Expanded Program on

Immunization (EPI)

Reported by:
Dr. Kristine De Los Reyes
Dr. Venus Gutierrez
Dr. Migo Luis
Dr. May Pilares
Background on EPI:

● Expanded Program on Immunization (EPI) was

established in 1973, which aims to ensure that children
especially infants, as well as their mothers, have access to
vaccines recommended for their age group to prevent
certain diseases.
● Only six vaccine-preventable diseases were initially
targeted as part of routine basic vaccination in the early
era of the EPI (1976-1982). These were tuberculosis,
poliomyelitis, diphtheria, whooping cough, tetanus, and
measles.
Background on EPI:

● Hepatitis B was the seventh VPD included in 1992. In the

last decade alone, the DOH expanded significantly to target
more age groups and add new vaccines.
● Noteworthy are the following:
● The addition of the second dose of measles vaccine in 2010
● The inclusion pneumococcal conjugate vaccine (PCV) in
2013; and most recently
● The inclusion of Japanese encephalitis vaccine (JEV) for
endemic areas in 2019.
 National Immunization Program (NIP)

● EPI eventually became the National Immunization Program

(NIP), which covered wider segments of the population.
● To date, the NIP provides immunity against 14 vaccine-
preventable diseases (VPDs) from only six in 1976.
● It expanded its population coverage beyond infants and
pregnant women to include school children,
adolescents/youth, senior citizens and those in special
situations.
Milestones of Immunization Program
in the Philippines
 Bacillus Calmette Guerin (BCG)
● Protective against Tuberculosis
● Administered intradermally (ID); 1 dose only
● Dose for < 12 months is 0.05 ml
● Dose for ≥ 12 months is 0.1 ml
● Schedule:
a. Given at the earliest possible age after birth,
preferably within the first 2 months of life
● For healthy infants and children > 2 months who are
not given BCG at birth, PPD prior to BCG vaccination
is not necessary.
 Bacillus Calmette Guerin (continuation..)

● However, PPD is recommended prior to BCG vaccination if

any of the following is present:
○ Congenital TB
○ History of close contact to known or suspected infectious
cases
○ Clinical findings suggestive of TB and/or chest x-ray
suggestive of TB
In the presence of any of these conditions, an induration of 5
mm is considered positive and BCG is no longer recommended
 Bacillus Calmette Guerin (continuation..)

● Possible Adverse Effects:

○ Koch’s phenomenon
○ Deep abscess
○ Indolent ulceration
○ Glandular enlargement
 Hepatitis B Vaccine (HBV)

● Protective against Hepatitis B

● Administered intramuscularly (IM); 3 doses;
● Given at birth, 4 weeks, 6 months; 4 weeks interval
● Schedule:
○ Administer the first dose of monovalent HBV to all
newborns ≥ 2kgs within 24 hours of life
○ A second dose is given 1-2 months after the birth dose
○ The final dose if administered not earlier than 24 weeks
of life
○ Another dose is needed if the last dose was given at an age
<24 weeks.
 Hepatitis B Vaccine (continuation..)
For infants born to HBsAg (+) mothers (preterm or term
infants):
● Administer HBV* and HBIG (0.5ml) within 12 hours of life.
HBIG should be administered not later than 7 days of age, if
not immediately available.
 Hepatitis B Vaccine (continuation..)
For infants born to mothers with unknown HBsAg status:
● With birth weight ≥2 kgs, administer HBV within 12 hours
of birth and determine the mother’s HBsAg as soon as
possible. If HBsAg (+), administer HBIG not later than 7
days of age.
● With birth weight <2 kgs, administer HBIG in addition to
HBV* within 12 hours of life
*For infants born <2 kgs, the 1st dose received at birth is not
counted as part of the vaccine series. Additional 3 HBV doses
are needed
● Possible AE: Local Soreness
Diphtheria, Pertussis, Tetanus (DPT) Vaccine

● Protective against tetanus, diphtheria, pertussis

● Administered intramuscularly (IM); ) 0.5mL
● Given at 6 weeks, 10 weeks, 14 weeks; 4 weeks interval
● Schedule:
● Initial: 6 weeks
● 2nd and 3rd: 4 weeks interval
● 1st booster (4th dose): as early as 12 months
● 2nd booster: 4-6 years
● dT: 9-10 years old
Diphtheria, Pertussis, Tetanus (continuation..)
● For children who are fully immunized, Td /Tdap
booster doses should be given every 10 years
● For children age >7 years a single dose of Tdap can be
given to replace due Td. Tdap can be administered
regardless of the interval since the last tetanus and
diphtheria-toxoid containing vaccine.
● Fully immunized is defined as:
○ 5 doses of DTP, or
○ 4 doses of DTP if the 4th dose was given on or after
the 4th birthday
Haemophilus Influenzae Type B Conjugate Vaccine
● Protects against invasive Hib disease
● Administered: Intramuscular route outer right upper thigh
● Three doses beginning at 6 weeks
● Schedule : 6, 10,14 weeks
● Interval : Four weeks after each dose
● Adverse reaction: Mild reactions to the vaccine include: (i) soreness,
redness, or swelling at the injection site, which resolves within one to
three days; and (ii) fever.
 Oral Polio Vaccine
● Live attenuated virus
● Protects against polio virus, provides
mucosal /gut immunity,protects contacts
who are unvaccinated
● Administered by: Oral dropper ( 2 drops)
● Three to four doses beginning at 6 weeks
● Schedule : 6, 10, 14 weeks
● Minimum interval: four weeks; an IPV
dose should be given from 14 weeks of age
(with OPV dose).
● Adverse reaction: rare
(vaccine-associated paralytic polio (VAPP))
 Inactivated Polio Vaccine
● Contains killed virus
● Provides immunity through blood, carries no risk of vaccine-associated
polio paralysis or vaccine derived polio virus
● Administered by: Injection (Intramuscular route 0.5ml ,outer left
upper thigh)
● One dose at 14 weeks together with OPV dose
● Adverse Reaction: No known serious reactions; mild injection site
reactions do occur (redness in less than 1% of those vaccinated, swelling
in 3%–11% and soreness in 14%–29%.)
 Rotavirus Vaccine

● Indications against rotavirus infections, which are the

leading cause of severe diarrhea among young children
● Given Per Orem as Oral liquid formulation
● Given as a 2 dose series with a minimum age of 6 weeks
and a minimum interval of 4 weeks between doses.
● Last dose should be administered not later than 24 weeks of
age
● Possible adverse reaction : Crying, Mild irritability, Fever,
Diarrhea, Vomiting
Pneumococcal Conjugate Vaccine (PCV13)

● Indicated for prevention of infections caused by S. Pneumoniae

● Intramuscular route
● Injection site - Vastus lateralis outer aspect for younger children
and deltoid muscle for older children
● Dosage 0.5 mL
● Given at 6, 10, 14. Booster dose given 6 months after the Third
dose
● Side effects - Fever, Loss of appetite, pain at injection site, chills,
headache.
● Adverse Reaction: Allergic reaction (Difficulty breathing, swelling
of the face, lips tongue or throat.) High fever, seizures
 Japanese Encephalitis Vaccine (JEV)

● Indicated for Japanese Encephalitis

● Given Subcutaneously
● Given at a minimum age of 9 months
● Given at the anterolateral aspect of thigh for 9 -11
months and at the deltoid muscle at age 1-3 years.
● Receive vaccine at the age of 9 months to 17 years and
booster dose 12-24 months after primary dose
● Side effects: Low grade fever, Chills, Flu like symptoms,
headache,
 Measles
● Protective against Measles Virus
● Live Attenuated vaccine
● Route: Subcutaneously (SC)
● Given at the age of 9 months, but maybe given as early as 6
months in cases of outbreaks
● If monovalent measles vaccine is not available, then MMR
vaccine may be given as substitute for infants below 12 months
○ Recipient should receive 2 more MMR/MR vaccines starting
1 year of age, following recommended schedule
● Adverse Reactions
○ Mild: Local injection site pain/tenderness, fever and rash
○ Serious: Severe allergic reaction to vaccine component
 Measles, Mumps, Rubella (MMR)

● Protective against Measles, Mumps and Rubella virus, also

Congenital Rubella Syndrome (CRS)
● Live Attenuated vaccine
● Route: Subcutaneously (SC)
● 2 doses of MMR vaccines are recommended
● Given at a minimum age of 12 months
● The second dose is usually given at 4-6 years of age but may
be given at an earlier age with a minimum of 4 weeks interval
between doses
● Adverse Reactions
○ Mild: Local injection site pain/tenderness, fever and rash
○ Serious: Severe allergic reaction to vaccine component
 Varicella
● Protective against Chickenpox (Varicella)
● Route: Subcutaneously (SC)
● 2 doses of varicella vaccine are recommended
● Given at a minimum age of 12 months
● The second dose is usually given at 4-6 years of age, but may be
given earlier at an interval of 3 months from the first dose
● If the dose was given 4 weeks from the first dose, it is considered
valid
● For children ≥13 years of age, the recommended minimum
interval between doses is 4 weeks
● Adverse Reactions
○ Mild: Local injection site pain/tenderness, fever and rash
○ Serious: Severe allergic reaction to vaccine component
Thank you for listening!
 References:
● National Immunization Program : Manual of Operations (Booklet 1) |
Department of Health website. (2021). Retrieved 7 October 2021, from
https://doh.gov.ph/publication/non-serial/NIP-MOP-booklet1
● National Immunization Program : Manual of Operations (Booklet 2) |
Department of Health website. (2021). Retrieved 7 October 2021, from
https://doh.gov.ph/publication/non-serial/NIP-MOP-booklet2
● National Immunization Program : Manual of Operations (Booklet 4) |
Department of Health website. (2021). Retrieved 7 October 2021, from
https://doh.gov.ph/publication/non-serial/NIP-MOP-booklet4
● Ulep, V., & Uy, J. (2021). An Assessment of the Expanded Program on
Immunization (EPI) in the Philippines: Challenges and Ways Forward.
Retrieved 7 October 2021, from
https://ideas.repec.org/p/phd/dpaper/dp_2021-04.html
● Pediatric Infectious Disease Society of the Philippines Journal; Vol 22 No
1, pp. 94-102; January-June 2021, Childhood Immunization Schedule
2021
QUIZ time!
Numbers 1-6
● What are the 6 preventable diseases initially
targeted as part of the basic vaccination in
the early era of EPI?
Number 7
● EPI eventually became known as ___?
Number 8
● What does BCG stand for?
Number 9
● Give an example of a live-attenuated vaccine
other than BCG and pertussis vaccine.
(be specific)
Number 10
● If there is an outbreak, Measles vaccine can
be given as early as ______?
Feedback:
Numbers 1-6
● What are the 6 preventable diseases initially
targeted as part of the basic vaccination in
the early era of EPI?

● Answer: Tuberculosis, Poliomyelitis,

Diphtheria, Pertussis, Tetanus, Measles
Number 7
● EPI eventually became known as ___?

● Answer: National Immunization Program

Number 8
● What does BCG stand for?

● Answer: Bacillus-Calmette Guerin

Number 9
● Give an example of a live-attenuated vaccine
other than BCG and pertussis vaccine.
(be specific)
Answer: Oral Polio Vaccine (OPV)
Number 10
● If there is an outbreak, Measles vaccine can
be given as early as ______?

● Answer: 6 months
Thank you!