day and is adopted in all parts of the country. Immunization is done monthly in barangay health stations, quarterly in remote areas of the country. Routine Immunization Schedule for Infants


Minimum Minimum Number Age Dose Interval of Doses at 1st Dose Between Doses




Bacillus CalmetteGurin

Birth or anytime after birth

1 dose

0.05 mL



Right deltoid region of the arm

BCG given at earliest possible age protects the possibility of TB meningitis and other TB infections in which infants are prone

DiphtheriaPertussisTetanus Vaccine

6 weeks old

3 doses

0.5 mL

4 weeks

Upper outer portion of Intramuscular the thigh, Vastus Lateralis

An early start with DPT reduces the chance of severe pertussis.

Oral Polio Vaccine

6 weeks old

3 doses

2-3 4 weeks drops



The extent of protection against polio is increased the earlier the OPV is given. Keeps the Philippines polio-free.

Hepatitis B Vaccine

At birth

3 doses

0.5 mL

6 weeks interval from 1st Upper dose to 2nd outer dose, and; 8 portion of Intramuscular weeks interval the thigh, from second Vastus dose to third Lateralis dose

An early start of Hepatitis B vaccine reduces the chance of being infected and becoming a carrier. Prevents liver cirrhosis and liver cancer which are more likely to develop if infected with Hepatitis B early in life. About 9,000 die of complications of Hepatits B. 10% of Filipinos have Hepatitis B infection

Measles Vaccine

9 months old

1 dose

0.5 mL


Upper outer portion of Subcutaneous the arms, Right deltoid

At least 85% of measles can be prevented by immunization at this age.

Tetanus Toxoid Immunization Schedule for Women When given to women of childbearing age, vaccines that contain tetanus toxoid (TT or Td) not only protect women against tetanus, but also prevent neonatal tetanus in their newborn infants.
Vaccine Minimum Age/Interval Percent Protected Duration of Protection


As early as possible 80% during pregnancy

protection for the mother for the first delivery


At least 4 weeks later 80%


infants born to the mother will be protected from neonatal tetanus gives 3 years protection for the mother infants born to the mother will be protected from neonatal tetanus gives 5 years protection for the mother


At least 6 months later 95%



At least 1 year later



infants born to the mother will be protected from neonatal tetanus gives 10 years protection for the mother gives lifetime protection for the mother all infants born to that mother will be protected


At least 1 year later



The EPI Vaccines and its Characteristics The vaccines that are most sensitive to heat are: y y Oral polio (live unattended)measles (freeze dried)

Storage temperature of those should be -15 degrees Celsius to 25 degrees Celsius at the freezer. The vaccines that are least sensitive to heat are: y D (toxoid which is a weakened toxin) P(killed bacteria) T(toxoid which is a weakened toxin) Hep B BCG (freeze dried) Tetanus Toxoid

y y y

Storage temperature of those should be +2 degrees Celsius to +8 degrees Celsius in the body of the refrigerator. A "first expiry and first out" (FEFO) vaccine system is practiced to assure that all vaccines are utilized before its expiry date. Proper arrangement of vaccines and/or labeling of expiry dates are done to identify those close to expiring. Vaccine temperature is monitored twice a day (early in the morning and in the afternoon) in all health facilities and plotted to monitor break in the cold chain. Each level of health facilities has cold chain equipment for use in the storage vaccines which included cold room, freezer, refrigerator, transport box, vaccine carriers, thermometers, cold chain monitors, ice packs, temperature monitoring chart and safety collector boxes. Role of a Nurse in improving the Delivery of Immunization Services in the Community As a nurse we need to: y y Actively masterlist 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.

y y y y y y y

Observe aseptic technique on immunization Dispose used syringes and needles properly Inform, educate and communicate with parents Conduct health visits in the community Identify cases of EPI target diseases per standard case definition Mange vaccines properly Record the children given with vaccination in the Target Client List and GECD/GCM card or any standard recording form utilized Submit report or 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.

ESSENTIAL MATERNAL AND CHILD HEALTH SERVICE PACKAGE This ensures the right of the child to survival, development, protection, and participation. It includes the delivery of essential maternal and child health and nutrition package of services that will ensure the right to survival, development, protection, and participation as follows: y y Breastfeeding- Human breast milk is the healthiest form of milk for babies because of the right nutrients found in it. Complementary feeding- should be timely, meaning that all infants should start receiving foods in addition to breast milk from 6 months onwards. It should be adequate, meaning that the complementary foods should be given in amounts, frequency, consistency and using a variety of foods to cover the nutritional needs of the growing child while maintaining breastfeeding. Foods should be prepared and given in a safe manner, meaning that measures are taken to minimize the risk of contamination with pathogens. And they should be given in a way that is appropriate, meaning that foods are of appropriate texture for the age of the child and applying responsive feeding following the principles of psycho-social care. Micronutrient supplementation- Araw Ng Sangkap Pinoy is the approach adopted to provide micronutrient supplements to 6-71 months old preschoolers on a nationwide scale.