Immunization: Expanded Program On Immunization (EPI)

CHN Week 6
Expanded Program on Immunization (EPI)

 Established in 1976 to ensure that infants/children and The Concept and Importance of
mothers have access to routinely recommended Vaccination
infant/childhood vaccines
Immunization is the process by which the vaccines are
 Reducing the morbidity and mortality among children
introduced into the body before infection sets in.
against the most common vaccine-preventable
diseases Vaccines are administered to induce immunity thereby
causing the recipient’s immune system to react to the
 Supporting Legislation:
vaccine that produces antibodies to fight infection.
 R.A. 10152, also known as Mandatory
Vaccines promote health and protect children from
Infants and Children Health Immunization
disease-causing agents.
Act of 2011
Infants and NB need to be vaccinated at an early stage
 R.A. 7846 provided for compulsory
since they belong to vulnerable age group. They are
immunization against hepatitis B for
susceptible to childhood diseases.
infants and children below 8 years old
 There are several general principles which apply in vaccinating children:
- It is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body
- Measles vaccine should be given as soon as the child is 9 months old.
- The vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded
the recommended interval by months or years
- Moderate fever, malnutrition, mild respiratory infection, cough diarrhea and vomiting are not contraindications
to vaccination
- Attenuated vaccine – a vaccine created by reducing the virulence of a pathogen. Weakened vaccine to become
a virulence meaning unable to cause a disease.
Maintaining the Potency of EPI Vaccines

To be potent, vaccines must be properly stored, handled and transported
1. Maintain the Cold Chain
 The cold chain is a system for ensuring the potency of a vaccine from the time of manufacture to the time
it is given to an eligible client
 In RHU, PHN is the Cold Chain Officer
2. Observe the first expiry-first out (FEFO) policy
3. Comply with recommended duration of storage and transport
4. Take note if the vaccine container has a vaccine vial monitor (VVM) and act accordingly.
 The VVM is a round disc of heat-sensitive material placed on a vaccine vial to register cumulative heat
exposure
5. Abide by the open-vial policy of the DOH
6. Reconstitute freeze-dried vaccines ONLY with the diluents supplied with them
7. Discard reconstituted freeze-dried vaccines six hours after reconstitution or at the end of the immunization
session, whichever comes sooner
8. Protect BCG and Rotavirus vaccine from sunlight.

Contraindications to Immunization
In general, there are no contraindications to immunization of a sick child if the child is well enough to go home
Absolute contraindications – DO NOT GIVE:
 Pentavalent vaccine/DPT to
 children over 5 years of age (DOH, 2003a);
 a child with recurrent convulsions or another active neurological disease of the central nervous
system (WHO, 2005a);
 Pentavalent vaccine 2 or 3/DPT 2 or DPT 3 to a child who has had convulsions or shock within 3 days of
the most recent dose (WHO, 2005a);
 Rotavirus vaccine when the child has a history of hypersensitivity to a previous dose of the vaccine,
intussusceptions or intestinal malformation, or acute gastroenteritis (DOH, 2012b); and
 BCG to a child who has signs and symptoms of AIDS or other immune deficiency conditions or who are
immunosuppressed (DOH, 2003a).
EPI Recording and Reporting

Accomplished using the Field Health Service Information System (FHSIS)
1. Fully immunized children (FIC)
a) BCG
b) 3 doses of OPV
c) 3 doses of DPT
d) hepatitis B vaccine or 3 doses of Pentavalent vaccine
e) one dose of anti-measles vaccine before reaching one year of age
2. Completely immunized children
a) completed their immunization schedule at the age of 12 to 23 months
3. Child protected at birth (CPAB)
a) It is a term used to describe a child whose mother has received
b) 2 doses of tetanus toxoid during this pregnancy, provided that the second dose was given at least a month
prior to delivery, OR
c) At least 3 doses of tetanus toxoid any time prior to pregnancy with this child
Tetanus Dose – .5cc/ml Interval given Length of protection

Toxoid
IM-deltoid area
TT1 Anytime as pregnancy

detected
TT2 1 mo. After TT1 3yrs
TT3 6 mos. After TT2 5yrs
TT4 A year after TT3 10 yrs
TT5 A year after TT4 Lifetime immunity

“FIM”
EPI Vaccines
Vaccine Contents Form

BCG (Bacillus Calmette- Live, attenuated bacteria Freeze-dried, reconstituted with a
Guerin) special diluent
Hepatitis B vaccine RNA-recombinant, using Hepatitis B surface Cloudy, liquid, in an auto-disable

antigen (HBs Ag) injection syringe if available
DPT-HepB-Hib (Pentavalent Diphtheria toxoid, inactivated pertussis Liquid, in an auto-disable injection

vaccine) bacteria, tetanus toxoid, recombinant DNA syringe
surface antigen, and synthetic conjugate of
Haemophilus influenzae B bacilli
Oral polio vaccine Live, attenuated virus (trivalent) Clear, pinkish liquid
Anti- measles vaccine (AMV1) Live, attenuated virus Freeze-dried, reconstituted with a
special diluent
Measles-mumps-rubella Live, attenuated viruses Freeze-dried, reconstituted with a

vaccine (AMV2) special diluent
Rotavirus vaccine Live, attenuated virus Clear, colorless liquid, in a container

with an oral applicator
Tetanus toxoid Weakened toxin Clear, colorless liquid
Immunization Schedule
Antigen Age Dose Route Site

BCG vaccine At birth 0.05 ml. Intradermal Right deltoid region
(arm)
Hepatitis B vaccine At birth 0.5 ml. Intramuscular Anterolateral thigh

muscle
DPT-HepB-Hib 6 weeks, 10 weeks, 14 0.5 ml Intramuscular Anterolateral thigh

(Pentavalent vaccine) weeks muscle
Oral polio vaccine 6 weeks, 10 weeks, 14 2 drops Oral Mouth

weeks
Anti-measles vaccine 9-11 months 0.5 ml. Subcutaneous Outer part of upper
(AMV1) arm
Measles-mumps-rubella 12-15 months 0.5 ml. Subcutaneous Outer part of upper

vaccine arm
(AMV2)
Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml. Oral Mouth

 It is safe and effective with mild side effects
 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/mother who missed a dose of DPT/HB/OPV/TT.
 Strictly follow the principle of NEVER, ever reconstituting the freeze-dried vaccination in anything other than the
diluents supplied with them.
 Use one syringe one needle per child during vaccination
 Eligible age for DPT is up to 6 mos. At 7 months, may be given only DT if available
 Booster doses are not really necessary school entrant BCG is given regardless of whether the child received infant
BCG or not
 Measles vaccine is not given to babies younger than 9 months because of maternal antibodies that baby may still
have.
 False contraindications to immunizations:
- Malnutrition, low grade fever, mild respiratory infection and other minor illness and diarrhea should
not be considered as C/I to OPV.
- Repeat BCG vaccination if the child does not develop a scar after 1st injection.
Allowable time frame for Storage of Vaccine
- Health centers with no refrigerator for vaccine only transport boxes – 5 days
- Provincial/ district level - 3 months
- Regional level – 6 months
- Main Health centers with Refrigerator - 1 month

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CHN Week 6

Expanded Program on Immunization (EPI)

 There are several general principles which apply in vaccinating children:

- Measles vaccine should be given as soon as the child is 9 months old.

Maintaining the Potency of EPI Vaccines

1. Maintain the Cold Chain

 In RHU, PHN is the Cold Chain Officer

2. Observe the first expiry-first out (FEFO) policy

3. Comply with recommended duration of storage and transport

5. Abide by the open-vial policy of the DOH

8. Protect BCG and Rotavirus vaccine from sunlight.

Absolute contraindications – DO NOT GIVE:

 children over 5 years of age (DOH, 2003a);

EPI Recording and Reporting

1. Fully immunized children (FIC)

d) hepatitis B vaccine or 3 doses of Pentavalent vaccine

e) one dose of anti-measles vaccine before reaching one year of age

2. Completely immunized children

a) completed their immunization schedule at the age of 12 to 23 months

3. Child protected at birth (CPAB)

a) It is a term used to describe a child whose mother has received

Tetanus Dose – .5cc/ml Interval given Length of protection

TT1 Anytime as pregnancy

TT2 1 mo. After TT1 3yrs

TT3 6 mos. After TT2 5yrs

TT4 A year after TT3 10 yrs

TT5 A year after TT4 Lifetime immunity

Vaccine Contents Form

Hepatitis B vaccine RNA-recombinant, using Hepatitis B surface Cloudy, liquid, in an auto-disable

DPT-HepB-Hib (Pentavalent Diphtheria toxoid, inactivated pertussis Liquid, in an auto-disable injection

Measles-mumps-rubella Live, attenuated viruses Freeze-dried, reconstituted with a

Rotavirus vaccine Live, attenuated virus Clear, colorless liquid, in a container

Tetanus toxoid Weakened toxin Clear, colorless liquid

Antigen Age Dose Route Site

Hepatitis B vaccine At birth 0.5 ml. Intramuscular Anterolateral thigh

DPT-HepB-Hib 6 weeks, 10 weeks, 14 0.5 ml Intramuscular Anterolateral thigh

Oral polio vaccine 6 weeks, 10 weeks, 14 2 drops Oral Mouth

Measles-mumps-rubella 12-15 months 0.5 ml. Subcutaneous Outer part of upper

Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml. Oral Mouth

 No extra doses must be given to children/mother who missed a dose of DPT/HB/OPV/TT.

 Use one syringe one needle per child during vaccination

 False contraindications to immunizations:

Allowable time frame for Storage of Vaccine

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