EPI & OTHER

RECOMMENDED
VACCINES
Ruby Ann L. Punongbayan, MD, FPPS

Active Immunization
Efficacy is assessed by the evidence of
protection against the particular disease.
Antibody formation indirect measure
Types of antigen for active immunization:
1. Live attenuated virus or bacteria (weakened)
2. Inactivated vaccine (killed microorganisms)

Inactivated vaccines
1. Hepatitis B vaccine
2. DPT vaccine
3. H.influenzae b vaccine
4. Pneumococcal vaccine
5. Hepatitis A vaccine
6. Meningococcal vaccine
7. Influenza trivalent vaccine
8. Human papillomavirus vaccine
9. Typhoid fever vaccine (IM)
10.Rabies vaccine
11.Inactivated polio vaccine (IPV)

Live vaccines
BCG vaccine
Measles vaccine
MMR vaccine
Varicella vaccine
Rotavirus vaccine
Influenza attenuated vaccine
(intranasal)
7. Typhoid fever (oral) vaccine
1.
2.
3.
4.
5.
6.

Passive Immunization
DEFINE passive immunization
For IM administration: peaks at 48-72 hrs not to
exceed 5 ml
Indications:
a) Congenital or acquired B-lymphocyte cell defects
alone or in combination with other
immunodeficiencies
b) When time does not permit adequate protection by
active immunization alone (hepatitis B, measles,
rabies, varicella)

Passive Immunization
c) When a person susceptible to a disease is
exposed to or has a high likelihood of
exposure to that infection or has a high risk
of complications from the disease (leukemic
child exposed to a person with varicella or
measles)
d) When a disease is already present and
antibody may aid in suppressing its toxin
effects (tetanus) or the inflammatory
response (Kawasaki disease)

The concept of cold chain

supplier abroad
central storage (vaccine lab)
regional cold rooms and freezers
hospitals / clinics / rural health units
infant / child

Cold Chain
It is a system for ensuring the potency of a
vaccine from the time of manufacture to the
time it is given to a child.
Two essential elements: people and
equipment
Vaccines will confer immunity only
when they are potent, and to be
potent they must be properly stored,
handled, and transported

Important points to remember:

Breastfeeding does not interfere with
successful immunization with oral
vaccines.
Vomiting within 10 minutes of receiving an
oral dose is an indication for repeating the
dose.
If the second dose is not retained, neither
dose should be counted, and the vaccine
should be re-administered.

Important points to remember:

Parenteral vaccine should be
administered in a site as free as
possible from risk of local neural,
vascular, or tissue injury.
Recommended route is based on
studies designed to demonstrate
maximum safety and efficacy.

Important points to remember:

In older children, the
deltoid muscle is usually
large enough for IM
injection.
The upper, outer aspect of
the buttocks should not be
used for active
immunization because the
gluteal region is covered
by a significant layer of
subcutaneous fat and
because of the possibility
of damaging the sciatic
nerve.

Important points to remember:

Preterm newborns: 5/8-inch long needle
Term infants: 7/8- to 1-in long needle
Toddlers & young infants: 7/8- to 1 -inch
long needle
22-25-gauge needle for most IM vaccines
Subcutaneous: 23-25-gauge needle and
5/8-3/4-inch long
Intradermal: gauge 25-27

Case:

A 9 month-old boy came in for a well-baby

visit. You intended to give him measles
vaccine for this visit. Upon reviewing his
record, you noted that he missed his 3rd
dose of hepatitis B vaccine. His mother
told you his baby was sick hence, he was
not given the said vaccine at that time.
Plan of action:
a) You will give both measles and hepatitis B
vaccine.
b) You will give measles vaccine today and
ask him to come back after 4 weeks for
the hepatitis B vaccine administration.

Principles of immunization:
1. Simultaneous administration of multiple
vaccines (for missed doses):
most vaccines can be safely and
effectively given simultaneously
EXCEPTION: cholera and yellow fever vaccines:
decrease in immunogenicity when given
together or 1-3 weeks apart
use separate syringes and sites

Antigen Combination
Equal or > 2
inactivated vaccines
Inactivated
and live vaccines
Equal or > 2 live

Recommended Minimum
Interval Between Doses

None; can be given

simultaneously or at
any interval between
doses
None; can be given
simultaneously or at
any interval between
doses
28-day minimum

Case:

A mother of a 3 year-old girl asked you if

there is a need to repeat the primary
series of DPT, OPV, and hepatitis B
vaccines of her daughter. She left her child
with her mother-in-law when she worked in
Singapore. Unfortunately, the grandmother
was not able to bring back the child to the
doctor after her second dose of DPT & OPV
and first dose of hepatitis B vaccine.

Principles of immunization:
2. Lapsed Immunizations
a lapse does not require reinstitution of
the entire series
subsequent immunizations should be
given at the next visit as if the usual
interval had elapsed

Case:
A 2 year-old boy was brought to you
for a well-child visit. His parents
claimed that their childs health
record was lost when their house was
burned down by fire several months
ago. The previous doctor of their
child has relocated to Australia and
they could not get a health record of
their son.
Plan of action?

Principles of immunization:
3. Unknown or uncertain immunization
status
In general, when in doubt,
immunizations should be initiated
without delay on a schedule
commensurate with the persons
current age.
No evidence that giving vaccines to
already immune recipients is harmful.

 What is the absolute

contraindication of
immunization?

Expanded Program on
Immunization (EPI):
Most cost-effective public health
intervention
In the Philippines, the EPI was
launched by the DOH on July 12, 1976.
Implementation of EPI contained in
PD No. 996 (Sept. 16, 1976)
providing for compulsory
immunization for infants and children
below 8 years

EPI:
In 1993, the number of EPI diseases
was expanded from 6 to 7 with the
inclusion of hepatitis B.
Senate Bill No. 1654: 14th Congress:
an Act Requiring Mandatory Basic
Immunization Services Against
Hepatitis B for Infants (Oct. 2, 2007)

EPI:
FULLY IMMUNIZED CHILD one who has
received 1 dose of BCG at birth or any time
before reaching 12 months, 3 doses of DPT
and polio with at least 4 weeks interval
between each dose, one dose of measles
at age 9 months or before 12 months, and
3 doses of hepatitis B with at least 4 weeks
interval between doses
MMR and Hib vaccines have now been
included in the Philippine EPI of the DOH.

EPI
Vaccine

BCG

Age
Newborn
up to 12
months
old

>12
months
old

Route
Dose
0.05
ml

0.1 ml

intraderm
al

Adverse
Reactions
Abscess or
ulcers at site
; axillary
lymphadenopathy

EPI
Vaccine

Age

Dose

DPT

8, 12,
16 wks
old

0.5
ml

OPV

8,12,
16 wks
old

2-3
drops

Route

Adverse
Reactions

intraFever,
muscular convulsions,
irritability,
prolonged
crying
PO

VAPP (0.06
million doses
among
recipients)

EPI
Vaccine

Age
Dose

Hepatitis
B

Soon
after
birth; if
mother is
+HBsAg;
0-1-6
months
old

Measles
vaccine

9 mos
old or 6
months

0.5
ml

0.5
ml

Rout
e

Adverse
Reactions

IM

Pain at the
injected site; local
redness, warmth
and swelling

SC

Fever 5-7 days

after vaccination;
rashes

EPI
Vaccine

Age
Dose Route

MMR
vaccine
(measles,
mumps,
rubella)

6 months
after the 1st
measles
vaccine;
booster shot
anytime bet.
4-6 yrs old

Hib
vaccine
(H.influenzae
b

2 months 4 months 6 months

old

0.5
ml

0.5
ml

SC

Adverse
Reactions
Pain at the injected
site; local redness,
warmth, and
swelling

IM Erythema at the
injection site

Recommended
Age

Vaccine

Comments

At birth
1 month
2 months

Hep B1; BCG

Hep B2
DPT1, OPV1 May be

4 months
6 months

DPT2, OPV2
DPT3, OPV3,
Hep B3
May be
Measles
given as
vaccine

9 months

given as
early as 6
wks old

early as 6
mos.old

Beyond 1 yr old: Recommendations

15
months
old
18
months
old
4-6
years old

MMR
(measlesmumpsrubella)

DPT, OPV

Given 6 months
after the first
measles vaccine

First booster
dose (given 12
months after
the 3rd dose)

DPT, OPV, Second booster

dose given at or
MMR before school
entry

11-12

Td (tetanus

Repeat every 10

Hepatitis b vaccine
A 4th dose is needed for the following:
a) If the 3rd dose is given at age less
than 6 months
b) If no birth dose is given using the
EPI schedule of 6, 10, 14 weeks old
c) For preterms less than 2 kgs, the
initial dose should not be counted in
a 3-dose immunization schedule

BCG vaccine
(Bacille Calmette Guerin):
BCG should be given preferably within the
1st 2 months of life
For healthy infants & children >2 months
who are not given BCG at birth, PPD prior
to BCG vaccination is not necessary.
However, PPD is recommended prior to
BCG vaccination if any of the ff are
present:

BCG
a) Suspected congenital TB
b) History of close contact to known or
suspected infectious cases of TB
c) Clinical findings suggestive of TB
and/or chest x ray suggestive of TB

H. influenzae b vaccine
Primary series: 2m, 4m, 6m
Booster dose at 12-15 months old
Dose #1 should not be given earlier than
age 6 wks old
The last dose (booster dose) is given no
earlier than age 12 months & a minimum
of 8 wks after the previous dose
Give only 1 dose to unvaccinated children ages
15-59 months old.

END OF LECTURE