Ancog, J – DDD

Expanded program on Immunization (EPI)

Goal: To achieve the over-all EPI goal of reducing morbidity and mortality among children
against the common vaccine preventable diseases.

Legal Basis:

RA 10152 Mandatory Immunization For infants and children up to 5yrs

RA 7846 Compulsory Immunization against Hepatitis B for infants and children below 8yrs old

Active Immunity – resistance developed in response to stimulus by an antigen and is

characterized by the production of antibodies by the hose

- protection produced by person’s own immune system

 Following clinical infection (Natural)

 Following subclinical infection (Natural)
 Following vaccination (Acquired)

Passive Immunity – Immunity conferred by an antibody produced in another host. It may be

acquired naturally or artificially (through an antibody – containing preparation)

- effective protection that wanes with time (principles of vaccination cdc.gov)

 Transfer of maternal antibodies through placenta (Natural)

 Transfer of maternal antibodies through milk (Natural)
 Following administration of immunoglobin or antiserum (Acquired)

Immunizing Agents

1.) Vaccines 2.) Immunoglobulins 3.) Antisera

Immunoglobulins – 5 major classes: IgM, IgA, IgG, IgE, and IgD. (M.A.G.E.D)

 2 types of immunoglobulin preparations are available for passive

immunization
1. Normal human immunoglobulin
2. Specific (hyper-immune) human immunoglobulin

Antisera or Antitoxins – these are materials prepared in animal or non-human sources

 Immunoglobulin and antiserum

Human normal Human specific Non-human Ig (antisera)

immunoglobulin immunoglobulin
Hepatitis A Hepatitis B Diphtheria
Measles Varicella Tetanus
Rabies Diphtheria Gas gangrene
Tetanus Botulism
Mumps Rabies

Vaccination – is a method of giving antigen to stimulate the immune response through active
immunization

 A vaccine is an immuno-biological substance designed to produce specific

protections against a given disease
 A vaccine is “antigenic” but not “pathogenic”

 Types of Vaccines
 Live vaccines
 Attenuated live vaccines
 Inactivated (killed vaccines)
 Toxoids
 Polysaccharide and polypeptide (cellular fraction) vaccine
 Surface antigen (recombinant) vaccines

Live Vaccines - made from live infectious agents without any modifications

- only live vaccine is “variola (small pox), not pathogenic but antigenic

- give cross immunity for variola

Live attenuated vaccines – virulent pathogenic organisms are treated to become attenuated
and avirulent but antigenic. (reduced in virulence, not harmful in effect)

- cannot make you sick but can still retain immunogenicity

should not be given to persons with suppressed immune response due to:

 Leukemia and Lymphoma

 Other malignancies
 Receiving corticosteroids and anti-metabolic agents
 Radiation
 Pregnancy
Inactivated vaccine – organisms are inactivated by heat or chemicals but remain antigenic.

- usually don’t provide immunity (protection) that’s as strong as live

vaccines. you may need several doses over time (booster shots) in order to
get ongoing immunity against diseases. (https://www.vaccines.gov/basics/types)

- usually safe but less effective than live attenuated vaccine

Toxoid vaccine - prepared by detoxifying the exotoxins of some bacteria rendering them
antigenic but not pathogenic

- In general, toxoids are highly efficacious and safe immunizing agents.

- Toxoid vaccines use a toxin (harmful product) made by the germ that causes a
disease. They create immunity to the parts of the germ that cause a disease instead of the germ
itself. That means the immune response is targeted to the toxin instead of the whole germ.
(principles of vaccination cdc.gov)

Polysaccharide and Polypeptide (cellular fraction) vaccine – prepared from extracted cellular
fractions. e.g., 1.) meningococcal vaccine from the polysaccharide antigen of the cell wall,
2.) the pneumococcal vaccine from the polysaccharide contained in the capsule of the
organism, and 3.) hepatitis B polypeptide vaccine

use specific pieces of the germ — like its protein, sugar, or capsid (a casing around the germ).

- efficacy and safety appear to be high

Surface antigen (recombinant) vaccine – prepared by cloning HBsAg gene in yeast cells where
it is expressed. HBsAg produced is then used for vaccine preparations

(HBsAg - Hepatitis B surface antigen)

 Types of Vaccines

Live Live Attenuated Killed Toxoids Cellular Recombinant

Vaccines Inactivated fraction
Small pox - BCG vaccine - Typhoid - - Meningococcal - Hepatitis B
(variola - Typhoid oral - Cholera Diphtheria polysaccharide vaccine
vaccine - Plague - Pertussis - Tetanus vaccine
- Oral polio - Plague - Pneumococcal
- Yellow fever - Rabies polysaccharide
- Measles - Salk polio Vaccine
- Mumps - - Hepatitis B
- Rubella Intramuscular polypeptide
intranasal Influenza vaccine
- Influenza - Japanese
- Typhus encephalitis

Scheme of vaccination

- Primary vaccination
- one dose vaccines (BCG, Variola, Measles, Mumps, Rubella, Yellow fever)
- multiple dose vaccines (Polio, DPT, Hepatitis B)
- Booster vaccination
- to maintain immunity level after it declines after some time has elapsed (DT, MMR)

MMR – Measles, mumps, rubella DPT – Diphtheria, pertussis, tetanus

OPV – Oral Polio Vaccine Pentavalent – 5-in-1 vaccine

BCG – Bacillus Calmette–Guérin vaccine TT – Tetanus Toxoid

Live attenuated Virus

Schedule of Immunization

Wednesday – designated immunization schedule for women and children nationwide

Consideration in Administering Immunization

1.) use one sterile syringe per client

2.) there is no need to restart a vaccination regardless of time lapsed

3,) all vaccines are safe and effective when administered simultaneously at different sites,

(inj. site interval of 2.5 – 3cm apart)

4.) If to administer vaccine simultaneously, OPV first followed by rotavirus and other vaccines

(OPV is given straight to the client’s tongue and not touching the tongue)

5.) Only monovalent vaccine will be given at birth

6.) Children who have not received AMV1 (or mother forgets), give AMV1 ASAP and AMV2
one month after

7.) All children entering school (preschool or 1 st grade) shall be screened for measles

8.) Rotavirus

- first dose: 6 – 15 weeks

- second dose: 10 – 32 weeks

administration of rotavirus should be slowly down one side of the mouth with the tip of
the applicator directed toward the back of the infant’s mouth. To prevent spitting
stimulate rooting reflex or lightly stroke the throat in a downward motion to stimulate
swallowing
 Target Setting and Vaccine Requirements

Targets:

- Infant
- Child
- Pregnant

The Cold Chain

The "cold chain" is a system of storage and transport of vaccines at low temperature from the
manufacturer to the actual vaccination site.

The cold chain system is necessary because vaccine failure may occur due to failure to store and
transport under strict temperature controls.

The Cold Chain Equipment

(a) Walk in cold rooms: They are

located at regional level, meant to store
vaccines up to 3 months and serve
districts.

(b) Deep freezers (300 ltr) and Ice lined

Refrigerators: supplied to all districts and
the WIC locations to store vaccines. Deep
freezers are used for making ice packs
and to store OPV and measles vaccines.

(c) Small deep freezers and ILR (140 ltr):

One set is provided to PHCs, and Family
Planning Centers

(d) Cold boxes: Cold boxes are supplied

to all peripheral centers. These are used
mainly for transportation of the vaccines.

(e) Vaccine carriers: Vaccine carriers are

used to carry small quantities of vaccines
(16-20 vials) for the out of reach
sessions. 4 fully frozen ice packs are used
for lining the sides, and vials of DPT, DT,
TT and diluents should not be placed in
direct contact with frozen ice packs. The
carriers should be closed tightly.

(f) Ice packs: The ice packs contain

water and no salt should be added to it.
1. Among the vaccines, Polio is the most sensitive to heat, requiring storage at -20ºC
2. Vaccines which must be stored in the freezer compartment are: polio and measles
3. Vaccines which must be stored in the COLD PART but never allowed to freeze are:
Typhoid, DPT, Tetanus toxoid, DT, BCG and Diluents.

Other Considerations to Maintain Potency

1.) observe first expiry first out (FEFO)

2,) comply with the recommended duration of storage and transport. Health center/RHU not to
exceed 1 month. Transport boxes kept at maximum of 5 days

3.) Multidose vaccines can be used up to 4 weeks, providing all following conditions are
met.

4.) discard reconstituted vaccines after 6 hours or at the end of the vaccination session.

5.) protect BCG and measles from heat and light

 Side effects of Immunization

Vaccines Side Effects Management

- Koch’s Phenomenon (2-4 days) - No management needed
BCG - Deep abscess - refer to physician for I & D
- Indolent ulceration > 12 weeks - treat with INH powder
- Glandular Enlargement - treat with INH powder
Hepatitis B - local soreness of inj. site - no treatment necessary
OPV - none - none
Tetanus Toxoid - local soreness at inj. site - apply cold compress at the site.
No other Tx needed
Pentavalent vaccine - fever for 1 day, if fever lasts for - advice patients not to give
more than a day, it may not be due antipyretic
to the vaccine
- local soreness at site - reassure soreness will disappear
after 3-4 days
- abscess after a week - indicates wrong technique, I&D
may be required
- convulsions (may be due to - proper management of
pertussis vaccine) convulsions and succeeding doses
may not be given
AMV - fever 5-7 days after immunization, - reassure parents and instruct to
sometimes mild rash give antipyretic
MMR - local soreness, fever, irritability - reassure parents and instruct to
and malaise give antipyretic

Contraindications:

1.) Pentavalent vaccine for children older than 5

2.) Pentavalent vaccine for a child with recurrent convulsions or experience convulsions 3 days
after shot

3.) Rotavirus vaccine when a child has history of hypersensitivity reactions to a previous dose

4.) BCG to a child who is immunosuppressed like AIDS or other immune conditions

False Contraindications:

1.) Malnutrition

2.) Low grade – fever

3.) Mild – respiratory infection

4,) Diarrhea, children with diarrhea who are due for OPV should receive a dose of OPV during
visit. However, the dose is not counted but the child should return when the next dose is due.
Fully Immunized Child (FIC) – those who were given BCG, 3 doses of OPV, Hep B and DPT or
Pentavalent vaccine

Completely Immunized Child (CIC) – refer to children who completed the required
immunization at the age of 12-23 months

Child Protected at Birth (CPAB) – is a term used to describe a child whose mother has received
2 doses of TT during this pregnancy, provided the 2nd dose was given a month prior to delivery