DEPARTMENT OF

HEALTH PROGRAMS
NATIONAL IMMUNIZATION
PROGRAM
(formerly EXPANDED PROGRAM ON
IMMUNIZATION)
 EPI NIP
Number of
Vaccine-
preventable
6 14
diseases
Target- Infant and Infant, pregnant
pregnant mothers mothers,
Population adolescent, elderly
and special
population
NATIONAL IMMUNIZATION PROGRAM
 EPI was established in 1976 to ensure that infants/children and mothers have access to
routinely recommended infant/childhood vaccines
 SIX VACCINE-PREVENTABLE DISEASES where initially included: TB, POLIOMYELITIS,
DIPHTHERIA,TETANUS, PERTUSSIS and MEASLES
 The immunization coverage of children has improved from 2003 to 2008
 GOALS OF EXPANDED PROGRAM ON
IMMUNIZATION AND SUPPORTING
LEGISLATION

OVER-ALL GOAL: “REDUCING THE

MORBIDITY AND MORTALITY AMONG
CHILDREN AGAINST THE MOST COMMON
VACCINE-PREVENTABLE DISEASES”
 GOALS OF EXPANDED PROGRAM ON
IMMUNIZATION AND SUPPORTING LEGISLATION
SPECIFIC GOALS:
1. To immunize all infants/children against the most common
vaccine-preventable diseases
2. To sustain the polio-free status of the Philippines
3. To eliminate measles infection. Pres. Proclamation No.4, s.
1998 (MEASLES ELIMINATION CAMPAIGN)
4. To eliminate maternal and neonatal tetanus. Pres.
Proclamation No.1066, s. 1997 (NATIONAL NEONATAL
TETANUS ELIMINATION CAMPAIGN)
5. To control diphtheria, pertussis, hepatitis B and German
measles
6. To prevent extrapulmonary TB among children
LAWS MANDATED TO PROTECT CHILDREN
THROUGH IMMUNIZATION TO THE DOH AND
LGUS:
1. R.A 10152- MANDATORY INFANTS AND
CHILDREN HEALTH IMMUNIZATION ACT OF
2011
-mandates basic immunization covering the vaccine- preventable
diseases.
- Added to the previously mentioned are HEPATITIS B, MUMPS,
RUBELLA, DISEASES CAUSED BY HAEMOPHILUS INFLUENZAE
TYPE B (Hib), and other diseases as determined by Department of
Health
R.A 10152- MANDATORY INFANTS AND
CHILDREN HEALTH IMMUNIZATION ACT
OF 2011
 Itgives the directive to gov’t hospitals and
health centers to provide free mandatory
basic immunization to infants and children
up to 5 years of age.
 This law has repealed PD 996 (Congress of
the Philippines,2011)
RA 7846- COMPULSORY
IMMUNIZATION AGAINST HEPATITIS B
Infants and children below 8 years
old
Within 24 hours after birth for
babies of women with hepatitis B
In 2012, TWO NEW VACCINES WERE INTRODUCED AS PART OF EPI:
 ROTAVIRUS VACCINE

- rotavirus infects the large intestine;most common

cause of severe diarrhea in infants and children.
-Ages 6 and 24 months are at greatest risk for
developing severe rotavirus infection.
 Hib VACCINE

- Hib is a bacterium responsible for serious illnesses, such

as MENINGITIS AND PNEUMONIA with almost all cases younger
than 5 yrs, with those between 4 and 18 months of age.
 IMMUNIZATION SCHEDULE and MANNER OF
ADMINISTRATION FOR INFANTS
ANTIGEN AGE DOSE ROUTE SITE

BCG vaccine At birth 0.05ml Intradermal Right Deltoid Region (ARM)

Hepatitis B vaccine At birth 0.5ml Intramuscular Anterolateral thigh muscle

DPT-HepB-
6 weeks, 10 weeks,
Hib(PENTAVALENT 0.5ml Intramuscular Anterolateral thigh muscle
14 weeks
VACCINE)
6 weeks, 10 weeks,
Oral Polio Vaccine 2 drops Oral Mouth
14 weeks
Anti-measles vaccine Outer part of the upper
9-11 months 0.5ml Subcutaneous
(AMV1) arm

Measles-Mumps- Rubella Outer part of the upper

12-15 months 0.5ml Subcutaneous
vaccine (AMV2)/MMR arm

Rotavirus vaccine 6 weeks, 10 weeks 1.5 ml Oral Mouth

 ADDED IMMUNIZATION SCHEDULE

ANTIGEN AGE DOSE ROUTE SITE

Inactivated Polio 14 weeks , Anterolateral thigh
0.5ml Intramuscular
Vaccine (IPV) 9 months muscle

❑ OPV/IPV as part of the National Immunization Program (DOH)

✓ The first dose of IPV is given together with the third dose of
OPV
✓ The second dose of IPV is given together with the measles
vaccine at 9 months
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING
INFANT IMMUNIZATION :
1. Use only one sterile syringe and needle per client (DOH, 2003a)
2. There is no need to restart a vaccination series regardless of the
time that has elapsed between doses (DOH, 2006a)
3. All the EPI antigens are safe and effective when administered
simultaneously , that is, during the same immunization session
but at different sites. It is NOT RECOMMENDED to mix different
vaccines in one syringe before injection, or to use a fluid vaccine
for reconstitution of a freeze-dried vaccine (DOH, 2003a)
When vaccine is administered to an infant at same time with
another injectable vaccine, the vaccines should be administered on
different sites.
IF MORE THAN ONE VACCINE GIVEN TO SAME LIMB, THE INJECTION
SITE SHOULD BE 2.5-5 CM APART TO PREVENT OVERLAPPING OF
LOCAL REACTIONS (DOH, 2006a)
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING INFANT
IMMUNIZATION :
4. The recommended sequence of the coadministration of
vaccines is OPV FIRST followed by rotavirus vaccine, then other
appropriate vaccines (DOH,2012b)
5. OPV is administered by putting drops of the vaccine straight
from the dropper onto the child’s tongue. Do not let the dropper
touch the tongue (DOH, 1995)
6. Only monovalent hepatitis B vaccine must be used for the
birth dose. Pentavalent vaccine must not be used for the birth
dose because DPT and Hib should not be given at birth.
Pentavalent vaccine contains antigens against five diseases:
diphtheria, pertusses, tetanus, hepatitis B and Hemophilus
influenza B
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING INFANT
IMMUNIZATION :
7. Children who have not received AMV1 as scheduled and children
whose parents or caregivers do not know whether they have
received AMV1 shall be given AMV1 as soon as possible, then AMV2
one month after AMV1 dose (DOH, 2010Dd)

8. All children entering day care centers/ pre-schoolers and grade 1

shall be screened for measles immunization. Those without the
immunization shall be referred to the nearest health facility for
immunization (DOH,2010d)

9. The first dose of rotavirus vaccine is administered only to infants

aged 6 weeks to 15 weeks. The second dose is given only to infants
aged 10 weeks up to a maximum of 32 weeks (DOH, 2012b
IMPORTANT CONSIDERATIONS RELATED TO THE
SCHEDULE AND MANNER OF ADMINISTERING INFANT
IMMUNIZATION :
10. Administer the entire dose of the Rotavirus vaccine
slowly down one side of the mouth (between cheeks and
gum) with the tip of the applicator directed toward the
back of the infant’s mouth.
To prevent spitting, or failed swallowing, stimulate the
rooting and sucking reflex of the young infant. For infants
aged 5 months or older, lightly stroke the throat downward
motion to stimulate swallowing ( DOH, 2012b)
NIP VACCINES CONTENTS AND FORM
VACCINE CONTENTS FORM
BCG (Bacillus Calmette Guerin) Freeze-dried, reconstituted with a
Live, attenuated bacteria
vaccine special diluent
RNA-recombinant, using hepatitis B Cloudy, liquid, in an auto-disable
Hepatitis B vaccine
surface antigen ( HBs Ag) injection syringe if available
Diphtheria toxoid, inactivated pertussis
bacteria, tetanus toxoid, recombinant
DPT-HepB-Hib(PENTAVALENT Liquid, in an auto-disable injection
DNA surface antigen, and synthetic
VACCINE) syringe
conjugate of Haemophilus influenza B
bacilli
Oral Polio Vaccine Live, attenuated virus (trivalent) Clear, pinkish liquid
Freeze-dried, reconstituted with a
Anti-measles vaccine (AMV1) Live, attenuated virus
special diluent
Measles-Mumps- Rubella vaccine Freeze-dried, reconstituted with a
Live, attenuated viruses
(AMV2) special diluent
Clear, colorless liquid, in a container
Rotavirus vaccine Live, attenuated virus
with an oral applicator
Sometimes slightly turbid in appearance;
Tetanus toxoid Weakened toxin
clear , colorless liquid;
MAINTAINING THE POTENCY OF EPI
VACCINES
 MAINTAIN THE COLD CHAIN
- The cold chain is a system for ensuring the potency
of the vaccine from the time of manufacture to the time it is
given to an eligible client.
✓ COLD CHAIN OFFICER- person directly responsible for cold
chain management at each level
✓ In RHU, the PUBLIC HEALTH NURSE is the C.C.O
 MAINTAINING THE POTENCY OF EPI VACCINES
COLD CHAIN EQUIPMENT AND SUPPLIES
❑ FREEZER/REFRIGERATOR
❑ TRANSPORT BOX
❑ VACCINE BAGS/CARRIERS
❑ COLD CHAIN MONITORS
❑ THERMOMETER
❑ COLD PACKS
✓ The nurse implements an emergency plan in the event of
an electrical breakdown or power failure
EPI VACCINES AND THE SPECIAL DILUENTS
HAVE THE FOLLOWING REQUIREMENTS
❑ OPV : -15 to -25◦C. OPV has to be stored in the freezer. In vaccine
bag, OPV is placed in contact with cold packs.
❑ ALL other vaccines, including measles vaccine, MMR, and Rotavirus
vaccine have to be stored in the refrigerator at the temperature of
+2 to +8◦c. these vaccines should be stocked neatly on the shelves of
refrigerator. Do not stock vaccines at the refrigerator shelves
❑ Hepatitis B vaccine, Pentavalent vaccine, Rotavirus vaccine, and TT
are damaged by freezing, so they should not be stored in the freezer.
Wrap the containers of these vaccines with paper before putting them
in the vaccine bag with cold packs
❑ Keep diluents cold by storing them in the refrigerator in the lower or
door shelves.
Other considerations to maintain potency
❑ Observe the FIRST EXPIRY-FIRST OUT (FEFO)
❑ Comply with the recommended duration of storage and transport.
❑ RHU with ref→ storage should not exceed 1 month
❑ Transport boxes→ kept only up to maximum of 5 days
❑ Take note if the vaccine container has a VACCINE VIAL MONITOR
(VVM) and act accordingly
❑ Reconstitute freeze dried vaccines only with the diluents supplied
with them
❑ Discard Reconstituted freeze dried vaccines 6 hours after
reconstituted or at the end of immunization session, whichever
comes first
❑ Protect BCG from sunlight and rotavirus vaccine from light
❑ Abide by the open vial policy of the DOH
VACCINE VIAL MONITOR

INNER SQUARE LIGHTER THAN OUTER RING.

If the expiry date has not been passed, USE THE
VACCINE!

AT A LATER TIME :
INNER SQUARE STILL LIGHTER THAN OUTER
RING.
If the expiry date has not been passed, USE THE
VACCINE!
DISCARD POINT:
INNER SQUARE MATCHES COLOUR OF OUTER
RING.
DO NOT USE THE VACCINE!
BEYOND THE DISCARD POINT:
INNER SQUARE DARKER THAN OUTER RING.
DO NOT USE THE VACCINE!
 A round disc of heat sensitive material placed on a vaccine vial to register
cumulative heat exposure
 The lower the tmp, the slower the color change: The higher the temp, the
faster the color change

24
VACCINE VIAL MONITOR

INNER SQUARE LIGHTER THAN OUTER RING.

If the expiry date has not been passed, USE THE
VACCINE!

AT A LATER TIME :
INNER SQUARE STILL LIGHTER THAN OUTER
RING.
If the expiry date has not been passed, USE THE
VACCINE!
DISCARD POINT:
INNER SQUARE MATCHES COLOUR OF OUTER
RING.
DO NOT USE THE VACCINE!
BEYOND THE DISCARD POINT:
INNER SQUARE DARKER THAN OUTER RING.
DO NOT USE THE VACCINE!
OPEN VIAL POLICY
 MULTIDOSE VIAL MAY BE opened for one or two clients if the health
worker feels that a client cannot come back for the scheduled
immunization session .
 MUTIDOSE LIQUID VACCINE from which one or more doses have been
taken following standard sterile procedures, may be used in the next
immunization session for up to maximum of 4 weeks, provided the
following conditions are met:
❑ The expiry date has not passed
❑ The vaccine has not been contaminated
❑ The vials has been stored under appropriate cold chain conditions
❑ The vaccine vial septum has not been submerged in water
❑ The VVM on the vial, if attached, has not reached discard point
SIDE EFFECTS:

BCG injection site- formation of wheal that disappears

within 30 mins.
- after 2 weeks→a small red tender swelling
appears at the site which may develop into a small abscess
which ulcerates→ heals and scar (12 weeks)
- expected outcome and dso not require any
management
 SIDE EFFECTS AND MANAGEMENT
VACCINES SIDE EFFECTS MANAGEMENT
KOCH’S PHENOMENON: an acute No management is needed
inflammatory reaction within 2-4
days after vaccination; usually
indicates previous exposure to
tuberculosis
Deep abscess at vaccination Refer to the physician for incision

BCG
site;atmost invariably due to and drainage
subcutaneous or deeper injection
Indolent ulceration: an ulcer Treat with INH powder
which persist after 12 weeks from
vaccination date
Glandular enlargement: If suppuration occurs, treat as
enlargement of the lymph glands deep abcess
draining the injection site
Local soreness at the injection site No treatment is necessary
HEPATITIS B VACCINE
 SIDE EFFECTS AND MANAGEMENT
VACCINES SIDE EFFECTS MANAGEMENT
Fever that usually lasts for only 1 Advise parent to give antipyretic
day. Fever beyond 24 hours is not
due to the vaccine but to other
causes
Local soreness at the injection site Reassure parents that soreness will
DPT-HepB-Hib disappear after 3-4 days

(PENTAVALENT Abscess after a week or more Incision and drainage maybe

usually indicates that the injection necessary
VACCINE) was not deep enough or the
needle was not sterile
Convulsions: although very rare, Propr management of convulsions;
may occur in children older than 3 pertussis vaccine should not be
months;caused by pertussis given anymore
vaccine
None
Oral polio vaccine
(OPV)
 SIDE EFFECTS AND MANAGEMENT
VACCINES SIDE EFFECTS MANAGEMENT
Fever 5-7 days after vaccination in Reassure parent and instruct them
ANTI-MEASLES some children; sometimes ther is a to give antipyretic to the child
mild rash
VACCINE
Local soreness, fever, irritability, Reassure parent and instruct them
MMR and malaise in some children to give antipyretic to the child

Some children develop mild Reassure parent and instruct them

Rotavirus vaccine vomiting and diarrhea, fever,
iriitability
to give antipyretic and oresol to
the child
Local soreness at the injection site Apply cold compress at the site.
Tetanus toxoid No other treatment needed
 CONTRAINDICATIONS TO IMMUNIZATION
 In general, there are no contraindications to immunization of a sick
child if the child is well enough to go home to prevent delay of
immunization
 ABSOLUTE CONTRAINDICATIONS/DO NOT GIVE:
1. PENTAVALENT VACCINE/DPT to children over 5 years of age
2. PENTAVALENT VACCINE/DPT to a child with recurrent convulsions
or another active neurological disease of CNS
3. PENTAVALENT VACCINE 2 or3 /DPT 2 or 3 to a child who has had
convulsions or shock within 3 days of the most recent dose
4. Rotavirus vaccine when the child has a history of
hypersensitivity to previous dose of the vaccine, intussusceptions or
intestinal malabsorption or acute gastroenteritis
5. BCG to a child who has signs and symptoms of AIDS or other
immune deficiency conditions or are immunosuppressed
False contraindications and if seen in
children the health worker may continue
with appropriate immunization :
❑ MALNUTRITON
❑ Low grade fever
❑ Mild respiratory infection
❑ Diarrhea

❑ Children with diarrhea who are due for OPV

should receive a dose of OPV during the visit.
However THE DOSE IS NOT COUNTED. The child
should return when the next dose of OPV Is due.
EPI RECORDING AND REPORTING
 Accomplished using the FHIS

❑ FULLY IMMUNIZED CHILDREN (FIC)-who were given BCG, 3 doses

of OPV, 3 doses of DPT and hepatitis B vaccine or 3 doses of
Pentavalent vaccine and one dose of anti measles vaccine before
reaching one year of age
❑ COMPLETELY IMMUNIZED CHILDREN – children who completed
their immunization schedule at the age of 12-23 months
❑ CHILD PROTECTED AT BIRTH( CPAB) – used to describe a child
whose mother has received (a) two doses of TT during her
pregnancy, provided that the second dose was given at least a
month prior to delivery or (b) at least 3 doses of TT anytime prior
to pregnancy with this child