MODULE 5- EXPANDED PROGRAM ON IMMUNIZATION (EPI)

The 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 induce immunity thereby causing the
recipient’s 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 newborns need to be vaccinated at an early age since they belong to the
vulnerable age group. They are susceptible to childhood diseases.

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, regardless of
whether other vaccines will be given on that day. Measles vaccines given at 9 months
provide 85% protection against measles infection. When given at one year and older
provides 95% protection
 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. Generally, one should immunize unless the child
is so sick that he needs to be hospitalized.
 The absolute contraindications to immunization are:
 DPT 2 or DPT 3 to a child who had convulsions or shock within 3 days the
previous dose. Vaccines containing the whole cell pertussis component should not
be given to children with an evolving neurological disease (uncontrolled epilepsy
of progressive encephalopathy)
 Live vaccines like BCG vaccine must not be given to individuals who are
immunosuppressed due to malignant disease (child with clinical AIDS), therapy
with immunosuppressive agents, or irradiation.
 It is safe and effective with mild side effects after vaccination. Local reaction, fever and
systemic symptoms can result as part of the normal immune response
 Giving doses of a vaccine at less than 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/OPV/TT.
The vaccination must be continued as if no time had elapsed between doses.
 False contraindications to immunizations 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.
 Use one syringe one needle per child during vaccination.

The EPI Target Diseases

Vaccination among infants and newborns (0-12 months) against the seven vaccine preventable
diseases. These include: tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles and
Hepatitis.
DISEAS STANDARD CASE AGENT/RESER SOURCE OF RISK FACTOR
E DEFINITION VOIR INFECTION FOR INFECTION
Measles A highly Agent: Close -Crowding
communicable Virus respiratory -Low socio
disease with the contact and economic status
history of the Reservoir: aerosolized
following: Humans droplets
-Generalized blotchy
rash, lasting for 3
days
-Fever (above 38 or
“hot” to touch and
- any of the following:
~cough
~runny nose
~red eyes/conjunctiva
Tuberculo -A child with history Agent: Droplet -Low access to care
sis of contact with a Mycobacterium infection, that is -Immunodeficiency
suspect or confirmed tuberculosis through -Malnutrition
case of pulmonary inhalation of - Alcoholism
tuberculosis Reservoir: bacilli from -Diabetes
-Any child who does -Man patients
not return to normal - Diseased cattle
health after measles
or whooping cough
- Loss of weight,
cough and wheeze
which does not
respond to antibiotic
therapy for acute
respiratory disease
- Abdominal swelling
with a hard painless
mass and free fluid
-Painful firm or
 swelling in a group of
superficial lymph
nodes
- Any bone or joint
lesion or slow onset
- Signs suggesting
meningitis or disease
in the central nervous
system
Diphtheri It is an acute Agent: By respiratory -Crowding
a pharyngitis, acute Corynebacterium droplets from -Low socio
nasopharyngitis or diphtheria discharge of a economic status
acute laryngitis with case or carrier
pseudo membrane Reservoir:
Man
Pertussis History of severe Agent: Bordetella -Primarily by -Young age
cough and history of pertussis direct contact -Crowding
any of the ff: with discharges
-cough persisting 2 or Reservoir: from respiratory
more weeks Man mucous
-cough followed by membranes of
vomiting infected persons
-airborne route
probably by
droplets
-Contact with
articles freshly
soiled with the
discharges of
infected persons
Poliomyel -A suspect cases of Agent: -Fecal-oral route Poor environmental
itis polio is defined as any Poliomyelitis type -Oral route hygiene
patient below 15 1,2,3 through
years of age with pharyngeal
acute flaccid Reservoir: secretion
paralysis(including Man, mostly -Contact with
those diagnosed to children infected persons
have Guilliane Barre
Syndrome) for which
no other cause can be
immediately
identified
Neonatal A newborn with the Agent: -Unhygienic -Contamination of
Tetanus history of all the three Clostridium tetani cutting of umbilical cord
of the ff: umbilical cord -Agricultural work
-normal suck for the -Improper
 first two days of life Reservoir: handling of cord
-onset of illness -Soil stump especially
between 3 to 26 days -Intestinal canals when treated
-inability to suck of animals(esp. with
followed by stiffness horses) contaminated
and the body/or -Man substance
convulsions
Hepatitis It is the liver infection Agent: Hepatitis B -HBeAg + mother
B caused by the B type Hepatitis B virus spreads through Multiple sexual
of hepatitis virus. It the ff: partners
attacks the liver often -from child to
resulting in Reservoir: child or mother
inflammation Man to child after
birth
-from mother to
child during
birth
-through sharing
of unsterilized
needles, knives
or razors
-through sexual
intercourse

The EPI Routine Schedule of Immunization

Every Wednesday is designated as immunization day and is adopted in all parts of the country.
In a barangay health station immunization is done monthly while in far flung areas it is done
quarterly. However, some areas adopted local practices to provide everyday vaccination in their
areas to cover all targets.

Routine Immunization Schedule for Infants

The standard routine immunization schedule for infants is adopted to provide maximum
immunity against seven vaccine preventable diseases before a child’s first birthday. A child is
said to be “Fully Immunized Child” when a child receives one dose of BCG, 3 doses of OPV, 3
doses of DPT, 3 doses of HB and one dose of measles before a child’s first birthday.

VACCINE MINIMUM NUMBER OF MINIMUM REASON

AGE AT 1ST DOSES INTERVAL
 DOSE BETWEEN
DOSES
BCG Birth or anytime 1 BCG given at
after birth earliest possible
age protects the
possibility of TB
meningitis &
other TB
infections in
which infants
are prone
DPT 6 weeks 3 4 weeks An early start
with DPT
reduces the
chance of severe
pertussis
OPV 6 weeks 3 4 weeks The extent of
protection
against polio is
increased the
earlier the OPV
is given
Hep B At birth 3 6 weeks interval An early start of
from the 1st dose Hep B reduces
and 8 weeks the chance of
interval from 2nd being infected
dose to 3rd dose and becoming a
carrier
Prevent liver
cirrhosis and
liver cancer
Measles 9 months At least 85% of
measles can be
prevented by
immunization at
this age
Prevents
death(2% die),
malnutrition,
pneumonia,
diarrhea (at least
20%)

Tetanus Toxoid Immunization Schedule for Women

 VACCINE MINIMUM PRECENT DURATION OF
AGE/INTERVAL PROTECTED PROTECTION
TT 1 As early as possible
during pregnancy
TT 2 At least 4 weeks later 80% -infants born to the
mother will be
protected from
neonatal tetanus
TT 3 At least 6 months 95% -infants born to the
later mother will be
protected from
neonatal tetanus
-gives 5 years
protection to the
mother
TT4 At least one year later 99% -infants born to the
mother will be
protected from
neonatal tetanus
TT 5 At least one year later 99% -gives life time
protection for the
mother
-all infants born to
that mother will be
protected

Administration of Vaccines
VACCINE DOSE ROUTE OF SITE OF
ADMINISTRATIO ADMINISTRATIO
N N
BCG Infants 0.05ml Intradermal Right deltoid region
of the arm
DPT 0.5ml Intramuscular Upper outer portion of
the thigh
OPV 2 drops or depending Oral Mouth
on manufacturer’s
instructions
Measles 0.5ml Subcutaneous Outer part of the
upper arm
HEP B 0.5 ml Intramuscular Upper outer portion of
the thigh
Tetanus Toxoid 0.5ml Intramuscular Deltoid region of the
upper arm
SIDE EFFECTS OF VACCINATION AND THEIR MANAGEMENT
VACCINE SIDE EFFFECTS MANAGEMENT
BCG Koch’s phenomenon: an No management is needed
acute inflammatory reaction
within 2-4 days after
vaccination, usually indicates
previous exposure to
tuberculosis
Deep abscess at vaccination Refer to the physician for
site, almost invariably due to incision and drainage
subcutaneous or deeper
injection
Indolent ulceration: an ulcer Treat with INH powder
which persists after 12 weeks
from vaccination date
Hepatitis B vaccine Local soreness at the No treatment is necessary
injection site
DPT-Hep B-Hib(Pentavalent Fever that usually lasts for Advise parents to give
vaccine) only 1 day. Fever beyond 24 antipyretic
hours is not due to the
vaccine but to other causes
Local soreness at the Reassure parents that
injection site soreness will disappear after
3-4 days
Abscess after a week or more Incision and drainage maybe
usually indicates that the necessary
injection was not deep
enough or the needle was not
sterile
Convulsions: although very Proper management of
rare, may occur in children convulsions: pertussis
older than 2 months, caused vaccine should not be given
by pertussis vaccine anymore
OPV None
Anti-measles vaccine Fever 5-7 days after Reassure parents and instruct
vaccination is some children, them to give antipyretic to the
sometimes, there is mild rash child
MMR Local soreness, fever, Reassure parents and instruct
irritability and malaise in them to give antipyretic to the
some children child
Rotavirus vaccine Some children might develop Reassure parents and instruct
mild vomiting and diarrhea, them to give antipyretic and
fever and irritability Oresol to the child
Tetanus Toxoid Local soreness at the Apply cold compress at the
 injection site site
No other treatment is needed

EPI Recording and Reporting

EPI recording and reporting are accomplished using the FHSIS.
Fully immunized children (FIC) are those who were given BCG, 3 doses of OPV, 3 doses of
DPT, and Hepatitis B vaccine or 3 doses of Pentavalent vaccine and 1 dose of anti-measles
vaccine before reaching 1 year of age
Completely immunized children refer to children who completed their immunization schedule
at the age of 12-23 months
A child protected at birth ( CPAB) is a term used to describe a child whose mother has
received 2 dosed of TT during this pregnancy, provided that the 2nd dose was given a month prior
to delivery or at least 3 doses of TT any time prior to pregnancy with this child.