INTRODUCTION:

Definition of Immunization:
It is a process to increase host resistance to specific microorganism or a disease agent to prevent them from causing
disease or provides protection from most of infectious diseases and that is indicated by the presence of antibody to
that organism.

The Presidential Decree 996 also known as the “Expanded Program on Immunization (EPI)” was established in
September 16, 1976 to ensure that infants/children and mothers have access to routinely recommended
infant/childhood vaccines. Seven vaccine-preventable diseases were initially included in the EPI:
1. Pulmonary tuberculosis,
2. Poliomyelitis,
3. Diphtheria,
4. Tetanus,
5. Pertussis,
6. Measles, and
7. Rubella

Vaccines under the EPI are:

1. BCG birth dose,
2. Hepatitis B birth dose,
3. Oral Poliovirus Vaccine,
4. DPT vaccine
5. Measles Vaccines

Expanded Program on Immunization (EPI)

7 vaccine-preventable diseases Vaccines
1. Tuberculosis Bacillus Calmette-Guérin (BCG) birth dose and 7 yrs old
2. Poliomyelitis Oral Poliovirus Vaccine (OPV)
3. Diphtheria Diphtheria-Pertussis-Tetanus (DPT)
4. Tetanus Diphtheria-Pertussis-Tetanus (DPT)
5. Pertussis Diphtheria-Pertussis-Tetanus (DPT)
6. Measles Measles Vaccine
7. Rubella Rubella Vaccine

REPUBLIC ACT NO. 10152

An act providing for mandatory basic immunization services for infants and children, repealing for the purpose
presidential decree no. 996, as amended.

Republic Act No. 10152 “Mandatory Infants and Children Health Immunization Act of 2011. Signed by President
Benigno Aquino III in July 26, 2010. The mandatory includes basic immunization for children under 5 including other
types that will be determined by the Secretary of Health.

The mandatory basic immunization for all infants and children provided under this Act shall cover the following
vaccine-preventable diseases:
(a) Tuberculosis;
(b) Diphtheria, tetanus and pertussis;
(c) Poliomyelitis;
(d) Measles;
(e) Mumps;
(f) Rubella or German measles;
(g) Hepatitis-B;
(h) H. Influenza type B (HIB)
Hepatitis B Control
 Republic Act No. 10152 has been signed. It is otherwise known as the “Mandatory Infants and Children
Health Immunization Act of 2011, which requires that all children under five years old be given basic
immunization against vaccine-preventable diseases. Specifically, this bill provides for all infants to be given
the birth dose of the Hepatitis-B vaccine within 24 hours of birth.
 One strategy to strengthen Hepatitis B coverage is to integrate birth dose in the Essential Intrapartum and
Newborn Care Package (EINC). In 2011, 11 tertiary hospitals are already EINC compliant.
 The goal of Hepatitis B control is to reduce the chronic hepatitis B infection rate as measured by HBsAg
prevalence to less than 1% in five-year-old born after routine vaccination started 100% Hepatitis B at birth
vaccination.

The DOH introduced inactivated poliovirus vaccine (IPV) into the national immunization schedule to help protect
children against type 2 vaccine-derived polioviruses together with the third dose of OPV, in 2012.

In 2014, Pneumococcal Conjugate Vaccine 13 was included in the routine immunization of EPI.
Basic immunization services shall include:
a) BCG Vaccination against tuberculosis;
b) Inoculation against diphtheria, tetanus, and pertussis;
c) Oral poliomyelitis immunization;
d) Inactivated polio vaccine;
e) Protection against measles;
f) Immunization against rubella;
g) Mumps;
h) Pneumococcal Conjugate Vaccine for pneumonia and meningitis;
i) Hepatitis-B; and
j) Haemophilus influenzae type B (HIB)

Routine Immunization Schedule for Infants

Vaccine Diseases Minimum Number Minimum Dose Rout Site of Reason
Age at of Doses Interval e administration
first Dose
Bacillus Infant: ID Right deltoid of BCG given at earliest possible age
Calmette- Tuberculosis At birth 1 none 0.05 mL the arm protects the possibility of TB meningitis
Guérin (BCG) and other TB infections in which
infants are prone.
Booster School ID Left deltoid of the Booster dose at school entry (Grade 1)
Entrants arm
:
0.1 mL
An early start Hepatitis B reduces the
Hepatitis B Hepatitis B At birth 1 none 0.5 mL IM Vastus lateralis chance of being infected and becoming
a carrier.
Pentavalent Diphtheria, 6 weeks 3 4 weeks 0.5 mL IM Upper outer An early start with DPT reduces the
Vaccine Tetanus, 10 weeks portion of the chance of severe pertussis.
(DPT, Hep B, Pertussis, 14 weeks thigh, Vastus Prevents liver cirrhosis and liver cancer
HiB) Hepatitis B, Lateralis (R-L-R) which are more likely to develop if
Haemophilu infected with Hepatitis B early in life.
s influenzae About 9,000 died of complications of
type B Hepatitis B. 10% of Filipinos have
Hepatitis B infection.
Oral Polio Polio 6 weeks 3 4 weeks 2 drops Oral Mouth The extent of protection against polio
Vaccine (OPV) is increased the earlier the OPV is
given.
Keeps the Philippines polio-free.
After the confirmation of a second
case from tests done on a 5-year-old
boy, both caused by vaccine-derived
poliovirus type 2 (VDPV2). the
government of the Philippines publicly
declared the polio outbreak on
September 19, 2019. According to the
World Health Organization (WHO), the
Philippines was eradicated of polio in
the year 2000.
Inactivated Polio 14 weeks 1 None 0.5 mL IM Upper outer The extent of protection against polio
Polio Vaccine portion of the is increased the earlier the OPV is
(IPV) thigh, Vastus given.
lateralis (L)
2 finger breath
away from PCV
Pneumococcal Pneumonia, 6 weeks 3 4 weeks 0.5 mL IM Upper outer The customary age for the first
Conjugate Meningitis portion of the dose is 2 months of age, but it can
Vaccine (PCV) thigh, Vastus be given as young as 6 weeks of
lateralis (L-R-L) age. The recommended dosing
(L-R-L) interval is 4-8 weeks. The fourth
(booster) dose should be administered
at approximately 12-
15 months of age, and at least 2
months after the third dose.

Measles, Measles, 9 months 2 3 months 0.5 mL SC or Outer part of the At least 80% can be prevented
Mumps, Mumps, SQ upper arm
Rubella Rubella
(MMR)

April 27, 2016, the switch of (tOPV) to (bOPV)

In 2016, the Expanded Program on Immunization will transition to become the National Immunization Program. It will include
immunizations of other populations such as senior citizen immunization, school-age immunization, and adolescent immunizations.

Routine Schedule of Immunization

Every Wednesday is designated as immunization day and is adopted in all parts of the country. Immunization is done monthly in
barangay health stations, quarterly in remote areas of the country.
Program Goals:

Over-all Goal: To reduce the morbidity and mortality among children against the most common vaccine-preventable diseases.

Specific Goal:

1. To immunize all infants/children against the most common vaccine-preventable diseases;

2. To sustain polio-free status of the Philippines;
3. To eliminate measles infection;
4. To eliminate maternal and neonatal tetanus;
5. To control diphtheria, pertussis, hepatitis b and German Measles;
6. To prevent extra pulmonary tuberculosis among children.

Program Target:

Achieve 95% Fully Immunized Child Coverage.

Program Strategies:

1. Conduct of routine immunizations for infants/children/women through Reaching Every Purok Strategy.
 The Reaching Every Purok Strategy is an innovation of the Reaching every Barangay.
2. Supplemental immunization Activities (SIA)
 Supplemental immunization activities are conducted to reach children who have not been vaccinated or have not
developed enough immunity after previous vaccinations.
3. Vaccine-Preventable Disease Surveillance
 Surveillance is conducted for all vaccine-preventable diseases most especially for measles cases and indigenous wild
poliovirus.

Disease/ Definition Causative Agent Reservoir Mode of Source of Incubation Period of Susceptibility
Transmission infection Period Communicability
Pulmonary tuberculosis: Mycobacterium Human; Droplet Coughing, 4-12 weeks Of as long as Children under 3
Considered as the world’s tubercle In some areas singing, talking, tubercle bacilli are years old
deadliest disease; highly also, diseased sneezing, fomites discharged in the Susceptibility to
infectious chronic disease cattle sputum infection is general
Diphtheria: Corynebacterium Human Respiratory Nasal and Throat 2-5 days, 2 to 3 weeks Infants to immune
Acute febrile, diphtheriae droplets discharge from maybe Shortened in pts mothers maybe
acute pharyngitis with a the host or longer taking antibiotic tx protected for 5
pseudomembrane or acute carrier. months
laryngitis with a Immunity with
psuedomembrane or acute vaccine
laryngitis with a
pseudomembrane
Measles: Measles Virus (MV) Human Droplet or With nasal /throat/ Usually From 1 to 3 days All people are
An acute highly Morbillivirus measles Direct contact urine secretions about 10 before the beginning susceptible.
communicable infection; Family: of infected person days with a of fever and cough. Infants born to
Death maybe due to Paramyxoviridae; range of 8- Decreases rapidly immune mothers are
complications; Genus: Morbillivirus 13 days from after the onset of protected for 5 to 9
Also known as Rubeola Species:Measles exposure to the rash. months.
onset of
fever
Pertussis: acute respiratory Bordetella pertussis Human Direct contact With discharges 7 to 10days 7 days after Exposed to disease
tract infection (ARTI); from respiratory not exposure to 3 may have prolonged
Aka whooping cough mucous exceeding to weeks after onset of immunity.
membranes of 10 days typical paroxysms Complete vaccine
infected persons developed immunity
Neonatal Tetanus: Clostridium tetani Soil, street Direct or Unhygienic 3 to 21 days Not directly Immunity last for 5
Contamination of unhealed dust, intestinal indirect contact cutting of the of transmitted from months from
stump of umbilical cord canal of umbilical cord or man to man immune mothers
animals, improper handling Natural infection
especially of the stump and does not play a
horses (normal puncture wounds significant role in
habitat) and by contaminated immunity;
human material or Complete vaccine
infection of developed immunity
wounds
Polio or poliomyelitis is a Poliovirus type 1, 2, Human, most Direct or Human feces 7 to 12 days, Patients with Infants born to
disabling and life- and 3 frequently Indirect contact Contaminated with a range maximal infectivity 7 immune mothers
threatening disease that persons with Through fecal- milk or water of of 3-21 days to 16 days before remain immune for 5
infect a person's spinal inapparent oral route or and in the first few months; immunity
cord, causing paralysis infections, oral route days after onset of following natural
(can't move parts of the especially symptoms infection, or with
body) children complete vaccine
maybe lifelong
Hepatitis B: Hepatitis B virus (HBV) Human Direct contact Spreads through Usually 45 to If an individual is Susceptibility is
Infection of the liver the ffg: 180 days positive to hep B general.
From child to Ave 60-90 virus the person is Infants are
child or mother to days infective and symptomatic.
child after birth; transmit the virus Should be
From mother to through blood vaccinated as early
child during birth; as possible in order
Blood transfusion to avoid becoming a
chronic carrier.

Mumps: Paramyxoviridae Human Direct contact With person’s 12-26 days, Before parotid Immunity following
Epidemic parotitis; mumps virus or indirect Oral and nasal usually 18 glands become natural infection or
contagious disease contact secretions days swollen and remains completed the MMR
Contaminated infective as long as vaccine.
articles or soiled glandular swelling is
lines present
Rubella: Rubella virus Human Direct Contact With 14 to 21 1 week before and Immunity following
German measles or Three- Family: Droplet nasopharynx-geal days after the onset of natural infection or
days measles is a mild viral Togoviridae secretions and rashes completed the MMR
illness can cause mild Genus: urine; Highly vaccine.
feverish illness associated Rubivirus Transplacental communicable
with rashes and aches in transmission in infants with
joints. congenital rubella congenital Rubella
may shed virus for
months after birth
Meningitis: Streptococcus Human Respiratory Nasopharyn-geal 1 to 10 days Susceptibility is
Infection of the meninges of pneumoniae droplets mucosa general.
the brain and spinal cord; Direct inavasion Immunity after
cerebrospinal fever from otitis media receiving complete
PVC vaccine.

Cold Chain
Cold Chain is a system used to maintain the potency of a vaccine from the time of manufacture to the time it is given to the child or the pregnant woman.

1. Storage of vaccines should not exceed:

 6 months at the regional level
 3 months at the provincial level/ district level
 1 month at the main health centers (with refrigerators)
 Not more than 5 days at the health centers
2. Transport of vaccines; use transport boxes or vaccines carrier
3. Handling of vaccines: once opened or reconstituted, vaccines must be placed in a special cold pack during immunization sessions.
4. Discard:
 Unopened or exposed vaccines may be put back in the refrigerator or freezer x only; discard after 3 rd time
 BCG vaccines after 4 hours
 The rest of the vaccines after 8 hours or at the end of a working day.

EPI VACCINES: FORMS, EXPOSURE TO CERTAIN CONDITIONS

VACCINE CONTENTS FORM CONDITIONS WHEN EXPOSED TO HEAT STORAGE

TEMPERATURE
Bacillus Live, attenuated Freeze-dried and to be Destroyed by heat, sunlight; not destroyed +2°C to +8 °C
Calmette-Guérin Bacterial vaccine reconstituted with a by freezing (body of the refrigerator)
(BCG) special diluent
Hepatitis B Plasma-derived; RNA - Liquid Damaged by heat or freezing +2°C to +8 °C
recombinant (body of the refrigerator)
Pentavalent D – weakened toxin Liquid D – destroyed by heat & freezing +2°C to +8°C
Vaccine P – killed bacteria (inactivated P – damaged by heat (body of the refrigerator)
(DPT, Hep B, whole-cell) T – damaged by heat & freezing
HiB) T – weakened toxin Hep B - Damaged by heat or freezing
Hep B – Plasma-derived; Hib –
RNA - recombinant
HiB – one-conjugate; (inactivated)
Oral Polio Live, attenuated virus Liquid Easily damaged by heat, not destroyed by -15°C to -25 °C
Vaccine (OPV) freezing (freezer)

Inactivated Polio Inactivated virus Liquid Damaged by heat or freezing +2°C to +8°C
Vaccine (IPV) (body of the refrigerator)
Pneumococcal Protein conjugate Liquid Damaged by heat or freezing +2°C to +8°C
Conjugate (body of the refrigerator)
Vaccine (PCV)
Measles, Mumps, Measles – Live, attenuated virus Freeze-dried and to be Easily damaged by heat, not destroyed by -15°C to -25 °C
Rubella (MMR) Mumps – reconstituted with a freezing (freezer)
special diluent
Tetanus Toxiod Immunization Schedule for Women

Percent
Vaccine Minimum Age Interval Protected Duration of Protection

As early as possible
TT1 during pregnancy 0% None

Infants born to the mother will be protected from neonatal tetanu

TT2 At least 4 weeks later 80% Gives 3 years protection for the mother from the tetanus.

Infants born to the mother will be protected from neonatal tetan

Gives 5 years protection for the mother.
TT3 At least 6 months later 90%

TT4 At least 1 year later 99% Gives 10 years protection for the mother

Gives lifetime protection for the mothers. All Infants born to tha
TT5 At least 1 year later 99% mother will be protected.

Dose: 0.5ml
Route: Intramuscular
Site: Right or Left Deltoid/Buttocks
Note: If the woman received 3 doses of PENTVALENT VACCINE during infancy. This should b e
considered as TT1 and TT2. The succeeding dose will be TT3, TT4 and TT5.