Expanded Program on Immunization

EXPANDED PROGRAM ON IMMUNIZATION Prepared by: Rosechelle Siupan-Elarco,RN,MAN

The Expanded Program on Immunization (EPI) was established in the Philippines by Pres. Marcos on the month of July, 1976, to ensure that infants/children and mothers have access to routinely recommended infant/childhood vaccines.

With the commitment of our country to Universal Child Immunization (UCI) goal, acceleration of EPI coverage had began in 1986

PD 996 : Providing for compulsory basic immunization for infants and children below 8 years old

Objective:To reduce the morbidity and mortality among infants and children caused by the seven childhood immunizable diseases.

Seven (7) Childhood Immunizable Diseases Tuberculosis ( Primary Complex if less than 3 years old ) Diphteria Pertussis DPT Neonatal Tetanus Poliomyelitis Hepatitis B Measles

Four Major Strategies Sustaining high routine FIC coverage of at least 90% in all provinces and cities. Sustaining the polio free country for global certification. Eliminating measles by 2008 Eliminating neonatal tetanus by 2008

Elements of EPI Target Setting (main element) Information, Education and Communication Cold chain logistic management Assessment and Evaluation of overall performance Surveillance, Studies and Research

Concept and Importance of Vaccination

Immunization - is the process by which vaccines are introduced into the body before infection sets in.Vaccines are administered to introduced immunity thereby causing the recipients 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.

General Principles in Vaccinating ChildrenIt is safe and immunologically effective to administer all EPI vaccines on the same day at different sites of the body.The vaccination schedule should not be restarted from the beginning even if the interval between doses exceeded the recommended interval by months or year.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 who missed a dose of DPT/HB/OPV. The vaccination must be continued as if no time had elapsed between doses.Do not give more than one dose of the same vaccine to a child in one session. Give doses of the same vaccine at the correct intervals.Strictly follow the principle of never, ever reconstituting the freeze dried vaccine in anything other than the diluent supplied with them.If you are giving more than one vaccine, do not use the same syringe and do not use the same arm or leg for more than one injection. False contraindications to immunization are children with malnutrition, low grade fever, mild respiratory infections and other minor illnesses and diarrhea should not be considered a contraindication to OPV vaccination. Repeat BCG vaccination if the child does not develop a scar after the 1st injection.

Contraindication to Immunization Anaphylaxis or severe hypersensitivity reaction to a previous dose of vaccine is an absolute contraindication to subsequent doses of vaccine

Person with a known allergy to a vaccine component should not be vaccinated. DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. Vaccines containing the whole cell pertussis component should not be given to a children with an evolving neurological disease. Do not give live vaccines like BCG to a individuals who are immunosuppressed due to malignant disease ( child with AIDS) , going therapy with immunosuppressive agents or radiation. A child with a sign and symptoms of severe dehydration Fever of 38.5 C and above

The following are NOT contraindication. Infants with these conditions SHOULD be immunized: Allergy or asthma ( except if there is a known allergy to a specific component of vaccine mentioned above) Minor respiratory tract infection Diarrhea Temp, below 38.5 C Family history of adverse reaction following immunization Family history of convulsions, seizures Known or suspected HIV infection with no signs and symptoms of AIDS Child being breastfed Chronic illness such as diseases of heart, lung, kidney or liver Stable neurological condition such as cerebral palsy or Downs Syndrome Premature or low birthweight (vaccination should not bepostponed) Recent or imminent surgery Malnutrition History of jaundice at birth

Note:If parent strongly objects to an immunization for a sick infant, do not give it. Ask the mother to comeback when child is well.

EPI Routine ScheduleEvery Wednesday is designated as immunization day and is adopted in all part of the country

FIC Fully Immunized Child when a child receives one dose of BCG, 3 doses of OPV, 3 doses of DPT, 3 doses of HepB and one dose of measles before a childs first birthday.

1

Type of Vaccine

Storage Temp. Hours of Life after opening

Most Sensitive to HeatOPV -15 to -25 C At the freezer8 hours

Measles

Most Sensitive to ColdHepa B2 to 8 C Body of refrigerator

DPT

T. Toxoid

Sensitive to Sunlight and Fluorescent light Fluorescent lightBCG4 hours

Vaccine can be stored in Refrigerator:Regional - 6 months Municipal / City - 3 months Main Health Center - 1 months

Transport Box : 5 daysNote: 3 trip in transport box with the same vaccine discard it

FEFO ( first expiry and first out ) vaccine is practiced to ensure that all vaccines are utilized before its expiry date. Proper arrangement of vaccines and labeling of vaccines expiry date are done to identify those near to expire vaccines

EPI VACCINES BCG (Bacille Calmette-Guerin ) VaccineType of VaccineLive Bacterial

Form of VaccineFreeze dried

Minimum Age at 1st DoseBirth or anytime at birth

Number of Doses to Complete the Immunization1st dose : at birth2nd dose: school entrance

ReasonBCG given at earliest possible age protects the possibility of TB meningitis and other TB infectious in which infants are prone.

Number of Doses per Ampule20 ( 20 children )

DosageAt birth : 0.05 ml At school entrance : 0.10 ml

Route of AdministrationIntradermal ( a special syringe and needle is used for the administration of BCG vaccine )

Site of AdministrationRight deltoid region of the arm

Storage Temperature2 C to 8 C ( in the body or refrigerator )Note: Freezing does not damage it but ampules may break.Diluents should also be kept cold before using

Special PrecautionsCorrect ID administration is essential. A special syringe and needle is used for the administration of BCG vaccine

Side EffectA wheal formationKoch phenomenon ( inflammatory reaction 2-4 days )

Undesired Effect Indolent ulceration Abscess on the injection site Enlarged lymph nodesNote: Swollen glands or abscesses occur because an unsterile needle or syringe was used, too much vaccine was injected or most commonly, the vaccine was injected incorrectly under the skin instead of its top layer.

ContraindicationImmunosuppressed indvidual due to malignant disease ( child with clinical AIDS ) ; therapy with immunosuppressive agent or radiation.

Health Teaching Do not massage the area of inj ection A scar will formed 12 weeks after injection Repeat BCG vaccination if the child does not develop a scar after first injection

DPT (Diphteria-Pertussis-Tetanus ) Vaccine

Type of VaccineDiphteria and Tetanus as toxiods which is a weakened toxinPertussis as killed whole-cell bacterium

Form of VaccineLiquid vaccine

Minimum Age at 1st Dose6 weeks

Number of Doses to Complete the Immunization3

Interval4 weeks / minimum of 28 days

ReasonAn early start with DPT reduces the chance of severe pertussis

Number of Doses per Ampule20 or 10

Dosage0.5 ml

Route of AdministrationIntramuscular

Site of AdministrationUpper outer portion of the thigh ( Vastus lateralis ) in infant ( R - L - R )Outer upper arm if older

Storage Temperature2 C to 8 C ( in the body of refrigerator )Note: DT component is damage by freezing P component is damage by heat

Special PrecautionsDPT not usually given over 6 years of age

Side Effect Fever in the evening after receiving the injection. Soreness, children may have pain, redness or swelling at the injection site.

Contraindication DPT2 or DPT3 is not given to a child who has convulsions or shock within 3 days after DPT1. Vaccines containing the whole cell pertussis component should not be given to a children with an evolving neurological disease.

Health Teaching If the child has fever give paracetamol or any appropriate antipyretic at the time and at four and eight hours after immunization. Alternating cold compress for 24 hours to warm compress if there is pain and soreness .

OPV ( Oral Polio Vaccine)Type of VaccineLive attenuated vaccine


Minimum Age at 1st Dose6 weeks


Interval4 weeks / minimum of 28 days

ReasonThe extent of protection against polio is increased the earlier the OPV is given


Dosage2 drop

Route of AdministrationOral

Site of AdministrationMouth

Storage Temperature-15 C to -25 C ( at the freezer )Note: It is easily damaged by heat but is not harmed by freezing.

Special PrecautionsChildren known to have rare congenital immune deficiency syndrome should receive IPV ( injectable polio vaccine ) rather OPV

Side EffectCauses almost no side-effects. Less than 1% of the people who receive the vaccine develop a headache, diarrhea or muscle pain.

ContraindicationNone

Health Teaching Nothing by mouth (NPO) 30 minutes before and after OPV. Do not touch the tip dropper bottle to the tongue.

Hepatitis B Vaccine

Type of VaccineMonovalent vaccine contain only one antigen

Form of VaccineCloudy liquid vaccine

Minimum Age at 1st DoseAt birth


Interval6 weeks interval from 1st dose to 2nd dose 8 weeks interval from 2nd dose to 3rd dose

ReasonAn early start of Hep B vaccine reduces the chance of being infected and becoming a carrier. Prevent liver cirrhosis and liver cancer

Number of Doses per Ampule1 for single dose vial10 for multi dose vial ( 10 children )

Dosage0.5 ml


Site of AdministrationUpper outer portion of the thigh ( Vastus lateralis ) in infant ( with DPT: L - R - L )

Storage Temperature2 C to 8 C ( in the body of refrigerator )Note: Both heat and freezing damages the vaccine )

Special PrecautionsBirth dose must be given if there is a risk of perinatal transmission.Note : Combination vaccines should not be given at birth, only monovalent HepB vaccine

Side Effect Mild fever that lasts one to two days after injection Soreness, children may have pain, redness or swelling at the injection site.

Contraindication Anaphylactic reaction such as severe rashes, difficulty in breathing and choking to a previous dose.

Health Teaching If the child has fever give paracetamol or any appropriate antipyretic at the time and at four and eight hours after immunization. Alternating cold compress for 24 hours to warm compress if there is pain and soreness .

Measles VaccineType of VaccineAttenuated Measles Virus

Form of VaccineFreeze dried

Minimum Age at 1st Dose9 months6 months: if there is an epidemic


ReasonMeasles vaccine given at 9 months provide at least 85% protection against measles infection.When given at one year and older provides 95% protection.Note: An infant with known or suspected HIV infection should receive measles vaccine at 6 months and then again at 9 months


Dosage0.5 ml

Route of AdministrationSubcutaneous

Site of AdministrationOuter part of the upper arm

Storage Temperature-15 C to -25 C ( at the freezer )Note: But can also be safely stored between 0 C to 8C until its expiry date.Diluents should also be kept cold before using.

Special PrecautionsBirth dose must be given if there is a risk of perinatal transmission.Note : Combination vaccines should not be given at birth, only monovalent HepB vaccine

Side Effect Fever that lasts one to two days after injection Soreness, children may have pain, redness or swelling at the injection site within 24 hours of immunization. It usually resolve within two to three days. About 1 in 20 children develop a mild rash five to 12 days after receiving the vaccine. The rash usually lasts about two days.

Contraindication Severe reaction to previous dose Pregnancy Congenital or acquired immune disorder

Health Teaching If the child has fever give paracetamol or any appropriate antipyretic at the time and at four and eight hours after immunization. Alternating cold compress for 24 hours to warm compress if there is pain and soreness . It also prevent diarrhea

Immunization Schedule For Infants Recommended By The EPIAGE

Birth6 weeks10 weeks14 weeks9 months

BCGX

OPVXXX

DPTXXX

HepB Option BXXX

Option AXXX

MeaslesX

EPI ROUTINE IMMUNIZATION SCHEDULE FOR INFANTS

VACCINETARGETDOSAGEINTERVALROUTESITE

1. BCGAnytime at Birth

School Entrance0.05ml

0.1mlOnce Intradermal (ID)

Assess for Wheal formationRight Deltoid

Left Deltoid

2. Hepa BAnytimeat Birth0.5ml6 wks. Interval from 1st dose to 2nd dose, then 8 weeks interval From 2nd to 3rd doseIntramuscular (IM)Upper outerPortion of the thigh

3. DPT6 wks. Up to 11 mos.0.5ml4 weeks x 3 dosesIntramuscular (IM)Upper outer portion of the thigh

4. OPV6 wks. Up to 11 mos.2 drops4 weeks x 3 dosesOral(Child must be PO for 30 mins.)Mouth(side of the cheek)

5. Measles9 months

(if epidemic crisis, 6 mos.)0.5mlOnceSubcutaneous(SQ)OuterPart of the upper arm

Tetanus Toxoid (TeTox) Vaccine

Type of VaccineWeakened toxin


Minimum Age at 1st DoseAs early as possible during pregnancy

Number of Doses to5 doses ( TeTox 1 - TeTox 5 )

Complete the ImmunizationTeTox 2 is the minimum required immunization during pregnancy

Number of Doses per Ampule10 or 20

Dosage0.5 ml


Site of AdministrationOuter upper arm

Storage Temperature2 C to 8 C ( in the body of refrigerator ) Note: Never freeze

Side Effect Fever in the evening after receiving the injection. Soreness, woman may have pain, redness or swelling and warmth at the injection site.

Contraindication Anaphylactic reaction to previous dose

Health Teaching NO MEDICATION FOR PREGNANT For Pain cold compress 24 hrs to warm compress

Tetox Routine Immunization of Pregnant WomenVaccineMinimumIntervalPercentProtectedDuration of Protection

TeTox 1As early as possible during pregnancy

TeTox 24 weeks after TeTox 180% infant will be protected by neonatal tetanus 3 years protection for the mother

TeTox 36 months after TeTox 295 % infant will be protected by neonatal tetanus 5 years protection for the mother

TeTox 41 year after TeTox 399 % infant will be protected by neonatal tetanus 10 years protection for the mother

TeTox 51 year after TeTox 499 % all infant born to that mother will be protected lifetime protection for the mother

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Expanded Program on Immunization